Continuous monitoring of perinatal women in a descriptive case study allowed us the opportunity to examine the time during which the COVID-19 infection led to physiological changes in two low-income pregnant women. An important component of this study was the use of a wearable sensor device, the Oura ring, to monitor and record vital physiological parameters during sleep. Two women in their second and third trimesters, respectively, were selected based on a positive COVID-19 diagnosis. Both women were tested using the polymerase chain reaction method to confirm the presence of the virus during which time we were able to collect these physiological data. In both cases, we observed 3–6 days of peak physiological changes in resting heart rate (HR), heart rate variability (HRV), and respiratory rate (RR), as well as sleep surrounding the onset of COVID-19 symptoms. The pregnant woman in her third trimester showed a significant increase in resting HR (p = 0.006) and RR (p = 0.048), and a significant decrease in HRV (p = 0.027) and deep sleep duration (p = 0.029). She reported experiencing moderate COVID-19 symptoms and did not require hospitalization. At 38 weeks of gestation, she had a normal delivery and gave birth to a healthy infant. The participant in her second trimester showed similar physiological changes during the 3-day peak period. Importantly, these changes appeared to return to the pre-peak levels. Common symptoms reported by both cases included loss of smell and nasal congestion, with one losing her sense of taste. Results suggest the potential to use the changes in cardiorespiratory responses and sleep for real-time monitoring of health and well-being during pregnancy.

Background The physical and emotional well-being of women is critical for healthy pregnancy and birth outcomes. The Two Happy Hearts intervention is a personalized mind-body program coached by community health workers that includes monitoring and reflecting on personal health, as well as practicing stress management strategies such as mindful breathing and movement. Objective The aims of this study are to (1) test the daily use of a wearable device to objectively measure physical and emotional well-being along with subjective assessments during pregnancy, and (2) explore the user’s engagement with the Two Happy Hearts intervention prototype, as well as understand their experiences with various intervention components. Methods A case study with a mixed design was used. We recruited a 29-year-old woman at 33 weeks of gestation with a singleton pregnancy. She had no medical complications or physical restrictions, and she was enrolled in the Medi-Cal public health insurance plan. The participant engaged in the Two Happy Hearts intervention prototype from her third trimester until delivery. The Oura smart ring was used to continuously monitor objective physical and emotional states, such as resting heart rate, resting heart rate variability, sleep, and physical activity. In addition, the participant self-reported her physical and emotional health using the Two Happy Hearts mobile app–based 24-hour recall surveys (sleep quality and level of physical activity) and ecological momentary assessment (positive and negative emotions), as well as the Perceived Stress Scale, Center for Epidemiologic Studies Depression Scale, and State-Trait Anxiety Inventory. Engagement with the Two Happy Hearts intervention was recorded via both the smart ring and phone app, and user experiences were collected via Research Electronic Data Capture satisfaction surveys. Objective data from the Oura ring and subjective data on physical and emotional health were described. Regression plots and Pearson correlations between the objective and subjective data were presented, and content analysis was performed for the qualitative data. Results Decreased resting heart rate was significantly correlated with increased heart rate variability (r=–0.92, P<.001). We found significant associations between self-reported responses and Oura ring measures: (1) positive emotions and heart rate variability (r=0.54, P<.001), (2) sleep quality and sleep score (r=0.52, P<.001), and (3) physical activity and step count (r=0.77, P<.001). In addition, deep sleep appeared to increase as light and rapid eye movement sleep decreased. The psychological measures of stress, depression, and anxiety appeared to decrease from baseline to post intervention. Furthermore, the participant had a high completion rate of the components of the Two Happy Hearts intervention prototype and shared several positive experiences, such as an increased self-efficacy and a normal delivery. Conclusions The Two Happy Hearts intervention prototype shows promise for potential use by underserved pregnant women.

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INTRODUCTION: Prenatal distress (ie, depression and anxiety) is associated with adverse maternal and infant outcomes. Importantly, emotional resilience has been found to protect women from mental health conditions. The goals of this research were to identify the prevalence of depression and anxiety and to examine relationships between emotional resilience and depression/anxiety in low socioeconomic (LSE) prenatal women during the COVID-19 pandemic. METHODS: The study adopted a cross-sectional design. We recruited 15 underserved Hispanic women who were aged 18-40 years and had a singleton pregnancy through WIC in California. The validated surveys were used to collect participants' demographics, mental health, and emotional resilience, including Patient Health Questionnaire (PHQ-8), Generalized Anxiety Disorder (GAD-7), Freiburg Mindfulness Inventory, and Coping Self-Efficacy. The Cronbach's alpha of these surveys ranged from 0.77 to 0.93. Descriptive statistics and partial correlations were conducted using SPSS. RESULTS: Maternal mean age was 26.8 (SD=3.73). Approximately one half of pregnant women (46.7%) had a Bachelor's degree or higher, 20% did not live with the baby's father, and 33.3% indicated having an at-risk pregnancy (e.g., anemia). Appropriately 13.3% of Hispanic pregnant women experienced prenatal depression and/or anxiety. After controlling for maternal education, higher mindfulness was significantly associated with a lower level of anxiety (r= −0.67, P=.009), and greater coping self-efficacy was significantly associated with a lower level of depression (r= −0.54, P=.049). CONCLUSION: It would be critical to improve pregnant women's mental health by increasing their ability to practice mindfulness and confidence to cope with distress.

BACKGROUND The physical and emotional well-being of women is critical for healthy pregnancy and birth outcomes. The Two Happy Hearts (THH) intervention is a personalized mind-body program, coached by community health workers (CHWs), that includes monitoring and reflecting on personal health, as well as practicing stress management strategies such as mindful breathing and movement. OBJECTIVE The study objectives were to 1) test the daily use of a wearable device to objectively measure physical and emotional well-being along with subjective assessments during pregnancy, and 2) explore the user’s engagement with the THH intervention prototype, as well as understand her experiences with the THH intervention prototype components. METHODS We recruited a 29-year-old woman, at 33 weeks gestation with a singleton pregnancy, and no medical complications or physical activity restrictions. She reported some college education and was identified as low income. The participant engaged in the THH intervention prototype from her third trimester until delivery. The Oura ring was used to continuously monitor objective physical and emotional states, such as heart rate, heart rate variability, sleep, and physical activity. In addition, the participant reported physical and emotional health using the Perceived Stress Scale, Center for Epidemiologic Studies Depression Scale, State Trait Anxiety Inventory, as well as the app-based 24-hour recall surveys and Ecological Momentary Assessment. Objective data from the Oura ring and subjective self-reported data on physical and emotional health were described. Furthermore, the participant’s engagement in the THH intervention prototype was recorded using both the smart ring and THH mobile phone app, and her experiences collected via survey. Descriptive statistics and Pearson correlations were conducted. RESULTS Decreased resting heart rate was significantly and negatively correlated with increased heart rate variability (r=-0.92, P<.001). We found significant associations between self-reported responses and Oura ring measures: i) positive emotions and RMSSD (r=0.54., P<.001), ii) sleep quality and sleep score (r=0.52, P<.001), and iii) physical activity and step-count (r=0.23, P=.097). In addition, deep sleep appeared to increase as light and REM sleep decreased. The psychological measures of stress, depression, and anxiety decreased from baseline to post-intervention. Furthermore, the participant had a high completion rate of the THH intervention prototype components and shared several positive experiences, such as increased self-efficacy and an uncomplicated delivery. CONCLUSIONS The Two Happy Hearts intervention prototype shows promise for potential use by underserved pregnant women.