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LITERATURE REVIEW: CORELATION OF PHYSICAL AND STRESS CONDITIONS TO ANXIETY LEVELS OF PREGNANT WOMEN DURING

A PANDEMIC

1Anisa Rizda Nabila, ²Lia Kurniasari

1,2Public Health, Muhammadiyah University of East Kalimantan Ir. H. Juanda St., Number. 15 Sidodadi Samarinda, 75124

Penelitian ini merupakan penelitian dengan menggunakan metode Literatur Review sederhana dengan pendekatan sistematik. Literatur review di lakukan pada artikel- artikel terpilih yang berasal dari jurnal nasional dan jurnal internasional. Adapun pencarian artikel di lakukan pada beberapa database.. secara keseluruhan dapat di simpulkan bahwa berdasarkan analisis artikel diatas peneliti beramsusi bahwa terdapat Hubungan antara aktifitas fisik terhadap tingkat kecemasan ibu hamil selama masa pandemi juga terdapat Hubungan antara kondisi stress terhadap tingkat kecemasan ibu hamil selama masa pandemi. Ibu hamil yang melakukan Aktifitas fisik selama masa pandemi memiliki pengaruh yang signifikan dalam menurunkan kecemasan. Faktor stress, karena pola hidup, adanya konflik keluarga dapat mendorong ibu menjadi stress. Manfaat penelitian ini yaitu untuk menambah wawasan peneliti dan pembaca, serta dapat dijadikan sebagai referensi untuk penelitian selanjutnya.

Kata kunci: Aktifitas Fisik, stres, kecemasan, Ibu Hamil

ABSTRACT

This study was used A simple comprehensive Literature Review methodology. The articles for the literature review were chosen from both domestic and foreign periodicals. Google Scholar, Elsevier, PubMed, and Willey Library databases were used to search for the publications. Overall, it can be inferred from those publications that there is a correlation between stress conditions and pregnant women's anxiety levels during the pandemic, as well as between physical activity and anxiety levels.

Pregnant women who exercise dramatically lessen their anxiety, especially during the epidemic period.

Pregnant women experience stress for a variety of reasons, including their way of life, their families, and their economic situation, as well as their anxiety over access to prenatal care. The advantage of this.

Keywords: Physical activity, stress, anxiety, pregnant women

INTRODUCTION

The human body goes through significant developments during pregnancy as a result of physiological stress. Pregnant ladies must take care of their requirements during pregnancy. To prevent stress before delivery, pregnant women's psychological needs are just as important as their nutritional requirements. Up to 10% of pregnant women globally suffer mental health issues and depression, according to WHO (2020). In poor nations, this number is significantly higher, at 15.6%.(Rahman &

Urbayatun, 2021).

Pregnant women must have good psychological conditions so that the fetus in their body remains healthy, because of the high risk of impairment and death during pregnancy, which is determined by stressor levels, nutrition, and genetics. Stress levels have considerably increased during pregnancy by more than 76%, especially during the Covid 19 pandemic, and are dangerous to the fetus..

Physical activity that is focused and consistent can help to reduce stress and anxiety. Pregnant women

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gain from biological exercise in terms of fitness and mental health. Worries, obsessions, and concerns related to pregnancy, childbirth, neonatal health, and childrearing are referred to as prenatal anxiety- associated psychological discomfort. Anxiety is a typical reaction to demanding circumstances. Thus, normal levels of anxiety associated to pregnancy aid pregnant women in following medical advice.

(Jayanti & Mayasari, 2020).

However, women's physical and mental health as well as the cognitive, emotional, and behavioral development of their offspring can be significantly impacted by severe pregnancy-related anxiety. Pregnancy-related stress is linked to health issues such intrauterine growth restriction, premature birth, cleft lip and palate, stillbirth, neonatal death, autism, ADHD, and neurodevelopmental impairments, according to various research. (Kusumawati, 2021) .

Anxiety disorders are one of the psychiatric disorders that pregnant women are particularly prone to. Research on anxiety in expectant mothers during the COVID-19 pandemic revealed that there was an increase in anxiety (Bender et al. 2020; Yassa et al. 2020; Purwaningsih 2020; Tantona 2020).

Pregnant women's elevated worry during the COVID-19 pandemic is linked to risks to their own health as well as the health of their unborn children, inadequate prenatal care, and social isolation. (Triyani, 2021).

One of the efforts that can be made to prevent bad psychological conditions during pregnancy is by doing physical activity. When doing physical activity, pregnant women can release energy and worries at the same time. Doing physical activity can help remove negative energy in the body to improve pregnant women's psychological condition. In addition, doing physical activities such as Kegel exercises, yoga, and swimming can help the delivery process (Indarwati K, Ayu Kurniawati A, 2019) . Doing light physical activities such as exercise, pregnancy exercise, swimming, walking, yoga, pilates, Kegel exercises to facilitate urination in pregnant women, jogging (light and relaxing jog), cycling, and other activities in cleaning the house such as mopping and sweeping These activities carried out by pregnant women if carried out regularly. The direction can provide benefits other than increasing happiness that triggers good psychological conditions for pregnant women so that they can prevent anxiety and the delivery process becomes smooth and comfortable so that it will reduce the incidence of maternal mortality and childbirth. On the other hand, if the activities of pregnant women are not controlled and excessive, it will be fatal (Setiawan et al., n.d.).

The COVID-19 pandemic causes psychiatric issues in pregnant mothers. The danger that COVID-19 poses to pregnant women and their unborn children, worries that prenatal care requirements won't be met, interpersonal conflicts, and social isolation all have an impact on anxiety problems.

Research by Durankus and Aksu (2020), which claims that the COVID-19 pandemic has an impact on pregnant women's anxiety in Turkey, demonstrates psychological issues in pregnant women. Then, the study by Mappa et al. (2020) claimed that the covid 19 outbreak had a substantial psychological impact

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(2020), pregnant women noticed a 50.7% rise in anxiety, which included 66.7% more worries about their pregnancy's condition and 50% more worries about caring for their unborn child. (Safitri et al., 2020).

Pregnancy-related anxiety is widespread (10–25%) in developing countries. The Iranian study, which measured pregnancy-related anxiety using a generalized anxiety questionnaire, reported prevalence rates of 32.5 and 40%, respectively. This pregnancy-related anxiety is primarily brought on by infectious illnesses, notably during epidemics and pandemics. Pandemics disturb groups because they have variable rates of impact on individuals and communities. Negative attitudes, stress, anxiety, sleep difficulties, and psychological resilience are frequently linked. (Effati-Daryani et al., 2020).

According to Muzzayana, in 2021, stress levels are related to anxiety levels in pregnant women during the COVID-19 pandemic. The incidence of anxiety in pregnant women in Indonesia reaches 373 million. as much as 107,000,000 or 28.7% of anxiety occurs in pregnant women before the delivery process. Pregnancy-related factors like inactivity, stress, and anxiety levels contributed to a number of psychological problems in pregnant women during the COVID-19 pandemic. (Rahayu, 2019).

Based on the various exposures to the data above, it is necessary to conduct further studies regarding the relationship between physical activity and stress conditions on the anxiety level of pregnant women during the pandemic. This literature review aims to determine the relationship between physical activity and stress conditions on pregnant women's anxiety levels during the pandemic.

METHOD

This research uses a simple Literature Review method with a systematic approach. Literature searches were conducted online in English and Indonesian journals from databases such as Willey, Science Direct, Google Scholar, PubMed, and Elsevier within the last 3 years (2019-2022). Keywords in the literature search are physical activity, anxiety, stress, psychology of pregnant women, mental health, and the COVID-19 pandemic, and physical activity, anxiety, stress, psychology of pregnant women, mental health, and the COVID-19 pandemic in English keywords.

The search for published articles will be carried out using Keywords in the literature search:

physical activity, anxiety, stress, psychology of pregnant women, mental health, and the COVID-19 pandemic. On Willey, Science Direct, Google Scholar, PubMed, and Elsevier databases. The next stage is screening which includes duplication screening and full-text availability screening. The literature that has passed the screening is then checked for the fulfillment of its inclusion criteria, namely a time of 3 years (2019-2022) in English or Indonesian, quantitative, descriptive, qualitative, quantitative, mixed method, and meta-analysis types of studies. The literature selection was made using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) method.

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The author conducted an independent electronic database search for 31 days, from June 3, 2022, to June 4, 2022. Initially, the author searched each database using keywords. Then the author explores the research title and reads the abstract based on the search results from writing keywords. The title of the research and the abstract are according to the inclusion criteria, followed by reading the full article amount 26 consisting of 18 stress and anxiety journals and 8 physical activity and anxiety journals.

After the publication, articles are obtained and selected through the PRISMA method. They are summarized in the form of a summary table. Research articles relevant to the research objectives are collected and summarized in a summary table. The table includes the researcher's name, the year the journal was published, the study's title, the method, and a summary of the findings. The next step is for the selected articles to be analyzed, synthesized, and written in narrative form by comparing and identifying similarities and differences between the chosen publication articles.

RESULTS AND DISCUSSION

Search for journal articles using accredited journal sites from Willey, Science Direct, Google Scholar, PubMed, and Elsevier searches. by using the keywords (Physical Activity), (anxiety levels AND depression), (stress), (pregnant women), (mental health AND psychological) and (covid-19 pandemic). The total search results for journals with predetermined keywords are 1010, with details of Google Scholar as many as 900 journals, Pubmed as many as 48 journals, Elsevier as many as 62. Next, screening was carried out, including screening for duplication of 203 journals. Subsequently, the full- text article was screened, and 61 journals were obtained. The last stage was the selection of inclusion and exclusion criteria so that 26 journals were obtained that met the researcher's criteria for the research criteria for review.

Of the 26 articles analyzed and synthesized, 18 were grouped into types of stress and anxiety in pregnant women, and 8 were grouped into types of physical activity and pressure. The search results for articles from the studies carried out are all grouped into tables, as shown in tables 1 and 2.

Table 1. Stress and Anxiety Review Results

No Author Title Method Research result

1. (Çolak et al., 2021) The level of depression, anxiety, and sleep quality in pregnancy during the coronavirus disease 2019 pandemic

Quantitative with Cross-Sectional Study

Subject: Pregnant Women

Pregnant women may experience sadness, anxiety, and sleep difficulties as a result of the COVID-19 pandemic.

Pregnant women who were isolated at home also scored higher for despair and anxiety than those who weren't quarantined. Sleep quality declines and mental health issues get worse as the weeks of pregnancy go on

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2. (Puertas-Gonzalez et al., 2022)

Resilience, stress, and anxiety in pregnancy before and throughout the pandemic a structural equation modeling approach

Pregnant women have less stress because they spend more time at home and experience less everyday tension from lockdowns and limitations. On the basis of everything

mentioned above, this study has important clinical implications.

3. (Bakır et al., 2021) Relationship of Depression, Anxiety, and Stress Levels with religious coping strategies among Turkish pregnant women during the covid 19 pandemic

Due to the risk of negative obstetric outcomes such intrauterine fetal mortality or fetal abnormalities, pregnant women often experience significant levels of stress and worry. During an infectious disease outbreak, stress and worry among people may rise.

In this study, Turkish pregnant women during the COVID-19 pandemic are examined for their levels of depression, anxiety, stress, and religious coping. It was discovered that severe stress symptoms affected 52.3% of pregnant women, severe depression affected 19.9%, and severe anxiety affected 97.9%. During the COVID-19 epidemic, pregnant women who were concerned about their health were seen to have more effective religious coping than those who were not.

4. (Zilver et al., 2021) Stress, anxiety, and depression in 1466 pregnant women during and before the covid 19 pandemic, a dutch cohort study

Quantitative with cohort studies Subject: Pregnant Women

Those who blamed the COVID- 19 pandemic for their stress had higher stress levels than women who did not. This finding raises the possibility that interventions geared specifically at reducing COVID-19 stress could help reduce stress dramatically.

pregnant women at all levels during the pandemic.

5. (Stepowicz et al., 2020)

Stress and Anxiety Levels in Pregnant and post-partum women during the covid 19 pandemic

According to the study, the polled patients reported moderate to severe levels of stress and anxiety. We demonstrate that women who are unmarried or in casual relationships, have a history of psychiatric treatment, are

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No Author Title Method Research result pregnant in the first trimester, and suffer greater levels of psychological discomfort and anxiety. Age, education, parity, previous obstetric history, comorbidities, and the number of hospitalizations were not considered statistically significant factors in the analysis. Our research can be utilized to identify patients who are more likely to suffer from negative mental consequences and give them the necessary psychological care.

6. (Preis et al., 2020) Pandemic-related pregnancy stress and anxiety among women pregnant during the

coronavirus disease 2019 pandemic

The significant stress that pregnant women endured during the COVID-19

pandemic is shown by the high incidence of mild, moderate, and severe anxiety in this population. Over and above pertinent sociodemographic, obstetric, and other health considerations, the stress associated with labor preparation during the pandemic and worries about COVID-19 infection in oneself and one's child can raise a woman's risk of having moderate or severe anxiety.

7. (Shirabe et al., 2021)

Changes in Anxiety and Stress Among Pregnant women during the covid 19 pandemic

During the COVID-19 pandemic, pregnant Japanese women expressed anxiety about infection. According to

previous reports, transportation and members of many pregnant women are anxious about the disease. Stress anxiety and emotional support were found in this study, and in previous studies, the prevalence of severe anxiety/depression increased by 30%

8. (Sirait et al., 2021) Stress and Anxiety in the Maternal During the COVID-19

Quantitative with Descriptive Study Subject: Pregnant Women

Pregnant women experienced significantly more worry and anxiety with symptoms after the coronavirus was declared a pandemic than they had previously. Self-harming ideas were more prevalent in

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pregnant women (P14.005).

The number of newly

confirmed coronavirus cases in 2019 (P14.003), suspected infections (P14.004), and daily deaths were all strongly correlated with stress and anxiety levels (P.001).

9. (Durankuş & Aksu, 2020)

Effects of the COVID 19 pandemic on anxiety and depressive symptoms in pregnant women a preliminary study

In this study, 35.4% of pregnant women had an EPDS score of 13 or above, and the case group's anxiety and depressive symptoms were considerably worse than the control group's, as measured by the BAI and BDI, respectively. According to the BDI results, pregnant women experience depressed episodes, whereas the BAI results suggest that they are more anxious than usual.

10. (King et al., 2021) Pregnancy during the pandemic, the impact of covid 19 related stress on risk for prenatal depression

Quantitative with cohort studies Subject: Pregnant Women

In this study, we investigate the COVID-19 pandemic

experiences of pregnant women, including their

exposure to stress and adversity and the resulting depressive symptoms. More over 40% of the 725 women we polled reported probable anxiety and depression symptoms. Women who became pregnant during the epidemic were also almost twice as likely to experience stress and depression compared to a sample of women who did so before the outbreak. The experiences of expectant women with COVID-19 can be divided into two categories:

emotional COVID-19 stress and objective COVID-19 difficulty.

11. (Kahyaoglu Sut &

Kucukkaya, 2021)

Anxiety, depression, and related factors in pregnant women during the covid 19 pandemic in turkey

During the COVID-19 pandemic, anxiety and depression have become much more common in pregnant women. Low levels of education, a lack of regular exercise, discomfort from in- person hospital visits, and ignorance of the effects of COVID-19 on pregnancy are

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No Author Title Method Research result all significant risk factors for the development of anxiety and depression in pregnant women.

Unemployment and a lack of knowledge about the effects of COVID-19 from physicians, nurses, and midwives are additional important risk factors for the condition.

12. (Akgor et al., 2021) Anxiety, depression, and concerns of pregnant women during the covid 19 pandemic

This study demonstrates that pregnant women experience anxiety. Babies are more likely to get the condition than pregnant mothers, which is a matter for concern.

Additionally, there is the worry that during the pandemic, you won't be able to reach a doctor.

Our research indicates that this disease is brought on by advanced maternal age and high anxiety levels, despite the fact that these worries are supported by science.

13. (Cameron et al., 2020)

maternal psychological distress and mental health service use during the covid-19 pandemic

Compared to previously reported demographic norms, maternal depression and anxiety appear to be rising in the setting of COVID-19. The COVID-19 pandemic's long- term effects on family wellbeing and child development can be avoided by using focused early intervention tactics that take into account the known risk factors for

depression and anxiety across a range of kid age groups.

14. (Dong et al., 2021) Investigation of the mental health status of pregnant women in China

Pregnant women's anxiety levels are the same as they were prior to the epidemic, but their levels of sadness are

significantly greater. During the COVID-19 outbreak, pregnant women in Wuhan, the disease's epicenter, were no more nervous or sad than pregnant women in other areas. Pregnant women with COVID-19 do not have more severe mental health issues

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15. (Ilska et al., 2022) Anxiety among pregnant women during the first wave of the covid 19 pandemic in Poland

More over one-third of respondents reported feeling moderately or severely anxious.

Non-pandemic related factors, such as unintended pregnancy, emotional and psychiatric issues, and pregnancy stress connected to the pandemic were predictors of moderate or severe anxiety. Pre-pandemic levels of anxiety were exceeded among pregnant mothers in Poland during the first wave of the COVID-19 pandemic. The results imply that the high anxiety risk in Polish pregnant women during the pandemic's commencement was influenced by prior psychiatric illnesses, unplanned pregnancies, and heightened pandemic-related pregnancy stress due to fears about infection or inadequate preparation for birth. Given the detrimental impact of prenatal anxiety on the health and wellbeing of mothers and their children, stress-reduction measures, psychotherapy therapies, and instruction in coping mechanisms are all necessary.

16. (Lebel et al., 2020) Elevated depression and anxiety

symptoms among pregnant individuals during the COVID- 19 pandemic

This finding suggests an alarming rise in anxiety and depressive symptoms in expectant women during the COVID-19 pandemic, which may have long-term effects on their offspring. Exercise and enhanced social support are important potential protective variables since they are linked to fewer symptoms and may hence aid to lessen the likelihood of long-term negative effects.

17. (Zainiyah &

Susanti, 2020)

Anxiety in Pregnant Women During Coronavirus (Covid- 19) Pandemic in East Java, Indonesia

Pregnant women's worry does increase as a result of the coronavirus pandemic, and this anxiety must be reduced to prevent harm to the mother and fetus. Counseling is required to

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No Author Title Method Research result lessen stress by advising mothers to remain at home, wash their hands, wear masks, consume wholesome food, monitor their pregnancies, engage in maternal exercise at home, and call for assistance in case of an emergency.

18. (Wu et al., 2020) Perinatal depressive and anxiety

symptoms of pregnant women during the

coronavirus disease 2019 outbreak in China

When relative to pregnant women assessed prior to the proclamation of the 2019 coronavirus disease epidemic, pregnant women assessed after the epidemic declaration exhibited significantly higher rates of anxiety and depressive symptoms (26.0% vs. 29.6%, P14.02). These women also had higher rates of suicidal thoughts (P14.005). The number of new confirmed cases of coronavirus disease in 2019 (P14.003), suspected infections (P.004), and daily deaths (P.004) were all positively correlated with anxiety and depression rates (P.001).

Table 2. Review Results of Physical Activity and Anxiety

Number Writer Title Method Research result

1. (Haßdenteufel et al., 2020)

Reduction In Physical Activity Significantly Increases Depression And Anxiety In The Perinatal Period A Longitudinal Study Based On A Self Report Digital

Assessment Tool

Quantitative with

Longitudinal Studies

Between the 20th and the 32nd week of pregnancy, we discovered a considerable decline in overall physical activity. Depression and anxiety scores were significantly higher in women who said they had more significant reductions during pregnancy. Only baseline mental health ratings were found to have a greater influence on postnatal depression and anxiety outcomes in the stratified analysis. Both during and after pregnancy, general physical activity and mother mental health have a considerable mutual impact. To prevent negative maternal and fetal outcomes, prenatal treatment should consistently promote both physical activity and the prevention of perinatal mental illnesses.

2. (MILA

ANGGRAINI;

of Pregnant Women's Classes

Quantitative by design

Between third-trimester pregnant women who attend programs for

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INTAN NUGRAHENI;

Sri Wahyuni M;

Elisa Ulfiana, 2021)

on Anxiety for Pregnant Women in the 3rd trimester During the Covid-19 Pandemic In the Work Area of the Bandar 02 Health Center, Batang Regency in 2020

quasi- experiment Subject:

Pregnant Women

pregnant women and those who do not during the COVID-19 pandemic, there is no discernible difference in the level of anxiety.

3. (Veftisia et al., 2020)

Prenatal Yoga in Reducing Anxiety and Stress Levels During the Covid-19 Pandemic

Qualitative with observation method Subject:

Pregnant Women

Researchers have demonstrated a connection between physical activity and anxiety through community service projects they have undertaken for expectant mothers. Researchers' Prenatal Yoga Activities for Pregnant Women in the Second and Third Trimesters of the Dala found that exercising, such as yoga, can help people feel less anxious and stressed during the Covid-19 epidemic.

4. (Nurfazriah &

Sakinah, 2021)

Reducing Mother's Anxiety By Taking Prenatal Yoga Classes for Pregnant Women

Quantitative with Pre Experiment Subject:

Pregnant Women

According to the results, 20 women (67% of the total) and 21 persons (70% of the total) in the 20–35 year age range were multigravida, which had the most parity mothers. Up to 25 pregnant women (83.3%) reported having moderate levels of maternal anxiety before giving delivery. After participating in prenatal yoga courses for expectant moms, 27 pregnant women (90% of them) reported an average stress level of mild anxiety.

This study demonstrates how prenatal yoga classes for pregnant women have an impact on lowering the incidence of anxiety in pregnant women preparing for childbirth.

5. (Hasriani, 2022) The Effect of Aerobic Dance on Anxiety in Third Trimester Pregnant Women at Puskesmas Solo

Quantitative with true experiment Subject:

Pregnant Women

Based on the study's findings, it can be stated that physical activities, such as aerobic dance, are more successful at lowering anxiety than other types of exercise, with a mean deviation of 12.2 and a p-value of 0.001.

6. (Dewi et al., 2019)

The Effect of Pregnancy Exercises on Anxiety Levels in Prenatal

Trimester III Mothers in Russia Cahaya Bunda

Quantitative with true experiment Subject:

Pregnant Women

From the results of research and discussions on the impact of pregnancy exercise on the level of anxiety of pregnant women in the third trimester at RSIA Cahaya Bunda Gerokgak Tabanan, it can be said that respondents' levels of anxiety before and after the intervention of pregnancy exercise were generally moderate.

Three times, some respondents saw their anxiety levels drop to mild anxiety. With a p-value of 0.05,

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Number Writer Title Method Research result statistical analyses revealed a significant relationship between the intervention of pregnant exercise and the level of stress in third-trimester pregnant women at RSIA Cahaya Bunda Gerokgak Tabanan.

7. (Hayati, 2020) Yoga To Relieve Anxiety Levels for Pregnant Women

Qualitative with observation method Subject:

Pregnant Women

Through physical activity, mental health, especially pregnancy anxiety, is lowered or removed. Yoga is one of the suggested physical activities since it is inexpensive, simple to perform, and advantageous for both physical and psychological fitness after the researchers offered health education and yoga instruction throughout pregnancy. It was discovered that pregnant women were becoming more informed about psychological changes and the benefits of yoga for coping with anxiety.

8. (Yuniza et al., 2021)

The Effect of Prenatal Yoga on Anxiety in Third Trimester Pregnant Women in Plaju. District

Quantitative with Quays Experiment Subject:

Pregnant Women

Exercise helps to improve or remove mental health, especially pregnancy anxiety. After the researchers gave health education and yoga instruction throughout pregnancy, they included yoga as one of the suggested physical exercises because it is inexpensive, simple to do, and advantageous for physical and psychological fitness. It was discovered that there was an improvement in pregnant women's knowledge of psychological changes and the benefits of yoga for coping with anxiety.

Based on the results of the selection of articles, 26 selected journal articles consisting of journals/articles from 4 databases obtained journals consisting of 20 international journal articles and 6 national journal articles. For this study, pregnant women were used as respondents. The method used is descriptive, quantitative, and qualitative. The results of a literature review are as follows:

Anxiety is a feeling of worry, nervousness, or anxiety about something with uncertain results and can accompany, influence, or cause depression.

The mother's readiness factor in facing childbirth during the Covid-19 pandemic is one of the effects of mothers experiencing excessive anxiety. This possibility is because the mother worries about the fetus's condition after birth. The Coronavirus disease will infect it impacts the baby's health.

According to Ervina PW, maternal readiness to face childbirth is one of the factors related to the anxiety pregnant women feel (Muzayyana & Saleh, 2021).

Several articles explain the factors that influence anxiety in pregnant women, namely social support (family), the threat of the spread and impact of Covid-19, physical activity, health services,

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Tall one).

Health status during pregnancy needs to be considered by pregnant women for the health of the mother and the fetus she contains. This can be achieved by performing directed and regular physical activity. Research (Elsanti & Yulistika, 2016) explains that pregnant women who often do activities regularly will have better body fitness. Physical activity for pregnant women, such as exercise, can be done for approximately 30-60 minutes to reduce fatigue.

Physical activity is the movement of limbs that expend energy to maintain physical and mental health and maintain quality of life to stay healthy and fit. Sport is one of the physical activities to keep the body healthy and fit. Pregnant women can do pregnancy exercises, swimming, walking, yoga, pilates, Kegel exercises to facilitate urination in pregnant women, jogging (light and relaxing jog), cycling, and other activities in cleaning the house such as mopping.

Activities carried out by pregnant women if carried out routinely and directed, then the delivery process becomes smooth and comfortable, so it will reduce the incidence of maternal mortality and childbirth, on the other hand, if the activities of pregnant women are not controlled and excessive, it will be fatal.

According to research by Kathrin in 2020, pregnant women aged 20 to 32 weeks who do regular physical activity can reduce anxiety and depression significantly. In line with further research conducted by Nurfarizah and Sakinah in 2021, it also concluded that pregnant women who routinely do physical activities such as classes with prenatal yoga influence reducing the incidence of anxiety in pregnant women facing childbirth. And research in 2022 conducted by Hasriani also produced similar results.

Hasriani concluded that physical activity, such as aerobic dance, was more effective in reducing anxiety.

Based on the above Study, it can be concluded that physical activity carried out by pregnant women, especially during the pandemic period, has a significant influence on the mental and psychological health of pregnant women because it can reduce the level of anxiety or stress felt by pregnant women. In addition to social support and physical activity, things that can be done to suppress anxiety or psychological disorders experienced by pregnant women by paying attention to their psychological needs of pregnant women include family support in the form of attention and affection, support from health workers in the form of moral support and the provision of health education regarding the condition. Pregnancy, a sense of security and comfort during pregnancy, and preparation for parenthood. Thus, this research can be said to be in line with previous research.

Changes in situations and conditions make individuals have to be able to think and act quickly in responding to everything that happens. This is important, especially in the current pandemic situation.

Individuals who can adapt to the situation can live their daily lives calmly. On the contrary, for individuals unable to adapt to all changes, it is not impossible to experience stressful conditions.

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Stress is the body's response that is non-specific to any demands on it. For example, how does a person's body respond when they experience an excessive workload? If the individual can handle it, it means that there is no disturbance in the function of the body's organs, then it is said that the person concerned is not experiencing stress.

According to Dayan et al (2006) in Huizink et al (2015), anxiety in pregnancy is relatively common, with around 10-15% of all pregnant women experiencing some level of anxiety or stress during this significant transition phase in one's life. Anxiety or anxiety is a feeling of worry, a fear that is not clear why. In this COVID-19 pandemic, there are many restrictions on almost all routine services, including maternal and neonatal health services. For example, pregnant women are reluctant to go to the puskesmas or other health care facilities for fear of infection.

According to research conducted by Zilver in 2021 in the Netherlands, it was found that women who linked their stress to the COVID-19 pandemic experienced higher levels of stress than women who did not associate their stress with the COVID-19 pandemic, indicating that interventions that significantly explicitly aimed at reducing the stress of COVID-19, can help reduce overall stress levels in pregnant women during the pandemic. Then a similar study conducted in Japan by Shirabe in 2021 said that during the COVID-19 pandemic, Japanese pregnant women expressed anxiety about infection.

According to previous reports, transportation and members of many pregnant women are anxious about infection. Stressful and emotional anxiety was found in this study, and in previous studies, the prevalence of severe anxiety/depression increased by 30%. In Poland, similar research on anxiety was also conducted by lska in 2022. The study concluded that anxiety levels among pregnant women during the first wave of the COVID-19 pandemic in Poland exceeded pre-pandemic norms. The findings suggest that previous psychiatric conditions, unplanned pregnancies, and increased pandemic-related pregnancy stress due to concerns about infection or poor preparation for birth contributed to the high anxiety risk in Polish pregnant women during the onset of the pandemic.

Thus, it can be concluded that stress and anxiety in pregnant women, especially during the COVID-19 pandemic, are still relatively high in various countries. All the literature reviewed in this literature review shows a significant effect on reducing stress and anxiety in pregnant women. Pregnant women can take steps to lower their stress levels by getting counseling; therapy is necessary to lower anxiety by advising moms to stay at home, wash their hands, wear masks, eat nourishing meals, monitor their pregnancies, and engage in physical activity.. Light exercises such as exercise for pregnant women at home, avoiding problems such as family and economic conflicts and seeking help when facing an emergency.

CONCLUSIONS AND SUGGESTIONS

Of the 26 articles conducted by the literature review, it was found that based on the analysis of the articles above, the researchers assumed that there was a relationship between physical activity and

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pandemic, the psychological condition of pregnant women can be said to be not good. Anxiety in pregnant women during the pandemic is caused by several things, such as the lack of treatment from a doctor during and after the pandemic and the fear of the baby being infected with the virus. Pregnant women have bad stress conditions that increase the anxiety felt by pregnant women during the pandemic.

Pregnant women who exercise during their pregnancies experience less stress and anxiety.

Physical exercise is linked to stress conditions and anxiety levels in pregnant women during the pandemic. Pregnant women who routinely do physical activity will have lower levels of anxiety and stress compared to pregnant women who do not do physical activity. Apart from doing physical activity, pregnant women also need to reduce stress-triggering factors that trigger anxiety.

ACKNOWLEDGMET

The author would like to thank the projected KDM (Student Lecturer Collaboration) at the Muhammadiyah University of East Kalimantan, which has supported completing the student thesis and publishing.

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