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Woodward KP, Testa A, Jackson DB. Racial disparities in death of someone close during pregnancy: Findings from the Pregnancy Risk Assessment Monitoring System (PRAMS), 2017-2021. Ann Epidemiol 2024; 97:16-22. [PMID: 39029544 DOI: 10.1016/j.annepidem.2024.07.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 07/08/2024] [Accepted: 07/16/2024] [Indexed: 07/21/2024]
Abstract
PURPOSE The COVID-19 pandemic increased the mortality rate in the U.S. and exposed many to the unexpected death of someone close. No prior research has assessed whether the COVID-19 pandemic was followed by an increase in bereavement during pregnancy, and whether patterns varied by race and ethnicity. METHODS Using data from the Pregnancy Risk Assessment Monitoring System from 2017-2021 across 23 U.S. sites (N = 107,226), we assessed trends in the odds of experiencing the death of someone close before and after the onset of the COVID-19 pandemic. RESULTS Findings revealed an increased percentage of women who reported having someone close to them die in the year prior to childbirth after the start of the COVID-19 pandemic (March 2020 or later) (aPR=1.121, 95 % CI (1.079 - 1.165). Analysis by mother's race and ethnicity showed death of someone close increased significantly after the COVID-19 pandemic for Hispanic (aPR = 1.192, 95 % CI = 1.062, 1.337), non-Hispanic Black (aPR = 1.115, 95 % CI = 1.015 - 1.225), and American Indian-Alaskan Native pregnant women (aPR = 1.391, 1.023 - 1.891) compared to White, Non-Hispanic pregnant women. CONCLUSIONS Increased bereavement among pregnant women during the COVID-19 pandemic warrants routine grief screening and response training in prenatal care.
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Affiliation(s)
- Krista P Woodward
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Alexander Testa
- Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Dylan B Jackson
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Perry JS. Resilience in Black Women: Lifeline or Double-Edged Sword? J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02119-5. [PMID: 39102173 DOI: 10.1007/s40615-024-02119-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 05/24/2024] [Accepted: 07/26/2024] [Indexed: 08/06/2024]
Abstract
Black women face many health disparities, many of which are tied to the stress of being a marginalized group member. Resilience, defined as the ability to bounce back from adversity and continue with life, has been introduced as a method to buffer the stress that Black women experience and improve their outcomes. However, there is not a universally agreed-upon definition of resilience in the literature. Thus, it is unclear how resilience works broadly, particularly for Black women. It is important to explore whether resilience is as positive as many scholars have perceived it to be. The current review analyzes 28 empirical articles that looked at stress, resilience, and health outcomes in Black women. The review revealed that there are many inconsistencies in how both stress and resilience are measured. Further, the positive effects of resilience seem to be largely context-dependent and vary depending on the demographic and health outcomes explored.
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Affiliation(s)
- Jasmine S Perry
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA.
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3
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Avorgbedor F, Gondwe KW, Aljarrah A, Bankole AO. COVID-19 Vaccine Decision-Making Among Black Pregnant and Postpartum Women. J Racial Ethn Health Disparities 2024; 11:2073-2082. [PMID: 37335424 DOI: 10.1007/s40615-023-01675-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/31/2023] [Accepted: 06/05/2023] [Indexed: 06/21/2023]
Abstract
INTRODUCTION The history of biomedical research is marred by racially discriminatory and abusive practices that impacted Black/African Americans. Medical racism impacts the trust and utilization of new medical interventions, such as the COVID-19 vaccine. This study aimed to understand Black pregnant and postpartum women's perspectives and decision-making about the COVID-19 vaccine. METHODS We used a qualitative descriptive design and recruited 23 pregnant and postpartum Black women aged 18 years and above. Data was collected using a semi-structured interview guide. Data were analyzed using content analysis. FINDINGS The participants described factors influencing their decision to receive or not receive the COVID-19 vaccines. These factors included individual, cultural, ethnicity, religious, and family-related factors (individual-personal beliefs influenced decisions about the vaccine; ethnicity, culture, and religion influenced vaccine decision-making; group-family and friends played a role in decision-making), vaccine or vaccination-related issues (concerns about vaccination and pregnancy outcomes and mistrust in the vaccine information), and contextual influence (sources of vaccine information influenced decision-making and healthcare providers influenced decision-making). CONCLUSION Understanding the vaccine decision-making process of underserved populations likely to decline vaccination due to pregnancy, postpartum, and breastfeeding status will help design tailored interventions to improve vaccine acceptance in minority communities, especially for pregnant and postpartum women.
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Affiliation(s)
- Forgive Avorgbedor
- School of Nursing, University of North Carolina Greensboro, Greensboro, NC, USA.
| | | | - Ahmad Aljarrah
- School of Nursing, University of North Carolina Greensboro, Greensboro, NC, USA
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Liu CH, Koire A, Ma C, Mittal L, Roffman JL, Erdei C. Prenatal mental health and emotional experiences during the pandemic: associations with infant neurodevelopment screening results. Pediatr Res 2024; 96:237-244. [PMID: 38431665 DOI: 10.1038/s41390-024-03100-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/27/2023] [Accepted: 01/17/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND This study determined whether parental mental health and emotional experiences during the prenatal period were linked to infant developmental outcomes through the Ages and Stages Questionnaire (ASQ-3) at 8-10 months. METHODS Participants included 133 individuals who were living in the US and were pregnant or had given birth within 6 months prior to enrollment. Respondents were majority White with high education and income levels. Online surveys were administered from May 2020 to September 2021; follow-up surveys were administered from November 2020 to August 2022. RESULTS Parent generalized anxiety symptoms were positively associated with infant communication (β = 0.34, 95% CI [0.15, 1.76], p < 0.05), while parent-fetal bonding was positively associated with infant communication (β = 0.20, 95% CI [0.05, 0.76], p < 0.05) and personal-social performance (β = 0.20, 95% CI [0.04, 0.74], p < 0.05). COVID-19-related worry was negatively associated with infant communication (β = -0.30, 95% CI [-0.75, -0.12], p < 0.05) and fine motor performance (β = -0.25, 95% CI [-0.66, -0.03], p < 0.05). CONCLUSION Parent mental health and emotional experiences may contribute to infant developmental outcomes in high risk conditions such as a pandemic. IMPACT STATEMENT Maternal SARS-CoV-2 infection has been evaluated in relation to child outcomes, however, parent psychosocial experiences should not be overlooked when considering pandemic risks to child development. Specific prenatal mental health and pandemic-related emotional experiences are associated with infant developmental performance, as assessed by the Ages and Stages. Questionnaire (ASQ-3) at 8 to 10 months old. Findings indicate that parental prenatal anxiety and emotional experiences from the pandemic should be assessed when evaluating child developmental delays.
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Affiliation(s)
- Cindy H Liu
- Brigham and Women's Hospital, 221 Longwood Ave., BLI 341, Boston, MA, 02115, USA.
- Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA.
- Harvard Medical School, 25 Shattuck St., Boston, MA, 02115, USA.
| | - Amanda Koire
- Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
- Harvard Medical School, 25 Shattuck St., Boston, MA, 02115, USA
| | - Candice Ma
- Brigham and Women's Hospital, 221 Longwood Ave., BLI 341, Boston, MA, 02115, USA
| | - Leena Mittal
- Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
- Harvard Medical School, 25 Shattuck St., Boston, MA, 02115, USA
| | - Joshua L Roffman
- Harvard Medical School, 25 Shattuck St., Boston, MA, 02115, USA
- Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA
| | - Carmina Erdei
- Brigham and Women's Hospital, 221 Longwood Ave., BLI 341, Boston, MA, 02115, USA
- Harvard Medical School, 25 Shattuck St., Boston, MA, 02115, USA
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Eldeirawi KM, Persky VW, Zielke C, Goldstein E, Bimbi O, Saenz J, Mustafa Z, Jumah TA, Ramirez XR, Aldirawi A, Quinn L, Hernandez R. Economic, Psychological, and Emotional Well-Being of Pregnant Women During the COVID-19 Pandemic. J Midwifery Womens Health 2024. [PMID: 38923387 DOI: 10.1111/jmwh.13659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/04/2024] [Indexed: 06/28/2024]
Abstract
INTRODUCTION The intersection between perinatal mental health and the coronavirus disease 2019 (COVID-19) pandemic remains of significant public health importance. The current study examined the emotional and financial well-being and predictors of elevated depressive symptoms among pregnant women during the COVID-19 pandemic. METHODS This online survey was conducted with 2118 women ≥18 years old who were pregnant at the time of the survey and living in the United States or Puerto Rico. Depressive symptoms were assessed with the Center for Epidemiologic Studies Depression Scale, with scores ≥10 indicative of elevated depressive symptoms. The final logistic regression model included housing insecurity, financial distress, COVID-19 diagnosis, exposure to COVID-19, and demographic covariates. RESULTS More than half the sample (53.8%) had elevated depressive symptoms. In logistic regression analyses, the odds of having elevated depressive symptoms were significantly higher for participants reporting housing insecurity (adjusted odds ratio [aOR], 1.56; 95% CI, 1.22-2.01), financial distress (aOR, 1.57; 95% CI, 1.17-2.12), COVID-19 diagnosis (aOR, 2.53; 95% CI, 1.53-4.17), and COVID-19 exposure (aOR, 1.41; 95% CI, 1.07-1.86), after adjusting for covariates. The association of elevated depressive symptoms with housing insecurity was especially strong among those who experienced COVID-19 (aOR, 6.04; 95% CI, 2.15-17.0). DISCUSSION Our findings are consistent with previous literature revealing that diagnosis, exposure, concerns about family, and effects on financial stability were related to depressive symptoms during the pandemic. The relationships between financial and housing concerns with elevated depressive symptoms, independent of concerns about infection in family members, suggest that there may be direct and indirect effects of the pandemic on mental health.
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Affiliation(s)
- Kamal M Eldeirawi
- College of Nursing, University of Illinois Chicago, Chicago, Illinois
| | - Victoria W Persky
- School of Public Health, University of Illinois Chicago, Chicago, Illinois
| | - Cameron Zielke
- School of Public Health, University of Illinois Chicago, Chicago, Illinois
| | - Ellen Goldstein
- College of Nursing, University of Illinois Chicago, Chicago, Illinois
| | - Olivia Bimbi
- College of Nursing, University of Illinois Chicago, Chicago, Illinois
| | - Jennifer Saenz
- College of Nursing, University of Illinois Chicago, Chicago, Illinois
| | - Zane Mustafa
- College Liberal Arts, University of Illinois Chicago, Chicago, Illinois
| | - Tamara A Jumah
- College Liberal Arts, University of Illinois Chicago, Chicago, Illinois
| | - Xavier R Ramirez
- School of Social Work, University of Illinois at Urbana Champaign, Urbana, Illinois
| | - Ali Aldirawi
- Neonatal Intensive Care Unit, Al-Shifa Hospital, Gaza, Palestine
| | - Laurie Quinn
- College of Nursing, University of Illinois Chicago, Chicago, Illinois
| | - Rosalba Hernandez
- College of Nursing, University of Illinois Chicago, Chicago, Illinois
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Diamond-Smith N, Logan R, Adler A, Gutierrez S, Marshall C, Kerns JL. Prenatal and postpartum care during the COVID-19 pandemic: An increase in barriers from early to mid-pandemic in the United States. Birth 2024; 51:450-458. [PMID: 38063250 DOI: 10.1111/birt.12800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 05/01/2023] [Accepted: 10/27/2023] [Indexed: 05/18/2024]
Abstract
BACKGROUND The COVID-19 pandemic led to changes in the provision of pregnancy and postpartum care. The purpose of this study was to describe changes in access to prenatal and postpartum care over time, from early in the pandemic (July 2020) to mid-pandemic (January 2021) and to explore socioeconomic and COVID-19-related economic factors associated with experiencing barriers to care. METHODS We recruited two cross sections of women and birthing people in the US in July 2020 (N = 4645) and January 2021 (N = 3343) using Facebook and Instagram Ads. RESULTS Three out of four women in the prenatal period and four out of five women in the postpartum period reported barriers to scheduling a visit. The likelihood of not having a visit (OR = 4.44, 95% CI 2.67-7.40), being unable to schedule a visit (OR = 2.73, 95% CI 1.71-4.35), and not being offered visits (OR = 4.26, 95% CI 2.32-7.81) increased over time. Participants were more likely to report barriers attending scheduled prenatal or postpartum appointments over time (OR = 2.72, 95% CI 2.14-3.45). Women who experienced more economic impacts from COVID-19 were older, less educated, and were Black, Indigenous, or a person of color, and were more likely to have barriers to attending appointments. CONCLUSIONS Certain subgroups are more at risk during COVID-19, and around 9 months into the pandemic, women were not only still facing barriers to care, but these had been amplified. Additional research using other data sources is needed to identify and ameliorate barriers and inequalities in access to prenatal and postpartum care that appear to have persisted throughout the pandemic.
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Affiliation(s)
- Nadia Diamond-Smith
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Rachel Logan
- Family and Community Medicine Department, University of California, San Francisco, California, USA
| | - Aliza Adler
- Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California, USA
| | - Sirena Gutierrez
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Cassondra Marshall
- School of Public Health, University of California, Berkeley, California, USA
| | - Jennifer L Kerns
- Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California, USA
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Okeafor IN, Hair NL, Chen B, Hung P. Racial and Ethnic Disparities in Postpartum Depressive Symptoms Before and During the COVID-19 Pandemic. J Womens Health (Larchmt) 2024. [PMID: 38757651 DOI: 10.1089/jwh.2023.0908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
Abstract
Background: Existing evidence regarding the impact of the COVID-19 pandemic on postpartum mental health is mixed, with disparate studies showing increased, stable, or even reduced risk of postpartum depression (PPD) amid the pandemic. Furthermore, although it is plausible that the pandemic impacted the mental health of mothers from vulnerable and underserved communities differentially, few studies have characterized racial and ethnic differences in the impact of the COVID-19 pandemic on PPD. Materials and Methods: Pregnancy Risk Assessment Monitoring System data for 2018-2019 (pre-pandemic period) and 2020 (peri-pandemic period) from 40 sites (n = 110,779, representing 5,485,137 postpartum women) were used to determine whether rates of PPD changed during the first year of the pandemic. Postpartum depressive symptoms were assessed using the Patient Health Questionnaire 2-item. Average marginal effects and contrasts of predictive margins derived from a multivariable logistic regression model were used to compare the risk of PPD before and during the pandemic in the overall sample and across racial/ethnic subgroups. Results: Adjusting for sociodemographic and clinical characteristics, we found that the overall risk for PPD remained stable (0.0 percentage points [pp]; 95% confidence interval [CI]: -0.7, 0.6 pp) in the first year of the pandemic. We detected no statistically significant changes in risk for PPD across seven of eight racial/ethnic groups considered; however, the risk of PPD among non-Hispanic Black women fell by 2.0 pp (95% CI: -3.5, -0.4 pp) relative to the pre-pandemic period. Conclusion: We identified important subgroup differences in pandemic-related changes in risk for PPD.
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Affiliation(s)
- Ibitein N Okeafor
- Department of Health Services Policy and Management, University of South Carolina Arnold School of Public Health, Columbia, South Carolina, USA
| | - Nicole L Hair
- Department of Health Services Policy and Management, University of South Carolina Arnold School of Public Health, Columbia, South Carolina, USA
| | - Brian Chen
- Department of Health Services Policy and Management, University of South Carolina Arnold School of Public Health, Columbia, South Carolina, USA
| | - Peiyin Hung
- Department of Health Services Policy and Management, University of South Carolina Arnold School of Public Health, Columbia, South Carolina, USA
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Mckinney J, Salmanian B, Grace R, Moufarrij S, Sangi-Haghpeykar H, Eppes C, Gandhi M. Social Drivers of COVID-19 Disease Severity in Pregnant Patients. Am J Perinatol 2024; 41:e2269-e2278. [PMID: 37311541 DOI: 10.1055/a-2109-3876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE While coronavirus disease 2019 (COVID-19), the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has had global impact in all populations, certain groups of patients have experienced disproportionate rates of morbidity and mortality. The purpose of this study was to assess the relationship between COVID-19 disease severity, demographic variables, race and ethnicity, and social determinants of health among pregnant patients in a diverse urban population. STUDY DESIGN A retrospective analysis was performed of all pregnant patients diagnosed with COVID-19 at two urban tertiary care centers in Houston, TX between March and August 2020. Maternal demographic, COVID-19 illness criteria, and delivery characteristics were collected. The Centers for Disease Control and Prevention Social Vulnerability Index (SVI) and COVID-19 Community Vulnerability Index (CCVI) were obtained based on a patients' census tract of residence. Analyses compared persons with asymptomatic, mild, or severe-critical disease at diagnosis. RESULTS A total of 317 persons tested positive for COVID-19 during this time period. Asymptomatic persons were more likely to be diagnosed at later gestational ages, but there were no other differences in baseline maternal characteristics. Persons with more severe disease had greater social vulnerability specifically for housing and transportation than those with mild disease (mean SVI [standard error]: 0.72 [0.06] vs. 0.58 [0.2], p = 0.03). Total SVI, total CCVI, and other themed SVI and CCVI indices were not significantly different between groups. CONCLUSION In this cohort of pregnant persons infected with SARS-CoV-2, an association was shown between disease severity and increased vulnerability in living conditions and transportation. Drivers of the pandemic and COVID-19 outcomes are complex and multifactorial, and likely change over time. However, continued efforts to accurately identify and measure social determinants of health in medicine will likely help identify geographic areas and patient populations that are at risk of higher disease burden. This could facilitate preventative and mitigation measures in these areas in future disaster or pandemic situations. KEY POINTS · SVI and CCVI estimate social determinants of health.. · COVID-19 is associated with housing and transportation vulnerability.. · Social determinants contribute to disease burden in pregnancy..
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Affiliation(s)
- Jennifer Mckinney
- Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, Texas
- Department of Obstetrics and Gynecology, Harris Health System, Houston, Texas
| | - Bahram Salmanian
- Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, Texas
| | - Rebecca Grace
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Sara Moufarrij
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | | | - Catherine Eppes
- Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, Texas
- Department of Obstetrics and Gynecology, Harris Health System, Houston, Texas
| | - Manisha Gandhi
- Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, Texas
- Division of Maternal Fetal Medicine, Texas Children's Hospital Pavilion for Women, Houston, Texas
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Gennaro S, Melnyk BM, Szalacha LA, Gibeau AM, Hoying J, O'Connor CM, Cooper AR, Aviles MM. Effects of Two Group Prenatal Care Interventions on Mental Health: An RCT. Am J Prev Med 2024; 66:797-808. [PMID: 38323949 PMCID: PMC11197933 DOI: 10.1016/j.amepre.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/09/2024] [Accepted: 01/09/2024] [Indexed: 02/08/2024]
Abstract
INTRODUCTION Perinatal depression and anxiety cost the U.S. health system $102 million annually and result in adverse health outcomes. Research supports that cognitive behavioral therapy improves these conditions, but barriers to obtaining cognitive behavioral therapy have prevented its success in pregnant individuals. In this study, the impact of a cognitive behavioral therapy-based intervention on anxiety, depression, stress, healthy lifestyle beliefs, and behaviors in pregnant people was examined. STUDY DESIGN This study used a 2-arm RCT design, embedded in group prenatal care, with one arm receiving a cognitive behavioral therapy-based Creating Opportunities for Personal Empowerment program and the other receiving health promotion content. SETTING/PARTICIPANTS Black and Hispanic participants (n=299) receiving prenatal care from 2018 to 2022 in New York and Ohio who screened high on 1 of 3 mental health measures were eligible to participate. INTERVENTION Participants were randomized into the manualized Creating Opportunities for Personal Empowerment cognitive behavioral therapy-based program, with cognitive behavioral skill-building activities delivered by advanced practice nurses in the obstetrical setting. MAIN OUTCOME MEASURES Outcomes included anxiety, depression, and stress symptoms using valid and reliable tools (Generalized Anxiety Disorder scale, Edinburgh Postnatal Depression Scale, and Perceived Stress Scale). The Healthy Lifestyle Beliefs and Behaviors Scales examined beliefs about maintaining a healthy lifestyle and reported healthy behaviors. RESULTS There were no statistically significant differences between groups in anxiety, depression, stress, healthy beliefs, and behaviors. There were significant improvements in all measures over time. There were statistically significant decreases in anxiety, depression, and stress from baseline to intervention end, whereas healthy beliefs and behaviors significantly increased. CONCLUSIONS Both cognitive behavioral therapy and health promotion content embedded in group prenatal care with advanced practice nurse delivery improved mental health and healthy lifestyle beliefs and behaviors at a time when perinatal mood generally worsens. TRIAL REGISTRATION This study is registered with clinicaltrials.gov NCT03416010.
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Affiliation(s)
- Susan Gennaro
- William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts
| | | | - Laura A Szalacha
- Morsani College of Medicine, University of South Florida, Tampa, Florida
| | | | | | - Caitlin M O'Connor
- William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts.
| | - Andrea R Cooper
- College of Nursing, The Ohio State University, Columbus, Ohio
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Sacchi C, De Carli P, Gregorini C, Monk C, Simonelli A. In the pandemic from the womb. Prenatal exposure, maternal psychological stress and mental health in association with infant negative affect at 6 months of life. Dev Psychopathol 2024; 36:810-820. [PMID: 36794393 DOI: 10.1017/s0954579423000093] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
For mother-infant health especially, the pandemic has brought multiple stressors inside a susceptible psychobiological system. We study the longitudinal associations between maternal prenatal and postpartum: (a) COVID-19 stressful events exposure, (b) pandemic psychological stress, and (c) mental health and infants' negative affect. A sample of 643 Italian pregnant women completed a web-based survey from April 8th to May 4th, 2020 and a follow-up at 6 months after delivery. Maternal assessment covered prenatal and postpartum measures for: COVID-19 stressful events exposure, pandemic psychological stress, mental health symptoms (i.e., depression, anxiety, posttraumatic stress disorder) and postpartum, social support and report of infants' negative affect. Maternal mental health symptoms during pregnancy, at the peak of pandemic, is longitudinally associated with infant negative affect, with postpartum mental health mediating this association. Also, maternal COVID-19 stressful events exposure in postpartum is associated with negative affect at 6 months mediated by postpartum mental health symptoms. Maternal pandemic psychological stress during pregnancy predicted mental health symptoms in postpartum. The study supports the association between pandemic-related maternal health across pregnancy and postpartum and offspring's development (i.e., negative affect). It also puts the spotlight on mental health risk in women experiencing lockdown during pregnancy, especially when feeling high psychological stress in pregnancy or when directly exposed to COVID-19 stressful events postpartum.
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Affiliation(s)
- Chiara Sacchi
- Department of Developmental and Social Psychology, University of Padova, Padua, Italy
| | - Pietro De Carli
- Department of Psychology, University of Milano Bicocca, Milano, Italy
| | - Camilla Gregorini
- Department of Psychology, University of Milano Bicocca, Milano, Italy
| | - Catherine Monk
- Departments of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, USA
| | - Alessandra Simonelli
- Department of Developmental and Social Psychology, University of Padova, Padua, Italy
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Chan JK, Marzuki AA, Vafa S, Thanaraju A, Yap J, Chan XW, Harris HA, Todi K, Schaefer A. A systematic review on the relationship between socioeconomic conditions and emotional disorder symptoms during Covid-19: unearthing the potential role of economic concerns and financial strain. BMC Psychol 2024; 12:237. [PMID: 38671542 PMCID: PMC11046828 DOI: 10.1186/s40359-024-01715-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 04/07/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Covid-19 has disrupted the lives of many and resulted in high prevalence rates of mental disorders. Despite a vast amount of research into the social determinants of mental health during Covid-19, little is known about whether the results are consistent with the social gradient in mental health. Here we report a systematic review of studies that investigated how socioeconomic condition (SEC)-a multifaceted construct that measures a person's socioeconomic standing in society, using indicators such as education and income, predicts emotional health (depression and anxiety) risk during the pandemic. Furthermore, we examined which classes of SEC indicators would best predict symptoms of emotional disorders. METHODS Following PRISMA guidelines, we conducted search over six databases, including Scopus, PubMed, etc., between November 4, 2021 and November 11, 2021 for studies that investigated how SEC indicators predict emotional health risks during Covid-19, after obtaining approval from PROSPERO (ID: CRD42021288508). Using Covidence as the platform, 362 articles (324 cross-sectional/repeated cross-sectional and 38 longitudinal) were included in this review according to the eligibility criteria. We categorized SEC indicators into 'actual versus perceived' and 'static versus fluid' classes to explore their differential effects on emotional health. RESULTS Out of the 1479 SEC indicators used in these 362 studies, our results showed that 43.68% of the SEC indicators showed 'expected' results (i.e., higher SEC predicting better emotional health outcomes); 51.86% reported non-significant results and 4.46% reported the reverse. Economic concerns (67.16% expected results) and financial strains (64.16%) emerged as the best predictors while education (26.85%) and living conditions (30.14%) were the worst. CONCLUSIONS This review summarizes how different SEC indicators influenced emotional health risks across 98 countries, with a total of 5,677,007 participants, ranging from high to low-income countries. Our findings showed that not all SEC indicators were strongly predictive of emotional health risks. In fact, over half of the SEC indicators studied showed a null effect. We found that perceived and fluid SEC indicators, particularly economic concerns and financial strain could best predict depressive and anxiety symptoms. These findings have implications for policymakers to further understand how different SEC classes affect mental health during a pandemic in order to tackle associated social issues effectively.
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Affiliation(s)
- Jee Kei Chan
- Department of Psychology, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan, Malaysia.
- Department of Psychology, Sunway University Malaysia, Jalan Universiti, No 5, 47500, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan, Malaysia.
- Sunway University Malaysia, Room: 4-4-11, Jalan Lagoon Selatan, Bandar Sunway, Petaling Jaya, 47500, Selangor, Malaysia.
| | - Aleya A Marzuki
- Department of Psychology, Sunway University Malaysia, Jalan Universiti, No 5, 47500, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan, Malaysia
| | - Samira Vafa
- Department of Psychology, Sunway University Malaysia, Jalan Universiti, No 5, 47500, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan, Malaysia
| | - Arjun Thanaraju
- Department of Psychology, Sunway University Malaysia, Jalan Universiti, No 5, 47500, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan, Malaysia
| | - Jie Yap
- Department of Psychology, Sunway University Malaysia, Jalan Universiti, No 5, 47500, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan, Malaysia
| | - Xiou Wen Chan
- Department of Psychology, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan, Malaysia
| | - Hanis Atasha Harris
- Department of Psychology, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan, Malaysia
| | - Khushi Todi
- Department of Psychology, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan, Malaysia
| | - Alexandre Schaefer
- Department of Psychology, Sunway University Malaysia, Jalan Universiti, No 5, 47500, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan, Malaysia
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12
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Lara-Cinisomo S, Melesse B, Mendy ME. Demographic and COVID-19-Related Factors Associated with Depressive and Anxiety Symptoms Among African American and Latina Women in a Midwestern State. J Racial Ethn Health Disparities 2024; 11:36-44. [PMID: 36622569 PMCID: PMC9838266 DOI: 10.1007/s40615-022-01495-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 01/10/2023]
Abstract
PURPOSE The COVID-19 pandemic exacerbated racial and ethnic disparities among Latina and African American (AA) women, including risk factors for depression and anxiety. This study sought to identify demographic- and pandemic-related factors associated with depressive and anxiety symptoms in adult AA and Latina women living in a Midwestern state. METHODS Data for this secondary analysis of 1037 AA and Latina women were collected in May 2020 and June/July 2020. Participants completed an online survey about their demographic characteristics, job changes due to COVID-19, general concern about COVID-19, concern about the effects COVID-19 on their mental health, and whether they prayed to cope with COVID-19. Linear regressions with bootstrapping were conducted to determine associations. RESULTS Latinas had significantly higher depressive and anxiety symptoms than AA women. Older age was a buffer against depressive and anxiety symptoms. Women who anticipated a reduction in work hours or job loss had significantly higher depressive and anxiety symptoms than those with no job changes. A reduction in work hours was also a risk for higher depressive symptoms. General and specific concerns about the impact of COVID-19 were positively associated with higher depressive and anxiety symptoms. Race/ethnicity moderated the effect of praying to cope with COVID-19 on depressive symptoms. CONCLUSIONS As the pandemic continues, mental health resources should be allocated to help AA and Latina women who experienced or anticipate reductions in paid hours and those concerned about its effects. Research is needed to identify how praying increased depressive symptoms in adult Latina women early in the pandemic.
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Affiliation(s)
- Sandraluz Lara-Cinisomo
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, 1206 S. Fourth Street, 2015 Khan Annex, Champaign, IL, 61820, USA.
| | - Biniyam Melesse
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, 1206 S. Fourth Street, 2015 Khan Annex, Champaign, IL, 61820, USA
| | - Mary Ellen Mendy
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, 1206 S. Fourth Street, 2015 Khan Annex, Champaign, IL, 61820, USA
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13
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Lenze SN, McKay-Gist K, Paul R, Tepe M, Mathews K, Kornfield S, Phillips C, Smith R, Stoermer A, Carter EB. Elevating Voices, Addressing Depression, Toxic Stress, and Equity Through Group Prenatal Care: A Pilot Study. Health Equity 2024; 8:87-95. [PMID: 38287981 PMCID: PMC10823176 DOI: 10.1089/heq.2023.0160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2023] [Indexed: 01/31/2024] Open
Abstract
Introduction Elevating Voices, Addressing Depression, Toxic Stress and Equity (EleVATE) is a group prenatal care (GC) model designed to improve pregnancy outcomes and promote health equity for Black birthing people. This article outlines the foundational community-engaged process to develop EleVATE GC and pilot study results. Methods We used community-based participatory research principles and the Ferguson Commission Report to guide creation of EleVATE GC. The intervention, designed by and for Black birthing people, centers trauma-informed care, antiracism, and integrates behavioral health strategies into group prenatal care to address unmet mental health needs. Using a convenience sample of patients seeking care at one of three safety-net health care sites, we compared preterm birth, small for gestational age, depression scores, and other pregnancy outcomes between patients in individual care (IC), CenteringPregnancy™ (CP), and EleVATE GC. Results Forty-eight patients enrolled in the study (n=11 IC; n=14 CP; n=23 EleVATE GC) and 86% self-identified as Black. Patients participating in group prenatal care (EleVATE GC or CP) were significantly less likely to experience a preterm birth <34 weeks. Rates of small for gestational age, preterm birth <37 weeks, depression scores, and other pregnancy outcomes were similar across groups. Participants in CP and EleVATE GC were more likely to attend their postpartum visit and breastfeed at hospital discharge than those in IC. Discussion Our findings model a systematic approach to design a feasible, patient-centered, community-based, trauma-informed, antiracist intervention. Further study is needed to determine whether EleVATE GC improves perinatal outcomes and promotes health equity.
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Affiliation(s)
- Shannon N. Lenze
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - Rachel Paul
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - Katherine Mathews
- SSM Health St. Mary's and Department of Obstetrics, Gynecology, and Women's Health, St. Louis University, St. Louis, Missouri, USA
| | - Sara Kornfield
- Center for Women's Behavioral Wellness, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Cheron Phillips
- St. Louis Integrated Health Network, St. Louis, Missouri, USA
| | - Richelle Smith
- St. Louis Integrated Health Network, St. Louis, Missouri, USA
| | - Amanda Stoermer
- St. Louis Integrated Health Network, St. Louis, Missouri, USA
| | - Ebony B. Carter
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri, USA
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14
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Njoroge WFM, Tieu T, Eckardt D, Himes M, Alexandre C, Hall W, Wisniewski K, Popoola A, Holloway K, Rodriguez Y, Kornfield S, Momplaisir F, Wang X, Gur R, Waller R. The impact of the pandemic on mothers and children, with a focus on syndemic effects on black families: the "Prenatal to Preschool" study protocol. Front Psychiatry 2024; 14:1281666. [PMID: 38260788 PMCID: PMC10801187 DOI: 10.3389/fpsyt.2023.1281666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/07/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction Racism, a known social determinant of health, affects the mental health and well-being of pregnant and postpartum women and their children. Convincing evidence highlights the urgent need to better identify the mechanisms and the ways in which young children's development and mental health are adversely impacted by their mothers' experiences of racism. With the additional stressor of the COVID-19 pandemic, the criticality of improving knowledge of these domains has never been starker. The proposed project will address these questions and move the field forward to create targeted, culturally informed preventative interventions, thus achieving mental health equity for all children and families. Methods This prospective research is a cohort study that will longitudinally observe the outcomes of a cohort of mothers and their children recruited during the initial phase of the COVID-19 pandemic. Data will be parent/caregiver questionnaires assessing mental health, racism, support, and resilience at multiple time points with the first beginning at 24 months, clinical interviews with mothers, electronic medical records of mothers, and videotaped dyadic interactions at child age 24 and 48 months. A subset of Black participants will be asked to participate in qualitative interviews at child age 36 months. Results Analyze will be performed within and across Black and Non-Latino/a/e/x white (NLW) groups, and comparing mothers and fathers/secondary caregivers. Descriptive and multivariate analyzes will be run to better characterize how young children's development and mental health may be adversely impacted by their caregiver's experiences of racism. Discussion This prospective longitudinal mixed-methods study evaluates the simultaneous effects of the COVID-19 pandemic and racism on mothers and their developing children to characterize cross-racial differences, providing insight into risk and resilience factors in early development and the peripartum period.
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Affiliation(s)
- Wanjikũ F. M. Njoroge
- Perelman School of Medicine, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Lifespan Brain Institute (LiBI), Children’s Hospital of Philadelphia and Penn Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Tiffany Tieu
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Devlin Eckardt
- Clinical Research Support Office, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Megan Himes
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Lifespan Brain Institute (LiBI), Children’s Hospital of Philadelphia and Penn Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Christina Alexandre
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Waynitra Hall
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Kate Wisniewski
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Ayomide Popoola
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Kayla Holloway
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Department of Neuroscience, University of Pennsylvania, Philadelphia, PA, United States
| | - Yuheiry Rodriguez
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, United States
| | - Sara Kornfield
- Lifespan Brain Institute (LiBI), Children’s Hospital of Philadelphia and Penn Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Penn Center for Women’s Behavioral Wellness, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Florence Momplaisir
- Perelman School of Medicine, Division of Infectious Diseases, University of Pennsylvania, Philadelphia, PA, United States
| | - Xi Wang
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Raquel Gur
- Perelman School of Medicine, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Lifespan Brain Institute (LiBI), Children’s Hospital of Philadelphia and Penn Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Rebecca Waller
- Lifespan Brain Institute (LiBI), Children’s Hospital of Philadelphia and Penn Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, United States
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15
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Waller R, Paz Y, Himes MM, White LK, Rodriguez Y, Gorgone A, Luby J, Gerstein ED, Brady RG, Chaiyachati BH, Duncan A, Barzilay R, Kornfield SL, Burris HH, Seidlitz J, Parish-Morris J, Laney N, Gur RE, Njoroge WFM. Observations of Positive Parenting from Online Parent-Child Interactions at Age 1. PARENTING, SCIENCE AND PRACTICE 2024; 24:39-65. [PMID: 38188653 PMCID: PMC10766433 DOI: 10.1080/15295192.2023.2286454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Objective Brief, reliable, and cost-effective methods to assess parenting are critical for advancing parenting research. Design We adapted the Three Bags task and Parent Child Interaction Rating System (PCIRS) for rating online visits with 219 parent-child dyads (White, n = 104 [47.5%], Black, n = 115 [52.5%]) and combined the video data with survey data collected during pregnancy and when children were aged 1. Results The PCIRS codes of positive regard, stimulation of child cognitive development, and sensitivity showed high reliability across the three parent-child interaction tasks. A latent positive parenting factor combining ratings across codes and tasks showed good model fit, which was similar regardless of parent self-identified race or ethnicity, age, socioeconomic disadvantage, marital/partnered status, and parity, as well as methodological factors relevant to the online video assessment method (e.g., phone vs. laptop/tablet). In support of construct validity, observed positive parenting was related to parent-reported positive parenting and child socioemotional development. Finally, parent reports of supportive relationships in pregnancy, but not neighborhood safety or pandemic worries, were prospectively related to higher positive parenting observed at age 1. With the exception of older parental age and married/partnered status, no other parent, child, sociodemographic, or methodological variables were related to higher overall video exclusions across tasks. Conclusions PCIRS may provide a reliable approach to rate positive parenting at age 1, providing future avenues for developing more ecologically valid assessments and implementing interventions through online encounters that may be more acceptable, accessible, or preferred among parents of young children.
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Affiliation(s)
- Rebecca Waller
- Department of Psychology, University of Pennsylvania, Stephen A Levin Building, 425 S University Ave, Philadelphia, PA 19104, USA
| | | | | | | | | | | | - Joan Luby
- Washington University School of Medicine
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16
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McCall T, Foster M, Tomlin HR, Schwartz TA. Black American women's attitudes toward seeking mental health services and use of mobile technology to support the management of anxiety. JAMIA Open 2023; 6:ooad088. [PMID: 37860603 PMCID: PMC10582519 DOI: 10.1093/jamiaopen/ooad088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 08/23/2023] [Accepted: 10/02/2023] [Indexed: 10/21/2023] Open
Abstract
Objectives This study aimed to understand Black American women's attitudes toward seeking mental health services and using mobile technology to receive support for managing anxiety. Methods A self-administered web-based questionnaire was launched in October 2019 and closed in January 2020. Women who identified as Black/African American were eligible to participate. The survey consisted of approximately 70 questions and covered topics such as, attitudes toward seeking professional psychological help, acceptability of using a mobile phone to receive mental health care, and screening for anxiety. Results The findings of the study (N = 395) showed that younger Black women were more likely to have greater severity of anxiety than their older counterparts. Respondents were most comfortable with the use of a voice call or video call to communicate with a professional to receive support to manage anxiety in comparison to text messaging or mobile app. Younger age, higher income, and greater scores for psychological openness and help-seeking propensity increased odds of indicating agreement with using mobile technology to communicate with a professional. Black women in the Southern region of the United States had twice the odds of agreeing to the use of mobile apps than women in the Midwest and Northeast regions. Discussion Black American women, in general, have favorable views toward the use of mobile technology to receive support to manage anxiety. Conclusion Preferences and cultural appropriateness of resources should be assessed on an individual basis to increase likelihood of adoption and engagement with digital mental health interventions for management of anxiety.
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Affiliation(s)
- Terika McCall
- Division of Health Informatics, Department of Biostatistics, Yale School of Public Health, New Haven, CT 06510, United States
- Section of Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, CT 06510, United States
- Center for Interdisciplinary Research on AIDS (CIRA), Yale School of Public Health, New Haven, CT 06510, United States
| | - Meagan Foster
- Division of Health Informatics, Department of Biostatistics, Yale School of Public Health, New Haven, CT 06510, United States
| | - Holly R Tomlin
- Division of Health Informatics, Department of Biostatistics, Yale School of Public Health, New Haven, CT 06510, United States
- Department of Population Health Sciences, Health Analytics, Weill Cornell Medicine, New York, NY 10065, United States
| | - Todd A Schwartz
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States
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17
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De Genna NM, Hossain F, Dwarakanath M, Balascio PM, Moore MM, Hill AV. Pandemic stressors and vaccine hesitancy among young, pregnant Black people: A qualitative study of health disparities during a global pandemic. Birth Defects Res 2023; 115:1912-1922. [PMID: 37807480 PMCID: PMC11061795 DOI: 10.1002/bdr2.2262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 09/11/2023] [Accepted: 09/26/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND The novel coronavirus 2019 (COVID-19) pandemic exacerbated existing health inequities in the United States, but no studies have focused on the lived experiences of younger Black birthing people. The goal of this qualitative study was to center the experiences of younger pregnant and birthing Black and Biracial people during the pandemic. METHODS We recruited 25 Black and Biracial pregnant and birthing people ages 16-23 for individual semi-structured interviews. Participants were asked about experiences with the healthcare system during the pandemic, and interviews were transcribed verbatim and coded for qualitative analysis using nVivo. We adhered to the Consolidated Criteria for Reporting Qualitative Research guidelines. RESULTS Participants identified pandemic-related stressors such as fears about infection, lack of support, and pressure to get vaccinated. Reasons for vaccine hesitancy included mistrust in the government and racism experienced during reproductive healthcare. Provider appeals highlighting patient autonomy and science were more effective in encouraging vaccine uptake than emotional appeals that made participants feel guilty about potentially infecting loved ones. CONCLUSIONS Restrictions on children and support people created barriers to timely prenatal care and reduced tangible support for young Black and Biracial birthing people during the pandemic. Their vaccine hesitancy was related to mistrust, concerns that the vaccines had not been tested enough prior to roll-out, and possible side effects of the vaccine including infection with the virus and pregnancy loss. Obstetric providers need to understand and recognize the ongoing impact of obstetric and scientific racism on health communication with younger Black and Biracial patients.
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Affiliation(s)
- Natacha M. De Genna
- Department of Psychiatry and Epidemiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Fahmida Hossain
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Megana Dwarakanath
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Phoebe Ms. Balascio
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Mikaela Ms. Moore
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Ashley V. Hill
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
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18
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Sayahi M, Nikbina M, Jahangirimehr A, Barati B. Mental health status of pregnant women during COVID-19 in healthcare centers of Iran: A cross-sectional study. PLoS One 2023; 18:e0294850. [PMID: 38015922 PMCID: PMC10683986 DOI: 10.1371/journal.pone.0294850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 11/08/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The COVID-19 pandemic impacted every single aspect of life. In addition to being a public health emergency, the COVID-19 outbreak impacted the mental health of individuals, especially pregnant women. This study aimed to examine the mental health status of pregnant women and also the effect of sociodemographic factors on their mental health status during COVID-19 in healthcare centers of Iran. METHODS This cross-sectional, analytical-descriptive study was conducted among pregnant women referring to healthcare centers in Shoushtar, Iran, in 2021. Multistage cluster sampling was used to select participants. Data were collected using the General Health Questionnaire-28 (GHQ-28). Data were analyzed using SPSS software version 22. The Pearson correlation coefficient was used to examine the association between quantitative variables. A generalized linear model (GLM) was applied to estimate the effect of independent variables on the dependent variable (mental health). RESULTS A total of 197 participants with a mean ± SD age of 27.85 ± 6.37 years took part in this study. The total mean score of mental health was estimated at 17.47±8.20. The highest mean ± SD score was, respectively, related to social dysfunction (6.63 ± 2.86), anxiety and insomnia (5.28 ± 3.53), and somatic symptoms (4.17 ± 3.27). Mental health disorder was significantly correlated with participants' age (R = .223, P = .00), number of pregnancy (gravida) (R = .272, P = .00), number of births (para) (R = 0.272, P = .00), and number of abortions (R = .172, P = .015). About 80% of pregnant women did not reveal impaired mental health conditions or psychological distress, while 19.3% showed scores that indicate probable mental health conditions. CONCLUSION Social dysfunction was the most common mental health problem among pregnant women. It is necessary to pay more attention to the mental health status of pregnant women during a pandemic. Interventions such as practical strategies to promote social support and improve pregnant women's mental health during pregnancy are highly important.
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Affiliation(s)
- Masoumeh Sayahi
- Department of Midwifery, Shoushtar Faculty of Medical Sciences, Shoushtar, Iran
| | - Maryam Nikbina
- Department of Midwifery, Shoushtar Faculty of Medical Sciences, Shoushtar, Iran
| | - Azam Jahangirimehr
- Department of Public Health, Shoushtar Faculty of Medical Sciences, Shoushtar, Iran
| | - Barat Barati
- Department of Radiologic Technology, Shoushtar Faculty of Medical Sciences, Shoushtar, Iran
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19
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White LK, Himes MM, Waller R, Njoroge WFM, Chaiyachati BH, Barzilay R, Kornfield SL, Burris HH, Seidlitz J, Parish-Morris J, Brady RG, Gerstein ED, Laney N, Gur RE, Duncan AF. The Influence of Pandemic-Related Worries During Pregnancy on Child Development at 12 Months. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01605-x. [PMID: 37805964 PMCID: PMC10999505 DOI: 10.1007/s10578-023-01605-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 10/10/2023]
Abstract
The COVID-19 pandemic has been linked to increased risk for perinatal anxiety and depression among parents, as well as negative consequences for child development. Less is known about how worries arising from the pandemic during pregnancy are related to later child development, nor if resilience factors buffer negative consequences. The current study addresses this question in a prospective longitudinal design. Data was collected from a sub-study (n = 184) of a longitudinal study of pregnant individuals (total n = 1173). During pregnancy (April 17-July 8, 2020) and the early postpartum period (August 11, 2020-March 2, 2021), participants completed online surveys. At 12 months postpartum (June 17, 2021-March 23, 2022), participants completed online surveys and a virtual laboratory visit, which included parent-child interaction tasks. We found more pregnancy-specific pandemic worries were prospectively related to lower levels of child socioemotional development based on parent report (B = - 1.13, SE = .43, p = .007) and observer ratings (B = - 0.13, SE = .07, p = .045), but not to parent-reported general developmental milestones. Parental emotion regulation in the early postpartum period moderated the association between pregnancy-specific pandemic worries and child socioemotional development such that pregnancy-specific pandemic worries did not relate to worse child socioemotional development among parents with high (B = - .02, SE = .10, t = - .14, p = .89) levels of emotion regulation. Findings suggest the negative consequences of parental worry and distress during pregnancy on the early socioemotional development of children in the context of the COVID-19 pandemic. Results highlight that parental emotion regulation may represent a target for intervention to promote parental resilience and support optimized child development.
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Affiliation(s)
- Lauren K White
- Lifespan Brain Institute, 3400 Spruce St. 10th floor, Gates Pavilion, Philadelphia, PA, 19104, USA.
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Megan M Himes
- Lifespan Brain Institute, 3400 Spruce St. 10th floor, Gates Pavilion, Philadelphia, PA, 19104, USA
| | - Rebecca Waller
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Wanjikũ F M Njoroge
- Lifespan Brain Institute, 3400 Spruce St. 10th floor, Gates Pavilion, Philadelphia, PA, 19104, USA
- Policy Lab, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Barbara H Chaiyachati
- Lifespan Brain Institute, 3400 Spruce St. 10th floor, Gates Pavilion, Philadelphia, PA, 19104, USA
- Policy Lab, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Ran Barzilay
- Lifespan Brain Institute, 3400 Spruce St. 10th floor, Gates Pavilion, Philadelphia, PA, 19104, USA
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sara L Kornfield
- Department of Psychiatry, Perelman School of Medicine, Penn Center for Women's Behavioral Wellness, University of Pennsylvania, Philadelphia, PA, USA
| | - Heather H Burris
- Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Jakob Seidlitz
- Lifespan Brain Institute, 3400 Spruce St. 10th floor, Gates Pavilion, Philadelphia, PA, 19104, USA
| | - Julia Parish-Morris
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Rebecca G Brady
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Emily D Gerstein
- Department of Psychological Sciences, University of Missouri-St. Louis, 325 Stadler Hall, 1 University Blvd., St. Louis, MO, USA
| | - Nina Laney
- Lifespan Brain Institute, 3400 Spruce St. 10th floor, Gates Pavilion, Philadelphia, PA, 19104, USA
| | - Raquel E Gur
- Lifespan Brain Institute, 3400 Spruce St. 10th floor, Gates Pavilion, Philadelphia, PA, 19104, USA
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrea F Duncan
- Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
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Shilton T, Mancini AD, Perlstein S, DiDomenico GE, Visoki E, Greenberg DM, Brown LA, Gur RC, Gur RE, Waller RE, Barzilay R. Contribution of risk and resilience factors to anxiety trajectories during the early stages of the COVID-19 pandemic: A longitudinal study. Stress Health 2023; 39:927-939. [PMID: 36751725 PMCID: PMC10404639 DOI: 10.1002/smi.3233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 12/17/2022] [Accepted: 01/31/2023] [Indexed: 02/09/2023]
Abstract
The COVID-19 pandemic, and the response of governments to mitigate the pandemic's spread, resulted in exceptional circumstances that comprised a major global stressor, with broad implications for mental health. We aimed to delineate anxiety trajectories over three time-points in the first 6 months of the pandemic and identify baseline risk and resilience factors that predicted anxiety trajectories. Within weeks of the pandemic onset, we established a website (covid19resilience.org), and enrolled 1362 participants (n = 1064 from US; n = 222 from Israel) who provided longitudinal data between April-September 2020. We used latent growth mixture modelling to identify anxiety trajectories and ran multivariate regression models to compare characteristics between trajectory classes. A four-class model best fit the data, including a resilient trajectory (stable low anxiety) the most common (n = 961, 75.08%), and chronic anxiety (n = 149, 11.64%), recovery (n = 96, 7.50%) and delayed anxiety (n = 74, 5.78%) trajectories. Resilient participants were older, not living alone, with higher income, more education, and reported fewer COVID-19 worries and better sleep quality. Higher resilience factors' scores, specifically greater emotion regulation and lower conflict relationships, also uniquely distinguished the resilient trajectory. Results are consistent with the pre-pandemic resilience literature suggesting that most individuals show stable mental health in the face of stressful events. Findings can inform preventative interventions for improved mental health.
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Affiliation(s)
- Tal Shilton
- Sheba Medical Centre, Child Adolescent Psychiatry Division, Tel Aviv University Sackler School of Medicine, Israel
| | | | - Samantha Perlstein
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Grace E DiDomenico
- Lifespan Brain Institute, Children’s Hospital of Philadelphia (CHOP) and Penn Medicine, Philadelphia, PA, USA
| | - Elina Visoki
- Lifespan Brain Institute, Children’s Hospital of Philadelphia (CHOP) and Penn Medicine, Philadelphia, PA, USA
| | | | - Lily A Brown
- Perelman School of Medicine, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Ruben C Gur
- Lifespan Brain Institute, Children’s Hospital of Philadelphia (CHOP) and Penn Medicine, Philadelphia, PA, USA
- Perelman School of Medicine, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Raquel E Gur
- Lifespan Brain Institute, Children’s Hospital of Philadelphia (CHOP) and Penn Medicine, Philadelphia, PA, USA
- Perelman School of Medicine, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Rebecca E Waller
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Ran Barzilay
- Lifespan Brain Institute, Children’s Hospital of Philadelphia (CHOP) and Penn Medicine, Philadelphia, PA, USA
- Perelman School of Medicine, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
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21
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Glassgow AE, Wagner-Schuman M, Knepper A, Holicky A, Angulo M, Handler A, Harris B, Hickey E, Manrique Y, Mauro A, Rodriguez A, Schulte J, Scott S, Wainwright S, Caskey R. Addressing Maternal Health Disparities: Building a Novel Two-Generation Approach to Comprehensive Postpartum Care. Popul Health Manag 2023; 26:275-282. [PMID: 37677001 DOI: 10.1089/pop.2023.0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023] Open
Abstract
The United States is facing a maternal health crisis with increasing rates of severe maternal morbidity and mortality. To improve maternal health and promote health equity, the authors developed a novel 2-generation model of postpartum and pediatric care. This article describes the Two-Generation Clinic (Two-Gen) and model of care. The model combines a dyadic strategy for simultaneous maternal and pediatric care with the collaborative care model in which seamless primary and behavioral health care are delivered to address the physical health, behavioral health, and social service needs of families. The transdisciplinary team includes primary care physicians, nurse practitioners, psychiatrists, obstetrician-gynecologists, social workers, care navigators, and lactation specialists. Dyad clinic visits are coscheduled (at the same time) and colocated (in the same examination room) with the same primary care provider. In the Two-Gen, the majority (89%) of the mothers self-identify as racial and ethnic minorities. More than 40% have a mental health diagnosis. Almost all mothers (97.8%) completed mental health screenings, >50.0% have received counseling from a social worker, 17.2% had a visit with a psychiatrist, and 50.0% received lactation counseling. Over 80% of the children were up to date with their well-child visits and immunizations. The Two-Gen is a promising model of care that has the potential to inform the design of postpartum care models and promote health equity in communities with the highest maternal health disparities.
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Affiliation(s)
- Anne Elizabeth Glassgow
- Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
- Department of Pediatrics, and College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Melissa Wagner-Schuman
- Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
- Department of Psychiatry, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Amanda Knepper
- Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Abigail Holicky
- Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Maria Angulo
- Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Arden Handler
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Bianca Harris
- Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Erin Hickey
- Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Yolanda Manrique
- Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ana Mauro
- Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Aida Rodriguez
- Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jennifer Schulte
- Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Shirley Scott
- Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Samuel Wainwright
- Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Rachel Caskey
- Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
- Department of Pediatrics, and College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
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22
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Julceus EF, Olatosi B, Hung P, Zhang J, Li X, Liu J. Racial disparities in adequacy of prenatal care during the COVID-19 pandemic in South Carolina, 2018-2021. BMC Pregnancy Childbirth 2023; 23:686. [PMID: 37741980 PMCID: PMC10517534 DOI: 10.1186/s12884-023-05983-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 09/07/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, hospitals' decision of not admitting pregnant women's partner or support person, and pregnant women's fear of contracting COVID-19 in hospitals may disrupt prenatal care. We aimed to examine whether prenatal care utilization in South Carolina varied before and during the COVID-19 pandemic, and whether the variation was different by race. METHODS We utilized 2018-2021 statewide birth certificate data using a pre-post design, including all women who delivered a live birth in South Carolina. The Kotelchuck Index - incorporating the timing of prenatal care initiation and the frequency of gestational age-adjusted visits - was employed to categorize prenatal care into inadequate versus adequate care. Self-reported race includes White, Black, and other race groups. Multiple logistic regression models were used to calculate adjusted odds ratio of inadequate prenatal care and prenatal care initiation after first trimester by maternal race before and during the pandemic. RESULTS A total of 118,925 women became pregnant before the pandemic (before March 2020) and 29,237 women during the COVID-19 pandemic (March 2020 - June 2021). Regarding race, 65.2% were White women, 32.0% were Black women and 2.8% were of other races. Lack of adequate prenatal care was more prevalent during the pandemic compared to pre-pandemic (24.1% vs. 21.6%, p < 0.001), so was the percentage of initiating prenatal care after the first trimester (27.2% vs. 25.0%, p < 0.001). The interaction of race and pandemic period on prenatal care adequacy and initiation was significant. The odds of not receiving adequate prenatal care were higher during the pandemic compared to before for Black women (OR 1.26, 95% CI 1.20-1.33) and White women (OR 1.10, 95% CI 1.06-1.15). The odds of initiating prenatal care after the first trimester were higher during the pandemic for Black women (OR 1.18, 95% CI 1.13-1.24) and White women (OR 1.09, 95% CI 1.04-1.13). CONCLUSIONS Compared to pre-pandemic, the odds of not receiving adequate prenatal care in South Carolina was increased by 10% for White women and 26% for Black women during the pandemic, highlighting the needs to develop individual tailored interventions to reverse this trend.
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Affiliation(s)
- Emmanuel Fabrice Julceus
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Bankole Olatosi
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Peiyin Hung
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Xiaoming Li
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Jihong Liu
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
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23
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Dwarakanath M, Hossain F, Balascio P, Moore MC, Hill AV, De Genna NM. Experiences of postpartum mental health sequelae among black and biracial women during the COVID-19 pandemic. BMC Pregnancy Childbirth 2023; 23:636. [PMID: 37667206 PMCID: PMC10478375 DOI: 10.1186/s12884-023-05929-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 08/16/2023] [Indexed: 09/06/2023] Open
Abstract
OBJECTIVE The objective of this study was to qualitatively examine coping mechanisms and desired supports in pregnant and birthing Black and Biracial adolescent and young adult women during the COVID-19 pandemic. METHODS Black and Biracial participants ages 16-23 were recruited for virtual individual semi-structured interviews. Participants (n = 25) were asked about pre- and post-natal experiences with the healthcare system, effects of the pandemic, and participants' experiences of or desires for ideal care within the healthcare system. Interviews were transcribed verbatim and coded for qualitative analysis using nVivo. Discussions around postpartum mental health evolved organically when asked about how participants were coping postpartum. RESULTS Nearly half the interviewees organically reported mental health symptoms consistent with postpartum depression (PPD) during questions regarding their postpartum experience. Of the 11 interviewees who reported mental health symptoms consistent with PPD, 2 were afraid to disclose their symptoms to a healthcare provider due to fear of child protective services involvement and their belief they would be treated unfairly because of their race. CONCLUSION Clinicians who care for Black and Biracial adolescent and young adult mothers must be particularly attuned to structural barriers for appropriate screening and treatment of postpartum depression. Expanding investigations of intersectional influences on young mothers' perinatal health and PPD are needed.
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Affiliation(s)
- Megana Dwarakanath
- University of Pittsburgh Medical Center, 200 Lothrop Street Pittsburgh, 15213, Pittsburgh, PA, USA.
| | - Fahmida Hossain
- University of Pittsburgh Medical Center, 200 Lothrop Street Pittsburgh, 15213, Pittsburgh, PA, USA
| | - Phoebe Balascio
- University of Pittsburgh Medical Center, 200 Lothrop Street Pittsburgh, 15213, Pittsburgh, PA, USA
| | - Mikaela C Moore
- University of Pittsburgh Medical Center, 200 Lothrop Street Pittsburgh, 15213, Pittsburgh, PA, USA
| | - Ashley V Hill
- University of Pittsburgh Medical Center, 200 Lothrop Street Pittsburgh, 15213, Pittsburgh, PA, USA
| | - Natacha M De Genna
- University of Pittsburgh Medical Center, 200 Lothrop Street Pittsburgh, 15213, Pittsburgh, PA, USA
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24
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Zimmerman ME, Hart LJ, Medrano P, Piccone C, Ramirez DM, Huggins LK, Sotres-Alvarez D, Fish LJ, Østbye T, Holliday KM. COVID-19 in the Community: Changes to Women's Mental Health, Financial Security, and Physical Activity. AJPM FOCUS 2023; 2:100095. [PMID: 37234692 PMCID: PMC10039779 DOI: 10.1016/j.focus.2023.100095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
Abstract
Introduction This study describes changes in the mental health, financial security, and physical activity levels of women in North Carolina during the COVID-19 pandemic. Methods Data were collected from women aged 20-40 years receiving primary care at 2 health centers in North Carolina during 2020-2022. Surveys (N=127) evaluated changes in mental health, financial security, and physical activity during the COVID-19 pandemic. These outcomes were analyzed both descriptively and for association with sociodemographic factors using logistic regression. A subset of participants (n=46) participated in semistructured interviews. Interview transcripts were reviewed and evaluated for recurring themes by primary and secondary coders using a rapid-coding technique. Analysis was conducted in 2022. Results Women surveyed were 28.4% non-Hispanic White, 38.6% non-Hispanic Black, and 33.1% Hispanic/Latina. Compared with reports before the pandemic, participants reported increased frustration or boredom (69.1%), loneliness (51.6%), anxiety (64.3%), depression (52.4%), and changed sleep patterns (68.3%). Increased alcohol and other recreational substance use were associated with race and ethnicity (p<0.05) after adjustment for other sociodemographic factors. Participants reported difficulty in paying for basic expenses (44.0%). Financial difficulties during COVID-19 were associated with non-Hispanic Black race and ethnicity, less education, and lower prepandemic household income. Data showed pandemic-associated reductions in mild (32.8%), moderate (39.5%), and strenuous (43.3%) exercise, with a correlation between increased depression and reduced mild exercise. Interviews identified themes including reduced activity while working remotely, lack of gym access, and reduced motivation for exercise. Conclusions This mixed-methods study is one of the first to evaluate the mental health, financial security, and physical activity challenges women aged between 20 and 40 years in the southern U.S. faced during the COVID-19 pandemic.
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Affiliation(s)
| | - Lauren J. Hart
- Department of Family Medicine & Community Health, Duke University School of Medicine, Durham, North Carolina
| | - Perla Medrano
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Caitlin Piccone
- Department of Family Medicine & Community Health, Duke University School of Medicine, Durham, North Carolina
| | - Diana M. Ramirez
- Sanford School of Public Policy, Duke University, Durham, North Carolina
| | - Lenique K.L. Huggins
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Department of Biology, Trinity College of Arts and Sciences, Duke University, Durham, North Carolina
| | - Daniela Sotres-Alvarez
- Department of Biostatistics, Gillings School of Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Laura J. Fish
- Department of Family Medicine & Community Health, Duke University School of Medicine, Durham, North Carolina
| | - Truls Østbye
- Department of Family Medicine & Community Health, Duke University School of Medicine, Durham, North Carolina
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Katelyn M. Holliday
- Department of Family Medicine & Community Health, Duke University School of Medicine, Durham, North Carolina
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25
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Dahl AA, Yada FN, Butts SJ, Tolley A, Hirsch S, Lalgondar P, Wilson KS, Shade L. Contextualizing the experiences of Black pregnant women during the COVID-19 pandemic: 'It's been a lonely ride'. Reprod Health 2023; 20:124. [PMID: 37626357 PMCID: PMC10463995 DOI: 10.1186/s12978-023-01670-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
The emergence of the COVID-19 pandemic significantly changed the prenatal care experience, specifically regarding medical appointments and social opportunities. It is critical to capture this change through the narratives of pregnant people, particularly those of marginalized populations, whose voices may often be underrepresented in the literature. This mixed-methods paper summarizes the experiences of 40 pregnant Black/African American (AA) women during the COVID-19 pandemic. A cross-sectional, online survey was administered between 2020 and 2021 to assess prenatal health and the impacts of the COVID-19 pandemic on patients' pregnancy experience. Coping behaviors during the pandemic were self-reported using the COPE-IS. Univariate analyses were conducted. An additional analysis of participants (n = 4) was explored through a week-long qualitative exercise using a photo documentation procedure. Photo-Elicitation Interviews (PEI) were conducted to capture and center their pandemic pregnancy experiences. Sources of stress during the pandemic varied, with the most common being financial concerns (n = 19, 47.5%). Over half of the sample (n = 18, 54.5%) self-reported increases in their positive coping behaviors during the pandemic, such as communicating with friends and family, talking to healthcare providers, listening to music, and engaging in spiritual practices-such as prayer. The four PEI study participants reflected on the impacts of social distancing on their prenatal experience and mentioned hospital and provider-related weariness due to their race. The findings of this study suggest that during the COVID-19 pandemic, Black/AA pregnant women in Charlotte, NC used social support, mindfulness practices, self-advocacy, and health literacy to navigate challenges present during their prenatal health experience. This paper highlights the personal, social, and structural experiences of pregnant women during a public health crisis so that responsive and effective programs or policies can be planned in the future.
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Affiliation(s)
- Alicia A Dahl
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223, USA.
| | - Farida N Yada
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223, USA
| | - Shanika Jerger Butts
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223, USA
| | - Annalise Tolley
- Department of Psychological Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223, USA
| | - Sophie Hirsch
- Department of Psychological Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223, USA
| | - Priyanka Lalgondar
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223, USA
| | - Kala S Wilson
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223, USA
| | - Lindsay Shade
- Department of Family Medicine, Atrium Health, 2001 Vail Avenue, Suite 400-B Mercy Medical Plaza, Charlotte, NC, 28207, USA
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26
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Lantigua-Martinez M, Trostle ME, Torres AM, Rajeev P, Dennis A, Silverstein JS, Talib M. Perinatal depression before and during the COVID-19 pandemic in New York City. AJOG GLOBAL REPORTS 2023; 3:100253. [PMID: 37560009 PMCID: PMC10407240 DOI: 10.1016/j.xagr.2023.100253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Quarantining and isolation during previous pandemics have been associated with higher levels of depression symptomatology. Studies in other countries found elevated rates of anxiety and/or depression among pregnant people during the COVID-19 pandemic compared with prepandemic rates. New York City was the initial epicenter of the pandemic in the United States, and the effects of the pandemic on perinatal depression in this population are not well known. OBJECTIVE This study aimed to evaluate the rates of perinatal depression before and during the COVID-19 pandemic. STUDY DESIGN This is a single-center retrospective cohort study of patients screened for perinatal depression with the Edinburgh Postnatal Depression Scale at 2 private academic practices in New York City. This screen is done in these practices at the time of the glucose challenge test and at the postpartum visit. Patients aged ≥18 years who completed a screen at a postpartum visit and/or glucose challenge test from February 1, 2019 to July 31, 2019 and from February 1, 2020 to July 31, 2020 were identified, and the 2019 and 2020 groups were compared. The primary outcome was a positive screen, defined as ≥13 and ≥15 for postnatal and prenatal screens, respectively. Secondary outcomes included monthly changes in rates of positive screens and factors associated with perinatal depression. Data were analyzed using Mann-Whitney U test, chi-square, or Fisher exact test, and univariate and multivariate analyses with P<.05 defined as significant. RESULTS A total of 1366 records met the inclusion criteria; 75% of the prepandemic (2019) records were included, as opposed to 65% of pandemic (2020) records due to a lower screen completion rate in the pandemic cohort. The 2020 cohort had a higher proportion of Hispanic patients (P=.003) and higher rates of diabetes mellitus (P=.007), preterm labor (P=.03), and current or former drug use (P<.001). The 2019 cohort had higher rates of hypertension (P=.002) and breastfeeding (P=.03); 4.6% of the 2020 cohort had a suspected or confirmed COVID-19 infection. There was no difference in perinatal depression between the 2019 and 2020 cohorts (2.8% vs 2.6%; P>.99). This finding persisted after adjusting for baseline differences (adjusted odds ratio, 0.89; 95% confidence interval, 0.38-1.86; P=.76). There were no differences in rates of positive Edinburgh Postnatal Depression Scale by month. Several risk factors were associated with a positive screen, including being unmarried (P<.001), pulmonary disease (P=.02), depression (P<.001), anxiety (P=.01), bipolar disorder (P=.009), and use of anxiolytics (P=.04). CONCLUSION There were no differences in the rates of perinatal depression between the periods before and during the COVID-19 pandemic. The rate of perinatal depression in this cohort was below the reported averages in the literature. Fewer women were screened for perinatal depression in 2020, which likely underestimated the prevalence of depression in our cohort. These findings highlight potential gaps in care in a pandemic setting.
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Affiliation(s)
- Meralis Lantigua-Martinez
- Department of Obstetrics and Gynecology, NYU Langone Health (Drs Lantigua-Martinez, Melendez Torres, and Talib), New York, NY
| | - Megan E. Trostle
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, NYU Langone Health (Drs Trostle and Silverstein), New York, NY
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, St. Luke's University Hospital (Dr Trostle), Bethlehem, PA
| | - Anthony Melendez Torres
- Department of Obstetrics and Gynecology, NYU Langone Health (Drs Lantigua-Martinez, Melendez Torres, and Talib), New York, NY
| | - Pournami Rajeev
- NYU Grossman School of Medicine (Mses Rajeev and Dennis), New York, NY
- Department of Obstetrics and Gynecology, Montefiore Medical Center, Albert Einstein College of Medicine (Ms Rajeev), New York, NY
| | - Alyson Dennis
- NYU Grossman School of Medicine (Mses Rajeev and Dennis), New York, NY
| | - Jenna S. Silverstein
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, NYU Langone Health (Drs Trostle and Silverstein), New York, NY
| | - Mahino Talib
- Department of Obstetrics and Gynecology, NYU Langone Health (Drs Lantigua-Martinez, Melendez Torres, and Talib), New York, NY
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27
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White LK, Barzilay R, Moore TM, Calkins ME, Jones JD, Himes MM, Young JF, Gur RC, Gur RE. Risk and Resilience Measures Related to Psychopathology in Youth. Child Psychiatry Hum Dev 2023; 54:961-972. [PMID: 35037180 PMCID: PMC9289457 DOI: 10.1007/s10578-021-01296-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 11/30/2022]
Abstract
Childhood adversity places youth at risk for multiple negative outcomes. The current study aimed to understand how a constellation of risk and resilience factors influenced mental health outcomes as a function of adversities: socioeconomic status (SES) and traumatic stressful events (TSEs). Specifically, we examined outcomes related to psychosis and mood disorders, as well as global clinical functioning. The current study is a longitudinal follow up of 140 participants from the Philadelphia Neurodevelopmental Cohort (PNC) assessed for adversities at Time 1 (Mean age: 14.11 years) and risk, resilience, and clinical outcomes at Time 2 (mean age: 21.54 years). In the context of TSE, a limited set of predictors emerged as important; a more diverse set of moderators emerged in the context of SES. Across adversities, social support was a unique predictor of psychosis spectrum diagnoses and global functioning; emotion dysregulation was an important predictor for mood diagnoses. The current findings underscore the importance of understanding effects of childhood adversity on maladaptive outcomes within a resilience framework.
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Affiliation(s)
- Lauren K White
- Lifespan Brain Institute, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA.
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
| | - Ran Barzilay
- Lifespan Brain Institute, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Tyler M Moore
- Lifespan Brain Institute, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Monica E Calkins
- Lifespan Brain Institute, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Jason D Jones
- Lifespan Brain Institute, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Megan M Himes
- Lifespan Brain Institute, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Jami F Young
- Lifespan Brain Institute, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Ruben C Gur
- Lifespan Brain Institute, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Raquel E Gur
- Lifespan Brain Institute, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
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28
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Preis H, Mahaffey B, Lobel M. Factors related to COVID-19 vaccination intention and uptake among childbearing women. Health Psychol 2023; 42:567-576. [PMID: 36074594 PMCID: PMC10819163 DOI: 10.1037/hea0001221] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Pregnant women are a vulnerable population for coronavirus disease 2019 (COVID-19) due to their risk for severe symptoms and adverse perinatal outcomes. Our objective was to identify contributors to COVID-19 vaccine intention in pregnancy and subsequent uptake, informed by the Theory of Planned Behavior, the Health Belief Model, and paradigms implicating social determinants of health (SDoH). METHOD Total of 1,899 pregnant women across the United States completed questionnaires in December 2020 (T1) and April 2021 (T2). A structural equation model (SEM) was built from hypothesized contributors to vaccine intention (T1) and uptake (T2), including perceived threat of COVID-19, attitudes toward infection mitigation behaviors, and social determinants of health SDoH (i.e., socioeconomic status [SES], minoritized identity), controlling for maternal health, age, and county-level political orientation. RESULTS In the SEM, SDoH variables, perceived threat and behavioral attitudes predicted vaccine intention. SDoH were directly associated with vaccine uptake and indirectly associated via vaccine intention (SES direct effect b = .17, total effect b = .38; identifying as Black/African American direct effect b = -.05, total effect b = -.09) The SEM demonstrated good fit and explained 38% of the variance in vaccine intention and 26% in vaccine uptake. CONCLUSIONS COVID-19 vaccination for pregnant women is influenced by SDoH and perceptual factors. Particular attention should focus on persons with lower SES and Black/African American women who reported lower vaccination intention and uptake. Potential routes to increase vaccination in perinatal populations include reducing accessibility barriers and providing information about vaccine safety and efficacy. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Heidi Preis
- Department of Psychology, Stony Brook University
- Department of Obstetrics, Gynecology and Reproductive Medicine, Renaissance School of Medicine, Stony Brook University
| | - Brittain Mahaffey
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook University
| | - Marci Lobel
- Department of Psychology, Stony Brook University
- Department of Obstetrics, Gynecology and Reproductive Medicine, Renaissance School of Medicine, Stony Brook University
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White LK, Kornfield SL, Himes MM, Forkpa M, Waller R, Njoroge WFM, Barzilay R, Chaiyachati BH, Burris HH, Duncan AF, Seidlitz J, Parish-Morris J, Elovitz MA, Gur RE. The impact of postpartum social support on postpartum mental health outcomes during the COVID-19 pandemic. Arch Womens Ment Health 2023; 26:531-541. [PMID: 37268777 PMCID: PMC10238239 DOI: 10.1007/s00737-023-01330-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 05/17/2023] [Indexed: 06/04/2023]
Abstract
Social support is an influential component of postpartum recovery, adjustment, and bonding, which was disrupted by social distancing recommendations related to the COVID-19 pandemic. This study reports on changes in the availability of social support for postpartum women during the pandemic, investigates how those changes may have contributed to postpartum mental health, and probes how specific types of social support buffered against poor postpartum mental health and maternal-infant bonding impairment. Participants were 833 pregnant patients receiving prenatal care in an urban USA setting and using an electronic patient portal to access self-report surveys at two time points, during pregnancy (April-July 2020) and at ~12 weeks postpartum (August 2020-March 2021). Measures included an assessment of COVID-19 pandemic-related change in social support, sources of social support, ratings of emotional and practical support, and postpartum outcomes including depression, anxiety, and maternal-infant bonding. Overall self-reported social support decreased during the pandemic. Decreased social support was associated with an increased risk of postpartum depression, postpartum anxiety, and impaired parent-infant bonding. Among women reporting low practical support, emotional support appeared to protect against clinically significant depressive symptoms and impaired bonding with the infant. Decreases in social support are associated with a risk for poor postpartum mental health outcomes and impaired maternal-infant bonding. Evaluation and promotion of social support are recommended for healthy adjustment and functioning of postpartum women and families.
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Affiliation(s)
- Lauren K White
- Lifespan Brain Institute, Children's Hospital of Philadelphia and Penn Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Sara L Kornfield
- Penn Center for Women's Behavioral Wellness, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
| | - Megan M Himes
- Lifespan Brain Institute, Children's Hospital of Philadelphia and Penn Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Markolline Forkpa
- Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Rebecca Waller
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Wanjikũ F M Njoroge
- Lifespan Brain Institute, Children's Hospital of Philadelphia and Penn Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Policy Lab, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Ran Barzilay
- Lifespan Brain Institute, Children's Hospital of Philadelphia and Penn Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Barbara H Chaiyachati
- Lifespan Brain Institute, Children's Hospital of Philadelphia and Penn Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Heather H Burris
- Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Andrea F Duncan
- Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Jakob Seidlitz
- Lifespan Brain Institute, Children's Hospital of Philadelphia and Penn Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Julia Parish-Morris
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Michal A Elovitz
- Women's Biomedical Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Raquel and Jaime Gilinski Department of Obstetrics, Gynecology and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Raquel E Gur
- Lifespan Brain Institute, Children's Hospital of Philadelphia and Penn Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
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Hull SJ, Massie JS, Holt SL, Bowleg L. Intersectionality Policymaking Toolkit: Key Principles for an Intersectionality-Informed Policymaking Process to Serve Diverse Women, Children, and Families. Health Promot Pract 2023; 24:623-635. [PMID: 36960782 PMCID: PMC10445436 DOI: 10.1177/15248399231160447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
Health and economic inequities among U.S. racial/ethnic minority women and children are staggering. These inequities underscore a dire need for intersectionality-informed, social-justice-oriented maternal and child (MCH) policies and programs for U.S. women and children. In response, we developed the "Intersectionality Policymaking Toolkit: Key Principles for an Intersectionality Informed Policymaking Process to Serve Diverse Women, Children and Families" to assist U.S. policymakers/aides, practitioners, and other stakeholders in developing more equitable MCH policies/programs. This article describes the Toolkit development process and initial assessments of acceptability and feasibility for use in MCH policymaking. Between 2018 and 2021, we utilized the process that the World Health Organization (WHO) used to develop its WHO Surgical Safety Checklist to develop the content (e.g., case studies) and format (i.e., structure), make strategic decisions (e.g., core items, primary audiences, timing of utilization), test concepts, and receive feedback. We convened a 2-day planning meeting with experts (n = 8) in intersectionality, policymaking, and MCH to draft the Toolkit. Next, we convened half-day workshops with policymaking and program leadership and staff in Washington, DC, New Orleans, LA, and Santa Fe, NM, to refine the Toolkit (n = 37). Then we conducted an initial assessment of the Toolkits' acceptability and feasibility using surveys (n = 21), followed by focus groups (n = 7). The resulting Toolkit distills Critical Race Theory's and intersectionality's most critical elements into a user-friendly modality to promote and enhance equitable MCH policies and programs for diverse U.S. women and families.
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Affiliation(s)
- Shawnika J. Hull
- Corresponding Author: Department of Communication, Rutgers University, 4 Huntington St. New Brunswick, NJ, 08901.
| | | | | | - Lisa Bowleg
- Department of Psychology, The George Washington University
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Preis H, Wang W, Zhu W, Mahaffey B, Lobel M. Social Determinants of Health, Prenatal Maternal Stress, and Earlier Birth During the COVID-19 Pandemic. SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2023; 17:e12751. [PMID: 38178920 PMCID: PMC10764037 DOI: 10.1111/spc3.12751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 03/21/2023] [Indexed: 01/06/2024]
Abstract
During the COVID-19 pandemic, pregnant women, especially those from socioeconomically disadvantaged and marginalized groups, experienced unprecedented stress. Prenatal stress and social determinants of health (SDoH) such as lower education and lack of a relationship partner are known to contribute to earlier birth. However, whether SDoH and stress independently contribute or whether the harmful impact of SDoH is mediated by stress is unknown. Moreover, the contributions of these factors has not been investigated in the context of a communal health crisis such as the COVID-19 pandemic. To examine these processes, we used a longitudinal cohort of 2,473 women pregnant during the COVID-19 pandemic who reported a live birth. We compared structural equation models predicting gestational age at birth from SDoH (race/ethnicity, education, financial security, health insurance, relationship status, and lifetime abuse) and from prenatal maternal stress related and unrelated to the COVID-19 pandemic. Results indicate that the association of SDoH with earlier birth was partially mediated by prenatal stress. These findings help uncover mechanisms explaining health disparities in the U.S. and highlight the need to address both SDoH and the stress that these factors produce in under-resourced and marginalized communities.
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Affiliation(s)
- Heidi Preis
- Department of Psychology, Stony Brook University
- Department of Obstetrics, Gynecology and Reproductive Medicine, Renaissance School of Medicine, Stony Brook University
| | - Weihao Wang
- Department of Applied Mathematics and Statistics, Stony Brook University
| | - Wei Zhu
- Department of Applied Mathematics and Statistics, Stony Brook University
| | - Brittain Mahaffey
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook University
| | - Marci Lobel
- Department of Psychology, Stony Brook University
- Department of Obstetrics, Gynecology and Reproductive Medicine, Renaissance School of Medicine, Stony Brook University
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Chung RYN, Lee TTY, Chan SM, Chung GKK, Chan YH, Wong SYS, Lai E, Wong H, Yeoh EK, Marmot M, Woo J. Experience of South and Southeast Asian minority women in Hong Kong during COVID-19 pandemic: a qualitative study. Int J Equity Health 2023; 22:110. [PMID: 37268921 PMCID: PMC10237077 DOI: 10.1186/s12939-023-01922-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 05/22/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Hong Kong has a relatively low incidence rate of COVID-19 across the globe. Nevertheless, ethnic minorities in Hong Kong, especially South Asians (SAs) and Southeast Asians (SEAs), face numerous physical, mental, social, economic, cultural and religious challenges during the pandemic. This study explores the experiences of SA and SEA women in a predominantly Chinese metropolitan city. METHODS Ten SA and SEA women were recruited and face-to-face interviews were conducted. Questions about participants' daily life experience, physical and mental health conditions, economic situation and social interaction amid COVID-19 pandemic were asked to assess the impact of COVID-19. RESULTS SAs and SEAs have a distinctive family culture, and women experienced significant physical and mental impact of COVID-19 due to their unique gender role in the family. In addition to taking care of their family in Hong Kong, SA and SEA women also had to mentally and financially support family members residing in their home countries. Access to COVID-related information was restricted due to language barrier. Public health measures including social distancing imposed extra burden on ethnic minorities with limited social and religious support. CONCLUSIONS Even when COVID-19 incidence rate is relatively low in Hong Kong, the pandemic made life even more challenging for SAs and SEAs, which is a community already struggling with language barriers, financial woes, and discrimination. This in turn could have led to greater health inequalities. Government and civil organizations should take the social determinants of health inequalities into account when implementing COVID-19-related public health policies and strategies.
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Affiliation(s)
- Roger Yat-Nork Chung
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, China.
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
- CUHK Centre for Bioethics, The Chinese University of Hong Kong, Hong Kong, China.
- CUHK Institute of Ageing, The Chinese University of Hong Kong, Hong Kong, China.
| | - Tobey Tsz-Yan Lee
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Siu-Ming Chan
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, China
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong, China
| | - Gary Ka-Ki Chung
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, China
| | - Yat-Hang Chan
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, China
| | - Samuel Yeung-Shan Wong
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, China
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
- CUHK Institute of Ageing, The Chinese University of Hong Kong, Hong Kong, China
| | - Eric Lai
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, China
| | - Hung Wong
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, China
- Department of Social Work, The Chinese University of Hong Kong, Hong Kong, China
| | - Eng Kiong Yeoh
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, China
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Michael Marmot
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, China
- Department of Epidemiology and Public Health, UCL Institute of Health Equity, University College London, London, United Kingdom
| | - Jean Woo
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, China
- CUHK Institute of Ageing, The Chinese University of Hong Kong, Hong Kong, China
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Schneider P, Lorenz A, Menegay MC, Afflitto S, Lamb E, Cossler N, Dixon K, Gibson KS, Lannon C, Fuller S, Ford S, Oza-Frank R, Everett R, Lappen JR. The Ohio Maternal Safety Quality Improvement Project: initial results of a statewide perinatal hypertension quality improvement initiative implemented during the COVID-19 pandemic. Am J Obstet Gynecol MFM 2023; 5:100912. [PMID: 37003568 PMCID: PMC10060203 DOI: 10.1016/j.ajogmf.2023.100912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/22/2023] [Accepted: 02/24/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Hypertensive disorders of pregnancy are a leading cause of severe maternal morbidity and mortality, and studies have shown that more than 60% of cases are preventable. As part of a statewide quality Maternal Safety Quality Improvement Project, we adapted the Alliance for Innovation on Maternal Health Severe Hypertension in Pregnancy bundle in a consortium of maternity hospitals in Ohio to improve care processes and outcomes for patients with a severe hypertensive event during pregnancy or the postpartum period. OBJECTIVE This study aimed to report the first year of data from this Maternal Safety Quality Improvement Project, including an assessment of the process measures by hospital level of maternal care designation, and provide perspective on the unique challenges of implementing a large-scale Maternal Safety Quality Improvement Project during a global pandemic. STUDY DESIGN This Maternal Safety Quality Improvement Project engaged Ohio level 1 to 4 maternity hospitals and provided multimodal quality improvement support. Participating hospitals submitted monthly patient-level data, which included all cases of new-onset sustained severe hypertension. The primary process measure was the proportion of birthing people in Ohio with sustained severe hypertension who received treatment with appropriate acute antihypertensive therapy within 60 minutes. The secondary process measures included receipt of a follow-up appointment after hospital discharge within 72 hours (if discharged on medication) or 10 days (if discharged without medication), a blood pressure cuff on hospital discharge, and education about urgent maternal warning signs. Data for primary and secondary process measures were plotted on a biweekly basis, and statistical process control methods were used to identify special cause variation over time. Data were stratified by various demographic variables, including race or ethnicity, insurance status, and maternal level of care. To assess the effect of the COVID-19 pandemic on this Maternal Safety Quality Improvement Project, process measure data were compared with COVID-19 case volume in Ohio across the study epoch. RESULTS A total of 29 hospitals participated in the project from July 2020 to September 2021. Data were collected on 4948 hypertensive events representing 4678 unique patients. In aggregate, the primary process measure (timely and appropriate treatment) demonstrated a 19.3% increase (from a baseline of 56.5% to 67.4%; P<.001). The secondary process measures demonstrated significant increases ranging from 26.1% to 166.8% (all P<.001). Both non-Hispanic Black and White pregnant or postpartum people demonstrated shifts and sustained improvements in the treatment of severe hypertension, which did not differ by race across the study period. Process measure improvements were achieved and sustained across peaks in the COVID-19 pandemic. CONCLUSION This Ohio Maternal Safety Quality Improvement Project demonstrated meaningful changes in project process measures in the identification and treatment of severe hypertension in pregnancy and the postpartum period. Process measures improvements were achieved across all hospital levels of maternal care, and differences were not observed by race or ethnicity. Our findings suggest that a robust and comprehensive quality improvement initiative with appropriate support and resources can achieve meaningful gains in the setting of a global pandemic.
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Affiliation(s)
- Patrick Schneider
- Ohio State University Wexner Medical Center, Columbus, OH (Drs Schneider and Dixon).
| | - Allison Lorenz
- Ohio Colleges of Medicine Government Resource Center, Columbus, OH (Ms Lorenz, Dr Menegay, Mr Afflitto, and Ms Lamb)
| | - Michelle C Menegay
- Ohio Colleges of Medicine Government Resource Center, Columbus, OH (Ms Lorenz, Dr Menegay, Mr Afflitto, and Ms Lamb)
| | - Stephen Afflitto
- Ohio Colleges of Medicine Government Resource Center, Columbus, OH (Ms Lorenz, Dr Menegay, Mr Afflitto, and Ms Lamb)
| | - Emily Lamb
- Ohio Colleges of Medicine Government Resource Center, Columbus, OH (Ms Lorenz, Dr Menegay, Mr Afflitto, and Ms Lamb)
| | - Nancy Cossler
- University Hospitals Cleveland Medical Center, Cleveland, OH (Dr Cossler and Ms Ford)
| | - Kamilah Dixon
- Ohio State University Wexner Medical Center, Columbus, OH (Drs Schneider and Dixon)
| | | | - Carole Lannon
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH (Dr Lannon and Ms Fuller); Ohio Perinatal Quality Collaborative, Cincinnati, OH (Dr Lannon and Mses Fuller and Ford)
| | - Sandy Fuller
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH (Dr Lannon and Ms Fuller); Ohio Perinatal Quality Collaborative, Cincinnati, OH (Dr Lannon and Mses Fuller and Ford)
| | - Susan Ford
- University Hospitals Cleveland Medical Center, Cleveland, OH (Dr Cossler and Ms Ford); Ohio Perinatal Quality Collaborative, Cincinnati, OH (Dr Lannon and Mses Fuller and Ford)
| | | | - Ryan Everett
- Ohio Hospital Association, Columbus, OH (Mr Everett)
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Phipps JE, Whipps MDM, D'Souza I, LaSalle JM, Simmons LA. Pregnant in a Pandemic: Mental Wellbeing and Associated Healthy Behaviors Among Pregnant People in California During COVID-19. Matern Child Health J 2023:10.1007/s10995-023-03657-w. [PMID: 37029891 PMCID: PMC10083068 DOI: 10.1007/s10995-023-03657-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 04/09/2023]
Abstract
INTRODUCTION Pregnancy is a time of increased vulnerability to mental health disorders. Additionally, the COVID-19 pandemic has increased the incidence of depression and anxiety. Thus, we aimed to assess mental health and associated healthy behaviors of pregnant people in California during the pandemic in order to contextualize prenatal well-being during the first pandemic of the twenty-first century. METHODS We conducted an online cross-sectional study of 433 pregnant people from June 6 through July 29, 2020. We explored 3 hypotheses: (1) mental health would be worse during the pandemic than in general pregnant samples to date; (2) first-time pregnant people would have worse mental health; and (3) healthy behaviors would be positively related to mental health. RESULTS Many of our participants (22%) reported clinically significant depressive symptoms and 31% reported clinically significant anxiety symptoms. Multiparous pregnant people were more likely to express worries about their own health and wellbeing and the process of childbirth than were primiparous pregnant people. Additionally, as pregnancy advanced, sleep and nutrition worsened, while physical activity increased. Lastly, anxious-depressive symptomology was significantly predictive of participant sleep behaviors, nutrition, and physical activity during the past week. DISCUSSION Pregnant people had worse mental health during the pandemic, and this was associated with worse health-promoting behaviors. Given that the COVID-19 pandemic and associated risks are likely to persist due to low vaccination rates and the emergence of variants with high infection rates, care that promotes mental and physical well-being for the pregnant population should be a public health priority.
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Affiliation(s)
- Jennifer E Phipps
- Department of Human Ecology, Perinatal Origins of Disparities Center, University of California, Davis, 1 Shields Ave, Davis, CA, 95616, USA.
| | - Mackenzie D M Whipps
- Department of Human Ecology, Perinatal Origins of Disparities Center, University of California, Davis, 1 Shields Ave, Davis, CA, 95616, USA
| | - Indira D'Souza
- Department of Human Ecology, Perinatal Origins of Disparities Center, University of California, Davis, 1 Shields Ave, Davis, CA, 95616, USA
| | - Janine M LaSalle
- Department of Medical Microbiology and Immunology, Perinatal Origins of Disparities Center, University of California, Davis, 1 Shields Ave, Davis, CA, 95616, USA
| | - Leigh Ann Simmons
- Department of Human Ecology, Perinatal Origins of Disparities Center, University of California, Davis, 1 Shields Ave, Davis, CA, 95616, USA
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Chambers BD, Fontenot J, McKenzie-Sampson S, Blebu BE, Edwards BN, Hutchings N, Karasek D, Coleman-Phox K, Curry VC, Kuppermann M. "It was just one moment that I felt like I was being judged": Pregnant and postpartum black Women's experiences of personal and group-based racism during the COVID-19 pandemic. Soc Sci Med 2023; 322:115813. [PMID: 36881972 PMCID: PMC9968447 DOI: 10.1016/j.socscimed.2023.115813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 02/06/2023] [Accepted: 02/24/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND Racial inequities in maternal and child health outcomes persist: Black women and birthing people experience higher rates of adverse outcomes than their white counterparts. Similar inequities are seen in coronavirus disease (COVID-19) mortality rates. In response, we sought to explore the intersections of racism and the COVID-19 pandemic impact on the daily lives and perinatal care experiences of Black birthing people. METHODS We used an intrinsic case study approach grounded in an intersectional lens to collect stories from Black pregnant and postpartum people residing in Fresno County (July-September 2020). All interviews were conducted on Zoom without video and were audio recorded and transcribed. Thematic analysis was used to group codes into larger themes. RESULTS Of the 34 participants included in this analysis, 76.5% identified as Black only, and 23.5% identified as multiracial including Black. Their mean age was 27.2 years [SD, 5.8]. Nearly half (47%) reported being married or living with their partner; all were eligible for Medi-Cal insurance. Interview times ranged from 23 to 96 min. Five themes emerged: (1) Tensions about Heightened Exposure of Black Lives Matter Movement during the pandemic; (2) Fear for Black Son's Safety; (3) Lack of Communication from Health Care Professionals; (4) Disrespect from Health Care Professionals; and (5) Misunderstood or Judged by Health Care Professionals. Participants stressed that the Black Lives Matter Movement is necessary and highlighted that society views their Black sons as a threat. They also reported experiencing unfair treatment and harassment while seeking perinatal care. CONCLUSIONS Black women and birthing people shared that exposure to racism has heightened during the COVID-19 pandemic, increasing their levels of stress and anxiety. Understanding how racism impacts Black birthing people's lives and care experiences is critical to reforming the police force and revising enhanced prenatal care models to better address their needs.
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Affiliation(s)
- Brittany D Chambers
- Department of Human Ecology, College of Agricultural and Environmental Sciences, University of California, Davis, Davis, CA, USA; California Preterm Birth Initiative, School of Medicine, University of California, San Francisco, San Francisco, CA, USA.
| | - Jazmin Fontenot
- California Preterm Birth Initiative, School of Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Obstetrics, Gynecology & Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Safyer McKenzie-Sampson
- California Preterm Birth Initiative, School of Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Bridgette E Blebu
- California Preterm Birth Initiative, School of Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Obstetrics, Gynecology & Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Brittany N Edwards
- Central Valley Health Policy Institute, College of Health and Human Services, California State University, Fresno. Fresno, CA, USA
| | | | - Deborah Karasek
- California Preterm Birth Initiative, School of Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Obstetrics, Gynecology & Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Kimberly Coleman-Phox
- California Preterm Birth Initiative, School of Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Obstetrics, Gynecology & Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Venise C Curry
- Central Valley Health Policy Institute, College of Health and Human Services, California State University, Fresno. Fresno, CA, USA
| | - Miriam Kuppermann
- California Preterm Birth Initiative, School of Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Obstetrics, Gynecology & Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
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Chasson M, Taubman-Ben-Ari O, Abu-Sharkia S, Weiss E, Khalaf E, Mofareh A. Psychological distress, optimism and emotion regulation among Israeli Jewish and Arab pregnant women during COVID-19. J Reprod Infant Psychol 2023; 41:228-243. [PMID: 34550836 DOI: 10.1080/02646838.2021.1983528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Pregnancy is a vulnerable period for women, and it is especially so under the worldwide COVID-19 pandemic. Whereas there is some evidence for distress among pregnant women during the outspread of COVID-19, little is known about the second wave of the pandemic. We therefore sought to examine the contribution of background variables, ethnicity (Jewish, Arab), personal resources (optimism, emotion regulation), and COVID-19-related anxieties to pregnant Israeli women's psychological distress. METHOD A convenience sample of 1127 Israeli women was recruited from 5 July to 7 October 2020. RESULTS Not having an academic degree, lower economic status, being an Arab woman, poorer physical health, lower levels of optimism and cognitive reappraisal, higher levels of emotion suppression and COVID-19-related anxieties all contributed significantly to greater psychological distress. Finally, ethnicity moderated the relationship between optimism and emotion suppression and the woman's level of psychological distress. CONCLUSIONS The findings reveal risk and resilience factors associated with the psychological distress of pregnant women during the second wave of the COVID-19 pandemic and highlight the potentially greater vulnerability of women from a minority group, showing that ethnicity plays a central role in the way personal resources are related to psychological distress at such times.
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Affiliation(s)
- Miriam Chasson
- The Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University, Ramat Gan, Israel
| | - Orit Taubman-Ben-Ari
- The Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University, Ramat Gan, Israel
| | - Salam Abu-Sharkia
- The Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University, Ramat Gan, Israel
| | - Efrat Weiss
- The Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University, Ramat Gan, Israel
| | | | - Ali Mofareh
- Clalit Health Services (Kupat Holim Clalit), Israel
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White LK, Himes MM, Waller R, Njoroge WFM, Chaiyachati BH, Barzilay R, Kornfield SL, Burris HH, Seidlitz J, Parish-Morris J, Brady RG, Gerstein ED, Laney N, Gur RE, Duncan A. The Influence of Pandemic-Related Worries During Pregnancy on Child Development at 12 Months. RESEARCH SQUARE 2023:rs.3.rs-2682358. [PMID: 36993329 PMCID: PMC10055645 DOI: 10.21203/rs.3.rs-2682358/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
The COVID-19 pandemic has been linked to increased risk for perinatal anxiety and depression among parents, as well as negative consequences for child development. Less is known about how worries arising from the pandemic during pregnancy are related to later child development, nor if resilience factors buffer negative consequences. The current study addresses this question in a prospective longitudinal design. Data was collected from a sub-study ( n = 184) of a longitudinal study of pregnant individuals (total n = 1,173). During pregnancy (April 17-July 8, 2020) and the early postpartum period (August 11, 2020-March 2, 2021), participants completed online surveys. At 12 months postpartum (June 17, 2021-March 23, 2022), participants completed online surveys and a virtual laboratory visit, which included parent-child interaction tasks. We found more pregnancy-specific pandemic worries were prospectively related to lower levels of child socioemotional development based on parent report (B=-1.13, SE = .43, p = .007) and observer ratings (B=-0.13, SE = .07, p = .045), but not to parent-reported general developmental milestones. Parental emotion regulation in the early postpartum period moderated the association between pregnancy-specific pandemic worries and child socioemotional development such that pregnancy-specific pandemic worries did not related to worse child socioemotional development among parents with high (B=-.02, SE = .10, t=-.14, p = .89) levels of emotion regulation. Findings suggest the negative consequences of parental worry and distress during pregnancy on the early socioemotional development of children in the context of the COVID-19 pandemic. Results highlight that parental emotion regulation may represent a target for intervention to promote parental resilience and support optimized child development.
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Deichen Hansen ME, Londoño Tobón A, Kamal Haider U, Moore Simas TA, Newsome M, Finelli J, Boama-Nyarko E, Mittal L, Tabb KM, Nápoles AM, Schaefer AJ, Davis WN, Mackie TI, Flynn HA, Byatt N. The role of perinatal psychiatry access programs in advancing mental health equity. Gen Hosp Psychiatry 2023; 82:75-85. [PMID: 36989766 DOI: 10.1016/j.genhosppsych.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/02/2023] [Accepted: 03/07/2023] [Indexed: 03/31/2023]
Abstract
This editorial presents: 1) a review of Perinatal Psychiatry Access Programs as an integrated care model with potential for promoting perinatal mental health equity; and 2) a summary of how the model has been and can be further adapted to help achieve perinatal mental health equity in geographically diverse settings. Within the editorial, we highlight Access Programs as a promising model for promoting perinatal mental health equity. This editorial is supported by original descriptive data on the Lifeline for Moms National Network of Perinatal Psychiatric Access Programs. Descriptive data is additionally provided on three statewide Access Programs. The Access Program model, and the accompanying Network of Access Programs, is a multi-level approach demonstrating promise in reducing perinatal mental health inequities. Access Programs demonstrate potential to implement interventions to address well-documented inequities in perinatal mental healthcare access at the patient-, clinician-, practice-, community-, and policy-levels. For Access Programs to leverage their potential to advance perinatal mental health equity, systematic efforts are needed that include partnership with impacted communities and implementation teams.
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Affiliation(s)
- Megan E Deichen Hansen
- Florida State University College of Medicine, Department of Behavioral Sciences & Social Medicine, 1115 W Call St., Tallahassee, FL 32304, United States of America.
| | - Amalia Londoño Tobón
- Department of Psychiatry, MedStar Georgetown University Hospital, Washington, DC 20007, United States of America
| | - Uruj Kamal Haider
- Department of Psychiatry, UMass Chan Medical School/UMass Memorial Health, 55 Lake Avenue North, Worcester, MA 01655, United States of America
| | - Tiffany A Moore Simas
- Departments of Obstetrics & Gynecology, Pediatrics, Psychiatry, and Population & Quantitative Health Sciences, UMass Chan Medical School/UMass Memorial Health, Memorial Campus,119 Belmont Street, Jaquith Building Room 2.060, Worcester, MA 01605, United States of America
| | - Melissa Newsome
- Florida State University College of Medicine, Department of Behavioral Sciences & Social Medicine, 1115 W Call St., Tallahassee, FL 32304, United States of America
| | - Julianna Finelli
- Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, 131 S Robertson St, New Orleans, LA 70112, United States of America
| | - Esther Boama-Nyarko
- Departments of Psychiatry, UMass Chan Medical School/UMass Memorial Health, 55 Lake Avenue North, Worcester, MA 01655, United States of America
| | - Leena Mittal
- Department of Psychiatry, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, United States of America
| | - Karen M Tabb
- Beckman Institute, University of Illinois at Urbana-Champaign, Champaign, IL 61820, United States of America; Social of Social Work, University of Illinois at Urbana-Champaign, Urbana, IL 61801, United States of America
| | - Anna M Nápoles
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, 9000 Rockville Pike, Building 3, Floor 5, Room E08, Bethesda, MD 20892, United States of America
| | - Ana J Schaefer
- School of Public Health, State University of New York, Downstate Health Sciences University, 450 Clarkson Avenue, Mail Stop Code 43, Brooklyn, NY 11203, United States of America
| | - Wendy N Davis
- Postpartum Support International, 6706 SW 54th Avenue, Portland, OR 97219, United States of America
| | - Thomas I Mackie
- Department of Health Policy and Management, School of Public Health, State University of New York, Downstate Health Sciences University, 450 Clarkson Avenue, Mail Stop Code 43, Brooklyn, NY 11203, United States of America
| | - Heather A Flynn
- Florida State University College of Medicine, Department of Behavioral Sciences & Social Medicine, 1115 W Call St., Tallahassee, FL 32304, United States of America
| | - Nancy Byatt
- Departments of Psychiatry, Obstetrics & Gynecology, and Population & Quantitative Health Sciences, UMass Chan Medical School/UMass Memorial Health, 222 Maple Ave - Chang Building, Shrewsbury, MA 01545, United States of America
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Penna AL, de Aquino CM, Pinheiro MSN, do Nascimento RLF, Farias-Antúnez S, Araújo DABS, Mita C, Machado MMT, Castro MC. Impact of the COVID-19 pandemic on maternal mental health, early childhood development, and parental practices: a global scoping review. BMC Public Health 2023; 23:388. [PMID: 36823592 PMCID: PMC9950022 DOI: 10.1186/s12889-023-15003-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 01/05/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND In March 2020, the COVID-19 outbreak was declared a pandemic by the World Health Organization (WHO), generating stark economic and social repercussions that directly or indirectly affected families' wellbeing and health status. AIMS This review aims at mapping the existing evidence on the impact of the COVID-19 pandemic on maternal mental health, early childhood development, and parental practices, worldwide, to identify evidence gaps and better inform future delivery of care and health policy measures. METHODS Following the protocol defined by PRISMA-ScR, this scoping review has searched for relevant studies published between January 2020 and June 2021, selecting evidence sources based on pre-established criteria. From a total of 2,308 articles, data were extracted from 537 publications from 35 countries on all three health domains. RESULTS The combined stressors brought forth by the pandemic have exerted a heavy burden on the mental health of mothers and the development of young children, partly mediated by its impact on parental practices. CONCLUSIONS Despite remaining gaps, we have identified sufficient evidence pointing to an urgent need for more concerted global research efforts and rapid policy responses to timely address severe and pervasive negative impacts to the mental health of mothers and children at a key developmental stage.
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Affiliation(s)
- Ana Luiza Penna
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, USA.
| | - Camila Machado de Aquino
- grid.8395.70000 0001 2160 0329Department of Community Health, Federal University of Ceará, Fortaleza, Brazil
| | | | | | - Simone Farias-Antúnez
- grid.411237.20000 0001 2188 7235Department of Health Sciences, Federal University of Santa Catarina, Araranguá, Brazil
| | | | - Carol Mita
- grid.38142.3c000000041936754XCountway Library, Harvard Medical School, Boston, USA
| | | | - Marcia C. Castro
- grid.38142.3c000000041936754XDepartment of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, USA
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Dwarakanath M, Hossain F, Balascio P, Moore MC, Hill AV, De Genna NM. Barriers to Diagnosis of Postpartum Depression among Younger Black Mothers. RESEARCH SQUARE 2023:rs.3.rs-2500330. [PMID: 36824914 PMCID: PMC9949245 DOI: 10.21203/rs.3.rs-2500330/v1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Objective: The objective of this study was to qualitatively examine coping mechanisms and desired supports in pregnant and birthing Black and biracial adolescent and young adult women during the COVID-19 pandemic. Method: Black and biracial participants ages 16-23 were recruited for virtual individual semi-structured interviews. Participants (n=25) were asked about pre- and post-natal experiences with the healthcare system, effects of the pandemic, and participants' experiences of or desires for ideal care within the healthcare system. Interviews were transcribed verbatim and coded for qualitative analysis using nVivo. Discussions around postpartum mental health evolved organically when asked about how participants were coping postpartum. Results: Nearly half the interviewees reported mental health symptoms consistent with postpartum depression (PPD). Of the 11 interviewees who reported mental health symptoms consistent with PPD, 2 were afraid to disclose their symptoms to a healthcare provider due to fear of child protective services involvement and their belief they would be treated unfairly because of their race. Conclusion: Clinicians who care for Black and biracial adolescent and young adult mothers must be particularly attuned to structural barriers for appropriate screening and treatment of postpartum depression. Expanding investigations of intersectional influences on young mothers' perinatal health and PPD are needed.
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Listen to the Whispers before They Become Screams: Addressing Black Maternal Morbidity and Mortality in the United States. Healthcare (Basel) 2023; 11:healthcare11030438. [PMID: 36767014 PMCID: PMC9914526 DOI: 10.3390/healthcare11030438] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 01/09/2023] [Accepted: 01/31/2023] [Indexed: 02/09/2023] Open
Abstract
Black women in the United States (U.S.) disproportionately experience adverse pregnancy outcomes, including maternal mortality, compared to women of other racial and ethnic groups. Historical legacies of institutionalized racism and bias in medicine compound this problem. The disproportionate impact of COVID-19 on communities of color may further worsen existing racial disparities in maternal morbidity and mortality. This paper discusses structural and social determinants of racial disparities with a focus on the Black maternal mortality crisis in the United States. We explore how structural racism contributes to a greater risk of adverse obstetric outcomes among Black women in the U.S. We also propose public health, healthcare systems, and community-engaged approaches to decrease racial disparities in maternal morbidity and mortality.
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The effect of COVID-19 lockdowns on women's perinatal mental health: a systematic review. Women Birth 2023; 36:47-55. [PMID: 35798661 PMCID: PMC9212959 DOI: 10.1016/j.wombi.2022.06.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 06/11/2022] [Accepted: 06/13/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Risk factors for poor maternal perinatal mental health include a previous mental health diagnosis, reduced access to perinatal services, economic concerns and decreased levels of social support. Adverse maternal perinatal mental health can negatively influence the psychological wellbeing of infants. The outbreak of the COVID-19 pandemic presented an additional stressor. While literature on the impact of COVID-19 on perinatal mental health exists, no systematic review has focused specifically on maternal perinatal mental health during periods of COVID-19 lockdown. AIMS This systematic review explores how periods of COVID-19 lockdown impacted women's perinatal mental health. METHODS Searches of CINAHL, PsycARTICLES, PsycINFO, PubMed, Scopus and Web of Science were conducted for literature from 1st January 2020-25th May 2021. Quantitative, peer-reviewed, cross-sectional studies published in English with perinatal women as participants, and data collected during a period of lockdown, were included. Data was assessed for quality and narratively synthesized. FINDINGS Sixteen articles from nine countries met the inclusion criteria. COVID-19 lockdowns negatively impacted perinatal mental health. Risk factors for negative perinatal mental health noted in previous literature were confirmed. In addition, resilience, educational attainment, trimester, and ethnicity were identified as other variables which may influence mental health during perinatal periods experienced during lockdown. Understanding nuance in experience and harnessing intra and interpersonal support could advance options for intervention. CONCLUSION Developing resources for perinatal women that integrate informal sources of support may aid them when normal routine is challenged, and may mediate potential long-term impacts of poor perinatal maternal health on infants.
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Delanerolle G, McCauley M, Hirsch M, Zeng Y, Cong X, Cavalini H, Sajid S, Shetty A, Rathod S, Shi JQ, Hapangama DK, Phiri P. The prevalence of mental ill-health in women during pregnancy and after childbirth during the Covid-19 pandemic: a systematic review and Meta-analysis. BMC Pregnancy Childbirth 2023; 23:76. [PMID: 36709255 PMCID: PMC9883834 DOI: 10.1186/s12884-022-05243-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/24/2022] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND This systematic review aims to explore the prevalence of the impact of the COVID-19, MERS, and SARS pandemics on the mental health of pregnant women. METHODS All COVID-19, SARS and MERS studies that evaluated the mental health of pregnant women with/without gynaecological conditions that were reported in English between December 2000 - July 2021 were included. The search criteria were developed based upon the research question using PubMed, Science Direct, Ovid PsycINFO and EMBASE databases. A wide search criterion was used to ensure the inclusion of all pregnant women with existing gynaecological conditions. The Newcastle-Ottawa-Scale was used to assess the risk of bias for all included studies. Random effects model with restricted maximum-likelihood estimation method was applied for the meta-analysis and I-square statistic was used to evaluate heterogeneity across studies. The pooled prevalence rates of symptoms of anxiety, depression, PTSD, stress, and sleep disorders with 95% confidence interval (CI) were computed. RESULTS This systematic review identified 217 studies which included 638,889 pregnant women or women who had just given birth. There were no studies reporting the mental health impact due to MERS and SARS. Results showed that women who were pregnant or had just given birth displayed various symptoms of poor mental health including those relating to depression (24.9%), anxiety (32.8%), stress (29.44%), Post Traumatic Stress Disorder (PTSD) (27.93%), and sleep disorders (24.38%) during the COVID-19 pandemic. DISCUSSION It is important to note that studies included in this review used a range of outcome measures which does not allow for direct comparisons between findings. Most studies reported self-reported measure of symptoms without clinical diagnoses so conclusions can be made for symptom prevalence rather than of mental illness. The importance of managing mental health during pregnancy and after-delivery improves the quality of life and wellbeing of mothers hence developing an evidence-based approached as part of pandemic preparedness would improve mental health during challenging times. OTHER The work presented in this manuscript was not funded by any specific grants. A study protocol was developed and published in PROSPERO (CRD42021235356) to explore several key objectives.
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Affiliation(s)
- Gayathri Delanerolle
- Nuffield Department of Primary Health Care Sciences, Uuniversity of Oxford, Oxford, UK
- Southern Health NHS Foundation Trust, Research and Innovation Department, Clinical Trials Facility, Tom Rudd Unit Moorgreen Hospital, Botley Road, West End, Southampton, SO30 3JB, UK
| | - Mary McCauley
- Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | - Martin Hirsch
- University College London, London, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Yutian Zeng
- Southern University of Science and Technology, Shenzhen, China
| | - Xu Cong
- Southern University of Science and Technology, Shenzhen, China
| | - Heitor Cavalini
- Southern Health NHS Foundation Trust, Research and Innovation Department, Clinical Trials Facility, Tom Rudd Unit Moorgreen Hospital, Botley Road, West End, Southampton, SO30 3JB, UK
| | - Sana Sajid
- Southern Health NHS Foundation Trust, Research and Innovation Department, Clinical Trials Facility, Tom Rudd Unit Moorgreen Hospital, Botley Road, West End, Southampton, SO30 3JB, UK
| | - Ashish Shetty
- University College London, London, UK
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Shanaya Rathod
- Southern Health NHS Foundation Trust, Research and Innovation Department, Clinical Trials Facility, Tom Rudd Unit Moorgreen Hospital, Botley Road, West End, Southampton, SO30 3JB, UK
| | - Jian Qing Shi
- Southern University of Science and Technology, Shenzhen, China
- National Center for Applied Mathematics, Shenzhen, China
| | | | - Peter Phiri
- Southern Health NHS Foundation Trust, Research and Innovation Department, Clinical Trials Facility, Tom Rudd Unit Moorgreen Hospital, Botley Road, West End, Southampton, SO30 3JB, UK.
- School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.
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Relationships between Depression, Fear of Childbirth, and Obsessive-Compulsive Symptoms among Pregnant Women under the COVID-19 Pandemic in Japan. Healthcare (Basel) 2023; 11:healthcare11030361. [PMID: 36766936 PMCID: PMC9914326 DOI: 10.3390/healthcare11030361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/17/2023] [Accepted: 01/24/2023] [Indexed: 02/03/2023] Open
Abstract
Little is known about the causality of antenatal depression (AND). We focused on the causal relationships between AND, fear of childbirth (FOC), and obsessive-compulsive symptoms (OCS) during the COVID-19 pandemic in Japan. We also examined whether the perceived threat of COVID-19 is associated with AND. Participants were recruited for an Internet survey conducted in December 2020. A total of 245 pregnant women completed the online survey at 12 to 15 weeks' gestational age (Time 1) and approximately 10 weeks later (Time 2). AND was estimated using the first two diagnostic items of Major Depressive Episode. The estimated prevalence of AND was 4.5% and 2.9% at Time 1 and Time 2, respectively. At both time points, no association was found between AND and the perception of COVID-19 threat. Structural equation modeling showed that AND predicted OCS (β = 0.16, p < 0.001), which, in turn, predicted FOC (β = 0.09, p = 0.042); FOC, in turn, predicted AND (β = 0.23, p < 0.001). AND, OCS, and FOC were predicted by borderline personality traits. Insecure adult attachment influenced AND and FOC via the perceived negative impact of the current pregnancy. Perinatal care providers should assess the personality and perception of pregnancy to prevent depression and pay attention to symptoms such as FOC and OCS in addition to those of depression.
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Accortt E, Mirocha J, Zhang D, Kilpatrick SJ, Libermann T, Karumanchi SA. Perinatal mood and anxiety disorders: biomarker discovery using plasma proteomics. Am J Obstet Gynecol 2023:S0002-9378(23)00016-9. [PMID: 36649818 DOI: 10.1016/j.ajog.2023.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/05/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Perinatal mood and anxiety disorders encompass a range of mental health disorders that occur during pregnancy and up to 1 year postpartum, affecting approximately 20% of women. Traditional risk factors, such as a history of depression and pregnancy complications including preeclampsia, are known. Their predictive utility, however, is not specific or sensitive enough to inform clinical decision-making or prevention strategies for perinatal mood and anxiety disorders. Better diagnostic and prognostic models are needed for early identification and referral to treatment. OBJECTIVE This study aimed to determine if a panel of novel third-trimester plasma protein biomarkers in pregnant women can be used to identify those who have a high predisposed risk for perinatal mood and anxiety disorders within 3 months postpartum. STUDY DESIGN We studied 52 women (n=34 with a risk for perinatal mood and anxiety disorders and n=18 controls) among whom mental health screening was conducted at 2 time points, namely in the third trimester and again at 3 months postdelivery. An elevated perinatal mood and anxiety disorder risk was identified by screening individuals with above-validated cutoffs for depression (Edinburgh Postnatal Depression Scale ≥12), anxiety (Overall Anxiety Severity and Impairment Scale ≥7), and/or posttraumatic stress disorder (Impact of Events Scale >26) at both time points. Plasma samples collected in the third trimester were screened using the aptamer-based SomaLogic SomaScan proteomic assay technology to evaluate perinatal mood and anxiety disorder-associated changes in the expression of 1305 protein analytes. Ingenuity Pathway Analysis was conducted to highlight pathophysiological relationships between perinatal mood and anxiety disorder-specific proteins found to be significantly up- or down-regulated in all subjects with perinatal mood and anxiety disorder and in those with perinatal mood and anxiety disorders and no preeclampsia. RESULTS From a panel of 53 significant perinatal mood and anxiety disorder-associated proteins, a unique 20-protein signature differentiated perinatal mood and anxiety disorder cases from controls in a principal component analysis (P<.05). This protein signature included NCAM1, NRCAM, and NTRK3 that converge around neuronal signaling pathways regulating axonal guidance, astrocyte differentiation, and maintenance of GABAergic neurons. Interestingly, when we restricted the analysis to subjects without preeclampsia, a 30-protein signature differentiated perinatal mood and anxiety disorder cases from all controls without overlap on the principal component analysis (P<.001). In the nonpreeclamptic perinatal mood and anxiety disorder group, we observed increased expression of proteins, such as CXCL11, CXCL6, MIC-B, and B2MG, which regulate leucocyte migration, inflammation, and immune function. CONCLUSION Participants with perinatal mood and anxiety disorders had a unique and distinct plasma protein signature that regulated a variety of neuronal signaling and proinflammatory pathways. Additional validation studies with larger sample sizes are needed to determine whether some of these molecules can be used in conjunction with traditional risk factors for the early detection of perinatal mood and anxiety disorders.
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Affiliation(s)
- Eynav Accortt
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA.
| | - James Mirocha
- Cedars-Sinai Biostatistics Core and Clinical & Translational Research Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Dongsheng Zhang
- Department of Medicine, Division of Nephrology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Sarah J Kilpatrick
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Towia Libermann
- Department of Medicine and Genomics, Proteomics, Bioinformatics and Systems Biology Center, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - S Ananth Karumanchi
- Department of Medicine, Division of Nephrology, Cedars-Sinai Medical Center, Los Angeles, CA
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Mehra R, Alspaugh A, Dunn JT, Franck LS, McLemore MR, Keene DE, Kershaw TS, Ickovics JR. "'Oh gosh, why go?' cause they are going to look at me and not hire": intersectional experiences of black women navigating employment during pregnancy and parenting. BMC Pregnancy Childbirth 2023; 23:17. [PMID: 36627577 PMCID: PMC9830615 DOI: 10.1186/s12884-022-05268-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/30/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Workplace legal protections are important for perinatal health outcomes. Black birthing people are disproportionally affected by pregnancy discrimination and bias in the employment context and lack of family-friendly workplace policies, which may hinder their participation in the labor force and lead to gender and racial inequities in income and health. We aimed to explore Black pregnant women's experiences of pregnancy discrimination and bias when looking for work, working while pregnant, and returning to work postpartum. Additionally, we explored Black pregnant women's perspectives on how these experiences may influence their health. METHODS Using an intersectional framework, where oppression is based on intersecting social identities such as race, gender, pregnancy, and socioeconomic status, we conducted an analysis of qualitative data collected for a study exploring the lived experience of pregnancy among Black pregnant women in New Haven, Connecticut, United States. Twenty-four women participated in semi-structured interviews (January 2017-August 2018). Interview transcripts were analyzed using grounded theory techniques. RESULTS Participants expressed their desire to provide a financially secure future for their family. However, many described how pregnancy discrimination and bias made it difficult to find or keep a job during pregnancy. The following three themes were identified: 1) "You're a liability"; difficulty seeking employment during pregnancy; 2) "This is not working"; experiences on the job and navigating leave and accommodations while pregnant and parenting; and 3) "It's really depressing. I wanna work"; the stressors of experiencing pregnancy discrimination and bias. CONCLUSION Black pregnant women in this study anticipated and experienced pregnancy discrimination and bias, which influenced financial burden and stress. We used an intersectional framework in this study which allowed us to more fully examine how racism and economic marginalization contribute to the lived experience of Black birthing people. Promoting health equity and gender parity means addressing pregnancy discrimination and bias and the lack of family-friendly workplace policies and the harm they cause to individuals, families, and communities, particularly those of color, throughout the United States.
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Affiliation(s)
- Renee Mehra
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College St, CT, 06520, New Haven, USA.
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, UCSF Box 0606, CA, 94143, San Francisco, USA.
| | - Amy Alspaugh
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, UCSF Box 0606, CA, 94143, San Francisco, USA.
- College of Nursing, University of Tennessee, 1200 Volunteer Blvd, Knoxville, 37916, USA.
| | - Jennifer T Dunn
- Department of Social and Behavioral Sciences, School of Nursing, University of California, 490 Illinois Street, CA, San Francisco, 94158, USA
| | - Linda S Franck
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, UCSF Box 0606, CA, 94143, San Francisco, USA
| | - Monica R McLemore
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, UCSF Box 0606, CA, 94143, San Francisco, USA
| | - Danya E Keene
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College St, CT, 06520, New Haven, USA
| | - Trace S Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College St, CT, 06520, New Haven, USA
| | - Jeannette R Ickovics
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College St, CT, 06520, New Haven, USA
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Somerville K, Rowell T, Stadulis R, Bell D, Neal-Barnett A. An evaluation of the feasibility and acceptability of sister circles as an anxiety intervention for pregnant Black women. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231185405. [PMID: 37480300 PMCID: PMC10363880 DOI: 10.1177/17455057231185405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 05/10/2023] [Accepted: 06/14/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Black women and their infants face heightened health risks during pregnancy, labor, and delivery that, for many, cost them their lives. Such health risks during this critical period are linked to increased rates of anxiety among Black pregnant and postpartum women. Black women also endure racism when seeking support from mental health and healthcare providers, which further contributes to pregnancy and postpartum-related anxiety. Evidence on sister circles has demonstrated that this indigenous form of healing may provide Black pregnant and postpartum women with the support and skills needed to cope with stressors associated with mental and physical health concerns and racism. OBJECTIVE Our study aimed to evaluate the feasibility and acceptability of the Birthing Beautiful Babies Sisters Offering Support, a sister circle cognitive behavioral therapy-based stress and anxiety intervention for Black pregnant and postpartum women. DESIGN Our study employed a mixed-methods framework. METHODS Descriptive analyses, paired samples t-test, and open and selective coding were conducted. We utilized the following measures: Penn State Worry Questionnaire-Abbreviated, Kessler Psychological Distress Scale, Pregnancy-Related Anxiety Scale, focus booklet, and focus group discussion. RESULTS Participants reported experiencing moderate levels of worry and distress and low levels of pregnancy-related anxiety prior to the start of the Birthing Beautiful Babies Sisters Offering Support intervention. Eighty women participated in Birthing Beautiful Babies Sisters Offering Support. Eleven focus groups were conducted to assess their experience. Participants reported a perceived increase in their knowledge about panic attacks and stress and ability to manage stressors effectively. They found that all completed activities contributed to their development and application of skills. They reported they enjoyed Birthing Beautiful Babies Sisters Offering Support because of the supportive environment, openness, and emphasis on sisterhood. Participants provided helpful feedback about the structure and flow of the intervention. CONCLUSION Limitations of the present study and future directions are discussed.
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Affiliation(s)
| | | | | | - Debra Bell
- Birthing Beautiful Communities, Cleveland, OH, USA
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Zalewski M, Liu S, Gunnar M, Lengua LJ, Fisher PA. Mental-Health Trajectories of U.S. Parents With Young Children During the COVID-19 Pandemic: A Universal Introduction of Risk. Clin Psychol Sci 2023; 11:183-196. [PMID: 36751427 PMCID: PMC9892531 DOI: 10.1177/21677026221083275] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 02/03/2022] [Indexed: 11/17/2022]
Abstract
Parents of young children were a subgroup of the population identified early in the pandemic as experiencing significant mental-health symptoms. Using a longitudinal sample of 3,085 parents from across the United States who had a child or children age 0 to 5, in the present study, we identified parental mental-health trajectories from April to November 2020 predicted by pre-COVID-19 cumulative risk and COVID-19-specific risk factors. Both growth-mixture modeling and latent-growth-curve modeling were used to test the relationship between risk factors and parent mental health. Pre-COVID-19 cumulative risk and COVID-19-specific risks of financial strain, decreased employment, and increased family conflict were salient risk factors predicting poor mental-health trajectories across both modeling approaches. These finding have public-health implications because prolonged exposure to mental-health symptoms in parents constitutes a risk factor for child development.
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Affiliation(s)
| | - Sihong Liu
- Graduate School of Education, Stanford University
| | - Megan Gunnar
- Institute of Child Development, University of Minnesota
| | - Liliana J Lengua
- Center for Child and Family Well-Being, University of Washington.,Department of Psychology, University of Washington
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The experience of women who delivered during the first wave of COVID-19 pandemic in Belgium: a retrospective study. AJOG GLOBAL REPORTS 2022; 3:100146. [PMID: 36573116 PMCID: PMC9772255 DOI: 10.1016/j.xagr.2022.100146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The lockdown caused by the COVID-19 pandemic has imposed some restrictions on hospital activities, requiring medical staff to find efficient alternatives to ensure adequate medical care for patients. OBJECTIVE This study aimed to investigate the experience of pregnant women who delivered during the first wave of COVID-19, and to evaluate the impact of COVID-19-related restrictions. STUDY DESIGN This was a retrospective multicenter study. All pregnant women who delivered a live infant between March 20, 2020 and June 20, 2020 were evaluated using a 35-item survey at 1 year following delivery. Each patient was contacted via 3 modalities. Patients who reported that their prenatal follow-up was interrupted were compared with those who reported that their prenatal follow-up was unchanged. Among 1096 patients who delivered a live infant across the 3 participating centers during the study period, 389 responses were needed for an estimated margin of error of 4%. RESULTS A total of 469 of 1096 (42.8%) patients answered the survey, of whom 151 (32.2%) reported that the follow-up of their pregnancy was interrupted (exposed group) and 318 (67.8%) reported that their follow-up was maintained as normal (unexposed group). The rate of presentation to the emergency department was higher in the exposed group than in the unexposed group (P=.001). The level of dissatisfaction was also higher in the exposed group, and patients in this group would have postponed their pregnancy if they had known about the pandemic in advance (P<.001 and P=.001, respectively). CONCLUSION Interruption and modification of antenatal follow-up in pregnant women is associated with patient dissatisfaction and increased presentation to the emergency department.
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The Differential Impact of the COVID-19 Pandemic on Prenatal Care Utilization Among US Women by Medicaid Expansion and Race and Ethnicity. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 29:E137-E146. [PMID: 36729927 DOI: 10.1097/phh.0000000000001698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The 2014 Medicaid expansion improved racial and ethnic equity in insurance coverage and access to maternal care among women of reproductive age. This study examines differential effects of the COVID-19 pandemic on prenatal care utilization by Medicaid expansion and by race and ethnicity. METHODS Using the pooled 2019-2020 National Natality file (N = 7 361 190), logistic regression was used to estimate the effect of COVID-19 on prenatal care utilization among US women aged 10 to 54 years after controlling for maternal age, race, ethnicity, marital status, parity, nativity/immigrant status, education, payment type, and smoking during pregnancy. Outcome measures were having no care and delayed prenatal care (third trimester or no care). Stratified models by race/ethnicity and Medicaid expansion status yielded the differential effects of COVID-19 on prenatal care utilization. RESULTS During the COVID-19 pandemic, the adjusted odds of having no prenatal care decreased by 4% (adjusted odds ratio [AOR] = 0.96; 95% confidence interval [CI], 0.94-0.97) in expansion states but increased by 13% (AOR = 1.13; 95% CI, 1.11-1.15) in nonexpansion states. While most racial/ethnic groups in expansion states experienced a decrease in having no prenatal care, the adjusted odds of having no prenatal care increased by 15% for non-Hispanic Whites, 9% for non-Hispanic Blacks, 33% for American Indians/Alaska Natives, 25% for Asian/Pacific Islanders, and 13% for Hispanics in nonexpansion states. Women in expansion states experienced no change in delayed prenatal care during the pandemic, but women in nonexpansion states experienced an increase in delayed care. CONCLUSIONS Prenatal care utilization decreased during the pandemic among women in nonexpansion states, particularly for American Indians/Alaska Natives and Asian/Pacific Islanders, compared with expansion states.
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