In a recent study published in open JAMA networkResearchers assessed the relationship between stress associated with coronavirus disease 2019 (COVID-19) prenatally and the mental well-being of mothers and their babies in the postpartum period.
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Studies have reported that prenatal stressors significantly increase the risk of adverse postpartum outcomes with regard to mental well-being, such as cognitive and behavioral problems among babies. Cases of anxiety and depression during pregnancy increased significantly during the severe acute respiratory coronavirus 2 (SARS-CoV-2) pandemic, with lower positive affectivity, worse orientation behavior, and greater urgency among infants.
However, the association between COVID-19-associated stress and postpartum maternal and infant outcomes is not completely understood. Previous studies evaluating the effects of prenatal stressors on maternal and child health outcomes were largely cross-sectional, single-centre, retrospective, with small sample populations, and often used unvalidated assessment measures without documentation of psychometric properties.
about the study
In the present research-based longitudinal study, researchers assessed the impact of prenatal stress associated with SARS-CoV-2 infection on postpartum maternal and child mental health outcomes.
The study included 318 subjects aged ≥11.0 years who participated in the lifetime risk of coronavirus disease 2019 (CORAL) study conducted in the United Kingdom (UK), United States (US), and Australia. Women who were expecting at baseline assessment between May 5 and September 30, 2020 and completed two follow-up assessments between October 28, 2021 and April 24, 2022 at three-month intervals were considered for analysis.
In addition, participants were asked to complete a fourth survey on maternal mental well-being and infant temperament at the follow-up period. Stress levels associated with COVID-19 were assessed using the Pandemic Anxiety Measurement Scale. The team used the eight-component Patient Health Questionnaire to assess depression among mothers and the seven-component General Anxiety Disorder (GAD) scale to assess levels of generalized anxiety.
During follow-up, levels of postpartum distress were assessed using the 10.0 component postpartum distress rating measure, and health outcomes among infants were assessed using the Child Behavior Questionnaire. Subjects were recruited into the study through paid advertising, social media, newsletters from mothers’ groups, mental wellness organizations, and Internet pregnancy forums.
Linear mixed effects modeling was performed for the analysis. Sensitivity analyzes were performed controlling for maternal mental health at baseline and the risks of COVID-19 experienced during pregnancy and the age of infants during follow-up assessments. Study participants received Amazon gift cards worth A$100 for the initial survey and A$20 for follow-up surveys.
Results
The mean age of study participants was 32 years, and among study participants, 28% (n=88), 30% (n=94), and 43% (n=136) resided in Australia, the United States, and the United Kingdom, respectively, among which 87% (n=276) were white and 81% (n=256) had a university degree. 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 Islanders, Asians, Hispanics, Mestizos or others, among two, 12, eight, seven and 10 participants, respectively. Secondary education was obtained by 19 women and professional or vocational training by 41 women.
At the initial assessment, the mean values for the number of children and gestational age (in months) were 1.20 and 5.80, respectively. In the final evaluation, the average age of the children was 14 months. The stress associated with COVID-19 in the prenatal period showed significant associations with distress, anxiety and depression among mothers and negative affectivity among infants in the postpartum period. Sensitivity analyzes produced similar results.
At baseline, three women had mild GAD and depression (mean GAD-7 and Patient Health Questionnaire scores 6.70 and 7.80, respectively), and symptoms remained elevated for 17.0 months postpartum . There were no interactive associations between infants’ age and prenatal stress associated with SARS-CoV-2 infection with infant health outcomes.
Conclusions
Overall, the study results showed that antenatal stressors associated with the pandemic should be addressed to improve postpartum outcomes for mothers and babies. Pregnant women should be considered vulnerable and prioritized during COVID-19 and other pandemics and should receive adequate care for their physical and mental well-being.
More research should be undertaken to determine methods of reducing pandemic-associated stress to promote maternal and newborn well-being in the postpartum period. The long-term relationships between stress associated with SARS-CoV-2 infection and maternal and newborn health should be evaluated.
Markers of psychological and biological vulnerability among a more diverse group of pregnant women belonging to different ethnicities and residing in different geographic regions must be identified to personalize prenatal care.