The COVID-19 pandemic will have impacted the transition of millions of women into motherhood in May 2021.
The preparation for childbirth is exciting and joyful, but COVID-19 regulations disrupted prenatal care, forcing some women to deliver infants with no support from their partners or families. Other mothers faced separation from their newborns after the birth.
The new parents missed many rituals and celebrations that mark the transition to parenthood, such as baby showers, bris ceremonies, and christenings, meals brought by neighbors, or grandparents traveling to meet the new family member.
In the last seven years, our lab has been studying new parents. We have followed couples from pregnancy to the first postpartum year. The COVID-19 lockdowns in the spring of last year stopped us from collecting data on campus. Even though it stopped our normal research, the pandemic provided an opportunity to study a unique type of prenatal anxiety in real time.
The effects of prenatal anxiety can persist throughout life
Researchers are exploring the links between stress during pregnancy and health later in life.
The Nazis cut off the food supply to the Netherlands at the end of World War II. This led to a famine in the Netherlands during the winter of 1944-1945. The differences in lifelong cardiometabolic health were observed in babies in utero who lived through the “Dutch Hunger Winter.” Researchers were able to study the effects of starvation on babies in utero because it was clearly defined. They found that those who were exposed to famine in early pregnancy had different outcomes than those who were exposed in late pregnancy.
Scientists have found that other major societal crises, such as the September 11 attacks, Hurricane Katrina, and the 2005 earthquake in Chile, can also cause long-term health problems for mothers and children. Scientists have linked other large-scale societal crises – like the Sept.
These events and the COVID-19 pandemic share many similarities, including a large number of deaths. It’s unique, but it is also a pandemic. After natural disasters, communities often come together to mourn and rebuild. Many people were isolated during the pandemic because they had to keep a social distance. This was especially true for pregnant women who are at high risk and may have chosen to follow stricter social distance measures.
What happens if a pregnant mother’s social network shrinks or disappears overnight in person?
COVID-19 and mental health: social connection
Scientists have found that social support can reduce the risk of mental health issues for mothers. Our lab was curious about how lockdowns, coupled with economic and health concerns of pandemics, could affect pregnant women.
In order to answer this, we recruited 760 expectant mothers (641 pregnant women and 79 partners or fathers) to take part in our Coronavirus, health, isolation, and Resilience in Pregnancy (CHIRP) study between early April and the end of July 2020. was at its peak in the U.S. during the week of April 7, 2020, coincidentally the week that we launched our research. Americans spent 93% of the time they had at home. Our usual lab battery of questions was converted into an online format and shared on social media as well as online parenting and pregnancy forums. Our preliminary findings are undergoing peer review at an academic publication.
As of spring 2020, only 5% of pregnant women responding to our survey have a confirmed or suspected case of COVID-19. A similar number (4.7%) has experienced the death of a close relative due to this pandemic.
Ninety-seven percent of respondents said that their local community had issued an order to stay at home or shelter in place. Sixty-one percent of women said that the pandemic has had a “very” or a “somewhat negative” impact on their relationships. The majority of women reported that they had less contact with their neighbors, community members, coworkers, family, and close friends at the time of this survey than before the outbreak of the pandemic. In contrast, 42% of women reported spending more time with their partners than they did before the pandemic.
This change in social contact seemed to have a negative impact on mental health: nearly two-thirds of respondents reported feeling at least some isolation during the week prior. A similar number of respondents felt more alone than usual due to the pandemic. About three-fourths said that COVID-19 had a negative impact on their mental health.
We asked our respondents questions about the Beck Depression Inventory. This is a tool used by mental health professionals to evaluate symptoms of depression. We were surprised that the average score of pregnant women in our study was higher than what clinicians used to indicate depression.
More than half of the women sampled reported having clinically significant depression symptoms. More than half of the women in our sample – 62% – reported clinically significant symptoms of anxiety. These proportions were more than double what we saw in our sample before the pandemic.
Our findings aren’t unique. Other studies of pregnant women and postpartum mothers have noted heightened distress during a pandemic. For example, a not-yet-peer-reviewed survey of pregnant women in the San Francisco Bay Area also found that 51% of their sample scored above the clinical cutoff for depression, compared with 25% of a demographically matched pre-pandemic sample.
Stress from COVID-19 could last a long time.
Our preliminary results are concerning, given that there is evidence that maternal anxiety during pregnancy can influence fetal growth and affect the health of mother and child in the long term. Our sample is being used to collect birth charts in order to assess the gestational outcomes such as birth weight, preterm birth, and stress during pregnancy.
The stress caused by the first wave of the pandemic is yet to be determined. Some mothers have experienced the benefits of the pandemic, such as being able to continue breastfeeding and work from home. The pandemic also took a heavier toll on communities that were already suffering from structural racism or poverty. Researchers may find that pandemic lockdowns have different effects on mental health. They could exacerbate some risk factors while protecting others.
Our first results suggest that this pandemic infant population and its parents will be a group to watch in the future. The transition from pregnancy to parenthood may be easier for pregnant women now that the restrictions on delivery rooms have been lifted and social norms are returning. Fear, uncertainty, and grief over the many deaths of the pandemic could linger after the world has reopened.
Evidence suggests that counseling, such as talk therapy, can relieve and prevent mood disorders during the time immediately prior to and after childbirth. Primary care and mental healthcare can be integrated, and pregnant women can access psychotherapy via their OB/GYN practice. This can help reach the mothers in greatest need. As healthcare providers switched to online visits, the pandemic helped to remove many barriers to telehealth. This format could also be a good way to reach families that are reluctant to visit in person.
Our participants will be followed three, six, and twelve months after the birth of their child to track their mental health. We plan to continue the follow-up beyond the first year. While infants born after 2020 will not have experienced the pandemic, its effects could still be felt in their early years. We are only just beginning to measure this.