Perinatal mental health during the COVID-19 pandemic

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Editorial

Perinatal

mental

health

during

the

COVID-19

pandemic

TheCOVID-19pandemichasinﬂuenced manyaspectsoflife, includingwomen'spregnancy,birthandpostnatalperiod.Dueto physicallyandimmunologicallyadaptiveperinatalchanges,itis well known that pregnant women usually have an increased susceptibilitytoinfection. Despite this, themajorityof women affectedbyCOVID-19todatehaveexhibitedmildsymptomsand makeagoodrecovery[1].However,thereisnoreliableevidence for transmission of COVID-19 from mother to infant during pregnancy [1,2]. COVID-19infection does not seem toincrease likelihoodofneedforobstetricinterventionatbirth,withhealthy infantsbornvaginallytomotherswiththeinfection[3].

Following birth, the World Health Organization (WHO) recommendswomenwithCOVID-19initiatebreastfeedingwithin 1h of birth, and engage in skin to skin contact and kangaroo mother care, while practising respiratory hygiene and hand washing before and after touching the baby, in addition to application of required infection control precautions [4]. WHO recommend consideration of women's clinical condition when makingdecisions aroundmaternal–infantinteraction, including temporarymaternal–infantseparation.Despitesuch recommen-dations and the relatively reassuring evidence from the _ﬁrst perinatalCOVID-19studies,theapproachtowardspregnancyand childbirthisnot yethomogeneous; womenare beingmanaged withdifferentproceduresindifferentcountriesand indifferent hospitals.

Atthetimeofwriting,researchhasnotyetbeenpublishedon the impactof COVID-19 on perinatalpsychological well-being; thoughstudiesareexaminingthechangeofperspectivetowards childbirth in Italian women. There is however evidence of signiﬁcantimpactsofthepandemiconmentalhealthingeneral populations. Stress, anxiety, depressive symptoms, insomnia, denial,angerand feararethemostcommonlyreportedmental health difﬁculties [5]. Thereis alsoevidenceof similaradverse perinatalmentalhealthoutcomesincomparablescenarios,suchas naturaldisasters,andfollowingotherstressfullife-events[6].Even intheabsenceofstressfullifeevents,thetransitionalnatureofthe perinatal period can lead to distress for some, though not all, women. As such there is a high likelihood that women's experiences of pregnancy, birth and the postpartum during COVID-19willimpactontheirperinatalmentalhealth.

Womenduring theperinatalperiod are likely toexperience distress related to restrictions of movement, socialization and engagement in normal routines. Women are also likely to experienceconcernsabouttheirownhealthandriskofinfection, aswellashealthrisksfortheirinfants,andlovedones.Changesin

antenatalcarealsolikely contributetoperinataldistress where women areconcernedaboutaccesstoperinatalhealthcare and healthcare professionals, risk of infection in antenatal care settings,childbirthduringthepandemic,andrestrictionsonthe presenceofpartnersatantenatalcheck-upsandinsomeinstances at the birth and/or during the postpartum period in hospital. Reducedaccesstosupportnetworksbothduringpregnancyand immediatelyafterbirthduringtheCOVID-19pandemicarealso highlylikelytoincreasedriskofperinataldistress.

It is essential to support women's perinatal mental health duringthistimeandtoenablewomentoprotecttheirownmental health. There are a number of things women, and their care providers, can do to support perinatal mental health during COVID-19. Maintaining contact with loved ones and support networksisessentialatthistime;thisimportanceisrecognizedin the shift of language from ‘social distancing’ to ‘physical distancing’. Supportive networks are of central importance to perinatalmental health and canstill beengaged withvirtually during the COVID-19 pandemic. Somesimple cognitive behav-iouralstrategieswithtreatmentandprotectiveeffectsforperinatal distressincludeusingadiary,recognizingthoughtsandemotions intensity, body relaxations and so on. Mindfulness is another potentially useful strategy, and though evidence for perinatal effectsaremixed[7],mindfulnessandotherrelaxationexercises areeasytolearnanduseinself-isolationandlock-downcontexts. Accesstoclearinformation andcommunicationaboutantenatal supports,aswellasaboutCOVID-19risks,areanimportant top-downstrategytoensurewomenarekeptinformedandthuscan haveanincreasedsenseofunderstandingandcontrolovertheir situations.Provisionofinformationaboutdietandexerciseduring the perinatal period also remains important, particularly given current restrictions on movement in many countries and the increasedlikelihoodforpoordietarybehavioursduringlock-down scenarios.

Supportfrommidwivesandotherhealthcareprofessionalsis also critical to support women's mental health during the pandemic.It isimportantforthoseinvolvedinperinatalcareto be awareof theincreasedrisk of poorperinatalmental health duringthistimeandofpotentialresourcesandstrategiesasnoted above, in additionto useof referral pathways should thesebe needed.Thisisparticularlytruewherewomenareexperiencing,or areatincreasedriskof,perinataldistress,and/orhaveCOVID-19 infection.Forexample,wherewomenarerequiredtotemporarily separatefrominfantsfollowingbirth,theincreasedpsychosocial support,inadditiontoincreasedbreastfeedingsupportisneeded

http://dx.doi.org/10.1016/j.wombi.2020.04.006

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Pleasecitethisarticleinpressas:K.Matvienko-Sikar,etal.,PerinatalmentalhealthduringtheCOVID-19pandemic,WomenBirth(2020),

https://doi.org/10.1016/j.wombi.2020.04.006

ContentslistsavailableatScienceDirect

Women

and

Birth

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[4,8]. We also acknowledge however the increased stress and challengesexperiencedbyhealthcareprofessionals globallyand theirneedforsupportsalso,whilesupportingwomenduringthis time.

Globally, weare currentlyexperiencing unprecedented chal-lengesthat cansigniﬁcantlyimpactonwomen'smental health. Awarenessof,andengagementwithsupportsforperinatalmental healthdifﬁcultieswillbettersupportandprotectperinatalmental healthandwell-beingduringthistime.

References

[1]Y.Luo,K.Yin,ManagementofpregnantwomeninfectedwithCOVID-19,Lancet Infect.Dis.(2020).

[2]H.Chen,J.Guo,C.Wang,F.Luo,X.Yu,W.Zhang,etal.,Clinicalcharacteristicsand intrauterine vertical transmission potential ofCOVID-19 infectionin nine pregnantwomen:aretrospectivereviewofmedicalrecords,Lancet395(10226) (2020)809–815.

[3]H.Zhu,L.Wang,C.Fang,S.Peng,L.Zhang,G.Chang,etal.,Clinicalanalysisof10 neonatesborntomotherswith2019-nCoVpneumonia,Transl.Pediatr.9(1) (2020)51–60.

[4]WHO,ClinicalManagementofSevereAcuteRespiratoryInfection(SARI)When COVID-19 Disease is Suspected: Interim Guidance V 1.2, World Health Organization,Geneva,2019.

[5]J.Torales,M.O’Higgins,J.Castaldelli-Maia,A.Ventriglio,Theoutbreakof COVID-19coronavirusanditsimpactonglobalmentalhealth,Int.J.Soc.Psychiatry (2020),doi:http://dx.doi.org/10.1177/0020764020915212[Epubaheadofprint]. [6]E.O’Connor,C.Senger,M.Henninger,E.Coppola,B.Gaynes,Interventionsto preventperinataldepression:evidencereportandsystematicreviewfortheUS preventiveservicestaskforce,JAMA321(6)(2019)588–601.

[7]B.LeverTaylor,K.Cavanagh,C.Strauss,Theeffectivenessofmindfulness-based interventionsintheperinatalperiod:asystematicreviewandmeta-analysis, PLoSOne11(5)(2016)e0155720.

[8]CentersforDiseaseControlandPrevention,About2019NovelCoronavirus (2019–nCoV)(CDC;28January2020),(2020)Availablefrom:https://www.cdc. gov/coronavirus/2019-ncov/about/index.html.

KarenMatvienko-Sikar*

UniversityCollegeCork,Ireland ShahlaMeedya UniversityofWollongong,Australia ClaudiaRavaldi CiaoLapoFoundation,Italy * Correspondingauthor. E-mailaddress:[email protected](K.Matvienko-Sikar). Availableonlinexxx

2 K.Matvienko-Sikaretal./WomenandBirthxxx(2019)xxx–xxx

GModel

WOMBI1116No.ofPages2

Pleasecitethisarticleinpressas:K.Matvienko-Sikar,etal.,PerinatalmentalhealthduringtheCOVID-19pandemic,WomenBirth(2020),