Stress levels among an international sample of pregnant and postpartum women during the COVID-19 pandemic

A Mixed Methods Approach to Understand Mother-Father Relationship and Perceived Stress Among Black Pregnant Women

BACKGROUND

Black women in the United States report moderate to high levels of perceived stress during pregnancy. Though lower levels of involvement and support from father of the baby (FOB) and higher levels of conflict have been associated with higher levels of maternal perceived stress, it is not clear how Black pregnant women experience the mother-father relationship and its influence on perceived stress.

PURPOSE

To examine and describe the mother-father relationship and its role in experiences of perceived stress from the perspective of Black pregnant women.

METHODS

Using a convergent, mixed methods approach with ideal-type analysis, we conducted a secondary analysis of data among 60 Black pregnant women enrolled in the Biosocial Impact on Black Births study. Women completed online self-report questionnaires and participated in a semi-structured interview by telephone.

RESULTS

Participants who reported more conflict with FOB also reported higher levels of perceived stress (ρ(47) = .431, P= .002). Themes (importance, communication, support, conflict, satisfaction, and stress) emerged from the data. Five distinct mother-father relationship typologies were identified following an ideal-type analysis of the combined dataset: Cared For; Managing Expectations; Just Friends, For the Kids; It's Complicated; and Can't be Bothered.

CONCLUSIONS

These findings are an innovative exemplar of ideal-type analysis and provide a deeper understanding of the nuance and dynamics within the mother-father relationship and how it influences perceived stress among Black pregnant women.

IMPLICATIONS

Clinicians must recognize the significance of the mother-father relationship and, when appropriate, encourage paternal involvement or intervene if there is conflict during pregnancy.

The prevalence of mental ill-health in women during pregnancy and after childbirth during the Covid-19 pandemic: a systematic review and Meta-analysis

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.

Maternal Stress and Human Milk Antibodies During the COVID-19 Pandemic

Importance

SARS-CoV-2-specific antibodies in human milk might protect the breastfed infant against COVID-19. One of the factors that may influence human milk antibodies is psychological stress, which is suggested to be increased in lactating women during the COVID-19 pandemic.

Objective

To determine whether psychological stress is increased in lactating women during the COVID-19 pandemic, and if maternal stress is associated with the level of SARS-CoV-2-specific antibodies in human milk.

Design

Population-based prospective cohort study.

Setting

Data collection took place in the Netherlands between October 2020 and February 2021.

Participants

Lactating women living in the Netherlands were eligible to participate in this study. In total, 2310 women were included.

Exposures

Stress exposure during the COVID-19 pandemic was determined using the Perceived Stress Scale (PSS) questionnaire and maternal lifetime stress was determined by the Life Stressor Checklist - revised (LSC-r) questionnaire.

Main Outcomes and Measures

Stress experience during the COVID-19 pandemic was compared with a pre-pandemic cohort. SARS-CoV-2-specific antibodies in human milk were measured using an Enzyme-Linked Immunosorbent Assay (ELISA) with the Spike protein of SARS-CoV-2. The association between maternal stress and human milk antibodies was determined using a multiple regression model.

Results

The PSS score of lactating mothers was not increased during the pandemic compared to the PSS score in the prepandemic cohort. Six hundred ninety-one participants had SARS-CoV-2-specific antibodies and were included in the regression models to assess the association between maternal stress and human milk antibodies. No association was found between PSS scores and human milk antibodies. In contrast, the LSC-r score was negatively associated with SARS-CoV-2-specific IgA in human milk (β = 0.98, 95% CI: 0.96-0.997, p = 0.03).

Conclusions and Relevance

Our results suggest that lactating women in the Netherlands did not experience higher stress levels during the COVID-19 pandemic. Breastfed infants of mothers with high chronic stress levels receive lower amounts of antibodies through human milk, which possibly makes them more vulnerable to respiratory infections. This emphasizes the importance of psychological wellbeing during lactation.