Geographic Variability in Perinatal Care Disruptions as a Consequence of COVID-19

• In Event: Understanding the Impact of COVID-19 on Parenting Young Children: Research Collaborations and International Perspectives

Abstract

Background: The impacts of COVID-19 have been unprecedented. Not only are there significant financial and health consequences associated with contracting this novel disease, but the COVID-19 pandemic has also disrupted medical care for unrelated conditions. Anecdotal reports describe a number of disruptions to perinatal care within the US, including the separation of mothers from their newborns after birth and barring support persons (e.g., partners) from the delivery room. However, systemic analyses of COVID-19-related disruptions in perinatal healthcare and associated distress in the United States (US) has yet to be conducted. Such efforts require large-scale prospective harmonization, first-person reporting, and facilitated data sharing.

Method: In March of 2020, a grassroots group of independent researchers coalesced to develop the NIH Disaster Research Response (DR2) tool: the COVID-19 Perinatal Experiences (COPE) survey1, and to form the COVID Generation (COVGEN) Research Alliance.2 Research protocols and translations of the tool are openly available via an Open Science Framework repository,3 enabling facilitated, rapid data and process sharing and future shared research products. Here, we will highlight strengths and limitations of this research infrastructure and will leverage this resource to directly assess disruptions in perinatal healthcare using geotemporal analyses across the US.

Results: Preliminary analyses in a subset of New York City (NYC) data (n=495) are complete at the time of this submission; additional analyses utilizing national datasets will be completed over the coming months. Initial findings demonstrate that temporal variability in disruption coincides with pandemic peak incidence rates in NYC (see Figure 1). In New York City, 39% of women report the quality of their perinatal care deteriorated as a consequence of COVID-19. The most common disruptions included cancellation of prenatal care visits (30.5%), change in birth plan location (30.9%), transition from in-person to virtual care visits (33.7%), and support people (e.g., family, partner) not permitted at delivery (16.2%). A high proportion of respondents also reported isolation from friends and family after the birth of their child (39.6%). Notably, in these preliminary analyses, we also observed a significant association between disruptions to perinatal care and maternal psychological health. Specifically, the number of disruptions to prenatal care (∆R2=0.01, 𝛃=0.12, p=0.02, 95%CI[0.01, 0.09]) and the number of disruptions to a mother’s birth plan (∆R2=0.04, 𝛃=0.19, p=0.004, 95%CI[0.03, 0.15) are both significantly associated with increased psychological distress, even after controlling for maternal history of mood and anxiety disorders and number of medical complications she experienced during pregnancy.

Conclusions: This project will provide the first large-scale, geotemporal analysis of perinatal care disruption in the US as a consequence of the COVID-19 pandemic and the relevance of this to maternal mental health. This is an integral step in informing future policies to effectively support the health of perinatal women and their children in times of national socioeconomic or health crises.

Authors

• Cassandra Lei Hendrix, New York University School of Medicine
  Presenting Author

• Denise Werchan, Brown University
  Non-Presenting Author

• Carly Lenniger, New York University Medical Center
  Non-Presenting Author

• Autumn Austin, New York University Medical Center
  Non-Presenting Author

• Natalie Hiromi Brito, New York University
  Non-Presenting Author

• Moriah E. Thomason, New York University School of Medicine
  Non-Presenting Author