COVID-related stress during pregnancy tied to later distress for moms and babies

Stressed mom and dad with baby

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Women who experience COVID-related stress during pregnancy have worse mental health 1.5 years after giving birth, and their babies show more distress and irritability, finds a follow-up study published yesterday in JAMA Network Open.

Led by a University of Cambridge researcher in the United Kingdom, the COVID-19 Risks Across the Lifespan Consortium assessed the mental well-being of 318 mothers before and after giving birth and the affectivity of their infants at an average of 17 months. The team used the Pandemic Anxiety Scale to measure before-birth COVID-related stress, which includes worries about infection and food- and job-related security.

Participants were pregnant at the first online assessment from May 5 to September 30, 2020, and completed a follow-up evaluation from October 28, 2021, to April 24, 2022, when the researchers also measured postpartum (after-birth) distress. This type of distress includes worry about the infant's health and well-being and harming the child.

During the follow-up evaluation, the researchers asked about infant mood and behavior. Babies with a negative affect are more likely to cry, less easily calmed, and less likely to explore.

Average participant age was 32.0 years, 28% were from Australia, 43% were from the United Kingdom, and 30% were from the United States.

Support, information for pregnant women

COVID-related stress was significantly linked to maternal postpartum distress (β, 0.40), depression (β, 0.32), and generalized anxiety (β, 0.35), as well as infant negative affect (β, 0.45). The findings were consistent across sensitivity analyses.

Negative affectivity has "'been associated with a range of behavioural problems, and importantly, also cognition," lead author Susanne Schweizer, PhD, said in a University of New South Wales news release. "It has also been associated with developmental outcomes across the lifespan." 

Schweizer, who said she also experienced pandemic-related pregnancy stress and postpartum distress, said that pregnant women need more support than that provided by standard care.

"Pregnancy is a period of vulnerability for mental health problems," she said. "Intense and rapidly fluctuating moods and emotions are a normal part of pregnancy, and after birth many people will experience intrusive, unwanted thoughts. But we are not told enough about this. Pregnant individuals need to be given information about what to expect, what is common and when they should seek help."

The study was a follow-up to research by Schweizer and colleagues published online in January in the Journal of Affective Disorders. That study, which included 742 pregnant women and 742 matched nonpregnant women who completed three online surveys 3 months apart, found that COVID-related stress most affected those who tended to worry, were lonely, or had a low tolerance for uncertainty.

Pregnancy is a period of vulnerability for mental health problems.

"A research agenda needs to be outlined to track the longer-term associations of COVID-19–related stress with maternal and infant outcomes," the researchers of the current study concluded. "There is a particular need to identify biological and psychological markers of vulnerability in this population to tailor antenatal [before birth] care approaches."

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