American Pregnancy Association. Understanding a high-risk pregnancy. 2020. (accessed 15 August 2020)

Bastani F, Hidarnia A, Kazemnejad A, Vafaei M, Kashanian M. A randomized controlled trial of the effects of applied relaxation training on reducing anxiety and perceived stress in pregnant women. Journal of Midwifery and Women's Health. 2005; 50:(4)e36-e40

Beck AT, Beck RW. Screening depressed patients in family practice: A rapid technic. Postgraduate Medicine. 1972; 52:(6)81-85

Brown VJ. Risk perception: it's personal. Environmental Health Perspectives. 2014; 122:(10)

Cameron E, Joyce K, Delaquis C, Reynolds K, Protudjer J, Roos LE. Maternal psychological distress and mental health services use during the COVID-19 pandemic. 2020;

Centers for Disease Control and Prevention. Pregnancy, breastfeeding, and caring for newborns. 2020. (accessed 15 August 2020)

Cervantes-Gonzalez M, Launay O. Pandemic influenza A (H1N1) in pregnant women: impact of early diagnosis and antiviral treatment. Expert Review of Anti-Infective Therapy. 2010; 8:(9)981-984

Chan GJ, Lee AC, Baqui AH, Tan J, Black RE. Risk of early-onset neonatal infection with maternal infection or colonization: a global systematic review and meta-analysis. PLOS Medicine. 2013; 10:(8)

Cohen S, Kamarck T, Mermelstein R. Perceived stress scale. Measuring stress: a guide for health and social scientists. 1994; 10:1-2

Cottreau JM, Barr VO. A review of antiviral and antifungal use and safety during pregnancy. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy. 2016; 36:(6)668-678

Curtis K, Weinrib A, Katz J. Systematic review of yoga for pregnant women: current status and future directions. Evidence-Based Complementary and Alternative Medicine. 2012;

Dadfar M, Kalibatseva Z. Psychometric properties of the persian version of the short beck depression inventory with Iranian psychiatric outpatients. Scientifica. 2016;

Davenport MH, Meyer S, Meah VL, Strynadka MC, Khurana R Moms are not OK: COVID-19 and maternal mental health. Frontiers in Global Women′s Health. 2020; 1:(1)

Ferrer RA, Klein WM. Risk perceptions and health behavior. Current Opinion in Psychology. 2015; 5:85-89

Goodwin R, Palgi Y, Lavenda O, Hamama-Raz Y, Ben-Ezra M. Association between media use, acute stress disorder and psychological distress. Psychotherapy and Psychosomatics. 2015; 84:(4)

Hay JL, McCaul KD, Magnan RE. Does worry about breast cancer predict screening behaviors? A meta-analysis of the prospective evidence. Preventive Medicine. 2006; 42:(6)401-408

Kashanian M, Faghankhani M, YousefzadehRoshan M, EhsaniPour M, Sheikhansari N. Woman's perceived stress during pregnancy; stressors and pregnancy adverse outcomes. The Journal of Maternal-Fetal and Neonatal Medicine. 2019; 1-9

Kline P. An easy guide to factor analysis.New York, NY: Routledge; 1994

Kourtis AP, Read JS, Jamieson DJ. Pregnancy and infection. New England Journal of Medicine. 2014; 370:(23)2211-2218

Kusev P, Purser H, Heilman R, Cooke AJ, van Schaik P, Baranova V Understanding risky behavior: the influence of cognitive, emotional and hormonal factors on decision-making under risk. Frontiers in Psychology. 2017; 8

Kwok KO, Li KK, Chan HH, Yi YY, Tang A, Wei WI, Wong YS. Community responses during the early phase of the COVID-19 epidemic in Hong Kong: risk perception, information exposure and preventive measures. MedRxiv. 2020;

Lee DT, Sahota D, Leung TN, Yip AS, Lee FF, Chung TK. Psychological responses of pregnant women to an infectious outbreak: a case-control study of the 2003 SARS outbreak in Hong Kong. Journal of Psychosomatic Research. 2006; 61:(5)707-713

Lothian JA. Safe, healthy birth: what every pregnant woman needs to know. The Journal of Perinatal Education. 2009; 18:(3)48-54

Maroufizadeh S, Zareiyan A, Sigari N. Reliability and validity of Persian version of perceived stress scale (PSS-10) in adults with asthma. Archives of Iranian Medicine. 2014; 17:(5)0-0

Momoi M, Murakami M, Horikoshi N, Maeda M. Dealing with Community Mental Health post the Fukushima disaster: lessons learnt for the COVID-19 pandemic. QJM: An International Journal of Medicine. 2020; 113:(11)787-788

Mosby LG, Rasmussen SA, Jamieson DJ. 2009 pandemic influenza A (H1N1) in pregnancy: a systematic review of the literature. American Journal of Obstetrics and Gynecology. 2011; 205:(1)10-18

Ngai FW, Chan SWC. Psychosocial factors and maternal wellbeing: an exploratory path analysis. International Journal of Nursing Studies. 2011; 48:(6)725-731

Nicola M, Alsafi Z, Sohrabi C, Kerwan A, Al-Jabir A, Iosifidis C The socio-economic implications of the coronavirus pandemic (COVID-19): a review. International journal of surgery (London, England). 2020; 78

North CS, Pfefferbaum B. Mental health response to community disasters: a systematic review. Jama. 2013; 310:(5)507-518

Rajabi GR. Psychometric properties of Beck depression inventory short form items (BDI-13). Journal of Iranian Psychologists. 2005; 1:(4)291-298

Raker EJ, Lowe SR, Arcaya MC, Johnson ST, Rhodes J, Waters MC. Twelve years later: the long-term mental health consequences of Hurricane Katrina. Social Science and Medicine. 2019; 242

Ropeik D. Understanding factors of risk perception. Nieman Reports. 2002; 56:(4)

Shahhosseini Z, Pourasghar M, Khalilian A, Salehi F. A review of the effects of anxiety during pregnancy on children's health. Materia Socio-medica. 2015; 27:(3)

Sheeran P, Harris PR, Epton T. Does heightening risk appraisals change people's intentions and behavior? A meta-analysis of experimental studies. Psychological Bulletin. 2014; 140:(2)

Speilberger CD, Gorsuch RL, Lushene RE. The state trait anxiety inventory manual. Palo Alto, Cal: Consulting Psychologists. 1970;

Staneva A, Bogossian F, Pritchard M, Wittkowski A. The effects of maternal depression, anxiety, and perceived stress during pregnancy on preterm birth: a systematic review. Women and Birth. 2015; 28:(3)179-193

Topalidou A, Thomson G, Downe S. Covid-19 and maternal and infant health: are we getting the balance right? A rapid scoping review. Practising Midwife. 2020; 23:(7)

World Health Organization. A report about health. 2020. (accessed 15 August 2020)

Perceived risk of COVID-19 acquisition and maternal mental distress

02 March 2021
Volume 29 · Issue 3



Pregnant women are a high-risk population for mental health effects during a pandemic.


This study aims to examine the association of perceived risk toward COVID-19 viral infection acquisition and maternal mental distress.


In a cross-sectional study, a total of 392 pregnant women were recruited. Data gathered using the perceived stress scale, State-Trait anxiety inventory, Beck depression inventory, and protective behaviour were assessed. Linear regression analysis was applied in both unadjusted and adjusted models to assess the association between the exposure and outcome variables.


In all five unadjusted and adjusted models, the perceived risk of COVID-19 acquisition remained a highly significant predictor for stress, anxiety factor 1 and 2, depression, and protective behaviours (P<0.001).


COVID-19 may be an important additional stress source for pregnant women.

Women experience specific physiological and psychological distress during pregnancy, leading to distinct physical and psychological requirements (Ngai and Chan, 2011; Curtis et al, 2012). This pregnancy related distress may be intensified when pregnant women encounter stressful events and external stressors, running the risk of numerous adverse perinatal and postnatal outcomes, including hypertensive symptoms, pre-eclampsia, gestational diabetes mellitus, preterm birth and low birth weight (Shahhosseini et al, 2015; Staneva et al, 2015).

Over the last decade, infectious diseases have threatened public physical and mental health across the world. The history of devastating environmental disasters with different geographical origins, including Ebola, West Nile encephalitis, severe acute respiratory syndrome (SARS), and avian flu indicate the global effect of infectious epidemics ([World Health Organization [WHO], 2020). Recently, COVID-19, as one of the most detrimental worldwide pandemics, has affected different countries from east to west (WHO, 2020). In terms of the psychological aspect, the response to the COVID-19 pandemic is suggested to be analogous to the response to natural disasters or other similar catastrophic events (Momoi et al, 2020), leading to permanent distress in the affected population (North and Pfefferbaum, 2013). Mental consequences of disasters may persist as long as 12 years in one out of six exposed people (Raker et al, 2019).

Register now to continue reading

Thank you for visiting British Journal of Midwifery and reading some of our peer-reviewed resources for midwives. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to our clinical or professional articles

  • New content and clinical newsletter updates each month