Trends in Stress Throughout Pregnancy and Postpartum Period During the COVID-19 Pandemic: Longitudinal Study Using Ecological Momentary Assessment and Data From the Postpartum Mothers Mobile Study (Preprint)

Abstract

BACKGROUND Stress has been associated with adverse birth and postpartum health outcomes. Few studies have explored racial differences in maternal stress in a birthing population longitudinally in the United States (U.S.) during the ongoing COVID-19 pandemic. OBJECTIVE This study aimed to: (1) assess changes in reported stress before, during, and after initial emergency declarations (e.g., stay-at-home orders) were in place due to the COVID-19 pandemic and (2) assess Black-White differences in reported stress in a pregnant and postpartum population from Southwestern Pennsylvania. METHODS We leveraged data from the ongoing Postpartum Mothers Mobile Study (PMOMS) which surveys participants in real-time throughout the pregnancy and postpartum periods via ecological momentary assessment (EMA) and smartphone technology. We analyzed data from a subset of PMOMS participants (n=85) who were either Black or White, and who submitted EMA responses regarding stress between November 1, 2019 and August 31, 2020, the timeframe of this study. Data were divided into four phases based on significant events during the COVID-19 pandemic: a pre-phase (baseline), early-phase (first case of COVID-19 reported in U.S.), during-phase (stay-at-home orders), and post-phase (stay-at-home orders eased). We assessed mean stress levels at each phase using mixed-effects models and post-hoc contrasts based on the models. RESULTS Overall mean stress (min: 0, max: 4 as measured by a modified Cohen Perceived Stress Scale) during the pre-phase was 0.8 for Black and White participants [range for Black participants: 0-3.9, range for White participants: 0-2.8]. There was an increase of 0.26 points (t=5.19, d.f.=5649, p<.0001) in the during-phase as compared with the pre-phase, and an increase of 0.19 points (t=3.09, d.f.=5649, p=0.002) in the post-phase compared with the pre-phase (n=85). No difference was found between Black and White participants in the change in mean stress from the pre-phase to the during-phase (δ ̂= -0.016, p=0.867). There was a significant difference between Black and White participants in the change in mean stress from the during-phase to the post-phase (δ ̂ = -0.39, p<0.0001). CONCLUSIONS There was an overall increase in mean stress levels in this subset of pregnant and postpartum participants during the same time as the emergency declarations/stay-at-home orders in the US. Compared to baseline, mean stress levels remained elevated when stay-at-home orders eased. We found no significant difference in the mean stress levels by race. Given that stress is associated with adverse birth outcomes and postpartum health, stress induced by the ongoing COVID-19 pandemic may have adverse implications for birthing populations in the U.S. INTERNATIONAL REGISTERED REPORT RR2-10.2196/13569

Adaptive Text Messaging for Postpartum Risky Drinking: Conceptual Model and Protocol for an Ecological Momentary Assessment Study

“…The need for tailored digital supportive interventions for the postpartum period is greater than ever given the increasing rates of perinatal stress, depression, and substance use during the COVID-19 pandemic [ 162 ]. A growing number of studies have shown increases in postpartum anxiety and depression, perinatal stress, and difficulties with bonding and breastfeeding since the beginning of the pandemic [ 163 , 164 ], all of which significantly increase the risk for risky drinking. This increased risk is combined with the fact that women who use substances are less likely to receive postpartum care [ 165 ] and are more likely to report poor relationships with their health care providers and negative experiences seeking care [ 166 ].…”