Maternal symptoms of depression and anxiety were among a number of maternal and fetal outcomes that worsened globally during the COVID-19 pandemic, according to a systematic review and meta-analysis published online ahead of print in The Lancet Global Health.
“One proposed explanation for the increase in adverse pregnancy outcomes is that such outcomes could be linked to reduced access to care,” wrote corresponding author Asma Khalil, MD, of St. George’s University of London, and colleagues. “Although maternal anxiety was consistently shown to be increased during the pandemic, healthcare providers around the world have reported reduced attendance for routine and unscheduled pregnancy care.”
The comprehensive assessment on the effects of the pandemic on maternal, fetal, birth, and neonatal outcomes spanned 40 studies from 17 countries published between January 1, 2020, and January 8, 2021. Assessment instruments used in the studies included the Generalized Anxiety and Depression Scale, Edinburgh Postnatal Depression Scale, Generalized Anxiety Disorder-7 questionnaire, Inventory of Depression and Anxiety Symptoms (Expanded Form), Symptom Checklist 90 Revised, and Patient Health Questionnaire-9.
Among the findings revealed in the meta-analysis was poorer maternal mental health, as signaled by Edinburgh Postnatal Depression Scale scores. An analysis of 3 studies found higher average scores for 2330 women during the pandemic compared with 6517 women before the pandemic. Researchers reported a pooled mean difference of 0.42.
Among 11 studies that investigated maternal mental health, 7 showed significant pandemic-era increases in postnatal depression, maternal anxiety, or both.
“Global maternal and fetal outcomes have worsened during the COVID-19 pandemic, with an increase in maternal deaths, stillbirth, ruptured ectopic pregnancies, and maternal depression. Some outcomes show considerable disparity between high-resource and low-resource settings,” researchers wrote. “There is an urgent need to prioritize safe, accessible, and equitable maternity care within the strategic response to this pandemic and in future health crises.”
Chmielewska B, Barratt I, Townsend R, et al. Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis. The Lancet Global Health. 2021 March 31;[Epub ahead of print].