A recent review published in the journal Progress in Neurology and Psychiatry discusses the adverse effects of the ongoing coronavirus disease 2019 (COVID-19) pandemic on perinatal mental health.

Study: Perinatal mental health during the COVID‐19 pandemic. Image Credit: Pormezz / Shutterstock.com

Background

The initial few weeks following childbirth are physically, emotionally, and mentally taxing. Perinatal depression can occur as early as before conception or as late as approximately one-year post-delivery.

Although women with pre-existing mental disorders are at an increased risk of relapse during the perinatal period, these disorders may also arise for the first time in women with no prior history of the condition. In fact, mental disorders, which are associated with poor maternal and child outcomes, are considered a major complication that women endure during the perinatal period and affect nearly one in five pregnant women.

The impact of the COVID-19 pandemic on perinatal mental health 

During the COVID-19 pandemic, pregnant women were especially vulnerable to the psychological effects of lockdowns and other restrictions that were put in place to reduce the transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Increased social isolation due to lockdowns and social distancing measures, combined with other socioeconomic stressors like financial hardships and occupational changes, have contributed to the development of mental health disorders, particularly in the perinatal population. 

Additional factors were also found to increase the likelihood of mental disorders in perinatal women during the COVID-19 pandemic. Travel restrictions, for example, increased the potential for relationship conflict, controlling behaviors, and, in some instances, domestic abuse and violence.

Furthermore, social distancing limited contact with friends, family, and support from healthcare providers, which also contributed to anxiety in these individuals. Despite the need for moral and emotional support from their peers, pregnant women often remained isolated from their support systems during the pandemic.

The replacement of in-person maternity care and perinatal mental health services with virtual visits, as well as new policies prohibiting partners from accompanying patients to their in-person visits, also contributed to the isolation of expectant mothers. The absence of customary birthing experiences also caused grief for many.

Concerns regarding the exposure of pregnant women and their unborn children to SARS-CoV-2 also increased anxiety in this patient population. In general, pregnant women with COVID-19 are more likely to necessitate intensive care unit (ICU) admission than non-pregnant women with COVID-19 of the same reproductive age.

Due to persisting disparities amongst various socioeconomic populations, pregnant women of minority ethnic groups are at a heightened risk for acquiring COVID-19 during the perinatal period as compared to pregnant women of other races.

Alcohol consumption has also been found to increase in the general population during the pandemic. In fact, one non-perinatal American study reported that this increase is more pronounced in women than men. It should be noted that the potential for domestic violence, abuse, and mental illness increases with alcohol abuse.

Global surveys report that healthcare personnel who were working in perinatal mental health settings at the onset of the pandemic identified several obstacles to assessing and providing care to perinatal women, as well as their infants and extended families. During remote consultations and follow-ups, staff often reported challenges regarding their ability to detect early signs of mental illness. Additional concerns on how to assess and encourage the interactions between the mother and infant through teleconsultations have also been described.

Guidance for improving clinical care

The COVID-19 pandemic has highlighted the importance of improving current perinatal mental healthcare services. For example, it is evident that virtual appointments are beneficial to some working mothers.

The current pandemic also emphasized the need for collaborative care between professionals in mental health and other organizations capable of assisting vulnerable perinatal women.

Several organizations have proposed guidelines to improve support for women suffering mental health problems during the pandemic. These guidelines emphasize the importance of recognizing the unpredictability of the current political climate and empowering women with information so that they can be equipped to handle the continuously changing situation.

A better understanding of the experiences of perinatal women during the pandemic could guide the adaptation and formulation of services for providing support aimed at improving perinatal mental health.