Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
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Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : June | Volume : 16 | Issue : 6 | Page : QC01 - QC05 Full Version

Knowledge and Anxiety of Pregnant Women towards COVID-19 Pandemic in the Prevaccination Phase


Published: June 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/53531.16450
Bharti Singh, Anusha Devalla, Kameshwarachari Pushpalatha, Namita Gautam, Deepti Dabar

1. Assistant Professor, Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India. 2. Senior Resident, Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India. 3. Additional Professor, Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India. 4. Assistant Professor, Department of Psychiatry, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India. 5. Assistant Professor, Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.

Correspondence Address :
Dr. Anusha Devalla,
Senior Resident, Department of Obstetrics and Gynaecology, 1st Floor, IPD Building, AIIMS Hospital, Bhopal, Madhya Pradesh, India.
E-mail: anushadevalla2@gmail.com

Abstract

Introduction: Coronavirus Disease-2019 (COVID-19) pandemic has led to devastating and unprecedented health crises especially in the vulnerable population, ever since its origin in 2019. COVID-19 management in pregnant women had been a matter of controversy before the introduction of the standard protocols by the various international bodies. A lot of concern still prevails around the adverse foeto-maternal outcomes such as preterm birth, stillbirth, increased caesarean rates, maternal morbidity and mortality. Furthermore, uncertainty about the duration of the COVID-19 pandemic had also increased anxiety among pregnant women, particularly during the first wave.

Aim: To find out the knowledge and beliefs of pregnant women towards the COVID-19 infection in first wave and to know whether it had increased anxiety among non infected pregnant women before the advent of the COVID-19 vaccination.

Materials and Methods: A cross-sectional study was conducted on the 280 asymptomatic pregnant women attending the Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India, over four months (10th October 2020 to 10th February 2021). These women were provided with a questionnaire and a Generalised Anxiety Disorder Score-7 (GAD-7) chart. Statistical analysis was performed using the Pearson Chi-square analyses with p<0.05 considered statistically significant.

Results: The total number of participants were 280. Majority of them were in their 20s and were primigravida. The mean GAD-7 score for the study population was 4.642 and the overall prevalence of anxiety in this study was 34.3% (n=96). GAD-7 score chart showed 65.7% (n=184) had 0-4 levels (minimal) while severe scores ≥15 were noted in 2.9% (n=8). In the current study, greater anxiety scores were found in the homemakers. A high prevalence of anxiety was seen in primigravida and during the third trimester. About 37.5% of the participants believed that COVID-19 could transmit to the foetus-in-utero, if infected and 50.36% felt being pregnant could increase the risk of contracting COVID-19 infection.

Conclusion: The present findings suggest that pregnant women showed a lot of concerns and significant anxiety due to COVID-19 during the study period.

Keywords

Caesarean section, Depression, Mental health, Premature birth, Prenatal care

The COVID-19 pandemic started as affected individuals with pneumonia of unknown aetiology from Wuhan, Hubei (China) province in December 2019 were found. It was declared as a public health emergency of international concern by World Health Organisation (WHO) on March 11, 2020 (1). The pathogen was recognised as the causative agent for Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) (2). Ever since the viral spread and implementing nationwide “lockdown”, pregnant women have shown concerns regarding their routine antenatal care services. Mental health disorders are a common cause of morbidity during pregnancy with approximately 12% of women experiencing depression and upto 22% experiencing high levels of anxiety in late pregnancy (3). GAD during pregnancy is more common and estimated to be around 8.5%, while its prevalence varies between 4.4-8% during the postpartum period (4).

A number of factors have been thought to increase the anxiety issues in pregnant women pertaining to the COVID-19 infection. These include the increased probability of acquiring the infection during pregnancy and possibility of vertical transmission to the foetus, if contracted (2),(5). Increased risk of delivery occurring before 37 weeks (preterm birth) has been suggested with COVID-19 infection, causal association is still unproven (6),(7),(8),(9). Few studies have also mentioned other possible risks associated with COVID-19 infection in pregnancy such as the need for caesarean section, risk of maternal death, abortion, neonatal respiratory distress (6),(10),(11). Despite the inconsistent data about the clinical outcomes of pregnant women with COVID-19, the unfavourable psychological outcome is almost certain by taking previous epidemics into account (12),(13). All these factors do have a huge psychological impact on the uninfected individuals.

To the best of our knowledge, this study was the first of its kind from the region of Central India during the first wave of COVID-19 pandemic (14),(15),(16),(17). Through this study, the authors aim to assess the degree of anxiety levels due to COVID-19 infection in uninfected pregnant women from Central India and their knowledge and beliefs towards COVID-19 infection in pregnancy during the prevaccination phase.

Material and Methods

A cross-sectional observational study was performed over four months from 10th October 2020 to 10th February 2021 on asymptomatic pregnant women from the Outpatient Department (OPD) and Inpatient Department (IPD) of Department of Obstetrics and Gynaecology. All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India. The study was conducted according to the principles expressed in the 1975 Declaration of Helsinki (18) and after obtaining approval from the Institutional Human Ethics Committee (IHEC) (LOP/2020/IM0311). An informed written consent was taken from all the eligible participants prior to inclusion in the study, in their vernacular language after elaborating the purpose of the study.

Inclusion criteria: Asymptomatic pregnant women attending the OPD and IPD sections of the department.

Exclusion criteria: Patients admitted for maternal or foetal emergencies, previous or current psychiatric disorder and patients in established labour were excluded. Pregnant women with known COVID-19 infection were also excluded.

Sample size calculation: Sample size was calculated by the following formula:

n=z2pq/d2
where,
n= sample size
p= prevalence of feeling vulnerable/weak during the pandemic because of their pregnant state (taken as 50% from the quoted study) (19);
d= allowable error (absolute) = 5%;
z= value of the standard normal variable at 0.05 (two sided) level of significance (1.96).

Substituting the values in the equation, the calculated sample size was 360. But due to the prevailing COVID-19 situation, a sample size of 280 could be achieved as there was a significant reduction in the number of patients attending the hospital for routine antenatal visits after March 2020 (far less than the preCOVID-19 patient load).

However, doing a post-hoc power analysis using 34.3% (as observed in this study) as the prevalence of the anxiety in the participants, the power of the study was still >90%. Thus, the results are presented with an acceptable error of ±5% points.

Detailed demographic and clinical information of all the participants was recorded viz. age, socio-economic status (modified Kuppuswami scale) (20), occupation, parity, gestational age and high-risk factors in pregnancy. These women were asked to fill a questionnaire (Hindi/English) which was prepared by the authors (experts from the departments of Obstetrics and Gynaecology and Psychiatry). The questionnaire was pretested on a group of 20 participants and their concerns were incorporated into it. The questionnaire comprised of 10 questions regarding knowledge and beliefs during pregnancy about the ongoing COVID-19 pandemic where these questions were designed to be answered in either “yes”, “no” or “I don’t know”; where “Yes” meant if the participant agreed to or was aware of the particular question asked; “No” = if the participant disagreed to the particular question asked or felt the question was not applicable to her and “I don’t know”= if the participant was not aware of the relevant answer to the particular question being asked. One of the co-investigators was involved in explaining the questions to the pregnant women who were illiterate (same co-investigator for all the participants).

The participants were also provided the GAD-7 scale to assess the levels of their anxiety. It is a seven-item anxiety scale (Likert scale) developed by Spitzer RL et al., (21). Scores range from 0 (never) to 3 (nearly every day) against each question with a total score from 0 to 21. As per the GAD-7 score, 0-4 was considered minimal anxiety, 5-9 mild, 10-14 moderate and a score of ≥15 suggested severe anxiety. The GAD-7 scores of the participants were also associated with all the demographic variables viz. education level, literacy status, socio-economic status, occupation, maternal characteristics like trimester, gravida and pregnancy associated risk factors.

Statistical Analysis

Descriptive and Pearson Chi-square analyses were used to determine the associations between stress and anxiety of current COVID-19 pandemic and other independent variables, including demographics. A p-value <0.05 was considered as statistically significant. R version 4.0.4 software was used for all the statistical calculations.

Results

Demographic characteristics: Majority of the study participants fell in the 20-30 years age group category (80.71%, n=226); most of the subjects were Primigravida (56.1%, n=157) and in third trimester (53.2%, n=149). Majority of the study participants hailed from periphery areas and belonged to lower middle socio-economic class (33.2%, n=93) and 52.9% (n=148) pregnant women were illiterate. A fair share of literate population comprised 47.1% of the total study population but only about 8.21% were engaged in payable jobs (Table/Fig 1). Eighty-five (30.4%) participants had associated risk factors in pregnancy. These risk factors included anaemia (n=25, 29.41%), hypothyroidism (n=20, 23.53%), anaemia with hypothyroidism (n=3, 3.53%), hyperthyroidism (n=2, 2.35%), hypertensive disorders of pregnancy (n=15, 17.65%), gestational diabetes mellitus (n=7, 8.24%), rheumatic heart disease (n=3, 3.53%), Rhesus negative (n=3, 3.53%), foetal congenital anomalies (n=5, 5.88%) and asthma (n=2, 2.35%).

Assessment of knowledge and beliefs: Owing to the widespread awareness about the COVID-19 infection and implementation of the community safety measures, nearly 80% (n=224) participants were aware of the necessary precautions to be followed to prevent the spread of Coronavirus infection. This also reflected well in the participants’ opinion regarding the need for testing as 47.5% (n=133) said “yes”, if the need arises. Around 50.36% (n=141) felt pregnancy poses an increased risk of getting infected with the virus (Table/Fig 2). 37.5% (n=105) of the participants felt that Coronavirus is capable of vertical transmission, but 40.36% (n=113) were uncertain of the effects of the virus. While only 16.07% (n=45) participants felt that COVID-19 infection in pregnancy can cause foetal anomalies, 54.29% (n=152) were certain that it does not. None of the participants felt that they were already infected by COVID-19 virus during their pregnancy (Table/Fig 2). Around 20.71% (n=58) participants considered the possibility of preterm delivery and 45% (n=126) felt there is no increased risk for the same. 28.22% of the participants felt that there was a need for change in the mode of delivery, if infected. Lastly, 41.07% (n=115) participants felt that infected mothers should not breastfeed their new-borns (Table/Fig 2).

Assessment of the anxiety: Mean GAD score for the study population was 4.642 and the overall prevalence of anxiety in this study was 34.3% (n=96). GAD-7 chart showed 65.7% (n=184), 24.3% (n=68), 7.1% (n=20) and 2.9% (n=8) scored minimal, mild, moderate and severe scores respectively (Table/Fig 3).

There were increased anxiety levels in the Homemakers. Of all the women having severe anxiety (GAD score ≥15) most were home-makers (n=5 of 8, 62.5%); while all women (n=20 of 20) with moderate anxiety were home makers (p=0.009) (Table/Fig 1). Literacy levels, however, have not been shown to have much effect on the anxiety levels; four participants in either group had GAD scores ≥15 (p=0.899) (Table/Fig 1). A score of more than 10 was found in 13.4% (21 of 157) Primigravida as compared to 5.7% (7 of 123) of multigravidas. Overall Primigravida (87.5%, n=7 of 8) were more anxious, amongst the participants with severe scores, when compared to the multigravidas (12.5%, n=1 of 8), although the results were statistically insignificant (p=0.129) (Table/Fig 1). Out of 85 participants had high risk factors during pregnancy, about 50.6% (n=43 of 85) of had GAD scores more than 10.

Discussion

The number of COVID-19 cases in Central India during the month of September alone were found to be more than the combined cases in all the previous months. Further, the beginning of October saw a flattening of the curve in this region (22). Through the current study, the authors attempted to highlight the knowledge possessed by the uninfected pregnant women about the effects of COVID-19 on mother and foetus and their attitudes pertaining to it.

In the current study, the working group of pregnant women comprised of 8.21% and homemakers 91.79% of the study population. Contrary to the findings of Wu Y et al., (2), being homemaker was the major contributing factor for the raised stress levels in this study. The findings were statistically significant (p=0.009). This could be possibly due to their psychological inhibition of stepping out of their houses and income losses incurred by the only working spouse due to the strain on the economic sector. Zhou Q and Li X reported greater anxiety levels (GAD-7 score) in participants having heavy work hours and higher incomes (23). Lower anxiety levels in the working group of this study could be attributed to the new “Work-from-home” culture which was implemented to mitigate the rates of transmission.

The awareness instilled by the local authorities encouraged the correct attitudes of wearing a mask, social distancing and hand hygiene among the pregnant women as demonstrated by 80% of the study group. This reflected well in the participants opinion regarding the need for testing as 47.5% (n=133) said “yes”, if the need arises. In contrast to this, a primary healthcare level study conducted in South Africa by Hoque AM et al., mentioned low levels of knowledge (43.5%) and attitudes (30%) among pregnant women towards the COVID-19 pandemic (24). Although the social distancing has had led to a commendable decrease in the transmission rates, it has increased the anxiety amongst the pregnant women owing to lack of social support.

Despite the decreasing trend of COVID-19 cases during the study period, the overall prevalence of anxiety in this study was 34.3%, which was lower than that reported by other studies (63-68%) (25),(26),(27). As much as 2.9% of pregnant women showed severe anxiety levels (GAD score ≥15) with the fear of contracting infection as per GAD-7 score chart whereas 65.7% fell into 0-4 score levels. This could be due to the fear of resurgence in the case load. The prevalence of anxiety in this study was more than that found in a similar study by Ding W et al., which reported 20.8% (28) and a global study with 18.2-24.6% which was conducted before the COVID-19 pandemic (29). In one of the foremost studies done by Wang C et al., the anxiety levels in were as high as 53.8% using Depression Anxiety Stress Scale-21 (DASS-21) (30).

The current findings revealed that the highest prevalence of anxiety (53.2%) was in the participants who were in the third trimester as also seen in the study by Nanjundaswamy MH et al., (31) and the lowest in those who were in the second trimester (13.6%) possibly due to the threat of preterm labour and in the anticipation of the arrival of the baby. Maternal age (p=0.324), education status (p=0.899) and socio-economic status (p=0.348) did not considerably affect the anxiety levels.

About 12.5% of multigravida and 87.5% of all primigravida revealed stress levels in severe GAD category (score ≥15); though this difference was not significant unlike observations made by Ding W et al., stating a positive correlation of parity with the maternal anxiety levels (28).

While only 16.07% (n=45) participants felt that COVID-19 virus infection in pregnancy could cause foetal anomalies, 54.29% (n=152) were certain that it does not. As high as 76% patients in a study by Yassa M et al., felt that the viral infection in mothers could lead to congenital anomalies (19).

A good proportion 45% (n=126) participants denied the possibility of a preterm delivery and only 20.71% felt there is an increased risk for the same. Di Mascio D et al., observed preterm delivery occurring in 41% COVID-19 positive patients though the cause was not known (7). There lies uncertainty of the effects of the medications used in the treatment of COVID-19 infection in pregnancy due to lack of robust evidence; for instance, Remdesevir, Hydroxychloroquine, Chloroquine. Corticosteroids have created a lot of concern in the general population including pregnant women for the fear of unknown long term effects (including Mucormycosis) (32).

When enquired about their outlook on the need for change in the mode of delivery upon contracting COVID-19 infection, 28.22% answered in favour. Yang R et al., compared the adverse foetal outcomes between infected and non infected pregnant women where they found an increased incidence of caesarean section in the COVID-19 group when compared to their non-infected counterparts (OR 3.63; 95% CI 1.95-6.76) (33). It is really difficult to predict the rates of caesarean section due to COVID-19 positive status and there is a need for larger multicentric studies for validation. In a systematic review including six studies with 51 pregnant women, it was found that the outcome has been generally favourable for both mothers and foetuses. In their review, women have been most often delivered by caesarean section and frequently before term gestation (34).

Lastly, majority of the participants, 41.07% (n=115) felt breastfeeding the new-born while being infected with the virus should not be practised. The study by Yassa M et al., similarly noticed around 50% were not aware if breastfeeding was safe (19). (Table/Fig 4) highlights the salient features of similar studies reporting psychological impact of COVID-19 pandemic on pregnant women (2),(19),(23),(24),(25),(26),(27),(28),(35).

Psychological stress of the COVID-19 pandemic during pregnancy can increase risk of neurodevelopmental disorders in off springs owing to the changes in hypothalamo-pituitary-adrenal axis in the mother (13). The increased risk of having a severe disease during pregnancy may be secondary to an unknown natural history of the disease and the sudden outbreak, which may lead to disproportionate socio-economic consequences (36),(37).

Concerns about the pandemic had led to drastic health measures including the large vaccination drive in the country. Although the general population was thought to be benefitted before its initiation, participants (pregnant women) who expressed their need for vaccination were unsure of the ill effects it could have on pregnancy including a small increased risk of thrombosis.

Limitation(s)

The calculated sample size was 360. But due to the prevailing COVID-19 situation, a sample size of 280 could be achieved. Also, the current study was based on a non-validated questionnaire.

Conclusion

The study findings suggest that healthcare providers should carefully attend to the pregnant women who have one or more of the risk factors for the increased anxiety scores like primigravida, third trimester of pregnancy and homemakers. The major concern shown by the participants was the possibility of vertical transmission either during the antenatal period or related to breastfeeding. Along with the risk of contracting the Coronavirus infection, psychological and other anxiety issues may be the second important focus of attention. The pregnant women concerns and anxiety are extremely relevant. Therefore, for better understanding of the psychological impact of the COVID-19 pandemic on pregnancy, further studies using a validated questionnaire will be needed to document the effect of COVID-19 pandemic on mental health of the pregnant women.

Acknowledgement

The authors would like to thank the participants who agreed to take part in the study.

References

1.
Wang C, Horby PW, Hayden FG, Gao GF. A novel coronavirus outbreak of global health concern. Lancet Lond Engl. 2020;395(10223):470-73. [crossref]
2.
Wu Y, Zhang C, Liu H, Duan C, Li C, Fan J, et al. Perinatal depressive and anxiety symptoms of pregnant women during the coronavirus disease 2019 outbreak in China. Am J Obstet Gynecol. 2020;223(2):240. [crossref] [PubMed]
3.
Woody CA, Ferrari AJ, Siskind DJ, Whiteford HA, Harris MG. A systematic review and meta-regression of the prevalence and incidence of perinatal depression. J Affect Disord. 2017;219:86-92. [crossref] [PubMed]
4.
Sutter-Dallay AL, Giaconne-Marcesche V, Glatigny-Dallay E, Verdoux H. Women with anxiety disorders during pregnancy are at increased risk of intense postnatal depressive symptoms: A prospective survey of the MATQUID cohort. Eur Psychiatry. 2004;19(8):459-63. [crossref] [PubMed]
5.
Tolu LB, Ezeh A, Feyissa GT. Vertical transmission of Severe Acute Respiratory Syndrome Coronavirus 2: A scoping review. PLOS ONE. 2021;16(4):e0250196. [crossref] [PubMed]
6.
Ashraf MA, Keshavarz P, Hosseinpour P, Erfani A, Roshanshad A, Pourdast A, et al. Coronavirus Disease 2019 (COVID-19): A systematic review of pregnancy and the possibility of vertical transmission. J Reprod Infertil. 2020;21(3):157-68.
7.
Di Mascio D, Khalil A, Saccone G, Rizzo G, Buca D, Liberati M, et al. Outcome of coronavirus spectrum infections (SARS, MERS, COVID-19) during pregnancy: A systematic review and meta-analysis. Am J Obstet Gynecol MFM. 2020;2(2):100107. [crossref] [PubMed]
8.
Juan J, Gil MM, Rong Z, Zhang Y, Yang H, Poon LC. Effect of coronavirus disease 2019 (COVID-19) on maternal, perinatal and neonatal outcome: Systematic review. Ultrasound Obstet Gynecol. 2020;56(1):15-27. [crossref] [PubMed]
9.
Karasek D, Baer RJ, McLemore MR, Bell AJ, Blebu BE, Casey JA, et al. The association of COVID-19 infection in pregnancy with preterm birth: A retrospective cohort study in California. Lancet Reg Health Am. 2021;2:100027. [crossref] [PubMed]
10.
Fenizia C, Biasin M, Cetin I, Vergani P, Mileto D, Spinillo A, et al. Analysis of SARS-CoV-2 vertical transmission during pregnancy. Nat Commun. 2020;11(1):5128. [crossref] [PubMed]
11.
Sinaci S, Ocal DF, Seven B, Anuk AT, Besimoglu B, Keven MC, et al. Vertical transmission of SARS-CoV-2: A prospective cross-sectional study from a tertiary center. J Med Virol. 2021;93(10):5864-72. [crossref] [PubMed]
12.
Coronavirus (COVID-19) infection and pregnancy [Internet]. Royal College of Obstetricians & Gynaecologists. [cited 2021 Feb 13]. Available from: https://www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-pregnancy/
13.
Abdoli A, Falahi S, Kenarkoohi A, Shamsi M, Mir H, Mofazzal Jahromi MA. The COVID-19 pandemic, psychological stress during pregnancy, and risk of neurodevelopmental disorders in offspring: A neglected consequence. J Psychosom Obstet Gynecol. 2020;41:01-02. [crossref] [PubMed]
14.
Jelly P, Chadha L, Kaur N, Sharma S, Sharma R, Stephen S, et al. Impact of COVID-19 pandemic on the psychological status of pregnant women. Cureus. 2021;13(1):e12875. [crossref]
15.
Kamal. Knowledge, attitude, and practice toward COVID-19 among pregnant women in a tertiary care hospital during the COVID-19 outbreak J Mar Med Soc. 2020;22(3): Suppl S1:66-71.
16.
Khatri. Psychological status of pregnant women during COVID-19 pandemic: A cross-sectional study from Mumbai J Mar Med Soc. 2020;22(3):113-17.
17.
Tikka SK, Parial S, Pattojoshi A, Bagadia A, Prakash C, Lahiri D, et al. Anxiety among pregnant women during the COVID-19 pandemic in India - A multicentric study. Asian J Psychiatry. 2021;66:102880. [crossref] [PubMed]
18.
WMA - The World Medical Association-Declaration of Helsinki 1975 [Internet]. [cited 2022 Jan 30]. Available from: https://www.wma.net/what-we-do/medical-ethics/declaration-of-helsinki/doh-oct1975/
19.
Yassa M, Birol P, Yirmibes C, Usta C, Haydar A, Yassa A, et al. Near-term pregnant women's attitude toward, concern about and knowledge of the COVID-19 pandemic. J Matern Fetal Neonatal Med. 2020;33(22):3827-34. [crossref] [PubMed]
20.
Wani RT. Socioeconomic status scales-modified Kuppuswamy and Udai Pareekh's scale updated for 2019. J Fam Med Prim Care. 2019;8(6):1846-9. [crossref] [PubMed]
21.
Spitzer RL, Kroenke K, Williams JBW, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092-97. [crossref] [PubMed]
22.
Covid-19: October flattens the curve with robust recoveries in MP | Bhopal News - Times of India [Internet]. The Times of India. [cited 2021 Feb 23]. Available from: https://timesofindia.indiatimes.com/city/bhopal/covid-19-october-flattens-the-curve-with-robust-recoveries-in-mp/articleshow/78839151.cms
23.
Zhou Q, Li X. Psychological impact of quarantine among pregnant women in unspecified areas of China during the COVID-19 outbreak [Internet]. Authorea, Inc.; [cited 2021 Jan 6]. Available from: https://www.authorea.com/users/309779/articles/440653-psychological-impact-of-quarantine-among-pregnant-women-in-unspecified-areas-of-china-during-the-covid-19-outbreak?commit=98b3c96171916dbd493eafdaa71243068d9ad3f0
24.
Hoque AM, Alam AM, Hoque M, Hoque ME, Hal GV. Knowledge, attitudes, and practices towards COVID-19 of pregnant women at a primary health care facility in South Africa. Eur J Med Health Sci. 2021;3(1):50-55. [crossref]
25.
Lebel C, MacKinnon A, Bagshawe M, Tomfohr-Madsen L, Giesbrecht G. Elevated depression and anxiety symptoms among pregnant individuals during the COVID-19 pandemic. J Affect Disord. 2020;277:5-13. [crossref] [PubMed]
26.
Saccone G, Florio A, Aiello F, Venturella R, De Angelis MC, Locci M, et al. Psychological impact of coronavirus disease 2019 in pregnant women. Am J Obstet Gynecol. 2020;223(2):293-95. [crossref] [PubMed]
27.
Corbett GA, Milne SJ, Hehir MP, Lindow SW, O'connell MP. Health anxiety and behavioural changes of pregnant women during the COVID-19 pandemic. Eur J Obstet Gynecol Reprod Biol. 2020;249:96-97. [crossref] [PubMed]
28.
Ding W, Lu J, Zhou Y, Wei W, Zhou Z, Chen M. Knowledge, attitudes, practices, and influencing factors of anxiety among pregnant women in Wuhan during the outbreak of COVID-19: a cross-sectional study. BMC Pregnancy Childbirth. 2021;21(1):80. [crossref] [PubMed]
29.
Dennis CL, Falah-Hassani K, Shiri R. Prevalence of antenatal and postnatal anxiety: Systematic review and meta-analysis. Br J Psychiatry J Ment Sci. 2017;210(5):315-23. [crossref] [PubMed]
30.
Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, et al. Immediate psychological responses and associated factors during the initial stage of the 2019 Coronavirus Disease (COVID-19) epidemic among the general population in China. Int J Environ Res Public Health. 2020;17(5):1729. [crossref] [PubMed]
31.
Nanjundaswamy MH, Shiva L, Desai G, Ganjekar S, Kishore T, Ram U, et al. COVID-19-related anxiety and concerns expressed by pregnant and postpartum women-A survey among obstetricians. Arch Womens Ment Health. 2020;23(6):787-90. [crossref] [PubMed]
32.
Ssekandi AM, Sserwanja Q, Olal E, Kawuki J, Adam MB. Corticosteroids Use in Pregnant Women with COVID-19: Recommendations from Available Evidence. J Multidiscip Healthc. 2021;14:659-63. [crossref] [PubMed]
33.
Yang R, Mei H, Zheng T, Fu Q, Zhang Y, Buka S, et al. Pregnant women with COVID-19 and risk of adverse birth outcomes and maternal-fetal vertical transmission: A population-based cohort study in Wuhan, China. BMC Med. 2020;18(1):330. [crossref] [PubMed]
34.
Della Gatta AN, Rizzo R, Pilu G, Simonazzi G. Coronavirus disease 2019 during pregnancy: A systematic review of reported cases. Am J Obstet Gynecol. 2020;223(1):36-41. [crossref] [PubMed]
35.
Nowacka U, Kozlowski S, Januszewski M, Sierdzinski J, Jakimiuk A, Issat T. COVID-19 pandemic-related anxiety in pregnant women. Int J Environ Res Public Health. 2021;18(14):7221. [crossref] [PubMed]
36.
Dalal PK, Roy D, Choudhary P, Kar SK, Tripathi A. Emerging mental health issues during the COVID-19 pandemic: An Indian perspective. Indian J Psychiatry. 2020;62(Suppl 3):S354. [crossref]
37.
Kotlar B, Gerson E, Petrillo S, Langer A, Tiemeier H. The impact of the COVID-19 pandemic on maternal and perinatal health: A scoping review. Reprod Health. 2021;18(1):1-39. [crossref] [PubMed]

DOI and Others

DOI: 10.7860/JCDR/2022/53531.16450

Date of Submission: Dec 10, 2021
Date of Peer Review: Jan 29, 2022
Date of Acceptance: Mar 26, 2022
Date of Publishing: Jun 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

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