"COVID-19 has caused a spike in post-traumatic stress among pregnant and postpartum women, internet-delivered cognitive behavioral therapy may help make treatment more accessible and less expensive for kids with social anxiety disorder, and other mental health news from spring 2021.
Pregnant Women Are More Vulnerable to Mental Health Problems Due to the COVID-19 Pandemic
What’s New Pregnant and postpartum women in 64 countries, including the United States, have been experiencing a higher level of symptoms of post-traumatic stress, depression, anxiety, and loneliness as a result of the ongoing COVID-19 pandemic, according to a study published in April 2021 in PLOS One. Factors that put women at the greatest risk were worrying about their children and medical care, as well as seeking information about the pandemic at least five times a day from any source, whether online searches or talking to others.
Research Details Nearly 6,900 pregnant and postpartum women from around the world participated in an online survey advertised on social media and online parenting forums. The survey found that 43 percent of women demonstrated higher levels of post-traumatic stress, 31 percent of women experienced more symptoms of depression and anxiety, and 53 percent of women had high levels of loneliness. Other key findings:
Why It Matters Psychological distress during pregnancy and after birth can negatively impact both mothers’ and their children’s health. “We know that maternal mental health has adverse effects on a range of outcomes for the offspring — for example, infant outcomes, mother-infant bonding, and later offspring physical and behavioral health,” says study author Karestan Koenen, PhD, a professor of psychiatric epidemiology at the Harvard T.H. Chan School of Public Health in Boston, adding that helpful ways to care for mental health could include:
Mental health screening among pregnant and postpartum women is also key, but efforts shouldn’t stop there, says study author Archana Basu, PhD, a research scientist at the Harvard T.H. Chan School of Public Health.
“In addition to screening and monitoring mental health symptoms, addressing potentially modifiable factors such as excessive information seeking and women’s worries about access to medical care and their children’s well-being, and developing strategies to target loneliness such as online support groups, should be part of intervention efforts for perinatal women,” says Dr. Basu."
By Ivana Kottasová, CNN | July 31, 2021
(CNN)-"The Delta variant of Covid-19 is dominating cases worldwide, and health officials in some countries are sounding alarm over its impact on pregnant women.
Several of England's top health officials issued a joint statement on Friday urging pregnant women to get vaccinated against the coronavirus. They pointed to new data showing that 98% of expectant mothers admitted to the hospital with Covid-19 in the country since May were unvaccinated.
The World Health Organization (WHO) has also previously said that infected, pregnant women face an increased risk of developing severe Covid-19 compared with non-pregnant women of a similar age.One concern is that risk might be even higher with the Delta strain, which has been shown to be more contagious and can cause more severe disease compared to the earlier variants of the virus.Here's what you need to know.
Is Delta more dangerous if you're pregnant?
The Delta variant is more contagious and can cause more severe disease for everyone, including pregnant women.The latest data gathered by the UK Obstetric Surveillance System (UKOSS) showed the number of pregnant women that are being admitted to hospital with Covid-19 is increasing in the UK due to the Delta strain.
"Compared to the original Covid virus the new variants (alpha and then delta) caused progressively more severe disease in pregnant women," Andrew Shennan, professor of obstetrics at King's College London, said in a statement to the UK's Science Media Centre. "This included need for ventilation, intensive care admission and pneumonia, more than 50% more likely to occur," he added.
The data collected by UKOSS show that around 33% of women in hospital with Covid-19 needed respiratory support and that 15% needed intensive care.
The UKOSS data only includes pregnant women. However, the group said that while the increase in hospitalizations was broadly in line with the current rise in Covid-19 hospital admissions in the UK's general population, the data highlights an increase among pregnant women needing care for acute symptoms.
What about risks to the baby?
Previous studies have shown that Covid-19 infection raises the risk of negative outcomes for both the mother and the baby. These risks include preeclampsia, infections, admission to hospital intensive care units and even death.
According to an April study published in JAMA Pediatrics that looked at over 2,000 pregnant women in 43 medical institutions across 18 countries, babies born to mothers infected with the coronavirus were also at a somewhat higher risk of preterm birth and low birth weight.
The new data collected by UKOSS showed that one in five women admitted to hospital with serious Covid-19 symptoms went on to give birth prematurely, and the likelihood of delivery by C-section doubled. One in five babies born to mothers with coronavirus symptoms were also admitted to neonatal units.
Is the vaccine safe for pregnant people?
Yes. Studies and real-world data have shown there are no specific safety concerns for pregnant people or their babies on taking a Covid-19 vaccine.
"Hundreds of thousands of pregnant women worldwide have been vaccinated, safely and effectively protecting themselves against Covid and dramatically reducing their risk of serious illness or harm to their baby," Gill Walton, the chief executive of the Royal College of Midwives in the UK, said in a statement on Friday.
The US Centers for Disease Control and Prevention, the Joint Committee on Vaccination and Immunization in the UK and Australia's Technical Advisory Group on Immunization all advise pregnant women to get a Covid-19 shot. The WHO says that pregnant women should get the vaccine in situations where the benefits of vaccination outweigh the potential risks -- such as if they are living in areas with high number of cases."
By MGH Center for Women's Mental Health | June 10th, 2021
"When we meet with women for perinatal psychiatry consultations, we now ask about vaccinations. It’s not something we typically do, but after the last year, we are now getting involved in their decisions regarding vaccination against COVID-19. Just as we counsel women to avoid alcohol and to consistently take their prenatal vitamins, providing information on the COVID-19 vaccine is an important aspect of promoting the health of pregnant and postpartum women.
Considering a growing body of evidence indicating that pregnant women are more likely to have certain manifestations of severe COVID-19 illness, including admission to the ICU and mechanical ventilation, the American College of Obstetricians and Gynecologists (ACOG) has urged the CDC’s Advisory Committee on Immunization Practices to include pregnant and lactating women in the high-priority populations for COVID-19 vaccine allocation. ACOG clearly states that all pregnant and lactating people should be allowed to receive the vaccine, and that their decision to do so should be based on a careful discussion of risks and benefits with their healthcare provider.
From our vantage point, there are other benefits to the COVID-19 vaccine. During the past year, before the vaccination was available, we watched as pregnant and postpartum patients undertook the most extreme forms of lockdown. Many of these women were literally housebound: never leaving the house and cutting off contact with friends and family, while at the same time taking on more childcare responsibilities as outside care providers and day care centers were no longer available. And all the while wondering what would happen if they or a member of their family felt ill?
We are yet to fully appreciate the impact of the COVID-19 pandemic on perinatal women, but preliminary studies indicate that during the lockdown, pregnant and postpartum women reported higher levels of stress, loneliness, depression, and anxiety. And this is not really a surprise. So many of the things we typically recommend to reduce stress and social isolation, such as exercising regularly or spending time with friends and family, vanished.
While it might seem like the pandemic is fading into the distance, the resurgence of the pandemic in places like India and Brazil where immunization rates are low, we cannot be so sure about this. So far the most successful way to avoid becoming seriously ill with COVID-19 is to get vaccinated.
A recent article in Medscape, however, suggests that mothers appear to be less likely to get vaccinated than others in the general population. According to a recent poll from Morning Consult, about two-thirds of adults in the US have either already been vaccinated against COVID-19 or plan to do so. In contrast, mothers are the most likely to be hesitant about the vaccine. In this study, 51% of the mothers reported that they are unwilling to get vaccinated or are uncertain about getting vaccinated, at 51% (compared to 32% of other women and 29% of fathers)."
"Seaneen Molloy was excited to discover she was expecting her second baby during lockdown. With a history of mental illness, she carefully planned the pregnancy, but when her baby arrived she experienced the "terrifyingly rapid" onset of a crisis which left her unable to hold baby Jack."
"Having a baby is supposed to be a joyful experience, and for lots of women it is. However, up to 20% experience mental ill health during pregnancy and the year after birth. Tragically, suicide is the leading cause of death in new mothers.
Women who already have a mental illness are at a high risk of relapse during pregnancy - that's women like me.
I have a diagnosis of bipolar disorder and an anxiety disorder. This meant that pretty much from the moment I became pregnant, the perinatal mental health team were involved.
This includes specialist midwives, psychiatrists, nurses and social workers whose goal is to support women to stay well, and intervene quickly if they don't.
Normally, I manage my mental health by being careful with my sleep and leading a pretty boring life away from overwork and alcohol, but pregnancy chucks in a host of factors you have no control over.
Hormones rage through your body, wreaking havoc upon your mood, your energy levels and your ability to keep your lunch down. You either can't stay awake or are awake for hours - peeing a thousand times and being hoofed by tiny feet.
I had managed to stay well, and off medication, for years, but in the run-up to birth antipsychotic medication was introduced to prevent postpartum psychosis. This can cause women to develop delusions and lose touch with reality.
It's the one I was most at risk of developing due to my history of bipolar disorder, but in the end, I experienced postnatal anxiety.
My mental health had been largely OK during my pregnancy and my labour and after-care were carefully planned.
I had a calm elective Caesarean section due to a traumatic first birth, a room of my own and the baby was whisked away on his inaugural night so that I could get some all-important sleep (this bit was hard - it went against every natural instinct). A procession of midwives, doctors and social workers visited to see how I was doing.
Although I found it intrusive, it helped me feel safe. When I was discharged from hospital with my baby, Jack, I felt swaddled in care and confident everything would be OK.
It was a complete shock that I did get ill.
In the chaos of newborn-life I forgot a dose of my anti-clotting medication which is given to mothers after C-sections.
And this one tiny event broke my brain.
I went from mildly chiding the home treatment team for their postnatal visits, because I was fine, to a full-blown mental health crisis within about 12 hours. It was terrifyingly rapid - which is why perinatal mental illness can be so deadly.
My mild anxiety exploded into an all-consuming panic that I was going to die imminently from a blood clot in my lung. I couldn't think of anything else but the black terror of certain death that was coming for me - how I was going to leave my children, how I'd brought a new child into the world never to know me.
I called out-of-hours GPs describing symptoms I was convinced I had, sobbed, screamed and couldn't breathe. I terrified my husband and myself.
Then we hit the emergency button.
The psychiatrist came over with the home treatment team. They took my fears seriously, which I appreciated, and gave me a physical examination and the missed dose of medication. My antipsychotic medication was increased to the maximum dose and benzodiazepines - a type of sedative - prescribed, to try and calm me down.
I wasn't allowed to be left alone and the mental health team were to visit me every day where I tried to articulate my terror to their masked faces.
At first I resented their visits, but they became a 30-minute space where I could let down the exhausting facade and share how I was really feeling.
My anxiety then transformed into an obsession that Jack was going to die. I was afraid to leave the room and rested my hand on his chest all night.
If my husband took him out to the shops with his brother, I cried and paced about, imagining they had all been hit by a car. I texted him incessantly.
Everyone was saying I needed "rest", so he tried to give me space. But after the second or third breakdown, he agreed to keep his phone on loud and to answer quickly. The home treatment team also advised he give me clear timescales so I knew when to expect them home.
But the medication also caused intense restlessness. I couldn't sit still. I couldn't get comfortable enough to hold my baby for more than a minute."
"Women who had Covid while expecting experienced guilt, shame and unhealthy levels of stress."
By Katharine Gammon | December 14, 2020
"Kate Glaser had chalked up her exhaustion to being 39 weeks pregnant and having twin toddlers in the house. She also wondered whether her flulike symptoms were a sign that she was about to go into labor. But when she woke up one morning with a 100.4-degree fever, she called her doctor and got a rapid Covid-19 test.
Two nurses came to deliver her results to her in the waiting room. They were dressed in full gowns, masks, face shields and gloves.
“I knew by the eerie silence and the way they were dressed that I was Covid positive,” she said. “It was an emotional moment; I felt really disappointed and shocked and, as a mom, I felt a lot of guilt. What did I do wrong?”
Glaser, who lives in the Buffalo, N.Y., area, returned home and isolated from her husband and the twins in her bedroom, where she spent hours mentally replaying all her activities leading up to the positive test result. She also made a public post on her Facebook page about her positive status, and what she was feeling — guilt, embarrassment and panic. The post went viral, and Glaser started hearing from women around the world who were pregnant and worried about Covid-19. The majority of the of the 2,300 comments she received were supportive; a few were harshly critical.
“I was going down a rabbit hole of guilt and stress,” Glaser said, adding that for her, as much as the physical symptoms were bad, the mental stress of Covid was much worse.
Prolonged stress can have real consequences on pregnant people even outside of a pandemic and has been tied to low birthweight, changes in neurological development and other health impacts in children. And the pressure associated with a positive Covid-19 test increases these mental health risks.
The anxiety is not without reason. As of November 30, there have been more than 42,000 cases of coronavirus reported in pregnant women in the U.S., resulting in 57 maternal deaths. U.S. health officials have said pregnancy increases the risk of severe disease for mother and child, and being coronavirus-positive in late pregnancy may increase the rate of preterm birth.
Prenatal care and birth plans are also disrupted by a positive test result. “Women are expressing so much fear about being infected, but also about going to the hospital, delivering and being separated from their child,” said Laura Jelliffe-Pawlowski, an epidemiologist who is the primary investigator of HOPE COVID-19, a new study that focuses on the well-being of women who are pregnant during the pandemic.
The study launched in July and will follow more than 200 women around the world, from pregnancy to 18 months postpartum, to understand how Covid-19 and the pandemic response impacts pregnancy and infant health outcomes.
Dr. Jelliffe-Pawlowski and her team have analyzed the data from the first group of women, and they are finding “absolutely incredible” levels of stress and anxiety. “Sixty percent of women are experiencing nervousness and anxiety at levels that impede their everyday functioning,” she said, citing preliminary data. “There are a number of women, particularly lower-income women, expressing how hard it is to choose to stay in a job that puts them at risk versus quitting the job and not having enough food for their baby.”
Nearly 70 percent of the participants reported feeling worried about decreasing family income and more than 22 percent worried about food insecurity (though none had experienced it at the time of the survey). Dr. Jelliffe-Pawlowski worried that women were not necessarily getting the psychological care they needed: “If you can’t feed your family, seeking out mental health care is not your top priority.”
She also said more than 84 percent of women reported moderate to severe anxiety about giving birth during a pandemic. “Many women do not want to get tested because they will be stigmatized or separated from their baby or not allowed to have people in the room to support them,” she said. She added that similar visiting rules often hold true for babies in the NICU after being born preterm during the pandemic: Only one parent can be present in a 24-hour period. “It’s heart-wrenching to see families go through those choices.”
Dr. Jelliffe-Pawlowski is particularly interested in how stress impacts births and long-term outcomes for children as psychological stress is highly associated with preterm birth. After the attacks of September 11, 2001, the risk of preterm births almost doubled for people living near or working at the site of the fallen towers. She’s also concerned about long-term effects of stress and anxiety on maternal bonding during the pandemic.
Margaret Howard, a psychologist at Women & Infants Hospital in Providence and postpartum depression researcher at Brown University thinks it is absurd for pregnant women who test positive for an infectious virus to bear any guilt or stress associated with their diagnosis: “Are moms in a special category where they are expected to not get Covid? What about a sinus infection? Hay fever? Cancer? Why is Covid a moral failing for mothers?”
When Erica Evert, a pregnant mom in northern Virginia, received her postive Covid-19 test result, it didn’t make sense. She was near the end of her pregnancy, and hadn’t left the house in four and a half months, except for ob-gyn appointments to check on the baby.
“My first thought was, is this a false positive? I feel fine. And my second reaction was to start bawling,” said Evert. She was scheduled to have a cesarean section with her second baby and the test was merely a formality — until it was a life-changing event.
The hospital gave her a choice: She could deliver the next day and be treated as a Covid-19 patient — separated from her baby with no skin-to-skin contact, per the hospital’s policies. Or she could wait 10 days from the date she received the positive test result and deliver with her regular plan. She had four hours to make a choice she wasn’t expecting. “I kept thinking: am I going to make a decision that results in my child dying?” said Evert."