The Term for Baby Whose Birthweight Is Significantly Lower Than Expected

J Affect Disord. 2020 Dec one; 277: 5–13.

Elevated depression and anxiety symptoms among meaning individuals during the COVID-19 pandemic

Catherine Lebel,^{a, b, c, ⁎} Anna MacKinnon,^{b, d} Mercedes Bagshawe,^{a, b, c} Lianne Tomfohr-Madsen,^{b, d, east, 1} and Gerald Giesbrecht^{b, d, due east, i}

Catherine Lebel

^aDepartment of Radiology, University of Calgary, Calgary, Alberta, Canada

^bAlberta Children's Infirmary Research Institute, University of Calgary, 28 Oki Drive, Alberta T3B 6A8, Canada

^cHotchkiss Brain Institute, University of Calgary, Canada

Anna MacKinnon

^bAlberta Children's Hospital Research Institute, University of Calgary, 28 Oki Drive, Alberta T3B 6A8, Canada

^dDepartment of Psychology, University of Calgary, Canada

Mercedes Bagshawe

^aDepartment of Radiology, University of Calgary, Calgary, Alberta, Canada

^bAlberta Children's Hospital Inquiry Institute, University of Calgary, 28 Oki Drive, Alberta T3B 6A8, Canada

^cHotchkiss Brain Institute, University of Calgary, Canada

Lianne Tomfohr-Madsen

^bAlberta Children'south Infirmary Research Institute, University of Calgary, 28 Oki Drive, Alberta T3B 6A8, Canada

^dDepartment of Psychology, Academy of Calgary, Canada

^eastSection of Pediatrics, Academy of Calgary, Canada

Gerald Giesbrecht

^bAlberta Children's Hospital Enquiry Institute, Academy of Calgary, 28 Oki Drive, Alberta T3B 6A8, Canada

^dDepartment of Psychology, University of Calgary, Canada

^eastwardDepartment of Pediatrics, Academy of Calgary, Canada

Received 2020 April 30; Revised 2020 Jul ten; Accustomed 2020 Jul 28.

Abstruse

Groundwork

Anxiety and depression symptoms in pregnancy typically touch on between 10 and 25% of pregnant individuals. Elevated symptoms of depression and anxiety are associated with increased risk of preterm birth, postpartum low, and behavioural difficulties in children. The current COVID-19 pandemic is a unique stressor with potentially wide-ranging consequences for pregnancy and beyond.

Methods

We assessed symptoms of feet and depression among significant individuals during the current COVID-19 pandemic and determined factors that were associated with psychological distress. 1987 pregnant participants in Canada were surveyed in Apr 2020. The cess included questions about COVID-19-related stress and standardized measures of depression, anxiety, pregnancy-related anxiety, and social back up.

Results

We plant substantially elevated anxiety and low symptoms compared to like pre-pandemic pregnancy cohorts, with 37% reporting clinically relevant symptoms of depression and 57% reporting clinically relevant symptoms of feet. College symptoms of depression and anxiety were associated with more than business concern near threats of COVID-19 to the life of the female parent and baby, as well as concerns near not getting the necessary prenatal care, relationship strain, and social isolation due to the COVID-19 pandemic. Higher levels of perceived social support and back up effectiveness, as well as more physical activity, were associated with lower psychological symptoms.

Conclusion

This report shows concerningly elevated symptoms of feet and low among pregnant individuals during the COVID-nineteen pandemic, that may have long-term impacts on their children. Potential protective factors include increased social back up and exercise, every bit these were associated with lower symptoms and thus may assistance mitigate long-term negative outcomes.

Keywords: Anxiety, COVID-xix, Depression, Pregnancy, Stress, Physical Activity

ane. Introduction

Since it was beginning recognized in December 2019, the 2019 novel coronavirus (COVID-19) has spread rapidly throughout the world. The health consequences of this virus are sorry: decease, strained wellness care systems, and economic dubiety. The psychological and social consequences may be equally devastating. People have been physically isolated from family, friends, and customs, and schools and daycares around the world have been closed. There is a growing urgency to understand the impact of the COVID-19 pandemic on mental health to best forbid the emergence of serious mental illness as a secondary consequence (Cullen et al., 2020; Geraldo da Silva et al., 2020).

Although express, previous work shows that infectious disease outbreaks increase symptoms of low and feet. A study of 129 individuals quarantined during the 2003 severe acute respiratory (SARS) outbreak in Toronto, Canada found that 29% of individuals had symptoms of post-traumatic stress disorder and 31% had symptoms of depression approximately one month following their quarantine; longer periods of quarantine were associated with more severe symptoms (Hawryluck et al., 2004). In the early stage of the COVID-19 outbreak, 53.8% of respondents in China's Wuhan region reported moderate or severe psychological impact, with 17% and 29% reporting moderate to severe low and anxiety symptoms, respectively (Wang et al., 2020). A survey past the Kaiser Family Foundation in late March 2020 constitute that 53% of women and 37% of men said that stress related to coronavirus had a negative impact on their mental health (Hamel and Salganicoff, 2020).

Pregnancy is a peculiarly vulnerable time when psychological distress can have negative consequences for both female parent and infant. Since women tend to report higher symptoms of anxiety and depression during illness outbreaks than men (Al-Rabiaah et al., 2020; Hamel and Salganicoff, 2020; Wang et al., 2020), women who are significant during the COVID-19 pandemic may be especially afflicted. Sustained, elevated prenatal anxiety and depression symptoms increase the risk of postpartum depression, as well as prenatal infection and affliction rates (Bayrampour et al., 2016; Coussons-Read, 2013). Prenatal feet and depression symptoms may too crusade changes in physical activity, nutrition, and sleep, which in plow affect maternal mood and fetal development (Coussons-Read, 2013). Prenatal anxiety and depression also increases the take a chance of miscarriage, preterm birth, lower birthweight, and lower Apgar scores at birth (Accortt et al., 2015; Grigoriadis et al., 2018; Qu et al., 2017; Rondo et al., 2003; Stein et al., 2014). Children of mothers who experienced high stress during pregnancy are more probable to have cognitive and behavioural problems, and are at higher risk for later mental health bug themselves (Glover, 2014; MacKinnon et al., 2018; Stein et al., 2014; Van den Bergh, Dahnke, and Mennes, 2018; Van den Bergh et al., 2017). Prenatal feet and low are also associated with changes to brain structure and role in infants and children (Adamson et al., 2018; Lebel et al., 2016; Qiu et al., 2013; Sandman et al., 2015). These long-lasting psychological and neurological effects highlight the importance of mitigating prenatal distress now, to support both meaning individuals and their babies.

It is also important to expect for potential resilience factors that may assistance protect against high prenatal stress. Social support can buffer the effects of prenatal stress, and has been shown to mitigate the impacts of prenatal anxiety and depression symptoms on maternal and infant stress response systems (Thomas, et al., 2018). Physical activity is also associated with reduced depressive and anxiety symptoms in pregnant individuals (Demissie et al., 2011), and thus may provide another resilience factor.

Given the potential negative psychological sequelae of psychological, wellness and fiscal uncertainty coupled with social isolation, at that place is an urgent need to determine the prevalence of psychological distress among pregnant individuals during this pandemic and place protective factors so that targeted interventions can be speedily implemented. The aims of the current study were to make up one's mind the prevalence of anxiety and depression symptoms in meaning people during the COVID-19 pandemic and identify potential resilience factors associated with lower symptoms. The social distancing universally recommended by governments effectually the world may be especially problematic during pregnancy because social support has a well-recognized role in buffering the negative furnishings of stress (Reid and Taylor, 2015).

2. Methods

2.1. Participants

The current study reports data collected from an ongoing study: Pregnancy during the COVID-19 Pandemic. This study recruited pregnant individuals across Canada via social media to complete an online survey. Study advertisements and the study website were shared via Twitter, Facebook, and Instagram. Ads were distributed to groups for expecting mothers, young parents, and midwifery and obstetric groups, and participants were encouraged to share the report with their friends and family. Inclusion criteria were: living in Canada, able to read and write English, and having a confirmed pregnancy <35 weeks gestation. The information reported here were collected between Apr 5–20, 2020. This study was canonical past the Conjoint Health Research Ideals Board (CHREB) at the Academy of Calgary, REB20–0500.

2.2. Demographics

Participants provided comprehensive demographic information including their birth month and year, postal code, education level, household income range, their baby's due engagement, and number of other children.

2.3. COVID-19

Participants completed a questionnaire most COVID-19 infections and isolations, as well as COVID-19-related life changes such chore loss. This questionnaire was developed specifically for this study, based on previous work assessing stress during natural disasters (King and Laplante, 2015). Participants were asked specifically about concerns due to COVID-19 with the following statements/questions: "During the COVID-19 pandemic, I have felt more alone than usual", "How much do y'all think your life is in danger during the COVID-19 pandemic?", "How much are y'all worried that exposure to the COVID-xix virus will harm your unborn infant?", and "Are y'all concerned that you or your baby are non receiving the care that you need?". Participants answered on a calibration of 0 (not at all) to 100 (very much then). Participants were also asked "How has the COVID-19 pandemic affected your relationship with your partner?" on a calibration of 0–100, with 0 (information technology has strained our relationship), 50 (non much has changed) and 100 (information technology has brought us closer together).

2.4. Anxiety and depression symptoms

Maternal depressive symptoms were assessed using the Edinburgh Depression Scale (EPDS) (Cox et al., 1987; Kozinszky and Dudas, 2015), a self-study questionnaire with possible scores ranging from 0 to 30. Scores ≥13 are used to identify women with clinically concerning depression symptoms and have been shown to accept maximal consistency with a diagnosis of major depressive disorder (Cox et al., 1987). For a cut-off of 13 on the EPDS, sensitivity ranges from 38 to 43% (depending on trimester) and specificity is 98–99% (Bergink et al., 2011). The PROMIS Anxiety Developed vii-item short course was used to assess full general anxiety symptoms; T-scores 60–69.9 are considered moderately elevated feet symptoms and scores at or higher up 70 are considered severely elevated (Cella et al., 2010); possible scores range from 36.3–82.7. Pregnancy-related anxiety symptoms were assessed with a 10-particular questionnaire well-nigh feelings surrounding the wellness of the baby and circumstances of the birth (Rini et al., 1999); possible scores on this questionnaire range from 10 to 40 . On all measures, higher scores indicate worse symptoms. There is no cutting score for the pregnancy-related anxiety calibration, but previous treatment studies used a median split to define groups with higher versus lower pregnancy anxiety symptoms (Urizar et al., 2019). In our sample the median was 19, which we used to divide the sample into groups with higher and lower pregnancy-related feet symptoms.

2.5. Social support

Participants completed the social support effectiveness questionnaire (SSEQ) (Rini et al., 2006), which evaluates the type and self-perceived effectiveness of the support they receive from their partner or another support person, and the interpersonal support evaluation listing (ISEL) (Cohen and Hoberman, 1983), which measures broader perceived social back up from friends, family, and others.

2.6. Physical activity

We asked questions nearly physical activity from the Godin-Shephard Leisure-Time Exercise Questionnaire (Godin, 2011), which is a validated self-report measure of practise frequency in which participants study the number of times per week they engaged in mild, moderate, and strenuous practice of more than than fifteen min. A total score was calculated, per standard procedure, past multiplying episodes of mild exercise past iii, moderate by 5, and strenuous practice by 9. Individuals with scores below 14 are considered sedentary, fourteen–23 are moderately agile, and 24 or more than are considered active.

2.7. Data analysis

Survey data were manually checked for accuracy and consistency earlier analysis. From an original 2225 respondents, nosotros identified and removed 238 invalid records because either participants had non provided consent or they provided invalid due dates (i.due east., their gestation fell exterior the range of 1–35 weeks).

All analyses were conducted using SPSS 26.0. Descriptive statistics were computed for demographics and main written report variables. An analysis of covariance (ANCOVA) was used to compare nulliparous to primiparous and multiparous meaning individuals on measures of mental wellness symptoms (EPDS, PROMIS anxiety, pregnancy-related anxiety). Mental wellness symptoms were included equally continuous variables. Historic period and gestation were included as covariates. The significance was set up at p<0.017 using Bonferroni correction for 3 multiple comparisons.

Bivariate correlations were used to determine relationships between mental wellness symptoms measures and social support measures. Multivariate binomial logistic regression was used to identify how COVID-19 related stressors (loss of employment, social isolation, relationship strain) and worries (business organization about threat to own life, harm to babe, and not receiving the care needed) were associated with clinically elevated mental health symptoms (EPDS, PROMIS anxiety, pregnancy-related anxiety). Clinically elevated mental wellness symptoms were defined using cutoffs from previous literature: ≥13 on the EPDS (Cox et al., 1987), and T-scores ≥ 60 for the PROMIS anxiety calibration (Cella et al., 2010). The loss of employment variable was binomial (yep/no); all other variables were measured from 0 to 100. The significance threshold was set up at p<0.0028 using Bonferroni correction for 18 multiple comparisons. The multivariate model was used to determine unique associations betwixt COVID-19 factors and anxiety and depression symptoms. Parity was included as a covariate in the pregnancy-related feet model considering of its meaning clan with pregnancy-related anxiety symptoms. No covariates were included in the other models. Univariate models were conducted as supplementary assay, also with Bonferroni correction at p<0.00028.

A logistic regression was used to identify resilience factors (concrete action, perceived partner support, perceived general social support) that were associated with lower odds of clinically elevated symptoms of anxiety and depression. Partner back up was operationalized equally the Total Support score from the SSEQ and general social support was operationalized every bit the Full Support from ISEL; both were continuous variables. The total score from the Godin was our measure out of physical activity. The significance was prepare at p<0.0056 using Bonferroni correction for ix multiple comparisons.

3. Results

3.1. Participants

A total of 1987 individuals provided information for at least 1 measure on the survey between Apr 5–xx, 2020 and were included in the current analysis; specific numbers of individuals providing information for each measure are listed in Table 1 . Not all participants provided data for each question, and then numbers included in each assay vary between 1581 and 1987. Missing information were handled with listwise deletion for each split analysis; n is provided in the tables for each assay.

Table 1

Sample characteristics. Mean, standard deviation, and range are provided for central demographic characteristics and depression and anxiety symptoms in the sample. The number of datapoints bachelor for each comparing is also given. .

Measure out	n	Mean	Standard departure	Range	Cronbach's Alpha
Gestation (weeks)	1987	22.five	8.iv	4–35.ix	–
Age (years)	1900	32.iv	iv.2	xviii.six–47.half-dozen	–
Anxiety and Low Symptoms
Pregnancy-related anxiety questionnaire	1757	19.one	v.1	8–38	0.82
Edinburgh postnatal depression scale (EPDS)	1764	10.7	5.3	0–30	0.88
PROMIS anxiety T-scores	1757	60.1	8.ane	36–83	0.94
COVID-19 Stressors
Chore loss due to COVID-xix	1581	254 yes / 1327 no			–
Threat to ain life from COVID-xix	1795	46.4	24.three	0–100	–
Threat to baby's life from COVID-19	1793	51.7	25.one	0–100	–
Strained relationship with partner during COVID-xix*	1735	56.3	21.3	0–100	–
Social isolation due to COVID-nineteen	1785	64.one	26.1	0–100	–
Concerned not receiving necessary care due to COVID-nineteen	1585	35.7	27.6	0–100	–
Resilience Factors
Physical activity (total score from Godin)	1947	33.1	21.2	0–119	–
Partner social support (SSEQ Total support)	1685	55.8	14.ix	4–lxxx	0.94
General social support (ISEL)	1674	34.ane	vi.3	6–42	0.88

Participants were anile 32.4 +/- four.2 years (range eighteen.6–47.6 years). 51% of participants had other children (37% had one child, 11% had 2 children, and iii.v% had three or more than other children). Participants lived beyond Canada (12% British Columbia, 41% Alberta, iv% Saskatchewan, 3% Manitoba, 29% Ontario, iii% Quebec, i% New Brunswick, four% Nova Scotia, ane% Prince Edward Island, two% Newfoundland and Labrador, and ane% from the Territories). The majority were married (77.9%) or cohabitating (19.4%) with a partner. Well-nigh participants self-identified equally Caucasian (87.ane%), with others identifying as Kickoff Nations (0.seven%), Metis (1.ii%), Inuit (0.1%), Black (0.7%), Chinese (1.6%), Filipino (0.nine%), Korean (0.two%), West Asian (due east.yard., Afghan, Iranian; 0.4%), South Asian (eastward.g., East Indian, Pakistani, Sri Lankan; two.6%), Southeast Asian (east.g., Cambodian, Indonesian; 0.3%), Hispanic/Latinx (1.1%), and Mixed Race or Other (3.three%). Most participants reporting having completed a trade or community college diploma (23%), bachelor's degree (41%), or higher (28%). Participants had a median household income range of $100,000-$124,999 CDN/twelvemonth [$seventy,000–88,000 USD].

While Alberta residents are over-represented in the data compared to Alberta's population within Canada (11.six% of Canadian residents live in Alberta), there were no significant differences in weeks gestation or maternal historic period betwixt Alberta respondents and the rest of the sample, Alberta respondents were equally likely to be born in Canada, and had a similar breakdown by ethnicity (p>0.05). Alberta residents had college incomes (p<0.001; median=$125,000–149,000/year vs $100,000–125,000/year), different education profiles (p = 0.002; higher proportion of high school diplomas and bachelor degrees), and were more likely to exist married than respondents from elsewhere (p<0.001; 83% vs 74%), which is consistent with population demographics in Alberta and Canada (Statistics Canada, 2013, 2016, 2019).

iii.2. COVID-19 stressors

Ane participant had a confirmed case of COVID-19; 25 others reported suspected but unconfirmed cases. At the time of this initial survey, most provinces in Canada were only testing serious cases (i.e., in hospital) or healthcare workers. None of these individuals were hospitalized. 11 individuals reported other people with COVID-19 infections within their household (6 partners; ane child, 1 housemate; 3 unspecified).

At the fourth dimension of the survey, 18.3% of participants reported job loss due to COVID-nineteen (xvi.1% laid off, 2.2% indicated their employment was terminated).

Participants rated their social isolation every bit 64 +/- 26, their worries that their own life was in danger due to COVID-19 equally 46 +/- 24, and worries that the virus would crusade damage to their unborn infant as 52 +/- 25, all on a scale of 0–100 (non at all to very much so). Average score on human relationship strain (where scores <50 point more strain and scores >50 point the pandemic brought them closer with their partner) were 56 +/- 21.

Most participants (89%) reported changes in prenatal intendance due to the pandemic, including canceled appointments (36%), or not existence allowed to bring a support person (xc%). Boilerplate scores on the question of whether participants believed that the quality of their prenatal care had decreased were 36 +/- 28, on a calibration of 0–100. 35% of respondents fabricated changes to their birth plan because of the pandemic, including the location (xi%), support people (25%), and childcare arrangements (11%). 74% had trouble accessing other healthcare during their pregnancy, most commonly reporting they could not access massage therapy services (58%), followed by chiropractic (26%); 9% reported that they were unable to access psychological counselling services.

three.3. Anxiety and depression symptoms

Mean scores are shown in Tabular array ane. 37.0% of participants had clinically elevated symptoms of depression (EPDS scores ≥xiii). 46.iii% of participants had moderately elevated anxiety symptoms (T-scores 60–69), and 10.3% severely elevated anxiety symptoms (T-scores>70). 56.6% total had clinically elevated anxiety symptoms. As expected, measures of feet and depression symptoms were moderately to strongly associated with each other, and negatively associated with perceived social support (Table 2 ).

Table ii

Bivariate correlations among mental health and social support measures. All p-values <0.001.

	PRAQ	Anxiety	EPDS	ISEL
Pregnancy-related anxiety questionnaire (PRAQ)
PROMIS Feet	0.50
Edinburgh postnatal depression calibration (EPDS)	0.46	0.fourscore
Interpersonal support evaluation listing (ISEL)	−0.24	−0.26	−0.35
Social support effectiveness questionnaire (SSEQ)	−0.20	−0.31	−0.37	0.42

3.iv. Parity

Nulliparous individuals were younger than primiparous and multiparous individuals (31.iii years vs 33.iii, 33.half dozen years, respectively; F = 67.4, p<0.001) and were further along in gestation (23.2 weeks vs 21.8, 21.6 weeks, respectively; F = 7.nine, p<0.001). Comparison of anxiety and depression symptoms by parity revealed no differences for EPDS (F = ii.6, p = 0.078) or PROMIS Anxiety (F = 0.34, p = 0.71), controlling for age and gestation. However, nulliparous individuals had higher pregnancy-related feet symptoms (F = 35.7, p < 0.0001) compared to primiparous and multiparous individuals (Table iii ).

Table three

Comparing of mental health symptoms by parity.

	Nulliparous (northward = 971)	Primiparous (n = 735)	Multiparous (n = 277)	F-value	p-value
Edinburgh postnatal depression calibration	10.6	10.half dozen	10.8	ii.half-dozen	0.078
PROMIS Anxiety T-scores	60.iv	60.0	59.iii	0.34	0.71
Pregnancy-related anxiety	20.ii	xviii.3	17.6	35.7	<0.001

3.five. COVID-19 worries and stressors in clan with anxiety and depression symptoms

Nosotros used binomial logistic regression to make up one's mind which COVID-19 related worries (threat to own life, impairment to babe, not getting needed care) and stressors (loss of employment, changes to relationship with partner, feelings of isolation) were associated with and clinically elevated feet and depression symptoms. The odds for clinically elevated depression symptoms were increased by COVID-19-related worries and by partner relationship strain, but not by loss of employment. Odds for clinically elevated depression symptoms increased by 1% for each unit increase in perceived threat to own life, damage to baby and not getting care needed, 5% for each unit increase in feelings of isolation, and 2% for each unit of measurement increment in human relationship strain (all measures on 0–100 scale). Loss of employment did non increase the odds of clinically elevated depression symptoms. Like findings were observed for full general feet and pregnancy-related anxiety symptoms (Table four ). For both depression and general anxiety symptoms, the largest effects were for social isolation. Results of univariate binomial logistic regression models showed significant associations between most COVID-19 factors and low, feet, and pregnancy-related anxiety symptoms (Supplementary Table i). But loss of employment (for all 3 symptoms) and relationship strain (for pregnancy-related feet symptoms) were not significant in the univariate assay.

Table 4

Multivariate models of COVID-19 specific factors predicting elevated anxiety and low symptoms.

	B	SE	Wald	df	p	Odds Ratio	95% CI for Odds Ratio
							Lower	Upper
Low Symptoms
Abiding	−4.42	0.36	152.52	1	<0.001	.012
Threat to life	0.011	0.003	9.93	1	0.002	ane.01	1.01	one.02
Harm to baby	0.010	0.003	nine.95	one	0.002	one.01	1.01	1.02
Non getting needed care	0.013	0.003	26.26	1	<0.001	i.01	1.01	1.02
Human relationship strain	−0.016	0.003	25.13	1	<0.001	0.98	0.98	0.99
Social isolation	0.045	0.004	163.92	1	<0.001	ane.05	1.04	one.05
Loss of employment	0.21	0.18	ane.42	1	0.23	1.24	0.87	one.76
General Anxiety Symptoms
Constant	−3.38	0.32	114.62	1	<0.001	0.03
Threat to life	0.021	0.003	39.09	1	<0.001	1.02	i.01	one.03
Harm to baby	0.011	0.003	12.87	one	0.001	1.01	1.01	1.02
Not getting needed care	0.012	0.003	19.83	1	<0.001	1.01	1.01	i.02
Human relationship strain	−0.006	0.003	3.47	1	0.063	0.99	0.99	1.00
Social isolation	0.032	0.003	119.46	1	<0.001	one.03	1.03	i.04
Loss of employment	0.180	0.18	1.02	1	0.31	one.20	0.85	1.70
Pregnancy-Related Feet Symptoms#
Constant	−0.0.991	0.31	10.22	one	<0.001	0.37
Threat to life	0.014	0.003	18.05	one	<0.001	1.01	1.01	1.02
Harm to baby	0.014	0.003	twenty.22	1	<0.001	1.01	1.01	1.02
Not getting needed care	0.020	0.003	fifty.xviii	one	<0.001	ane.02	1.02	1.03
Human relationship strain	−0.007	0.003	four.16	ane	0.04	0.99	0.99	1.00
Social isolation	0.007	0.003	6.68	1	0.01	ane.01	one.00	1.01
Loss of employment	−0.12	0.18	0.46	1	0.50	0.89	0.63	one.26

iii.six. Resilience factors

The hateful physical activeness score on the Godin was 33, indicating that the sample could be considered 'active', using the classifications established by the Godin. Average scores on the SSEQ Total Support (partner social back up) were 55.eight +/- 14.nine. Average scores on the ISEL Total Support (general social support) were 34.i +/- vi.three, which are consequent with previous reports in pregnant women, M = 35.four–38.7 (Chou et al., 2008; Christian et al., 2009; Messer et al., 2013).

The odds of clinically elevated depression and anxiety symptoms were lower if participants and had better perceived social support (contained effects for partner and general support) (Table 5 ). The odds of clinically elevated anxiety symptoms (both general feet and pregnancy-related anxiety) were lower if participants reported more than concrete activity.

Tabular array v

Resilience factors predicting reduced feet and depression symptoms.

	B	SE	Wald	df	p	Odds Ratio	95% CI for Odds Ratio
							Lower	Upper
Depression Symptoms
Constant	3.42	.33	107.97	1	<0.001	30.47
Physical Activity	−0.01	0.003	6.66	1	0.01	0.99	0.988	0.99
Partner support	−0.03	0.004	68.91	i	<0.001	0.97	0.96	0.98
Full general support	−0.06	0.01	36.63	1	<0.001	0.95	0.93	0.96
General Anxiety Symptoms
Constant	3.49	0.34	108.07	1	<0.001	32.84
Physical activity	−0.01	0.002	8.28	1	0.004	0.99	0.988	0.998
Partner back up	−0.03	.004	57.38	1	<0.001	0.97	0.96	0.98
General support	−0.04	0.01	13.45	1	<0.001	0.97	0.95	0.98
Pregnancy-Related Anxiety Symptoms#
Abiding	three.39	0.36	91.44	1	<0.001	29.70
Physical activity	−0.01	0.003	7.39	1	0.007	0.99	0.988	0.998
Partner support	−0.02	0.004	24.32	1	<0.001	0.98	0.97	0.99
Full general support	−0.05	0.01	29.54	1	<0.001	0.95	0.93	0.97

4. Discussion

Meaning participants reported loftier levels of depression, full general anxiety, and pregnancy-specific feet symptoms. Higher symptoms were associated with more business organisation about threats of COVID-19 to the life of the mother and baby, likewise as concerns about non getting the necessary prenatal intendance, human relationship strain, and social isolation due to the COVID-19 pandemic. These findings suggest that the COVID-xix pandemic presents serious psychological challenges for pregnant individuals, with the potential for both short term (e.g., preterm birth, postpartum depression) and long-lasting impacts on the developing fetus. These findings highlight the urgent need to reduce psychological distress during pregnancy. Increased perceived social back up and increased physical activity were associated with reduced symptoms, and thus may be possible targets for intervention.

Elevated symptoms (to a higher place cut-off scores) of depression (37%), anxiety (59%) were higher than expected based on previous pre-COVID-nineteen cohort studies assessing symptoms in meaning women with similar demographic profiles. Prenatal low is estimated to affect nine–xi% of individuals at any given fourth dimension, with 18% of individuals experiencing a depressive episode at some point during pregnancy (Gavin et al., 2005; Woody et al., 2017). The England-based Avon Longitudinal Study of Parents and Children (ALSPAC) plant that 17% of 2390 pregnant women reported clinically elevated depressive symptoms (≥13 on the EPDS) in the outset wave of the study (1990–1992), while 25% of 180 women in the second generation (2012–2016) reported clinically elevated depressive symptoms (Pearson et al., 2018). In the Canadian Alberta Pregnancy Outcomes and Nutrition (APrON) study (Kaplan et al., 2014), a written report with similar demographic profiles to those seen hither, 11% of women had clinically elevated depression symptoms on the EPDS (Leung et al., 2017). Normative data for the United States indicates prevalence of clinically elevated depression symptoms in 8% of adults (Brody et al., 2018). These comparisons suggest that symptoms of depression take increased substantially during the COVID-19 pandemic (Fig. 1 ).

To sympathise low and anxiety symptoms in context, nosotros compared results to published meta-analyses and normative scores on our measures of depression and anxiety. The prevalence of clinically elevated anxiety (bluish) and depression (red) symptoms in the electric current study was substantially higher compared to meta-analyses (light-green boxes point full range of estimates) and the US population norms (light-green circles). References 1: (Dennis et al., 2017); 2: (Cella et al., 2019) 3: (Gavin et al., 2005) 4: (Brody et al., 2018).

In a survey of Chinese residents early on in the COVID-19 outbreak (Jan 31-Feb 2, 2020), 17% of respondents reported moderate or severe depression, and 29% reporting moderate to astringent anxiety (C. Wang et al., 2020). The rates of elevated depressive and feet symptoms in our pregnancy cohort are fifty-fifty higher, suggesting that the psychological impact of the outbreak may be of detail concern for meaning individuals.

Pregnancy-related anxiety symptoms were similarly elevated in our accomplice (hateful=nineteen.ane) compared to recent studies with similar demographics, which reported mean scores of seven.three (Tomfohr-Madsen et al., 2019) and 7.v (Thomas et al., 2017). Full general anxiety was elevated compared to a meta-assay of pregnancy which reports 18–25% prevalence (Dennis et al., 2017) and the full general The states population prevalence of 16% (Cella et al., 2019); run into Fig. i. Loftier levels of prenatal distress, particularly pregnancy anxiety, are concerning due to unique associations with elevated risk of preterm birth (Bussieres et al., 2015). The elevated anxiety and depression symptoms appear to be, at least in part, a event of the COVID-xix pandemic given that COVID-xix-related worries were associated with higher symptoms. The odds of depression increased by 1–5% for each unit of measurement (on a 0–100 scale) increment in COVID-19 worries, results that were mirrored in the feet outcomes. Importantly, participants' worries that they were not getting acceptable prenatal care due to COVID-19 were associated with higher symptoms in all categories, with the largest result for pregnancy-related anxiety symptoms. This suggests that maintaining high quality prenatal care is a priority for pregnant individuals, and changes to care may atomic number 82 to increased anxiety symptoms.

Consequent with the broader literature, better social support was associated with lower symptoms of depression and feet. The finding that college perceived support and support effectiveness are associated with decreased depression and anxiety symptoms is consistent with the notion that social back up buffers the effects of stress on anxiety and depression symptoms (Cohen, 2004) and previous inquiry showing decreased prenatal and postnatal feet and depression among women with higher levels of social support (Akiki et al., 2016; Friedman et al., 2020). Social back up is an important determinant of concrete and psychological well-being, especially during pregnancy when individuals accept on new responsibilities and roles (Dunkel Schetter, 2011). Supportive social relationships directly affect mental health past encouraging positive health behaviors, increasing positive feelings, and enhancing emotion regulation (Cohen and Wills, 1985) and indirectly by reducing the physiological stress response (Giesbrecht et al., 2013). Social support too reduces the effects of prenatal maternal stress on infant stress responses, suggesting that positive social relationships buffer the biological cascade of stress from mother to infant (Thomas et al., 2018).

Previous studies in multiple populations (Cotman and Berchtold, 2002; Erickson et al., 2011; Vankim and Nelson, 2013), including significant individuals (Demissie et al., 2011), indicate that concrete activity is associated with reduced depression and anxiety symptoms. Our results were highly consistent, although the effect did not reach significance for low after Bonferroni correction, merely was at tendency-level (p = 0.01). These associations have implications for pandemic control measures that limit opportunities for physical action (east.g., closure of parks, beaches, and gyms) and suggests that encouraging physical activity amidst significant individuals may assist reduce feelings of feet and low.

The loftier anxiety and depression symptoms reported past participants are concerning for both maternal and child health. Children whose mothers experienced high prenatal stress are at college hazard of cognitive and behavioural bug, as well as mental illness in their own lives (Brouwers et al., 2001; DiPietro et al., 2006; Glover, 2014; Huizink et al., 2004; Kinsella and Monk, 2009; Mennes et al., 2006; O'Connor et al., 2003; Stein et al., 2014; Van den Bergh et al., 2005; Weinstock, 2008). Prenatal anxiety and low symptoms are as well associated with changes to brain construction and function in children (Adamson et al., 2018; Lebel et al., 2016; Sandman et al., 2015). Such changes in offspring development are known to occur via multiple mechanisms, including epigenetic, hormonal (e.m., cortisol), behavioral (e.g., lifestyle factors), and social (e.one thousand., lack of adequate back up) factors (Beijers et al., 2014), all of which are modifiable and therefore correspond potential intervention/prevention targets.

Given the potentially serious consequences of untreated feet and depression symptoms in pregnancy on physical and psychological outcomes, interventions are urgently needed to reduce symptoms and build resilience. Psychological interventions for preventing and treating low and anxiety in pregnancy are effective, with cerebral behavior therapy (CBT) emerging as a front-line handling and interpersonal therapy (IPT) potentially offer additional benefits to reduce depression and increase social support (Field, 2017; Manber et al., 2019; O'Connor et al., 2019). Preliminary evidence also provides support for e-health interventions; however, trials to date are relatively small and scaling for widespread dissemination is urgently needed (Felder et al., 2020; Heller et al., 2020; Loughnan et al., 2019). Evaluation of east-health treatments should be a priority, given that in-person psychological treatments are currently not available or severely limited. Handling of pregnancy feet is too effective with brief midwife or obstetric lead interventions; however, the ability to deliver these via telehealth has not been tested (Stoll et al., 2018). There is also suggestion that online programs ameliorate partner social support and satisfaction, merely to our noesis these accept not been tested in pregnancy (Doss et al., 2020). Psychological treatments may require specific investments from authorities to ensure wide access only could accept big future returns.

I of the factors that may be closely associated with pregnancy-specific feet symptoms is parity, as showtime-time mothers tend to report greater pregnancy-related anxiety than parous women (Huizink et al., 2016). Indeed, in our sample, nulliparous individuals had significantly higher pregnancy-related feet symptoms than primiparous and multiparous individuals. Parity was not significantly related to EPDS or PROMIS Anxiety scores.

Our sample was slightly older and more likely to be married or cohabitating than the Canadian averages for pregnancy (Chalmers et al., 2008; Provencher et al., 2018). While this suggests that our data may not be entirely representative of Canadian pregnant individuals, samples with higher didactics, older historic period, and where more individuals are partnered tend to accept fewer prenatal anxiety and depression symptoms. Thus, the elevated feet and depression symptoms seen here would be highly unexpected under normal circumstances. Given the depression sociodemographic risks in our sample and the fact that Canada has had a relatively contained outbreak and universal health care, the results may be worse in populations with higher sociodemographic risks (east.grand., low educational activity, low income) or living in countries with larger outbreaks and/or worse containment measures. Symptoms of anxiety and low can vary across pregnancy (Bayrampour et al., 2016; Bennett et al., 2004; Gavin et al., 2005), and the rapid changes in government policies and outbreak risks during the current pandemic could add further confounding. Therefore, longitudinal studies with multiple assessment points will be necessary to improve understand the nature of anxiety and depression symptoms in pregnant women during the current pandemic. Futurity studies should consider other factors that may additionally contribute to anxiety and depression symptoms such every bit history of mental health problems.

5. Conclusions

Pregnant individuals are experiencing substantially elevated anxiety and low symptoms during the COVID-19 pandemic that are significantly related to COVID-xix specific worries about threats to their own lives, their infant's health, not getting enough prenatal care, and social isolation. These levels far exceed those commonly expected during pregnancy and those experienced by other groups of people during the current pandemic. Social support and physical activeness appear to be protective resilience factors. Given the known effects of stress on pregnancy, babe, and child outcomes, there is an urgent need to back up pregnant individuals during this critical time to mitigate long-term negative outcomes.

Declaration of Competing Interest

The authors written report no conflicts of interest.

Funding

This research was supported by the Alberta Children's Hospital Research Establish and the Owerko Centre; the funder had no function in the enquiry.

Acknowledgements

Nosotros thank Mary Kate Dichoso, Ashley Dhillon, Diego Santillo, and Pooja Sohal for their help with survey prepare.

Footnotes

Appendix. Supplementary materials

References

• Accortt E.E., Cheadle A.C., Schetter C.D. Prenatal depression and adverse nascency outcomes: an updated systematic review. Matern. Child Health J. 2015;19(6):1306–1337. [PMC free article] [PubMed] [Google Scholar]
• Adamson B., Letourneau N., Lebel C. Prenatal maternal feet and children'due south brain structure and function: a systematic review of neuroimaging studies. J. Affect. Disord. 2018;241:117–126. doi: x.1016/j.jad.2018.08.029. [PubMed] [CrossRef] [Google Scholar]
• Akiki S., Avison W.R., Speechley K.N., Campbell Yard.K. Determinants of maternal antenatal state-feet in mid-pregnancy: role of maternal feelings almost the pregnancy. J. Bear upon. Disord. 2016;196:260–267. doi: ten.1016/j.jad.2016.02.016. [PubMed] [CrossRef] [Google Scholar]
• Al-Rabiaah A., Temsah M.H., Al-Eyadhy A.A., Hasan 1000.M., Al-Zamil F., Al-Subaie S., Somily A.K. Middle due east respiratory syndrome-corona virus (MERS-CoV) associated stress amid medical students at a university teaching infirmary in Saudi Arabia. J. Infect. Public Health. 2020 doi: ten.1016/j.jiph.2020.01.005. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
• Bayrampour H., Tomfohr L., Tough South. Trajectories of perinatal depressive and anxiety symptoms in a community cohort. J. Clin. Psychiatry. 2016;77(11):e1467–e1473. doi: ten.4088/JCP.15m10176. [PubMed] [CrossRef] [Google Scholar]
• Beijers R., Buitelaar J.K., de Weerth C. Mechanisms underlying the effects of prenatal psychosocial stress on kid outcomes: across the HPA axis. Eur. Child. Adolesc. Psychiatry. 2014;23(x):943–956. doi: 10.1007/s00787-014-0566-3. [PubMed] [CrossRef] [Google Scholar]
• Bennett H.A., Einarson A., Taddio A., Koren Chiliad., Einarson T.R. Prevalence of depression during pregnancy: systematic review. Obstet. Gynecol. 2004;103(4):698–709. doi: ten.1097/01.AOG.0000116689.75396.5f. [PubMed] [CrossRef] [Google Scholar]
• Bergink V., Kooistra L., Lambregtse-van den Berg G.P., Wijnen H., Bunevicius R., van Baar A., Pop V. Validation of the Edinburgh low scale during pregnancy. J. Psychosom. Res. 2011;70(4):385–389. doi: 10.1016/j.jpsychores.2010.07.008. [PubMed] [CrossRef] [Google Scholar]
• Brody D., Pratt Fifty., J. H. Prevalence of depression amongst adults aged 20 and over: united states of america. NCHS Data Brief. 2018;(303):2013–2016. [PubMed] [Google Scholar]
• Brouwers Due east.P., van Baar A.L., Pop 5.J. Does the Edinburgh postnatal low scale measure out anxiety? J. Psychosom. Res. 2001;51(5):659–663. https://world wide web.ncbi.nlm.nih.gov/pubmed/11728506 Retrieved from. [PubMed] [Google Scholar]
• Bussieres E., Tarabulsy G., Pearson J., Tessier R., Wood J.C., Giguere Y. Maternal prenatal stress and babe nascence weight and gestational historic period: a meta-assay of prospective studies. Dev. Rev. 2015;36:179–199. [Google Scholar]
• Cella D., Choi S.W., Condon D.Chiliad., Schalet B., Hays R.D., Rothrock Due north.Eastward., Reeve B.B. PROMIS((R)) Adult Wellness Profiles: efficient Curt-Form Measures of Seven Health Domains. Value Wellness. 2019;22(5):537–544. doi: 10.1016/j.jval.2019.02.004. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
• Cella D., Riley Due west., Rock A., Rothrock N., Reeve B., Yount S., Group P.C. The Patient-Reported Outcomes Measurement Data System (PROMIS) developed and tested its first wave of adult cocky-reported health outcome particular banks: 2005-2008. J. Clin. Epidemiol. 2010;63(11):1179–1194. doi: 10.1016/j.jclinepi.2010.04.011. [PMC free commodity] [PubMed] [CrossRef] [Google Scholar]
• Chalmers B., Dzakpasu South., Heaman K., Kaczorowski J. The Canadian maternity experiences survey: an overview of findings. J. Obstet. Gynaecol. Tin. 2008;30(3):217–228. doi: 10.1016/S1701-2163(xvi)32758-10. [PubMed] [CrossRef] [Google Scholar]
• Chou F.H., Avant G.C., Kuo S.H., Fetzer S.J. Relationships between nausea and airsickness, perceived stress, social support, pregnancy planning, and psychosocial adaptation in a sample of mothers: a questionnaire survey. Int. J. Nurs. Stud. 2008;45(8):1185–1191. doi: 10.1016/j.ijnurstu.2007.08.004. [PubMed] [CrossRef] [Google Scholar]
• Christian L.1000., Franco A., Glaser R., Iams J.D. Depressive symptoms are associated with elevated serum proinflammatory cytokines among pregnant women. Brain Behav. Immun. 2009;23(half-dozen):750–754. doi: 10.1016/j.bbi.2009.02.012. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
• Cohen South. Social relationships and health. Am. Psychol. 2004;59(8):676–684. doi: ten.1037/0003-066X.59.8.676. [PubMed] [CrossRef] [Google Scholar]
• Cohen S., Hoberman H. Positive events and social supports every bit buffers of life change stress. J. Appl. Soc. Psychol. 1983;13:99–125. [Google Scholar]
• Cohen S., Wills T.A. Stress, social back up and the buffering hypothesis. Psychol. Bull. 1985;98:310–357. [PubMed] [Google Scholar]
• Cotman C.W., Berchtold Due north.C. Practice: a behavioral intervention to enhance brain health and plasticity. Trends Neurosci. 2002;25(6):295–301. doi: 10.1016/S0166-2236(02)02143-four%3C. [PubMed] [CrossRef] [Google Scholar]
• Coussons-Read Yard.Due east. Effects of prenatal stress on pregnancy and human development: mechanisms and pathways. Obstet. Med. 2013;6(ii):52–57. doi: ten.1177/1753495X12473751. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
• Cox J.L., Holden J.Yard., Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br. J. Psychiatry. 1987;150:782–786. http://world wide web.ncbi.nlm.nih.gov/pubmed/3651732 Retrieved from. [PubMed] [Google Scholar]
• Cullen W., Gulati G., Kelly B.D. Mental health in the Covid-19 pandemic. QJM. 2020 doi: 10.1093/qjmed/hcaa110. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
• Demissie Z., Siega-Riz A.M., Evenson K.R., Herring A.H., Dole N., Gaynes B.North. Physical activity and depressive symptoms among pregnant women: the PIN3 study. Arch. Womens Ment. Wellness. 2011;14(2):145–157. doi: x.1007/s00737-010-0193-z. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
• Dennis C.L., Falah-Hassani K., Shiri R. Prevalence of antenatal and postnatal anxiety: systematic review and meta-analysis. Br. J. Psychiatry. 2017;210(5):315–323. doi: x.1192/bjp.bp.116.187179. [PubMed] [CrossRef] [Google Scholar]
• DiPietro J.A., Novak M.F., Costigan K.A., Atella Fifty.D., Reusing S.P. Maternal psychological distress during pregnancy in relation to kid development at age two. Kid Dev. 2006;77(3):573–587. doi: 10.1111/j.1467-8624.2006.00891.x. [PubMed] [CrossRef] [Google Scholar]
• Doss B.D., Knopp K., Roddy One thousand.K., Rothman One thousand., Hatch S.One thousand., Rhoades G.K. Online programs amend relationship functioning for distressed depression-income couples: results from a nationwide randomized controlled trial. J. Consult. Clin. Psychol. 2020;88(4):283–294. doi: ten.1037/ccp0000479. [PubMed] [CrossRef] [Google Scholar]
• Dunkel Schetter C. Psychological science on pregnancy: stress processes, biopsychosocial models, and emerging research issues. Annu. Rev. Psychol. 2011;62:531–558. doi: 10.1146/annurev.psych.031809.130727. [PubMed] [CrossRef] [Google Scholar]
• Erickson M.I., Voss 1000.W., Prakash R.S., Basak C., Szabo A., Chaddock L., White S.Chiliad.. Practice preparation increases size of hippocampus and improves memory. Proc. Natl. Acad. Sci. 2011;108(7):3017–3022. [PMC free commodity] [PubMed] [Google Scholar]
• Felder J.Due north., Epel E.Due south., Neuhaus J., Krystal A.D., Prather A.A. Efficacy of digital cognitive behavioral therapy for the treatment of indisposition symptoms among pregnant women: a randomized clinical trial. JAMA Psychiatry. 2020 doi: 10.1001/jamapsychiatry.2019.4491. [PMC gratis commodity] [PubMed] [CrossRef] [Google Scholar]
• Field T. Prenatal low risk factors, developmental effects and interventions: a review. J. Pregnancy Child Health. 2017;four(1) doi: 10.4172/2376-127X.1000301. [PMC free commodity] [PubMed] [CrossRef] [Google Scholar]
• Friedman L.E., Gelaye B., Sanchez S.E., Williams K.A. Association of social support and antepartum low among meaning women. J. Touch on. Disord. 2020;264:201–205. doi: ten.1016/j.jad.2019.12.017. [PubMed] [CrossRef] [Google Scholar]
• Gavin Due north.I., Gaynes B.N., Lohr 1000.North., Meltzer-Brody S., Gartlehner G., Swinson T. Perinatal low: a systematic review of prevalence and incidence. Obstet. Gynecol. 2005;106(5 Pt 1):1071–1083. doi: 10.1097/01.AOG.0000183597.31630.db. [PubMed] [CrossRef] [Google Scholar]
• Geraldo da Silva, A., Marques Miranda, D., Paim Diaz, A., Silva Teles, A., Fernandes Malloy-Diniz, 50., & Pacheco Palha, A. (2020). Mental wellness: why it nonetheless matters in the midst of a pandemic. Braz. J. Psychiatry, in press. [PMC free article] [PubMed]
• Giesbrecht G.F., Poole J.C., Letourneau N., Campbell T., Kaplan B.J. The buffering effect of social support on hypothalamic-pituitary-adrenal axis function during pregnancy. Psychosom. Med. 2013;75(9):856–862. doi: x.1097/PSY.0000000000000004. [PubMed] [CrossRef] [Google Scholar]
• Glover V. Maternal depression, anxiety and stress during pregnancy and child outcome; what needs to exist done. All-time Pract. Res. Clin. Obstet. Gynaecol. 2014;28(1):25–35. doi: 10.1016/j.bpobgyn.2013.08.017. [PubMed] [CrossRef] [Google Scholar]
• Godin G. The Godin-Shephard leisure-time concrete activity questionnaire. Health Fettle J. Can. 2011;4(i):eighteen–22. [Google Scholar]
• Grigoriadis S., Graves Fifty., Peer M., Mamisashvili L., Tomlinson G., Vigod S.N., Richter M. Maternal anxiety during pregnancy and the association with adverse perinatal outcomes: systematic review and meta-analysis. J. Clin. Psychiatry. 2018;79(5) doi: 10.4088/JCP.17r12011. [PubMed] [CrossRef] [Google Scholar]
• Hamel, L., & Salganicoff, A. (2020). Is there a widening gender gap in coronavirus stress?Retrieved from.
• Hawryluck L., Gold West.L., Robinson South., Pogorski Southward., Galea S., Styra R. SARS control and psychological effects of quarantine, Toronto, Canada. Emerg. Infect. Dis. 2004;10(7):1206–1212. doi: 10.3201/eid1007.030703. [PMC gratuitous commodity] [PubMed] [CrossRef] [Google Scholar]
• Heller H.Yard., Hoogendoorn A.W., Honig A., Broekman B.F.P., van Straten A. The effectiveness of a guided internet-based tool for the treatment of low and anxiety in pregnancy (MamaKits Online): randomized controlled trial. J. Med. Cyberspace Res. 2020;22(3):e15172. doi: x.2196/15172. [PMC gratuitous article] [PubMed] [CrossRef] [Google Scholar]
• Huizink A.C., Delforterie M.J., Scheinin N.M., Tolvanen G., Karlsson L., Karlsson H. Adaption of pregnancy anxiety questionnaire-revised for all pregnant women regardless of parity: PRAQ-R2. Arch. Womens Ment. Health. 2016;19(ane):125–132. doi: ten.1007/s00737-015-0531-two. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
• Huizink A.C., Mulder E.J., Buitelaar J.K. Prenatal stress and adventure for psychopathology: specific effects or induction of general susceptibility? Psychol. Balderdash. 2004;130(1):115–142. doi: 10.1037/0033-2909.130.one.115. [PubMed] [CrossRef] [Google Scholar]
• Kaplan B.J., Giesbrecht Yard.F., Leung B.1000., Field C.J., Dewey D., Bell R.C., Martin J.Westward.. The Alberta Pregnancy Outcomes and Nutrition (Apron) cohort written report: rationale and methods. Matern. Kid Nutr. 2014;10(one):44–60. doi: x.1111/j.1740-8709.2012.00433.x. [PMC costless commodity] [PubMed] [CrossRef] [Google Scholar]
• King S., Laplante D.P. Using natural disasters to study prenatal maternal stress in humans. Adv. Neurobiol. 2015;10:285–313. doi: ten.1007/978-one-4939-1372-5_14. [PubMed] [CrossRef] [Google Scholar]
• Kinsella M.T., Monk C. Impact of maternal stress, depression and anxiety on fetal neurobehavioral development. Clin. Obstet. Gynecol. 2009;52(three):425–440. doi: 10.1097/GRF.0b013e3181b52df1. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
• Kozinszky Z., Dudas R.B. Validation studies of the Edinburgh Postnatal Low Scale for the antenatal catamenia. J. Bear on. Disord. 2015;176:95–105. doi: ten.1016/j.jad.2015.01.044. [PubMed] [CrossRef] [Google Scholar]
• Lebel C., Walton M., Letourneau N., Giesbrecht G.F., Kaplan B.J., Dewey D. Prepartum and postpartum maternal depressive symptoms are related to children's brain construction in preschool. Biol. Psychiatry. 2016;eighty(xi):859–868. doi: 10.1016/j.biopsych.2015.12.004. [PubMed] [CrossRef] [Google Scholar]
• Leung B., Letourneau N., Brilliant K., Giesbrecht G.F., Ntanda H., Gagnon 50., Squad A.P. Appraisal of the psychiatric diagnostic screening questionnaire in a perinatal cohort: the APrON study. Scand. J. Public Health. 2017;45(6):658–665. doi: ten.1177/1403494817717835. [PubMed] [CrossRef] [Google Scholar]
• Loughnan S.A., Sie A., Hobbs Thousand.J., Joubert A.Eastward., Smith J., Haskelberg H., Newby J.M. A randomized controlled trial of 'MUMentum Pregnancy': cyberspace-delivered cognitive behavioral therapy program for antenatal anxiety and depression. J. Affect. Disord. 2019;243:381–390. doi: 10.1016/j.jad.2018.09.057. [PubMed] [CrossRef] [Google Scholar]
• MacKinnon North., Kingsbury 1000., Mahedy L., Evans J., Colman I. The association between prenatal stress and externalizing symptoms in babyhood: evidence from the avon longitudinal written report of parents and children. Biol. Psychiatry. 2018;83(2):100–108. doi: ten.1016/j.biopsych.2017.07.010. [PubMed] [CrossRef] [Google Scholar]
• Manber R., Bei B., Simpson N., Asarnow L., Rangel E., Sit A., Lyell D. Cerebral behavioral therapy for prenatal insomnia: a randomized controlled trial. Obstet. Gynecol. 2019;133(v):911–919. doi: 10.1097/AOG.0000000000003216. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
• Mennes M., Stiers P., Lagae Fifty., Van den Bergh B. Long-term cerebral sequelae of antenatal maternal anxiety: interest of the orbitofrontal cortex. Neurosci. Biobehav. Rev. 2006;30(viii):1078–1086. doi: ten.1016/j.neubiorev.2006.04.003. [PubMed] [CrossRef] [Google Scholar]
• Messer L., Maxson P., Miranda M.L. The urban built environment and associations with women's psychosocial health. J. Urban Health: Balderdash. New York Acad. Med. 2013;90(five):857–871. [PMC free article] [PubMed] [Google Scholar]
• O'Connor East., Senger C.A., Henninger 1000.Fifty., Coppola East., Gaynes B.N. Interventions to prevent perinatal depression: evidence written report and systematic review for the United states of america preventive services task force. JAMA. 2019;321(vi):588–601. doi: 10.1001/jama.2018.20865. [PubMed] [CrossRef] [Google Scholar]
• O'Connor T.G., Heron J., Golding J., Glover Five., Team A.Due south. Maternal antenatal feet and behavioural/emotional problems in children: a test of a programming hypothesis. J. Child Psychol. Psychiatry. 2003;44(7):1025–1036. https://world wide web.ncbi.nlm.nih.gov/pubmed/14531585 Retrieved from. [PubMed] [Google Scholar]
• Pearson R.M., Carnegie R.E., Cree C., Rollings C., Rena-Jones L., Evans J., Lawlor D.A. Prevalence of prenatal depression symptoms amongst 2 generations of significant mothers: the avon longitudinal study of parents and children. JAMA Netw. Open. 2018;1(3) doi: 10.1001/jamanetworkopen.2018.0725. [PMC complimentary commodity] [PubMed] [CrossRef] [Google Scholar]
• Provencher, C., Milan, A., Hallman, South., & D'Aoust, C. (2018). Fertility: overview, 2012-2016. Retrieved from.
• Qiu A., Rifkin-Graboi A., Chen H., Chong Y.S., Kwek One thousand., Gluckman P.D, Meaney M.J. Maternal feet and infants' hippocampal evolution: timing matters. Transl. Psychiatry. 2013;3:e306. doi: ten.1038/tp.2013.79. . . [PMC free article] [PubMed] [CrossRef] [Google Scholar]
• Qu F., Wu Y., Zhu Y.H., Barry J., Ding T., Baio Thousand., Hardiman P.J. The clan betwixt psychological stress and miscarriage: a systematic review and meta-analysis. Sci. Rep. 2017;vii(1):1731. doi: x.1038/s41598-017-01792-3. [PMC costless article] [PubMed] [CrossRef] [Google Scholar]
• Reid K.M., Taylor M.Thousand. Social support, stress, and maternal postpartum low: a comparing of supportive relationships. Soc. Sci. Res. 2015;54:246–262. [PubMed] [Google Scholar]
• Rini C.K., Dunkel Schetter C., Hobel C., Glynn 50., Sandman C.A. Constructive social support: antecedents and consequences of partner support during pregnancy. Pers. Relatsh. 2006;13(2):207–229. [Google Scholar]
• Rini C.K., Dunkel-Schetter C., Wadhwa P.D., Sandman C.A. Psychological adaptation and birth outcomes: the part of personal resources, stress, and sociocultural context in pregnancy. Health Psychol. 1999;eighteen(iv):333–345. https://www.ncbi.nlm.nih.gov/pubmed/10431934 Retrieved from. [PubMed] [Google Scholar]
• Rondo P.H., Ferreira R.F., Nogueira F., Ribeiro One thousand.C., Lobert H., Artes R. Maternal psychological stress and distress equally predictors of depression birth weight, prematurity and intrauterine growth retardation. Eur. J. Clin. Nutr. 2003;57(two):266–272. doi: 10.1038/sj.ejcn.1601526. [PubMed] [CrossRef] [Google Scholar]
• Sandman C.A., Buss C., Caput One thousand., Davis E.P. Fetal exposure to maternal depressive symptoms is associated with cortical thickness in late childhood. Biol. Psychiatry. 2015;77(4):324–334. doi: 10.1016/j.biopsych.2014.06.025. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
• Statistics Canada. (2013). Canadian vital statistics, marriages database, 1981-2008. Retrieved fromhttps://www150.statcan.gc.ca/n1/pub/91-209-x/2013001/article/11788/tbl/tbl1-eng.htm.
• Statistics Canada. (2016). Highest level of educational attainment (detailed). Retrieved fromhttps://www12.statcan.gc.ca/census-recensement/2016/dp-pd/hlt-fst/edu-sco/Tabular array.cfm?Lang=E&T=21&Geo=00&SP=1&view=2&age=one&sexual activity=1.
• Statistics Canada. (2019). The income of Canadians, 2017. Retrieved fromhttps://www150.statcan.gc.ca/n1/pub/eleven-627-m/11-627-m2019013-eng.pdf.
• Stein A., Pearson R.K., Goodman Due south.H., Rapa Due east., Rahman A., McCallum M., Pariante C.Thousand. Furnishings of perinatal mental disorders on the fetus and child. Lancet. 2014;384(9956):1800–1819. doi: 10.1016/S0140-6736(14)61277-0. [PubMed] [CrossRef] [Google Scholar]
• Stoll K., Swift E.Chiliad., Fairbrother N., Nethery E., Janssen P. A systematic review of nonpharmacological prenatal interventions for pregnancy-specific anxiety and fearfulness of childbirth. Nascence. 2018;45(1):seven–eighteen. doi: x.1111/birt.12316. [PubMed] [CrossRef] [Google Scholar]
• Thomas J.C., Letourneau N., Bryce C.I., Campbell T.Due south., Giesbrecht M.F., APrON Report Team Biological embedding of perinatal social relationships in infant stress reactivity. Dev. Psychobiol. 2017;59(4):425–435. doi: ten.1002/dev.21505. [PubMed] [CrossRef] [Google Scholar]
• Thomas J.C., Letourneau N., Campbell T.Southward., Giesbrecht G.F., Apron Study Team Social buffering of the maternal and infant HPA axes: mediation and moderation in the intergenerational manual of adverse childhood experiences. Dev. Psychopathol. 2018;thirty(three):921–939. [PubMed] [Google Scholar]
• Tomfohr-Madsen 50., Cameron Eastward.E., Dunkel Schetter C., Campbell T., O'Beirne 1000., Letourneau Due north., Giesbrecht G.F. Pregnancy anxiety and preterm nascence: the moderating role of sleep. Wellness Psychol. 2019;38(11):1025–1035. doi: 10.1037/hea0000792. [PubMed] [CrossRef] [Google Scholar]
• Urizar G.G., Jr., Yim I.S., Rodriguez A., Schetter C.D. The SMART Moms Program: a Randomized Trial of the Bear upon of Stress Direction on Perceived Stress and Cortisol in Low-Income Pregnant Women. Psychoneuroendocrinology. 2019;104:174–184. doi: 10.1016/j.psyneuen.2019.02.022. [PubMed] [CrossRef] [Google Scholar]
• Van den Bergh B.R., Dahnke R., Mennes Thousand. Prenatal stress and the developing brain: risks for neurodevelopmental disorders. Dev. Psychopathol. 2018;30(three):743–762. [PubMed] [Google Scholar]
• Van den Bergh B.R., Mulder Due east.J., Mennes M., Glover V. Antenatal maternal feet and stress and the neurobehavioural development of the fetus and child: links and possible mechanisms. A review. Neurosci. Biobehav. Rev. 2005;29(2):237–258. doi: ten.1016/j.neubiorev.2004.10.007. [PubMed] [CrossRef] [Google Scholar]
• Van den Bergh B.R., van den Heuvel 1000.I., Lahti M., Braeken M., de Rooij S.R., Entringer S., King S. Prenatal developmental origins of behavior and mental health: the influence of maternal stress in pregnancy. Neurosci. Biobehav. Rev. 2017 [PubMed] [Google Scholar]
• Vankim N.A., Nelson T.F. Vigorous physical activity, mental health, perceived stress, and socializing among college students. Am. J. Health Promot. 2013;28(i):7–xv. doi: 10.4278/ajhp.111101-QUAN-395. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
• Wang C., Pan R., Wan X., Tan Y., Xu Fifty., Ho C.South., Ho R.C. Immediate psychological responses and associated factors during the initial stage of the 2019 Coronavirus Affliction (COVID-19) Epidemic among the General Population in Prc. Int. J. Environ. Res. Public Health. 2020;17(five) doi: x.3390/ijerph17051729. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
• Weinstock M. The long-term behavioural consequences of prenatal stress. Neurosci. Biobehav. Rev. 2008;32(6):1073–1086. doi: 10.1016/j.neubiorev.2008.03.002. [PubMed] [CrossRef] [Google Scholar]
• Woody C.A., Ferrari A.J., Siskind D.J., Whiteford H.A., Harris M.M. A systematic review and meta-regression of the prevalence and incidence of perinatal low. J. Bear on. Disord. 2017;219:86–92. doi: x.1016/j.jad.2017.05.003. [PubMed] [CrossRef] [Google Scholar]

tillettwoutiornow39.blogspot.com

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7395614/

Share this post