Longitudinal Changes in Maternal Depressive and Anxiety Symptoms Following COVID-19 During Pregnancy: A Cohort Study from Slovakia.

Background/Objectives: The COVID-19 pandemic has raised concerns about maternal mental health, particularly among women infected during pregnancy. This study aimed to examine longitudinal changes in depressive and anxiety symptoms and subjective distress among pregnant women in Slovakia with confirmed SARS-CoV-2 infection and to explore the role of obstetric complications and vaccination status in these trajectories. Methods: In this retrospective longitudinal study, women with SARS-CoV-2 infection during pregnancy were assessed at three time points: during infection, six weeks postpartum, and one year postpartum (11 March 2020-5 May 2023). Depressive symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS; cut-off ≥ 11), anxiety symptoms were measured using the EPDS-3A subscale (cut-off ≥ 5), and subjective distress was measured using visual analogue scales (VAS). A repeated-measures ANCOVA design was used to evaluate within-subject changes over time while adjusting for vaccination status and pregnancy complications. Results: Of 1184 contacted women, 170 provided complete data. The proportion of women exceeding the EPDS cut-off decreased from 27.6% during infection to 17.6% at six weeks postpartum and 4.7% at one year postpartum. Anxiety symptoms showed a similar pattern, declining from 27.6% during infection to 20.6% at six weeks postpartum and 7.6% at one year postpartum. Repeated-measures analyses confirmed significant time effects across psychological outcomes, with symptom levels decreasing over the postpartum year. Post-infection obstetric complications were associated with higher subjective distress at selected time points. Conclusions: Psychological symptoms were highest during the acute infection period and declined significantly over time. These findings support the importance of timely mental health screening during pregnancy affected by COVID-19, while suggesting that, in many women, psychological distress may decrease across the postpartum year.