June 19, 2023

New research from Asst. Prof. Kim McKee explores impact of COVID-19 on maternal health and birth outcomes

Two papers find that the pandemic was associated with decreased gestational age of infants and maternal distress over prenatal care, but had no significant effects on prenatal depression, perceived stress.

The COVID-19 pandemic has had an undeniably adverse effect on numerous health and social aspects in the United States and across the globe. New research from Kimberly McKee, Ph.D., MPH, assistant professor in the Department of Family Medicine at the University of Michigan, measured its impact on maternal and newborn health.

Kimberly McKee PhD MPH
Assistant Professor Kimberly McKee, Ph.D., MPH

Two papers written in collaboration with researchers affiliated with the National Institutes of Health’s Environmental Influences on Child Health Outcomes Program (ECHO), examined how COVID-19 impacted rates of depression, perceived stress, sedentary behaviors and emotional support of pregnant individuals and their effects on birth outcomes such as gestational age at delivery.

ECHO is a diverse consortium of groups across the U.S. that specializes in studying the impact of the pandemic on the health population. It also includes cohorts of caregivers and children enrolled in multiple existing, long-term studies and evaluates the impact of early-life exposures on child outcomes. They include survey, medical record and biospecimen collections.

Perinatal outcomes during vs. prior to the COVID-19 pandemic, factoring in maternal depression and perceived stress

McKee and her colleagues compared birth outcomes of 2,335 patients before and during the first 15 months of the pandemic (i.e., aim 1 of the study). They also accessed 1,490 patient surveys that included information comparing self-reported stressors across four time periods during the pandemic (aim 2). A total of 862 participants were included in both study aims.

The researchers found that the COVID pandemic did not worsen overall rates of prenatal depression or perceived stress, with levels of both variables remaining around the same rate before and after the pandemic, according to patient data. Researchers observed slight differences in gestational ages between babies born prior to and during the pandemic (on average, a two-day difference). They also observed that pregnant individuals who experienced symptoms of depression were more likely to have shorter gestation periods independent of the pandemic. However, infants born during the pandemic had slightly larger birth weights for gestational age at delivery than those born before the pandemic.

Additionally, individuals who gave birth during the pandemic reported heightened feelings of stress and anxiety around their birthing experience and their lives in general, with 72% of those surveyed reporting somewhat to extremely negative views of the impact of COVID-19 on their lives. Individuals who gave birth earlier in the pandemic were more likely to report being moderately or extremely distressed about changes to their prenatal care and delivery compared with those who delivered later in the pandemic.

However, these perceived stressors were not significantly associated with reduced outcomes in infant birth weight or gestational age.

“While we found that there were no significant effects of COVID-19 on prenatal depression or perceived stress, this doesn’t negate the fact that this was a worrisome time for pregnant individuals, particularly with changes in pre-natal care, and was still associated with decreases in gestational age at birth,” McKee said.  “This could have implications at the population level and over the life course of the infant.”

Sedentary behaviors and emotional support and their impact on prenatal psychological distress and birth outcomes during the COVID-19 pandemic

An additional study co-authored by McKee suggests that physical activity and emotional support could be important tools to help pregnant individuals reduce feelings of stress and depressive symptoms during the birthing process, independent of unusual stressors like a pandemic.

Analyzing a smaller cohort of patients from the ECHO program, McKee and her co-authors found that prolonged periods of inactivity were associated with heightened stress and depressive symptoms among pregnant individuals, while adequate emotional support appeared to mitigate these feelings. However, neither sedentary behaviors nor emotional support appeared to significantly impact gestational age or birth weight.

“These results underscore the necessity of promoting healthy movement and emotional support as vital components of maternal health before, during and after birth,” McKee said.

 A few research limitations and future directions

While these papers provide important insights into the impact of COVID on pregnant individuals and their newborns, the authors note a major limitation of the dataset used for the paper examining sedentary and prenatal psychological distress and birth outcomes during COVID-19. Specifically, it relied on pregnant individuals who were able to actively participate in the study, which may have precluded certain sub-populations that may be at high risk of adverse birth outcomes and experience a disproportionate pandemic burden.

“Given the elevated rates of preterm birth among Black, American Indian and Hispanic/Latinx infants, there is a clear need for additional studies that focus specifically on their impact of the pandemic on prenatal distress and birth outcomes for these groups,” the authors write.

McKee and her research colleagues assert that the two studies provide useful insight into the design of future research and methods to support pregnant individuals and their families during critical periods of human development. What’s more, future research should examine ways to better understand how pregnant individuals best access and receive emotional support and the types that are most effective on psychological well-being during pregnancy.

Articles cited:

McKee, K. S., Tang, X., Tung, I., Wu, G., Alshawabkeh, A. N., Arizaga, J. A., Bastain, T. M., Brennan, P. A., Breton, C. V., Camargo, C. A., Cioffi, C. C., Cordero, J. F., Dabelea, D., Deutsch, A. R., Duarte, C. S., Dunlop, A. L., Elliott, A. J., Ferrara, A., Karagas, M. R., … Comstock, S. S. (2023). Perinatal outcomes during versus prior to the COVID-19 pandemic and the role of maternal depression and perceived stress: A report from the echo program. American Journal of Perinatology. https://doi.org/10.1055/a-2033-5610

Hipwell, A. E., Tung, I., Sherlock, P., Tang, X., McKee, K., McGrath, M., Alshawabkeh, A., Bastain, T., Breton, C. V., Cowell, W., Dabelea, D., Duarte, C. S., Dunlop, A. L., Ferrera, A., Herbstman, J. B., Hockett, C. W., Karagas, M. R., Keenan, K., Krafty, R. T., … Comstock, S. S. (2023). Impact of sedentary behavior and emotional support on prenatal psychological distress and birth outcomes during the covid-19 pandemic. Psychological Medicine, 1–14. https://doi.org/10.1017/s0033291723000314