Published: 2022-02-28

COVID-19 associated anxiety and perceived risk among the pregnant women: a cross-sectional study

Shanila Nooruddin, Tooba Jawed Khan, Sidrah Nausheen, Fouzia Nasir, Ghulam Abbas Shaikh, Asif Shaikh, Ayesha Sadiqa, Shabnam Abbas, Arjumand Rizvi, Sajid Soofi, Muhammad Atif Habib


Background: COVID-19 is an infectious disease, categorized as a global pandemic. Daily implications and coping strategies of pregnant women with coronavirus outbreak is currently unknown. This study will assess their knowledge, attitude, and practices (KAP), risk perceptions, anxiety and concerns related to COVID-19.

Methods: A hospital-based cross-sectional survey was conducted in Karachi. Self-reported questionnaires including KAP, generalized anxiety disorder (GAD) scale and perception of pregnancy risk questionnaire were administered. Descriptive statistics were calculated for continuous variables and were reported as mean ± standard deviation. Frequencies and percentages were computed for categorical variables. Pearson correlation was calculated to explore linear associations among the perception of pregnancy risk, age, body mass index (BMI), and gestation. All data analysis was done using STATA 16.0.

Results: The 575 pregnant women were enrolled with an average age of 26.07 years and 27.22±8.99 gestational age. Their knowledge showed that 92.2% knew that coronavirus causes COVID-19 and 72.30% knew the importance of wearing masks. Regarding attitudes, 96.3% felt safe to breastfeed their newborns, 80.20% considered changing their birth method whereas 54.6% were not concerned about the outbreak and around 70-80% cancelled their social gatherings. 72% trusted healthcare frontline staff with their struggle towards COVID-19. The 43.82% women were more anxious (scoring ≥7) and 56.17% were less anxious (<7) on GAD scale. The mean score for perceived risk for baby and mother was 22.95±13.72 and 19.40±0.57 respectively.

Conclusions: Considering the burden of COVID-19, pregnant women’s perception is a major contributor to her and her baby’s health and wellbeing. Well-planned strategies by media, healthcare providers and government would significantly support such pregnant women during COVID-19.


COVID-19, Risk perception, Pregnancy, Anxiety

Full Text:



World Health Organization. Coronavirus disease (COVID‐19) advice for the public. 2021. Available at: Accessed on 10 December 2021.

Murthy S, Gomersall CD, Fowler RA. Care for Critically Ill Patients With COVID-19. JAMA. 2020;323(15):1499-500.

Sohrabi C, Alsafi Z, O’Neill N, Khan M, Kerwan A, Al-Jabir A et al. World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19). Int J Surg. 2020;76:71-6.

World Health Organization. WHO Coronavirus (COVID-19) Dashboard. Available at: Accessed on 3 May 2021.

Pakistan COVID-19 Situation Report No. 25 UNICEF. Reporting Period: 2021. Available at: Accessed on 10 December 2021.

National COVID Statistics Website. “No Title,” Natl. COVID website 2021. Available at: Accessed on 10 December 2021.

Di Mascio D. Outcome of coronavirus spectrum infections (SARS, MERS, COVID-19) during pregnancy: a systematic review and meta-analysis. Am. J. Obstet. Gynecol. 2020;2(2):100-7.

Schwartz DA, Graham AL. Potential Maternal and Infant Outcomes from (Wuhan) Coronavirus 2019-nCoV Infecting Pregnant Women: Lessons from SARS, MERS, and Other Human Coronavirus Infections. Viruses. 2020;12(2).

Liu Y, Chen H, Tang K, Guo Y. Clinical manifestations and outcome of SARS-CoV-2 infection during pregnancy. J Infect. 2020.

Din YM, Munir SM, Razzaq SA, Ahsan A, Maqbool S, Ahmad O. Risk Perception of COVID-19 Among Pregnant Females. Ann King Edward Med Univ. 2020;26:176-80.

Aghababaei S. Perceived risk and protective behaviors regarding COVID-19 among Iranian pregnant women. Middle East Fertil. Soc J. 2020;25(1):29.

Ellington S, Strid P, Tong VT, Woodworth K, Galang RR, Zambrano LD et al. Characteristics of Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status-United States. Morb Mortal Wkly Rep. 2020;69:769-75.

Nie R. Clinical features and the maternal and neonatal outcomes of pregnant women with coronavirus disease 2019. MedRxiv. 2020.

Cheng C, Ng AK. Psychosocial Factors Predicting SARS-Preventive Behaviors in Four Major SARS-Affected Regions. J Appl Soc Psychol. 2006;36(1):222-47.

Yassa M, Birol P, Yirmibes C, Usta C, Haydar A, Yassa A et al. Near-term pregnant women’s attitude toward, concern about and knowledge of the COVID-19 pandemic. J Maternal-Fetal Neonatal Med. 2020;33(22):3827-34.

Jabeen N, Zaheer F, Ali K, Faruqi A, Mughal IA, Irfan A. Impact of COVID-19 on Antenatal, Natal, and Postnatal Care of pregnant females at Akbar Niazi Teaching Hospital. J Rawalpindi Med College. 2021;25(1):60-5.

Cheng C, Tang CK. The psychology behind the masks: Psychological responses to the severe acute-respiratory syndrome outbreak in different regions. Asian J Soc Psychol. 2004;7(1):3-7.

RCoOa G. Coronavirus (COVID-19) infection in pregnancy: information for healthcare professionals (version 13), 2021. Available at: Accessed on 28 October 2021.

Villar J, Ariff S, Gunier RB. Maternal and neonatal morbidity and mortality among pregnant women with and without COVID-19 infection: the inter COVID multinational cohort study. JAMA Pediatr. 2021;175(8):817-26.

Patabendige M, Gamage MM, Weerasinghe M, Jayawardane A. Psychological impact of the COVID-19 pandemic among pregnant women in Sri Lanka. Int J Gynecol Obstet. 2020;151(1):150-3.

Healy CM. COVID-19 in Pregnant Women and Their Newborn Infants. JAMA pediatrics. 2021;175(8):781-3.

Kevin M. Sullivan RAM. Sample Size for X-Sectional, Cohort, and Clinical Trials. OpenEpi. Available at: Accessed on 28 October 2020.

Gynaecologists RCoOa. Coronavirus (COVID-19) infection in pregnancy: information for healthcare professionals (version 6). 2020. Available at: Accessed on 20 March 2021.

World Health Organization. Coronavirus disease (COVID‐19) advice for the public. 2020. Available at: Accessed on 20 March 2021.

Heaman MI, Gupton AL. Psychometric testing of the Perception of Pregnancy Risk Questionnaire. Res Nurse Health. 2009;32(5):493.

Nwafor JI, Aniukwu JK, Anozie BO, Ikeotuonye AC, Okedo-Alex IN. Pregnant women's knowledge and practice of preventive measures against COVID-19 in a low-resource African setting. Int J Gynaecol Obstet. 2021;150(1):121-3.

Apanga PA, Kumbeni MT. Adherence to COVID-19 preventive measures and associated factors among pregnant women in Ghana. Trop Med Int Heal. 2021;26(6):656-63.

Fikadu AM, Yeshaneh A, Melis T, Mesele M, Anmut W. COVID-19 Preventive Measure Practices and Knowledge of Pregnant Women in Guraghe Zone Hospitals. Int J Womens Heal. 2021;13:39-50.

Olapegba PO, Ayandele O. Survey data of COVID-19-related Knowledge, Risk Perceptions and Precautionary Behavior among Nigerians. Data Brief. 2020;30:105685.

Nausheen S, Bhamani S, Makhdoom A, Sheikh L. Fear of COVID-19 among pregnant women in Pakistan: a cross-sectional study. International Journal of Community Medicine and Public Health. 2020;7(12):4749.

Karasneh R, Azzam S, Muflih S, Soudah O, Hawamdeh S, Khader Y. Media's effect on shaping knowledge, awareness risk perceptions and communication practices of pandemic COVID-19 among pharmacists. Res Social Admin Pharmacy. 2020;4:55-9.

Rajkumar RP. COVID-19 and mental health: A review of the existing literature. Asian J Psychiatr. 2020;52:102066.

Mukhtar MS. Mental health and psychosocial aspects of coronavirus outbreak in Pakistan: psychological intervention for public mental health crisis. Asian J Psychiatr. 2020;51:102069.

Azlan AA, Hamzah MR, Sern TJ, Ayub SH, Mohamad E. Public knowledge, attitudes and practices towards COVID-19: A cross-sectional study in Malaysia. PLoS one. 2020;15:e0233668.

Syed Anwar Aly SA, Abdul Rahman R, Sharip S, Shah SA, Abdullah Mahdy Z, Kalok A. Pregnancy and COVID-19 Pandemic Perception in Malaysia: A Cross-Sectional Study. Int J Environmental Res Public Health. 2021;18(11):5762.

Zhong BL, Luo W, Li HM, Zhang QQ, Liu XG, Li WT et al. Knowledge, attitudes, and practices towards COVID-19 among Chinese residents during the rapid rise period of the COVID-19 outbreak: A quick online cross-sectional survey. Int J Biol Sci. 2020;16:1745-52.

Al-Hanawi MK, Angawi K, Alshareef N, Qattan AMN, Helmy HZ, Abudawood Y et al. Knowledge, Attitude and Practice Toward COVID-19 Among the Public in the Kingdom of Saudi Arabia: A Cross-Sectional Study. Front. Public Health. 2020;8:217.

Abdelhafiz AS, Mohammed Z, Ibrahim ME, Ziady HH, Alorabi M, Ayyad M et al. Knowledge, Perceptions, and Attitude of Egyptians Towards the Novel Coronavirus Disease (COVID-19). J. Community Health. 2020;45:881-90.

Hossain N, Samuel M, Sandeep R, Imtiaz S, Zaheer S. Perceptions, generalized anxiety and fears of pregnant women about corona virus infection in the heart of pandemic. 2020;1-16.

Mortazavi F, Mehrabadi M, Kiaee Tabar R. Pregnant women’s well-being and worry during the COVID-19 pandemic: a cross-sectional study. BMC Pregnancy Childbirth. 2021;21(1):59.

Woods SM, Melville JL, Guo Y, Fan MY. Psychosocial stress during pregnancy. Am J Obst Gynecol. 2010;202(1):61-7.

Patabendige M, Gamage MM, Weerasinghe M, Jayawardane A. Psychological impact of the COVID-19 pandemic among pregnant women in Sri Lanka. Int J Gynecol Obstet. 2020;151(1):150-3.