**3. Results**

A total of 173 women participated in the study, which accounted for 49% of women who completed the questionnaire. Detailed sociodemographic characteristics of study participants are presented in Table 1.

The respondents were asked if they were concerned about contracting COVID-19 during pregnancy. It was found that infection with COVID-19 during pregnancy had a significant impact on the answer to this question. Fear of contracting COVID-19 was reported by 30.77% of women with a history of infection and over 50% of women in the group with no such history.

Table 2 summarizes the descriptive statistics of the standardised tools used in the study. A detailed analysis of GAD-7 results showed that the total score indicated anxiety symptoms of varying severity in 71% of respondents. A total of 23 (13.3%) respondents scored at least 10 points, which suggests a suspected generalised anxiety disorder. The mean score obtained by respondents was 13.29 for the SHAI scale. In the GAD-7 scale, most respondents scored between 5 and 9 points. The mean scores obtained in STAI-XI and STAI-X2 were similar, i.e., 42.26 and 40.24, respectively. Details are shown in Table 2.


**Table 1.** Sociodemographic characteristics of respondents.

**Table 2.** Summary of descriptive statistics of the standardised research tools.


**Abbreviations:** GAD-7—General Anxiety Disorder-7, M—mean, Max.—maximum, Me—median, Min.—minimum, SD—standard deviation, SHAI—Short Health Anxiety Inventory, STAI—State-Trait Anxiety Inventory, Q1—lower quartile, and Q3—upper quartile.

Primiparas were found to have statistically significantly (*p* = 0.031) higher SHAI scores (M = 14.45, Me = 14) compared to multiparas (M = 12.22, Me = 12). Primiparas were significantly younger. Both study groups were also compared for the following scales: GAD-7 and both STAI subscales. No statistically significant differences were found for these tools (Table 3).


**Table 3.** Comparison of primiparas and multiparas for SHAI, GAD-7, and STAI.

**Abbreviations:** GAD-7—General Anxiety Disorder-7, M—mean, Me—median, *p*—*p*-value, SD—standard deviation, SHAI—Short Health Anxiety Inventory, STAI—State-Trait Anxiety Inventory, Q1—lower quartile, and Q3—upper quartile.

> The analysis has shown that women with higher education scored statistically significantly higher in SHAI (*p* = 0.019, M = 14.17, Me = 13) and GAD-7 (*p* = 0.006, M = 6.31, Me = 6). No statistically significant results were found for the other scales (Table 4).

**Table 4.** Comparison of women with and without higher education for the following tools: SHAI, GAD-7, and STAI.


**Abbreviations:** GAD-7—General Anxiety Disorder-7, M—mean, Me—median, *p*—*p*-value, SD—standard deviation, SHAI—Short Health Anxiety Inventory, STAI—State-Trait Anxiety Inventory, Q1—lower quartile, Q3—upper quartile, and \*—statistically significant.

> Hospitalised pregnant women scored significantly higher in STAI-X1. No statistically significant differences were found between pregnant women hospitalised during pregnancy and those not requiring hospitalisation in the remaining scales (Table 5).

**Table 5.** The impact of hospital stays during pregnancy on the rating of anxiety.


**Abbreviations:** GAD-7—General Anxiety Disorder-7, M—mean, Me—median, *p*—*p*-value, SD—standard deviation, SHAI—Short Health Anxiety Inventory, STAI—State-Trait Anxiety Inventory, Q1—lower quartile, Q3—upper quartile, and \*—statistically significant.

## **4. Discussion**

So far, it has been established that the outbreak of the pandemic increased the level of mental health disorders in the general population [21,22], and it is more visible in women than in men. Some studies report that during catastrophes or major events, pregnant women are more likely to develop mental health problems than in the general population [23,24]. A recent systematic review and meta-analysis [25] assessing the impact of the pandemic on the mental health of pregnant women has shown that the level of mental health disorders in pregnant women is 37%. Our study showed that women who had

COVID-19 had lower levels of fear of infection with the SARS-CoV-2 than pregnant women who had not contracted the disease so far. Different results were obtained in another Polish study by Nowak et al. [26]. The authors proved that pregnant women who had been infected with SARS-CoV-2 experienced a higher level of anxiety than those who had not been infected so far.

Our study showed moderate anxiety among pregnant women in the STAI scale. Another study among pregnant women also assessed the level of antenatal anxiety using the STAI scale. Similar findings were obtained in both studies [27]. Similar results in the same scale were also shown in a study in Italy [28]. These findings confirm the conclusions obtained by Sinjari et al. [29], that questionnaires could be useful tools to assess patients' conditions before the visit to a doctor.

Considering the parity of respondents, we found that primiparas show higher COVID-19-related anxiety than multiparous women, as confirmed by SHAI scores. STAI results reported by Italian researchers also confirmed our hypothesis [28]. Such findings may be due to both the new life situation and the lack of knowledge about pregnancy and coronavirus infection during this special time.

The data on the impact of gestational age on the level of COVID-19-related anxiety among pregnant women are contradictory. In our analysis, we compared the scores obtained in the standardized scales depending on the trimester of pregnancy, but no statistically significant differences were found. Other authors reported higher STAI scores in the first and third trimesters than those obtained in our study [30]. Schubert et al. showed that, on the other hand, STAI scores remained stable throughout pregnancy [31].

We measured the prevalence of anxiety symptoms using the GAD-7 scale. It was found to be high, i.e., 62.5% among pregnant women, including 49% with mild, 10% with moderately severe, and 3.5% with severe anxiety due to COVID-19. Other studies have also shown that pregnant women are much more prone to stress during the COVID-19 pandemic [32].

Our analysis showed that pregnant women with higher education were significantly older and scored statistically significantly higher in both SHAI and GAD-7. Similar findings on the impact of higher education on the increased levels of anxiety have been reported by other authors [32]. It can be assumed that greater awareness of one's own health negatively affects its loss as a result of a serious illness. The differences in the obtained results can be due to the dynamic nature of the disease and the fact that it is perceived differently around the world.

In this study, the median STAI score for anxiety was 41. A total of 57.23% of the pregnant women scored ≥40. In a similar study involving pregnant women, the median score in the same scale was 37, including a score of ≥40 in 38.2% of participants [33]. Another study among pregnant women showed that the overall prevalence of anxiety symptoms measured with STAI (STAI > 40) was 62.6% [34]. An Italian study found similar levels of COVID-19-related anxiety in pregnant women (68%) [30]. Turkish studies also reported STAI scores above the cut-off for clinically significant symptoms of anxiety [35]. Similar findings in all the above-mentioned studies may be due to the different state of the women (pregnancy) and their concern about the health of their unborn children.

The presented results confirm COVID-19-related anxiety among pregnant women. Its level varies and is related to sociodemographic factors. Due to the negative effects of anxiety and stress on pregnant women and their unborn children, further research is needed on anxiety caused by the COVID-19 pandemic to prevent negative effects and improve the health of the population. Mental health screening for pregnant women should be included in the mandatory prenatal screening to reduce any potential anxiety symptoms.

### *Limitations of the Study*

The study has certain limitations. The presented results come from an analysis based on a subjective assessment of anxiety symptoms in pregnant women. Although we used scales that are considered sensitive research tools, they are based on subjective feelings and do not include objective criteria of clinical symptoms, which may lead to false-positive results. The number of pregnant women participating in the study is another limitation. The small sample size does not allow for extrapolation of results to the general population of pregnant women in Poland. However, despite these limitations, our findings can be a reference point for further studies assessing the level of COVID-19-related anxiety among pregnant women both in Poland and in the world.
