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Perinatal Mental Health and COVID-19: Evidence from the Mother-Infant Support Program

Wed, April 7, 1:10 to 2:40pm EDT (1:10 to 2:40pm EDT), Virtual

Abstract

Perinatal mental health concerns can lead to premature birth, biological risk, increased cesarean delivery, and post-partum depression and anxiety. For the yet unborn infants, there may be effects on brain development, attachment, subsequent learning and mental health challenges. For newborns and infants, risks include difficulties with attachment and developmental concerns. An important factor to support pregnant women and new mothers is the initial and ongoing engagement in a supportive relationship that builds a sense of trust. For many women facing multiple adversities during pregnancy who themselves live in families or communities where there has been violence, trauma, economic hardship, and disparities in care, this supportive relationship can be crucially important. In order to be most effective, mental health support needs to be embedded with other clinical services so that they can be offered during clinic visits or scheduled at convenient times. Maternal-infant specialists in collaboration with adult psychiatrists and obstetricians, developed the Mother Infant Support Team (MIST). Clinical psychologists and social workers, experienced in treating serious mental illness and substance abuse, joined with physicians and staff in offering supportive services to pregnant women at a high risk Maternal and Fetal Medicine Clinic and other obstetrical clinics. The hospital is part of an inner city academic medical center serving the community. The pregnant women were given a choice to participate in the MIST program. If they agreed, the clinicians administered a screener identifying potential stressors, substance use issues, adverse childhood experiences, trauma and mood symptoms as well as a measure of resilience and quality of maternal-fetal attachment. Services are offered to each patient who determines whether she wants services and what supports would be most helpful. The patient is provided “check ins” by the mental health specialist at her obstetrical appointments and is also offered telehealth supports during and following pregnancy which may be more convenient. Those patients who elect to participate in research follow-up are contacted monthly by telephone to repeat the screening tool. These calls are performed by an LCSW with expertise in the assessment and treatment of serious mental health disorders. The MIST program was ongoing when the COVID-19 pandemic impacted on the United States with telehealth already integrated into the work. Therefore, continuity of support services could be provided and, in order to be more sensitive to patients, an additional assessment related to concerns about COVID-19 was added. Initial results indicated that 62% of the women reported a reduction in household income, 50% reported a loss of childcare, a third had a family member or close friend become ill, and several reported a death. The majority reported worries about paying rent, loss of employment, concerns about family or friends becoming ill with COVID, their own health, and the baby’s health. Preliminary analyses on early data indicate that greater COVID-19 concerns were associated with significantly higher levels of anxiety. The goal is to develop a supportive relationship with high-risk pregnant women and new mothers and, especially with COVID-19, to improve maternal and infant outcomes and support infant well-being.

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