Prenatal care disruptions and associations with maternal mental health during the COVID-19 pandemic

Abstract

As the novel coronavirus (COVID-19) spread across Canada in March 2020, provinces imposed strict lockdowns causing restrictions and disruptions to health care. These changes impacted how pregnant individuals received prenatal care and experienced childbirth. The additional stress caused by these changes may negatively affect the well-being of pregnant individuals and the developing child. This study investigated the impact of the pandemic on prenatal care and birth plans of pregnant individuals in Canada and potential associations with maternal mental health. Data from 4604 participants was collected from English- and French-speaking Canadians between April 5-June 1, 2020 as part of the Canada-wide Pregnancy During the COVID-19 Pandemic study. Symptoms of maternal depression, general anxiety, and pregnancy-related anxiety were assessed. Participants also answered questions about disruptions and changes to prenatal care and their birth plans due to the COVID-19 pandemic. Logistic regression was used to estimate associations between prenatal care disruptions and maternal mental health. Cancellation of prenatal appointments and birth plan changes (specifically changes to childcare during birth and change of support person attending the birth) were significantly associated with greater odds of experiencing clinically-elevated depression, anxiety, and/or pregnancy-related anxiety symptoms. These results illustrate the need for reliable and accessible prenatal care during the pandemic, such as the integration of mental health screenings and co-ordination of prenatal care providers.

The impact of the COVID‐19 pandemic and related policy responses on non‐COVID‐19 healthcare utilization in China

“…Among the care types we examined, prenatal care visits were the most negatively affected by the pandemic and related policy responses. This finding coincides with studies in Canada (Groulx et al., 2021) and the United States (Preis et al., 2020), which show common disruptions and alterations in prenatal care visits during the pandemic. Inadequate prenatal care may contribute to the uncertainty around maternal and fetal health, and increase the risk of prenatal psychological stress, which was already elevated owing to the pandemic (Groulx et al., 2021).…”

Alcohol and substance use in pregnancy during the COVID-19 pandemic

“…Historically, factors associated with alcohol and substance use during pregnancy include concurrent mental health problems ( Zhao et al, 2017 ) and financial difficulties ( Finnegan, 2013 ; Latuskie et al, 2019 ), both of which have been dramatically elevated by the COVID-19 pandemic ( Durankuş and Aksu, 2020 ; Lebel et al, 2020 ; Mappa et al, 2020 ; Moyer et al, 2020 ). Previous studies have indicated that pregnant individuals are facing changes in perinatal care ( Afshar et al, 2020 ; Bradley et al, 2020 ; Burgess et al, 2021 ; Groulx et al, 2021 ; Peahl et al, 2021 ), are worried about mom and baby’s health, and notably, are experiencing higher symptoms of anxiety and depression ( Durankuş and Aksu, 2020 ; Lebel et al, 2020 ; Mappa et al, 2020 ; Moyer et al, 2020 ). Additionally, physical distancing and related restrictions have contributed to feelings of loneliness, loss of employment, and consequent financial instability ( Brooks et al, 2020 ; Pfefferbaum and North, 2020 ).…”

Unexpected changes in birth experiences during the COVID-19 pandemic: Implications for maternal mental health

“…The vast majority of population-level assessments of perinatal anxiety and depression in the past year and a half have highlighted negative impacts of the COVID-19 pandemic on maternal mental health, with clinically significant anxiety reported in the range of 34–71% [ 5 – 8 ] and clinically significant depressive symptoms in 34–43% among mothers [ 5 – 9 ], with the highest rates being documented in Europe and North America [ 5 ]. The COVID-19 pandemic has been shown to affect peripartum women in myriad ways, including the cancelation of labor and delivery preparation classes [ 10 ], the cancelation of prenatal appointments [ 8 , 11 ], and decreases in exercise and quality of life due to quarantine [ 10 ].…”