Is prenatal COVID-19 stress associated with postpartum maternal mental health and infant outcomes?

In a recent study published in JAMA Network Openresearchers assessed the relationship between prenatal coronavirus disease 2019 (COVID-19) stress and the psychological well-being of mothers and their infants in the postpartum period.

Study: Association of prenatal stress related to COVID-19 with postpartum maternal mental health and infant negative affectivity. Image credit: GrooveZ/Shutterstock


Studies report that antenatal stressors significantly increase the risk of adverse postnatal outcomes in terms of mental well-being, such as cognitive and behavioral problems in infants. The incidence of anxiety and depression during pregnancy increased significantly during the severe acute respiratory coronavirus 2 (SARS-CoV-2) pandemic, with reduced positive affectivity, impaired orienting behavior, and higher urgency among infants.

However, the relationship between COVID-19-related stress and postpartum maternal and infant outcomes is not fully understood. Previous studies evaluating the effects of antenatal stressors on maternal and infant health outcomes have been largely cross-sectional, single-center, retrospective, with small sample populations, and often used unvalidated assessment measures without documenting psychometric properties.

About the research

In the present longitudinal, survey-based study, researchers assessed the impact of antenatal stress associated with SARS-CoV-2 infection on maternal and infant mental health outcomes after birth.

The study included 318 individuals aged ≥11.0 years who participated in the 2019 Coronavirus Disease Risks Over a Lifetime Study (CORAL) conducted in the United Kingdom (UK), the United States (US) and Australia. Women who were expecting at the initial assessment between 5 May and 30 September 2020 and completed two follow-up assessments between 28 October 2021 and 24 April 2022 at three-month intervals were considered for the analysis.

In addition, participants were invited to complete a fourth survey on maternal psychological well-being and infant temperament at follow-up. Stress levels related to COVID-19 were assessed using the Pandemic Anxiety Scale. The team used the eight-item Patient Health Questionnaire to assess depression among mothers and the seven-item Generalized Anxiety Disorder (GAD) scale to assess levels of generalized anxiety.

At follow-up, levels of postpartum distress were assessed using the 10.0-item Postpartum Distress Rating Scale, and infant health outcomes were assessed using the Infant Behavior Questionnaire. Individuals were recruited for the study through paid advertising, social media, mother group newsletters, mental health organizations, and web-based pregnancy forums.

Linear mixed-effects modeling was performed for the analysis. Sensitivity analyzes were performed controlling for maternal mental health at baseline assessment and the risks of COVID-19 experienced during pregnancy and infant age at follow-up assessments. Study participants were provided with A$100 Amazon gift vouchers for the initial survey and A$20 for follow-up surveys.


The average age of study participants was 32 years, and among study participants, 28% (n=88), 30% (n=94), and 43% (n=136) lived in Australia, the United States, and the United Kingdom, respectively. among whom 87% (n=276) were white and 81% (n=256) had university degrees. A history of psychiatric disorders was reported by 36% (n=114) of study participants.

Other races and ethnicities included in the population sample were Aboriginal or Torres Strait Islander, Asian, Hispanic, mixed or other, between two, 12, eight, seven and 10 participants respectively. 19 women received secondary education, and 41 women received professional or vocational training.

At baseline, the mean values ​​for number of children and gestational age (in months) were 1.20 and 5.80, respectively. At the final assessment, the average age of the baby was 14 months. Prenatal stress related to COVID-19 showed significant associations with distress, anxiety, and depression among mothers and negative affectivity among infants in the postpartum period. Sensitivity analyzes yielded similar findings.

At baseline, three women showed mild GAD and depression (mean GAD-7 and Patient Health Questionnaire scores of 6.70 and 7.80, respectively), and symptoms remained elevated for 17.0 months postpartum. There were no interactive associations between infant age and antenatal stress associated with SARS-CoV-2 infection and infant health outcomes.


Overall, the study results suggest that antenatal stressors associated with the pandemic should be targeted to improve maternal and infant postnatal outcomes. Expectant women should be considered vulnerable and prioritized during COVID-19 and other pandemics and provided with appropriate care for physical and mental well-being.

Additional research should be conducted to determine methods to reduce pandemic-related stress to promote maternal and newborn well-being in the postpartum period. Long-term associations between SARS-CoV-2 infection-related stress and maternal and newborn health need to be evaluated.

Markers of psychological and biological vulnerability need to be identified among a more diverse group of pregnant women belonging to different ethnicities and living in different geographic regions in order to personalize prenatal health care.

Written by

Pooja Toshniwal Paharia

Dr. based clinico-radiological diagnosis and treatment of oral lesions and conditions and associated maxillofacial disorders.


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