Impact of the COVID-19 Pandemic on Maternal Mental Health During Pregnancy: The CONCEPTION Study – Phase I

Background: Mental health regional differences during pregnancy through the COVID-19 pandemic are understudied. The first phase of CONCEPTION cohort aims to compare country-specific mental health status in pregnant women following the start of the pandemic. Methods: Pregnant women, >18 years were recruited, and data collected using a web-based strategy. Although Canadian women were primarily targeted, pregnant women worldwide were eligible. The current analysis includes data on women enrolled between 06/2020-11/2020. Self-reported data included COVID-19 testing/diagnosis, mental health measures (Edinburgh Perinatal Depression Scale (EPDS), Generalized Anxiety Disorders (GAD-7)), prenatal care/birth plan changes. We compared maternal mental health stratifying on country/continents of residence; and identified determinants of mental health with multivariable linear regression models. Findings: Of 2,109 pregnant women recruited (mean gestational age, 24·7 weeks (SD 9·7)), 1,932 were from Canada, 48 the United States (US), 73 Europe, 35 Africa, and 21 Asia/Oceania. Among the 226 pregnant women who were tested for SARS-CoV-2, 26 were positive (11·5% test positivity rate); COVID-19 prevalence was 1·2% (26/2,109). Mean depressive symptom scores were lower in Canada (EPDS 8·2, SD 5·2) compared to the US (EPDS 10·5, SD 4·8) and Europe (EPDS 10·4, SD 6·5) (p<0·05). Maternal anxiety, stress, decreased income and access to health care due to the pandemic were independently increasing maternal depression. Mean anxiety symptoms were higher in the US (GAD-7 6·5, SD 4·3) than Canada (GAD-7 4·3, SD 3·8) (p<0·05). Maternal depression, stress, and earlier recruitment during the pandemic were independently associated with increased maternal anxiety. Interpretation: In this first international study on the impact of the COVID-19 pandemic, CONCEPTION has shown significant country/continent-specific variations in depression and anxiety during pregnancy. Given that gestational depression/anxiety have been associated with preterm birth and childhood cognitive problems, strategies are needed to reduce COVID-19’s mental health burden. Funding: Faculty of Pharmacy, Universite de Montreal, Canada. Declaration of Interests: We declare no competing interests. Ethics Approval Statement: This study was approved by the CHU Sainte-Justine's Research Ethics Committee, which autorized worldwide recruitment of subjects.