Graduation Year

2023

Document Type

Dissertation

Degree

Ph.D.

Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department

Community and Family Health

Major Professor

William M. Sappenfield, M.D., M.P.H., C.P.H.

Co-Major Professor

Cheryl Vamos, Ph.D., M.P.H.

Committee Member

Jason Beckstead, Ph.D.

Committee Member

Kimberly Fryer, M.D., M.S.C.R.

Committee Member

Abraham Salinas Miranda, M.D., Ph.D., M.P.H.

Keywords

Anxiety, Coping, Depression, Social Support, Stress

Abstract

Background: Psychosocial distress, anxiety, depression, and reduced maternal-fetal attachment (MFA) during pregnancy can negatively affect the health of both mothers and their children. Stress during pregnancy is a significant risk factor for maternal mental health issues and low MFA. The global COVID-19 pandemic, which has resulted in millions of deaths worldwide, is a major stressor that has likely had a profound impact on maternal mental health and MFA during pregnancy.

Purpose: The purpose of this study was to examine the influence of COVID-19-related psychosocial factors on the mental health and MFA in pregnant women during the COVID-19 pandemic. This study had two aims: (1) to assess the effects of COVID-19-related pregnancy stress, social support, coping strategies, anxiety, and depression on MFA, and (2) to identify factors that improved or contributed to maternal stress during the COVID-19 pandemic.

Methods: A cross-sectional anonymous survey, guided by the stress and coping theory, main-effects model, stress-buffering model, and attachment theory, was conducted from January to March 2022, involving 403 pregnant women in their third trimester during the COVID-19 pandemic. The quantitative portion gathered data on various factors, including perceived stress, pandemic-related pregnancy stress, social support, coping strategies, anxiety, depression, and MFA. Structural equation modeling was used to analyze the quantitative data. Additionally, qualitative data was collected through open-ended questions to explore the factors that increased or decreased maternal stress during the pandemic, and thematic analysis was applied.

Results: The study revealed several significant findings. While pregnancy-related anxiety and prenatal depression did not mediate the relationship between COVID-19-related pregnancy stress and MFA, the choice of coping strategies played a crucial role. Planning-preparation coping strategies had the most significant positive influence on MFA, while avoidance coping strategies and COVID-19-related pregnancy stress had the strongest association with increased pregnancy-related anxiety. Moreover, avoidance coping strategies moderated the relationship between COVID-19-related pregnancy stress and pregnancy-related anxiety. Common themes identified as increasing maternal stress included fear, worry, and anxiety related to COVID-19 infection, fear, worry, and anxiety related to preparedness for birth and the baby, prevention concerns associated with COVID-19, lack of social support, return to normalcy, social determinants of health, physical health issues, and family issues. Themes identified as reducing maternal stress were prevention concerns associated with COVID-19, coping strategies, and social support.

Conclusion: These findings hold valuable implications for perinatal healthcare providers, emphasizing the importance of enhancing mental health screening and offering tailored interventions to address the specific challenges faced by pregnant women during public health emergencies like the COVID-19 pandemic. Policymakers are encouraged to prioritize policies that support mental health education, screening, treatment, and equitable access to mental health services. This study also underscores the necessity of integrating perinatal mental health into public health emergency preparedness plans. By addressing the mental health and MFA of pregnant women during public health crises, overall health outcomes can be significantly improved.

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