Prenatal distress during the COVID-19 pandemic: clinical and research implications
Open accessAbstract
Purpose: The objective of this study was to identify risk and protective factors related to general prenatal distress and COVID-19-specific prenatal distress to inform intervention targets among women pregnant during the COVID-19 pandemic. Methods: The study relied on data obtained from U.S. pregnant women (N = 701) who participated in the Perinatal Experiences and COVID-19 Effects (PEACE) Study from May 21 to October 3, 2020. The present cross-sectional study examined the potential risk and protective factors associated with different features of prenatal distress among U.S. pregnant women during the COVID-19 pandemic. Results: Approximately two-thirds of expectant mothers indicated being more stressed about going to the hospital because of COVID-19. Generalized anxiety and PTSD were associated with higher levels of general and COVID-19-specific prenatal distress. Depression symptoms were associated with higher general prenatal distress. Higher levels of distress tolerance were associated with lower levels of general prenatal distress (B = − 0.192, p <.001) and COVID-19-specific prenatal distress (B = − 0.089, p <.05). Higher levels of instrumental social support were marginally associated with lower COVID-19-specific prenatal distress (B = − 0.140, p < 0.1). Conclusion: Findings draw attention to prenatal distress experiences during the COVID-19 pandemic, including new types of distress arising from the pandemic itself. Women might benefit from the introduction of interventions such as mindfulness-based or relaxation therapy. Coverage of responsibilities and financial assistance is particularly needed during the COVID-19 pandemic. Limitations include a majority White and high socioeconomic sample. These findings provide specificity regarding potential targets for addressing prenatal distress. © 2021, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
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Claims the paper makes
2 of 9 cited sources checked · 1 supported · 0 flagged · accuracy not yet measured
- Premisecitation
Stress about birth preparations and COVID-19 infection risk is linked to elevated anxiety during pregnancy.
“Stress regarding birth preparations and COVID-19 infection risk are linked to elevated anxiety during pregnancy [18].”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [18] Preis H, Mahaffey B, Heiselman C, Lobel M (2020) Pandemic-related pregnancy stress and anxiety among women pregnant during the coronavirus disease 2019 pandemic. Am J Obstet Gynecol MFM 2:100155. https://doi.org/10.1016/j.ajogmf.2020.100155 source
- Premisecitation
Emotional social support is associated with lower pregnancy-specific distress.
“Emotional social support [18], along with interpersonal characteristics such as relationship satisfaction or better rapport with one’s mother during pregnancy is associated with lower pregnancy-specific distress [19].”
Quote in the paperNot a substantial claim1 of 2 sources checked- cites [18] Preis H, Mahaffey B, Heiselman C, Lobel M (2020) Pandemic-related pregnancy stress and anxiety among women pregnant during the coronavirus disease 2019 pandemic. Am J Obstet Gynecol MFM 2:100155. https://doi.org/10.1016/j.ajogmf.2020.100155 source
The Study Design lists the factors assessed but does not include emotional social support. The Results examine pandemic-related pregnancy stress and anxiety, not whether social support is associated with lower pregnancy-specific distress (searched: emotional social support, social support, pregnancy-specific distress). (LLM, conf=0.76)
Experimental — accuracy not yet measured - cites [19] Campbell-Sills L, Stein MB (2007) Psychometric analysis and refinement of the connor–davidson resilience scale (CD-RISC): validation of a 10-item measure of resilience. J Traum Stress 20:1019–1028. https://doi.org/10.1002/jts.20271 source
- Findingown data
Taking the survey later in the pandemic was associated with higher general prenatal distress (B=0.066, p<0.05).
“Those who took the survey later in the pandemic had higher levels of general prenatal distress (B = 0.066, p < 0.05).”
Quote in the paperNot a substantial claim - Findingown data
33.3% of respondents were worried about COVID-19 stress interfering with maternal bonding.
“followed by worries about COVID-19 stress interfering with maternal bonding (33.3%)”
Quote in the paperNot a substantial claim - Findingown data
Cohabitating with a partner was marginally associated with lower general prenatal stress (B=-0.061, p<0.1).
“Cohabitating with a partner was marginally associated with lower general prenatal stress (B = − 0.061, p < 0.1)”
Quote in the paperNot a substantial claim
- Findingown data
Greater distress tolerance was linked to lower COVID-19-specific prenatal distress (B=-0.089, p<0.05).
“and COVID-19-specific prenatal distress (B = − 0.089, p < .05)”
- Also stated in: § Results · plain
“distress tolerance: B = − 0.089, p < 0.05”
Quote in the paperSubstantial claim - Also stated in: § Results · plain
- Findingown data
Resilience showed no significant association with COVID-19-specific prenatal distress after psychiatric symptoms were controlled.
“Contrary to expectations, no significant associations were observed between resilience with either general prenatal distress or COVID-19-specific prenatal distress after controlling for psychiatric symptoms”
Quote in the paperSubstantial claim - Findingown data
No sociodemographic or pre-existing depression and generalized anxiety diagnoses were associated with COVID-19-specific prenatal distress.
“No sociodemographic or pre-existing depression and generalized anxiety mental health diagnoses were associated with COVID-19-specific prenatal distress.”
Quote in the paperSubstantial claim - Findingown data
All predictors together explained 26.8% of the variance in COVID-19-specific prenatal distress.
“All the predictors accounted for 26.8% of the model variance.”
Quote in the paperNot a substantial claim - Findingown data
29.7% of respondents feared transmitting the virus to the baby.
“fears about transmitting the virus to the baby (29.7%)”
Quote in the paperNot a substantial claim - Findingown data
More severe generalized anxiety symptoms were linked to greater general prenatal distress (B=0.114, p<0.05).
“generalized anxiety: B = 0.114, p < 0.05”
Quote in the paperSubstantial claim - Findingown data
16.6% of respondents were worried about becoming very sick and not having a trusted person to care for their baby.
“and 16.6% being worried/stressed about becoming very sick and not having a trusted member or friend to care for their baby.”
Quote in the paperNot a substantial claim - Findingown data
The mean general prenatal distress score was 1.66.
“The mean score for general prenatal stress, as assessed by the 12-item PDQ was 1.66.”
Quote in the paperNot a substantial claim - Findingown data
All predictors together explained 42.0% of the variance in general prenatal distress.
“All the predictors accounted for 42.0% of the model variance.”
Quote in the paperNot a substantial claim - Findingown data
About two-thirds of the pregnant women in the sample reported feeling worried or stressed regarding hospital visits due to COVID-19.
“Approximately two-thirds of expectant mothers indicated being more stressed about going to the hospital because of COVID-19.”
- Also stated in: § Results · plain
“Notably, 67.2% of respondents indicated being worried/stressed about going to the hospital because of COVID-19.”
Quote in the paperNot a substantial claim - Also stated in: § Results · plain
- Findingown data
Pre-existing mental health diagnoses showed no association with general prenatal distress.
“Pre-existing mental health diagnoses showed no association with general prenatal distress.”
Quote in the paperNot a substantial claim - Findingown data
24.1% of respondents were worried about contracting COVID-19 during labor and delivery.
“and contracting COVID-19 during labor and delivery (24.1%)”
Quote in the paperNot a substantial claim - Findingown data
The mean COVID-19-specific prenatal distress score was 2.54.
“The mean score for COVID-19-specific prenatal distress was 2.54.”
Quote in the paperNot a substantial claim - Findingown data
Resilience showed no significant association with general prenatal distress after psychiatric symptoms were controlled.
“Contrary to expectations, no significant associations were observed between resilience with either general prenatal distress or COVID-19-specific prenatal distress after controlling for psychiatric symptoms”
Quote in the paperSubstantial claim - Findingown data
More severe PTSD symptoms were linked to greater general prenatal distress (B=0.117, p<0.05).
“PTSD: B = 0.117, p < 0.05”
Quote in the paperSubstantial claim - Findingown data
Greater instrumental social support was marginally linked to lower COVID-19-specific prenatal distress (B=-0.140, p<0.1).
“Higher levels of instrumental social support were marginally associated with lower COVID-19-specific prenatal distress (B = − 0.140, p < 0.1).”
- Also stated in: § Results · plain
“instrumental support: B = − 0.140, p < 0.1”
Quote in the paperNot a substantial claim - Also stated in: § Results · plain
- Findingown data
More severe generalized anxiety symptoms were linked to greater COVID-19-specific prenatal distress (B=0.193, p<0.01).
“generalized anxiety: B = 0.193, p < 0.01”
Quote in the paperSubstantial claim - Findingown data
More severe depression symptoms were linked to greater general prenatal distress (B=0.259, p<0.001).
“Depression symptoms were associated with higher general prenatal distress.”
- Also stated in: § Results · plain
“depression: B = 0.259, p < 0.001”
Quote in the paperSubstantial claim - Also stated in: § Results · plain
- Findingown data
Greater distress tolerance was linked to lower general prenatal distress (B=-0.192, p<0.001).
“Higher levels of distress tolerance were associated with lower levels of general prenatal distress (B = − 0.192, p < .001)”
- Also stated in: § Results · plain
“distress tolerance was found to significantly predict general prenatal distress, with higher levels of distress tolerance being associated with lower levels of general prenatal distress (B = − 0.192, p < 0.001).”
Quote in the paperSubstantial claim - Also stated in: § Results · plain
- Findingown data
Reporting this pregnancy as the first was significantly associated with higher general prenatal distress (B=0.156, p<0.001).
“whereas the report of this pregnancy being the first was significantly associated with higher levels of general prenatal distress (B = 0.156, p < 0.001).”
Quote in the paperNot a substantial claim - Findingown data
16.8% of respondents were worried about their birth partner not being able to be with them during labor and delivery.
“Among respondents, 16.8% indicated being worried/stressed about their birth partner or support person not being able to be with them during labor and delivery”
Quote in the paperNot a substantial claim - Findingown data
45.1% of respondents were worried or stressed about accessing the hospital if they or their baby became sick.
“The next item that showed the highest rate of worry/stress pertained to accessing the hospital if the respondent or her baby became sick (45.1%)”
Quote in the paperNot a substantial claim - Findingown data
More severe PTSD symptoms were marginally linked to greater COVID-19-specific prenatal distress (B=0.155, p<0.1).
“PTSD: B = 0.155, p < 0.1”
Quote in the paperNot a substantial claim - Interpretationcitation
Women in the sample did not report high levels of general prenatal distress compared with other work.
“The baseline scores for general prenatal distress and COVID-19-specific prenatal distress indicate that women in general did not report high levels of general prenatal distress during our study period comparable to other work on general prenatal distress [31].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [31] Pluess M, Bolten M, Pirke K-M, Hellhammer D (2010) Maternal trait anxiety, emotional distress, and salivary cortisol in pregnancy. Biol Psychol 83:169–175. https://doi.org/10.1016/j.biopsycho.2009.12.005 source
- Study design and conductreasoning
The cross-sectional design prevents drawing causal conclusions between predictors and outcomes.
“Second, the cross-sectional design does not allow us to draw causal inferences between our predictors and outcome variables”
Quote in the paperSubstantial claim - Premisecitation
Instrumental support may be especially critical during the pandemic because quarantine measures limited access to resources.
“However, instrumental support, or tangible assistance such as financial support or having someone assist with household chores [20], may be particularly critical during the pandemic, as quarantine measures limited access to resources, such as prenatal care or caregiver support.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [20] Connor KM, Davidson JRT (2003) Development of a new resilience scale: the Connor-Davidson resilience scale (CD-RISC). Depress Anxiety 18:76–82. https://doi.org/10.1002/da.10113 source
- Premisecitation
Pregnancy-specific distress may independently predict birth outcomes, even more than general stress.
“there is evidence that pregnancy-specific distress may independently predict birth outcomes [11], even more so than general stress experiences or stress unrelated to pregnancy itself [10, 15].”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [11] Alderdice F, Lynn F (2011) Factor structure of the prenatal distress questionnaire. Midwifery 27:553–559. https://doi.org/10.1016/j.midw.2010.05.003 source
- cites [10] Huizink AC, Mulder EJH, Robles de Medina PG et al (2004) Is pregnancy anxiety a distinctive syndrome? Early Human Dev 79:81–91. https://doi.org/10.1016/j.earlhumdev.2004.04.014 source
- cites [15] Lobel M, Cannella DL, Graham JE et al (2008) Pregnancy-specific stress, prenatal health behaviors, and birth outcomes. Health Psychol 27:604 source
- Borderline: one of the tests for a substantial claim is unclear. 1
- May combine two claims. 10
- Classified as probably not a substantial claim. 2
Borderline on S3 (load-bearing), S4 (based): unclear from the text.
Findingnone givenA pre-existing PTSD diagnosis was marginally associated with COVID-19-specific prenatal distress.
“A pre-existing PTSD diagnosis was marginally associated with COVID-19-specific prenatal distress.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataThe sample was mostly White (92.9%) and highly educated (90.5% college educated), with over 40% reporting household income above $150,000.
“Women were on average 32.5 years of age, with the large majority college educated (90.5%), White (92.9%) and cohabitating with their partners (98.3%). More than 40% reported a household income of more than $150,000.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataInstrumental support, but not emotional support, was marginally linked to COVID-19-specific prenatal distress.
“Instrumental support but not emotional support was marginally associated (p < 0.1) with COVID-19-specific prenatal distress.”
Quote in the paperSubstantial claimMay combine two claims.
Interpretationown dataDistress tolerance seemed to protect against both general and COVID-19-specific prenatal distress.
“rather, it was distress tolerance that appeared to protect against general prenatal distress and COVID-19-specific prenatal distress.”
Quote in the paperSubstantial claimMay combine two claims.
Study design and conductown dataThe 8-item COVID-19-specific prenatal distress measure had a Cronbach's alpha of 0.81, indicating good reliability.
“Cronbach’s alpha for measure items was 0.81, indicating good reliability.”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationThe COVID-19 pandemic is a new source of stress with unique implications for parents and those preparing for childbirth.
“The COVID-19 pandemic represents a new source of stress with unique implications for parents and those preparing for childbirth [16], which we refer to as COVID-19-specific prenatal distress.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [16] Liu CH, Doan SN (2020) Psychosocial stress contagion in children and families during the COVID-19 pandemic. Clin Pediatr (Phila) 59:853–855. https://doi.org/10.1177/0009922820927044 source
May combine two claims.
Study design and conductown dataThe PDQ had a Cronbach's alpha of 0.78, indicating good reliability.
“The Cronbach’s alpha for the overall scale was 0.78 indicating good reliability.”
Quote in the paperNot a substantial claimMay combine two claims.
Study design and conductreasoningThe findings rely only on self-report, which is subjective and not diagnostic, and may be affected by recall bias.
“Third, the results are solely based on the self-report, including the self-screening for mental health symptoms, which is subjective and not diagnostic. Thus, our data, as with other survey studies, may be subject to problems related to recall bias.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductnone givenThe study embedded attention checks and human verification, and staff visually inspected data to ensure data quality.
“To ensure data quality, several attention checks and human verification were embedded throughout the survey. Furthermore, study staff visually inspected data to detect any response irregularities.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim. May combine two claims.
Study design and conductown dataThe regression models controlled for sociodemographic characteristics, pre-existing mental health diagnoses, and current mental health symptoms.
“The regression models included covariates and predictor variables that were entered through the following steps: sociodemographic characteristics (Block 1), pre-existing mental health diagnoses (depression, generalized anxiety, PTSD; Block 2), current mental health symptoms (depression, generalized anxiety, PTSD; Block 3), and protective factors (instrumental support, emotional support, resilience”
Quote in the paperSubstantial claimMay combine two claims.
Study design and conductreasoningThe study used convenience sampling, which likely over-represented White women and those with higher socioeconomic status.
“First, although we were able to collect data nationwide, the study utilized a convenience sampling approach. This is likely to have led to an over-representation of White women and those who are higher in socioeconomic status”
Quote in the paperSubstantial claim
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“10,15,18 PTSD symptoms are associated with depression and anxiety, suggesting the comorbidity of perinatal mental health problems during the pandemic.”
Koire, A. M., Feldman, N., Erdei, C., Mittal, L. P., & Liu, C. H. (2023) · Psychiatry Research · doi:10.1016/j.psychres.2023.115169 · Cited by 6 · see citing works
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Support Needs of Perinatal Women amid the COVID-19 Pandemic
Arai, Y. (2021) · Journal of Nursing and Women s Health · doi:10.29011/2577-1450.100077
“In a survey in the United States, two-thirds of pregnant women indicated that the spread of COVID-19 caused them to feel stressed about going to the hospital [7].”
Background
- Authors
- Liu, C. H., Hyun, S., Erdei, C., & Mittal, L.
- Affiliations
- Brigham and Women's Hospital (US)
- Corresponding author
- Liu, Cindy H.
- Venue
- Archives of Gynecology and Obstetrics
- Published
- 2021-10-30
- Volume
- 306
- Issue
- 2
- Pages
- 397-405
- ISSN
- 0003-9128 (ISSN-L)
- 1432-0711
- PMC
- PMC8556835
- OpenAlex
- W3210577594
- Cited by
- 11
- References
- 47
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1 · 2023: 4 · 2022: 3 · 2021: 1
- FWCI
- 1.95
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Archives of Gynecology and Obstetrics (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health (K23 MH 107714-01 A1, T32 MH016259)
- Mary A. Tynan Faculty Fellowship
- Weinberg and Barton Families
- Family Health and Resiliency Fund
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Health Sciences › Medicine › Obstetrics and Gynecology › COVID-19 Impact on Reproduction
- Keywords
- prenatal distress, COVID-19 pandemic, pregnant women, risk and protective factors, generalized anxiety disorder, post-traumatic stress disorder, depression, distress tolerance, instrumental support, hospitalization anxiety, mindfulness-based interventions
- MeSH terms
- COVID-19, SARS-CoV-2, Anxiety, Cross-Sectional Studies, Depression, Female, Humans, Pregnancy, Stress, Psychological, Pandemics
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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