INTRODUCTION

It is already evident that pregnancy has a profound effect on several aspects of a woman's life today and affects, directly and indirectly, the whole world in many aspects like birth rates, economy, medical care, and mental health. Not to mention the changes that are brought about by the pandemic and the backdrop of increased prevalence of mental health issues in the world if we consider various studies regarding depression, low self-esteem, and anxiety to consider a [1-3]. The analyzed target group is a population of pregnant women who were enrolled in the pregnancy follow-up program by their family doctor/GP. As a novelty, this research follows a group of pregnant women and pregnancy during the pandemic (in the last year). It uses the test and retest method to establish the initial depression, anxiety, and self-esteem levels, following their evolution in each trimester of the pregnancy. Relating to the research group's background, we considered that a structured explication from each perspective could offer more insight into the mechanism implicated [4, 5]. The team's background is in interdisciplinary fields such as medicine and psychology (clinical psychology and psychology applied to national security). In the interdisciplinary framework, the pain caused by diseases of the dental-maxillary and osteoarticular system, such as arthritis and gingivitis, potentiates depression and anxiety in pregnant women, requiring maxillofacial surgery therapy, recovery, physical medicine, and balneology.

We chose to address mental problems such as depression, anxiety, and low self-esteem because of their effects [6-13]. As hormonal changes are mostly evident in the first and third trimesters [14-16] and as there are reports relating such changes to psychological modulations [17-19], we hypothesized that these psychological alterations will be more evident in these circumstances. (Other authors also found this type of dynamics, in pregnant women, besides the pandemic [19].

MATERIALS AND METHODS

This is a prospective study.

Instruments – Questionnaires

The questionnaires chosen by the research team were BECK's (depression assessment), Hamilton's (anxiety scale – H.R.S.A.), and the Rosenberg (self-esteem test).

Participants

The research lot was convenient (convenience sampling, opportunity sampling) because the only admission criteria were: informed consent, pregnancy status, and the desire to be monitored and evaluated quarterly by completing a questionnaire. The target for completing the questionnaire was "the week" in the middle of the trimester (+/- one week).

A large number of pregnant women looked forward to this research, and the fact that they had the opportunity to contact a group of mental health specialists made them happy. Thus, the initial number received by the three questionnaires for depression, anxiety, and low self-esteem during the COVID-19 outbreak in Romania was very high, 635.

From the initial group, we excluded people who needed or chose psychological intervention and people who missed the quarterly evaluations. Three hundred seventy-three pregnant women passed these exclusion criteria (Figure 1).

Procedure

We chose the test and retest method to establish the initial level of depression, anxiety, and self-esteem (at T1) and applied the questionnaires in each successive trimester, in the midweek (+/- 1 week), for each participant. The implemented procedure was specific for the test and retest method, with three testing moments (T1, T2, T3).

These were as follows: Trimester 1 (1-13 weeks) T1 at 7 weeks +/- one week, Trimester 2 (14-27 weeks) T2 at 21 weeks +/- one week, Trimester 3 (28-42 weeks) T3 at 34 weeks +/- one week. The data collection period was 20 June 2020 - 20 August 2021.

Admission criteria were informed consent, pregnancy status, and the desire to be monitored and evaluated quarterly by completing a questionnaire. The target for completing the questionnaire was "the week" in the middle of the trimester (+/- one week).

Statistical analysis was performed in SPSS 23, with the independent samples t-test, as this test could evaluate the significance of the difference among the three trimesters.

Hypothesis

Main Hypothesis

1. During the SARS-COV-2 pandemic, pregnant women have a higher incidence of depression in the first and third trimester.

Secondary Hypothesis

2. During the SARS-COV-2 pandemic, pregnant women have a higher incidence of anxiety in the first and third trimester.

3. During the SARS-COV2 pandemic, pregnant women have a higher incidence of low self-esteem in the first and third trimester.

4. During the SARS-COV-2 pandemic, pregnant women have a higher incidence of psychological problems in the first and third trimesters.

RESULTS AND DISCUSSION

Descriptive Analysis

The general age average of the 373 pregnant women was 29 years. The youngest person was 18 years old, and the oldest was 40 years old.

Of the 373 people, 207 (55.5%) gave birth once, 160 (42.9%) twice, and only 6 (1.6%) gave birth three times.

The majority of people, 252 (32.4%), had their background in urban areas, while the other 121 (67.6%) were in rural areas.

Inferential Analysis of Results

The depression score registered a higher value in the first and third trimesters, with averages of 17.34 and 20.21, respectively (Table 1).

SD = standard deviation, SEM = standard error mean

As seen in Table 2, the average score of depression was statistically significantly higher at T3 compared to T2 and T1; the same average score was higher at T1 compared to T2 (0.001 sig in all three cases).

SD = standard deviation, SEM = standard error mean

The first hypothesis is, therefore, confirmed. The anxiety score registered a higher value in the first and third trimesters, with averages of 16,72 and 16,21, respectively (Table 3).

SD = standard deviation, SEM = standard error mean

As seen in Table 4, the average score of anxiety was statistically significantly higher at T3 compared to T2; the same average score was higher at T1 compared to T2 (0.001 sig in both cases).

SD = standard deviation, SEM = standard error mean

The second hypothesis is, therefore, confirmed.

The self-esteem score registered a lower value in the first and third trimesters, with averages of 24,51 and 1 7,76, respectively (Table 5).

SD = standard deviation, SEM = standard error mean

As seen in Table 6, the average score of self-esteem was statistically significantly lower at T3 compared to T2 and T1; the same average score was lower at T1 compared to T2 (0.001 sig in all three cases).

SD = standard deviation, SEM = standard error mean