Association of psychological states, sleep patterns, vaccine, and pregnancy outcomes during the COVID-19 pandemic

This study investigates the relationships among psychological state, sleep patterns, COVID-19 vaccination during the COVID-19 pandemic, with postpartum hemorrhage as the primary outcome, and other adverse pregnancy outcomes, mental health, and sleep quality as secondary outcomes.

A prospective cohort study was conducted from April 2022 to November 2022 at the First Affiliated Hospital of Sun Yat-sen University, including 260 pregnant women meeting the inclusion criteria in the obstetric department. The Depression Anxiety Stress Scales (DASS-21) was used to assess depression, anxiety, and stress; the Impact of Event Scale-Revised (IES-R) was utilized to evaluate psychological stress related to COVID-19, and the Pittsburgh Sleep Quality Index (PSQI) was employed to measure sleep quality; Participants were grouped based on their scores or vaccination status (vaccinated: n = 204; unvaccinated: n = 56), and the incidence of adverse pregnancy outcomes was compared among different groups.

The primary outcome showed that the incidence of postpartum hemorrhage (PPH) differed significantly across depression subgroups (normal: 3.6%, mild: 15.0%, moderate-severe: 13.0%; χ²(2) = 9.450). Compared with the non-depression group, mild depression was significantly associated with an increased risk of PPH (OR = 4.19, 95% CI: 1.15–15.18, P = 0.006); moderate-to-severe depression was also significantly associated with an elevated risk of PPH (OR = 4.78, 95% CI: 1.39–16.40, P = 0.013). For secondary outcomes, no significant differences in adverse pregnancy outcomes were observed among groups stratified by anxiety, stress, COVID-19-related psychological stress, or sleep quality (all P > 0.05).In addition, pre-pregnancy inactivated COVID-19 vaccination was not associated with an elevated risk of PPH or other adverse pregnancy outcomes(P > 0.05).

COVID-19-related depressive symptoms are associated with an increased risk of postpartum hemorrhage. Pre-pregnancy COVID-19 vaccination showed no adverse effects on maternal mental health or pregnancy outcomes.