Rationale Women pregnant during the COVID-19 pandemic are experiencing moderate to high levels of emotional distress, which has previously been shown to be attributable to two types of pandemic-related pregnancy stress: stress associated with feeling unprepared for birth due to the pandemic (Preparedness Stress) and stress related to fears of perinatal COVID-19 infection (Perinatal Infection Stress). Objective . Given the well-documented harms associated with elevated prenatal stress and the critical importance of developing appropriately targeted interventions, we investigated factors predictive of pandemic-related pregnancy stress. Method . Between April 25 and May 15, 2020, 4,451 pregnant women in the U.S. were recruited via social media to complete an online questionnaire that included sociodemographic, medical, and COVID-19 situational factors, as well as the Pandemic-Related Pregnancy Stress Scale (PREPS). Binary logistic regression was used to calculate odds ratios for high stress. Results . Nearly 30% of participants reported high Preparedness Stress; a similar proportion reported high Perinatal Infection Stress. Abuse history, chronic illness, income loss due to the pandemic, perceived risk of having had COVID-19, alterations to prenatal appointments, high-risk pregnancy, and being a woman of color were associated with greater levels of one or both types of stress. Access to outdoor space, older age, and engagement in healthy behaviors were protective against stress. Conclusions . Practices that may alleviate pandemic-related stress such as minimizing disruptions to prenatal care, ensuring access to outdoor space, and motivating engagement in health behaviors are of vital importance. Particular attention is needed for more vulnerable populations including women of color, women with a history of abuse, and those with high-risk pregnancy. Research focused on the short and longer-term impact of pandemic-related pregnancy stress on maternal mental and physical health, perinatal outcomes, and child development is critical to identify these effects and marshal appropriate resources to reduce them.

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Purpose: Pregnant women are facing numerous COVID-19 related burdens including social isolation, financial insecurity, uncertainty about the impact of the virus on fetal development, and prenatal care restrictions. We tested the psychometric properties of a new instrument designed to assess the extent and types of pandemic-related stress experienced by pregnant women. Materials and methods: 4,451 pregnant women from across the U.S. were recruited via social media and completed an online questionnaire in April-May 2020. The questionnaire included measures of psychological, sociodemographic, and obstetric factors and the new Pandemic-Related Pregnancy Stress Scale (PREPS). Results: Confirmatory factor analyses of the PREPS showed excellent model fit. Three factors -Perinatal Infection Stress (5 items), Preparedness Stress (7 items), and Positive Appraisal (3 items) converged and diverged with expected psychological factors, and scales created from these factors demonstrated acceptable to good reliability (a's 0.68-0.86). In addition, mean PREPS scores were associated with perceived risk of infection, and with financial and vocational COVID-19 related burdens. Conclusion:The PREPS is a robust instrument to assess multidimensional COVID-19 pandemic prenatal stress. It is a valuable tool for future research to examine vulnerability to pandemic stress and how this stress may affect women and their offspring.