EMOTIONAL ASPECTS ASSESSED BY THE DASS-21 SCALE IN PREGNANT WOMEN CONCEIVED BY IN VITRO FERTILIZATION DURING THE COVID-19 PANDEMIC

Abstract

The COVID-19 pandemic has brought new challenges to infertile couples: the fear and uncertainty of potential SARS-CoV-2 infection effects during pregnancy. The present study aims to evaluate depression, anxiety and stress parameters in pregnant women conceived by IVF, during the coronavirus outbreak. This prospective cohort study included 109 clinical pregnant women (fetal heart beat) that consecutively underwent embryo transfer after an IVF treatment during the coronavirus outbreak between Jun/20 to Feb/21 in a private ART (assisted reproductive technology) clinic. Patients were evaluated through telephonic interview at the end of each trimester of pregnancy (12, 24 and 34 weeks) by the DASS-21 questionnaire, an internationally validated scale to track the severity of depression, anxiety and stress symptoms. Clinical variables such as age, obstetric history, clinical comorbities and years of infertility were also included. Comparison statistical tests were applied accordingly to normal distribution of values. A p value <0,05 was considered significant. The mean age was 38,97±5,02 years old. The majority of patients had never been pregnant before (67%) and had no other comorbid associated (75,2%). The mean infertility time was 3,76±2,38 years. Singleton pregnancies represented 83,5%. During the follow-up, two patients had late miscarriage at 21 weeks of singleton pregnancies (1,8%) and one had a fetal demise at 26 weeks of a singleton pregnancy (0,9%). Four patients (3,7%) had very preterm labor (between 28-32 weeks), seven (6,4%) had moderate preterm labor (between 33-35 weeks) and one (0,9%) had a late preterm labor (36th week). In general, there were no difference in any of the emotional aspects evaluated (depression, anxiety and stress) along first, 2nd and 3rd trimesters (p=0.13, p=0.93 and p=0.55, respectively). However, when participants were separated by groups of age (<38 yo and ≥38 yo, means 34,84±2,90 and 42,35±3,69, p=0.007), older patients presented higher levels of stress (p=0.017) compared to the youngers. Furthermore, patients with history of previous pregnancy loss presented higher levels of anxiety and stress (p=0.037 and 0.036 respectively) compared to the nulliparous. In addition, when comorbidities were associated with infertility, patients also presented higher levels of anxiety and stress (p=0.03 and 0.002, respectively). Years of infertility (≤3 or ˃3 years) was not associated with aggravation in DASS scores during pregnancy. Our data demonstrated that patients who conceived during the pandemic by IVF showed higher levels of anxiety and stress throughout their pregnancy, as assessed by the DASS-21 scale, mainly if they are greater than 38yo, had previous pregnancy loss or presented other comorbity associated.