Benefits of Breastfeeding on Child and Postpartum Psychological Health of the Mother

Ab s t r ac t Aim: The aim of this study was to summarize different types of benefits that have been observed in the baby's development and the mother's psychological health during the postpartum period. Background(s): Breastfeeding is a natural process that plays a vital role in the physical as well as mental health of the mother and child. Breast milk is rich in contents such as proteins, fats, and vitamins, which are responsible for building the immune system of the baby. Lactation helps in decreasing the prevalence of infant mortality rate. It enhances the development of the physical health of the children. Breastfeeding protects the mother from many systemic conditions like endometrial cancer, ovarian cancer, breast cancer, etc. It has been observed that with an increase in healthy breastfeeding practices, there is a decline in the cases of maternal mental health issues reported mainly in the postpartum period. Review result: The authors have explained various types of advantages of breastfeeding on the child's and mother's health, their mechanism of action, effects on the baby, and mother-child relationship. Conclusion(s): The mother's mental health plays a crucial role in a healthy infant, and breastfeeding is key to it. The role of breastfeeding is therefore considered a boon for the mother because if there is a decrease in health issues in the child, the mother's mental condition improves automatically. Therefore, breastfeeding should be promoted at the national level. Clinical significance: Breastfeeding not only helps in reducing maternal stress and postpartum depression but also improves the physical health of the child and mother during the postpartum period. The clinicians should teach mothers about the importance and also the correct positions of breastfeeding. "Breastfeeding week" is celebrated every year from August 1 to August 7, as implemented by the Indian government.Copyright © The Author(s). 2023 Open Access.

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.

Social determinants of health, prenatal maternal stress, and earlier birth during the COVID-19 pandemic

During the COVID-19 pandemic, pregnant women, especially those from socioeconomically disadvantaged and marginalized groups, experienced unprecedented stress. Prenatal stress and social determinants of health (SDoH) such as lower education and lack of a relationship partner are known to contribute to earlier birth. However, whether SDoH and stress independently contribute or whether the harmful impact of SDoH is mediated by stress is unknown. Moreover, the contributions of these factors has not been investigated in the context of a communal health crisis such as the COVID-19 pandemic. To examine these processes, we used a longitudinal cohort of 2473 women pregnant during the COVID-19 pandemic who reported a live birth. We compared structural equation models predicting gestational age at birth from SDoH (race/ethnicity, education, financial security, health insurance, relationship status, and lifetime abuse) and from prenatal maternal stress related and unrelated to the COVID-19 pandemic. Results indicate that the association of SDoH with earlier birth was partially mediated by prenatal stress. These findings help uncover mechanisms explaining health disparities in the U.S. and highlight the need to address both SDoH and the stress that these factors produce in under-resourced and marginalized communities. © 2023 John Wiley & Sons Ltd.

Self perceived health and stress in the pregnancy during the COVID-19 pandemic.

Introduction: The COVID-19 pandemic has had numerous maternal and neonatal consequences, especially at the mental level. Pregnant women experience a rise in anxiety symptoms and prenatal stress. Aims: The aim was to describe self-perceived health status, general stress and prenatal stress and to analyze relations and associations with sociodemographic factors. Methods: A quantitative, descriptive and cross-sectional study was conducted using non-probabilistic circumstantial sampling. The sample was recruited during the first trimester of pregnancy during the control obstetrical visit. The Google Forms platform was used. A total of 297 women participated in the study. The Prenatal Distress Questionnaire (PDQ), the Perceived Stress Score (PSS) and the General Health Questionnaire (GHQ-28) were used. Results: Primiparas presented higher levels of worry about childbirth and the baby (10.93 ± 4.73) than multiparous women (9.88 ± 3.96). Somatic symptoms were present in 6% of the women. Anxiety-insomnia was scored positively by 18% of the women. In the Spearman correlation analysis, statistically significant values were found between almost all study variables. A positive correlation was observed between self-perceived health and prenatal and general stress levels. Discussion: During the first trimester of gestation, prenatal concerns increase when levels of anxiety, insomnia and depression also increase. There is a clear relationship between prenatal worries, anxiety, insomnia and depression with stress. Health education that focuses on mental health of pregnant women would help reduce worries during pregnancy and would improve the pregnant women perception of her health and well-being.

Prenatal maternal stress was not associated with birthweight or gestational age at birth during COVID-19 restrictions in Australia: The BITTOC longitudinal cohort study.

BACKGROUND: Various forms of prenatal maternal stress (PNMS) have been reported to increase risk for preterm birth and low birthweight. However, the associations between specific components of stress - namely objective hardship and subjective distress - and birth outcomes are not well understood. AIMS: Here, we aimed to determine the relationship between birthweight and gestational age at birth and specific prenatal factors (infant gender and COVID-19 pandemic-related objective hardship, subjective distress, change in diet), and to determine whether effects of hardship are moderated by maternal subjective distress, change in diet, or infant gender. MATERIALS AND METHODS: As part of the Birth in the Time of COVID (BITTOC study), women (N = 2285) who delivered in Australia during the pandemic were recruited online between August 2020 and February 2021. We assessed objective hardship and subjective distress related to the COVID pandemic and restrictions, and birth outcomes through questionnaires that were completed at recruitment and two months post-partum. Analyses included hierarchical multiple regressions. RESULTS: No associations between maternal objective hardship or subjective distress and gestational age at birth or birthweight were identified. Lower birthweight was significantly associated with female gender (adjusted ß = 0.083, P < 0.001) and with self-reported improvement in maternal diet (adjusted ß = 0.059, P = 0.015). CONCLUSIONS: In a socioeconomically advantaged sample, neither objective hardship nor subjective distress related to COVID-19 were associated with birth outcomes. Further research is warranted to understand how other individual factors influence susceptibility to PNMS and how these findings are applicable to women with lower socioeconomic status.

MATERNAL STRESS IN NICU DURING THE COVID-19 PANDEMIC

During the COVID-19 pandemic, measures have been taken to reduce the number of contacts between people, restrict visits to medical facilities and patients. These restrictions also affected one of the most vulnerable populations - mothers whose newborns were treated in neonatal intensive care units (NICUs). Infant's admission in the NICU is a disturbing and potentially traumatic event for mothers, as it limits the round-the-clock stay with their children, accompanied by anxiety and worries about the health of the newborn and its further prognosis, makes it impossible to fully fulfill the parental role and independent care for a baby, disrupts the establishment of psychological and physical contact between a mother and a child, which is superimposed on the labile psycho-emotional state of the woman in labor caused by the restructuring of hormonal status. The aim of the study was to assess the stress level of mothers whose infants needed treatment in the neonatal intensive care unit (NICU) before and during the COVID-19 pandemic, to analyze the impact of quarantine restrictions on the frequency and duration of mother-child visits, as well as on breastfeeding. Materials and methods. The design included 194 mothers: 67 - mothers whose children were in the NICU before the COVID-19 pandemic and 127 - during the COVID-19 pandemic. Stress sensitivity was assessed using the «Parental Stress Scale: NICU» (PSS: NICU). The study included the results of the survey of mothers whose infants were in the intensive care unit for at least 3 days. Statistical data processing was carried out using the program "STATISTICA 13.0. WINDOWS" with the calculation of mean scores (M). The data were considered reliable at p<0.05. The t-test (for two independent groups) wаs used to compare numerical data (PSS: NICU scores). The research complies with the bioethical norms of clinical research in accordance with the provisions of the GSR (1996), the Council of Europe Convention on Human Rights and Biomedicine (from 04.04.1997), the Helsinki Declaration of the World Medical Association on the Ethical Principles of Scientific Medical Research with Human Participation (1964-2013), orders of the Ministry of Health of Ukraine No. 690 dated September 23, 2009. The research got the permission of the bioethical commission of the Ternopil National Medical University named after I.Ya. Gorbachevskii. Results of the study and their discussion. During the COVID-19 pandemic, the proportion of mothers who visited their newborns in the NICU by 3 or more times a day decreased (56.69%), while before the pandemic this index was 64.18% (p before and during COVID-19 < 0.05). During the COVID-19 pandemic, the average duration of the mother-newborn visits at the NICU also significantly decreased, only 10.24% of mothers stayed more than 1 hour during the visit with the baby, while this indicator was 89.76% before the pandemic (p before and during COVID-19 < 0.05). The highest level of stress in mothers was associated with the "Parental role alteration" subscale and was 4.15 points during the COVID-19 pandemic and 4.04 points before the pandemic (p before and during COVID-19 < 0.05). During the pandemic, the number of children receiving breast milk decreased by 16.52% (p before and during COVID-19 < 0.05). Conclusion. The COVID-19 pandemic is a powerful stress factor for mothers of newborns in NICUs, as it limits contact with the child, enhances stress due to impaired parental role and has a negative impact on breastfeeding. © H.A. Pavlyshyn, I.M. Sarapuk, U.V. Saturska, 2022.

Maternal stress as a risk factor for non-syndromic orofacial clefts: Systematic review and meta-analysis.

Background: Non-syndromic orofacial clefts (NSOFC) are among the most common congenital malformations. Several studies have investigated the association between stress and NSOFC; however, they have reported different and heterogeneous results. Therefore, this systematic review was conducted to investigate the association between maternal periconceptional stress and non-syndromic orofacial clefts in infants.The research question was "Is maternal periconceptional stress an etiological factor for non-syndromic orofacial clefts in infants"? Methods: Search strategy, inclusion/exclusion criteria, and data extraction from studies reporting periconceptional maternal exposure to stress and NSOFC were implemented without language restrictions. The risks of bias in the identified studies was assessed, and this information was used in the sensitivity analyses to explain heterogeneity. A meta-analysis of the extracted data was performed. Results: Twelve eligible studies were included. Forest plot for meta-analysis of the association between maternal periconceptional exposure to stress and NSOFC among studies with adjustment for potential confounders showed a statistically significant association with an increased risk of NSOFC (odds ratio [OR]:1.17; P = 0.03), which was apparent for both cleft lip with and without palate (OR:2.07; P = 0.007) and cleft palate (OR:1.72; P = 0.003). There was a substantial heterogeneity between studies, which improved when analyzing only studies that were adjusted for potential confounders. Conclusion: Based on the currently available evidence, maternal exposure to periconceptional stress could be considered a risk factor for NSOFCs. Therefore, we strongly recommend research investigating the effect of stress caused by the coronavirus disease-2019 pandemic on the incidence of clefts.

The COVID-19 stress may influence on the sex ratio at birth.

The ratio of boys to girls (sex ratio) at birth (SRB) is about 1.01-1.05 in most populations and is influenced by various factors, such as maternal stress, maternal inflammation, and endocrine disruption. Male fetus is biologically weaker and more vulnerable to prenatal events than female fetuses. Hence, premature death (and consequently decline the SRB) is higher in boys than girls. The recent coronavirus disease 2019 (COVID-19) has been known to have a variety of stressful and psychological impacts. This stress may consequently enhance maternal inflammation, pregnancy complication, and fetal loss. Also, male fetuses have more adverse outcomes than female fetuses among asymptomatic pregnant women with SARS-Cov-2 infection. Inasmuch as the male fetus are more vulnerable to prenatal events and premature death, it is proposed that the SRB can decline in pregnant women following the COVID-19 stress. However, future studies are needed to define the impact of the COVID-19 on SRB rate.

The impact of maternal stress on placental pathology at delivery in COVID-19 patients

Objectives: The COVID-19 pandemic has placed unprecedented stress on many populations, particularly pregnant women. Maternal adversity has been shown to impact fetal development by way of placental perturbations. The aim of this study is to characterize the impact of maternal stress from the COVID-19 pandemic on placental pathology at delivery and on perinatal outcomes. Method(s): We recruited women with singleton pregnancies in a prospective, observational study on the impact of the COVID-19 pandemic on maternal-fetal wellness. Pregnant women completed a series of validated mental health questionnaires, namely the Speilberger State-Trait Anxiety Inventory (SSAI-S, state anxiety, SSTAI-T, trait anxiety) and the Perceived Stress Scale (PSS). Standardized placental pathologic examinations were performed and assessed using the Amsterdam classification scheme. Maternal mental health assessments and placental weight were analyzed using linear regression and group differences were assessed using student's t-test. Result(s): Thirty-one pregnant women with singleton pregnancies were recruited at a mean gestational age (28.48 +/- 13.34 weeks);of these, 5 (16%) had documented COVID-19 infection in pregnancy. Mean GA at birth was 39.45 +/- 1.49 weeks;14 (45%) of infants were male. Maternal mental health questionnaires were available for 24 women. Maternal anxiety state was significantly associated with increased placental weight at delivery, while anxiety trait and stress did not reach statistical significance (placental weight vs. STAI-S: p = 0.04, vs. STAI-T: p = 0.07, vs. PSS: p = 0.398);Figure 1A-C. Pregnant women with COVID-19 had greater placental weight compared to pregnant women without COVID-19 exposures (p = 0.025);Figure 1D. Conclusion(s): In this cohort, maternal anxiety and positive COVID-19 status have been associated with increased placental weight. Previous studies of increased placental weight have been associated with altered nutritional and endocrinologic functions of the placenta and subsequent fetal programming. The impact of maternal mental distress and disrupted placental growth on short-and long-term infant outcomes are currently underway. Optimizing maternal and fetal care, as well as perinatal outcomes, during the COVID-19 pandemic will require establishing stronger associations between pandemic stress, SARS-CoV-2 infections, and placental pathology.

Exploring the lived experiences of women with children during COVID-19: Maternal stress and coping mechanisms.

This paper presents the results of a qualitative study of mothers' lived experiences during the COVID-19 lockdown in the United States. An analysis of open-ended interviews with 44 mothers who had children ages zero-to-five identified two main themes: (1) increased stress among mothers; and (2) resilience through the use of coping mechanisms. The findings indicate that the COVID-19 pandemic has led to higher stress among mothers due to issues of work-family life balance, family and children's needs, decision-making about getting sick, concerns for children's development, and lack of clarity from government officials. Mothers described using a variety of problem-focused and emotion-focused methods to cope with this stress. The lived experiences of mothers during the pandemic highlights the need for innovations in childcare modalities, paid leave policies to relieve stress, and strengthening whole family processes and resilience through the use of coping mechanisms.

The Pandemial babies: effects of maternal stress on temperament of babies gestated and born during the pandemic.

The COVID-19 pandemic may configure an adverse prenatal context for early development. The aim of this study was to analyze the effects of pandemic-related negative experiences, prenatal anxiety and depression on the temperament of six-month-old babies. The sample consisted of 105 mother-child dyads. A longitudinal evaluation was carried out using pre- and postnatal online surveys. Mothers completed the State-Trait Anxiety Inventory, the Beck Depression Inventory - II, the Pandemic Impact Questionnaire and the Infant Behavior Questionnaire Revised. Serial mediation models were tested, in which the pandemic-related negative experiences constituted the independent variable, the prenatal anxiety and depression were the mediators, and the children's temperament dimensions were the dependent variables. Pandemic-related negative experiences were indirectly associated with the offspring's negative affect and surgency through anxious symptomatology, which acted as a mediating variable. This was the first study to identify the effects of the COVID-19 pandemic on temperament. Such an adverse context implies risks for child development. Public health policies aiming to evaluate socioemotional variables during early childhood become necessary to allow on-time interventions for lessening these risks.

Impact of COVID-19 Related Maternal Stress on Fetal Brain Development: A Multimodal MRI Study.

BACKGROUND: Disruptions in perinatal care and support due to the COVID-19 pandemic was an unprecedented but significant stressor among pregnant women. Various neurostructural differences have been re-ported among fetuses and infants born during the pandemic compared to pre-pandemic counterparts. The relationship between maternal stress due to pandemic related disruptions and fetal brain is yet unexamined. METHODS: Pregnant participants with healthy pregnancies were prospectively recruited in 2020-2022 in the greater Los Angeles Area. Participants completed multiple self-report assessments for experiences of pandemic related disruptions, perceived stress, and coping behaviors and underwent fetal MRI. Maternal perceived stress exposures were correlated with quantitative multimodal MRI measures of fetal brain development using multivariate models. RESULTS: Increased maternal perception of pandemic related stress positively correlated with normalized fetal brainstem volume (suggesting accelerated brainstem maturation). In contrast, increased maternal perception of pandemic related stress correlated with reduced global fetal brain temporal functional variance (suggesting reduced functional connectivity). CONCLUSIONS: We report alterations in fetal brainstem structure and global functional fetal brain activity associated with increased maternal stress due to pandemic related disruptions, suggesting altered fetal programming. Long term follow-up studies are required to better understand the sequalae of these early multi-modal brain disruptions among infants born during the COVID-19 pandemic.

Common model of stress, anxiety, and depressive symptoms in pregnant women from seven high-income Western countries at the COVID-19 pandemic onset.

OBJECTIVE: Increases in stress, anxiety, and depression among women pregnant during the COVID-19 pandemic have been reported internationally. Yet rigorous comparison of the prevalence of maternal mental health problems across countries is lacking. Moreover, whether stress is a common predictor of maternal mental health during the pandemic across countries is unknown. METHODS: 8148 pregnant women from Germany, Israel, Italy, Poland, Spain, Switzerland, and the United States were enrolled in the International COVID-19 Pregnancy Experiences (I-COPE) Study between April 17 and May 31, 2020. Sociodemographic characteristics, pandemic-related stress, pregnancy-specific stress, anxiety, and depression were assessed with well-validated instruments. The magnitude of stress and mood disturbances was compared across countries. A path model predicting clinically significant levels of anxiety and depression from maternal characteristics and stress was tested for all study participants and then examined separately in each country with >200 participants. RESULTS: Countries differed significantly in magnitude of pandemic-related pregnancy stress and pandemic-unrelated pregnancy-specific stress, and in prevalence of clinically significant anxiety and depression levels. A well-fitting common path model for the entire sample indicated that mood and anxiety disturbances were strongly predicted by pandemic-related and pregnancy-specific stress after accounting for maternal characteristics. The model was replicated in individual countries. CONCLUSIONS: Although pregnant women in high-income Western countries experienced different levels of stress resulting from the COVID-19 pandemic, stress is a strong, common predictor of anxiety and depressive symptoms in these individuals. The common model can be used to inform research and clinical interventions to protect against adverse consequences of prenatal maternal stress, anxiety, and depression for mothers and infants.

Infant behavioral problems in the first year of life and maternal stress during the COVID-19 pandemic: Results from the "CoviFam" online survey

(German) Theoretischer Hintergrund: Die COVID-19-Pandemie stellte in vielen Bereichen eine Belastung fur Familien dar, insbesondere durch die einschneidenden Beschrankungen zu Beginn. Fragestellung: Wie wirkte sich dies auf die Belastung von Muttern mit Kindern im ersten Lebensjahr und auf die kindliche Verhaltensregulation aus? Methode: In einer Online-Befragung schatzten 577 Mutter das Schrei-, Schlaf- und Futter-/Essverhalten ihrer Kinder (M = 7.3;0-12 Mon., SD = 3.25) und ihre eigene Belastung ein, zudem Stresserleben, depressive Symptomatik, Partnerschaftszufriedenheit und Bonding. Ergebnisse: Schlafprobleme traten bei 21.7%, schwer trostbares und haufiges Schreien bei 12.3% und exzessives Schreien bei 1.6% der Kinder auf. Mindestens jede funfte Mutter fuhlte sich durch Schreien oder Schlafprobleme belastet. Mehr Stress, beeintrachtigtes Bonding und weniger Partnerschaftszufriedenheit erklarten 17-21% der Varianz der mutterlichen Belastung durch Schrei- und Schlafverhalten. In der Zeit der starksten Beschrankungen zeigte sich signifikant mehr Belastung in der Gruppe von Muttern, die von vermehrtem Schreien und verlangerter Einschlaflatenz berichteten, sowie mit mindestens einem weiteren Kind im Haushalt (MANOVA). Diskussion und Schlussfolgerung: Pandemiebedingt belastend fur Mutter im ersten Jahr scheinen eingeschrankter Zugang zum Versorgungssystem, die Betreuung von mehr als einem Kind sowie das Alter des Kindes zu sein, wahrend eine gute Beziehung zum Kind (Bonding) und/oder zum Partner (Partnerschaftszufriedenheit) abmildernd wirken. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

More MOM(mother's Own Milk)Quality Improvement Initiative to Increase Breast Milk at Discharge in the an Urban NICU

Purpose/Objectives: It is well established that breast milk provides newborns with nutritional support, improved immunological defense, and better neurodevelopmental outcome. The American Academy of Pediatrics (AAP) recommends breastfeeding for 6 months and it is imperative that we as neonatal providers, promote and help sustain mother's breast milk supply so that upon discharge, these mothers may achieve this goal. Premature or Very Low Birth Weight (VLBW) infants tend to be sicker and unable to feed immediately. These challenges, paired with their critical illness in the Neonatal Intensive Care Unit (NICU), along with maternal stress and separation from the infant, makes meeting the AAP recommendation a challenge. On review of our data (demographics: 62% African American, 27% Hispanics, 8% Caucasians), we found that only 55% of babies discharged from the NICU at University of Illinois Hospital (UIH) received any breast milk at the time of discharge, while only 31% of VLBW infants received any breast milk at discharge. This identified an opportunity for improvement for our NICU in September 2019. Design/Methods: Our quality improvement (QI) initiative aimed to improve the rate of maternal breast milk administration at discharge by 8% by August 2022 for newborns born <34 weeks or <1500 grams admitted to the UIH NICU from birth. Our multidisciplinary team included physicians, nurses, and dietician. We used the Institute of Healthcare Improvement Model for. Change and Process maps and Key Driver Diagrams to develop and identify interventions. Tests of change were conducted using plan-do-study-act (PDSA) cycles targeting interventions such as increased maternal support by providing an early recognition reward trinket for breast milk, improving EMR handoff, and providing a lactation bundle. Process measures (documentation, checklist), balance measures (time to first feed, length of central line, length of stay), and our overall outcome measure (improving breast milk administration at discharge) were identified and data was collected and presented as control charts with statistical analysis. Results: Although we have yet to see a statistically significant shift, we have achieved ∼30% of our targeted aim and see a trend towards desired outcome, Figure 1. The project has gained momentum from all key stakeholders and frontline staff, leading to ownership and pride in the project. Conclusion/Discussion: Although the COVID-19 pandemic caused the initiative to slow down, the continual conversation surrounding the project, played a large component in changing the culture around breast milk and has potentially impacted outcomes, Figure 1. On feedback from the medical team, the morale and quality of conversations with bedside RN regarding mother's milk supply had increased. We have made steps in the right direction, but there is still much work to accomplish. Moving forward, this initiative will work towards achieving our aim, a sustainability phase, and expand to other departments.

Detrimental Intrauterine Stress Exposure and Post-natal Outcomes in Prenatally Diagnosed Congenital Heart Disease

Background: Prenatal diagnosis of congenital heart disease (CHD) is a stressful event that leads to anxiety, depression and traumatic stress in expectant parents. Cortisol is elevated in times of stress, and when present in mothers, crosses the placenta and leads to suppression of the fetus' own production of cortisol. When those neonates go on to require stressful procedures in the first months of life, some are unable to effectively mount a cortisol mediated stress response which can lead to poor outcomes and even death. We sought to investigate the relationship between maternal stress during pregnancy, and neonatal outcomes. Methods: We conducted a retrospective chart review of pregnancies complicated by a fetal diagnosis of critical CHD (including transposition of the great arteries, tetralogy of Fallot, total anomalous pulmonary venous return, and coarctation) who were born between 5/1/2019 and 5/1/2021. Maternal data included demographics and medical comorbidities. Composite maternal prenatal stress score (PSS) was calculated based upon 1) prenatal mental health diagnoses, 2) housing/food insecurity 3) income insecurity, 4) social support/child care, 5) legal involvement, 6) transportation issues and 7) other stressors. Categories ranged from 0 (no concerns) to 3 (significant concerns). Infant charts were reviewed for postnatal, and post-operative outcomes including infection, inotropic support, and exogenous steroid treatment. Results: 41 maternal-fetal dyads met inclusion criteria. Demographic and catheter based intervention at a median of 8 (2-54) days of life. 13 patients had single ventricle anatomy (8 initial surgical palliation, 5 catheterization). Mothers with higher composite PSS were more likely to have infants that required steroids after CHD surgery compared to mothers with lower scores (p=.01) (figure 1). Surgical patients needing bypass were more likely to require post-operative steroids than those not requiring bypass (18/22 vs 0/4, p<.005). None of the catheter-based interventions (including those with high risk single ventricle anatomy) required steroids (p <.0001). Maternal individual stress sub-categories, severity of prenatal CHD diagnosis, and counseling during the COVID-19 era did not correlate with steroid treatment. Finally, PSS did not correlate with individual outcomes such as birthweight, inotropic support, infection or hypoglycemia. Conclusion: Maternal prenatal stress is multifactorial and higher composite maternal prenatal stress scores are correlated with post-bypass steroid requirements, suggesting that a stressful intrauterine environment can be associated with worse postoperative outcomes for the neonate.

PRENATAL MATERNAL STRESS NOT ASSOCIATED WITH BIRTH OUTCOMES IN BABIES BORN DURING COVID-19 RESTRICTIONS: THE AUSTRALIAN BITTOC STUDY

Background: Certain forms of prenatal maternal stress (PNMS) are risk factors for preterm birth and low birthweight. In the context of the COVID-19 pandemic, two components of PNMS, objective hardship and subjective distress, may be differentially associated with birth outcomes. We aimed to determine the association of pandemic-related objective hardship and subjective distress with birth outcomes, and we explored moderating factors of objective hardship. Methods: Australian women who delivered during the pandemic completed online questionnaires at baseline and at two months postpartum, including self-reports of pandemic-related objective hardship, subjective distress and birth outcomes. We conducted linear regressions with objective hardship and subjective distress controlled for objective hardship as predictor variables and gestational length and birthweight as outcome variables. Moderation of objective distress by subjective distress, infant sex, and change in diet was evaluated by adding two-way interaction terms. Results: The sample included 2285 women (51.6% male infants, 48.0% female and 0.4% unreported sex). Age 30-34 years was the most frequent maternal age category. No associations between maternal objective hardship or subjective distress with gestational age at birth or birthweight were identified. After controlling for objective hardship, female infant sex and self-reported improvement in maternal diet were significantly associated with lower birthweight (β = -0.090 and -0.069, respectively), but there were no significant interactions with objective hardship. Conclusions: Objective hardship and subjective distress were not associated with birth outcomes. Other factors such as change in diet and infant sex may be more important for risk stratification in this context.

Prenatal stress from the COVID-19 pandemic predicts maternal postpartum anxiety as moderated by psychological factors: The Australian BITTOC Study.

BACKGROUND: While there have been reports of increased perinatal anxiety during the COVID-19 pandemic (Stepowicz et al., 2020), there has been a lack of research on the relative importance of objective hardship and subjective distress. In this study, we explored the extent to which resilience, tolerance of uncertainty, and cognitive appraisal of the pandemic's consequences moderate the effect of prenatal objective hardship and subjective distress due to the pandemic on 2-month postpartum anxiety. METHODS: Data were collected as part of the Birth in the Time of COVID (BITTOC) study. We measured objective hardship and subjective distress, mental health, and potential psychological moderators in 419 pregnant women residing in Australia, and at two months postpartum. Hierarchical multiple regressions were used. RESULTS: Objective hardship and subjective distress independently predicted postpartum anxiety. All three psychological factors moderated the effect of objective hardship on anxiety. For women with low/neutral resilience, or low/moderate tolerance of uncertainty, or a negative cognitive appraisal, greater objective hardship predicted higher postpartum anxiety. Conversely, for women with high resilience, or high tolerance of uncertainty, or neutral/positive cognitive appraisal, there was no association. Only a neutral/positive cognitive appraisal significantly buffered the effect of subjective distress on anxiety. LIMITATIONS: Participants self-selected themselves into the study. The generalizability of our results could be restricted to women of higher socio-economic status. CONCLUSIONS: These findings help us better understand options for intervention and assessment of vulnerable women during times of stress, along with the mechanisms by which COVID-related stress during pregnancy contributes to postpartum anxiety.

Physical Health, Media Use, Stress, and Mental Health in Pregnant Women during the COVID-19 Pandemic.

BACKGROUND: The COVID-19 pandemic has led to significant changes in the care of pregnant women and their fetuses. Emerging data show elevated depression and anxiety symptoms among pregnant women. AIMS: The purpose of this article is to investigate the psychological and behavioral impact of the COVID-19 pandemic on pregnant women in Greece during the first national lockdown. METHODS: We used a cross-sectional, anonymous survey to collect data in two fetal medicine clinics in the largest urban centers of Greece during the months of April and May 2020. The questionnaire was largely based on the CoRonavIruS Health Impact Survey (CRISIS), and assessed sociodemographic characteristics, general health and obstetric data and COVID-19-related worries and life changes. Mood symptoms, substance use and lifestyle behaviors were assessed at two time points (3 months prior to the pandemic and the 2 weeks before taking the survey), while perceived stress was measured with the perceived stress scale (PSS-14). RESULTS: A total of 308 pregnant women (Mage = 34.72), with a mean gestation of 21.19 weeks participated in the study. Over one-third of the women found COVID-19 restrictions stressful, and their highest COVID-19-related worry was having to be isolated from their baby. Mean PSS-14 score was 21.94, suggesting moderate stress. The strongest predictors of stress were physical and mental health status before COVID-19 and having experienced a stressful life event during their pregnancy. Compared to 3 months before the pandemic, women reported higher scores on mood symptoms (p < 0.001), TV use (p = 0.01) and social media use (p = 0.031) in the last 2 weeks before taking the survey. CONCLUSION: Our study provides important preliminary evidence of the negative impact of the COVID-19 pandemic and the lockdown on pregnant women's well-being and functioning.

Maternal Perceived Stress During the COVID-19 Pandemic: Pre-Existing Risk Factors and Concurrent Correlates in New York City Women.

Objective: We examined whether pre-pandemic mental health and sociodemographic characteristics increased the susceptibility of pregnant women and mothers of young children to stress in the early months of the COVID-19 pandemic. Methods: Between April and August 2020, we surveyed 1560 women participating in a sociodemographically diverse birth cohort in New York City. Women reported their perceived stress, resiliency, and financial, familial/societal, and health-related concerns. We extracted pre-pandemic information from questionnaires and electronic health records. Results: Pre-pandemic history of depression, current financial difficulties, and COVID-19 infection were the main risk factors associated with high perceived stress. Being Hispanic and having higher resiliency scores and preexisting social support were protective against high perceived stress. Major contributors to current perceived stress were financial and familial/societal factors related to the COVID-19 pandemic. Among pregnant women, changes to prenatal care were common, as were changes to experiences following birth among postpartum women and difficulties in arranging childcare among mothers of young children. Conclusion: Our findings suggest that major risk factors of higher stress during the pandemic were similar to those of other major traumatic events.