In a recent study published in the journal Infancy, researchers looked for evidence of prenatal stress during the coronavirus disease 2019 (COVID-19) pandemic, which may have adversely affected infants.
Study: Prenatal stress lability during the COVID-19 pandemic is linked to negative childhood outcomes. Image credit: maxbelchenko/Shutterstock
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The COVID-19 pandemic served as an ideal time to examine fluctuations in prenatal stress levels of pregnant women during the already difficult period of pregnancy. Emotional dysregulation in early childhood is a transdiagnostic indicator of later developmental psychopathology.
Therefore, several research studies have examined whether perceived stress during the prenatal period causes emotional dysregulation in infants. However, retrospective studies documented past prenatal stress measured at a single time point. Furthermore, despite the correlation between prenatal stress and child development evidenced in previous literature, the mechanisms that drive them, and the levels or patterns at which prenatal stress becomes detrimental, have remained unknown.
About the study
In the present study, researchers used the ecological momentary assessment (EMA) method to collect intensive stress data via text messages. These data better captured the gestational experience than retrospective questions about past stress measured at a single time point.
They determined three indicators of prenatal stress using EMA: initial stress, average stress, and stress lability. They determined its relationship with the social-emotional development of three-month-old infants. Stress lability, the extent to which stress levels fluctuate over time during pregnancy, is the most useful predictor of adverse neurodevelopmental outcomes with important implications for prevention.
The team did the initial assessment using an online tool called REDCap between four and 22 weeks of gestation. Mothers completed the 10-item version of the Perceived Stress Scale (PSS-10). For the average assessment of prenatal stress, they used up to four times a day with the same four items of the PSS (PSS-4). They examined correlations between EMA time and stress levels over the 14-week EMA period.
For stress lability, the researchers used the Child Behavior Questionnaire-Revised: Very Short Form (IBQ-R-VSF), focusing on the negative affect dimension, which consists of 12 items from three subscales: sadness, anxiety at limitations and fear. The mother completed the IBQ-R-VSF at the three-month assessment using a seven-point scale ranging from one to seven, with one indicating “never” and seven indicating “always.” The team summed the response scores for the individual items and calculated their mean, where higher scores indicated more negative affect on the infants.
The team used a t-test to determine whether baseline stress levels varied by the time of study enrollment relative to the start of the pandemic, i.e. March 20, 2020. The study participants were urban US women aged 18 or older with access to a smartphone and wireless internet. They were recruited between nine and 20 weeks of gestation and followed until their child’s second birthday.
Results of the study
The current study analyzed prenatal and infant outcome data from 72 women and 39 female and 33 male infants. The mean age of the infants at outcome was 3.45 months. Almost 39% of mothers completed their EMAs before March 20, 2020, and ~61% of mothers completed their EMAs on or after March 20, 2020.
The main finding of the study was that baseline stress did not differ depending on whether mothers completed the EMA before or during the COVID-19 pandemic. Clearly, the timing of EMA was not correlated with mean stress and stress lability. Several previous studies have found significant effects of COVID-19 on mental health; therefore, this was an unexpected finding. A possible explanation could be that the current study population was of highly educated middle and upper class women. They had more economic and social support and were better able to protect themselves from COVID-19. They were generally not afraid of job loss, lack of social support, and exposure to disease.
The current study examined expectant mothers’ emotional dysregulation by statistically capturing natural day-to-day stress variations during pregnancy through multi-day reports over 14 weeks of pregnancy using differences successive mean squares (MSSD). The authors monitored the proportion of EMAs completed during the pandemic. Surprisingly, mothers who completed more EMAs during the pandemic, reflecting spending more time pregnant during the COVID-19 pandemic, reported lower levels of negative affect in their infants. This finding suggested that these women were better able to adapt to the demands of a changing environment, which may have had a positive effect on the baby’s development.
The current study did not estimate postnatal stress lability and mechanisms underlying stress lability. Future research should examine why large fluctuations in stress may be important for infants’ social-emotional development in the prenatal period. In addition, caution should be exercised when interpreting the association between prenatal stress lability and childhood negative affect.
Conclusions
The current study demonstrated how daily fluctuations in an expectant mother’s stress during pregnancy during the COVID-19 pandemic could have influenced child neurodevelopmental outcomes. Thus, the study emphasized child developmental trajectories, focusing on underlying biological mechanisms and repeated measurement of constructs.
Future research should examine these stress variations and their correlation with child outcomes using a larger study sample than the one used in the current study. Given that depressive symptoms and anxiety may have unique and additive effects on early infant outcomes, future studies should also consider these aspects, especially considering the benefits of interventions related to these conditions to improve the maternal welfare
Journal reference:
- Leigha A. MacNeill, Sheila Krogh-Jespersen, Yudong Zhang, Gina Giase, Renee Edwards, Amelie Petitclerc, Leena B. Mithal, Karen Mestan, William A. Grobman, Elizabeth S. Norton, Nabil Alshurafa, Judith T. Moskowitz, Darius Tandon , Lauren S. Wakschlag. (2022). Prenatal stress lability during the COVID-19 pandemic is linked to adverse childhood outcomes. doi: