Women Pregnant During the Pandemic Had Increased Prenatal Stress, Not Significantly Linked to Adverse Birth Outcomes

During the COVID-19 pandemic, being pregnant was associated with higher levels of anxiety and depression symptoms, according to a recent study by the National Institutes of Health and published in Psychological Medicine. The associated pregnancies were shorter, however, it did not have a significantly negative effect on birth outcomes.^1,2

“This increase [of stress and depression symptoms] may reflect the disruptions to daily life and health, social, and financial concerns experienced by many during the pandemic,” the study authors wrote in the article.²

Some epidemiological studies suggest that the COVID-19 pandemic increased related psychiatric morbidity and distress in the general population. Others emphasize the pandemic had an impact on the psychological stress of women who are pregnant, and a healthy number of studies suggest this is linked to preterm birth, according to the authors of the current study. However, the link between the pandemic and rates of preterm birth and/or low birthweight is still largely unknown.²

The authors of the current study looked at the effect of the COVID-19 pandemic on birth outcomes, using propensity-score matching to uncover the influence of the pandemic on increased psychological stress and pregnancy outcomes. The hypothesis was that maternal psychological distress from the COVID-19 pandemic is associated with negative birth outcomes.²

The team collected complete sociodemographic data on 501 pandemic-exposed pregnant women who were enrolled in prenatal cohorts as part of the Environmental Influences on Child Health Outcomes (ECHO) Program—an NIH-funded consortium of US cohort studies that looks at early life exposures on child health and development. They measured gestational age at birth (GA) and sex-specific birthweight adjusted for GA.²

The pandemic did not greatly increase the psychological distress of women who are pregnant compared to women who were pregnant before the pandemic. Although GA was slightly shorter at birth, there was not a strong association between pandemic exposure, psychological distress, and clinically significant rates of preterm birth or GA.There was no effect on birthweight adjusted for GA either.²

Women with emotional support and consistent participation in physical activity before and during the COVID-19 pandemic also reported lower levels of stress and depression symptoms. Sedentary behavior was opposingly linked to higher levels of perceived stress and depressive symptoms, but emotional support improved both symptoms.²

These findings support screening and interventions that reduce inactivity and improve psychological wellbeing during pregnancy, pandemic or not, according to the investigators.²

The study contains some limitations, the first of which being that more than 75% of participants identified as either White, non-Hispanic, or college educated.²

“Given the elevated rates of preterm birth among Black, American Indian, and Hispanic/Latinx infants, there is a clear need for additional studies that focus specifically on the impact of the pandemic on prenatal distress and birth outcomes for these groups,” the study authors wrote.²

In addition, investigators gathered data during a period of varied infection rates and mitigation measures from March 2020 to May 2021. They also focused on GA and birthweight in live births, which may create sample bias.²

“[And] more research is needed to understand how social support and physical activity may protect pregnant people during difficult times,” said Alison Hipwell, PhD, ClinPsyD, of the University of Pittsburgh, in the press release.¹