BACKGROUND
Stress has been associated with adverse birth and postpartum health outcomes. Few studies have explored racial differences in maternal stress in a birthing population longitudinally in the United States (U.S.) during the ongoing COVID-19 pandemic.
OBJECTIVE
This study aimed to: (1) assess changes in reported stress before, during, and after initial emergency declarations (e.g., stay-at-home orders) were in place due to the COVID-19 pandemic and (2) assess Black-White differences in reported stress in a pregnant and postpartum population from Southwestern Pennsylvania.
METHODS
We leveraged data from the ongoing Postpartum Mothers Mobile Study (PMOMS) which surveys participants in real-time throughout the pregnancy and postpartum periods via ecological momentary assessment (EMA) and smartphone technology. We analyzed data from a subset of PMOMS participants (n=85) who were either Black or White, and who submitted EMA responses regarding stress between November 1, 2019 and August 31, 2020, the timeframe of this study. Data were divided into four phases based on significant events during the COVID-19 pandemic: a pre-phase (baseline), early-phase (first case of COVID-19 reported in U.S.), during-phase (stay-at-home orders), and post-phase (stay-at-home orders eased). We assessed mean stress levels at each phase using mixed-effects models and post-hoc contrasts based on the models.
RESULTS
Overall mean stress (min: 0, max: 4 as measured by a modified Cohen Perceived Stress Scale) during the pre-phase was 0.8 for Black and White participants [range for Black participants: 0-3.9, range for White participants: 0-2.8]. There was an increase of 0.26 points (t=5.19, d.f.=5649, p<.0001) in the during-phase as compared with the pre-phase, and an increase of 0.19 points (t=3.09, d.f.=5649, p=0.002) in the post-phase compared with the pre-phase (n=85). No difference was found between Black and White participants in the change in mean stress from the pre-phase to the during-phase (δ ̂= -0.016, p=0.867). There was a significant difference between Black and White participants in the change in mean stress from the during-phase to the post-phase (δ ̂ = -0.39, p<0.0001).
CONCLUSIONS
There was an overall increase in mean stress levels in this subset of pregnant and postpartum participants during the same time as the emergency declarations/stay-at-home orders in the US. Compared to baseline, mean stress levels remained elevated when stay-at-home orders eased. We found no significant difference in the mean stress levels by race. Given that stress is associated with adverse birth outcomes and postpartum health, stress induced by the ongoing COVID-19 pandemic may have adverse implications for birthing populations in the U.S.
INTERNATIONAL REGISTERED REPORT
RR2-10.2196/13569
Creating New Strategies to Enhance Postpartum Health and Wellness
