Study design and participants
This is a cross-sectional study through a self-administered questionnaire. The anonymous survey questionnaire was designed with four modules to collect a wide range of data regarding: (1) background information of demographic, pregnancy and COVID-19 epidemic; (2) attitudes towards COVID-19; (3) anxiety status, by using Self-Rating Anxiety Scale (SAS) 23,24, which is widely used and demonstrated to have excellent reliability and validity among pregnant mothers 25,26; (4) various obstetrical choices. The content of the questionnaire was reviewed and pretested by professors in Psychiatry (Xinyu Zhou and his colleagues) and Obstetrics (Hongbo Qi and Xin Luo). Eventually, the validity was proved following appropriate revision. The main content of the questionnaire is shown in Figure 1 and the translated version of the full questionnaire (from Chinese to English) in the Appendix.
From February 3 to 9, 2020, the questionnaires were distributed, mainly through a widely-used big data platform for pregnant mothers (YunYiTong27, covering more than 250,000 WeChat users nationwide) to those registered for prenatal care in hospitals in Wuhan and Chongqing only. Two distribution strategies, namely, one-by-one WeChat message and advertising on the official accounts, were applied. Additional questionnaires were distributed by obstetricians in both cities to those referred for outpatient services. Of note, through backstage set, each participant could only fill in this questionnaire once and only completed questionnaires could be submitted.
We followed relevant guidelines to ensure that the study was voluntary and confidential. The study was approved by the ethics committee of the First Affiliated Hospital of Chongqing Medical University (20200501), and an electronic informed consent was obtained before completing the questionnaire.