Results
A total of 1947 valid questionnaires were received, of whom 932 and 1015 were from Wuhan and Chongqing, respectively. 866 (92.92%) in Wuhan and 934 (92.02%) in Chongqing stayed at where they were registered during the study period (Figure 2). Participants reported diverse demographic, pregnancy and epidemic characteristics (Table 1). Firstly, the general situation of their demographic background was a family with middle-level income and a working pregnant mother, though distribution difference existed between cities. Secondly, most pregnant women we surveyed were on their second (32.82%) or third trimester (62.92%). Women in Wuhan had more advanced gestational age (79.83% in Wuhan vs 47.39% in Chongqing on third trimester). The majority of participants in both areas were nullipara and experienced a process of spontaneous singleton conception without comorbidity or complication, though Chongqing had a higher proportion of multiple pregnancy. Detailed distribution of comorbidity and complication was supplied in Table 1S. Thirdly, information on COVID-19 from official media were widely accepted during this period in both cities. The proportions of self-reported symptoms were statistically the same in both cities, but the exposure history to diagnosed or suspected cases was more severe in Wuhan.
Attitudes toward COVID-19 were more extreme in Wuhan (Figure 3). In general, four fifths of mothers felt nervous about the objective impacts of COVID-19, such as epidemic control, outdoor activity and person-to-person contact. Over 90% of our participants considered themselves vulnerable to this epidemic. Women in both cities, especially in Chongqing, held comparatively positive attitudes towards online medical consultation and psychological counselling.
The Cronbach’s alpha for the SAS was indicative of moderate-to-good internal reliability: 0.78. Specific details are shown in Figure 4. As shown in Table 2, the mean standard score for anxiety was 43.97 (SD 8.71) for pregnant mothers in Wuhan, with a quarter of them scoring 50 or more. While in Chongqing, an average score of 40.37 (SD 7.15) was reported, among whom about 90% scored lower than 50. The overall prevalence of anxiety during this period was 17.16%. Obviously, pregnant women in the epidemic hardest-hit area were much more anxious, 18.78% and 5.69% of whom underwent mild and moderate or severe anxiety, while 9.36% and 1.08% in Chongqing. The effect of the area on SAS standard score was small-to-medium (ES 0.44).
The participants’ obstetrical choices are summarized in Table 3.
Online consultation was requested by more than 70% of the participants, a higher proportion of which was in Wuhan (75.43% vs 69.46%). Absolute differences could be found between the two areas in hospital preference during this period. Of pregnant women in Wuhan, 41.85% reported nearly unconditional refusal of going to hospital recently, compared with 27.68% in Chongqing. Questionnaire responses revealed a general trust in previous (53%) and specialized (29.02%) hospital among mothers, although differences existed in the proportion of that trust between cities.
Inconvenience caused by traffic bans raised significant concern, and as a result, 80.39% and 42.41% of the 1947 participants would put off their appointments for prenatal care and hospitalized delivery. This phenomenon was more common in Wuhan (92.38% vs 72.86% and 47.29% vs 31.03%). Fear of infection was another reason for delaying their plans. With respect to prenatal care, the minority (16.3% in general) reported ”as planned”. Very few mothers in Wuhan chose to complete their scheduled check online (N=4) or face-to-face (2.61%). In Chongqing, however, 2.76% and 21.61% were willing to do it on time via the Internet and face-to-face. When it came to hospitalized delivery, 27.93% of all participants chose ”ahead of time”, among whom 15.17% wanted to be hospitalized earlier to wait for the onset of labor while 12.76% wanted to have a caesarean in advance. Only 25.17% of all women reported an ”as planned” hospitalized delivery, and this proportion was higher in Chongqing (39.08% vs 19.21%).
The delivery mode seemed to be changed because of this epidemic. 12.66% of pregnant women in Wuhan would change from vaginal delivery to caesarean section, while this proportion in Chongqing was halved (6.01%). However, the reverse change, from caesarean to vaginal delivery, was smaller (Wuhan 5.58%, Chongqing 3.05%). These city-based differences and uneven changes in mode could also be seen in choosing ways of child-feeding and postnatal resting. Overall, there would be more women who preferred caesarean section, bottle feeding and postnatal rest at home during this period than before, especially in Wuhan.
Over 90% of pregnant women, in total, believed in the negative impact of changing schedule and reducing activities on pregnancy, and these subjective impacts were more significant in Wuhan. Slightly more than half of the women (50.08%) thought the chest CT scan would significantly influence their pregnancy, and it was more severe in Chongqing.
The multivariable analysis (Table 4) showed strong associations between background, attitude, and anxiety. First of all, pregnant women from a middle-level income family were about half as likely to report anxiety than those earning an extremely high or low wage. Secondly, women in Wuhan were about twice likely to develop anxiety. Thirdly, those who had fever, cough, diarrhea or symptoms of suspected infection were five times likely to have anxiety than otherwise healthy women. Furthermore, the attitudes towards COVID-19 were associated with anxiety status. Those with relatively more knowledge about COVID-19 and with rational risk perception (not too nervous about epidemic control or going out), were less likely to be anxious. Additionally, positive attitudes towards online medical consultation demonstrated a protective feature from anxiety, while those towards psychological consultation showed the opposite effect.