Background Initial studies found that mental health symptoms increased in pregnant and postpartum individuals during the COVID-19 pandemic. Less research has focused on if these putative increases persist over time and what factors influence these changes. We examined the longitudinal change in mental health symptoms in pregnant and postpartum individuals and investigated moderation by maternal emotion dysregulation and the incidence of coronavirus. Methods Pregnant and postpartum individuals at the University of Utah were invited to join the COVID-19 and Perinatal Experiences (COPE) Study. Beginning on April 23, 2020 participants were sent a survey comprised of demographics, medical and social history, pregnancy information and self-assessments (Time 1). Participants were contacted 90 days later and invited to participate in a follow-up questionnaire (Time 2). Daily coronavirus case counts were accessed from the state of Utah and a 7-day moving average calculated. Within-subject change in mental health symptom scores, as measured by the Brief Symptom Inventory, was calculated. Linear mixed effects regression modeling adjusted for history of substance abuse and mental health disorders. Results 270 individuals responded between April 23rd, 2020 and July 15th, 2021. Mental health symptom scores improved by 1.36 points (0.7-2.0 p < 0.001). The decrease in mental health symptoms was not moderated by the prevalence of COVID-19 cases (p = 0.19) but was moderated by emotion dysregulation (p = 0.001) as defined by the Difficulties in Emotion Regulation Scale short form. Participants with higher emotion dysregulation also had higher mental health symptom scores. Conclusion Mental health symptoms improved over the course of the pandemic in the same pregnant or postpartum participant. Our findings do not negate the importance of mental health care during the pandemic. Rather, we believe this identifies some aspect of resiliency and adaptability. Examining emotion dysregulation, or asking about a history of mental health, may be helpful in identifying persons at higher risk of heightened responses to stressors.

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INTRODUCTION:The objective of this study was to evaluate pharmacologic and psychotherapy treatment among individuals with postpartum depression or anxiety living in urban versus rural areas of the United States.METHODS:We performed a retrospective cohort study of individuals diagnosed with postpartum depression or anxiety within 12 months of delivery from 2011 to 2020 in the MarketScan Commercial Research Database. Individuals with postpartum depression and anxiety were identified using International Classification of Diseases codes. Individuals previously receiving treatment were excluded. The exposure, urban residence, was determined by residence in a metropolitan statistical area. The primary outcome was a composite of pharmacologic and psychotherapy treatment. Secondary outcomes included components of the primary outcome and time from delivery to first prescription fill. Multivariable modeling adjusted for clinically relevant confounders including history of depression or anxiety. Sensitivity analysis included individuals with prior treatment.RESULTS:Of 1,602,058 individuals included, 1,415,793 (88%) had urban residence. Individuals with postpartum depression or anxiety residing in urban areas were less likely to receive treatment (adjusted hazard ratio [aHR] 0.86, 95% CI 0.85–0.88) than those residing in rural areas, including pharmacologic (aHR 0.75, 95% CI 0.73–0.77), and psychotherapy (aHR 0.94, 95% CI 0.92–0.96). Fifty percent of individuals filled a prescription by 107 days from delivery in urban compared to 100 days in rural areas. Results were similar in sensitivity analysis.CONCLUSION:Urban-residing individuals with postpartum depression or anxiety were less likely to receive pharmacologic or psychotherapy treatment than rural-residing individuals in this U.S. cohort. Future studies evaluating reasons for treatment differences are warranted.

INTRODUCTION: Maternal anxiety affects 20–35% of pregnancies. Both untreated anxiety and its medical therapy are associated with adverse pregnancy outcomes; however, data are mixed and limited. We examined pregnancy outcomes in women with treated and untreated anxiety in a well-characterized cohort. METHODS: An IRB approved secondary analysis of the NuMoM2b study, a prospective multi-center cohort of nulliparous women that included study visits each trimester and postpartum. Anxiety was assessed at 6w0d-13w6d using the State Trait Anxiety Inventory (STAI-T). Women were divided into three groups: anxiety and medical treatment, anxiety and no medical treatment, and no anxiety (controls). The primary outcome was a composite of preterm birth, abruption, hypertensive disorders of pregnancy, and small for gestational age. Potential confounders were adjusted for using multivariable logistic regression. RESULTS: Among 8,292 eligible women, 23.9% (n=1983) had anxiety; 311 were treated medically. The composite outcome occurred more often in women with untreated anxiety than controls (28.6% vs 25.9%, P=.02), with no difference between treated anxiety and controls (27.7% vs 25.9%, P=.5). The primary outcome increased across STAI-T score deciles (P<.009). After adjustments for confounders there were no differences in the primary outcome among groups, although untreated anxiety was associated with more neonatal intensive care unit stays >48 hours. CONCLUSION: Anxiety occurred in almost a quarter of nulliparas. Although untreated anxiety is associated with increased perinatal morbidity, other factors likely contribute. Treated anxiety was not associated with a change in perinatal outcomes. Given the frequency, the relationship between anxiety, associated factors, treatment and perinatal outcomes warrants further research.