(122) Prenatal-, Birth- and Post-Partum- Related Experiences among Women who were Pregnant in First Three Waves of the COVID-19 Pandemic in Canada: a Study Within the CONCEPTION Cohort.

Background: The World Health Organization emphasizes the importance of a positive childbirth experience for improved maternal health. The COVID-19 pandemic impacted birth experiences as restrictions were imposed to curb the spread of the virus, resulting in negative changes in prenatal care, birth and post-partum follow-up.

Objectives: We aimed to describe how the pandemic impacted 3 categories of experiences related to prenatal, birthing, and post-partum care among women who were pregnant during the first 3 waves of the pandemic. We then aimed to quantify the association between these 3 categories of changes and post-partum depression (PPD) and anxiety (PPA) by wave.

Methods: Pregnant individuals ≥18 years were recruited in Canada and provided data through web-based questionnaires. We analyzed data on persons recruited between 06/2020-08/2021 and who completed questionnaires while pregnant and 2-months PP. Data on maternal sociodemographics, lifestyle habits, maternal health conditions, mental health (e.g. Edinburgh Postnatal Depression Scale [EPDS], General Anxiety Disorder-7 [GAD-7]), antidepressant use and changes in 3 categories as above were self-reported. The number of changes were summarised and plotted to determine the upper quartile which was used to create binary variables: changes in prenatal care and birth experience (0-2, >2) and post-partum care (0-1, >1). Adjusted relative risks (aRR) with 95% confidence interval (95%CI) were calculated to quantify the association between changes and severe PPD (EPDS≥13) and moderate-to-severe PPA (GAD-7>9).

Results: The study included 1,231 participants, of which 74.0%, 9.4% and 16.6% were pregnant in the 1st, 2nd and 3rd wave of the pandemic, respectively. Overall, 10.8% were exposed to antidepressants during pregnancy. Frequent changes were the absence of visits from family/friends (79.7%), reduction of prenatal visits (37.1%) and their change from in-person to virtual (29.7%) and lack of lactation support (18.7%). Severe PPD was associated with experiencing changes in prenatal care in the 1st (aRR 1.87, 95%CI [1.27-2.76]) and 3rd wave (aRR 3.12, 95%CI [1.18-8.25]), as well as at birth (aRR 1.60, 95%CI [1.11-2.30]) and in post-partum (aRR 1.56, 95%CI [1.07-2.27]) in the 1st wave. Moderate-to-severe PPA was associated with experiencing changes at birth in the 1st (aRR 1.93, 95%CI [1.21-3.10]) and 2nd wave (aRR 7.24, 95%CI [1.26-41.62]), as well as in prenatal care in the 3rd wave (aRR 7.16, 95%CI [1.72-29.75]).

Conclusions: Experiencing negative changes related to pregnancy, birth or post-partum was associated with severe PPD and moderate-to-severe PPA in the pandemic. Our findings highlight the importance of ensuring adequate care in the context of pregnancy to improve women’s post-partum mental health