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Article

Self-Reported Religious Affiliation and the Prevalence of Psychiatric Disorders in a Cohort of 609 Asymptomatic and Mildly Symptomatic SARS-CoV-2-Positive Pregnant Women

by
Claudine J. Egol
1,*,
Katherine M. Piderman
2,
Harold G. Koenig
3,
Victor N. Nettey
1,
Matthew J. Van Ligten
4,
Mohamed Aly
5,
Shirshendu Sinha
1,
Terry D. Schneekloth
2 and
Osama A. Abulseoud
1,6
1
Department of Psychiatry and Psychology, Mayo Clinic Arizona, Phoenix, AZ 58054, USA
2
Department of Psychiatry and Psychology, Mayo Clinic Rochester, Rochester, MN 55905, USA
3
Center for Spirituality, Health & Human Values, Duke University Medical Center, Durham, NC 27710, USA
4
Alix School of Medicine at Mayo Clinic, Phoenix, AZ 58054, USA
5
Department of Cardiothoracic Surgery, Mayo Clinic Arizona, Phoenix, AZ 85054, USA
6
Department of Neuroscience, Graduate School of Biomedical Sciences, Mayo Clinic College of Medicine, Phoenix, AZ 58054, USA
*
Author to whom correspondence should be addressed.
COVID 2026, 6(4), 69; https://doi.org/10.3390/covid6040069
Submission received: 23 January 2026 / Revised: 14 March 2026 / Accepted: 11 April 2026 / Published: 16 April 2026
(This article belongs to the Section COVID Public Health and Epidemiology)
Versions Notes

Abstract

Background: Religious affiliation has traditionally served as a coping strategy during stressful events such as the COVID-19 pandemic. Pregnant women faced heightened stress during the pandemic due to concerns about their health as well as that of their fetus. This study examined the prevalence of self-reported religious affiliation among SARS-CoV-2-positive pregnant women and investigated differences in psychiatric diagnoses and pregnancy outcomes based on religious affiliation. Methods: The study included all asymptomatic or mildly symptomatic SARS-CoV-2-positive pregnant women who received care at the Mayo Health System from March 2020 through October 2021 and completed the routine religious affiliation questionnaire. Those selecting “none” were categorized as having no religious affiliation (RA−), whereas those selecting a specific religion were categorized as religiously affiliated (RA+). Results: Among 609 women, 49.6% were RA+ and 50.4% were RA−. RA+ women were more likely to be white, married, college-educated, and have fewer prior abortions. There were no significant differences in rates of depression, anxiety, psychotropic medication use, substance use, or pregnancy and labor complications between RA+ and RA− groups. Conclusions: Half of the women in this cohort reported no religious affiliation. Previously reported protective associations between religiosity and mental health were not observed when religious affiliation alone was examined.

1. Introduction

Religious affiliation in the United States has shifted substantially over recent decades, with an increasing proportion of individuals identifying as religiously unaffiliated [1,2]. Although some individuals without formal affiliation describe themselves as spiritual, religious affiliation remains a distinct construct with potential implications for coping, health behaviors, and mental health outcomes [3]. A substantial body of literature has demonstrated associations between religiosity, spirituality, and religious coping practices and mental health outcomes [4,5,6]. Despite this, relatively little research has examined psychiatric outcomes among individuals without religious affiliation.
Religious constructs encompass multiple related but distinct dimensions. Religious affiliation refers to identification with a religious tradition or group, whereas religiosity typically reflects the degree of religious belief or practice. Spirituality refers more broadly to personal connection with the transcendent, and religious coping describes the use of religious beliefs or practices to manage stress. The present study examines self-reported religious affiliation only, which does not directly measure religious practice, spiritual engagement, or coping style. Therefore, interpretations are limited to affiliation status rather than broader dimensions of religiosity or spirituality.
Religious beliefs and practices have been shown to help people cope with the stressors associated with physical illness [7]. The perinatal period is a time when women are more susceptible to experiencing a mood or anxiety disorder [8]. The prevalence of anxiety and depression during pregnancy and the postpartum period has been reported to be as high as 17.1% and 4.8%, respectively [9]. If symptoms are left untreated, a constellation of psychosocial complications can arise, including disrupted mother–infant attachments, interpersonal conflicts, and sustained negative physical and mental health consequences. Prior studies suggest that engagement in religious or spiritual practices may be associated with improved psychosocial and perinatal outcomes [10]. Pregnancy complications, including physical health comorbidities, can contribute to high perceived stress [11].
The COVID-19 pandemic introduced significant psychological stressors, particularly for pregnant women [12]. For those with mild symptoms or who were asymptomatic, testing positive for SARS-CoV-2 may have been an additional source of stress and anxiety. There have been several studies exploring the impact of SARS-CoV-2 infection on maternal mental health [13]. However, no previous study has examined the impact of religious affiliation on the prevalence of psychiatric diagnoses in this at-risk population. The aim of this study is to further our understanding of the association between self-reported religious affiliation and psychiatric diagnoses, pregnancy course, and outcomes in pregnant women testing positive for SARS-CoV-2.

2. Methods

2.1. Patients and Data Collection

This retrospective cohort study was conducted within the Mayo Clinic Health System and approved by the Mayo Clinic Institutional Review Board (IRB No. 21-010940). The study included pregnant women with laboratory-confirmed SARS-CoV-2 infection by reverse-transcriptase polymerase chain reaction (RT-PCR) testing (nasopharyngeal or oropharyngeal specimen), performed using clinically validated RT-PCR assays within the Mayo Clinic laboratory system (manufacturers and locations available upon request), who received obstetric care within the health system between 1 March 2020 and 1 October 2021. Clinical follow-up extended through delivery, with the final recorded delivery occurring on 9 March 2022.
Data extracted from the electronic medical record included demographic characteristics, self-reported religious affiliation (RA), COVID-19 symptom checklist responses, date of SARS-CoV-2-positive test, delivery date, gestational age at delivery, delivery method, pregnancy-related medical comorbidities, psychiatric diagnoses (including depression, anxiety, and substance use disorders) documented before or during pregnancy, and psychotropic medication use during pregnancy. Race and ethnicity categories were based on self-reported patient information recorded in the electronic medical record. Neonatal outcomes included birth weight, head circumference, and Apgar scores at 1 and 5 min.
Psychiatric diagnoses were defined as documented mental health conditions recorded by a treating clinician and identified through chart review and associated diagnostic coding (e.g., ICD-10 entries). The use of the term psychiatric diagnosis in this study refers to clinician-documented mental health conditions and does not imply the presence of a primary medical disorder. Because diagnoses were derived from routine clinical documentation rather than structured research assessments, outcome ascertainment may have been influenced by variability in clinician recognition and documentation practices. Information regarding symptom severity, duration, and treatment adherence was not consistently available.

2.2. Sample Identification

A total of 799 pregnant women with confirmed SARS-CoV-2 infection were initially identified based on RT-PCR test results, pregnancy status, and available religious affiliation data. The cohort consisted predominantly of asymptomatic or mildly symptomatic infections based on standardized symptom screening protocols implemented during the study period. Of these, 190 individuals (23.8%) were excluded because the religious affiliation question was unanswered. Because religious affiliation represented the primary exposure variable, individuals with missing responses could not be categorized and were therefore excluded from analysis.
The final analytic cohort consisted of 609 participants, including 302 women categorized as religiously affiliated (RA+) and 307 categorized as non-affiliated (RA−). Psychiatric diagnoses (referred to herein as mental health conditions) were identified through review of clinical documentation within the electronic medical record and were considered present if a diagnosis was recorded either prior to pregnancy or during the index pregnancy. No standardized diagnostic interviews or validated symptom rating scales were used in this retrospective analysis. No imputation procedures were performed for missing religious affiliation data because the variable represented the primary grouping exposure.

2.3. Statistical Analysis

Continuous variables were assessed for normality using the Kolmogorov–Smirnov test and are presented as mean ± standard deviation (SD) when normally distributed or as median with interquartile range (IQR) when non-normally distributed. Categorical variables are summarized as frequencies and percentages.
Between-group comparisons were performed using Student’s t-tests for normally distributed continuous variables and the Mann–Whitney U test for non-parametric variables. Fisher’s exact test was used to compare categorical variables between the religiously affiliated and non-affiliated groups.
To account for potential confounding, multivariable logistic regression analyses were performed to evaluate associations between religious affiliation and psychiatric outcomes while adjusting for demographic variables that differed significantly between groups, including maternal age, race, marital status, and educational attainment.
All statistical analyses were performed with GraphPad Prism version 9 (San Diego, CA, USA) and SPSS Statistics version 27 software (Armonk, NY, USA: IBM Corp). A two-sided p value < 0.05 was considered statistically significant.

3. Results

3.1. Demographics

There was no difference between the two groups in mean age at time of delivery (RA+: 30.7 ± 5.4 vs. RA−: 30.1 ± 5.4, p = 0.13) or employment status (75.8% vs. 74.3%, p = 0.70). RA+ women were more likely to be White (86.4% vs. 79.2%, p = 0.02), non-Hispanic (91.0% vs. 81.8%, p < 0.001), married (73.8% vs. 60.9%, p < 0.001), and to have an associate’s or bachelor’s degree (RA+ vs. RA−: 56.6% vs. 44%, p = 0.002) (Table 1).

3.2. Psychiatric Diagnoses

Among religiously affiliated women, 54% (n = 165) had a psychiatric diagnosis. Depression or other mood disorders were present in 26% (n = 80), and anxiety disorders in 28% (n = 85). Among patients with no religious affiliation, 48.6% (n = 147) had a psychiatric diagnosis. Depression or other mood disorders were present in 23.8% (n = 72), and anxiety disorders in 24.8% (n = 75). Psychotropic medication during pregnancy was documented in 15% of religiously affiliated women (n = 44) and 11.2% of non-affiliated women (n = 34) (p = 0.20). Eleven percent of pregnant women without religious affiliation and psychiatric diagnoses (n = 34) received a psychotropic medication during pregnancy (p = 0.20). The most commonly prescribed antidepressant/anxiolytic was sertraline in the religious group, 7% (n = 21), and the non-religious affiliated group, 5.3% (n = 16) of patients (p = 0.30). In addition, documented substance use during pregnancy was present in 6.0% (n = 18) of religiously affiliated women and 7.6% (n = 23) of non-religiously affiliated women (p = 0.50). The most commonly documented substances were nicotine use in 2.0% (n = 5) of the religious group and 2.6% (n = 8) of the non-religious group. Cannabis use was documented in 1.0% (n = 2) of the religiously affiliated group and 1.7% (n = 5) of the non-affiliated group. Other psychiatric diagnoses and pharmacotherapies are listed in Table 2.
To account for demographic differences between groups, adjusted analyses were performed. Multivariable logistic regression analyses adjusting for age, race, marital status, and educational attainment yielded results consistent with the primary bivariate analyses. Religious affiliation was not significantly associated with any psychiatric comorbidity (adjusted OR 1.30, 95% CI 0.90–1.88), depression (adjusted OR 1.21, 95% CI 0.81–1.81), or anxiety (adjusted OR 1.12, 95% CI 0.76–1.64).

3.3. COVID-19 Symptoms

Overall, 33% percent of participants reported COVID-19 symptoms. The most commonly reported symptoms were new or worse cough or shortness of breath, loss of smell and muscle aches. No significant differences were observed between the two groups except for a significantly higher proportion of women in the religiously affiliated group reporting diarrhea (Table 3).

3.4. Obstetrical History

The mean age at delivery was 30.5 years for the religious group and 29.7 years for the non-religiously affiliated group. Multigravid patients accounted for 57.3% of patients in the religiously affiliated group compared to 59.9% of patients in the non-religiously affiliated group (p = 0.50). Primigravid patients accounted for approximately a quarter in both groups, and grand multigravid patients (≥5 pregnancies) accounted for approximately 15% of patients in both groups. There were no statistically significant differences in the number of full-term births between groups. A history of one previous abortion was reported in 26.1% of the non-religiously affiliated group (n = 80) compared to 6.6% (n = 20) in the religiously affiliated group (p < 0.001). Habitual (≥3) abortions were reported in 3.6% (n = 11) of the non-religiously affiliated group compared to 0.3% of the religiously affiliated group (p = 0.01). The percentage of patients with one living child was 31.8% and 29.6% in the religiously affiliated group and non-religiously affiliated group, respectively (p = 0.60). The groups did not differ with respect to the numbers of living children. There were no significant between-group differences in medical comorbidities. Morbid obesity (>40 Kg/m2) was documented in 13.2% and 16.3% of the groups, respectively (p = 0.30). Gestational diabetes was reported in 10.9% and 17.6% (p = 0.20), gestational hypertension in 13.2% and 12.1% (p = 0.70), preeclampsia in 3.0% and 6.5% (p = 0.06), hypothyroidism in 6% and 6.2% (p > 0.90), anemia in 9.6% and 10.1% (p = 0.90), asthma in 9.6% and 7.2% (p = 0.30) and Group B Streptococcal infection in 15.2% and 15.0% (p > 0.90) (Table 4).

3.5. Labor and Delivery

Mean gestational age at delivery (in weeks) did not differ between the groups (religious affiliation: 38.6 ± 2.1 weeks vs. non-affiliated: 38.8 ± 1.7 weeks, p = 0.23). The two groups did not differ significantly in terms of their labor history. Preterm labor (birth before 37 weeks of gestation) occurred in 8.9% of the religious-affiliated group compared to 11.1% of the non-religious-affiliated group (p = 0.42). There was a non-significant trend for higher rates of labor induction in the religiously affiliated group compared with the non-affiliated group [49.2% (n = 148) vs. 41.7% (n = 128), p = 0.07], while epidural anesthesia was applied in 61.8% and 57.7% (p = 0.36) in the two groups, respectively. Normal vaginal delivery occurred in 64.1% and 63.2% (p = 0.80), and 3.0% and 2.6% (p = 0.80) had instrumental delivery, respectively. Cesarean delivery was performed in 28.2% and 29.6% (p = 0.70) of the two groups, respectively. The most common maternal complication during labor was fetal heart rate abnormalities occurring in 12% of the religiously affiliated group and 9.8% of the non-religiously affiliated group (p = 0.40). Additional obstetric and labor outcomes are shown in Table 4.

4. Discussion

This study demonstrated a high prevalence of religious non-affiliation among young pregnant women with SARS-CoV-2 infection. Both religiously affiliated and non-affiliated groups had elevated rates of depression, anxiety, and antidepressant treatment compared with national estimates. Contrary to expectations based on prior literature, psychiatric outcomes did not differ significantly according to religious affiliation. The absence of significant associations persisted after adjustment for key demographic variables, suggesting that differences in race, marital status, and educational attainment did not account for the observed similarity in psychiatric outcomes between groups.
As anticipated, religiously affiliated women were more likely to be married, to have higher levels of educational attainment, and to report fewer prior abortions. Taken together, the findings indicate that in this cohort of SARS-CoV-2-positive pregnant women, self-reported religious affiliation alone was not associated with differences in psychiatric outcomes, suggesting that affiliation status by itself may not capture dimensions of religiosity or coping previously linked to mental health outcomes. The absence of statistically significant associations should be interpreted cautiously, particularly given the inability to establish temporal sequencing between exposures and outcomes. These findings may reflect limitations in measurement, variability in clinical documentation, or residual confounding rather than the absence of a relationship between religious factors and mental health. To our knowledge, this is the first study examining religious affiliation among pregnant women with confirmed SARS-CoV-2 infection.
Religious non-affiliation has increased substantially in the United States over recent decades [14]. From the 1970s through the 1990s, according to various national surveys, the proportion of U.S. adults identifying as having no religion was estimated to be 7% [15]. This proportion has steadily increased since that time period. In 2010, according to the General Social Survey, the proportion of U.S. adults identifying as having no religion was estimated to be 18% [15]. By 2021, various estimates suggest between 20% and 26% of U.S. adults identify as non-religiously affiliated [14,16]. As noted above, about half of the pregnant women in this cohort reported no religious affiliation. This proportion is approximately double national estimates of religious non-affiliation [17] and may be explained by irreligiosity being under-reported in U.S. surveys [18]. Also, the mean age of the non-religious affiliated group was 29.4, which may reflect a younger demographic than those represented in national surveys.
Religious nonaffiliates represent a diverse group of various sexes, age ranges, ethnicities, and socioeconomic status variations [19,20]. In contrast, religious affiliation is associated with several demographic variables including a higher marriage rate [21]. Forty-four percent of Americans identify as White Christian, and 26% of Americans identify as Christians of color [22]. Non-Christian religious groups in the U.S. represent 4% of Americans [22]. In our study, pregnant women with religious affiliation were more likely to be non-Hispanic White individuals and Black or African American individuals. This finding is consistent with other research studies [23].
Religious affiliation has a strong association with women’s attitudes about abortion [24]. In the U.S., religion is one of the strongest predictors of a woman’s view on abortion [25]. Despite a clear relationship between these variables, there are more complex factors involved. Religiously affiliated women may be less likely to have premarital sex [26], have sex later in life than non-religiously affiliated women [27], and have fewer lifetime sex partners [26,28]. The findings of our study are consistent with previous findings and reveal lower abortion rates among religiously affiliated pregnant women.
Prior research has demonstrated associations between religiosity, spiritual engagement, and religious coping practices and improved mental health outcomes during pregnancy. Prior studies demonstrating protective associations between religion and mental health have frequently assessed religious practice or coping strategies rather than affiliation status alone, which may account for differences between those findings and the results observed in the present study. Higher levels of religiosity have been associated with lower rates of depressive symptoms in pregnant women [29]. Religious or spiritual coping strategies have been linked to better psychological quality of life, whereas the absence of such coping strategies has been associated with higher levels of depressive, anxious, and stress-related symptoms in pregnant women [30]. Studies examining religious practices have also reported lower rates of mood and anxiety disorders among pregnant women reporting greater religious engagement [31]. However, findings are nuanced; increased use of positive religious practices has been associated with reduced anxiety, while negative or passive religious coping strategies may be associated with worse psychological outcomes [32]. Importantly, these studies primarily assessed religious practice, coping style, or degree of religiosity, whereas the present study evaluated self-reported religious affiliation only, which represents a distinct construct and may partially explain differences between prior findings and the results observed in this cohort. Thus, the absence of observed differences in psychiatric outcomes in this study should be interpreted within the context of measuring affiliation status rather than religious behavior or coping mechanisms.
Our study revealed no clinically significant difference in the prevalence of psychiatric diagnoses or antidepressant treatment. Both groups had high rates of depression, anxiety, and substance use. These findings are in contrast to previous studies demonstrating that pregnant women showing more depressive and anxiety symptoms have negative religious coping skills [33]. In addition to traditionally higher rates of mood and anxiety disorders in expectant mothers, the external stressor of the COVID-19 pandemic has contributed significantly to increased rates of mood and anxiety disorders [34]. The rates of antenatal depression and anxiety disorders have been shown to be higher during the COVID-19 pandemic [35]. In a study by Bin-Nun et al., the COVID-19 pandemic was associated with worse psychosocial well-being among mothers, and religious practices were not protective against stress [36]. The protective effects of religious affiliation in previously studied cohorts may reflect coping under less distressing environmental conditions. It is possible that the pervasive uncertainty and societal disruption associated with the COVID-19 pandemic attenuated potential buffering effects of religious identification alone. Women in this cohort faced the potentially life-threatening effects of COVID-19 infection, along with that of their fetus. In addition to the direct medical effects of the infection, many dealt with social isolation and constant changes to daily societal life [33]. Furthermore, a significant positive correlation was observed between pregnant women’s fears of COVID-19 and depression in another study [37].
There were no differences between the groups in the course, delivery method, or outcome of pregnancy. In one study of all pregnancies completed during a COVID-19-associated hospitalization, 2.2% resulted in pregnancy losses [38].
This study has several important strengths and limitations. A key strength of this study is the relatively large cohort of pregnant women evaluated during the COVID-19 pandemic, which enabled examination of the relationship between self-reported religious affiliation and psychiatric diagnoses. The use of clearly defined inclusion criteria and multivariable statistical adjustment enhances the internal validity of the findings. The use of an empirical clinical cohort from a major academic healthcare system enhances the real-world applicability of the study findings.
However, this study has some limitations. First, psychiatric diagnoses were identified using routine clinical documentation within the electronic medical record rather than standardized diagnostic interviews or validated symptom scales. As a result, diagnoses may reflect variability in clinician documentation practices and may underestimate the true prevalence of psychiatric conditions due to underrecognition or underdocumentation. Additionally, information regarding symptom severity and temporal course was not consistently available, limiting more granular characterization of psychiatric illness. At the same time, chart-based diagnostic ascertainment reflects real-world clinical practice and may better reflect clinical practice than research-only diagnostic procedures.
Second, the exclusion of 190 women who did not respond to the religious affiliation question may have introduced selection bias and may limit the generalizability of the study’s findings. Additionally, the cohort was drawn from a single healthcare system in the Midwest, which may further limit representation of broader demographic or geographic populations. The study’s cross-sectional design prevents the determination of causality between religious affiliation and mental health outcomes. Additionally, the temporal relationship between psychiatric symptoms, pregnancy, SARS-CoV-2 infection, and religious affiliation cannot be determined. Psychiatric diagnoses may have preceded pregnancy or infection, emerged during these periods, or influenced how individuals reported religious affiliation. As such, the directionality of observed associations remains uncertain and interpretations should be limited to contemporaneous associations rather than temporal or causal relationships.
An additional limitation relates to missing data for religious affiliation. Approximately 24% of the initially identified cohort did not complete the religious affiliation question and were excluded from analysis. This level of missingness introduces the possibility of selection bias if individuals who declined to report religious affiliation differed systematically from those included in the final cohort. For example, nonresponse may have been associated with personal beliefs, cultural factors, or clinical characteristics not captured in the dataset. Because demographic and clinical data were incomplete for excluded individuals, formal comparison between included and excluded participants was not feasible. Accordingly, the final analytic sample may not fully represent all SARS-CoV-2-positive pregnant women within the healthcare system, and findings should be interpreted with consideration of potential limitations in generalizability.
Finally, a key limitation of this study is that religious affiliation was assessed as a binary self-reported variable, and measures of religiosity, spiritual engagement, or religious coping styles were not included. Consequently, the study cannot evaluate psychological mechanisms through which religion may influence mental health outcomes, and interpretations should not be extended beyond affiliation status. Despite these limitations, the study highlights the need for further research examining multiple dimensions of religious experience, including religiosity, spiritual engagement, and coping practices, in relation to mental health during times of crisis.
The findings of this study suggest a high prevalence of religious non-affiliation among young Midwestern pregnant women with confirmed SARS-CoV-2 infection. Rates of depression, anxiety, and substance use were similar between religiously affiliated and non-affiliated groups. These findings highlight the importance of distinguishing between religious affiliation and broader dimensions of religious experience when examining mental health outcomes in high-stress clinical populations. Future prospective studies incorporating measures of religiosity, coping style, social support, and pandemic-related stress exposure are needed to further clarify these relationships in more diverse populations.

Author Contributions

Conceptualization, C.J.E., K.M.P., H.G.K., T.D.S. and O.A.A.; Methodology, C.J.E., V.N.N. and O.A.A.; Formal Analysis, C.J.E., V.N.N., T.D.S. and O.A.A.; Validation, C.J.E.; Investigation, C.J.E., V.N.N., M.J.V.L., S.S., M.A. and O.A.A.; Resources, K.M.P. and H.G.K.; Data Curation, C.J.E., V.N.N., M.J.V.L., S.S. and M.A.; Writing—Original Draft Preparation, C.J.E.; Writing—Review and Editing, C.J.E., T.D.S. and O.A.A.; Visualization, C.J.E. and O.A.A.; Supervision, K.M.P., T.D.S. and O.A.A.; Project Administration, O.A.A. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

This study was approved by the Institutional Review Board of the Mayo Clinic and COVID-19 Research Task Force (ID: 21-010940). IRB Approval Date: 11 November 2021.

Informed Consent Statement

Patient consent was waived due to the retrospective nature of the study and the use of limited identifiers from electronic medical records.

Data Availability Statement

The data that support the findings of this study contain identifiable patient information, including names and medical record numbers, and cannot be shared publicly due to ethical and legal restrictions related to patient confidentiality. The data are protected under institutional policies and data protection laws. De-identified data may be made available upon reasonable request and pending appropriate ethical approvals and data use agreements. Requests should be directed to Claudine Egol, MD, email: egol.claudine@mayo.edu.

Conflicts of Interest

The authors declare no conflicts of interest.

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Table 1. Demographics.
Table 1. Demographics.
DemographicsRA+ (n = 302)RA− (n = 307)p Value
Maternal age groups (years) at time of delivery <25 47 (15.6%)61 (19.9%)0.17
25–35 195 (64.6%)195 (63.5%)0.08
>3560 (19.9%)51 (16.6%)0.34
RaceWhite261 (86.4%)243 (79.2%)0.02
Black or African American23 (7.6%)11 (3.6%)0.03
Other or missing18 (6.0%)53 (17.3%)p < 0.001
Ethnicity Hispanic24 (7.9%)49 (16.0%)0.003
Non-Hispanic275 (91.1%)251 (81.8%)p < 0.001
Missing 3 (1.0%)7 (2.3%)0.34
Marital status Single65 (21.5%)117 (38.1%)p < 0.001
Married223 (73.8%)187 (60.9%)p < 0.001
Other or missing14 (4.6%)3 (1.0%)0.01
Educational level ≤high school 73 (24.2%)95 (30.9%)0.07
Associate’s or Bachelor’s degrees171 (56.6%)135 (44.0%)0.002
Higher education 25 (8.3%)26 (8.5%)1.00
Missing 33 (10.9%)51 (16.6%)0.05
Employment status Unemployed62 (20.5%)70 (22.8%)0.56
Employed (full time, or part time) 229 (75.8%)228 (74.3%)0.71
Student 7 (2.3%)6 (2.0%)0.79
Missing 4 (1.3%)3 (1.0%)0.72
Table 2. Psychiatric Diagnoses.
Table 2. Psychiatric Diagnoses.
Psychiatric DiagnosesRA+ (n = 302)RA− (n = 307)p Value
Any 165 (54%)147 (48.6%)0.10
Depression or other mood disorders80 (26%)72 (23.8%)0.40
Anxiety disorders85 (28%)75 (24.8%)0.31
Prescribed antidepressant medications during pregnancy Any medications44 (15%)34 (11.2%)0.23
Sertraline21 (7%)16 (5.3%)0.40
Escitalopram6 (2%)7 (2.3%)p > 0.99
Citalopram3 (1%)4 (1.3%)p > 0.99
Fluoxetine4 (1%)2 (0.7%)0.45
Duloxetine3 (1%)2 (0.7%)0.68
Buspirone5 (2%)4 (1.3%)0.75
Bupropion or Bupropion XL4 (1%)2 (0.7%)0.45
Venlafaxine or desvenlafaxine2 (1%)2 (0.7%)p > 0.99
Paroxetine1 (0%)0 (0%)0.50
Alprazolam4 (1%)0 (0%)0.06
Not mentioned8 (3%)3 (1.0%)0.14
Drug use during pregnancyAny18 (6%)23 (7.6%)0.52
Nicotine5 (2%)8 (2.6%)0.58
Cannabis2 (1%)5 (1.7%)0.45
Cannabis + Nicotine2 (1%)0 (0.0%)0.25
Cannabis + Methamphetamine1 (0%)1 (0.3%)p > 0.99
Cannabis + Ketamine1 (0%)0 (0%)0.50
Alcohol1 (0%)3 (1.0%)0.62
Methamphetamine1 (0%)1 (0.3%)p > 0.99
Stimulant + Synthetic marijuana 1 (0%)0 (0%)0.50
Opioid1 (0%)0 (0%)0.50
Not mentioned3 (1%)0 (0%)0.12
Table 3. COVID-19 Symptoms.
Table 3. COVID-19 Symptoms.
COVID-19 Symptoms RA+ (n = 302)RA− (n = 307)p Value
New or worse cough or Shortness of breath17 (5.6%)13 (4.2%)0.46
Loss of smell15 (5.0%)11 (3.6%)0.43
Diarrhea 13 (4.3%)4 (1.3%)0.03
Muscle aches 13 (4.3%)7 (2.3%)0.18
Fever 11 (3.6%)7 (2.3%)0.35
Loss or change of taste11 (3.6%)8 (2.6%)0.49
Chills 9 (3.0%)3 (1.0%)0.09
Sore throat 7 (2.3%)6 (2.0%)0.79
Respiratory distress 5 (1.7%)1 (0.3%)0.12
Table 4. Maternal Data.
Table 4. Maternal Data.
Maternal and Obstetric CharacteristicsRA+ (n = 302)RA− (n = 307)p Value
Maternal age at time of delivery 30.7 ± 5.430.1 ± 5.40.13
Number of pregnanciesPrimigravida (1st pregnancy) 67 (22.2%)68 (22.1%)0.99
Multigravida (2–4 pregnancies)173 (57.3%)184 (59.9%)0.51
Grand multigravida (≥5 pregnancies)46 (15.2%)47 (15.3%)0.99
Missing data 15 (5.0%)8 (2.6%)0.14
Number of full-term birth(s)065 (21.5%)72 (23.5%)0.63
1103 (34.1%)95 (30.9%)0.44
267 (22.2%)73 (23.8%)0.70
≥351 (16.9%)59 (19.2%)0.46
Missing data 15 (5.0%)8 (2.6%)0.14
History of preterm labor 27 (8.9%)34 (11.1%)0.42
Number of previous abortion(s)0259 (85.8%)183 (59.6%)p < 0.001
120 (6.6%)80 (26.1%)p < 0.001
26 (2.0%)25 (8.1%)p < 0.01
≥31 (0.3%)11 (3.6%)0.01
Missing data 15 (5.0%)8 (2.6%)0.14
Number of living children 061 (20.2%)68 (22.1%)0.62
196 (31.8%)91 (29.6%)0.60
270 (23.2%)74 (24.1%)0.85
≥359 (19.5%)66 (21.5%)0.62
Missing data 15 (5.0%)8 (2.6%)0.14
Medical history BMI < 30 Kg/m2118 (39.1%)110 (35.8%)0.45
BMI 30–40 Kg/m2143 (47.4%)145 (47.2%)0.99
BMI > 40 Kg/m240 (13.2%)50 (16.3%)0.31
Gestational diabetes33 (10.9%)54 (17.6%)0.21
Hypothyroidism 18 (6.0%)19 (6.2%)0.99
Hypertension40 (13.2%)37 (12.1%)0.72
Preeclampsia 9 (3.0%)20 (6.5%)0.06
Anemia 29 (9.6%)31 (10.1%)0.89
Asthma29 (9.6%)22 (7.2%)0.31
Group β Streptoccal infection 46 (15.2%)46 (15.0%)0.99
Labor quantitative dataGestational age at time of delivery (weeks) 38.6 ± 2.138.8 ± 1.70.23
Preterm labor (<37 weeks) 24 (8.0%)21 (6.8%)0.64
Induced labor 148 (49.2%)128 (41.7%)0.07
Epidural anesthesia 186 (61.8%)177 (57.7%)0.36
Normal vaginal delivery 193 (64.1%)194 (63.2%)0.87
Instrumental delivery 9 (3.0%)8 (2.6%)0.81
Cesarean delivery (All) 85 (28.2%)91 (29.6%)0.72
Cesarean delivery for fetal indication 34 (11.3%)28 (9.1%)0.42
Maternal complications during laborPremature rupture of membrane6 (2.0%)4 (1.3%)0.54
Group β Streptococcal infection 5 (1.7%)4 (1.3%)0.75
Chorioamnionitis2 (0.7%)4 (1.3%)0.69
Cord prolapse or nuchal cord12 (4.0%)19 (6.2%)0.27
Obstructed labor/failure to progress 15 (5.0%)16 (5.2%)0.99
Precipitous labor (<3 h)13 (4.3%)10 (3.3%)0.53
Prolonged labor (>20 h)3 (1.0%)4 (1.3%)0.99
Placenta retained/manual extraction5 (1.7%)7 (2.3%)0.77
Fetal heart rate abnormalities36 (12.0%)30 (9.8%)0.44
Meconium5 (1.7%)8 (2.6%)0.58
Vaginal laceration21 (7.0%)23 (7.5%)0.88
Bleeding11 (3.7%)14 (4.6%)0.68
Apgar Score ≤ 3at 1 min9 (3.0%)7 (2.3%)0.62
at 5 min2 (0.7%)4 (1.3%)0.69
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Egol, C.J.; Piderman, K.M.; Koenig, H.G.; Nettey, V.N.; Van Ligten, M.J.; Aly, M.; Sinha, S.; Schneekloth, T.D.; Abulseoud, O.A. Self-Reported Religious Affiliation and the Prevalence of Psychiatric Disorders in a Cohort of 609 Asymptomatic and Mildly Symptomatic SARS-CoV-2-Positive Pregnant Women. COVID 2026, 6, 69. https://doi.org/10.3390/covid6040069

AMA Style

Egol CJ, Piderman KM, Koenig HG, Nettey VN, Van Ligten MJ, Aly M, Sinha S, Schneekloth TD, Abulseoud OA. Self-Reported Religious Affiliation and the Prevalence of Psychiatric Disorders in a Cohort of 609 Asymptomatic and Mildly Symptomatic SARS-CoV-2-Positive Pregnant Women. COVID. 2026; 6(4):69. https://doi.org/10.3390/covid6040069

Chicago/Turabian Style

Egol, Claudine J., Katherine M. Piderman, Harold G. Koenig, Victor N. Nettey, Matthew J. Van Ligten, Mohamed Aly, Shirshendu Sinha, Terry D. Schneekloth, and Osama A. Abulseoud. 2026. "Self-Reported Religious Affiliation and the Prevalence of Psychiatric Disorders in a Cohort of 609 Asymptomatic and Mildly Symptomatic SARS-CoV-2-Positive Pregnant Women" COVID 6, no. 4: 69. https://doi.org/10.3390/covid6040069

APA Style

Egol, C. J., Piderman, K. M., Koenig, H. G., Nettey, V. N., Van Ligten, M. J., Aly, M., Sinha, S., Schneekloth, T. D., & Abulseoud, O. A. (2026). Self-Reported Religious Affiliation and the Prevalence of Psychiatric Disorders in a Cohort of 609 Asymptomatic and Mildly Symptomatic SARS-CoV-2-Positive Pregnant Women. COVID, 6(4), 69. https://doi.org/10.3390/covid6040069

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