Literature Review 

: Psychological Impact of Pregnant Women

during Covid-19 Pandemic

Retno Tristanti1, Prihatini Tina Irtanti2, Nickhen Sindyana Susilo3

Midwifery Study Program, University of Muhammadiyah Gombong

Background: 
In addition to medical risks, the emergence of the Covid-19
pandemic has a huge psychological and social impact on pregnant
women. In an unprecedented situation, it is difficult to accurately
predict the psychological and emotional consequences of the
Keywords onset of the Covid-19 pandemic. The purpose of this literature
Pregnant women review is to analyze the results of previous research on the
Impact of Psychology psychological impact of pregnant women during the Covid-19
Covid-19
Pandemic.
Method: The method used is literaturereview. The first stage
begins with straightening out articles using Pubmed and Google
scholar search engines . The keyword used in article searches
is "Pregnant women, psychological impact, Covid-19"
Results: From eight articles, results were obtained that the Covid-
19 pandemic had an impact on the psychology of pregnant
women.
Conclusion: The Covid-19 pandemic has an impact on the
psychology of pregnant women.
 

1. Introduction
The COVID-19 pandemic is the worst pandemic that has occurred in the 21st century [1]. Rapid
transmission, the occurrence of unexpected deaths, the vagueness of the transmission model
become a frightening scourge and cause anxiety in society [1]. Currently, there is little information
about the long-term changes in mental health status during the COVID-19 pandemic [2]. Almost all
health services are affected by this virus, including maternal and neonatal health services both in
terms of access and quality [3]. Individuals who are vulnerable to stress due to the COVID-19
pandemic are pregnant women and mothers who have just given birth [2]. In general, about 10-
20% of mothers suffer from mental health problems during the gestational and perinatal
periods [4]. As many as 10% of pregnant women in the world report mental health disorders and
depression, this figure is even higher in developing countries, reaching 15.6% [5]
Physiological and mechanical changes in pregnancy in general increase susceptibility to
infections, especially if the cardiorespiratory system is affected, and can cause respiratory failure in
pregnant women [1]. The fatality rate of SAR-CoV infection cases in pregnant women reaches
25%. The further impact of COVID-19 infection on pregnant women is the emergence of concerns
related to growth and development as well as neonatal [6]. Pregnancy accompanied by anxiety will
reduce the immunity of pregnant women so that pregnant women will be more susceptible to being
infected with COVID19 and the recovery period will be longer if they have been
infected [7]. Therefore, pregnant women need special attention related to prevention, diagnosis,
and management [6]. The further impact of COVID-19 infection on pregnant women is the
emergence of concerns related to growth and development as well as neonatal [8]. Therefore,
pregnant women need special attention related to prevention, diagnosis, and management [6]. The
impact of the Covid-19 pandemic is widespread in society [9]. More and more people feel anxious
and even depressed due to this pandemic [7]. Great concern also occurs with the majority of
mothers. The results of the study found that 83.1% of women experienced concerns about their
health since the covid-19 pandemic, while pregnant women experienced an increase in concern of
more than 50.7%. These concerns include concerns about pregnancy 66.7% and baby care as
much as 35% [10]. Other studies say most pregnant women worry about their health problems and
the fetus being conceived all the time. The existence of this psychological change can affect
pregnant women during treatment up to the postpartum period (post partum) [11]. Some studies
suggest that this psychological alteration is one of the predisposing factors that inhibit the growth
and development of the fetus [11]. The long-term effects of untreated mental health disorders will
also affect personal and fetal health care during pregnancy [12]
Based on the background above, the author is interested in analyzing the results of previous
studies on the psychological impact of pregnant women during the Covid-19 pandemic

2. Materials and Method

The method used is literaturee review. The first stage begins with straightening out articles
using Pubmed and Google scholar search engines . The keywords used in article searches are
pregnant women, psychological impact, Covid-19. The obtained article will be reviewed to obtain
an article that fits the predetermined criteria. The journals that have been found are then
determined according to the inclusion criteria and exclusion criteria, namely IC1: journals
published by Google Scholar and Pubmed obtained as many as 42 articles, IC2: journals published
in 2017-2021, IC3: qualitative and quantitative types of research, IC4: non-duplicate journals
published in Google scholar and Pubmed . Once in accordance with IC1-IC4, only 13 articles
remain. Then IC5 was selected based on the compatibility of article titles and abstracts with the aim
of this literature review, which has the main content that analyzes the psychological impact of
pregnant women during the Covid-19 Pandemic period and only 8 journals are selected for
analysis. Strategies in searching for literature can be seen in the following figure:
 
:

Gambar 1
Literatur search The results of the
study were not
Google Scholar, pubmed
reprocessed (n=29)
not in accordance
with IC1-IC4
Search results: (n=38)
PubMed (n=4) Total 42

full-text studies assessed for

eligibility (n=13)
The results of the
study were not
reprocessed (n=5)
not in acordance
1. in the review
studies included with IC 5
(n=8)

Figure 1. Flow of literature review

3. Results and Discussion
3.1. Results
The author explores the journal through the journal database based on the suitability of
predetermined criteria and predetermined keywords, namely pregnant women, psychological
impact, Covid-19
Table 1. Literature review results
Author's name Heading Method Sampling Research results
techniques
Lopez, The impact of Qualitative Purposive n pregnant women showing an
Herman, et The coronavirus sampling increase in depression, anxiety
al (COVID-19) and other negative influences
(2020) pandemic compared to women who are
[4] on maternity not pregnant, it is necessary to
care in Europe provide health services to
optimize perinatal health care.
         
Gabrielle Perinatal mental during Qualitative purposive Based on gestational age,
Saccone,et, the covid-19 pandemic sampling women in the first trimester of
al pregnancy during the COVID-19
(2020) epidemic experience higher
[7] anxiety and a more severe
psychological impact than in the
second or third trimester of
pregnancy.

Zhou et al The prevalence of This research purposive During the COVID-19 epidemic
(2020) [11] psychiatric symptoms of uses qualitative sampling in China, pregnant women
pregnant and non- methods with faced mental problems caused
pregnant women during phenomenologic by COVID-19, namely showing
the COVID-19 epidemic al models fewer symptoms of depression,
anxiety, insomnia, and PTSD
than women who were not
pregnant.
 
Yingfei Psychological responses This study is a Purposive In pregnant women showing an
Zhan et al and lifestyle changes descriptive sampling increase in depression, anxiety
(2020)[13] among pregnant women study, and other negative influences
with respect to the early compared to women who are
stages of COVID-19 not pregnant, it is necessary to
pandemic provide health services to
optimize perinatal health care.

Orit  Distress  and  anxiety  Descriptive Purposive The increase in anxiety

Taubman, e associated  with  COVID- qualitative sampling disorders in vulnerable groups
t  al (2020) 19 among Jewish and Ar   such as pregnant women with
[2] ab pregnant women in Is the greatest concerns arises
rael when they leave the house,
namely taking public
transportation or being in public
places, concerns about the
health of others, either the fetus
or family members, and worry if
the pregnant woman herself is
infected and anxiety about
childbirth during the COVID-
19 pandemic

Aslinda The Relationship Descriptive Simple Random The results of research that has
Hafid , between the COVID 19 Observational Sampling been carried out on the
Hasrul Pandemic And The Design relationship of the covid 19
[8] Anxiety of Pregnant pandemic event to the anxiety
level of pregnant women in the
Women in the Third
third trimester
Trimester

Anxiety of Pregnant Descriptive Simple random pregnant women and

Diki Retno Women and Puerperal sampling postpartum mothers in
(2020) Mothers During the Baturraden District, during the
[9] Covid-19 Pandemic in COVID-19 pandemic, the
 Baturraden District majority experienced anxiety on
a mild-moderate scale

Ayu Yona Anxiety in Pregnant Quantitative Purposive there is a relationship between

wia Women During the sampling work and anxiety in pregnant
(2021) Covid-19 Pandemic at women during the Covid-19
[12] pandemic at Ibnu Sutowo
Ibnu Sutowo Baturaja
Baturaja Hospital, obtained a
Hospital
value of 0.024 < α (0.05).

3.2. Discussion
The period of pregnancy in women puts them in a condition prone to the occurrence of
psychological disorders. This review explores the mental health status of pregnant women and their
predictive factors amid the COVID-19 pandemic [14]. Based on the results of previous studies, it
shows that in some countries, pregnant women experience significant psychological changes from
before Covid-19 and during Covid-19 [7]. The high level of anxiety and stress in pregnant women is
due to changes in behavior that occur during pregnancy during the COVID-19 pandemic such as
fear of interacting outside due to the high incidence of COVID-19 infection due to fear of contracting
it, fear of insufficient food availability, to household conflicts that occur [2] . These factors directly
changed the level of maternal anxiety and stress during the COVID-19 pandemic to increase
significantly [15]
In general, the prevalence of symptoms of psychiatric disorders is higher in pregnant women
when compared to pre-pandemic prevalence [10]. Variations in the prevalence of all studies have
differences from measurement scales, differential reporting patterns including cultural differences in
each country, economic conditions, government readiness to face the pandemic, availability of
health facilities and appropriate dissemination of information related to COVID-
19 [15]. Psychological disorders are more commonly seen at the beginning of outbreaks when
individuals are faced with mandatory quarantine, unexpected unemployment, and uncertainty
associated with outbreaks [1]. Pregnant women are a group that is prone to psychological disorders
during their pregnancy, having a high level of anxiety and depression in the face of childbirth [16]
This could be exacerbated by the  current COVID-19 pandemic as pregnant women may
experience barriers to access to mental health services. The gestation period is a time when it is
very psychologically vulnerable that distress can have negative consequences for both the mother
and her baby [12]. Because women tend to report higher symptoms of anxiety and depression
during disease outbreaks than men [17]. Increased anxiety in the prenatal period and depressive
symptoms will increase the risk of postpartum depression, as well as prenatal infections and
disease rates [6]. Prenatal anxiety and the appearance of depressive symptoms can also cause
alterations in physical activity, nutrition and sleep, which in turn affect the mood of the mother and
the development of the fetus. Anxiety and prenatal depression also increase the risk of miscarriage,
premature birth, low birth weight, and lower Apgar scores at birth [16]. Research [4] states that
symptoms of anxiety and depression in pregnancy typically affect between 10 and 25% of pregnant
women in individuals [18]. Anxiety and depression experienced a 37% increase in pregnant women
with 57% experiencing anxiety symptoms. This anxiety is influenced by the threat of COVID-19 to
the lives of mothers and babies, as well as concerns about the unmet needs of prenatal care,
relationship tensions, and social isolation due to the COVID-19 pandemic [18].
Anxiety disorders and depression in pregnant women will also affect the role of mothers in the
care of children [15]. Children of mothers who experience high stress during pregnancy are more
likely to have cognitive and behavioral problems, and are at higher risk then mental health problems
themselves [2]. Anxiety and prenatal depression are also associated with changes in brain structure
and function in infants and children [12]. This is influenced by the ineffectiveness of the mother
during prenatal care and the existing resilience system (social support and spousal
support). Similarly, previous studies on COVID-19 showed a significant increase in psychological
distress in pregnant women [13]
However, some studies have also shown that family functioning improves in several ways as a
result of self-isolation, including increased social support from family members when in need,
sharing emotions in the family, and sharing compassion between family members. In addition,
having more than two children can protect the mental health of the mother during the
epidemic [2]. Long-term effects can occur on the development and health of children with unkempt
mental health, it is imperative that risk factors and resilience to mental distress are identified during
the pandemic as it informs early intervention strategies to improve healthy family functioning [9]. In
general, psychological changes during the pandemic are influenced by changes in income,
employment, and childcare needs. As a result, many families face psychological and
socioeconomic stressors that are usually associated with increased mental health needs [16].
The psychological health of pregnant women is also more at increased risk of depression and
anxiety [12]. Anxiety is often caused by situations that include patients, respiratory tract disorders,
reduced social activities, feelings of rejection by society and the drastically changing social
dynamics of society [10]. Research states that symptoms of anxiety and depression in pregnancy
usually affect between 10 and 25% of pregnant women in individuals. Anxiety and depression
increased by 37% in pregnant women with 57% experiencing anxiety symptoms [12]. This anxiety
is influenced by the threat of COVID-19 to the lives of mothers and babies, as well as concerns
about unmet prenatal care needs, relationship tensions, and social isolation due to the COVID-19
pandemic [2].
One of the factors that cause the appearance of anxiety and depression in pregnant women is
social support [13]. The more effective the social support provided, the lower the symptoms of
anxiety and depression experienced by pregnant women [8]. Social support is an important
determinant of physical and psychological well-being, especially during pregnancy as the individual
takes on new responsibilities and roles [15]. Social relationships that directly support mental health
by encouraging positive health behaviors, increasing positive feelings, and improving emotional
regulation and indirectly by reducing the psychological stress response in pregnant
women [12]. Social support also reduces the effect of prenatal maternal stress on the baby's stress
response, suggesting that positive social relationships increase the biological flow of stress from
mother to baby [8].
Symptoms of anxiety and depression in pregnancy usually affect between 10 and 25% of
women pregnant individuals [8]. Increased depressive and anxiety symptoms are associated with
an increased risk of premature birth, postpartum depression, and behavioral difficulties in
children [2]. The current COVID-19 pandemic is a stressor with potentially far-reaching
consequences for pregnancy and beyond [2]. Some of the symptoms of depression and increased
anxiety associated with an increased risk of premature birth, postpartum depression, and
behavioral difficulties in children [8] The current COVID-19 pandemic is a stressor with potentially
far-reaching consequences for pregnancy and beyond [7]. The symptoms that appear in patients
are anxiety which has an impact on the patient's sleep patterns. This psychological consequence
strikes because the patient has excessive anxiety, especially physical condition and restricted
interaction patterns in order to suppress the spread of the virus [10].
.
4. Conclusion
During the COVID-19 pandemic, the incidence of psychological disorders in pregnant women
has increased and has a negative impact due to feelings of anxiety and fear for the safety of
themselves and their babies. Emotional changes that occur during pregnancy due to hormonal
function can also trigger emotional stability in pregnant women so that it can have an impact on the
psychological health of the mother and the well-being of the fetus. This is related to threats to their
health of pregnant women themselves, the health of their babies, not getting enough pregnancy
care, and social isolation. Some of the factors that affect anxiety and depression include factors of
maternal and partner education, employment, income, marital status, number of children, parity,
gestational age, social isolation and resilience factors.
 
.