The Impact of Prenatal Maternal Mental Health during the COVID-19 Pandemic on Birth Outcomes: A Study within CONCEPTION Cohort

Background: External natural events, such as hurricanes, floods, and the COVID-19 pandemic can contribute to increased populational stress, especially for pregnant persons. Exposure to crises can produce short- and longterm health effects on pregnant persons and their offspring. There has been much interest in the association between maternal depression, anxiety, and stress during pregnancy and perinatal outcomes such as preterm birth (PTB) and low birth weight (LBW), before and since the COVID-19 pandemic, however results are controversial. Objective(s): Assess the association between prenatal mental health during the COVID-19 pandemic and preterm birth (delivery <37 weeks gestation) and low birthweight (<2,500 grams). Method(s): Pregnant individuals, >18 years, were recruited in Canada and provided data through a web-based questionnaire. We analyzed data on persons recruited between 06/2020-08/2021 who completed questionnaires while pregnant and two months post-partum. Data on maternal sociodemographics, comorbidities, medication use, mental health (Edinburgh Postnatal Depression Scale, General Anxiety Disorder-7, stress), pandemic hardship (CONCEPTION - Assessment of Stress from COVID-19), and on gestational age at delivery and birth weight, were selfreported. Crude and adjusted relative risks (aRR) with 95% confidence interval (95%CI) were calculated to quantify the association between PTB/LBW and maternal mental health. Result(s): A total of 1,265 and 1,233 participants were included in the analyses of PTB and LBW, respectively. No associations between PTB and prenatal mental health (depression [aRR 1.01, 95%CI 0.91-1.11], anxiety [aRR 1.04, 95%CI 0.93-1.17], stress [aRR 0.88, 95%CI 0.71-1.10], nor hardship [aRR 1.00, 95%CI 0.96-1.04]) after adjusting for potential confounders. The risk of PTB was increased with nonwhite ethnicity/race (aRR 3.85, 95%CI 1.35-11.00), consistently with the literature. Similar findings were observed for LBW (depression [aRR 1.03, 95%CI 0.96- 1.13], anxiety [aRR 1.05, 95%CI 0.95-1.17], COVID stress [aRR 0.92, 95%CI 0.77-1.09], or overall hardship [aRR 0.97, 95%CI 0.94-1.01]). Conclusion(s): No association was found between prenatal mental health nor hardship during the COVID-19 pandemic and the risk of PTB or LBW. However, it is imperative to continue the follow-up of mothers and their offspring to detect long-term health problems early.

A Comparative Study of Peripartum Mental Health Disorders between COVID-19-infected and Non-infected during the Pandemic

Introduction: This study was done to compare the prevalence of mental health disorders between COVID-19-infected and non-infected mothers during the COVID-19 pandemic. The secondary objective was to find out the risk factors and long-term outcome of peripartum depression (PPD). Material(s) and Method(s): This was an observational and comparative study using a questionnaire-based direct interview, conducted in a tertiary hospital. After judging the inclusion and exclusion criteria, 842 subjects were selected between September 2020 to December 2020. The Edinburgh postnatal depression scale (EPDS) and COVID-19 anxiety scale (CAS) was used for evaluation of the mental health. Subjects with PPD were followed up for a year. Result(s): The mean age of the subjects was 24.8 +/- 3.9 years, 142 (16.8%) were confirmed COVID-19 positive. Overall, 317 (37.6%) had possible PPD (EPDS >=14) and 763 (90.6%) had peripartum anxiety (EPDS anxiety subscore >=4). While there was no significant difference in the prevalence of PPD (32.6% vs 39%, p = 0.12), peripartum anxiety was higher among COVID non-infected subjects (91.6% vs 86.6%, p = 0.04). Furthermore, COVID-19-related anxiety was higher among COVID-19-infected compared to the non-infected [17 (10-28) vs 15 (8-25), p = 0.00]. In multivariate analysis, medical comorbidities (p = 0.000), history of psychiatric illness (p = 0.002), domestic violence (p = 0.032) and obstetric complications (p = 0.000) were significant risk factors for PPD. Among the subjects who had PPD, only 35% still had depression after a year. Conclusion(s): This study provides an in-depth analysis of PPD and anxiety during the COVID-19 pandemic, the risk factors, and the long-term effects. Clinical significance: It highlights the importance of routine screening for perinatal mental health disorders and early psychiatric consultation when required.Copyright © The Author(s).

Maternal Mental Health during the COVID-19 Pandemic and Its Impact on Child Cognitive Development

Introduction: The COVID-19 pandemic has had a significant impact on pregnant persons' mental health. Prepandemic data reports an impact of depression, anxiety, and stress on the emotional and behavioral development of the child. Objective(s): We aimed to evaluate the impact of gestational maternal depression, anxiety, and stress during the COVID-19 pandemic on the child's cognitive development at 18 months. Method(s): The CONCEPTION study is a prospective mother-child cohort, established since June 23, 2020, during the COVID-19 pandemic. Depression and anxiety were assessed during pregnancy using validated tools in French and English (Edinburgh Postnatal Depression Scale [EPDS] and General Anxiety Disorder-7 [GAD-7]) as well as stress and antidepressant consumption. The child's cognitive development was reported by the mother using the third edition of Ages and stages questionnaires (ASQ-3) at 18 months of age. Data on other covariates were collected electronically. Multivariate linear regression models were built to assess the association between prenatal maternal depression, anxiety, stress, and child development across domains: communication, gross motor, fine motor, problem solving, and personal-social domains while adjusting for covariates. In addition, sensitivity analyses have been added like COVID-19 diagnosis. Result(s): Overall, 445 mother-child dyads were included in analyses (mean gestational age at delivery 39.2 weeks +/-1.8). Mean gestational scores were, for depression (EDPS, 7.8+/-5.4), anxiety (GAD-7, 4.4+/-4.0), and stress (4.3+/-2.1). Adjusting for potential confounders, as well as for maternal depression and anxiety during pregnancy, maternal prenatal stress was associated with communication skills (adjusted beta = 1.5, CI 95 % (0.34, 2.7)) and fine motor skills (adjusted beta = 1.06, CI 95 % (0.02, 2.6)) at 18 months age. Gestational depression, anxiety, and antidepressants use were not associated with any of the ASQ-3's domains. In addition, no significant association was found in stratified analysis for COVID-19 diagnosis. Conclusion(s): During the COVID-19 pandemic, gestational maternal stress was associated with some aspects of childhood cognitive problems, including communication and fine motor skills. Our results highlight the need to continue following-up on children until kindergarten to better understand the impact of maternal mental health during pregnancy on the child's cognitive development in the era of COVID-19.

Resident Perceptions and Confidence Regarding Pediatric Preventive Care

Purpose of Study: Residents have experienced changes in educational structure, format, content, and patient experience due to the COVID-19 pandemic. Resident physicians across the country have reported changes in workload including a decrease in well child checks and immunizations resulting in limited clinical exposure. This study aimed to assess the confidence of first year pediatric residents (interns) in conducting routine preventive screening for children and to identify potential gaps in knowledge among this cohort. Methods Used: We conducted a cross-sectional observation study that included 13 categorical first year pediatric residents. A voluntary, anonymous online survey was administered in September 2022. The survey assessed confidence levels, and perceived comfort regarding common preventive pediatric encounters and screening tools. The survey included 7-questions based on the 4th Edition Bright Future's Guidelines and respondents rated their answers on a 5-point Likert scale. The surveys were distributed anonymously via e-mail using Survey Monkey, a web-based software platform that provided an intuitive interface for validated data capture. Participants were given 2 weeks to complete the survey and reminders were sent via email. Summary of Results: Eight of 13 interns participated for a response rate of 62%. Sixty-three percent of the residents had completed a subinternship in pediatrics. Of our respondents, 75% reported feeling "not at all confident" in executing well child check-ups for children <12months old and 63% reported feeling "very confident" in examining children> 13months old. Regarding the ability to perform a genitourinary examination in children >12years of age, 63% of respondents stated that they were "slightly" or "not at all confident". We asked interns to rate their confidence in providing anticipatory guidance to their patients. Interns perceived being somewhat confident regarding guidance about safe sex, tobacco use, and healthy lifestyles but less confident regarding newborn care, breast feeding and infant nutrition. Nearly 40% reported comfort in recommending and advising parents about the risks and benefits of age appropriate immunizations. We asked residents to report their ability in administering and interpreting screening tools (ASQ, MCAT, EPDS). Interns reported that were able to interpret results but lacked confidence in providing guidance. Conclusion(s): Our study identifies opportunities to bridge experiential knowledge gaps and confidence among pediatric interns who may have had limited clinical exposure to pediatrics following the COVID-19 pandemic. Graduate medical education programs should consider developing tailored educational interventions specifically geared for identified learning gaps to mitigate the challenges posed by the pandemic.

Maternal and Infant Outcomes Following Maternal Exposure to SARS-CoV-2 During Pregnancy in an Australian Cohort

Background: Infections during pregnancy can increase the risk for neurodevelopmental disorders in offspring. This study aimed to prospectively monitor children exposed in utero to SARS-CoV-2 from birth to 15 years of age with a secondary aim to identify biomarkers of neurodevelopmental impairments. Method(s): Women infected with SARS-CoV-2 during pregnancy and sociodemographic and age matched non-exposed women were recruited from Monash Health, Australia (N=112 mother-infant dyads). Demographics, biospecimens and clinical data are collected at multiple time points from birth-15 years using standardised sample collection and neurological and behavioural scales. We present here the birth data. Result(s): Mother-infant dyads are classified as;non-exposed, mild SARS-CoV-2 (limitation of activities) and severe SARS-CoV-2 (hospitalised). Edinburgh postnatal depression scale scores were significantly higher in severe SARS-CoV-2 vs. non-exposed mothers (p<0.05). Maternal attachment scores were unchanged. Hammersmith neonatal neurological assessment scores were unchanged across groups, as were anthropometric measures. Severe SARS-CoV-2 exposed infants had lower scores on the sensory profile 2 questionnaire auditory domain than non-exposed infants (p<0.05). Analysis of infant buccal DNA (Illumina MethylationEPIC BeadChip >850,000 CpGs, N=8) showed hypomethylation of the gene AFAP-1 (q value<0.0008), and hypermethylation of neurodevelopmental pathways;'dendrite morphology' and 'axogenesis' in SARS-CoV-2 infants vs. non-exposed. Conclusion(s): While most assessments show no group differences thus far, the severe SARS-CoV-2 exposed group are faring worse in terms of maternal mental health, infant auditory domains and infant hypermethylation of genes belonging to neurodevelopmental pathways. Follow up assessments at 1-15 years will inform as to whether these initial group differences are early signs of more severe neurodevelopmental outcomes. Funding Source: Other - One in Five Philanthropic organisation Keywords: SARS-CoV-2, Pregnancy, DNA methylation, in utero, Neurodevelopmental trajectoriesCopyright © 2023

The Impact of COVID-19 Related Distress on Antenatal Depression in Australia.

Globally, the impact of COVID-19 on mental health has been significant. Pregnant women are known to be a vulnerable population in relation to mental health. In Australia, there was an unprecedented demand during the pandemic for mental health services, including services for pregnant women. Maternal mental health has unique and enduring features that can significantly shape a child's overall development and poor maternal mental health can have considerable social and economic costs. This cross-sectional study evaluated symptoms of antenatal depression and COVID-19-related distress in a sample of two hundred and sixty-nine pregnant women residing in Australia aged between 20 and 43 (M = 31.79, SD = 4.58), as part of a larger study. Social media advertising was used to recruit participants between September 2020 and November 2021. Prevalence rates for antenatal depression were found to be higher in this study (16.4%) compared with previous Australian prevalence rates (7%). COVID-19 distress in relation to having a baby during a COVID-19 outbreak significantly predicted symptoms of antenatal depression, B = 1.46, p < 0.001. Results from this study suggest that mothers and families may have increased mental health vulnerabilities as a consequence of the pandemic for some time yet.

A Pilot Randomized Controlled Trial of an Online Educational Program for Primiparous Women to Improve Breastfeeding.

BACKGROUND: There are different approaches to breastfeeding interventions, but the global 6-month exclusive breastfeeding rates remain suboptimal. The COVID-19 pandemic has brought extra difficulties in promoting breastfeeding. RESEARCH AIM: To test the feasibility and effectiveness of a theory-based, real-time online educational and support program for breastfeeding related outcomes. METHODS: An assessor-blinded, prospective pilot randomized controlled trial with parallel-group, repeated-measures design was used. The sample was low-risk primiparous mothers (N = 40) who delivered in the local public hospitals. Study outcomes consisted of exclusive breastfeeding rate, breastfeeding self-efficacy, and other breastfeeding outcomes measured by a self-reported questionnaire, including the Breastfeeding Self-Efficacy Scale and the Edinburgh Postnatal Depression Scale. Comparisons between the differences in the intervention and control groups were carried out. RESULTS: Thirteen participants in the intervention group successfully completed the program. They had a higher exclusive breastfeeding rate, breastfeeding self-efficacy, breastfeeding initiation rate, and longer exclusive breastfeeding duration than the control group. Additionally, the intervention group had a lower partial breastfeeding rate, and a higher maternal postnatal depression score and infant's morbidity at postnatal 2 months. However, all the results were not statistically significant (p > .050). Overall, the intervention was highly valued by all participants who appreciated the regular postnatal follow-ups. CONCLUSIONS: Despite showing the satisfactory feasibility of the program, no significant improvements were found in all study outcomes. Considering the participants' comments, we suggest refining and further testing the intervention with a larger sample size over a longer-term follow-up to confirm its effectiveness.This study has been registered at ClinicalTrials.gov (NCT04741425).

Depressive Symptoms in Mothers With Infants: The Quantitative Evidence of the Association of COVID-19 Crisis-Related Factors in Japan.

OBJECTIVE: This study explores the depressive symptoms in postpartum women during the coronavirus disease 2019 (COVID-19) crisis in Japan. METHODS: An online survey conducted from May 31 to June 6, 2020 resulted in 3073 responses obtained from mothers with infants < 12 mo. RESULTS: The point prevalence of the Edinburgh Postnatal Depression Scale (EPDS) score of ≥ 9 was 28.66% for primipara and 25.83% for multipara. Logistic regression analysis indicated a negative association between the COVID-19 crisis and EPDS ≥ 9; specifically, decreased social support and financial concern were identified as risk factors. The COVID-19-related experiences significantly increased the score of each factor of EPDS, ie, anxiety, anhedonia, and depression. CONCLUSIONS: During the COVID-19 crisis, the number of mothers who faced depreciation in social support and income had increased. Moreover, spending their perinatal period during the crisis increased the propensity of facing unexpected changes, such as changes of hospitals for delivery, or cancellation of parenting classes. These multiple factors were associated with an elevated risk of depression in postpartum women. In a prolonged crisis, postpartum mental health should be treated carefully with the prevention of infection.

Comparison of response options and actual symptom frequency in the Japanese version of the Edinburgh Postnatal Depression Scale in women in early pregnancy and non-pregnant women.

BACKGROUND: The positive predictive rate of the Japanese version of the Edinburgh Postnatal Depression Scale (EPDS) is lower than those of other versions. This study aimed to confirm whether the EPDS Japanese version reflects actual symptom frequency and to examine the possibility of improving the positive predictive rate. METHODS: This is a methodological study aimed at improving the positive predictive value of EPDS. The participants were 63 non-pregnant and 382 pregnant women. They answered the 10 questions of the Japanese version of the EPDS and reported the specific number of days as the frequency. The EPDS score (EPDS-S) and the frequency score (FREQ-S) were calculated for three factors of emotion: anhedonia, anxiety, and depression. RESULTS: The positive rates of the EPDS-S and FREQ-S in pregnant women were 6% and 8%, respectively, which were lower than those in non-pregnant women (17%). On comparing the EPDS-S with the FREQ-S, a significant underestimation of frequency was observed in approximately 3% of pregnant women. The FREQ-S showed better internal consistency than the EPDS-S. Among the factors of emotion, women tended to rate anhedonia lower in the EPDS-S than in the frequency scale. CONCLUSION: Pregnant women tended to report a lower frequency on the Japanese version of the EPDS than their actual symptom frequency, which was especially true for those with a desire to self-harm. The combined use of the FREQ-S and EPDS-S can prevent underestimation and help improve the detection rate of depression.

Determination of factors affecting post-partum depression in primary healthcare during the COVID-19 pandemic

Postpartum depression is a phe-nomenon that occurs in the first postpartum days. Symptoms of postpartum depression peak on days 3 to 5 postpartum with a dura-tion ranging from a few hours to several days. Of course, this will be different during the Covid-19 pandemic. The aim of this study was to analyze the determinants that influence the incidence of post-partum depression in primary health during the pandemic. The method in this research is descriptive analysis with cross sectional approach with a total sample of 100 respon-dents. The research instrument used a standard instrument, namely the EPDS (Edinburgh Postnatal Depression Scale) instrument. The results of the study were the determinant factors of parity in primi-gravida and attitudes. From the results of this study, it can be concluded that the dom-inant factors that greatly influence the risk of post-partum depression in women in primary health during the pandemic are parity (primigravida) and the attitude of women who take it for granted when they know that they are at risk of post-partum depression. Copyright © the Author(s),2022.

Distribution of Depression among Different Groups and Sub-Groups of Women during the Covid Pandemic an Analysis from an Interdisciplinary Perspective

Objective. In this article, we analyze depression in the female population using interference and descriptive statistics applied to multiple groups and subgroups to better understand depression in the population (pregnant, not pregnant, and newly mothers-6 to 8 weeks) and also analyzing the perspective of suicide during the COVID-19 pandemic. Thus, depending on the analyzed perspective, we have from 2 to 6 study groups. Methods. The analysis was done by applying the Edinburgh Postnatal Depression Scale (EPDS) questionnaire in groups of pregnant women during pregnancy and new mothers (six to eight weeks after birth) and Beck Depression Inventory BDI in all the groups. Results. According to forecasts, all hypothesis where validated . Conclusion(s): An immediate priority of the scientific community should be collecting high-quality data on the mental health effects of the COVID-19 pandemic across the whole population and especially vulnerable groups such as that of pregnant women who were presented in this study. Copyright © 2022 Romanian Society of Legal Medicine.

The level of depressive, anxiety and obsessivecompulsive psychopathological dimensions in symptomatic versus asymptomatic SARS-CoV-2 infected pregnant women

Introduction: The neurotropic valence of SARS-CoV-2 has been revealed in several studies. Depressive and anxiety symptoms are more frequent in the perinatal period leading to maternal and neonatal negative outcomes. Accordingly, depressive and anxiety symptoms are more frequent in the perinatal period leading to negative consequences in both mothers and their neonates. Objective(s): To determine the level of depression, anxiety, and obsessive-compulsive symptoms depending on the severity of SARS-CoV-2 infection of pregnant women. Method(s): Based on the RT-PCR test, thirty-eight pregnant women with SARS-CoV-2 infection, hospitalized in Bega Clinic in Timisoara, were assessed concerning the presence of psychopathology. The severity of infection was dichotomized based on the presence or absence of the symptoms. The Edinburgh Postnatal Depression Scale, State and Trait Anxiety Inventory, and the Obsessive- Compulsive Inventory were administered to all participants. Result(s): Of 38 recruited pregnant women, 12 (31,5%) had symptomatic SARS-CoV-2 infection. Symptomatic SARS-CoV-2 infected pregnant women had a higher average score of depression (p = 0.001) and state and trait anxiety (p = 0.002 and p < 0.001, respectively) compared to their asymptomatic counterparts. There were no differences in obsessive-compulsive symptoms (p > 0.05) in relation to the severity of SARS-CoV-2 infection. Conclusion(s): The SARS-CoV-2 infection significantly interferes with the psychological status, thus jeopardizing the mental health of pregnant women. Therefore, SARS-CoV-2 infection should be considered an additional risk factor for anxiety and affective disorders during pregnancy.

Paternal postpartum depression in an obsessive personality following the COVID-19 lockdown successfully treated with Vortioxetine

Introduction: A growing amount of studies investigating the mental health impact of the current COVID-19 pandemic worldwide have been recently published, even though very few studies investigating the impact of the COVID-19 outbreak and lockdown on the mental health of fathers of newborns during the COVID-19 pandemic, particularly on paternal postpartum depression (PPD). Objective(s): A case report describing a 37-years-old man with an obsessive-compulsive personality who manifests the onset of a clinically relevant PPD following his wife's delivery during the COVID-19 pandemic and the onset of obsessive symptomatology. Method(s): At baseline and during a 12-months follow-up were administered the Edinburgh Postnatal Depression Scale (EPDS), Fear of COVID-19 (FCV-19-S), Coronavirus Anxiety Scale (CAS) and Y-BOCS-II (Yale-Brown Obsessive Compulsive Scale). Result(s): Patient was successfully treated with vortioxetine up to 20 mg/die with a significant clinical remission of depressive and obsessive symptomatology at 6 months and a maintenance therapy with vortioxetine 10 mg daily. Conclusion(s): PPD should be better investigated, particularly the impact of COVID-19 pandemic on mental health of fathers of newborns during the COVID-19-related situation.

The impact of the Covid-19 pandemic on peripartum affective psychopathology

Introduction: Despite COVID-19 pandemic significantly impacting mental health, few studies evaluated effects on perinatal mental health. Objective(s): Therefore, we aimed at assessing pregnant and puerperal women during first and second COVID-19 waves. Method(s): 70 women (41 pregnant and 29 puerperal) consecutively afferent to our outpatient service for Perinatal Mental Health (March 2020-March 2021) were administered Edinburgh Postnatal Depression Scale (EPDS), Fear of COVID-19 (FCV-19-S), Coronavirus Anxiety Scale (CAS) and Wijma Delivery Expectancy/Experience questionnaire (WDEQ). Result(s): Women who reported last menstruation date (LMD) in 2019 second semester showed higher EPDS scores (p=0.026), those with estimated delivery date (EDD) in 2021 second semester showed higher CAS scores than those with EDD in 2020 first semester (p= 0.020) or in 2021 first semester (p<0.001). Women with clinically significant EPDS Scores reported higher FCV-S-19 (p=0.005) and CAS (p=0.003). Subjects with a previous psychiatric hospitalization showed higher FCV-S-19 (p=0.003). A weak positive correlation (r= 0,290;R2=0,084;p=0.015) has been observed between FCV-S-19 and EPDS. Furthermore, there was a strong positive correlation (r= 0,377;R2=0,142;P=0.001) between CAS and EPDS and between CAS and FCV-S-19 (r=0,641;R2=0.410;p<0.001). All subjects showed high scores for tocophobia after experiencing delivery. Conclusion(s): COVID-19 pandemic significantly impacted pregnant and/or postpartum women also without a previous psychiatric condition. Early identification and screening tools should be routinely provided to all pregnant and postpartum women.

Postpartum Depression after Maternal Isolation during the COVID-19 Pandemic: The MUMI-19 Study (Mothers Undergoing Mental Impact of COVID-19 Pandemic).

BACKGROUND: The COVID-19 pandemic has shaken the world by imposing unprecedented health measures, including in the postpartum period. OBJECTIVES: We aim to assess the impact of maternal isolation in the immediate postpartum period on the rate of postpartum depression (PPD) in a tertiary center. STUDY DESIGN: We conducted a prospective cohort study, between 22 April and 29 October 2020, using anonymous questionnaires on 265 participants (129 during lockdown and 135 outside). The Edinburgh Postnatal Depression Scale (EPDS) was used as screening for PPD. We used a univariate logistic regression model to analyze the association between risk factors and PPD. RESULTS: There was no difference between the two groups for PPD assessed by an EPDS score >10.5 on day 30 and/or day 60 (23.1% vs. 29.3%, p = 0.661) but on day 3 it was higher (31% vs. 17.8%, p = 0.015) during the lockdown period and partners were more impacted psychologically (48.3% vs. 10.5%, p < 0.001). Parity ≥1 was a protective factor for PPD (OR = 0.2, 95% CI [0.1-0.6], p = 0.003). Risk factors of PPD were: history of psychological abuses (OR = 6.4, CI 95% [1.1-37.6], p = 0.04), stressful life event (OR = 4.5, CI 95% [1.6-12.6], p = 0.004), and bad birth experience (OR = 5.1, CI 95% [1.4-17.8], p = 0.012). CONCLUSION: Maternal isolation in the immediate postpartum period is associated with an increased rate of moderate to severe symptoms of postpartum blues. The well-known long-term consequences of PPD must be balanced against the expected benefits of partner's restrictive access to maternity ward.

IMPACT in PRENATAL EVALUATION of PREGNANT WOMEN with RHEUMATIC DISEASES by the SARS-COV2 PANDEMIC

Background: Due to the SARS-CoV-2 pandemic, an increase in stress, anxiety, and depression has been seen, as well as greater use of substances and a decrease in prenatal care in pregnant women. (1) Women of childbearing age with autoimmune rheumatic diseases (ARDs) experience greater psychological stress, which can negatively influence behavior. (2) Objectives: This study aims to compare changes in prenatal laboratory and ultrasound tests by trimester, as well as the detection of anxiety and depression in pregnant women with ARDs due to the SARS CoV-2 pandemic. Methods: This study was carried out on pregnant patients with ARDs from the Pregnancy and Rheumatic Diseases clinic of the rheumatology department of the University Hospital 'Dr. José Eleuterio González' during the period from February 2018 to August 2021. Two standardized evaluations of anxiety and depression were carried out using the Inventory of Trait and State Anxiety (IDARE) and the Edinburgh Postpartum Depression Scale (EPDS) respectively in the third trimester of pregnancy. Maternal report of alcohol consumption during any trimester of pregnancy, as well as adherence to routine laboratory studies such as structural ultrasound and gesta-tional diabetes screening, was addressed. Positive COVID-19 nasopharynx PCR results were evaluated during pregnancy beginning in the pandemic period (March 2020). The pre-pandemic recruited group was compared with the pandemic group. The comparison of the groups was carried out using the Chi-Square and Fisher tests. A significant value of p < 0.05 was considered. Statistical analysis was performed using the IBM SPSS v.25 program. Results: 50 pregnant patients with ARDs were recruited, of which 24 were included in the pre-pandemic group and 26 in the pandemic group. Compared with the pre-pandemic group, pregnant women recruited during the pandemic had a statistically signifcant higher positivity for state anxiety (p=0.023), likewise trait anxiety, depression, and suicidal ideation were detected more frequently, but the difference was not statistically signifcant, a higher rate of adherence to laboratory and cabinet studies was found, being signifcant for laboratories performed in the 1st and 2nd trimesters (0.005 and 0.025 respectively). See Table 1. Conclusion: A higher frequency of positivity for state anxiety was demonstrated in pregnant women with ARDs recruited during the pandemic, as well as higher trait anxiety, depression, and suicidal ideation, although this increase was not statistically signifcant. On the other hand, concern about the pandemic and health status could positively influence better adherence to screening and routine studies during pregnancy.

Experience of COVID-19 and Postpartum Mental Health

Background: Early reports show pregnant and postpartum women have increased rates of anxiety and depression during the COVID-19 pandemic. These elevations could be related to fear of contracting COVID or mitigation strategies, such as social distancing and stay-at-home orders. First-time mothers may be uniquely vulnerable to these stressors. We examined whether 1) exposure to potentially stressful COVID-19 events, perceived impact of COVID-19, and COVID-19 distress are related to anxiety and depression symptoms reported by first-time mothers, and 2) whether the relationship between COVID-19 related stressors and anxiety and depression is stronger for mothers reporting less social support. Methods: We interviewed 125 first-time mothers of infants less than 3 months old from four pediatric primary care offices in Pennsylvania and Delaware (June 2020 - February 2021). Mothers completed a self-report interview asking about social support, COVID-19 experiences, and anxiety and depression symptoms (EPDS Total, Anxiety, Depression). The COVID-19 measure yielded three variables: 1) number of potentially stressful COVID-19 pandemic-related events (Event Exposure), 2) perceived impact of the COVID-19 pandemic on family (Family Impact), and 3) overall perceived distress related to the pandemic (Distress). Results: Participants (mean age = 29.18, SD: 5.50) were racially representative of the recruitment clinics (40.8% White;37.6% Black;11.2% Asian/Asian American;6.4% Latina). Hierarchical linear regression found COVID-19 Event Exposure was unrelated to Depression (β = 0.03, n.s.) and Anxiety (β = 0.04, n.s.). Controlling for Event Exposure, Family Impact was associated with higher EPDS Total (β = 0.32, p = 0.001), Depression (β = 0.29, p =.003), and Anxiety (β = 0.23, p = 0.02). Distress was significantly associated with higher EPDS Total (β = 0.21, p = 0.04) and Depression (β = 0.26, p = 00.01) but not Anxiety (β = 0.08, n.s.). Mothers reporting less social support had higher Depression scores (r = 0.26, p =.003), but social support was unrelated to Anxiety (r = 0.08, p = 0.41). The interaction of Family Impact and social support produced a nonsignificant trend (p = 0.09, Figure). Conclusion: While experience of more COVID-19 related events was unrelated to maternal anxiety and depression symptoms, maternal report of impact of COVID-19 on the family was associated with both anxiety and depression symptoms. Additionally, higher maternal distress reports and less perceived social supports were related to increased maternal depression symptoms. Therefore, future work should explore how to mitigate impact of COVID-19 families and connect mothers to social support to support maternal mental health.

Efficacy of a Home Visiting Program on Child Outcomes: A Randomized Controlled Trial

Background: High-quality home visiting programs are designed to improve child health and support expecting and new parents. These programs can assist families in developing skills and garnering the resources necessary to raise healthy children. A non-profit organization operating in the Southwestern United States provides a universal home visiting program to families having their first child (first-time for either the mother or father), including child by birth, adoption, or child placement. The program includes participant advocacy, home-based visits, and an enhanced referral program. The present study examines the effects of the program on child development outcomes at 12- month follow-up. Methods: Data were collected as part of a larger randomized controlled trial in which first-time families were randomly assigned to the home visiting program (n = 179) or a business-as-usual control group (n =164). This study follows the family and the child until the child graduates from high school or turns 19. The Ages •Stages Questionnaire (ASQ) was used to assess five domains of child development. Although this outcome was measured at 2, 6, 12, 18, 24, and 36-month, the present study focuses on the five domain outcomes at 12 months. Results: Results of independent-sample t-tests showed that, compared to controls, children in the home visiting program reported significantly better communication (t(280)=2.328, p=0.02, d=.277 [small effect]), gross motor skills (t(280)=2.601, p=0.01, d=.306 [small effect]), fine motor skills (t(280)= 3.010, p=.008, d=.357 [small effect]), problem-solving (t(280)=5.218), p<.001, d=.631 [moderate effect]), and personalsocial functioning (t(280)=3.355, p=.002, d=.404 [small effect]) at 12-month follow-up. Conclusion: The 12-month follow-up showed promising evidence of the effectiveness of the home visiting program under investigation. It is important to continue to follow these children to determine longer-term outcomes. As this study is ongoing, we will be able to examine the degree to which these early childhood outcomes are predictive of school readiness, broader dimensions of health functioning, and decreased criminal justice involvement. Graph of non-significant trend for interaction between social support and COVID-19 Family Impact. This was in direction of a stronger link between COVID Family Impact and EPDS Depression subscale for mothers with less social support.

Postpartum Mental Health and Infant Development During the COVID-19 Pandemic

Background: Infection mitigation strategies implemented during the COVID-19 pandemic influenced social experiences for new mothers and their infants, with potential to negatively impact infant development. Early reports during the pandemic show postpartum women have increased rates of anxiety and depression which are known risk factors for developmental delay. Additionally, stay-at-home orders, social distancing, and use of face masks may alter visual input (facial expressions and oral motor movements) infants receive with the potential to negatively impact social-emotional and communication development. Thus, there is need to examine the developmental trajectory of infants born during the COVID-19 pandemic. We hypothesized that higher COVID impact and maternal symptoms of anxiety and depression would be linked to greater risk for developmental delay. Methods: We recruited 125 first-time mothers of infants less than 3 months of age from four pediatric primary care offices in Pennsylvania and Delaware (June 2020 - February 2021). Mothers completed a self-report interview when their infants were less than 3 months of age (baseline) and again at 6 months of age (follow-up), asking about COVID-19 family impact, anxiety and depression symptoms (EPDS Total, Anxiety, Depression), infant development (ASQ-3 at 3 months and 6 months and ASQ-SE at 6 months), and items inquiring about the frequency of mother-child caretaking activities across a range of behaviors. Results: Bivariate correlations found that while perceived family impact from COVID-19 was related to maternal self-report of postpartum depression symptoms at baseline (r = .32, p = .001), it was not related to the frequency of mother-child caretaking activities or infant development in the first 6 months of life. However, hierarchical linear regression found when controlling for COVID-19 family impact, baseline postpartum depression symptoms were related to fewer concurrent motherchild caretaking activities (β =.24, p = .007) and predicted poorer infant social-emotional development at 6 months of age (β = .23, p = .013). Conclusion: Consistent with prior literature, maternal postpartum depression symptoms were related to fewer concurrent mother-child caretaking activities and poorer infant social-emotional development at 6 months of age. However, despite anecdotal maternal concern, there was not a relationship between the effect of COVID-19 on the family unit and infant development. It is possible that COVID-19 pandemic effects will play a more prominent role as infants' complex language and social skills emerge. However, the current findings do not support a direct effect of pandemic family impact on infant development during the first six months of life, instead underscoring the importance of maternal wellbeing and functioning for infant social-emotional development.

Parenting During a Pandemic: Providing Online Parenting Supportto Mothers of Infants

Background: Adverse experiences in early childhood can have short and long-term consequences on an individual's physical and mental well-being (1). Inversely, secure attachments between infants and their parents help foster healthy social, emotional and cognitive child development (2). However, parenthood can be a period of heightened stress, even under ideal circumstances (3,4). The year 2020 brought forth new parenting challenges, with the presence of the COVID-19 pandemic. Increased levels of unemployment, financial insecurity, school closures, decreased communal support and social isolation led to augmented parental stress and burnout, which has shown to result in higher cases of abuse and neglect (3,4). Now more than ever, it is crucial that appropriate parenting interventions be available to families with infants (1). Programs like the Incredible Years™ Parents and Babies (IYPB), foster peer support networks and shared learning (5). This study aims to evaluate the impact of the IYPB curriculum for parents with infants. Methods: IYPB is a structured parent-baby group. This pilot study will evaluate the effects of IYPB on parenting confidence, maternal attachment, and infant well-being and development. It will also evaluate the implementation and acceptance of IYPB online. Recruitment was limited to 36, English or Spanish speaking mothers and their infants aged 0-12 months. Four, 8 weeklong workshops of 9 mother-infant dyads each will be conducted by two trained facilitators through a secure virtual platform. Pre- and post-intervention questionaries will be completed (demographics, Ages and Stages, Edinburgh postnatal depression scale, maternal attachment inventory, Karitane parenting confidence scale). Parents will complete an evaluation after each class, and after the final session, they will complete a satisfaction survey and participate in a focus group. Results: One online group with 9 parents took place from 2/13 to 4/10/2021. The average age of infants was 24 weeks and mean age of mothers was 31 years. Preliminary themes from focus group transcripts highlight the benefits of networking and learning from other parents and experts. Participants thought follow-up communication with facilitators was beneficial for those who felt alone during the pandemic. Some comments included: “I liked meeting with other moms and professionals in a safe space and learning skills to help with babies' development. I also appreciated being able to talk in small groups and normalize our experiences as parents with young children and feel seen and heard.” “I just feel so much more capable and comfortable raising a child after having had these foundational building blocks”. Barriers to participation included time constraints, work obligations, and childcare. Conclusion: Online parenting groups during a pandemic have allowed mothers to connect with one another and build support networks. Recruitment is ongoing and additional data will be collected and analyzed to determine the effects of IYPB on maternal attachment and infant development.