Depression, Anxiety, and Physical Activity among Antenatal Women During COVID-19 Pandemic: A Cross Sectional Study

Siti Roshaidai Mohd Arifin


The prevalence of mental health problems among antenatal women has escalated during the COVID-19 pandemic compared to the pre-pandemic period. Many strategies have been proposed to reduce depression and anxiety, one of the techniques being physical activity. This study aimed to assess the association between physical activity with depression and anxiety among antenatal women during the COVID-19 pandemic. This cross-sectional study applied convenience sampling to recruit 544 antenatal women from March to June 2021. Questionnaires including the Edinburgh Postnatal Depression Scale (EPDS), State-Trait Anxiety Inventory (STAI), and Pregnancy Physical Activity Questionnaire (PPAQ) were distributed via social media to determine the prevalence of depression, anxiety, and physical activity level. Data were analysed using descriptive statistics, Chi-Square, Mann-Whitney, and Kruskal Wallis tests. Out of 544 antenatal women, 24.1% of them had depressive symptoms and 82.4% had anxiety. Only 12.1% of the women were sufficiently active during the pandemic. There was no association between physical activity, depression, and anxiety. The high prevalence of depression and anxiety during the COVID-19 pandemic among Malaysian antenatal women underscores the urgent need for addressing this public health burden. Interventions to alleviate the symptoms should include strategies beyond physical activity, for example, a mobile application or telephone-delivered social support that is made easily accessible throughout the pandemic.


Saccone G, Florio A, Aiello F, et al. Psychological impact of coronavirus disease 2019 in pregnant women. Am J Obstet Gynecol 2020; 223(2): 293-295.

Ryan, J., Mansell, T., Fransquet, P., and Saffery, R. Does maternal mental well-being in pregnancy impact the early human epigenome? Epigenomics 2017; 9(3), 313–332.

Glover, V., Ahmed-Salim, Y., and Capron, L. Maternal Anxiety, Depression, and Stress During Pregnancy: Effects on the Fetus and the Child, and Underlying Mechanisms. Fetal Development 2016; 213–227.

Wu Y, Zhang C, Liu H, Duan C, Li C, Fan J, Li H, Chen L, Xu H, Li X, Guo Y, Wang Y, Li X, Li J, Zhang T, You Y, Li H, Yang S, Tao X, Xu Y, Lao H, Wen M, Zhou Y, Wang J, Chen Y, Meng D, Zhai J, Ye Y, Zhong Q, Yang X, Zhang D, Zhang J, Wu X, Chen W, Dennis CL, Huang HF. Perinatal depressive and anxiety symptoms of pregnant women during the coronavirus disease 2019 outbreak in China. Am J Obstet Gynecol 2020; 223(2): 240.e1-240.e9.

Lebel C, MacKinnon A, Bagshawe M, Tomfohr-Madsen L, and Giesbrecht G. Elevated depression and anxiety symptoms among pregnant individuals during the COVID-19 pandemic. J Affect Disord 2020; 277: 5-13.

Mappa I, Distefano FA, and Rizzo G. Effects of coronavirus 19 pandemic on maternal anxiety during pregnancy: a prospectic observational study. J Perinat Med 2020; 48(6): 545-550.

Davenport, M. H., Meyer, S., Meah, V. L., Strynadka, M. C., & Khurana, R. Moms Are Not OK: COVID-19 and Maternal Mental Health. Front. Glob. Womens Health 2020; 1: 1–6.

Mihaela Rus, Sandu, T. T. A new decade for social changes. Technium: Social Science Journal 2020; 6(6), 69–87 (2021, accessed 1 November 2021).

Zhang, J. People’s responses to the COVID-19 pandemic during its early stages and factors affecting those responses. Humanit Soc Sci Commun 2021; 8: 37.

Saadati NN, Abedi P. Health anxiety of pregnant women and its related factors during the pandemic of coronavirus. Ultrasound Obstet Gynecol 2020; 56(Suppl 1): 264.

Davenport MH, McCurdy AP, Mottola MF, Skow RJ, Meah VL, Poitras VJ, Jaramillo Garcia A, Gray CE, Barrowman N, Riske L, Sobierajski F, James M, Nagpal T, Marchand AA, Nuspl M, Slater LG, Barakat R, Adamo KB, Davies GA, Ruchat SM. Impact of prenatal exercise on both prenatal and postnatal anxiety and depressive symptoms: a systematic review and meta-analysis. Br J Sports Med 2018; 52(21): 1376-1385.

Hanlon C, Khoo S, Morris T, Eime R. Factors influencing women in physical activity programs in Malaysia. Health Promot Int 2019; 34(3): 389-399.

Khoo S, Poh BK, Suhaimi SA, Chong KH, Ramirez Varela A. Physical Activity Promotion in Malaysia: Challenges and Opportunities. Front Public Health 2020 Oct 27; 8:536239.

Karim HMR. Practice and reasons for routine pre-operative investigations among anaesthesiologists and surgeons: An online survey. Indian J Anaesth 2017; 61(11): 933-935.

Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry 1987; Jun;150:782-6.

Hashim E, Wan Hasyila WO, Ang YH, Azlan Helmy AS, Husyairi H. Psychometric properties of the Malay translated Spielberger state-trait anxiety inventory in exploring parental anxiety. Med Health 2018; 13(1): 106-116.

Mamat PS. Validation of the Malay version of pregnancy physical activity questionnaire (PPAQ) and the assessment of physical activity, dietary intake and gestational weight gain rate among pregnant women in Kota Bharu, Kelantan. Master Thesis, University Science Malaysia, 2016.

Chasan-Taber L, Schmidt MD, Roberts DE, Hosmer D, Markenson G, Freedson PS. Development and validation of a Pregnancy Physical Activity Questionnaire. Med Sci Sports Exerc 2004; 36(10): 1750-60.

Ceulemans M, Hompes T, Foulon V. Mental health status of pregnant and breastfeeding women during the COVID-19 pandemic: A call for action. Int J Gynaecol Obstet 2020; 151(1): 146-147.

Durankuş F, Aksu E. Effects of the COVID-19 pandemic on anxiety and depressive symptoms in pregnant women: a preliminary study. J Matern Fetal Neonatal Med 2020; 18:1-7.

Bakioğlu F, Korkmaz O, Ercan H. Fear of COVID-19 and Positivity: Mediating Role of Intolerance of Uncertainty, Depression, Anxiety, and Stress. Int J Ment Health Addict 2020; 28:1-14.

Nasreen HE, Rahman JA, Rus RM, Kartiwi M, Sutan R, Edhborg M. Prevalence and determinants of antepartum depressive and anxiety symptoms in expectant mothers and fathers: results from a perinatal psychiatric morbidity cohort study in the east and west coasts of Malaysia. BMC Psychiatry 2018; 18(1): 195.

Mappa I, Distefano FA, Rizzo G. Effects of coronavirus 19 pandemic on maternal anxiety during pregnancy: a prospectic observational study. J Perinat Med 2020; 48(6): 545-550.

Salehi L, Rahimzadeh M, Molaei E, Zaheri H, Esmaelzadeh-Saeieh S. The relationship among fear and anxiety of COVID-19, pregnancy experience, and mental health disorder in pregnant women: A structural equation model. Brain Behav 2020; 10(11): e01835.

Padmapriya N, Bernard JY, Liang S, Loy SL, Shen Z, Kwek K, Godfrey KM, Gluckman PD, Chong YS, Saw SM, Meaney MJ, Chen H, Müller-Riemenschneider F; GUSTO Study Group. Association of physical activity and sedentary behavior with depression and anxiety symptoms during pregnancy in a multiethnic cohort of Asian women. Arch Womens Ment Health 2016; 19(6): 1119-1128.

Walasik I, Kwiatkowska K, Kosińska Kaczyńska K, Szymusik I. Physical Activity Patterns among 9000 Pregnant Women in Poland: A Cross-Sectional Study. Int J Environ Res Public Health 2020; 9;17(5): 1771.

El-Rafie MM, Khafagy GM, Gamal MG. Effect of aerobic exercise during pregnancy on antenatal depression. Int J Womens Health 2016; Feb 24;8: 53-57.

Demissie Z, Siega-Riz AM, Evenson KR, Herring AH, Dole N, Gaynes BN. Associations between physical activity and postpartum depressive symptoms. J Womens Health (Larchmt) 2011; 20(7):1025-34.

Meyer J, McDowell C, Lansing J, Brower C, Smith L, Tully M, Herring M. Changes in Physical Activity and Sedentary Behavior in Response to COVID-19 and Their Associations with Mental Health in 3052 US Adults. Int J Environ Res Public Health. 2020 Sep 5;17(18):6469.

Wu H, Sun W, Huang X, Yu S, Wang H, Bi X, Sheng J, Chen S, Akinwunmi B, Zhang CJP, Ming WK. Online Antenatal Care During the COVID-19 Pandemic: Opportunities and Challenges. J Med Internet Res. 2020;22(7):e19916.



  • There are currently no refbacks.

International Journal of Public Health Science (IJPHS)
p-ISSN: 2252-8806, e-ISSN: 2620-4126

View IJPHS Stats

Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.