Can maternal mental distress predict pregnancy outcomes during the COVID-19 pandemic?

Mental distress, in and of itself, is suggested to be a significant risk factor for poor maternal and neonatal outcomes. The distress induced during the COVID-19 pandemic may be intensified, leading to an increase in poor pregnancy outcomes. The current study aimed to investigate the association between maternal mental distress and pregnancy outcomes during the first COVID-19 pandemic in Iran. In a prospective cohort study, 392 pregnant women under coverage of comprehensive health centers affiliated with Golestan University of Medical Sciences were recruited. They completed the Perceived Stress Scale (PSS-10), State-Trait Anxiety Inventory (STAI-state), Beck Depression Inventory (BDI-13), and two questions about their perceived risk of COVID-19. Pregnancy outcomes were accessed through Electronic Health Records system (NAB). Logistic regression models were applied to examine the associations between maternal mental distress and pregnancy outcomes. Perceived stress was significantly associated with lower odds of hypertension (OR = 0.89, p = 0.03) and higher odds of SGA (OR = 1.08, p = 0.02). Perceived risk of COVID-19 was associated with lower odds of preeclampsia (OR = 0.57, p = 0.02). Higher preventive behavior scores were associated with greater odds of SGA (OR = 1.52, p = 0.01). Neither depression nor trait anxiety showed a statistically significant association with any of the maternal or neonatal outcomes. Some levels of perceived stress were associated with lower odds of hypertension, while both perceived stress and preventive behaviors were associated with higher odds of SGA. Perceived risk of COVID-19 was associated with lower odds of preeclampsia. These findings suggest that maternal mental distress and preventive behaviors may be differentially associated with maternal and neonatal outcomes, and further studies are needed to clarify these relationships.