Perinatal Outcomes during versus Prior to the COVID-19 Pandemic and the Role of Maternal Depression and Perceived Stress: A Report from the ECHO Program

Kimberly S. McKee; Xiaodan Tang; Irene Tung; Guojing Wu; Akram N. Alshawabkeh; Jessica A. Arizaga; Theresa M. Bastain; Patricia A. Brennan; Carrie V. Breton; Carlos A. Camargo Jr.; Camille C. Cioffi; Jose F. Cordero; Dana Dabelea; Arielle R. Deutsch; Cristiane S. Duarte; Anne L. Dunlop; Amy J. Elliott; Assiamira Ferrara; Margaret R. Karagas; Barry Lester; Cindy T. McEvoy; John Meeker; Jenae M. Neiderhiser; Julie Herbstman; Leonardo Trasande; Thomas G. O'Connor; Alison E. Hipwell; Sarah S. Comstock; on behalf of program collaborators for Environmental influences on Child Health Outcomes

doi:10.1055/a-2033-5610

American Journal of Perinatology, Table of Contents

Am J Perinatol 2024; 41(S 01): e1404-e1420
DOI: 10.1055/a-2033-5610

Original Article

Perinatal Outcomes during versus Prior to the COVID-19 Pandemic and the Role of Maternal Depression and Perceived Stress: A Report from the ECHO Program

Kimberly S. McKee

¹Department of Family Medicine, University of Michigan, Ann Arbor, Michigan

,

Xiaodan Tang

²Department of Medical Social Sciences, Northwestern University, Chicago, Illinois

,

Irene Tung

³Department of Psychology, California State University Dominguez Hills, Carson, California

,

Guojing Wu

⁴Department of Epidemology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

,

Akram N. Alshawabkeh

⁵Department of Civil and Environmental Engineering, College of Engineering, Northeastern University, Boston, Massachusetts

,

Jessica A. Arizaga

⁶Department of Psychiatry and Behavioral Sciences, University of California-San Francisco, San Francisco, California

,

Theresa M. Bastain

⁷Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California

,

Patricia A. Brennan

⁸Department of Psychology, Emory University, Atlanta, Georgia

,

Carrie V. Breton

⁷Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California

,

Carlos A. Camargo Jr.

⁹Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts

,

Camille C. Cioffi

¹⁰Prevention Science Institute, University of Oregon, Eugene, Oregon

,

Jose F. Cordero

¹¹Department of Epidemiology and Biostatistics, College of Public Health, Athens, Georgia

,

Dana Dabelea

¹²Department of Epidemiology, Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado

,

Arielle R. Deutsch

¹³Department of Pediatrics, Avera Research Institute, University of South Dakota School of Medicine, Sioux Falls, South Dakota

,

Cristiane S. Duarte

¹⁴Department of Psychiatry, Columbia University-NYSPI, New York, New York

,

Anne L. Dunlop

¹⁵Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia

,

Amy J. Elliott

¹³Department of Pediatrics, Avera Research Institute, University of South Dakota School of Medicine, Sioux Falls, South Dakota

,

Assiamira Ferrara

¹⁶Division of Research, Kaiser Permanente Northern California, Oakland, California

,

Margaret R. Karagas

¹⁷Department of Epidemiology, Geisel School of Medicine, Lebanon, New Hampshire

,

Barry Lester

¹⁸Center for the Study of Children at Risk, Brown University, Providence, Rhode Island

,

Cindy T. McEvoy

¹⁹Department of Pediatrics, MCR Oregon Health and Science University, Portland, Oregon

,

John Meeker

²⁰University of Michigan, Environmental Health Sciences, Global Public Health, Ann Arbor, Michigan

,

Jenae M. Neiderhiser

²¹Department of Psychology, Pennsylvania State University, University Park, Pennsylvania

,

Julie Herbstman

²²Columbia Mailman School of Public Health, Environmental Health Sciences, New York, New York

,

Leonardo Trasande

²³Department of Pediatrics, New York University, New York

²⁴Department of Environmental Medicine, and Population Health, New York University Grossman School of Medicine and New York University School of Global Public Health, New York University, New York

,

Thomas G. O'Connor

²⁵Departments of Psychiatry, Psychology, Neuroscience, and Obstetrics and Gynecology, University of Rochester, Rochester, New York

,

Alison E. Hipwell

²⁶Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania

,

Sarah S. Comstock

²⁷Department of Food Science and Human Nutrition, Michigan State University, East Lansing, Michigan

,

on behalf of program collaborators for Environmental influences on Child Health Outcomes

› Author Affiliations

Abstract

Objective We sought to evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on perinatal outcomes while accounting for maternal depression or perceived stress and to describe COVID-specific stressors, including changes in prenatal care, across specific time periods of the pandemic.

Study Design Data of dyads from 41 cohorts from the National Institutes of Health Environmental influences on Child Health Outcomes Program (N = 2,983) were used to compare birth outcomes before and during the pandemic (n = 2,355), and a partially overlapping sample (n = 1,490) responded to a COVID-19 questionnaire. Psychosocial stress was defined using prenatal screening for depression and perceived stress. Propensity-score matching and general estimating equations with robust variance estimation were used to estimate the pandemic's effect on birth outcomes.

Results Symptoms of depression and perceived stress during pregnancy were similar prior to and during the pandemic, with nearly 40% of participants reporting mild to severe stress, and 24% reporting mild depression to severe depression. Gestations were shorter during the pandemic (B = − 0.33 weeks, p = 0.025), and depression was significantly associated with shortened gestation (B = − 0.02 weeks, p = 0.015) after adjustment. Birth weights were similar (B = − 28.14 g, p = 0.568), but infants born during the pandemic had slightly larger birth weights for gestational age at delivery than those born before the pandemic (B = 0.15 z-score units, p = 0.041). More women who gave birth early in the pandemic reported being moderately or extremely distressed about changes to their prenatal care and delivery (45%) compared with those who delivered later in the pandemic. A majority (72%) reported somewhat to extremely negative views of the impact of COVID-19 on their life.

Conclusion In this national cohort, we detected no effect of COVID-19 on prenatal depression or perceived stress. However, experiencing the COVID-19 pandemic in pregnancy was associated with decreases in gestational age at birth, as well as distress about changes in prenatal care early in the pandemic.

Key Points

COVID-19 was associated with shortened gestations.
Depression was associated with shortened gestations.
However, stress during the pandemic remained unchanged.
Most women reported negative impacts of the pandemic.

Keywords

stress - pregnancy - COVID-19 - perinatal - birth weight - gestational age

Full Text

References

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Supplementary Material

Supplementary Material