Maternal mental health is being affected by poverty and COVID-19
Authors: Miguel Parra-Saavedra, Jezid Miranda
Journal: The Lancet Global Health (2021)

Scientific efforts during the COVID-19 pandemic, in respect to pregnancy, have shown that COVID-19 infection is associated with a substantial increase in severe maternal morbidity and mortality,1Ellington S Strid P Tong VT et al.Characteristics of women of reproductive age with laboratory-confirmed SARS-CoV-2 infection by pregnancy status–United States, January 22–June 7, 2020.MMWR Morb Mortal Wkly Rep. 2020; 69: 769-775Crossref PubMed Scopus (0) Google Scholar preterm birth, and low birthweight.2Villar J Ariff S Gunier RB et al.Maternal and neonatal morbidity and mortality among pregnant women with and without COVID-19 infection: the INTERCOVID multinational cohort study.JAMA Pediatr. 2021; (published online April 22.)https://doi.org/10.1001/jamapediatrics.2021.1050Crossref Scopus (698) Google Scholar In addition, preliminary data now suggest that vaccination in pregnant women is safe,3Shimabukuro TT Kim SY Myers TR et al.Preliminary findings of mRNA COVID-19 vaccine safety in pregnant persons.N Engl J Med. 2021; (published online April 21.)https://doi.org/10.1056/NEJMoa2104983Crossref PubMed Scopus (562) Google Scholar and that there is an infrequent possibility of vertical transmission.4Kotlyar AM Grechukhina O Chen A et al.Vertical transmission of coronavirus disease 2019: a systematic review and meta-analysis.Am J Obstet Gynecol. 2021; 224: 35-53.e3Summary Full Text Full Text PDF PubMed Scopus (373) Google Scholar Yet, less attention has been paid to the maternal health of uninfected women. Challenges that pregnant women face during the COVID-19 pandemic include fear of viral exposure, concerns about their health and of their unborn children, social isolation, childcare, and the increase of job, food, housing, and health-care insecurity.5Parra-Saavedra M Villa-Villa I Pérez-Olivo J et al.Attitudes and collateral psychological effects of COVID-19 in pregnant women in Colombia.Int J Gynaecol Obstet. 2020; 151: 203-208Crossref PubMed Scopus (48) Google Scholar Negative effects on the mental health of mothers (eg, depression, anxiety, and parenting stress) are associated with disruption in the physical, cognitive, and socioemotional development of their children.6Walsh K McCormack CA Webster R et al.Maternal prenatal stress phenotypes associate with fetal neurodevelopment and birth outcomes.Proc Natl Acad Sci USA. 2019; 116: 23996-24005Crossref PubMed Scopus (102) Google Scholar Emotional or psychological stress during pregnancy affects the neurodevelopment potential of the unborn child. This negative effect further reduces the probability of equal capabilities and opportunities as adults. Since the COVID-19 pandemic began, the consequences to specific population groups have never been fair; mortality is higher in elderly people, poorer populations, and ethnic minorities, and the economic consequences are also unequally distributed across the population.7Muñoz-Price LS Nattinger AB Rivera F et al.Racial disparities in incidence and outcomes among patients with COVID-19.JAMA Netw Open. 2020; 3e2021892Crossref PubMed Scopus (234) Google Scholar The COVID-19 pandemic is an abrupt and chronic stressor that puts several pregnant women at risk of developing mental and behavioural health problems, particularly mothers from deprived backgrounds and marginalised areas.5Parra-Saavedra M Villa-Villa I Pérez-Olivo J et al.Attitudes and collateral psychological effects of COVID-19 in pregnant women in Colombia.Int J Gynaecol Obstet. 2020; 151: 203-208Crossref PubMed Scopus (48) Google Scholar, 8Kotlar B Gerson E Petrillo S Langer A Tiemeier H The impact of the COVID-19 pandemic on maternal and perinatal health: a scoping review.Reprod Health. 2021; 18: 10Crossref PubMed Scopus (305) Google Scholar In The Lancet Global Health, Andrés Moya and colleagues analyse the effect of the COVID-19 pandemic and associated policy responses on maternal mental health in a highly vulnerable and violence-exposed population in the context of a fragile and conflict-stricken setting in Tumaco, Colombia.9Moya A Serneels P Desrosiers A Reyes V Torres MJ Lieberman A The COVID-19 pandemic and maternal mental health in a fragile and conflict-affected setting in Tumaco, Colombia: a cohort study.Lancet Glob Health. 2021; (published online June 24.)https://doi.org/10.1016/S2214-109X(21)00217-5Summary Full Text Full Text PDF PubMed Scopus (18) Google Scholar This longitudinal data analysis shows an 8-month follow-up of two cohorts (before and after the pandemic) and describes the changes in mental health and parenting stress among caregivers while adjusting for baseline characteristics. Colombia's decades-long armed conflict has left more than 260 000 people dead, and is a country that hosts the second largest number of refugees (1·7 million) and the largest number of internally displaced people (8·1 million) worldwide. In Tumaco, for instance, almost 10% of the inhabitants are internally displaced people, 45% live below the poverty line, and 92% are informal workers. Almost 44% of the population has no access to safe drinking water, and the public hospital network is deficient.9Moya A Serneels P Desrosiers A Reyes V Torres MJ Lieberman A The COVID-19 pandemic and maternal mental health in a fragile and conflict-affected setting in Tumaco, Colombia: a cohort study.Lancet Glob Health. 2021; (published online June 24.)https://doi.org/10.1016/S2214-109X(21)00217-5Summary Full Text Full Text PDF PubMed Scopus (18) Google Scholar In this worrying scene, the COVID-19 pandemic arrived and amplified existing inequalities. Moya and colleagues report that caregiver mental health significantly worsened during the COVID-19 pandemic, revealing a significant increase in anxiety, depression, and parenting stress. Specifically, participants in the post-COVID-19 cohorts had on average a 14 percentage point higher probability of reporting anxiety rates above the at-risk threshold compared with the pre-COVID-19 cohorts, which is an 88% increase in the probability of scoring above the at-risk threshold relative to the baseline mean value and a 30% increase in the probability of reporting parenting stress compared with pre-COVID-19 cohorts. These results show that the effect was greater among people who had a history of forced displacement, low levels of education, pre-existing mental health conditions, and other COVID-19-related stressors, and that these stressors increased mental health detriment in a dose-dependent manner. This study found that 70% of the participants reported a scarcity of food, resulting in an increased probability of depression (by 8 percentage points) and parenting stress (by 10 percentage points). These findings reinforce the suggestion that the adverse mental health effects of the COVID-19 pandemic varied depending on socioeconomic and violence-related vulnerabilities. The future of a society is at stake. This deep socioeconomic inequality might have profound intergenerational consequences. The circle of poverty and detriment environments for unborn children will reinforce poverty dynamics and socioeconomic exclusion that will have an effect on the next generation, who might also have to deal with an unprecedented economic crisis after the pandemic. Efforts to mitigate the effect of COVID-19 will fail without an equity lens to face health and social inequalities. We believe that, from a health-care policy perspective, legislators and those planning health-care access are responsible for considering the effect of COVID-19 on vulnerable communities, and should ensure mental health services and social support targeting gender-based violence. Regular income support for vulnerable families need to be assured. Without such action, the current health crisis will become a social crisis with long-lasting consequences for pregnant women and their unborn children among highly vulnerable and violence-exposed populations.10Kumar J Kumar P COVID-19 pandemic and health-care disruptions: count the most vulnerable.Lancet Glob Health. 2021; 9: e722-e723Summary Full Text Full Text PDF PubMed Scopus (20) Google Scholar We declare no competing interests The COVID-19 pandemic and maternal mental health in a fragile and conflict-affected setting in Tumaco, Colombia: a cohort studyMaternal mental health significantly worsened during the early stages of the pandemic. Considering the vulnerability and pre-existing mental health conditions of this population, the estimated effects are substantial. Policies in fragile and conflict-affected settings targeting IDP and other vulnerable people will be important to mitigate further mental health and socioeconomic problems. Full-Text PDF Open AccessThe need for an intersectional lens in health emergenciesIt was unsettling to read the Comment by Miguel Parra-Saavedra and Jezid Miranda (August, 2021).1 Their sense of alarm is focused on the next generation and anchored largely on the impact the COVID-19 pandemic might have on the unborn child and "the future of a society". This theoretical framing is concerning; we know that public health emergencies have a gendered impact on the lives of women, and particularly on the most vulnerable among them.2 Women are the most seriously affected,3 and global health policies continue to shift the focus away from women, even after substantial evidence has shown the importance of applying an intersectional gender lens to preparedness and response to health emergencies. Full-Text PDF Open Access