When the first shelter-in-place orders were taken in California, pregnant women reported dramatically elevated symptoms of depression, which could adversely affect their health and that of their babies.
By Adam Hadhazy
Even in ordinary times, depression is a common problem for pregnant women and new mothers. Now, a new study led by Stanford University examining the extraordinary times of the COVID-19 era has found that the risk of depression among pregnant women nearly doubled after the onset of the pandemic.
The study sheds light on the impact of the pandemic on this vulnerable population and highlights the need for policymakers and clinicians to provide additional support to pregnant women during the COVID-19 pandemic. The findings, which have been published online and will appear in an upcoming issue of Psychological Medicine, have added significance given the growing evidence that depressive symptoms during pregnancy not only harm the health of the mother, but also that of the mother. her developing fetus and her future infant. .
For the study, Stanford researchers assessed pregnant women in the Bay Area before and after the lockdowns triggered by a coronavirus went into effect in March 2020. In the pre-pandemic group, one in four women had signs of possible depression. In the post-pandemic group, this figure rose to more than half of the women surveyed.
“Going into this study, we naturally expected that pregnant women would have more difficulty after the onset of the pandemic,” said lead author Lucy King, graduate student at Stanford Neurodevelopment, Affect and Psychopathology Laboratory (SNAP Lab). “Nonetheless, we were quite surprised to see how the rates of potential depression turned out to be in the group affected by the pandemic.”
Senior author and SNAP lab director Ian Gotlib, Professor David Starr Jordan at Stanford’s School of Humanities and Sciences, pointed out that the damaging effects of maternal stress on infants are a form of collateral damage caused by COVID-19, affecting those whom the virus never actually infected.
“Since depression during pregnancy can affect fetal development as well as the relationship between mother and child after birth, these effects are unlikely to end when the pandemic ends,” King said.
The story of two cohorts
The study compared survey responses provided by pregnant women who participated in two projects led by King and others in Gotlib’s lab. The first, called the Brain and Behavior Infants Experiences (BABIES) project, assessed about 90 pregnant women living in the Bay Area of California before the COVID-19 pandemic.
The second project, named COVID-19 Perinatal Experiences (COPE), was conducted remotely between March and May 2020 and again recruited pregnant women living in the California Bay Area through online advertisements. More than 700 pregnant women responded to the COPE survey, answering questions on 16 indicators of stress and adversity they experienced as a result of the pandemic in April 2020. The survey questions focused on effects goals of the pandemic on women’s lives, such as whether they have lost their jobs or undergone changes in antenatal care, such as having to change providers or switching from a planned vaginal birth to induction or to a cesarean. The questions also asked participants about their subjective reactions to stress in the face of the pandemic, such as their worry about catching the virus, disruptions in social support, possible changes in the quality of medical care to be received during labor and childbirth, and their capacity. caring for their babies after birth in light of the pandemic.
With the survey data in hand, the researchers set out to make as direct as possible comparisons of self-reported depressive symptoms by women in the two groups. King and his colleagues did this by matching a subset of 164 women in the cohorts. The women were of similar age, marital status, and race / ethnicity, and had similar incomes, education levels, and treatment histories for mental health or substance abuse issues.
Overall, about 40 percent of the 700+ women in the post-pandemic group scored high for depressive symptoms in the survey, showing many of the hallmarks of depression. In the matched groups, 25 percent of pre-pandemic women and 51 percent of post-pandemic women reported symptoms indicating potential depression.
Get help where it’s needed
From a public policy perspective, the findings support large-scale screenings to identify pregnant women at risk for depression, King says. These women and their infants could then benefit from counseling, better access to available resources and other interventions. These forms of assistance could help women partially recover from the current pandemic and, for the future, better cope with a similar type of stressful environment imposed by possible disease outbreaks.
Since the study only assessed women until April 2020, it is not known whether the rates of stress and depression stayed the same or changed as the pandemic continued. Stress and depression may have eased as pregnant women adjusted to the “new normal,” or worsened if, for example, women learned that loved ones were suffering or dying from the virus, King explained. and Gotlib.
Of particular note is that the study found that the women most vulnerable to depressive symptoms during the pandemic were those who were already struggling due to socio-economic inequalities, such as people of color and immigrants, as well. than women with pre-existing poor physical health and a history of mental disorders.
“These results indicate that there may be specific groups of women who should be targeted to receive special attention in terms of support,” says King.
As more and more studies continue to document the detrimental effects of maternal depression and stress on infant development, they highlight the need to understand the prevalence of depression in different populations of pregnant women.
“Studies like this are helpful in highlighting pregnancy in particular as a critical time to ensure women have support,” Gotlib said. “This support is not only intended to help women overcome pregnancy, but to help them improve their future health and the health and development of their children.”
Gotlib is also a member of Bio-X, the Maternal and Child Health Research Institute and Wu Tsai Institute of Neuroscience. He is also affiliated with the faculty of the Stanford Center on Longevity.
Other co-authors of the study, titled “Pregnancy During the Pandemic: The Impact of COVID-19 Stress on Prenatal Depression Risk,” include Daisy E. Feddoes, researcher, and Jacklyn S. Kirshenbaum , graduate student, Stanford University’s Department of Psychology; and Kathryn L. Humphreys, assistant professor at Vanderbilt University.
Funding was provided by the National Institutes of Health, the National Science Foundation (JSK, Graduate Student Research Fellowship) and the Jacobs Foundation.