Psychological Effects of COVID-19 on Pregnant Women and New Mothers Living in a US Hotspot

Abstract Background: This study investigated COVID-19 related psychological distress among expectant and new mothers, with and without infection, in metropolitan New York. It also examined the trajectories of participants' distress during pregnancy and postpartum, and the moderating effect of socioeconomic status (SES). Methods: An online survey was conducted April through June 2020 among expectant and new mothers with infants (<12 months) (N=642). Associations between infection status and psychological symptoms, suicidal ideation, and substance use were examined. Changes in distress related to COVID-19 infection and SES were then examined. Results: We found elevated anxiety and depression among infected compared to uninfected women. Similarly, infected, compared to uninfected women, had elevated risk for suicidal thoughts (quite often, AOR=3.97, sometimes AOR=13.2), and for substance use [alcohol (AOR=3.30); tobacco (AOR=4.54); cannabis (AOR=7.01); heroin (AOR=7.09); cocaine (AOR=10.05)]. Differences in trajectories of distress across pregnancy between the two groups were significant. Among infected women, distress was consistently high throughout. Among uninfected women, it started low and intensified toward the end of pregnancy. SES further moderated the impact of infection on distress. During earlier trimesters, infected/low SES women had greatest, and uninfected/high SES women had lowest, levels of distress. Their trajectories converged nearing childbirth.Conclusions: New and expectant mothers, especially those infected, have suffered substantial psychological distress due to the pandemic. Moreover, SES moderated the trajectory of distress. Infected women who also had low SES experienced the highest distress levels among all groups. Mitigating strategies are imperative to alleviate this distress.