Impacto de la pandemia por COVID-19 en el bienestar emocional de la mujer gestante

Abstract

INTRODUCTION The physiological changes that occur in women during pregnancy have contributed to the inclusion of pregnant women as a group of special vulnerability to SARS-CoV-2 infection. An increased risk for the development of pre-eclampsia, threatened preterm delivery, low birth weight, hospital admission, and admission to the intensive care unit have been reported. Despite the existence of validated tools in different population groups for the evaluation of the emotional impact caused by COVID-19 and taking into account the importance of psycho-emotional health in pregnant women and the fact that in numerous studies women showed higher levels of fear and anxiety compared to men, it was necessary to develop a specific tool for a group with psychological characteristics that differed from those of the groups already studied, given that the levels of fear and anxiety in pregnant women may be influenced by both the characteristics of the pandemic context and the concern associated with the presence of an intrauterine foetus. METHODOLOGY This research was carried out in four different phases. In the first phase, a systematic review of the literature related to the mental health of pregnant women during the pandemic was carried out. In the second phase, the AMICO scale was adapted by a panel of experts to the population of pregnant women, followed by a psychometric validation study of the AMICO_Pregnant scale. In the third phase, a descriptive cross-sectional study was carried out using the questionnaire adapted to the population of pregnant women in Spain. Finally, in a fourth phase, a second descriptive cross-sectional study was carried out using the AMICO_Pregnant scale in the final phase of the health crisis caused by COVID-19, marked by the relaxation of isolation measures in public spaces. OBJECTIVE To assess the impact of the COVID-19 pandemic on the emotional well-being of pregnant women in Spain. RESULTS Seventeen studies were included in the systematic literature review, which showed a high prevalence of fear levels, ranging from 44.8% to 80%, and anxiety levels, ranging from 45.9% to 62%. Risk factors were identified in relation to high levels of fear and, as for anxiety. The AMICO_Pregnant scale was developed based on the AMICO scale designed by Gomez-Salgado et al. The exploratory factor analysis showed a two-factor structure with two factors that could explain 78.935% of the total variance. The first dimension consisted of 8 items with factor loadings ranging between 0.873 and 0.93, and the second dimension consisted of 8 items with a minimum factor loading of 0.76 and a maximum factor loading of 0.87. The Kaiser-Meyer-Olkin (KMO) Measure of Sampling Adequacy was estimated to be 0.962 and Bartlett's test of sphericity was estimated to be statistically significant at p<0.000. Subsequently, a confirmatory factor analysis (CFA) was carried out on the AMICO_Pregnant survey data. Regarding the reliability of the instrument, the Cronbach's Alpha index was used (α=0.95), showing a quite fair level, and the McDonald's Omega coefficient (0.94) was used for added reliability, which was optimal and provided greater robustness. Finally, a study of percentiles and quartiles was carried out for the distribution of the mean scores of the AMICO_Pregnant scale, which helped to identify three differentiated levels of fear and anxiety: low level, with scores from 0 to 3.06 points; intermediate level, from 3.07 to 6.53 points; and high level, a score above 6.54 points. The bivariate analysis showed statistically significant differences regarding the mean score of the scale and the variables: weeks of gestation, contact with the disease, vaccination schedule, or changes in the birth plan. Besides, perceived level of danger and self-reported levels of fear and anxiety in relation to the pandemic situation reported one year earlier showed in both cases a strong relationship with the assessment of the AMICO_Pregnant scale. CONCLUSIONS The COVID-19 pandemic has had an impact on the mental health of pregnant women resulting in increased levels of fear and anxiety. AMICO_Pregnant has been shown to be a valid and reliable instrument for the assessment of fear and anxiety in pregnant women.