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 Table of Contents  
LETTER TO EDITOR
Year : 2022  |  Volume : 8  |  Issue : 1  |  Page : 53-55

Proceedings of the national symposium on “COVID-19, Pregnancy, and Mental Health”


1 Department of Psychiatry, AIIMS, Bibinagar, Telangana, India
2 Maternal Mental Health, Auckland District Health Board, Auckland, New Zealand
3 Department of Obstetrics and Gynecology, AIIMS, Bibinagar, Telangana, India
4 Department of Anatomy, AIIMS, Bibinagar, Telangana, India
5 Department of Psychiatry, Asha Hospital, Hyderabad, Telangana, India
6 Dhanwantari Clinic and Hospital, Raipur, Chhattisgarh, India
7 Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India

Date of Submission23-Dec-2021
Date of Acceptance24-Dec-2021
Date of Web Publication30-May-2022

Correspondence Address:
Dr. Barikar Chandrappa Malathesh
Department of Psychiatry, AIIMS Bibinagar, Hyderabad, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjp.tjp_47_21

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How to cite this article:
Tikka SK, Malathesh BC, Prakash C, Kumar N, Motwani R, Devi M G, Parial S, Jagannath G, Bhatia V, Chandra PS. Proceedings of the national symposium on “COVID-19, Pregnancy, and Mental Health”. Telangana J Psychiatry 2022;8:53-5

How to cite this URL:
Tikka SK, Malathesh BC, Prakash C, Kumar N, Motwani R, Devi M G, Parial S, Jagannath G, Bhatia V, Chandra PS. Proceedings of the national symposium on “COVID-19, Pregnancy, and Mental Health”. Telangana J Psychiatry [serial online] 2022 [cited 2022 Jun 30];8:53-5. Available from: https://tjpipstsb.org/text.asp?2022/8/1/53/346239



Dear Sir,

COVID-19 outbreak, which began in December 2019, has wreaked havoc and has bought the world to stand still. COVID-19 pandemic has affected the mental health of the entire humankind. Pregnant women are one among those specific populations who are particularly affected. In them, the risk of being affected with a mental disorder due to the COVID-19 pandemic-related stress is much higher. During the COVID-19 pandemic, pregnant women are faced with an array of concerns and worries related to health of the woman herself, her unborn fetus, as well as the family. These are related to fear of infection, apprehensions about pregnancy outcomes, hesitancy toward vaccination, privation of social connectedness, worries related to antenatal care visits, as well as other social and financial problems. Even otherwise, they are vulnerable to develop mental disorders in varying severity, across the three trimesters. A need was felt to discuss these issues on a larger, academic platform that involved psychiatrists, obstetricians, public health specialists, and other medical stakeholders.

A half-day national symposium titled “COVID-19, Pregnancy, and Mental Health” was jointly organized by the Department of Psychiatry, AIIMS Bibinagar (Hyderabad), the perinatal psychiatry taskforce of the Indian Psychiatric Society and the Indian Psychiatric Society – Telangana State Branch, on July 15, 2021. The symposium was held in virtual mode.

Dr. Chandni Prakash, a perinatal psychiatrist from New Zealand, began the symposium by deliberating on the global impact of COVID-19 pandemic on women's mental health. Her talk highlighted the fact that females are likely to suffer from more hyperarousal symptoms, negative alteration in cognition, and re-experiencing the COVID-related symptoms.[1] She put certain hard facts to the audience – risk of greater domestic violence,[2] a sharp rise in unwanted pregnancy during periods of lockdown and increase unsafe abortions in turn,[3] a global rise in the rates of alcohol use among women leading to a gender convergence of heavy drinking with women surpassing men,[4] and also an expected higher prevalence of depression, anxiety, and posttraumatic stress symptoms among women infected with COVID-19.[5]

Dr. Naina Kumar, an obstetrician, then spoke on pregnancy-related outcomes and COVID-19. Dr. Kumar reiterated that due to pregnancy-related immunosuppression and other physiological adaptations, pregnant women may be more prone to acquire COVID-19 infection. She shared recent data from the Centers for Disease Control and Prevention surveillance that there is an increased risk of hospitalization, intensive care unit admissions, and mechanical ventilation in pregnant women with COVID-19 infection.[6] Her talk then featured a review of studies that demonstrated vertical transmission of COVID-19 infection from mother to fetus and that severe COVID-19 infection during pregnancy is associated with adverse maternal and perinatal outcomes, such as increased risk of abortions, still births, intrauterine fetal growth restriction, preterm births, increased risk of operative interventions in mothers such as cesarean sections, and high maternal and neonatal morbidity and mortalities.[7]

With India particularly badly hit with the COVID-19 pandemic, providing a special impetus to the relevance of the discussion on “COVID-19, Pregnancy, and Mental Health” to Indian settings was a mandate of the symposium. Dr. Prabha Chandra, a senior perinatal psychiatrist from the National Institute of Mental Health and Neuro Sciences (NIMHANS), heralded as the “champion for women's mental health in India,”[8] spoke on these issues. She highlighted that pregnant women from India have definite concerns regarding contracting the COVID-19 infection, safety of their infant, safety-related hospital visits, frequent changes in treating obstetricians, methods of protection against COVID-19, and anxieties related to social media messages to their obstetricians.[9],[10] While informing the audience that research on mental health aspects of pregnant women from India is scarce, she shared results of two Indian studies where she has been involved. A multicenter study conducted across five centers on approximately 600 pregnant women attending antenatal care visits found that about 1 in 10 of them to be suffering from moderate-to-severe generalized anxiety. These women also reported greater levels of anxiety specific to the composite context of COVID-19 and pregnancy.[11] In another study (yet to be published) conducted in the capital city on around 250 pregnant women admitted due to COVID-19 infection, 80% and 55% of these women had at least mild depression and anxiety, respectively. She shared that the risk of transmission to fetus/child and the risk of having adverse pregnancy outcome also add to anxiety and depression among pregnant women. She noted that pregnant women from remote places have very high chances of not being able to get the adequate medial care because of travel restrictions and other factors and therefore lead to higher stress. She informed the audience that a certificate course in perinatal mental health for obstetrics and gynecologists, a first of its kind in India, has been initiated at NIMHANS, Bengaluru, under her leadership, and aims to train 1000 obstetricians and gynecologists across the country. She concluded her talk by strongly opining that pregnant women need to be regularly screened for early detection of above mental issues for preventing a pandemic of mental health issues in them.

India saw significant delays in getting the COVID-19 vaccine “shot” despite availability. This drew the focus on the concept of vaccine hesitancy, which was defined by the WHO as delay in acceptance or refusal to take vaccines despite availability of vaccine services. With the Government of India having approved vaccination of pregnant women against COVID-19 on June 25, 2021, our symposium also discussed COVID-19 vaccine hesitancy in pregnant women. Dr. Rohini Motwani, an anatomist at AIIMS, Hyderabad, spoke on this topic. In her talk, she reiterated that the benefits of vaccination outweigh the potential risks from vaccination. However, she suggested that vaccine hesitancy has been found globally.[12] She claimed that barriers for effective vaccination have been identified as sociodemographic factors (education, lack of knowledge about risks and benefits of vaccination, and employment status), belief that vaccine can affect fetus in the womb, or fear of congenital anomalies to their unborn, lack of support by family members, negative inputs from friends or neighbors, news channels, etc.

The symposium closed with a question and answer session, moderated by Dr. M. Gowri Devi, a senior psychiatrist from Hyderabad. The following issues were highlighted during this session:

  1. When sought by couples on whether or not to go for pregnancy during COVID-19 pandemic, one-answer to it will definitely be “Yes,” but with proper education on safety and risk
  2. The distinct scenario of “COVID-19, Pregnancy, and Mental Health” has given the scientific community a good chance to understand the biological underpinnings of perinatal psychiatric illnesses
  3. Need for a better liaison between psychiatrists and obstetricians is essential. This particularly will help establishing a birth registry of children born to mothers with mental illness during pregnancy to assess long-term effects of it on child's development.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Thibaut F, van Wijngaarden-Cremers PJ. Women's mental health in the time of COVID-19 pandemic. Front Glob Womens Health 2020;1:588372.  Back to cited text no. 1
    
2.
Vora M, Malathesh BC, Das S, Chatterjee SS. COVID-19 and domestic violence against women. Asian J Psychiatr 2020;53:102227.  Back to cited text no. 2
    
3.
New UNFPA Projections Predict Calamitous Impact on Women's Health as COVID-19 Pandemic Continues | UNFPA – United Nations Population Fund. Available from: https://www.unfpa.org/press/new-unfpa-projections-predict-calamitous-impact-womens-health-covid-19-pandemic-continues. [Last accessed on 2021 Aug 02].  Back to cited text no. 3
    
4.
Rodriguez LM, Litt DM, Stewart SH. Drinking to cope with the pandemic: The unique associations of COVID-19-related perceived threat and psychological distress to drinking behaviors in American men and women. Addict Behav 2020;110:106532.  Back to cited text no. 4
    
5.
Guo Q, Zheng Y, Shi J, Wang J, Li G, Li C, et al. Immediate psychological distress in quarantined patients with COVID-19 and its association with peripheral inflammation: A mixed-method study. Brain Behav Immun 2020;88:17-27.  Back to cited text no. 5
    
6.
Wastnedge EA, Reynolds RM, van Boeckel SR, Stock SJ, Denison FC, Maybin JA, et al. Pregnancy and COVID-19. Physiol Rev 2021;101:303-18.  Back to cited text no. 6
    
7.
Prochaska E, Jang M, Burd I. COVID-19 in pregnancy: Placental and neonatal involvement. Am J Reprod Immunol 2020;84:e13306.  Back to cited text no. 7
    
8.
Kirby T. Prabha Chandra-Champion for women's mental health in India. Lancet Psychiatry 2018;5:619.  Back to cited text no. 8
    
9.
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;23:787-90.  Back to cited text no. 9
    
10.
Fan S, Guan J, Cao L, Wang M, Zhao H, Chen L, et al. Psychological effects caused by COVID-19 pandemic on pregnant women: A systematic review with meta-analysis. Asian J Psychiatr 2021;56:102533.  Back to cited text no. 10
    
11.
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.  Back to cited text no. 11
    
12.
Troiano G, Nardi A. Vaccine hesitancy in the era of COVID-19. Public Health 2021;194:245-51.  Back to cited text no. 12
    




 

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