COVID-19 Impacts on Perinatal Care and Maternal Mental Health: A Geotemporal Analysis of Healthcare Disruptions and Emotional Well-Being Across the United States (preprint)

Background: Adequate perinatal care is essential for maternal and infant health. The novel coronavirus (COVID-19) pandemic is potentially the largest natural disruption to perinatal care in recent history, but these disruptions have yet to be characterized in a rigorous and systematic manner. Our goal was to document COVID-19 induced disruptions to perinatal care across the United States (US) using analyses sensitive to the temporal and geographical variability of the pandemic, and to examine the impact of these healthcare disruptions on maternal mental health.Methods: We performed an observational cross-sectional study of 1,922 postpartum and 3,868 pregnant individuals during the 2020 COVID-19 pandemic. Perinatal individuals were recruited from 15 academic institutions across the US, resulting in a geographically diverse sample. We conducted (1) descriptive analyses on the prevalence and timing of perinatal care disruptions, (2) group difference analyses to compare perinatal care disruptions depending on when and where individuals gave birth, (3) cross correlations to assess the temporal linkage between perinatal care disruptions and COVID-19 infection rates, and (4) hierarchical linear regressions to evaluate the impact of prenatal care and birth protocol disruptions on maternal psychological health.Findings: The COVID-19 pandemic significantly altered perinatal care across the US, both through restriction of in-person support and by shifting the focus of care. These changes occurred unevenly over time and across geographic locations. Changes in COVID-19 infection rates explained 65 to 78% of the variance in perinatal care disruptions from August 2019 to August 2020. Moreover, disruptions to perinatal care were robustly associated with heightened psychological distress in mothers, even after controlling for mental health history, number of pregnancy complications, and general stress about the COVID-19 pandemic.Interpretation: Our analyses reveal widespread disruptions to perinatal care across the US that fluctuated depending on where and when individuals gave birth, demonstrating reactivity and elasticity of the US healthcare system. In addition to influencing health outcomes, disruptions to perinatal care may also exacerbate mental health concerns during the COVID-19 pandemic.Funding Information: This research was supported by the NYU COVID-19 Research Catalyst rant, R34DA050287-S1, R34DA050287-S2, R34DA050254-01S2, R01MH126468, R01MH125870, the Nathaniel Wharton Fund, the Columbia University Population Research Center, R34DA050255, R34DA050255-01S2, the Fralin Biomedical Research Institute at VTC, the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Numbers UL1TR003015 and KL2TR003016, the University of Utah Center for Clinical and Translational Science COVID-19 Research Award, Virginia Commonwealth University School of Nursing Internal Grants Program, Sarah P. Farrell Legacy Research Endowment-Virginia Commonwealth University, 5R03HD096141-02, R01HD085990, R34DA050283-01S2, the USC Center for the Changing Family, the Stanford Institute for Research in the Social Sciences, R34DA050291, R01MH119070, R01MH117177, R34 DA050272-01S1, R01 MH113883, R01 DA046224, R21 MH111978, and R21 HD090493, R37 MH10149, UH3OD023279, and National Center for Advancing Translational Sciences (NCATS) Grant UL1TR001881Declaration of Interests: The authors report no conflicts of interest.Ethics Approval Statement: This study has received Institutional Review Board approval from theNYU Langone Health IRB as well as the local IRBs at each data collection site. All data was collected in accordance with the Helsinki Declaration.

Behavioral coping phenotypes and psychosocial outcomes in a national U.S. sample of pregnant and postpartum women during the COVID-19 pandemic (preprint)

Maternal stress exposure during the COVID-19 pandemic may have transgenerational effects, adversely affecting both the pregnant woman and her offspring. Therefore, there is an urgent need to characterize the coping styles and psychosocial distress of pregnant and postpartum women during the COVID-19 pandemic to help mitigate lasting sequalae on both mothers and infants. Here we use latent profile analysis to examine patterns of behavioral coping strategies associated with risk and resiliency to adverse mental and physical health outcomes. Leveraging a large U.S. sample of perinatal women (N = 2,876 pregnant women, N = 1,536 postpartum women), we identified four behavioral phenotypes of coping strategies: (1) passive-coping, characterized by primarily engaging in high levels of screen time, social media use, and eating comfort foods; (2) active-coping, characterized by primarily engaging in high levels of self-care, social support, and limiting media exposure; (3) low-coping, characterized by low levels of all coping strategies; (4) high-coping, characterized by high levels of both active and passive coping strategies. Critically, we found that passive-coping phenotypes were associated with higher levels of depression and anxiety and worsening stress and energy levels in both pregnant and postpartum women. Supplementing passive coping strategies with high levels of active coping strategies (the high-coping profile) lessened adverse outcomes in postpartum women. These behavioral coping phenotypes highlight potential risk and protective factors for perinatal women, which is critical in helping to identify and treat perinatal women most at risk for experiencing mood and affective disorders resulting from the COVID-19 pandemic.

Pregnancy during the pandemic: The impact of COVID-19-related stress on risk for prenatal depression (preprint)

Pregnant women may be particularly sensitive to negative events (i.e., adversity) related to the COVID-19 pandemic and affective responses to these events (i.e., stress). We examined COVID-19-related stress and adversity in a sample of 725 pregnant women residing in the San Francisco Bay Area in March-May 2020, 343 of whom provided addresses in California that were geocoded and matched by census tract to measures of community-level risk factors. Women who were pregnant during the pandemic had substantially elevated depressive symptoms compared to matched women who were pregnant prior to the pandemic. Several individual- and community-level risk and protective factors were associated with women’s scores on two latent factors of COVID-19-related stress and adversity. Highlighting the role of subjective responses to the pandemic in vulnerability to prenatal depression and factors that influence susceptibility to COVID-19-related stress, these findings inform understanding of the psychosocial sequelae of disease outbreaks among pregnant women.