Prenatal and Postpartum Factors Impacting Maternal and Infant Mental Health during the Pandemic

• In Event: The Pandemic and the Mental Health of Parents and Children Across Pregnancy, Infancy, and Childhood

Abstract

Background. The COVID-19 pandemic is having a colossal impact on global health and well-being, including mental health. Depression in perinatal women is of concern because it adversely affects mother-infant bonding and child development (Beeghly et al., 2017). The pandemic has created a pernicious set of circumstances that increase risk of depression, including worries surrounding health and financial security, and for pregnant women, specific concerns surrounding prenatal visits, delivery, and access to medication. Moreover, for women who have recently given birth, the lack of social support imposed by the pandemic may be particularly detrimental since social support, including both emotional support and instrumental help, mitigates early challenges facing mothers (Milgrom et al., 2019).

Methods. To understand how maternal and infant mental health has been impacted during the pandemic, we conducted a longitudinal survey of 787 pregnant women (n=216 Black; n=571 White). Time 1 data were collected during a 2-week stay-at-home mandate in May 2020. We are now conducting Time 2 follow-up assessments with women at 1-15 weeks postpartum (current N=238; planned completion, February 2021). We assessed prenatal depression at Time 1 via the Patient Health Questionnaire-2 (Spitzer et al., 1999) and postpartum depression at Time 2 via the Edinburgh Postnatal Depression Scale (Cox et al., 1996), as well as distress caused by the pandemic during pregnancy and delivery. We assessed emotional support via the Multidimensional Scale of Perceived Social Support (Zimet et al., 1990; “I get the emotional help and support I need from my family”) and instrumental help via the Maternal Social Support Index (Pascoe, 1998), which assesses sharing of household (“who fixes meals”) and childcare (“who gets child(ren) to bed”) chores. Finally, we assessed maternal-infant bonding via the Postpartum Bonding Questionnaire (Brockington et al., 2001). We used regression analysis and path modeling to explore prospective risk and resilience pathways across the perinatal period, controlling for race, maternal age, parity, marital status, and socioeconomic status.

Results. First, we found that prenatal depression symptoms predicted more symptoms of postpartum depression (β=.36, p<.001; Table 1). Distress arising from the pandemic during pregnancy (β=.22, p<.001), but not delivery, was uniquely related to postpartum depression over and above depression in pregnancy (Table 1). Second, more emotional support was related to fewer symptoms of postpartum depression (β=-.22, p<.001), with a marginally significant effect for instrumental help (β=-.13, p<.10) (Table 1). Finally, we tested a path model to explore risk and resilience factors that influenced mother-infant bonding. There were significant indirect effects such that prenatal depression, more distress arising from the pandemic, and less emotional support in the postpartum period were all related to impaired mother-infant bonding via postpartum depression (Figure 1).

Discussion. Our results suggest the critical importance of identifying mothers at risk for postpartum depression during pregnancy and establish that the pandemic is increasing that risk over and above premorbid depression. Emotional support buffers against this risk, including in relation to infant mental health. Thus, even as the pandemic continues to disrupt life, we must prioritize mental health support systems for perinatal women.

Authors

• Rebecca Waller, University of Pennsylvania
  Presenting Author

• Raquel E. Gur, Perelman School of Medicine
  Non-Presenting Author

• Lauren White, Children’s Hospital of Philadelphia
  Non-Presenting Author

• Ran Barzilay, Children's Hospital of Philadelphia
  Non-Presenting Author

• Tyler Moore, University of Pennsylvania Health System
  Non-Presenting Author

• Sara Kornfield, University of Pennsylvania
  Non-Presenting Author

• Wanjiku Njoroge, University of Pennsylvania Perelman School of Medicine
  Non-Presenting Author

• Andrea F. Duncan, Children's Hospital of Philadelphia
  Non-Presenting Author

• Barbara H. Chaiyachati, Children’s Hospital of Philadelphia
  Non-Presenting Author

• Julia Parish-Morris
  Non-Presenting Author

• Megan Michelle Himes, Children's Hospital of Philadelphia
  Non-Presenting Author

• Nina Laney, Children’s Hospital of Philadelphia
  Non-Presenting Author

• Keri Simonette, Maternal and Child Health Research Center
  Non-Presenting Author

• Valerie Riis, Maternal and Child Health Research Center
  Non-Presenting Author

• Michal A. Elovitz, Maternal and Child Health Research Center
  Non-Presenting Author