Perinatal Health Care and Maternal Mental Health during the COVID-19 Pandemic

Background and Purpose:

Research has shown that the COVID-19 pandemic affected health care use, with increases in care delays and disruptions in appointment access. There has also been emerging research on the myriad of ways that the pandemic affected mental health, with increased rates of depression, anxiety, and maternal mental health symptoms. This study aims to contribute to the literature on how the COVID-19 pandemic may have affected perinatal care and maternal mental health experiences.

Methods:

This cross-sectional survey study uses data from the Pregnancy Risk Assessment and Monitoring System (PRAMS), a large, multi-site survey of individuals with a recent live birth. Respondents in 28 states and New York City who gave birth in April 2020-December 2020 were asked about their perinatal experiences during the COVID-19 pandemic. Frequencies were weighted using PRAMS-provided survey weights. Outcomes of interest included: A) prenatal care cancellation due to COVID-19 fears or COVID-19 infection; B) trouble accessing infant check-ups due to cancellations or transitions to virtual appointments; and C) COVID-19 experiences of perinatal depression or anxiety.

Results:

We identified a total of 12,351 respondents whose deliveries had occurred April 2020-December 2020, representing a weighted total of 643,868 individuals. We find that COVID-19 impacted respondents’ ability to access care: 8.00% reported prenatal care cancellations due to fears of COVID-19, and 6.78% reported prenatal care cancellations due to COVID-19 infections. Infant care disruptions were reported among 7.25% of respondents, who experienced cancelled infant check-ups, and 5.49% reported challenges accessing infant care check-ups due to provider transitions to virtual appointments. COVID-19 experiences of perinatal mental health symptoms were reported among 28.75% for depression and 50.34% for anxiety.

Conclusions and Implications:

Although the reports of interruptions in health care are small, there are potentially meaningful effects of skipping prenatal and infant care appointments, with implications for worsening maternal and infant health outcomes in the United States. This study adds to the emerging literature on how the COVID-19 affected care and mental health, particularly focusing on maternal and infant health care and maternal mental health. We observe maternal and infant care disruptions ranging from 5.49% to 8.00% of respondents and considerably heightened reports of COVID-19 experiences of maternal anxiety and depression: approximately half of all individuals with a recent birth reporting anxiety experiences and approximately one-quarter reporting depression experiences. These reported rates of maternal mental health symptoms are substantially higher than pre-pandemic levels of approximately 12% of individuals with a birth experiencing maternal mental health symptoms. These findings are consistent with previous research that has suggested that there were worsened mental health outcomes and worsened access to care during the COVID-19 pandemic. This research has implications for ensuring care is not disrupted during pandemic waves, with special consideration of increased maternal mental health care needs.