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Am J Perinatol
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
1   Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
,
Xiaodan Tang
2   Department of Medical Social Sciences, Northwestern University, Chicago, Illinois
,
Irene Tung
3   Department of Psychology, California State University Dominguez Hills, Carson, California
,
Guojing Wu
4   Department of Epidemology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
,
Akram N. Alshawabkeh
5   Department of Civil and Environmental Engineering, College of Engineering, Northeastern University, Boston, Massachusetts
,
Jessica A. Arizaga
6   Department of Psychiatry and Behavioral Sciences, University of California-San Francisco, San Francisco, California
,
Theresa M. Bastain
7   Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California
,
Patricia A. Brennan
8   Department of Psychology, Emory University, Atlanta, Georgia
,
Carrie V. Breton
7   Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California
,
Carlos A. Camargo Jr.
9   Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
,
Camille C. Cioffi
10   Prevention Science Institute, University of Oregon, Eugene, Oregon
,
Jose F. Cordero
11   Department of Epidemiology and Biostatistics, College of Public Health, Athens, Georgia
,
Dana Dabelea
12   Department 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
13   Department of Pediatrics, Avera Research Institute, University of South Dakota School of Medicine, Sioux Falls, South Dakota
,
Cristiane S. Duarte
14   Department of Psychiatry, Columbia University-NYSPI, New York, New York
,
Anne L. Dunlop
15   Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
,
Amy J. Elliott
13   Department of Pediatrics, Avera Research Institute, University of South Dakota School of Medicine, Sioux Falls, South Dakota
,
Assiamira Ferrara
16   Division of Research, Kaiser Permanente Northern California, Oakland, California
,
Margaret R. Karagas
17   Department of Epidemiology, Geisel School of Medicine, Lebanon, New Hampshire
,
Barry Lester
18   Center for the Study of Children at Risk, Brown University, Providence, Rhode Island
,
Cindy T. McEvoy
19   Department of Pediatrics, MCR Oregon Health and Science University, Portland, Oregon
,
John Meeker
20   University of Michigan, Environmental Health Sciences, Global Public Health, Ann Arbor, Michigan
,
Jenae M. Neiderhiser
21   Department of Psychology, Pennsylvania State University, University Park, Pennsylvania
,
Julie Herbstman
22   Columbia Mailman School of Public Health, Environmental Health Sciences, New York, New York
,
Leonardo Trasande
23   Department of Pediatrics, New York University, New York
24   Department 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
25   Departments of Psychiatry, Psychology, Neuroscience, and Obstetrics and Gynecology, University of Rochester, Rochester, New York
,
Alison E. Hipwell
26   Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
,
Sarah S. Comstock
27   Department 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 Funding Research reported in this publication was supported by the Environmental influences on Child Health Outcomes (ECHO) program, Office of the Director, National Institutes of Health, under Award Numbers U2COD023375 (Coordinating Center), U24OD023382 (Data Analysis Center), U24OD023319 (PRO Core), UH3OD023251 (Alshawabkeh), UH3OD023320 (Aschner), UH3OD023253 (Camargo), UH3OD023248 (Dabelea), UH3OD023313 (Deoni), UH3OD023328 (Duarte), UH3OD023318 (Dunlop), UH3OD023279 (Elliott), UH3OD023289 (Ferrara), UH3OD023282 (Gern), UH3OD023287 (Breton), UH3OD023244 (Hipwell), UH3OD023275 (Karagas), UH3OD023271 (Karr), UH3OD023347 (Lester), UH3OD023389 (Leve), UH3OD023288 (McEvoy), UH3OD023349 (O'Connor), UH3OD023285 (Kerver), UH3OD023290 (Herbstman), UH3OD023272 (Schantz), UH3OD023249 (Stanford), UH3OD023305 (Trasande), and UH3OD023337 (Wright).
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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

Conclusion

In this national cohort, we detected no effect of the COVID-19 pandemic 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.


Note

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.


* See Acknowledgments for full listing of collaborators.


Supplementary Material



Publication History

Received: 21 July 2022

Accepted: 13 February 2023

Accepted Manuscript online:
13 February 2023

Article published online:
23 March 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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