Data from a 2020 survey suggests nearly 70 per cent of people who were pregnant during the early stages of the COVID-19 pandemic reported moderate to high levels of mental distress, with one in five experiencing symptoms of depression.

The findings of the research, led by clinicians at Unity Health Toronto, were .

Researchers conducted the survey online from May to June 2020 with responses from nearly 1,500 participants, 87 per cent of whom were Canadian, who were either pregnant or had recently given birth. Nearly 69 per cent of respondents reported moderate to high levels of distress with 20 per cent reporting depressive symptoms.

Dr. Tali Bogler, study lead author and chair of family medicine obstetrics at St. Michael's Hospital, said uncertainly around COVID-19 transmission and implementation of new social restrictions contributed to anxiety for many early in the pandemic.

But Bogler added that stress levels have "maintained a high level" as the pandemic has progressed.

"The sources of concern have changed ... but the demand for perinatal mental health is still extremely high," she said. "And that indicates there are still high levels of distress."

The top concerns during early pandemic pregnancy, according to the survey, were hospital policies regarding support persons in labour; not being able to introduce new babies to loved ones; getting sick from COVID-19 while pregnant; and not being able to rely on family or friends for support after labour.

Some of those concerns are still in play 18 months later, Bogler said, including the lack of in-person pre-natal classes that offer social support to pregnant people. But new concerns have also emerged.

Bogler said some of her patients have expressed fears recently about the more transmissible Delta variant and concern they won't be able to get support from family members who remain unvaccinated.

"The heart of this is that it's not just the unknown of COVID-19, which was apparent in the beginning," Bogler said. "It's (missing) all the support systems that the perinatal population has always relied on that has been such an impact for this particular cohort."

While the study didn't compare mental distress of pregnant people to mental distress among the general population, it did look at studies that focused on mental health in pregnancy from before the pandemic.

The new study saw a drastic jump compared to pre-COVID Japanese samples suggesting 28.4 to 32.3 per cent of the pregnant population reported at least moderate levels of mental distress.

"What our study really highlights is that there's all these different domains that are transition periods during pregnancy, and the pandemic really impacted all of those," said Dr. Lucy Barker, a perinatal psychiatrist at Women's College Hospital and study co-author.

"Pregnant people were experiencing a lot of uncertainty, a lot of stress when it came to accessing health care, post-natal support, family support.... This highlights how multifactorial that impact has been and how we need to support people in all these different areas."

Bogler said she and her team came up with the idea to create the online survey after setting up an Instagram account -- @pandemicpregnancyguide -- in the early days of the COVID-19 crisis. Meant to address some of the major concerns obstetricians were hearing from patients, the account motivated Bogler to "formalize peoples' concerns and study them properly."

Because she had heard so many mental health concerns from pregnant patients early on, Bogler said she wasn't shocked by the survey results.

"But I was (surprised) to hear how high the levels of distress were," she said. "It's one thing to hear and and feel it, but to see the numbers confirm it like that, it was scary, actually.

"It's unsettling to see the confirmation of it even though you know it's there."

Bogler said mental distress during pregnancy can potentially have "downstream effects" on the baby before birth and afterwards, with those who experience perinatal depression more likely to suffer post-partum mental illness.

She said it can be hard, especially during a first pregnancy, to know whether anxiety is stemming from typical pre-baby jitters or something more serious.

Bogler said family physicians are well placed to support perinatal mental health and offer treatment if needed, including counseling or psychiatric appointments.

"People tend to say, 'Oh this is normal,' and often attribute it to normal pregnancy hormones ... but I think the moment it starts impacting you, your sleep, your relationship, your ability to function at work, I think anyone would benefit from speaking to someone," she said.

"It's a highly vulnerable time and with more concerns around the pandemic, I think more supports are needed."

This report by The Canadian Press was first published Sept. 14, 2021.