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INTRODUCTION Evidence on perinatal mental health during the COVID-19 pandemic and its potential determinants is limited. Therefore, this multinational study aimed to assess the mental health status of pregnant and breastfeeding women during the pandemic, and to explore potential associations between depressive symptoms, anxiety and stress, and women\'s socio-demographic, health and reproductive characteristics. MATERIAL AND METHODS A cross-sectional, web-based study was performed in Ireland, Norway, Switzerland, the Netherlands, and the UK between 16 June and 14 July 2020. Pregnant and breastfeeding women up to three months postpartum who were older than 18 years were eligible. The online, anonymous survey was promoted via social media and hospital websites. The Edinburgh Depression Scale (EDS), the Generalized Anxiety Disorder 7-item scale (GAD-7), and the Perceived Stress Scale (PSS) were used to assess mental health status. Regression model analysis was used to identify factors associated with poor mental health status. RESULTS In total, 9041 women participated (including 3907 pregnant and 5134 breastfeeding women). The prevalence of major depressive symptoms (Edinburgh Depression Scale ≥13) was 15% and 13% in the pregnancy and breastfeeding cohort, respectively. Moderate to severe generalized anxiety symptoms (GAD≥10) were found among 11% and 10% of the pregnant and breastfeeding women. The mean(±SD) Perceived Stress Scale scores for pregnant and breastfeeding women were 14.1±6.6 and 13.7±6.6, respectively. Risk factors associated with poor mental health included having a chronic mental illness, a chronic somatic illness in the postpartum period, smoking, having an unplanned pregnancy, professional status, and living in the UK or Ireland. CONCLUSIONS This multinational study found high levels of depressive symptoms and generalized anxiety among pregnant and breastfeeding women during the COVID-19 outbreak. The study findings underline the importance of monitoring perinatal mental health during pandemics and other societal crises to safeguard maternal and infant mental health.
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