Perinatal Outcomes During vs. Prior to the COVID-19 Pandemic and the Role of Maternal Depression and Perceived Stress: A Report from the ECHO Program

Objective: We sought to evaluate the impact of the COVID-19 pandemic on perinatal outcomes while accounting for maternal depression or perceived stress and to describe COVID-specific stressors, including changes in prenatal care, across specifc time periods of the pandemic. Study Design: Data dyads from 41 cohorts from the National Institutes of Health Environmental influences on Child Health Outcomes Program (N=2983) were used to compare birth outcomes before and during the pandemic (n= 2355), and a partially overlapping sample (n=1490) responded to a COVID-19 questionnaire. Psychosocial stress was defined using prenatal screening for depression and perceived stress. Propensity-score matching and general estimating equations with robust variance estimation were used to estimate the pandemic's effect on birth outcomes. Results: Symptoms of depression and perceived stress during pregnancy were similar prior to and during the pandemic, with nearly 40% of participants reporting mild to severe stress, and 24% reporting mild depression to severe depression. Gestations were shorter during the pandemic (B=-0.33 weeks, p=0.025), and depression was significantly associated with shortened gestation (B=-0.02 weeks, p=0.015) after adjustment. Birth weights were similar (B=-28.14 g, p=0.568), but infants born during the pandemic had slightly larger birth weights for gestational age at delivery than those born before the pandemic (B=0.15 z-score units, p=0.041). More women who gave birth early in the pandemic reported being moderately or extremely distressed about changes to their prenatal care and delivery (45%) compared with those who delivered later in the pandemic. A majority (72%) reported somewhat to extremely negative views of COVID-19 on their life. Conclusions: In this national cohort, we detected no efect of COVID-19 on prenatal depression or perceived stress. However, experiencing the COVID-19 pandemic in pregnancy was associated with decreases in gestational age at birth as well as distress about changes in prenatal care early in the pandemic.