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COVID-19 Impacts on Perinatal Care and Maternal Mental Health: A Geotemporal Analysis of Healthcare Disruptions and Emotional Well-Being Across the United States

36 Pages Posted: 1 Jun 2021

See all articles by Cassandra Lei Hendrix

Cassandra Lei Hendrix

New York University (NYU) - Department of Child and Adolescent Psychiatry

Denise Werchan

New York University (NYU) - Department of Child and Adolescent Psychiatry

Carly Lenniger

New York University (NYU) - Department of Child and Adolescent Psychiatry

Jennifer C. Ablow

University of Oregon

Ananda B. Amstadter

Virginia Commonwealth University (VCU) - School of Business

Autumn Austin

New York University (NYU) - Department of Child and Adolescent Psychiatry

Vanessa Babineau

Columbia University - Department of Obstetrics and Gynecology

G. Anne Bogat

Michigan State University

Leigh-Anne Cioffredi

University of Vermont - Hospital Pediatrics

Elisabeth Conradt

University of Utah

Sheila E. Crowell

University of Utah

Dani Dumitriu

Columbia University, College of Physicians & Surgeons, Department of Pediatrics

Amy J. Elliott

University of South Dakota - Department of Pediatrics

William Fifer

Columbia University - Department of Psychiatry

Morgan Firestein

Columbia University - Department of Psychiatry

Wei Gao

Cedars-Sinai Medical Center, Division of Immunology, Department of Biomedical Sciences

Ian Gotlib

Stanford University

Alice Graham

Oregon Health and Science University - Department of Psychiatry

Kimberly D. Gregory

Cedars Sinai Medical Center - Department of Obstetrics and Gynecology

Hanna Gustafsson

Oregon Health and Science University - Department of Psychiatry

Kathryn L. Havens

University of Southern California

Christine Hockett

University of South Dakota - Department of Pediatrics

Brittany R. Howell

Virginia Polytechnic Institute & State University - Fralin Biomedical Research Institute

Kathryn L. Humphreys

Vanderbilt University

Nancy Jallo

Virginia Commonwealth University (VCU) - School of Business

Lucy S. King

Stanford University

Patricia A. Kinser

Virginia Commonwealth University (VCU) - School of Business

Alytia A. Levendosky

Michigan State University

Joseph S. Lonstein

Michigan State University

Maristella Lucchini

Columbia University - Department of Psychiatry

Rachel Marcus

Cedars Sinai Medical Center - Department of Biomedical Sciences

Catherine Monk

Columbia University - Department of Psychiatry

Sara Moyer

Virginia Commonwealth University (VCU) - School of Business

Maria Muzik

University of Michigan Medical School

Amy K. Nuttall

Michigan State University

Alexandra S. Potter

University of Vermont

Cynthia Rogers

Washington University in St. Louis - Department of Psychiatry

Amy Salisbury

Virginia Commonwealth University (VCU) - School of Business

Lauren C. Shuffrey

Columbia University - Department of Psychiatry

Beth A. Smith

University of Southern California

Chris Smyser

Washington University in St. Louis - Department of Neurology

Lynne Smith

University of California, Los Angeles (UCLA) - The Lundquist Institute

Elinor Sullivan

Oregon Health and Science University - Department of Psychiatry

Judy Zhou

University of Southern California - Division of Biokinesiology and Physical Therapy

Natalie H. Brito

New York University (NYU) - Department of Applied Psychology

Moriah E. Thomason

New York University (NYU) - Department of Child and Adolescent Psychiatry

More...

Abstract

Background: Adequate perinatal care is essential for maternal and infant health. The novel coronavirus (COVID-19) pandemic is potentially the largest natural disruption to perinatal care in recent history, but these disruptions have yet to be characterized in a rigorous and systematic manner. Our goal was to document COVID-19 induced disruptions to perinatal care across the United States (US) using analyses sensitive to the temporal and geographical variability of the pandemic, and to examine the impact of these healthcare disruptions on maternal mental health.

Methods: We performed an observational cross-sectional study of 1,922 postpartum and 3,868 pregnant individuals during the 2020 COVID-19 pandemic. Perinatal individuals were recruited from 15 academic institutions across the US, resulting in a geographically diverse sample. We conducted (1) descriptive analyses on the prevalence and timing of perinatal care disruptions, (2) group difference analyses to compare perinatal care disruptions depending on when and where individuals gave birth, (3) cross correlations to assess the temporal linkage between perinatal care disruptions and COVID-19 infection rates, and (4) hierarchical linear regressions to evaluate the impact of prenatal care and birth protocol disruptions on maternal psychological health.

Findings: The COVID-19 pandemic significantly altered perinatal care across the US, both through restriction of in-person support and by shifting the focus of care. These changes occurred unevenly over time and across geographic locations. Changes in COVID-19 infection rates explained 65 to 78% of the variance in perinatal care disruptions from August 2019 to August 2020. Moreover, disruptions to perinatal care were robustly associated with heightened psychological distress in mothers, even after controlling for mental health history, number of pregnancy complications, and general stress about the COVID-19 pandemic.

Interpretation: Our analyses reveal widespread disruptions to perinatal care across the US that fluctuated depending on where and when individuals gave birth, demonstrating reactivity and elasticity of the US healthcare system. In addition to influencing health outcomes, disruptions to perinatal care may also exacerbate mental health concerns during the COVID-19 pandemic.

Funding Information: This research was supported by the NYU COVID-19 Research Catalyst rant, R34DA050287-S1, R34DA050287-S2, R34DA050254-01S2, R01MH126468, R01MH125870, the Nathaniel Wharton Fund, the Columbia University Population Research Center, R34DA050255, R34DA050255-01S2, the Fralin Biomedical Research Institute at VTC, the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Numbers UL1TR003015 and KL2TR003016, the University of Utah Center for Clinical and Translational Science COVID-19 Research Award, Virginia Commonwealth University School of Nursing Internal Grants Program, Sarah P. Farrell Legacy Research Endowment-Virginia Commonwealth University, 5R03HD096141-02, R01HD085990, R34DA050283-01S2, the USC Center for the Changing Family, the Stanford Institute for Research in the Social Sciences, R34DA050291, R01MH119070, R01MH117177, R34 DA050272-01S1, R01 MH113883, R01 DA046224, R21 MH111978, and R21 HD090493, R37 MH10149, UH3OD023279, and National Center for Advancing Translational Sciences (NCATS) Grant UL1TR001881

Declaration of Interests: The authors report no conflicts of interest.

Ethics Approval Statement: This study has received Institutional Review Board approval from theNYU Langone Health IRB as well as the local IRBs at each data collection site. All data was collected in accordance with the Helsinki Declaration.

Suggested Citation

Hendrix, Cassandra Lei and Werchan, Denise and Lenniger, Carly and Ablow, Jennifer C. and Amstadter, Ananda B. and Austin, Autumn and Babineau, Vanessa and Bogat, G. Anne and Cioffredi, Leigh-Anne and Conradt, Elisabeth and Crowell, Sheila E. and Dumitriu, Dani and Elliott, Amy J. and Fifer, William and Firestein, Morgan and Gao, Wei and Gotlib, Ian and Graham, Alice and Gregory, Kimberly D. and Gustafsson, Hanna and Havens, Kathryn L. and Hockett, Christine and Howell, Brittany R. and Humphreys, Kathryn L. and Jallo, Nancy and King, Lucy S. and Kinser, Patricia A. and Levendosky, Alytia A. and Lonstein, Joseph S. and Lucchini, Maristella and Marcus, Rachel and Monk, Catherine and Moyer, Sara and Muzik, Maria and Nuttall, Amy K. and Potter, Alexandra S. and Rogers, Cynthia and Salisbury, Amy and Shuffrey, Lauren C. and Smith, Beth A. and Smyser, Chris and Smith, Lynne and Sullivan, Elinor and Zhou, Judy and Brito, Natalie H. and Thomason, Moriah E., COVID-19 Impacts on Perinatal Care and Maternal Mental Health: A Geotemporal Analysis of Healthcare Disruptions and Emotional Well-Being Across the United States. Available at SSRN: https://ssrn.com/abstract=3857679 or http://dx.doi.org/10.2139/ssrn.3857679

Cassandra Lei Hendrix (Contact Author)

New York University (NYU) - Department of Child and Adolescent Psychiatry ( email )

Bobst Library, E-resource Acquisitions
20 Cooper Square 3rd Floor
New York, NY 10003-711
United States

Denise Werchan

New York University (NYU) - Department of Child and Adolescent Psychiatry ( email )

New York, NY
United States

Carly Lenniger

New York University (NYU) - Department of Child and Adolescent Psychiatry ( email )

New York, NY
United States

Jennifer C. Ablow

University of Oregon

1280 University of Oregon
Eugene, OR 97403
United States

Ananda B. Amstadter

Virginia Commonwealth University (VCU) - School of Business

301 W Main Street
Richmond, VA 23284
United States

Autumn Austin

New York University (NYU) - Department of Child and Adolescent Psychiatry ( email )

New York, NY
United States

Vanessa Babineau

Columbia University - Department of Obstetrics and Gynecology ( email )

630 West 168th Street, 3rd Floor, Suite 3-470
New York, NY 10032
United States

G. Anne Bogat

Michigan State University

Agriculture Hall
East Lansing, MI 48824-1122
United States

Leigh-Anne Cioffredi

University of Vermont - Hospital Pediatrics ( email )

Burlington, VT
United States

Elisabeth Conradt

University of Utah

1645 E. Campus Center
Salt Lake City, UT 84112
United States

Sheila E. Crowell

University of Utah

1645 E. Campus Center
Salt Lake City, UT 84112
United States

Dani Dumitriu

Columbia University, College of Physicians & Surgeons, Department of Pediatrics ( email )

NY
United States

Amy J. Elliott

University of South Dakota - Department of Pediatrics ( email )

414 East Clark Street
Vermillion, SD 57069
United States

William Fifer

Columbia University - Department of Psychiatry ( email )

United States

Morgan Firestein

Columbia University - Department of Psychiatry ( email )

United States

Wei Gao

Cedars-Sinai Medical Center, Division of Immunology, Department of Biomedical Sciences

8700 Beverly Blvd.
Los Angeles, CA
United States

Ian Gotlib

Stanford University

Stanford, CA 94305
United States

Alice Graham

Oregon Health and Science University - Department of Psychiatry ( email )

3181 S.W. Sam Jackson Park Rd.
Portland, OR 97201
United States

Kimberly D. Gregory

Cedars Sinai Medical Center - Department of Obstetrics and Gynecology ( email )

8700 Beverly Blvd.
Los Angeles, CA 90048
United States

Hanna Gustafsson

Oregon Health and Science University - Department of Psychiatry ( email )

3181 S.W. Sam Jackson Park Rd.
Portland, OR 97201
United States

Kathryn L. Havens

University of Southern California

2250 Alcazar Street
Los Angeles, CA 90089
United States

Christine Hockett

University of South Dakota - Department of Pediatrics ( email )

414 East Clark Street
Vermillion, SD 57069
United States

Brittany R. Howell

Virginia Polytechnic Institute & State University - Fralin Biomedical Research Institute ( email )

2 Riverside Circle
Roanoke, VA 24016
United States

Kathryn L. Humphreys

Vanderbilt University

2301 Vanderbilt Place
Nashville, TN 37240
United States

Nancy Jallo

Virginia Commonwealth University (VCU) - School of Business

301 W Main Street
Richmond, VA 23284
United States

Lucy S. King

Stanford University

Stanford, CA 94305
United States

Patricia A. Kinser

Virginia Commonwealth University (VCU) - School of Business

301 W Main Street
Richmond, VA 23284
United States

Alytia A. Levendosky

Michigan State University

Agriculture Hall
East Lansing, MI 48824-1122
United States

Joseph S. Lonstein

Michigan State University

Agriculture Hall
East Lansing, MI 48824-1122
United States

Maristella Lucchini

Columbia University - Department of Psychiatry ( email )

United States

Rachel Marcus

Cedars Sinai Medical Center - Department of Biomedical Sciences

8700 Beverly Blvd.
Los Angeles, CA 90048
United States

Catherine Monk

Columbia University - Department of Psychiatry ( email )

United States

Sara Moyer

Virginia Commonwealth University (VCU) - School of Business

301 W Main Street
Richmond, VA 23284
United States

Maria Muzik

University of Michigan Medical School

Ann Arbor, MI
United States

Amy K. Nuttall

Michigan State University

Agriculture Hall
East Lansing, MI 48824-1122
United States

Alexandra S. Potter

University of Vermont

212 Kalkin Hall
Burlington, VT 05405-0158
United States

Cynthia Rogers

Washington University in St. Louis - Department of Psychiatry

660 S. Euclid Avenue
St. Louis, MO 63110
United States

Amy Salisbury

Virginia Commonwealth University (VCU) - School of Business

301 W Main Street
Richmond, VA 23284
United States

Lauren C. Shuffrey

Columbia University - Department of Psychiatry ( email )

United States

Beth A. Smith

University of Southern California

2250 Alcazar Street
Los Angeles, CA 90089
United States

Chris Smyser

Washington University in St. Louis - Department of Neurology ( email )

St. Louis, MO
United States

Lynne Smith

University of California, Los Angeles (UCLA) - The Lundquist Institute

CA
United States

Elinor Sullivan

Oregon Health and Science University - Department of Psychiatry ( email )

3181 S.W. Sam Jackson Park Rd.
Portland, OR 97201
United States

Judy Zhou

University of Southern California - Division of Biokinesiology and Physical Therapy

2250 Alcazar Street
Los Angeles, CA 90089
United States

Natalie H. Brito

New York University (NYU) - Department of Applied Psychology ( email )

550 First Ave.
VZ30, Office 626
New York, NY 10016
United States

Moriah E. Thomason

New York University (NYU) - Department of Child and Adolescent Psychiatry ( email )

New York, NY
United States

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