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    European Journal of Obstetrics & Gynecology and Reproductive Biology

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    George Apostol

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    European Journal of Obstetrics & Gynecology and Reproductive Biology

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    European Journal of Obstetrics & Gynecology and Reproductive Biology

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    George Apostol

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    © All Rights Reserved
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    of 2

    European Journal of Obstetrics & Gynecology and Reproductive Biology 252 (2020) 615–616

    Contents lists available at ScienceDirect

    European Journal of Obstetrics & Gynecology and


    Reproductive Biology
    journal homepage: www.elsevier.com/locate/ejogrb

    Correspondence

    COVID-19 positive mothers are not more anxious prospectively collected more data from an additional three SARS-
    or depressed than non COVID pregnant women COv-2 positive pregnant patients and were able to compare GAD-7
    during the pandemic: A pilot case-control and PHQ-9 scores of 14 laboratory proven COVID-19 positive
    comparison mothers with that of a control group of non-COVID pregnant
    women (n = 14) matched for ethnicity, age, gestation and parity. The
    control cohort of asymptomatic non-COVID pregnant women were
    Dear Editor, recruited from antenatal clinics and completed their GAD-7 and
    PHQ-9 questionnaires in the same week as the index cases.
    Most recent studies on SARS-Cov-2 in pregnancy have focused on The median GAD-7 score for the COVID-19 positive mothers
    physical effects of the pandemic on infected mothers and the were statistically comparable to the non COVID pregnant women
    possibility of vertical transmission rather than the equally pertinent (2.72 vs 2.87; p = 0.9) (scores of 5, 10, and 15 are taken as the cut-off
    maternal mental wellbeing. There is little doubt that pregnant points for mild, moderate and severe anxiety). Similarly, median
    women express greater levels of anxiety and depression during the PHQ-9 score for the two groups were not statistically different
    pandemics weeks compared to before [1] and in particular, voiced (3.07 vs 3; p = 0.95) (scores of 5, 10, 15, and 20 represent boundaries
    concerns about health of their family and unborn children, as well as for mild, moderate, moderately severe and severe depression).
    anxiety regarding behavioural changes such as social-isolation, Interestingly, the anxiety and depression measurements in both
    working remotely, transport difficulties, childcare and stockpiling groups followed similar trajectories, rising to a peak at the height
    (especially of food, hand sanitizers and toiletries) [2]. of the pandemic deaths (around 23/3/2020) and falling sharply
    We had previously used the Generalised Anxiety Disorder after the 17th April 2020 as more published information were
    Questionnaire-7 (GAD-7) and Patient Health Questionnaire-9 available through social media and the Royal Colleges of
    (PHQ-9) to objectively assess maternal anxiety and depression in Obstetricians and Gynaecologists and Midwives Guidelines [4].
    a group of 11 laboratory proven SARS-Cov-2 positive pregnant In the free text section attached to our GAD-7 and PHQ-9
    women during the initial pandemic period in the United Kingdom questionnaires, both groups of COVID-19 positive and non COVID
    (from 1/3/2020 to 11/5/2020). This showed that median GAD-7 and mothers equally expressed specific concerns regarding vertical
    PHQ-9 scores in these COVID-19 positive mothers rose to a maximum transmission, potential absence of birth partner’s support during
    at the height of the pandemic deaths in the UK when “lockdown” active labour, financial insecurities due to loss of livelihood of self
    rules were instituted but declined later as more information and or partner and restricted visitors’ policy for family and partner in
    national guidelines appeared [3]. As of 31/5/2020, we had immediate postnatal period.

    Table 1
    Demographics, GAD-7 (anxiety) and PHQ-9 (depression) scores in COVID-19 positive vs non COVID mothers between 1/3/2020 and 31/5/2020. Data expressed as median and
    range.

    COVID positive (n = 14) Non-COVID (n = 14) p value


    Age (yrs) 32.6 (29 39) 32.9 (27 40) 0.8
    Gestation at time of questionnaire (wks) 32.8 (24 39) 32.8 (28 39) 1
    Parity 1 (0 4) 1 (0 4) 0.6
    % Caucasian 14 7.2 0.3
    GAD-7 2.71 (0 5) 2.78 (0 6) 0.9
    PHQ-9 3.07 (0 7) 3.0 (0 8) 0.9

    Free text comments.


    “Anxious about vertical transmission to baby”.
    “Is home birth still possible if no complications in pregnancy?”.
    “Transferring infection to newborn through secretions through breast feeding”.
    “Anxious as no support during induction of labour as partner not permitted in hospital”.
    “Not having enough information”.
    “Family not being tested as contact tracing not in place”.
    “Delaying baby’s immunisation due to fear of transmission in hospital”.
    “Fear of using public transport”.
    “Financial concerns as partner has lost job”.
    “Transmission to other children in the family”.
    “Schools closed, no support from grandparents, other children at home full-time leading to physical exhaustion”.

    https://doi.org/10.1016/j.ejogrb.2020.07.037
    0301-2115/© 2020 Elsevier B.V. All rights reserved.
    616 Correspondence / European Journal of Obstetrics & Gynecology and Reproductive Biology 252 (2020) 615–616

    The data from our small study indicate that GAD-7 and PHQ-9 References
    median scores were broadly low in both groups, suggesting that
    the sociodemographic influences of the pandemic affected [1] Wu Y, Zhang C, Liu H, Duan C, et al. Perinatal depressive and anxiety symptoms
    of pregnant women along with COVID-19 outbreak in China. Am J Obstet
    pregnant women equally irrespective of their COVID status. Gynecol 2020, doi:http://dx.doi.org/10.1016/j.ajog.2020.05.009.
    Nevertheless, it is still vital to appreciate the potential effects of [2] Corbett GA, Milne SJ, Hehir MP, Lindow SW, O’Connell MP. Health anxiety and
    the pandemic on the mental health of vulnerable groups such as behavioural changes of pregnant women during the COVID-19 pandemic. Eur J
    Obstet Gynecol Reprod Biol 2020, doi:http://dx.doi.org/10.1016/j.
    pregnant women. Antenatal care is currently conducted virtually, ejogrb.2020.04.022 Apr 13. pii: S0301-2115(20)30190-30191. doi: 10.1016/j.
    using telephone or video calls, during which non-verbal cues, ejogrb.2020.04.022. PMID: 32317197.
    (previously apparent in face to face appointments), could be [3] Kotabagi P, Essien S, Fortune L, Nauta M, Yoong W. Anxiety and depression levels
    among pregnant women with COVID-19. Acta Gynecol Obstet Scand 2020, doi:
    missed. Adherence to social isolation and shielding guidances has http://dx.doi.org/10.1111/aogs.13928.
    also resulted in a 25 % increase in domestic violence helpline calls [4] Royal College of Midwives. Royal College of Obstetricians and Gynaecologists.
    and safeguarding must be ensured in suspected cases. It is Corona Virus Infection in Pregnancy. Information for healthcare professionals.
    V8 17/4/2020. https://www.rcog.org.uk/globalassets/documents/guidelines/
    therefore crucial that frontline healthcare workers make conscious
    2020-04-17-coronavirus-covid-19-infection-in-pregnancy.pdf.
    efforts to inquire about anxiety, depression, stress and sleeping [5] Clark DM. Implementing NICE guidelines for the psychological treatment of
    patterns particularly during postnatal consultations, so that those depression and anxiety disorders: the IAPT experience. Int Rev Psychiatry
    deemed to be at higher risk could be supported by the local 2011;23(4):318–27, doi:http://dx.doi.org/10.3109/09540261.2011.606803.

    specialist mental health carers such as Perinatal Mental Health or


    Improving Access to Psychological Therapies (IAPT) teams [5] P. Kotabagi
    (Table 1). Department of Obstetrics and Gynaecology, North Middlesex
    University Hospital, London, NW18 1QX, UK
    Funding M. Nauta
    Camden Health Improvement Practice, Margarete Centre, London,
    None. NW1 2LS, UK

    Ethical approval L. Fortune


    North Middlesex University Hospital, London, NW18 1QX, UK
    Not required, as registered as part of quality improvement for
    W. Yoong*
    COVID positive patients
    North Middlesex University Hospital, London N18 1QX, UK

    Declaration of Competing Interest


    * Corresponding author.
    E-mail address: waiyoong@nhs.net (W. Yoong).
    The authors declare that they have no known competing
    financial interests or personal relationships that could have
    Received 14 July 2020
    appeared to influence the work reported in this paper.

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