Examining Stress, Depression, and Anxiety Levels in Pregnant Women in the Time of Zika


Both Zika-infected and uninfected pregnant women showed levels of high stress in a recent study conducted in Puerto Rico.

In 2016, the US Department of Health and Human Services declared a public health emergency on the island of Puerto Rico (PR) as a result of the devastating Zika virus endemic impacting over 1000 women on the island. Now, new research presented at the First International Zika Conference this week in Washington, DC is reporting that the ongoing epidemic is expected to affect 25% of pregnant women in the US territory.

Zika brings with it a host of medical complications, such as microcephaly in infants of mothers infected with the virus. This devastating complication alone is enough to add unwanted stress and anxiety to what should be a happy and enjoyable time for these woman. Because of this, Carmen D. Zorrilla, MD, Professor of Obstetrics and Gynecology, University of Puerto Rico, School of Medicine in San Juan, PR and her colleagues sought to determine the stress, anxiety, and depression levels in pregnant women in PR who were either infected with the Zika virus or at-risk of becoming infected.

The researchers established prenatal groups exclusively for women with Zika infection at the University Hospital High Risk clinic in PR. General counseling sessions as well as Zika prevention activities were included in the groups sessions. Students from a doctoral program in clinical psychology were also included in each of the groups.

After starting in their prenatal groups, the levels of stress, anxiety, and depression among 52 women with Zika infection and 171 women without Zika infection were measured with Cohen PSS-10, GAD-7 and PHQ-9 instruments. The mean age for women in both groups was 23 years of age.

The researchers found that there were no statistically significant differences in the levels of stress, depression, and anxiety among Zika-infected pregnant women versus uninfected women. A total of 25% of the women infected with Zika showed moderate to severe depression scores, compared with 19% of those women who were uninfected. The mean Generalized Anxiety (GAD-7) scores were 23 for women who were infected with Zika, and 22.5 for those who were not infected.

Both groups of women reported high stress levels: 69% in Zika-infected women and 63% in uninfected women. The presence of psychology students in the sessions and the group prenatal session format overall may have contributed to the decreased stress levels among those pregnant women who were infected with the Zika virus.

The researchers felt that given that the hospital already had an existing Group Prenatal care program in place, is was easy to adapt the model to include women who were infected with Zika or at risk of being infected. The group model enabled the pregnant women who were infected with Zika to establish a support system for themselves that enabled them to “make decisions in a non-judgmental environment.” In addition, both groups of women provided testimonies and information in their groups sessions that will be utilized to improve methods of care as the epidemic continues to evolve.

The women continue to receive “comprehensive innovative care at the onset of the epidemic,” while, “a multidisciplinary group of health care providers have been exposed first hand to the issues that create anxiety and uncertainty, as they shape new guidelines and protocols.”


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First International Conference on Zika Virus


Stress, Depression And Anxiety in Pregnancy During the Zika Epidemic in Puerto Rico: The Case for Group Prenatal Care

Carmen D. Zorrilla , Juana Rivera-Vinas , Cynthia Garcia-Coll , Jose Rodriguez-Quinonez , Angela Miranda , Fiorella Reyes , Clarianne Moscoso , Johnathan Lopez , Alberto De La Vega , Silvia Rabionet

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