Association Of Continuous Folic Acid Supplementation During Pregnancy With Antenatal Depressive Symptoms And Factors Influencing The Mental Health Status Of Pregnant Women In Early Pregnancy Under Universal Access To The New Crown Vaccine

Background: Depression and anxiety have increased dramatically with the outbreak of the neocon epidemic,and there are differences in prevalence,with women being more likely than men to be vaccinated.2021 saw the start of a universal neocon vaccination program in China,but it is recommended that the vaccination be delayed in the pregnant women population.This measure is expected to affect the mental health of local pregnant women,particularly in terms of prenatal depressive symptoms.As a special group of women,pregnant women face more stressful risks and life issues and are more likely to develop mood disorders such as anxiety or depressive symptoms.The prevalence of anxiety and depression among pregnant women in China during the epidemic was 33.0% and 48.7%,with detection rates two to three times higher than before.Prolonged exposure to anxiety or depression may cause irreversible damage to oneself,the child,and even society,such as autism,bipolar disorder,and pre-eclampsia.Therefore,identifying mental health hazards and protective factors for pregnant women in the context of the COVID-19 pandemic is a public health priority.In addition,some studies have shown that blood folate levels are significantly lower than normal in depressed patients,and pregnant women are at greater risk of developing folate deficiency,and the relationship between folate and perinatal depression has not been well described.Meta-analysis,an important method of evidence seeking in evidence-based medicine,may provide an idea of the relationship between continuous folate supplementation during pregnancy and the risk of perinatal depression.Combining the above research base,this study further analyzes the role of folic acid during pregnancy in terms of changes in maternal depressive symptoms in early and mid-life and describes the factors influencing maternal mental health in the pandemic.Objective: 1.To preliminarily explore the relationship between folic acid supplementation during pregnancy and perinatal depression through Meta-analysis of studies on folic acid supplementation during pregnancy and perinatal depression;2.To provide a scientific basis for the prevention and treatment of perinatal depression by analysing the association between erythrocyte folate levels and depressive symptoms in late pregnancy;3.To investigate the situation of stress and anxiety and depressive symptoms in early pregnancy before and after the popularisation of the new crown vaccine under the pandemic and the factors affecting them.Methods: 1.A systematic search of the available literature published before November30,2021 was conducted.Databases searched included Embase,Pub Med,Cochrane Library,Medline,Russian science citation index,China Biomedical Literature Service,China Knowledge Network,Wanfang,and Vipul.Quality evaluation of randomized controlled trials（RCT’s）using the Cochrane Collaboration tool.Quality evaluation of observational studies was performed using the Newcastle-Ottawa Scale（NOS）;2.A cohort of 100 pregnant women followed up to late pregnancy in the Maternal and Infant Birth Cohort in Huaibei City,Anhui Province from November 12,2020 to January2022 was used for the study.Blood samples were collected from eligible pregnant women in mid-to late-pregnancy,red blood cell folate levels were measured,and late-pregnancy depressive symptoms were measured;3.735 pregnant women in early pregnancy who were enrolled in the Maternal and Child Health Hospital and local community in Huai Bei City,Anhui Province from November 12,2020 to October 28,2021 were selected as the survey population.The socio-demographic and obstetric characteristics questionnaire,dietary and nutritional supplementation questionnaire,sleep quality questionnaire and mental health measurement data questionnaire were completed through face-to-face interviews to understand the anxiety and depression status of pregnant women in early pregnancy under current conditions,and to analyze the correlation between anxiety and depression and influencing factors.Results: 1.A total of 15 studies,including 11 observational studies and 4 randomized controlled trials,with a total of 26,275 women,were included.The current Meta results showed that folic acid supplementation behavior contributed to a reduced risk of perinatal depression [OR = 0.742,95% CI（0.647,0.852）,OR of studies with direct OR values provided = 0.84,95% CI（0.76,0.93）].There was a negative association between blood folate levels and depressive symptoms [SMD= 0.127,95%CI（0.183,0.071）].No association was observed between folic acid intervention and Edinburgh postpartum depression scores.Continuous folic acid supplementation during pregnancy reduced the incidence of peripregnancy depressive symptoms(R=0.017,95%CI（0.014,0.021）].2.The eligible sample size for follow-up to mid-to late-pregnancy was 100,and there was a statistically significant association between mid-pregnancy erythrocyte folate deficiency and late-pregnancy depressive symptoms（p=0.044）,but no association was observed between late-pregnancy erythrocyte folate levels and late-pregnancy depressive symptoms.3.A total of 738 eligible pregnant women in Huaibei City,Anhui Province were enrolled in this study（23 ineligible samples were excluded）.All participants were 17-47 years old（mean = 28.38）,and 94.6% were under35 years old.In this study,the prevalence of stress symptoms among pregnant women was 5%,the prevalence of anxiety symptoms was 71.5%,and the prevalence of depressive symptoms was 23.8% when using the 21-item Depression Anxiety Stress Scale（DASS-21）as a measurement tool.The prevalence of anxiety measured using the GAD-7 scale was 3%,and the prevalence of depression measured using the PHQ-9scale was 6.13%.Conclusions: 1.Continuous folic acid use during pregnancy reduces the prevalence of depressive symptoms during the same period;2.Erythrocyte folate levels in mid-pregnancy at acceptable levels may help improve depression in late pregnancy;3.During the pandemic period,before the universal vaccine policy,the prevalence of anxiety and depression in early pregnancy was relatively high,whereas after vaccination of all citizens,there was a variable decrease in the prevalence of depression and anxiety,and sleep quality also improved considerably,and factors affecting mental health changed across time.