Increased Risk for Maternal Anxiety during the COVID-19 Outbreak in Brazil among Pregnant Women without Comorbidities

Nomura, Roseli Mieko Yamamoto; Ubinha, Ana Carla Franco; Tavares, Isabela de Paula; Costa, Maria Laura; Opperman, Maria Lucia da Rocha; Brock, Marianna Facchinetti; Trapani Jr., Alberto; Damásio, Lia Cruz Vaz da Costa; Reis, Nadia Stella Viegas; Borges, Vera Therezinha Medeiros; Zaconeta, Alberto Carlos Moreno; Araujo, Ana Cristina Pinheiro Fernandes de; Ruano, Rodrigo

doi:10.1055/s-0041-1740234

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Revista Brasileira de Ginecologia e Obstetrícia

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Original Article, Gynecological Endocrinology • Rev Bras Ginecol Obstet. 43 (12) • Oct 2021 • https://doi.org/10.1055/s-0041-1740234 copy

Increased Risk for Maternal Anxiety during the COVID-19 Outbreak in Brazil among Pregnant Women without Comorbidities

Aumento do risco de ansiedade materna durante o surto de COVID-19 no Brasil entre gestantes sem comorbidades

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To study maternal anxiety in pregnant women without comorbidities in the context of the COVID-19 outbreak in Brazil and to study maternal knowledge and concerns about the pandemic.

Methods

This is a secondary analysis from a national multicenter cross-sectional study performed in 10 cities, from June to August, 2020, in Brazil. Interviewed postpartum women, without medical or obstetrical comorbidities, were included in the present subanalysis. A structured questionnaire and the Beck Anxiety Inventory (BAI) were applied.

Results

Out of the 1,662 women, 763 (45.9%) met the criteria for the current analysis and 16.1% presented with moderate and 11.5% with severe maternal anxiety. Moderate or severe maternal anxiety was associated with high school education (odds ratio [OR]:1.58; 95% confidence interval [CI]:1.04–2.40). The protective factor was cohabiting with a partner (OR: 0.46; 95%CI: 0.29–0.73). There was a positive correlation between the total BAI score and receiving information about care in the pandemic (r_partial 0.15; p < 0.001); concern about vertical transmission of COVID-19 (r_partial 0.10; p = 0.01); receiving information about breastfeeding (r_partial 0.08; p = 0.03); concerns about prenatal care (r_partial 0.10; p = 0.01), and concerns about the baby contracting COVID-19 (r_partial 0.11; p = 0.004). The correlation was negative in the following aspects: self-confidence in protecting from COVID-19 (r_partial 0.08; p = 0.04), having learned (r_partial 0.09; p = 0.01) and self-confidence in breastfeeding (r_partial 0.22; p < 0.001) in the context of the pandemic.

Conclusion

The anxiety of pregnant women without medical or obstetrical comorbidities was associated to high school educational level and not living with a partner during the COVID-19 pandemic. Self-confidence in protecting against COVID-19 and knowledge about breastfeeding care during the pandemic reduced maternal anxiety.

Keywords
pregnancy; maternal anxiety; childbirth; postpartum; questionnaires; breastfeeding; coronavirus disease 2019; pandemic

Characteristics	Results
Maternal age, years old, mean, SD	27.1	(6.3)
Parity 0	311	40.8
Maternal race
White	233	30.5%
Mixed	443	58.1%
Black	74	9.7%
Asian or Brazilian Indian	13	1.7%
Cohabiting / married	667	87.4%
Educational level
Incomplete elementary school	4	0.5%
Elementary school	186	24.4%
High school	455	59.6%
College/University	118	15.5%
Religion
Evangelical	276	36.2%
Catholic	263	34.5%
Others	36	4.7%
Without religious belief	188	24.6%
Smoking	36	4.7%
Alcohol consumption	26	3.4%
Illicit drugs consumption	5	0.7%
Mode of delivery
Vaginal	451	59.1%
Cesarean	298	39.1%
Forceps / vacuum	14	1.9%
Companionship in labor	648	84.9%
Gestational age at birth, weeks, mean, SD	39.3	(1.2)
Birth weight, g, mean, SD
Low birthweight (< 2,500g)	28	3.7%
Macrosomia (> 4,000g)	63	8.3%
5-minute Apgar < 7	19	2
COVID-19 during pregnancy	13	1.7%
COVID-19 in the family	31	4.1%
Maternal anxiety
Minimal	344	45.1%
Mild	208	27.3%
Moderate	123	16.1%
Severe	88	11.5%
BAI, total score
mean, SD	11.4	(10.5)
median (95%CI)	8.0	(8.0–9.0)

	Total	Geographic region
		Central West	North	Northeast	South	Southeast
		(n =150)	(n = 161)	(n = 106)	(n = 181)	(n = 165)
Maternal anxiety (BAI)
Minimal (0–7)	344 (45,1%)	63 (42.0)	82 (50.9)	61 (57.5)	75 (41.4)	63 (38.2)
Mild (8–15)	208 (27,3%)	41 (27.3)	43 (26.7)	25 (23.6)	48 (26.5)	51 (30.9)
Moderate (16–25)	123 (16,1%)	29 (19.3)	20 (12.4)	12 (11.3)	34 (18.8)	28 (17.0)
Severe (26–63)	88 (11,5%)	17 (11.3)	16 (9.9)	8 (7.5)	24 (13.3)	23 (13.9)
BAI score
Mean (SD)	11.4 (10.5)	12.1 (10.4)	10.2 (11.6)	8.4 (8.4)	12.4 (10.7)	12.6 (10.3)
Median (95%CI)*	8.0 (8.0–9.0)	10.0 (7.5–11.5)	5.0 (4.6–9.0)	7.0 (5.0–8.0)	10.0 (8.0–12.0)	10.0 (8.0–12.0)

Characteristic	Maternal anxiety
	Minimum or mild	Moderate or severe (n = 211)	p-value^a	aOR (95%CI)^b	p-value^b
	(n = 552)	Moderate or severe (n = 211)	p-value^a	aOR (95%CI)^b	p-value^b
Age, years old, median, AVR	26 (385.9)	26 (371.7)	0.426	–	0.896
Parity 0	212 (38.4)	99 (46.9)	0.032	–	0.133
Maternal race
White	154 (27.9)	79 (37.4) 33.9	0.011^c	–	0.137
Nonwhite	398 (72.1)	132 (62.6) 24.9
Cohabiting / married	495 (89.7)	172 (81.5)	0.002	0.46 (0.29–0.73)	0.001
Educational level
High school	305 (55.3)	140 (66.4)	0.007	1.58 (1.04–2.40)	0.030
College/University	89 (16.1)	29 (24.6)	0.484	–	0.985
No religious belief	136 (24.6)	52 (24.6)	0.998	–	0.430
Smoking	21 (3.8)	15 (7.1)	0.054	–	0.154
Alcohol consumption	17 (3.1)	9 (4.3)	0.420	–	0.290
COVID-19 during pregnancy	8 (1.4)	5 (2.4)	0.380	–	0.433
COVID-19 in the family	20 (3.6)	11 (5.2)	0.320	–	0.473
Geographic location
Central West	104 (18.8)	46 (21.8)	–	–	–
North	125 (22.6)	36 (17.1)	0.125	–	0.139
Northeast	86 (15.6)	20 (9.5)	0.048	–	0,064
South	123 (22.3)	58 (27.5)	0.881	–	0.910
Southeast	114 (20.7)	51 (24.2)	0.940	–	0.821

Questionnaire items	Rho	p-value^a	Coefficient	Standard error	t	p-value^b	r_partial
Knowledge and preventive care						–	–
I am afraid about getting COVID-19.	−0.033	0.367	−0.409	0.323	−1.27	0.206	−0.046
I know the signs and symptoms of COVID-19.	−0.033	0.364	−0.410	0.307	−1.34	0.182	−0.049
I received information about care in the pandemic.	0.104	0.004	1.350	0.334	4.05	<0.001	0.147
I feel confident in protecting myself from COVID-19.	−0.073	0.043	−0.630	0.298	−2.11	0.035	−0.077
Prenatal concerns
I was worried about COVID-19 affecting my baby during pregnancy.	0.074	0.040	1.059	0.382	2.77	0.006	0.101
I was instructed on caring for the newborn.	0.025	0.495	−0.362	0.313	−1.16	0.247	−0.043
I was guided on breastfeeding during COVID-19.	0.093	0.010	0.630	0.288	2.18	0.029	0.080
I was worried about prenatal difficulties.	0.067	0.063	0.796	0.300	2.65	0.008	0.097
Cautions and fears during childbirth
I received guidance on childbirth care due to COVID-19.	0.031	0.395	0.134	0.237	0.56	0.573	0.021
My companion was afraid of COVID-19 at delivery.	0.076	0.036	0.171	0.253	0.68	0.499	0.025
I was worried about giving birth at the hospital.	−0.020	0.582	−0.107	0.283	−0.38	0.706	−0.014
I was afraid to be without a companion at childbirth.	0.030	0.412	0.181	0.319	0.57	0.572	0.021
I was worried that childbirth care might be compromised due to COVID-19.	−0.030	0.406	−0.113	0.272	−0.42	0.678	−0.015
Care and concerns about the newborn
I learned how to breastfeed due to COVID-19.	−0.050	0.164	−0.614	0.245	−2.51	0.012	−0.092
I feel confident to breastfeed despite COVID-19.	−0.161	<0.001	−2.369	0.382	−6.20	<0.001	−0.222
I am worried about having COVID-19.	0.009	0.798	−0.637	0.360	−1.77	0.077	−0.065
I am worried that my baby has COVID-19.	0.011	0.757	−0.321	0.301	−1.07	0.287	−0.039
I am worried about my baby having COVID-19 after birth.	0.093	0.010	1.208	0.413	2.92	0.004	0.107
(Constant)	–	–	13.166	–	–	–	–

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[1] Address for correspondence Roseli Nomura, MD, PhD, Rua Napoleão de Barros 875, 04024002, São Paulo, SP, Brazil (e-mail: roseli.nomura@hotmail.com).