Answer :

Title- Impact of COVID-19 on the mental health of pregnant women in Western Australia

A literature review

Introduction 

The Covid-19 pandemic has positive and negative effects on maternal health, and the positive and negative impacts are interconnected. Being a mother is an emotional experience and during the pandemic, it has been found that pregnant women suffered stress and anxiety more than usual (WA government, 2021). Early parenthood is about family care and during pandemic physical isolation has been difficult for pregnant women. The primary research questions for the literature review are: 

How COVID-19 does impact the mental health of pregnant women?

What are the factors that caused poor mental health for pregnant women during COVID-19? 

What are the mental health issues faced by pregnant women during and post-pregnancy in the COVID-19? 

Based on these primary research questions this assessment aims at highlighting thorough literature analysis on the mental health of pregnant women in Western Australia during the pandemic. Also, it deals with the analysis of the literature search process followed by evaluation of mental health issues, steps taken by the government/researchers to cope up with maternal mental health. 

Literature Search Process 

Search terms- The literature search strategy includes the use of databases including PubMed, CINHAL, Embase, Medline and Cochrane. Further, for obtaining reliable and authentic evidence the search is completed by using Boolean operators. The various search terms for literature analysis are “pregnant women”, “mental health”, “COVID-19 pandemic, “maternal mental health” and so on. Next, the Boolean operators include maternal health AND pregnancy, COVID-19 AND mental health, Pregnancy AND COVID-19, Pandemic AND mental health issues and negative OR positive mental health effects.  AND, OR are important for attaining quantifiable and logical evidence. 

Limits- the study included the evidenced that had the following inclusion characteristics- 1) the authentic and ethical practice 2) the research study was only selected if it was in the English language 3) the period is not more than 5 years of publications that are from 2017 till present 4) the study was peer-reviewed and 6) the sample population was taken above 18 years of age. 

Screening- The number of research papers retrieved after using Boolean operators was 225. Following that, a manual search yielded a total of 202 articles. Following that, the majority of researches that were repeated further reduced to 151. The scan yielded 73 papers using an exclusion and inclusion strategy (18 years, English language). The search words, abstracts, and AND/OR review yielded 15 research papers.

Literature Review 

Pregnant women are more vulnerable to mental instability and distress, according to many reports. As a result, pregnancy can be a potential risk that exacerbates the emerging COVID-19 pandemic's increasingly detrimental impact (Gribble et al., 2020).  Wang et al. (2020) put forth that over half of the participants had mild to extreme mental conditions in a recent survey (depression, anxiety and stress). Furthermore, young people and women have been the most affected groups in particular. Pregnant women have traditionally been regarded as a high-risk group. Mental illnesses such as anxiety and depression are more common during perinatal phases in middle- and lower nations than during non-pregnancy periods, according to randomized trials (Farewell et al., 2020). Pregnant women are more vulnerable to mental distress and everyday stress, according to several reports. Pregnant women, on the other hand, are an especially vulnerable group because of the dual effects on them and their infants. There is a limited number of evidence that has looked at the impact of infectious diseases and social isolation on pregnant women's psychological health. Depression, anxiety, and psychological stress were found to be substantially higher during the SARS quarantine, according to reports (Delahoy et al., 2020).

Szabo et al. (2021) state that the connection between maternal mental health and COVID-19 is evident and results in negative effects. Isolation has been reported to result in symptoms of anxiety and depression, poorer quality of psychological development, a rise in subjective rates of depression, as well as a moderate psychological effect, according to these reports (Chasson et al., 2021). In particular, other studies have found that neurobiological indicators grow with the number of reported COVID-19 cases or frequent deaths, and when exclusion steps are removed, depression and anxiety disorders decrease. Nevertheless, there are no researches that have followed this population over the course of the lockdown. Depression and anxiety were linked to maternal fears of vertical virus transmission to their children, inadequate access to antenatal care services, and feelings of loneliness; such conditions were also stressful for pregnant and postpartum women despite COVID (Kotlar et al., 2021). During the disease outbreak, social isolation and exclusion protocols raise the rate of psychological issues in new and pregnant mothers. In a multicentre study conducted by Derya et al. (2021) self-reported rates of clinically related depression and anxiety appeared to increase among women who are pregnant compared to their prospectively self-assessed pre-pandemic rates and then when opposed to non-pregnant females. Self-harming emotions were also much more prevalent in the same research than it was before the disease outbreak.

According to a global study of postpartum and pregnant women conducted by Davenport et al. (2020) 42 per cent of women tested positive for post-traumatic stress (PTSD); over 71 per cent of women have registered clinically relevant anxiety or depression. These results are highly probable, but they must be interpreted in light of the lack of carefully monitored randomized trials. It is inherently difficult to determine time trends in psychological or trauma prevalence because the same demographic must be tested using the same methods in the same environment before and after crises. In comparison to the intrapartum era, the postpartum period has received less research. Restricted health services and the increasing prevalence of home deliveries by qualified obstetric practitioners, according to several writers, may have led to depression and anxiety among both pregnant new and pregnant mothers (Frankham et al., 2021). Matvienko et al. (2020) stated that enhanced levels of clinically significant anxiety, were likely caused by parental fear of virus for themselves and their children, social exclusion, and confusion about viral dissemination, but statistical findings are lacking.

Sensitivity analyses based on preterm delivery found that women in their first trimester of pregnancy had higher levels of anxiety and a more serious psychological effect during the COVID-19 outbreak than in their second or third trimesters. According to Hessami et al. (2020), 61.6 per cent of women in their first weeks of pregnancy during the COVID-19 epidemic chose cell-free DNA over combined testing as their first-trimester assessment process in Australia. The possibility that first-trimester risk analysis for trisomy 21 using cell-free DNA is linked to better prenatal validation and less anxiety than standard first-trimester integrated screening centred on nuchal translucency may describe the high percentage of non-invasive prenatal screening. Feminist theory is a collection of ideas that emphasises the assumption that women's life is not solely for establishing a compatible relationship, and that they are not expected to remain subservient to men (Mittal, 2020). As per the theory, women should be given more care and consideration during their pregnancy. A woman's ability to give rise to a new life necessitates special attention and care during certain life stages. Covid-19 has enabled families to spend more time together and has provided opportunities to support pregnant women in order to ensure a safe baby and mother. According to the theory, a good attitude must be instilled in the pregnant woman to maintain her mental health (Mittal, 2020). The government have also led the development of policies and help the pregnant women to get mental health assistance in Western Australia including individual therapies, support at home and medication management (Healthy WA, 2021). 

Chasson et al. (2021), contends that pregnant women generally, and minority groups, in particular, may be more vulnerable to psychological distress during periods of crisis. Furthermore, the findings illustrate the importance of women's environmental and personal support in times of crisis, a knowledge that could be used in tailored initiatives to alleviate distress in vulnerable communities (Vieira et al., 2020). Pregnancy is a very well period of significant transition. Appropriate emotional health is a contributing cause of depressive disorders, and pregnancy can increase vulnerability to clinical depression in some women. In developing countries, prenatal depression affects around 11% of people, and the number of pregnant women taking antidepressants has risen throughout the last decades (Zhou et al., 2020). Isolation, social distance, and drastic changes in everyday life can all raise the risk of mental illness in vulnerable people including pregnant women. As a result, determining the psychological effects of the COVID-19 outbreak is critical.

Conclusion

In conclusion, over half of the expectant mothers labelled the psychological impact of the COVID-19 epidemic as significant and about two-thirds recorded anxiety levels higher than average. About 50 % of women shared concern about the disease's vertical transmission. The COVID-19 virus seems to have a greater psychological effect and fear in women who are pregnant during the epidemic. These findings, while not definitive, support the hypothesis that the disease outbreak environment could intensify pre-existing vulnerabilities. Hence, for attaining positive mental health outcomes for pregnant women it is important to have social support and family attention to alleviate stress and fear.