The Coronavirus disease 2019 (COVID-19) pandemic significantly damaged pregnant women’s mental health, underscoring the critical need for robust support networks. This research adopted a systematic literature review, which was based on studies published between 2019 and 2024 that examine the coping mechanisms and support systems available to pregnant women in the UK at the time of the pandemic in a comparable environment, assess their efficacy, and consider the function of spouse support. Key findings from a thematic analysis of recent literature show that social isolation, fear of infection, and limitations on birth partners raised the stress, anxiety, and depression levels of expectant mothers. It was discovered that professional, social, and emotional support networks were crucial for reducing these detrimental impacts. Strong social networks, such as those with family and friends, helped people feel less stressed and anxious, while professional health services offered the assurance and care they needed. Prenatal depression and anxiety were shown to be greatly reduced in pregnant women who received supportive spouse connections and good communication. Additionally, pregnant women’s difficulties were greatly alleviated by the availability of health resources, such as online support groups and mental health counselling. Enhancing maternity services, boosting social support networks, fostering partner involvement, promoting health and well-being, and strengthening emotional and psychological support are just a few of the recommendations. The results provide insightful information for creating focused interventions and policies to support pregnant women during traumatic situations.

Coronavirus disease, Pregnant women, Spousal support, Mental health, Social support.

Pregnancy is a developmental stage in the life cycle of women classified by several physical, psychological, and social features. It is a period of considerable changes in terms of physical changes as the expectant mother’s body undergoes many transformations to enable it to accommodate the unborn baby to be born, and fluctuations in mood swings because of the excitement of having a new baby.[1,2] On the contrary, it is a period sometimes filled with stress, depression, anxiety, and any exacerbation, such as health complications, bereavement, or socio-economic difficulties.[3] When the COVID-19 outbreak began in late 2019, it was quickly apparent that the virus was fatal with insidious impacts on almost every domain of human life, and this also applied to pregnancy.[4] Because of the elevated percentage at which COVID-19 continued to infect more people, there was a need for the government and other health facilities to come up with measures that would reduce this rate and this led to drastic measures such as lockdowns, social distancing among others which have highly impacted the lives of pregnant women including the exposure to trauma[5,6]. Tella et al. [7] defined trauma as an act of receiving or observing harm that resulted from actual or threatened violence or death, or experiencing sexual assault. While the pandemic by itself does not constitute a traumatic event, pandemic-related stressors could lead to traumatic stress responses in some pregnant women.[8] Although not every person or pregnant woman who experienced the pandemic was identified as having trauma-related illnesses, including PTSD (posttraumatic stress disorder), available research suggests that pregnant women can be susceptible to the psychological consequences of the pandemic based on several physiological, emotional, or social factors.[9]

According to Vousden et al.[10], A total of 1,148 pregnant women were admitted to hospitals in the UK between March 1, 2020, and August 31, 2020, due to confirmed cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection; around two-thirds (n = 722, 63%) were symptomatic. An estimated 364,830 maternity cases were recorded throughout this time, translating to an overall incidence of proven SARS-CoV-2 in hospitalised pregnant patients of 3.1 per 1,000 cases (95% CI 3.0–3.3). There were 2.0 cases of symptomatic SARS-CoV-2 (95% CI 1.9–2.2) and 1.2 cases of asymptomatic SARS-CoV-2 (95% CI 1.1–1.4) per 1,000 cases of pregnancy.  Additionally, about 25% of expecting mothers reported having symptoms that were consistent with major depressive disorder, generalised anxiety disorder, PTSD, or other serious mental health conditions such as dysregulation, somatization, or dissociation. According to Czeisler et al.[11] A study found that 30.9% of respondents reported having signs of a depressive disease or an anxiety disorder during the COVID-19 pandemic, which represents a 30% increase worldwide. Some discovered that almost 50% of the women reported feeling more stressed as a result of food shortages (59.2%, N = 1622), job loss or household income (63.7%, N = 1745), and having to take care of their children (56.3%, N = 1543).

Furthermore, household conflicts caused more than a third of respondents to suffer elevated stress (37.5%, N = 1028), and a significant majority (93%, N = 2556) were stressed about contracting COVID-19. Nearly half of the respondents (41.4%, N = 1133) were healthcare workers or (45.5%, N = 1246) worked in essential services. Fan et al.[12] revealed a significant degree of variability (I2 = 99.6%), and a general frequency of anxiety was 42% (95% CI 26%–57%). Depression was present in 25% of cases (95% CI 20%–31%), with considerable variability (I2 = 97.9%). Pregnant women’s mental health was found to be linked to age, the financial standing of the family, social support, and physical activity, among other factors. Going further, coping strategies and networks of support become essential in this situation. The techniques people use to control stress and preserve their psychological health are referred to as coping mechanisms.[13] In the UK, expectant mothers have had to balance these changes with taking care of their health and well-being. Expectant mothers’ worry increased because of the frequent moving or postponement of antenatal appointments, which are normally a time for monitoring and assurance.[14] Birth plans had to be modified to consider new hospital policies aimed at reducing the spread of viruses. These policies included caps on the number of partners who could give birth and short stays in the hospital after giving birth.[15] The Aim of this journal is to investigate the role of spousal support as a coping mechanism and support system for pregnant women in the UK during the COVID-19 pandemic.

This systematic review is guided by a theoretical framework based on the biopsychosocial model, which suggests that human health and sickness are influenced by social, biological, and psychological factors. This model was key in understanding the intricate relationships impacting expectant mothers during the COVID-19 pandemic. The biopsychosocial approach allows for a consideration of how spousal support moderates these factors to impact pregnant women’s coping and well-being during a pandemic, such as COVID-19. The model will help in making sense of the results and presenting a systematic approach to considering the application of spousal support within the biological, psychological, and social experiences of pregnant women during the COVID-19 pandemic. Several scholarly databases were used to guarantee an extensive and methodical evaluation of the body of current material; the search was restricted to articles published between December 2019 and 2024. Thematic analysis was also conducted.

Literature Review
According to Esteban-Gonzalo et al.[16], A common symptom among pregnant women was anxiety and sadness during the pandemic due to issues like isolation and fear. The pandemic, along with the stressors that accompany pregnancy, a state that is not only physical but also psychological, proved to be an extremely challenging combination for many would-be Mothers.[17] In this context, spousal support has become a critical and instrumental source of emotional assistance for pregnant women, aiding in the reduction of stress and trauma exacerbated by the pandemic. Husbands and wives can offer help in various ways, including offering actual help and caregiving assistance in household chores, fulfilling household requirements, and listening sessions together with empathy.[18] Having a supportive partner is beneficial in coping with undesirable consequences associated with stress by enhancing the prenatal mental health of expectant women.[19] Some study found that among expectant mothers in the United Kingdom, 29% had PTSD signs related to the pandemic, people use coping skills to manage their stress and maintain their mental health, while women use a range of coping tactics when they are pregnant, from self-care practices like exercise and mindfulness to outside resources like social media and medical services. Effective coping mechanisms are essential for reducing stress and supporting healthy consequences of pregnancy for the mother and the foetus, as highlighted by Family, friends, and local resources can be provided as sources of social support.[20] However, during the pandemic, lockdown procedures restricted access to these conventional support systems, which increased the significance of spouse support. Research has looked at the coping methods and tactics pregnant women utilise to address the stress and difficulties caused by the COVID-19 epidemic, and there were several typical coping mechanisms found in a systematic review carried out by Shorey et al.[21], including asking for help from others, looking for knowledge, addressing problems, and taking care of oneself. Although these techniques might have been useful in reducing stress and anxiety, it was discovered that there are possible limits and disadvantages of some coping strategies, such as substance abuse or avoidance, which may have unfavourable long-term effects.

Research has examined how spousal support affected pregnant women during the COVID-19 pandemic, both globally and within the UK. There are significant gaps in the literature, especially regarding the UK-specific setting, and the results have been inconsistent. Spousal support was linked to lower levels of anxiety and sadness among pregnant women during the pandemic, according to a study conducted in Israel by Taubman-Ben-Ari et al.[22] A qualitative study conducted in Mexico by Brown and Shenker (2020) discovered that during the pandemic, numerous pregnant women experienced difficult interactions with their spouses, which had a negative impact on their mental health. The study found that some variables could be contributing to these marital problems, including financial strain, an increase in household responsibilities, and limited social engagements.

The literature review reveals several significant gaps in our understanding of the role of spousal support for pregnant women during the COVID-19 pandemic. Firstly, there is a lack of focused research on the complex dynamics of spousal support and how it can vary based on factors such as communication styles, emotional stability, and socioeconomic levels. Another gap identified in the literature is the potential impact of socioeconomic disparities on the availability and effectiveness of spousal support. As noted by Knight et al.[23], “Socioeconomic differences hamper the availability and efficacy of spousal support, with lower-income households having more difficulty sustaining regular support”. However, developing a thorough knowledge of the function of spousal support as a coping strategy for pregnant women during the COVID-19 epidemic requires filling in these gaps in the literature. By addressing these gaps, policies, support services, and interventions that are specifically designed to meet the needs of pregnant women and their partners during crisis situations can be developed.

Brik et al.[24] determined that social support has a crucial role in mitigating symptoms of sadness and anxiety in pregnant women residing in Spain. Nevertheless, it is important to acknowledge that cultural and societal norms might impact how social support systems are seen and used, which may restrict the applicability of these findings to different settings, like the UK.

Furthermore, Dib et al.[25] observed that personal health support, engagement with support groups, and longer gestational age were identified as predictors of improved mental health during the lockdown. This emphasises the vital significance of these support networks in reducing negative consequences. This aligns with Rauf et al.[26] which emphasised that economic instability and barriers to obtaining support services were linked to lower mental health. This underscores the importance of establishing accessible and fair support systems. The studies also emphasise the significance of healthcare services and initiatives in offering assistance to pregnant women during the pandemic. McKinlay et al.[27] highlighted the importance of ensuring that maternity services prioritise the provision of a delivery partner or support person to safeguard the mental well-being of pregnant women. This result is consistent with Knight et al.[23] who observed that the COVID-19 pandemic caused disruptions in healthcare services, resulting in heightened stress and anxiety among pregnant women. Kim and Kang emphasised the significance of posttraumatic growth in fostering health promotion behaviours among expectant couples[28]. Although this discovery is valuable, it is essential to acknowledge the possible difficulties in promoting psychological resilience and posttraumatic growth during a continuing traumatic event like the COVID-19 pandemic. Antoniou et al.[1] emphasised that strong interpersonal relationships, especially with romantic partners, had a significant effect on prenatal mental health, although this contradicts the findings of Brown and Shenker, who conducted research in Mexico that some pregnant women had strained relationships with their partners during the pandemic, negatively affecting their mental health.[29] Efficient communication and shared comprehension between partners were also emphasised as crucial elements in providing support to pregnant women during the pandemic. Brown A et al.[29] observed substantial dyadic associations between husbands and pregnant women concerning the fear of COVID-19, mental well-being, and preventive actions. Although open communication is important, it is vital to consider the possible influence of cultural norms, gender roles, and societal expectations on communication dynamics within romantic partnerships.

The study conducted by Sun Hee Kim and Hee Sun Kang utilised the Actor-Partner Interdependence Model to show that spousal support had a substantial impact on health promotion behaviours among pregnant women and their spouses.[28] These findings are similar to those of the literature study conducted by Battulga et al.[30], which repeatedly showed that having great support from one’s spouse is linked to reduced levels of anxiety and depression, as well as enhanced overall well-being, during pregnancy.

The pandemic affected pregnant women immensely since it increased mental health problems and stressed the importance of support mechanisms. The conclusions of the present study emphasise the complex effects of the pandemic on pregnant women and their mental well-being, as well as the use of different coping strategies and the importance of partnership support; this study finds that pregnant women were significantly affected by depression, anxiety, and stress during the pandemic. These are some causes of mental health problems, such as loneliness, fear of the virus, and limited visits by birth companions.  The findings identified in spouse relationships showed that appropriate interpersonal communication between partners was useful in minimising prenatal depression and anxiety. Based on the findings, Spouses’ training programs will play a crucial role in enhancing well-being if partners acquire knowledge about mental disorders. Such programs should aim at recognizing signs of depression, anxiety, and stress, and learning how to comfort someone.[31,32] There should be programs whose aim is to address issues touching on mental health, stress, and well-being among expectant women and their male counterparts. Such programs should consist of the preparation of prenatal and postnatal consultations, mindfulness, and other types of physical exercises, nutrition, and physical activity plans. As such, these programs can support and strengthen protective factors that are crucial in improving health-related merits. Involvement in health promotion activities or exercises like prenatal exercises or the preparation of meals will make the couple support each other, enhancing the feeling of togetherness.[33,34]

Special thanks to my supervisor, Esther Azasi (PhD), for her contribution and review towards this article, and to my husband (Samuel Alade) for his support and contribution, and also to my parents (Micheal and Roseline Kolawole) for their parental support.

Not reported

Oluwanitemi Kolawole
Department of Physiology
Queen Margaret University Edinburgh, UK
Email: kolawolenitemi@gmail.com

The author contributed to the conceptualization, investigation, and data curation by acquiring and critically reviewing the selected articles, and was involved in the writing – original draft preparation and writing – review & editing to refine the manuscript.

Not applicable

Not reported

None

https://doi.org/10.63096/medtigo30622449

Kolawole OE. Role of Spousal Support as a Coping Mechanism for Pregnant Women Experiencing Trauma During the COVID-19 Pandemic in the United Kingdom. medtigo J Med. 2024;2(4):e30622449. doi:10.63096/medtigo30622449 Crossref