High Levels of Anxiety in Pregnant Women, Major Neglect in the Pandemic Covid- 19

During the pandemic of Covid-19, pregnant women experience all concerns of pregnancy, physical and mental changes, Covid-19 and its complications, and medical warnings that pregnant women are at high risk. Using an extensive search, all databases including Medline, Web of Science, and Scopus, database were searched. We used of keywords COVID-19, neonatal mortality, neonatal morbidity, pregnancy outcome, or combining these words. Clinical evidence has shown an increased risk of miscarriage, IUGR, and preterm delivery in pregnant women, without risk of damage to their newborns. The possibility of transmission from mother to fetus is another concern in pregnant women. Increased coagulation as a physiological change during pregnancy in women with Covid- 19 increases the risk of venous thromboembolism. So limited data about the effect of Covid 19 on pregnant women, it is not possible to express conclusively the generalizability of the results in all women, and further studies are needed.

Keywords: Anxiety in pregnancy; Covid- 19; Pregnancy outcome

Pregnancy, as part of a woman's life, is a physiological process that is associated with some physical and mental changes in women. Changes in the cardiovascular system, digestion, respiration, and the immune system are important physical changes in pregnant women. In addition; most pregnant women experience some degree of psychological change due to ignorance of their physical changes. Therefore, pregnant women experience some degree of anxiety compared to non-pregnant women (1).

Covid- 19 as a new disease has been implicated in a large number of the world's population. The disease began in December 2019 in Wuhan, China, and spread rapidly in most countries around the world. Some groups, including underlying diseases and the elderly, have been identified as high risk for mortality and morbidity from Covid- 19. Pregnant women have been identified as a high-risk group during the pandemic Covid-19. Both immune-compromised status and physiological changes during pregnancy are the main factors to evaluate the risk among pregnant women compared to non-pregnant women (1). So a careful follow-up of pregnant women is necessary to ensure the health of the mother and fetus during the mother's infection (2).

Using an extensive search, all databases including Medline, Web of Science, and Scopus, database were searched. We used of keywords COVID-19, neonatal mortality, neonatal morbidity, pregnant women, pregnancy outcome, or combining these words. The time of publication of the articles was considered from December 2019 until now. All English language articles about COVID-19 in pregnant women and the outcome of pregnancy were included. Review articles were deleted because they were repeated in other articles.

Clinical evidence has shown an increased risk of miscarriage, IUGR, and preterm delivery in pregnant women, without risk of damage to their newborns (3). The possibility of transmission from mother to fetus is another concern in pregnant women (4).

Increased coagulation is another physiological change during pregnancy, on the other hand, the Covid- 19 increases the risk of venous thromboembolise (3).

While one case of maternal death in Iran has been attributed to Covid- 19( 5), but a study of 100 pregnant women with Covid-19 did not show maternal deaths (3). In another study, no serious pregnancy complications have been reported in pregnant women compared to non-pregnant women (6). In one study, pulmonary symptoms in pregnant patients were milder than in non-pregnant women(7). In a study of pregnant women in Wuhan, China, the symptoms of the disease in pregnant women were similar to those in non-pregnant women. None of the newborns had the infection. Also, all samples of breast milk, amniotic fluid, cord blood, and neonatal throat swab were negative (8). In most countries, the social distance policy has been implemented to prevent the further spread of Covid-19 among all people. In this regard, the policy of social distance is being implemented since March 2020 in Iran. Therefore, access to normal care services, including prenatal care, was not performed properly.

It should be noted that during the pandemic of Covid-19, pregnant women experience all concerns of pregnancy, physical and mental changes, Covid-19 and its complications, and medical warnings that pregnant women are at high risk. While it must be accepted to pay attention to the specific conditions of mothers and to avoid neglecting the serious consequences of anxiety in pregnant mothers.