Pharmacoepidemiologist Research Centre - CHU Sainte-Justine, Canada
Background: External natural events, such as hurricanes, floods, and the COVID-19 pandemic can contribute to increased populational stress, especially for pregnant persons. Exposure to crises can produce short- and long-term health effects on pregnant persons and their offspring. Many studies, including the CONCEPTION study, observed that depression and anxiety scores among pregnant persons during the pandemic were greater compared to pre-pandemic scores. There has been much interest in the association between maternal depression, anxiety, and stress during pregnancy and perinatal outcomes such as PTB and LBW, before and since the COVID-19 pandemic, however results are controversial.
Objectives: We aimed to assess the association between prenatal mental health during the COVID-19 pandemic and preterm birth (PTB; delivery < 37 weeks gestation) and low birthweight (LBW; < 2,500 grams).
Methods: Pregnant individuals, >18 years, were recruited in Canada and provided data through a web-based questionnaire. We analysed data on persons recruited between 06/2020-08/2021 who completed questionnaires while pregnant and 2-months post-partum. Data on maternal sociodemographics, comorbidities, medication use, mental health (Edinburgh Postnatal Depression Scale, General Anxiety Disorder-7, stress), pandemic hardship (CONCEPTION - Assessment of Stress from COVID-19), and on gestational age at delivery and birth weight, were self-reported. Crude and adjusted relative risks (aRR) with 95% confidence interval (95%CI) were calculated to quantify the association between PTB/LBW and maternal mental health
Results: A total of 1,265 and 1,233 participants were included in the analyses of PTB and LBW, respectively. No associations between PTB and prenatal mental health (depression [aRR 1.01, 95%CI 0.91-1.11], anxiety [aRR 1.04, 95%CI 0.93-1.17], stress [aRR 0.88, 95%CI 0.71-1.10], nor hardship [aRR 1.00, 95%CI 0.96-1.04]) after adjusting for potential confounders. The risk of PTB was increased with non-white ethnicity/race (aRR 3.85, 95%CI 1.35-11.00), consistently with the literature. Similar findings were observed for LBW (depression [aRR 1.03, 95%CI 0.96-1.13], anxiety [aRR 1.05, 95%CI 0.95-1.17], COVID stress [aRR 0.92, 95%CI 0.77-1.09], or overall hardship [aRR 0.97, 95%CI 0.94-1.01]).
Conclusions: No association was found between prenatal mental health nor hardship during the COVID-19 pandemic and the risk of PTB or LBW. However, it is imperative to continue the follow-up of mothers and their offsprings to detect long-term health problems early.
