COVID-19: More postpartum depression, decreased deliveries at public hospital

Pregnant women who delivered in a public hospital in Hong Kong reported more depressive symptoms in the postpartum period following the alert announcement regarding the coronavirus disease 2019 (COVID-19) pandemic, results of a retrospective study have shown.

The study – the first study to report the impact of COVID-19 on obstetric care and postpartum depression in Hong Kong – also showed a reduced delivery rate in the hospital following the COVID-19 alert announcement. [Hong Kong Med J 2020, doi: 10.12809/hkmj208774]

In the study, researchers retrieved data of 4,531 pregnant women (maternal age, 33.1 years; gestational age, 38.5 weeks) who delivered at Queen Mary Hospital in Hong Kong during the pre-alert period of 1 January 2019 to 4 January 2020 (n=3,577) and the post-alert period of 5 January 2020 to 30 April 2020 (n=954). The presence and severity of postpartum depression were screened using a validated Chinese version of the Edinburgh Postpartum Depression Scale (EPDS) questionnaire 1 day and within 1 week following delivery. The threshold of EPDS ≥10 for postpartum depression was adopted locally.

Results showed a 13.1 reduction in the numnber of actual deliveries during the 4-month period from Janurary to April 2020 (n=994) compared with the 4-month period from Janurary to April 2019 (n=1,144). Chinese patients accounted for 81.5 percent and 85.1 percent of all pregnant women who delivered during the pre-alert and post-alert periods, respectively.

In terms of pain relief, there was a significant increase in pethidine use (6.2 percent vs 4.6 percent; p<0.05) and a significant decrease in use of birthing ball (8.5 percent vs 12.4 percent; p=0.001) in the post- vs pre-alert period. This change might be due to the suspension of labour companionship in the post-alert period, reflected by a significant decrease in labour companionship rate vs the pre-alert period (21.8 percent vs 88.8 percent; p<0.05).

Screening for depressive symptoms was performed for 96.2 percent and 83.2 percent of the pregnant women at 1 day and 1 week following delivery, respectively.

A significantly higher proportion of women scored EPDS ≥10 a day following delivery in the post-alert vs pre-alert period (14.4 percent vs 11.9 percent; p<0.05). The proportion of women with postpartum depression decreased over time (ie, within a week after delivery) in both the pre- and post-alert periods, with a similar proportion reported in both periods (2.3 percent vs 2.9 percent).

“The reduced delivery rate coul represent a shift of childbirth from public to private hospitals, which did not manage suspected or confirmed COVID-19 patients,” the researchers suggested. “Pregnant women who deliver in public hospitals now face an increasing challenge of childbirth without the companionship of family members during their hospital stay.”

“[In addition,] women of reproductive age in Hong Kong have experienced the fearsome severe adult respiratory syndrome [SARS] epidemic in 2002–2003. The memories of SARS coupled with the abrupt changes in social behaviour during the post-alert period would likely have triggered an increase in stress level in pregnant women, reflected in their EPDS scores,” they continued.

“Obstetricians should be aware of the psychological burden of the COVID-19 outbreak on pregnant women, particularly those in the immediate postpartum period,” they advised. “Alternative measures, including provision of online education materials, a lactation support hotline, early postnatal discharge, and family support as well as effective intervention from the Comprehensive Child Development Service, should be made available to support these women during the pandemic.”