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Pregnancy during the pandemic: the impact of COVID-19-related stress on risk for prenatal depression

Published online by Cambridge University Press:  30 March 2021

Lucy S. King Open the ORCID record for Lucy S. King [Opens in a new window] ,
Daisy E. Feddoes ,
Jaclyn S. Kirshenbaum ,
Kathryn L. Humphreys  and
Ian H. Gotlib Open the ORCID record for Ian H. Gotlib [Opens in a new window]
Lucy S. King*
Affiliation:
Department of Psychology, Stanford University, Stanford, CA, USA
Daisy E. Feddoes
Affiliation:
Department of Psychology, Stanford University, Stanford, CA, USA
Jaclyn S. Kirshenbaum
Affiliation:
Department of Psychology, Stanford University, Stanford, CA, USA
Kathryn L. Humphreys
Affiliation:
Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
Ian H. Gotlib
Affiliation:
Department of Psychology, Stanford University, Stanford, CA, USA
*
Author for correspondence: Lucy S. King, E-mail: lucy.king@stanford.edu
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Abstract

Background

Pregnant women may be especially susceptible to negative events (i.e. adversity) related to the coronavirus disease 2019 (COVID-19) pandemic and negative affective responses to these events (i.e. stress). We examined the latent structure of stress and adversity related to the COVID-19 pandemic among pregnant women, potential antecedents of COVID-19-related stress and adversity in this population, and associations with prenatal depressive symptoms.

Method

We surveyed 725 pregnant women residing in the San Francisco Bay Area in March−May 2020, 343 of whom provided addresses that were geocoded and matched by census tract to measures of community-level risk. We compared their self-reported depressive symptoms to women matched on demographic factors and history of mental health difficulties who were pregnant prior to the pandemic.

Results

Women who were pregnant during the pandemic were nearly twice as likely to have possible depression than were matched women who were pregnant prior to the pandemic. Individual- and community-level factors tied to socioeconomic inequality were associated with latent factors of COVID-19-related stress and adversity. Beyond objective adversity, subjective stress responses were strongly associated with depressive symptoms during the pandemic.

Conclusions

Highlighting the role of subjective responses in vulnerability to prenatal depression and factors that influence susceptibility to COVID-19-related stress, these findings inform the allocation of resources to support recovery from this pandemic and future disease outbreaks. In addition to policies that mitigate disruptions to the environment due to the pandemic, treatments that focus on cognitions about the self and the environment may help to alleviate depressive symptoms in pregnant women.

Keywords

pregnancypandemicdepressionstressadversity
Type
Original Article
Information
Psychological Medicine , Volume 53 , Issue 1 , January 2023 , pp. 170 - 180
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Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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References

Adhikari, S., Pantaleo, N. P., Feldman, J. M., Ogedegbe, O., Thorpe, L., & Troxel, A. B. (2020). Assessment of community-level disparities in Coronavirus Disease 2019 (COVID-19) infections and deaths in large US metropolitan areas. JAMA Network Open, 3(7), e2016938. https://doi.org/10.1001/jamanetworkopen.2020.16938.CrossRefGoogle ScholarPubMed
Bock, J., Wainstock, T., Braun, K., & Segal, M. (2015). Stress in utero: Prenatal programming of brain plasticity and cognition. Biological Psychiatry, 78(5), 315–326. https://doi.org/10.1016/j.biopsych.2015.02.036.CrossRefGoogle ScholarPubMed
Camacho, M. C., King, L. S., Ojha, A., García, C. M., Sisk, L. S., Cichocki, A. C., … Gotlib, I. H. (2020). Cerebral blood flow in 5- to 8-month-olds: Regional tissue maturity is associated with infant affect. Developmental Science, 23(5), e12928. https://doi.org/10.1111/desc.12928.Google Scholar
Cameron, E. E., Joyce, K. M., Delaquis, C. P., Reynolds, K., Protudjer, J. L. P., & Roos, L. E. (2020). Maternal psychological distress & mental health service use during the COVID-19 pandemic. Journal of Affective Disorders, 276, 765–774. https://doi.org/10.1016/j.jad.2020.07.081.CrossRefGoogle ScholarPubMed
Cárdenas, E. F., Kujawa, A., & Humphreys, K. L. (2020). Neurobiological changes during the peripartum period: Implications for health and behavior. Social Cognitive and Affective Neuroscience, 15(10), 1097–1110. https://doi.org/10.1093/scan/nsz091.CrossRefGoogle ScholarPubMed
Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. The British Journal of Psychiatry : The Journal of Mental Science, 150, 782–786. https://doi.org/10.1192/bjp.150.6.782.CrossRefGoogle ScholarPubMed
Danese, A., & Widom, C. S. (2020). Objective and subjective experiences of child maltreatment and their relationships with psychopathology. Nature Human Behaviour, 4(8), 811–818. https://doi.org/10.1038/s41562-020-0880-3.CrossRefGoogle ScholarPubMed
Davenport, M. H., Meyer, S., Meah, V. L., Strynadka, M. C., & Khurana, R. (2020). Moms are not OK: COVID-19 and maternal mental health. Frontiers in Global Women's Health, 1(June), 1–6. https://doi.org/10.3389/fgwh.2020.00001.CrossRefGoogle Scholar
Edvinsson, Å, Bränn, E., Hellgren, C., Freyhult, E., White, R., Kamali-Moghaddam, M., … Sundström-Poromaa, I. (2017). Lower inflammatory markers in women with antenatal depression brings the M1/M2 balance into focus from a new direction. Psychoneuroendocrinology, 80, 15–25. https://doi.org/10.1016/j.psyneuen.2017.02.027.CrossRefGoogle ScholarPubMed
Ettman, C. K., Abdalla, S. M., Cohen, G. H., Sampson, L., Vivier, P. M., & Galea, S. (2020). Prevalence of depression symptoms in US adults before and during the COVID-19 pandemic. JAMA Network Open, 3(9), e2019686. https://doi.org/10.1001/jamanetworkopen.2020.19686.CrossRefGoogle ScholarPubMed
Fancourt, D., Steptoe, A., & Bu, F. (2021). Trajectories of anxiety and depressive symptoms during enforced isolation due to COVID-19: Longitudinal analyses of 36520 adults in England. The Lancet Psychiatry, 8(2), 141–149. https://doi.org/10.1101/2020.06.03.20120923.CrossRefGoogle Scholar
Figueiredo, B., Canário, C., & Field, T. (2014). Breastfeeding is negatively affected by prenatal depression and reduces postpartum depression. Psychological Medicine, 44(5), 927–936. https://doi.org/10.1017/S0033291713001530.CrossRefGoogle ScholarPubMed
Fransson, E., Karalexi, M., Kimmel, M., Bränn, E., Kollia, N., van Zoest, V., … Skalkidou, A. (2020). Mental health among pregnant women during the pandemic in Sweden – A mixed methods approach using data from the Mom2B mobile application for research. MedRxiv, 1–36. https://doi.org/10.1101/2020.12.18.20248466.Google Scholar
Glover, V. (2014). Maternal depression, anxiety and stress during pregnancy and child outcome; what needs to be done. Best Practice and Research: Clinical Obstetrics and Gynaecology, 28(1), 25–35. https://doi.org/10.1016/j.bpobgyn.2013.08.017.Google Scholar
Gunja, M. Z., Fitzgerald, M., & Zephyrin, L. (2020). Maternal mortality and maternity care in the United States compared to 10 other developed countries. Retrieved from https://www.commonwealthfund.org/publications/issue-briefs/2020/nov/maternal-mortality-maternity-care-us-compared-10-countries.Google Scholar
Gustafsson, H. C., Sullivan, E. L., Nousen, E. K., Sullivan, C. A., Huang, E., Rincon, M., … Loftis, J. M. (2018). Maternal prenatal depression predicts infant negative affect via maternal inflammatory cytokine levels. Brain Behavior and Immunity, 73(June), 470–481. https://doi.org/10.1016/j.bbi.2018.06.011.CrossRefGoogle ScholarPubMed
Hammen, C. (2005). Stress and depression. Annual Review of Clinical Psychology, 1(1), 293–319. https://doi.org/10.1146/annurev.clinpsy.1.102803.143938.CrossRefGoogle ScholarPubMed
Harkness, K. L., & Monroe, S. M. (2016). The assessment and measurement of adult life stress: Basic premises, operational principles, and design requirements. Journal of Abnormal Psychology, 125(5), 727–745. https://doi.org/10.1037/abn0000178.CrossRefGoogle ScholarPubMed
Heggeness, M. L. (2020). Estimating the immediate impact of the COVID-19 shock on parental attachment to the labor market and the double bind of mothers. Review of Economics of the Household, 1–26. https://doi.org/10.1007/s11150-020-09514-x.CrossRefGoogle Scholar
Ho, D. E., Imai, K., King, G., & Stuart, E. A. (2011). MatchIt: Nonparametric preprocessing for parametric causal inference. Journal of Stastical Software, 42(8), 1–28. https://doi.org/10.18637/jss.v042.i08.Google Scholar
Hoffman, M. A., & Kruczek, T. (2011). A bioecological model of mass trauma: Individual, community, and societal effects. The Counseling Psychologist, 39(8), 1087–1127. https://doi.org/10.1177/0011000010397932.CrossRefGoogle Scholar
Humphreys, K. L., King, L. S., Choi, P., & Gotlib, I. H. (2018). Maternal depressive symptoms, self-focus, and caregiving behavior. Journal of Affective Disorders, 238, 465–471. https://doi.org/10.1016/j.jad.2017.07.051.CrossRefGoogle ScholarPubMed
James, G., Hastie, T., & Tibshirani, R. (2013). Resampling methods. In An Introduction to statistical learning. Springer texts in statistics (Vol. 103, pp. 175–201). New York, NY: Springer. https://doi.org/10.1007/978-1-4614-7138-7_5.Google Scholar
Jay, J., Bor, J., Nsoesie, E. O., Lipson, S. K., Jones, D. K., Galea, S., … Raifman, J. (2020). Neighborhood income and physical distancing during the COVID-19 pandemic in the United States. Nature Human Behavior, 4, 1294–1302. https://doi.org/10.1038/s41562-020-00998-2.CrossRefGoogle ScholarPubMed
Jerome, F., Hastie, T., Simon, N., & Tibshirani, R. (2010). Regularization paths for generalized linear models via coordinate descent. Journal of Statistical Software, 33(1), 1–22. Retrieved from http://www.jstatsoft.org/v33/i01/.Google Scholar
Karaca-Mandic, P., Georgiou, A., & Sen, S. (2020). Assessment of COVID-19 hospitalizations by race/ethnicity in 12 states. JAMA Internal Medicine, 181(1), 131–134. https://doi.org/10.1001/jamainternmed.2020.3857.CrossRefGoogle Scholar
King, L. S., Camacho, M. C., Montez, D. F., Humphreys, K. L., & Gotlib, I. H. (2021a). Naturalistic language input is associated with resting-state functional connectivity in infancy. The Journal of Neuroscience, 41(3), 424–434. https://doi.org/10.1523/jneurosci.0779-20.2020.CrossRefGoogle ScholarPubMed
King, L. S., Querdasi, F. R., Humphreys, K. L., & Gotlib, I. H. (2021b). Dimensions of the language environment in infancy and symptoms of psychopathology in toddlerhood. Developmental Science, e13082. https://doi.org/10.1111/desc.13082.CrossRefGoogle ScholarPubMed
Lebel, C., MacKinnon, A., Bagshawe, M., Tomfohr-Madsen, L., & Giesbrecht, G. (2020). Elevated depression and anxiety symptoms among pregnant individuals during the COVID-19 pandemic. Journal of Affective Disorders, 277(July), 5–13. https://doi.org/10.1016/j.jad.2020.07.126.CrossRefGoogle ScholarPubMed
Levis, B., Negeri, Z., Sun, Y., Benedetti, A., & Thombs, B. D. (2020). Accuracy of the Edinburgh Postnatal Depression Scale (EPDS) for screening to detect major depression among pregnant and postpartum women: Systematic review and meta-analysis of individual participant data. BMJ, 371, m4022. https://doi.org/10.1136/bmj.m4022.CrossRefGoogle ScholarPubMed
Martin, J. A., Hamilton, B. E., Osterman, M. J. K., & Driscoll, A. K. (2018). Births: Final Data for 2017. National vital statistics reports: from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics Report, 67(8), 1–50. Retrieved from https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_08-508.pdf.Google ScholarPubMed
McElroy, E., Patalay, P., Moltrecht, B., Shevlin, M., Shum, A., Creswell, C., & Waite, P. (2020). Demographic and health factors associated with pandemic anxiety in the context of COVID-19. British Journal of Health Psychology, 25(4), 934–944. https://doi.org/10.1111/bjhp.12470.CrossRefGoogle ScholarPubMed
Morris, A. R., Traube, D. E., Lakshmanan, A., West, A., & Saxbe, D. E. (2020). Perinatal mental health during the COVID-19 pandemic: Evidence for heightened distress in pregnant women highlights the need for novel interventions. PsyArXiv, 2–33. https://doi.org/10.31234/osf.io/j349z.Google Scholar
Muthén, L. K., & Muthén, B. O. (2017). Mplus user's guide (8th ed.). Los Angeles, CA: Muthén & Muthén.Google Scholar
Nelson, B. W., Pettitt, A., Flannery, J. E., & Allen, N. B. (2020). Rapid assessment of psychological and epidemiological correlates of COVID-19 concern, financial strain, and health-related behavior change in a large online sample. PloS One, 15(11), e0241990. https://doi.org/10.1371/journal.pone.0241990.CrossRefGoogle Scholar
Osborne, S., Biaggi, A., Chua, T. E., Du Preez, A., Hazelgrove, K., Nikkheslat, N., … Pariante, C. M. (2018). Antenatal depression programs cortisol stress reactivity in offspring through increased maternal inflammation and cortisol in pregnancy: The Psychiatry Research and Motherhood – Depression (PRAM-D) Study. Psychoneuroendocrinology, 98, 211–221. https://doi.org/10.1016/j.psyneuen.2018.06.017.CrossRefGoogle Scholar
Preis, H., Mahaffey, B., Heiselman, C., & Lobel, M. (2020). Vulnerability and resilience to pandemic-related stress among U.S. women pregnant at the start of the COVID-19 pandemic. Social Science and Medicine, 266(September), 113348. https://doi.org/10.1016/j.socscimed.2020.113348.CrossRefGoogle ScholarPubMed
Rasmussen, J. M., Graham, A. M., Entringer, S., Gilmore, J. H., Styner, M., Fair, D. A., … Buss, C. (2019). Maternal Interleukin-6 concentration during pregnancy is associated with variation in frontolimbic white matter and cognitive development in early life. NeuroImage, 185, 825–835. https://doi.org/10.1016/j.neuroimage.2018.04.020.CrossRefGoogle Scholar
R Core Team. (2020). R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing. Retrieved from https://www.r-project.org/.Google Scholar
Rossen, L., Hutchinson, D., Wilson, J., Burns, L., A Olsson, C., Allsop, S., … Mattick, R. P. (2016). Predictors of postnatal mother-infant bonding: The role of antenatal bonding, maternal substance use and mental health. Archives of Women's Mental Health, 19(4), 609–622. https://doi.org/10.1007/s00737-016-0602-z.CrossRefGoogle ScholarPubMed
Saxbe, D., Goldenberg, D., & Rossin-Slater, M. (2018). The transition to parenthood as a critical window for adult health. American Psychologist, 73(9), 1190–1200. https://doi.org/10.1037/amp0000376.CrossRefGoogle ScholarPubMed
Stuart, E. A. (2010). Matching methods for causal inference: A review and a look forward. Statistical Science, 25(1), 1–21. https://doi.org/10.1214/09-STS313.CrossRefGoogle Scholar
Tan, J. J. X., Kraus, M. W., Carpenter, N. C., & Adler, N. E. (2020). The association between objective and subjective socioeconomic status and subjective well-being: A meta-analytic review. Psychological Bulletin, 146(11), 970–1020. https://doi.org/10.1037/bul0000258.CrossRefGoogle ScholarPubMed
Thakrar, A., Forrest, A., Maltenfort, M., & Forrest, C. (2018). Child mortality in the US and 19 OECD comparator nations: A 50-year time-trend analysis. Health Affairs, 37(1), 140–149. https://doi.org/10.1377/hlthaff.2017.0767.CrossRefGoogle Scholar
Thayer, Z. M., & Gildner, T. E. (2020). COVID-19-related financial stress associated with higher likelihood of depression among pregnant women living in the United States. American Journal of Human Biology, e23508. https://doi.org/10.1002/ajhb.23508.CrossRefGoogle Scholar
Underwood, L., Waldie, K., D'Souza, S., Peterson, E. R., & Morton, S. (2016). A review of longitudinal studies on antenatal and postnatal depression. Archives of Women's Mental Health, 19(5), 711–720. https://doi.org/10.1007/s00737-016-0629-1.CrossRefGoogle ScholarPubMed
U.S. Bureau of Labor Statistics. (2020). Employment situation summary − October 2020. Retrieved from https://www.bls.gov/news.release/empsit.nr0.htm.Google Scholar
U.S. Department of Labor. (2012). National Compensation Survey: Employee benefits in the United States, March 2012 (Bulletin No. 2773). Retrieved from www.bls.gov/ncs/ebs/benefits/2012/ebbl0050.pdf.Google Scholar
Van den Bergh, B. R. H., van den Heuvel, M. I., Lahti, M., Braeken, M., de Rooij, S. R., Entringer, S., … Schwab, M. (2017). Prenatal developmental origins of behavior and mental health: The influence of maternal stress in pregnancy. Neuroscience and Biobehavioral Reviews, S0149–7634(16), 1–39. https://doi.org/10.1016/j.neubiorev.2017.07.003.Google Scholar
Woodworth, K. R., Olsen, E. O., Neelam, V., Lewis, E. L., Galang, R. R., Oduyebo, T., … Whitehill, F. (2020). Birth and infant outcomes following laboratory-confirmed SARS-CoV-2 infection in pregnancy – SET-NET, 16 Jurisdictions, March 29–October 14, 2020. MMWR. Morbidity and Mortality Weekly Report, 69(44), 1635–1640. https://doi.org/10.15585/mmwr.mm6944e2.CrossRefGoogle ScholarPubMed
Zambrano, L. D., Ellington, S., Strid, P., Galang, R. R., Oduyebo, T., Tong, V. T., … Zapata, L. (2020). Update: Characteristics of symptomatic women of reproductive age with laboratory-confirmed SARS-CoV-2 infection by pregnancy status – United States, January 22–October 3, 2020. MMWR. Morbidity and Mortality Weekly Report, 69(44), 1641–1647. https://doi.org/10.15585/mmwr.mm6944e3.CrossRefGoogle ScholarPubMed
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