Is stress related to COVID-19 related to postpartum maternal mental health and infant outcomes?

In a recent study published in JAMA Network is openresearchers assessed the relationship between coronavirus disease 2019 (COVID-19) associated with prenatal stress and the mental health of mothers and their infants in the postpartum period.

Study: Association of prenatal coronavirus-related stress with postpartum maternal mental health and negative affect in infants.  Image credit: GrooveZ/Shutterstock
Stady: Association of COVID-19-related stress with postpartum maternal mental health and negative affect in infants. Image credit: GrooveZ/Shutterstock


Studies have reported that prenatal stressors significantly increase the risk of negative postpartum mental health outcomes, such as cognitive and behavioral problems, among infants. Incidences of pregnancy anxiety and depression increased significantly during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, with decreased positive emotion, poor directive behaviour, and increased impulsivity among infants.

However, the relationship between stress related to COVID-19 and postpartum maternal and infant outcomes is not fully understood. Previous studies evaluating the effects of prenatal stress on maternal and child health outcomes have been largely cross-sectional, unicentric, retrospective, with a small sample population, often using uncertain assessment measures with no documentation of psychometric characteristics.

about studying

In the current survey-based longitudinal study, researchers evaluated the impact of stress associated with prenatal SARS-CoV-2 infection on postnatal mental health outcomes for the mother and child.

The study included 318 individuals aged 11.0 years and older who participated in the Coronavirus Disease 2019 Risk Across the Age (CORAL) Study conducted in the United Kingdom (UK), the United States (US) and Australia. Females who were expecting an initial assessment between 5 May and 30 September 2020 and who completed two follow-up assessments between 28 October 2021 and 24 April 2022 at three-month intervals were taken for analysis.

In addition, the participants were invited to fill out a fourth questionnaire on the mother’s mental health and the infant’s mood in the follow-up period. Stress levels associated with COVID-19 were assessed using the Epidemic Anxiety Scale. The team used the eight-component Patient Health Questionnaire to assess depression among the mothers and the seven-component generalized anxiety disorder scale to assess general levels of anxiety.

During follow-ups, levels of postpartum distress were assessed using the 10.0-component Postpartum Distress Rating Scale, and health outcomes among infants were assessed using the Infant Behavior Questionnaire. Individuals were recruited for the study through paid advertising, social media, mothers’ group newsletters, mental health organizations, and pregnancy web forums.

Linear mixed effects modeling was performed for the analysis. Sensitivity analyzes were performed controlling for maternal mental health at initial assessment and for COVID-19 risks encountered during pregnancy and infant age during follow-up assessments. Study participants received AU$100 Amazon gift vouchers for the initial survey and AU$20 for follow-up surveys.


The average age of the study participants was 32 years, and among the study participants, 28% (n = 88), 30% (n = 94), and 43% (n = 136) resided in Australia, the United States, and the United Kingdom, respectively, of whom 87% (n = 276) were white, and 81% (n = 256) had university degrees. A history of mental disorders was reported by 36% (n = 114) of the study participants.

Other races and ethnicities included in the sample were Aboriginal, Torres Strait Islander, Asian, Hispanic, mixed, or other among two, 12, eight, seven, and 10 participants, respectively. 19 women had secondary education and 41 women had vocational or vocational training.

At the initial assessment, the mean values ​​for number of children and gestational age (in months) were 1.20 and 5.80, respectively. At final assessment, the mean age of the infant was 14 months. COVID-19-related stress in the perinatal period showed significant associations with distress, anxiety, and depression among mothers and negative emotionality among infants in the postnatal period. Sensitivity analyzes yielded similar results.

At the initial evaluation, three women showed mild generalized anxiety disorder (GAD) and depression (mean scores on the GAD-7 scale and the Patient Health Questionnaire of 6.70 and 7.80, respectively), and symptoms remained elevated for 17.0 months postpartum. There were no interactional associations between infant age and stress associated with antenatal SARS-CoV-2 infection with infant health outcomes.


Overall, the results of the study showed that stressors associated with the prenatal pandemic should be aimed at improving maternal and infant outcomes after birth. Waiting women should be considered vulnerable and prioritized during COVID-19 and other epidemics and provided with appropriate care for physical and mental well-being.

More research is required to identify ways to reduce pandemic-related stress to enhance the well-being of the mother and newborn in the postpartum period. Long-term relationships between stress associated with SARS-CoV-2 infection and maternal and neonatal health must be evaluated.

Signs of psychological and biological vulnerability must be identified among a more diverse group of pregnant women of different races residing in different geographic areas to personalize antenatal care.

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