Q&A: How can physicians ease COVID-19-related stress in pregnant women?

Many pregnant women reported experiencing psychological stress stemming from the COVID-19 pandemic and subsequent shelter-in-place orders, according to research published in BMC Pregnancy and Childbirth.

Researchers surveyed 162 women — 125 pregnant and 37 postpartum — from April 28, 2020, through June 30, 2020. They analyzed quantitative responses on stress and coping and qualitative responses to open-ended questions on stress and needed resources during the pandemic.

Overall, 27% of pregnant women said they were unable to obtain healthy food. Among them, 16% reported that shelter-in-place restrictions affected their ability to access healthy foods and 7% said that they were unable to get healthy food due to financial hardship.

Additionally, 25% of women reported that they missed prenatal appointments and 36% said that they used telehealth services for prenatal appointments.

Nineteen percent of women reported a reduced income, 9% reported being laid off or furloughed and 10% said that they had severe financial problems.

Researchers found that 69% of women reported taking breaks from news outlets to cope with stress and isolation, and 62% said they tried to eat healthy, exercise, get adequate sleep and avoided drugs or alcohol during the pandemic. They determined that pregnant women were less likely than postpartum women to engage in these health coping behaviors.

Additionally, researchers found that women from historically underrepresented groups and women with lower incomes were more likely to indicate that they had serious financial problems compared with non-Hispanic white women and those with higher incomes.

In the qualitative survey, 52% of pregnant women and 49% of postpartum women said they were concerned about their baby developing COVID-19, and 38% of pregnant women and 32% of postpartum women reported that they were concerned about themselves or their partners becoming infected.

The researchers also found that 17% of pregnant women and 14% of postpartum women were concerned about being isolated from their baby if one of them tested positive for COVID-19.

Healio Primary Care spoke with study coauthor Celestina Barbosa-Leiker, PhD, vice chancellor for research and associate professor in the College of Nursing at Washington State University Health Sciences Spokane, to learn more about the findings and what efforts are needed to support pregnant women during the COVID-19 pandemic.

Healio: What should primary care physicians and OBGYNs tell pregnant patients to ease their stress related to COVID-19?

Barbosa-Leiker: Health care providers can engage in conversations regarding access to resources needed to care for newborns, refer patients to counseling services — which can be delivered online/via telephone — and virtual support groups, and consistently screen pregnant women for stressors. Indeed, the American College of Obstetricians and Gynecologists has acknowledged the impact of psychological stress on infant and maternal health and therefore recommends perinatal screening and intervention for stress for all pregnant women. Inquiring about their patients’ specific stressors, resources needed, and specific concerns about SARS-CoV-2 and the COVID-19 pandemic is crucial. Our research shows that primary patient concerns are about themselves or their newborns contracting SARS-CoV-2, having to isolate from their newborn if either test positive for the virus, and lack of social and financial support. Talking with patients about reducing risk for contracting SARS-CoV-2, specific hospital policies about isolating, and who can attend key OB appoints and delivery would help decrease stress, as well as discussing wrap-around services for their patients. In addition, discussion about healthy vs. unhealthy ways in which the patients are coping with their stress would be very helpful.

Healio: How should physicians address stress about COVID-19 vaccines among pregnant women?

Barbosa-Leiker: The CDC offers great guidance on COVID-19 vaccines for pregnant women. Following the CDC’s lead, I would advise physicians to share that pregnant people are at increased risk for severe illness from COVID-19, that there is limited data about the safety of COVID-19 vaccines for people who are pregnant, and this is a personal choice that can be linked to how likely they are to being exposed to SARS-CoV-2. Our research participants expressed frustration about the lack of information on the potential impacts of SARS-CoV-2 to themselves, their fetus and the development of their baby. This is understandable as they are trying to keep their baby as healthy as possible, but we do not have all of the answers that they are looking for at this time. Helping patients think through the risks associated with contracting the virus vs. getting the vaccine would help decrease stress about the vaccine.

Healio: What potential health effects could stress have on pregnant women and their children?

Barbosa-Leiker: Since the COVID-19 pandemic began, perinatal women have experienced psychological stress due to changes in labor and delivery hospital policies, possible perinatal SARS-CoV-2 transmission and COVID-19-related clinical maternal-infant outcomes. These perinatal-related stressors are in addition to the economic and mental health issues that many people are currently experiencing. Psychological stress experienced during pregnancy can have deleterious effects on maternal and infant health, where the pathway between stress and physiological issues involves cortisol, norepinephrine and inflammatory markers, including cytokines. The health ramifications due to perinatal stress not only impact the mother but also may harm the fetus and infant. For example, elevated glucocorticoids during fetal development are associated with a higher likelihood of adverse birth outcomes (e.g., preterm birth and intrauterine growth restriction) and predisposition to obesity and other late-onset diseases. In addition, effects of prenatal stress on offspring neurodevelopment, cognitive development, negative affectivity, difficult temperament and psychiatric disorders have been demonstrated in numerous epidemiological and case-control studies. The COVD-19 pandemic is not only exacerbating stress, but is also worsening heath disparities: our research shows increased stressors induced by the COVID-19 pandemic, and less social support, in perinatal women of color and lower-income status. These are women who are already at risk for increased levels of stress. We also see that due the pandemic, pregnant and postpartum patients report missing prenatal appointments, so highlighting the importance of attending prenatal appointments is vital.

Healio: What resources are needed to help support pregnant women during the COVID-19 pandemic?

Barbosa-Leiker: Our research demonstrated that financial resources, COVID-19 information and research as it relates to maternal-infant health outcomes, access to safe health care and access to baby supplies — formula, diapers, etc. — emerged as the primary resources needed by participants. We also heard from participants that they need help communicating safe COVID-19 pandemic practices to their family and friends.

References:

Barbosa-Leiker C, et al. BMC Pregnancy Childbirth. 2021;doi:10.1186/s12884-021-03665-0.

CDC. Information about COVID-19 Vaccines for People who Are Pregnant or Breastfeeding. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/pregnancy.html. Accessed March 23, 2021.