Prenatal stress during COVID-19


In a recent study, greater levels of prenatal concern were associated with higher risks of anxiety, insomnia, and depression.

Prenatal stress during COVID-19 | Image Credit: © rudisetiawan - © rudisetiawan -

Prenatal stress during COVID-19 | Image Credit: © rudisetiawan - © rudisetiawan -

Higher levels of stress during the first trimester were reported in pregnant women during the COVID-19 pandemic, according to a recent study published in Frontiers in Psychiatry.

COVID-19 led to restrictions on prenatal care such as cancellations of prenatal and postnatal appointments, restricted accompaniment, mandatory mask use, and discouraged breastfeeding in some locations. The general population experienced increased anxiety symptoms, with these symptoms especially found in pregnant women.

Insomnia has been reported as one of the most important alterations in pregnant women. An increase in the presence of insomnia in women was observed during the COVID-19 pandemic, with some studies finding an association between insomnia and mental health effects, along with potential physical health effects.

Past studies have indicated adverse effects in pregnant women and fetuses because of high maternal stress levels during pregnancy, with stress commonly seen during the first trimester of gestation. To determine how stress affects maternal self-perceived health during the first trimester throughout the COVID-19 pandemic, investigators conducted a cross-sectional study.

Participants included pregnant women in the first trimester of pregnancy who attended an obstetrics consultation for the first time. Exclusion criteria included a previous diagnosis of anxiety, depression, and psychiatric illness, along with language difficulties during recruitment. There were 170 women in the final sample.

From September 2021 to June 2022, participants completed a questionnaire on the Google Forms platform, with a 10-minute completion time.This included the Prenatal Distress Questionnaire (PDQ), which contained 12 items measuring pregnancy-specific stresswith responses based on a 5-point scale.

Factors measured in the PDQ included worries about childbirth and baby, worries about weight or self-image, and worries about emotions. Self-perceived stress was measured using the Perceived Stress Scale, a 14 item, 5-point scale.

The General Health Questionnaire (GHQ-28), a 28-item scale, was also included. Social dysfunction, health perception, anxiety-insomnia, and major depressive symptoms in the past 2 weeks were measured.

The mean age of participants was 33.61 years, with a mean pregnancy length of 8.7 weeks at assessment. For 45.5% of women, the assessed pregnancy was their first, while 54.5% were multiparous. Of participants, 92.6% were Spanish, 5.4% Latin American, and 2% non-Spanish Europeans.

Greater levels of concern about childbirth and the baby were seen in primiparous women compared to multiparous women, with the highest levels of concern seen in women who had no previous children. In comparison, women with a previous cesarean section had greater levels of concern about weight and personal image.

Somatic symptoms based on the GHQ-28 scale were seen in 6% of women, all of which were multiparous. Positive scores for anxiety or insomnia were seen in 18% of women, more of which were multiparous. Significant differences in depression and social dysfunctions were not seen between multiparous and primiparous women.

An increase in general stress and prenatal stress scores was associated with a worse health perception. An additional point in the assessment of prenatal concerns led to 1.17 times increase in the risk of somatic symptoms. 

An increase in prenatal concerns was also associated with an increased risk of insomnia and anxiety. For depression, the risk increased by 1.18 times in women with prenatal concerns, 1.62 in women with concerns over weight or body image, and 1.44 in women with concerns about emotions.


Liebana-Presa C, Martínez-Fernández MC, García-Fernández R, Martín-Vázquez C, Fernández-Martínez E, Hidalgo-Lopezosa P. Self perceived health and stress in the pregnancy during the COVID-19 pandemic. Front Psychiatry. 2023;14. doi: 10.3389/fpsyt.2023.1166882

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