(WITHDRAWN) Pandemic- Related Pregnancy Stress (PREP): Psychometric Properties of a New Scale to Assess the Impacts of COVID-19 on the Pregnant Population

Background and Purpose: Prenatal maternal stress increases risk for adverse pregnancy and postpartum outcomes including preterm birth and postpartum mood disorders. COVID-19 related burden and stressors including social distancing, financial insecurity, uncertainty about the impact of the virus on fetal development, and restrictions related to prenatal care are some of the many problems that pregnant women are now facing. To assess the potential effects of this public health crisis on pregnant women, there is a need to accurately assess their Pandemic- Related Pregnancy Stress (PREP). In the current study we describe the creation a new measure created for this purpose and its psychometric properties.

Methods: 788 pregnant women from across the U.S. were recruited via social media and completed an online questionnaire at the end of April 2020. The questionnaire included various psychological, sociodemographic and obstetric factors as well as PREP and COVID-19 exposure and burden.

Results: Exploratory factor analysis of the PREP on a random half of the sample produced three subscales: Perinatal infection concerns (5 items), Preparedness concerns (7 items) and Positive thoughts (3 items). Confirmatory factors analyses were conducted on the rest of the sample showed good model fit. Each of the subscales converged and diverged with expected mental health and psychological factors (e.g., generalized anxiety symptoms, fear of birth, post-traumatic growth, non-pregnancy COVID-19 infection concerns) and all subscales demonstrated good reliability (α’s 0.67-0.87). PREP subscales were differentially associated with women’s history. For example, first time mothers had a higher positive appraisal and greater concerns regarding preparedness but not greater infection concerns. Women who reported that their pregnancy was high-risk, that had chronic health conditions or that had prenatal appointments cancelled or rescheduled due to COVID-19, had greater concerns about preparedness and infection compare to their counterparts, but there was no difference in positive appraisal mean. Women who were younger and those whose pregnancies were unplanned had more concerns about preparedness, but no difference was observed in the other subscales. Having received fertility treatment and gestational age were not associated with any of the PREPS subscales.

Discussion: The PREPS is a robust measure to assess multidimensional COVID-19 pandemic impacts on pregnant women. Tools such as the PREPS are critical to investigating the longitudinal impacts of COVID-19 on pregnancy and postpartum outcomes. Interventions during prenatal care such as screening for intimate partner violence and referring to treatment, behavioral health interventions and even different administrative practices (i.e, rescheduling appointment done by medical provider) can potentially reduce COVID-19 concerns, improve mental health outcomes and ensure healthier pregnancies. Further research is needed to examine efficacy of interventions to reduce psychopathology during pregnancy in light of COVID-19 impacts.