Serwaa S Omowale1,2, Andrea Casas3, Yu-Hsuan Lai3, Sarah Annalise Sanders2, Ashley V Hill4, Meredith L Wallace5, Stephen L Rathbun6, Tiffany L Gary-Webb4, Lora E Burke7, Esa M Davis8, Dara Daneen Mendez2,4,8. 1. School of Social Work, University of Pittsburgh, Pittsburgh, US. 2. Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, US. 3. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, US. 4. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, US. 5. Department of Psychiatry, University of Pittsburgh, Pittsburgh, US. 6. Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, US. 7. Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, US. 8. Division of Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, US.
Abstract
BACKGROUND: Stress is associated with adverse birth and postpartum health outcomes. Few studies have longitudinally explored racial differences in maternal stress in a birthing population in the United States (US) 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. We divided data into four phases based on significant events during the COVID-19 pandemic: 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 linear mixed-effects models and post-hoc contrasts based on the models. RESULTS: Overall mean stress (0="not at all" to 4="a lot") 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 0.3 points (t=5.2, df=5649, P<0.0001) in the during-phase as compared with the pre-phase, and an increase of 0.2 points (t=3.1, df=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 ̂= -0.02, P=0.87). 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 ̂ = 0.4, 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 US. INTERNATIONAL REGISTERED REPORT: RR2-10.2196/13569.
BACKGROUND:Stress is associated with adverse birth and postpartum health outcomes. Few studies have longitudinally explored racial differences in maternal stress in a birthing population in the United States (US) 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. We divided data into four phases based on significant events during the COVID-19 pandemic: 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 linear mixed-effects models and post-hoc contrasts based on the models. RESULTS: Overall mean stress (0="not at all" to 4="a lot") 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 0.3 points (t=5.2, df=5649, P<0.0001) in the during-phase as compared with the pre-phase, and an increase of 0.2 points (t=3.1, df=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 ̂= -0.02, P=0.87). 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 ̂ = 0.4, 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 US. INTERNATIONAL REGISTERED REPORT: RR2-10.2196/13569.
Authors: Serwaa S Omowale; Tiffany L Gary-Webb; Meredith L Wallace; John M Wallace; Mary E Rauktis; Shaun M Eack; Dara D Mendez Journal: Womens Health (Lond) Date: 2022 Jan-Dec