Is antenatal COVID-19-related stress associated with postpartum maternal mental health and infant outcomes?

In a recent study published in JAMA network openedresearchers assessed the relationship between stress associated with the 2019 coronavirus disease (COVID-19) in the prenatal period and the mental well-being of mothers and their babies in the postpartum period.

Study: Association of antenatal COVID-19-related stress with postpartum maternal mental health and negative affectivity in infants. Image credit: GrooveZ/Shutterstock


Studies have reported that prenatal stressors significantly increase the risk of adverse postpartum outcomes related to mental well-being, such as cognitive and behavioral problems in infants. Cases of anxiety and depression in pregnancy have increased significantly during the severe acute respiratory coronavirus 2 (SARS-CoV-2) pandemic, with reduced positive affectivity, impaired orienting behaviors and higher success rates in infants.

However, the link between COVID-19-associated stress and postpartum outcomes for mothers and babies is not fully understood. Previous studies evaluating the effects of prenatal stressors on maternal and child health outcomes have been largely cross-sectional, single-center, retrospective, with small sample populations, and often used unvalidated assessment measures without documentation of psychometric properties.

About the study

In the current longitudinal survey-based study, researchers evaluated the impact of antenatal SARS-CoV-2 infection-related stress on maternal and child postpartum mental health outcomes.

The study included 318 subjects ≥11.0 years of age who participated in the 2019 Coronavirus Disease, Lifetime Risk (CORAL) study, conducted in the United Kingdom (UK), United States (US), and Australia. Females who were pregnant at the first evaluation between May 5 and September 30, 2020 and completed two follow-up evaluations between October 28, 2021 and April 24, 2022 at three-month intervals were eligible for the analysis.

In addition, participants were invited to complete a fourth survey on the mother’s mental well-being and child’s temperament in the follow-up period. COVID-19-associated stress levels were evaluated using the pandemic anxiety measurement scale. The team used the eight-component patient health questionnaire to assess maternal depression and the seven-component generalized anxiety disorder (GAD) scale to assess general anxiety levels.

During follow-ups, postpartum distress levels were evaluated using the 10.0-component Postpartum Distress Assessment Measure, and infant health outcomes were assessed using the Infant Behavior Questionnaire. Individuals were recruited for the study through paid advertising, social media, newsletters from mothers’ groups, mental health organizations, and web-based pregnancy forums.

Linear mixed-effects modeling was performed for the analysis. Sensitivity analyzes were performed to control for maternal mental health at initial assessment and COVID-19 risks during pregnancy and infant age at follow-up assessments. The study participants received A$100 Amazon gift cards for the first survey and A$20 for follow-up surveys.


The mean age of the study participants was 32 years and of the study participants, 28% (n=88), 30% (n=94) and 43% (n=136) lived in Australia, the United States and the United Kingdom, respectively. who were 87% (n=276) white and 81% (n=256) had a college degree. A history of psychiatric disorders was reported by 36% (n=114) of study participants.

Other races and ethnicities included in the sample population were Aboriginal or Torres Strait Islander, Asian, Hispanic, mixed or other, among two, 12, eight, seven and 10 participants, respectively. High school education was achieved by 19 women and vocational or vocational training by 41 women.

At the first evaluation, the mean values ​​for number of children and gestational age (in months) were 1.20 and 5.80, respectively. At the final evaluation, the mean baby age was 14 months. COVID-19-associated stress in the prenatal period showed significant associations with fear, anxiety, and depression in mothers and negative affectivity in infants in the postpartum period. Sensitivity analyzes yielded similar findings.

At initial evaluation, three women presented with mild GAD and depression (mean scores on the GAD-7 Scale and Patient Health Questionnaire of 6.70 and 7.80, respectively), and symptoms persisted for 17.0 months increased postpartum. There were no interactive associations between infant age and prenatal SARS-CoV-2 infection-associated stress with infant health outcomes.


Overall, the study results showed that prenatal pandemic stressors need to be addressed to improve maternal and infant postpartum outcomes. Expectant women should be considered vulnerable during COVID-19 and other pandemics and should be prioritized and given appropriate care for physical and mental well-being.

Further research needs to be conducted to determine methods for reducing pandemic stress to promote maternal and newborn well-being in the postpartum period. The long-term relationships between SARS-CoV-2 infection-associated stress and maternal and child health need to be assessed.

Psychological and biological vulnerability characteristics among a more diverse group of pregnant women belonging to different ethnicities and living in different geographic regions need to be identified in order to personalize antenatal care.

Is antenatal COVID-19-related stress associated with postpartum maternal mental health and infant outcomes?

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