Numerous research studies of catastrophic events suggest that stress linked to events such as pandemics, earthquakes and famine may be associated with immediate and long-lasting mental and physical health consequences for both mother and baby. In the context of the current COVID-19 pandemic, there are many potential sources of stress that could impact on mental health. Slowing the transmission of a virus during pandemics requires significant shifts in behaviour some of which can be detrimental to mental health. For example, a key strategy for slowing the COVID-19 pandemic is social distancing; however, as humans we have an instinctive need to connect to others. Social connection helps us cope with stress and maintain resilience (Van Bavel et al., Citation2020).
In regard to perinatal mental health, pregnant women have been identified as a vulnerable group and they are among those who are most worried and concerned about spreading or getting infected by the SARS-CoV-2 (Brooks et al., Citation2020). Restriction of movement has led to pregnant women not attending antenatal care or having their appointments by telephone or through online services. Measures to restrict the virus have also led to impaired support from relatives and friends, an increase of financial difficulties and also an increase of the risk of intimate partner and domestic violence. These potential sources of maternal stress have been identified as risk factors for mental health problems during the COVID-19 pandemic (Royal College of Obstetrics and Gynaecologists [RCOG], Citation2020). Additional sources of stress include the challenges of homeschooling, remote work and overcrowded homes (Holmes et al., Citation2020).
Poon et al. (Citation2020) found that in the course of the ongoing COVID-19 pandemic, mental health problems during pregnancy have been associated with adverse maternal and infant outcomes including suicidal ideation and an inefficient mother-infant bonding.
Research on the 1918 flu pandemic would suggest ongoing long-term monitoring of the direct and indirect outcomes for pregnant women and their families are needed following the COVID-19 pandemic. The Barker hypothesis, also known as the DOHaD hypothesis, suggests that the environment that a developing foetus is exposed to in the womb may programme the health and disease of this child from birth to death (Barker, Citation2003). From an evolutionary and adaptive perspective, a stressful environment during pregnancy prepares the foetus to adapt to the conditions the child will find after birth. In this respect, anxiety has been associated with high vigilance and deficit of attention with an elevated perception of risks (Glover, Citation2011). Longer term consequences are reflected in a Swedish study which examined the influence of foetal exposure to the 1918 flu pandemic on adult health (Helgertz & Bengtsson, Citation2019). Helgertz, & Bengtsson, found, for both men and women, foetal exposure resulted in higher morbidity in ages 54–87, as measured by hospitalisation; however, international findings from the 1918 pandemic are by no means consistent.
The COVID-19 pandemic has also highlighted inequalities and the need to identify high-risk groups of women. A recent prospective national population-based cohort study conducted in the UK describing pregnant women hospitalised with COVID-19 found that women who were minority ethnicity, overweight/obese, over 35 years old and had pre-existing comorbidities had a higher risk of SARS-CoV-2 infection (Knight et al., Citation2020). Our understanding of the science underlying why some groups are more at risk is currently limited but we need to ensure that inequalities do not continue to widen as a consequence of this pandemic.
Due to the potential direct and indirect effects COVID-19 might have on perinatal mental health, every pregnant women should be asked about their mental health at every antenatal and postnatal appointment (RCOG, Citation2020). Clinicians continue to play the key role on ameliorating the impact of COVID-19 pandemic on women in the perinatal period and they need support by research that rigorously evaluates the short and longer term impact of COVID-19 on mothers, babies and families.
Disclosure statement
No potential conflict of interest was reported by the authors.
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