Evaluating Maternal Depression and Anxiety Throughout Pregnancy and Postpartum: Impact of the COVID-19 Pandemic

Objective: The COVID-19 pandemic presents unique mental health challenges for women during pregnancy. We sought to determine its impact on maternal depression and anxiety during the perinatal and postpartum periods. Methods: Participants were enrolled in the Ontario Birth Study, an open longitudinal pregnancy cohort. Depression was assessed using the patient health questionnaire in early pregnancy and the Edinburgh postnatal depression scale in late pregnancy and postpartum. Anxiety was assessed using the generalized anxiety disorder questionnaire at all periods. Logistic regression models were created to examine the pandemic’s association with clinically elevated mental health scores while adjusting for covariates. Results: 416 participants were assessed in early pregnancy, 373 in late pregnancy, and 370 postpartum. Time comparisons revealed mean ranks of depression and anxiety scores were significantly higher during the pandemic (p=0.02, p=0.003) only in postpartum. Unadjusted and adjusted models showed no significant association between pandemic time and scores in earlier periods. In the postpartum unadjusted model, mothers were 2.6 times more likely to report clinically elevated depression scores during the pandemic (95% CI= 1.2-5.7, p=0.02). This association strengthened after adjusting for ethnicity and income as the odds ratio increased to 3.3 (95% CI= 1.4-8.0, p=0.007). Interpretation: This study was the first to evaluate the effect of the COVID-19 pandemic on maternal mental health in multiple periods. Increased depression and anxiety scores were confined to the postpartum period, highlighting a need for increased support for mothers postnatally as this pandemic continues. Funding Information: This research was supported by the Canadian Institutes for Health Research (SGM; FDN-148368). Declaration of Interests: The authors declare no conflicts of interest for this manuscript. Ethics Approval Statement: This study was approved by the Mount Sinai Hospital Research Ethics Board, Toronto, Ontario. All participants provided written informed consent for their participation in both study components and access to their clinical data for research.