Mental health of pregnant and postpartum women in response to the COVID-19 pandemic

Abstract

Background: The COVID-19 pandemic has been uniquely challenging for pregnant and postpartum women. Uncontrollable stress amplifies risk for maternal depression and anxiety, which are linked to adverse mother and child outcomes. This study examined change in internalizing symptoms from before to during the COVID-19 pandemic among pregnant and postpartum women longitudinally, and investigated moderation by loneliness and other contextual risk factors.

Methods: 135 women (M _age = 31.81; 26% Latina, 55% non-Hispanic White, 11% Black; 39% low-income) enrolled in an existing prospective study completed self-report questionnaires including the EPDS and STAI-short form during early pregnancy, prior to COVID-19, and during COVID-19.

Results: Depressive symptoms were higher during COVID-19 compared to pre-COVID-19 and just as high as during early pregnancy. Anxiety symptoms were higher during COVID-19 compared to both pre-COVID-19 and early pregnancy. Higher loneliness was associated with increased depressive symptoms during COVID-19. Greater COVID-19 specific adversity was linked to greater increases in internalizing symptoms during COVID-19. Lower income-to-needs-ratio most strongly predicted symptoms during early pregnancy.

Limitations: The present study is longitudinal, but the correlational nature of the data precludes causal conclusions regarding the effect of the pandemic on mental health.

Conclusion: Longitudinal analyses suggest the COVID-19 pandemic resulted in increased internalizing symptoms among diverse pregnant and postpartum women. Interpersonal and contextual factors exacerbate risk and the impact of the pandemic on women's mental health. Identifying mothers at-risk for depression and anxiety may increase treatment utilization, mitigate fetal and infant exposure to maternal depression and anxiety, and help prevent adverse child outcomes.

Keywords: Covid-19 pandemic; Depression; Longitudinal; Pregnancy; Stress; anxiety.

Fig. 1

Symptoms of depression and anxiety before and during the COVID-19 pandemic Note: Total depression symptoms scores (as measured by the EPDS) range from 0–30. Total anxiety symptoms scores (as measured by the STAI-SF) ranged from 6–24.

Fig. 2

Loneliness and change in symptoms of depression and anxiety before and during the COVID-19 pandemic Note: Data were analyzed continuously but were graphed using a median split for visualization purposes. For within timepoint analyses, see Table 2.

Fig. 3

Symptoms of depression and anxiety before and during COVID-19 for lower and higher INR groups Note: Examination of within time point group differences revealed that the low INR group reported elevated scores compared to the higher INR group during pregnancy for both symptoms of depression [t(133) = 3.81, p < .001)] and anxiety [(t(133) = 2.31, p = .02], but the two groups did not significantly differ at pre-COVID-19 [depression: t(133) = 1.73, p = .09; anxiety: t(133) = 0.97, p = .33] or during COVID-19 [depression: t(133) = 0.17, p = .86; anxiety: t(133) = −1.22, p = .23].

Fig. 4

Symptoms of depression and anxiety before and during the COVID-19 pandemic for lower and higher groups for COVID-19 specific adversity Note: Examination of within time point group differences showed differences for depressive symptoms during the pandemic (t(133) = −3.27, p = .001) such that the higher adversity group reported elevated symptoms of depression. There were no group differences in symptoms of depression or anxiety pre-COVID-19 [t(133) = −1.52, p = .13; t(133) = −1.15, p = .25, respectively] or during early pregnancy [t(133) = −0.83, p = .41; t(133) = −0.43, p = .67, respectively].