Is COVID-19 related stress a distinct disorder? The different aspects of the impact of pandemic stress on pregnancy and child birth

The appearance of COVID-19 created a pandemic catastrophic event with impact on all human beings on nearly all areas of daily life. This prompted research into COVID-19 related effects on a variety of health outcomes in different populations. Women in peripartum period became a specific group of interest, as they unavoidably faced many different aspects of COVID-related stress. These stressors related to the direct effects of the virus itself on pregnancy and child outcomes, fear of becoming infected and the effect of strict measures to prevent the virus from spreading further, through extensive lockdowns that limited access to support services and networks. Given these numerous types of COVID-19 related stress in peripartum period, it has been a scientific challenge to identify the distinctive characteristics of stressors and determine their impact on mother and child well-being.

In this edition, nine studies focused on the different impacts of COVID-19 in peripartum period. One article explored the impact related to a wider range of catastrophic events, including the present COVID-19 pandemic but also SARS epidemic, Gulf War and a nuclear threat [1]. Women exposed to catastrophic events reported an increased risk of anxiety compared to controls. Interestingly, the effect seemed to be more pronounced in low-risk pregnancies, which is explained by the authors as a natural reaction to a prevailing uncertainty. In line with this research, Chaibekava et al. 2022 evaluated whether women experienced a diminished sense of control as a specific consequence of childbirth during COVID-19 [2]. Their assumption was that during labor and birth, a sense of control is important to women, since it is a significant predictor of long-term effects on health and well-being of mother and child. However, they showed that the specific restrictions in maternity care, that included limitation to one companion during labor, limited face-to-face interaction with healthcare providers, social distancing and not allowing visitors during maternity period, did not impact women’s sense of control during childbirth. Another study in this issue showed that women who delivered during the COVID-19 pandemic had higher stress levels at full dilation and lower cord cortisol levels, consistent with a chronic stress response [3]. Taken together, these results indicate that COVID related stress might point toward a normal reaction to a stressful event irrespective of coping related to giving birth.

In addition, the question arises how to measure COVID-related peripartum stress as a specific entity distinct from mental disorders such as depression, anxiety and post-traumatic stress. In this edition two instruments were validated for COVID-related stress. Soto Briseno et al. 2022, validated a modification of the existing COVID-19 Fear Scale (FCV-19S) to make it applicable for the specific group of peripartum women [4]. They confirmed that adding a question specifically focusing on worry and fear related to exposure and/or infection of the newborn contributed to its applicability during the peripartum period. Levison et al. 2022, expanded the previously validated Pandemic-Related Pregnancy Stress Scale (PREPS) into a postpartum version [5]. The subscales preparedness for the postpartum and concerns about infection of the PREPS-PP only modestly correlated with common anxiety measures, suggesting that the PREPS-PP successfully assessed pandemic related stress. Moreover, associations with individual characteristics, such as chronic medical conditions, primiparity and pandemic-related conditions such as worries about a loved one getting infected and loss of income with COVID-19, suggest that the instrument was appropriately sensitive to these factors.

Given the progress being made in identifying specific aspects and associated factors of COVID-19 related stress, the next step will be to investigate its specificity on long-term mother and child outcomes. For this it will be important to know whether these outcomes differ from outcomes related to common psychiatric disorders such as anxiety and depression. If COVID-19 related stress could indeed be considered a normal reaction to an abnormal situation, these effects hopefully might be to some extent mitigated by returning to normal life postpandemic.

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