Abstract
The COVID-19 pandemic has been linked to increased risk for perinatal anxiety and depression among parents, as well as negative consequences for child development. Less is known about how worries arising from the pandemic during pregnancy are related to later child development, nor if resilience factors buffer negative consequences. The current study addresses this question in a prospective longitudinal design. Data was collected from a sub-study (n = 184) of a longitudinal study of pregnant individuals (total n = 1173). During pregnancy (April 17–July 8, 2020) and the early postpartum period (August 11, 2020–March 2, 2021), participants completed online surveys. At 12 months postpartum (June 17, 2021–March 23, 2022), participants completed online surveys and a virtual laboratory visit, which included parent–child interaction tasks. We found more pregnancy-specific pandemic worries were prospectively related to lower levels of child socioemotional development based on parent report (B = − 1.13, SE = .43, p = .007) and observer ratings (B = − 0.13, SE = .07, p = .045), but not to parent-reported general developmental milestones. Parental emotion regulation in the early postpartum period moderated the association between pregnancy-specific pandemic worries and child socioemotional development such that pregnancy-specific pandemic worries did not relate to worse child socioemotional development among parents with high (B = − .02, SE = .10, t = − .14, p = .89) levels of emotion regulation. Findings suggest the negative consequences of parental worry and distress during pregnancy on the early socioemotional development of children in the context of the COVID-19 pandemic. Results highlight that parental emotion regulation may represent a target for intervention to promote parental resilience and support optimized child development.
Similar content being viewed by others
Data Availability
All data can be made available upon request.
References
Stokes EK (2020) Coronavirus disease 2019 Case surveillance — United States, January 22–May 30, 2020. MMWR Morb Mortal Wkly Rep. https://doi.org/10.15585/mmwr.mm6924e2
CDC (2022) Pregnant and Recently Pregnant People. In: Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/pregnant-people.html. Accessed 5 Apr 2022
Chmielewska B, Barratt I, Townsend R et al (2021) Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis. Lancet Glob Health 9:e759–e772. https://doi.org/10.1016/S2214-109X(21)00079-6
Kotlar B, Gerson E, Petrillo S et al (2021) The impact of the COVID-19 pandemic on maternal and perinatal health: a scoping review. Reprod Health 18:10. https://doi.org/10.1186/s12978-021-01070-6
Berthelot N, Lemieux R, Garon-Bissonnette J et al (2020) Uptrend in distress and psychiatric symptomatology in pregnant women during the coronavirus disease 2019 pandemic. Acta Obstet Gynecol Scand 99:848–855. https://doi.org/10.1111/aogs.13925
Davenport MH, Meyer S, Meah VL et al (2020) Moms are not OK: COVID-19 and maternal mental health. Front Glob Womens Health 1:1. https://doi.org/10.3389/fgwh.2020.00001
Gur RE, White LK, Waller R et al (2020) The disproportionate burden of the COVID-19 pandemic among pregnant black women. Psychiatry Res 293:113475. https://doi.org/10.1016/j.psychres.2020.113475
Kornfield SL, White LK, Waller R et al (2021) Risk and resilience factors influencing postpartum depression and mother-infant bonding during COVID-19: study examines postpartum depression and mother-infant bonding during the COVID-19 pandemic. Health Aff 40:1566–1574. https://doi.org/10.1377/hlthaff.2021.00803
Saccone G, Florio A, Aiello F et al (2020) Psychological impact of coronavirus disease 2019 in pregnant women. Am J Obstet Gynecol 223:293–295. https://doi.org/10.1016/j.ajog.2020.05.003
Wu Y, Zhang C, Liu H et al (2020) Perinatal depressive and anxiety symptoms of pregnant women during the coronavirus disease 2019 outbreak in China. Am J Obstet Gynecol 223:240.e1-240.e9. https://doi.org/10.1016/j.ajog.2020.05.009
Yan H, Ding Y, Guo W (2020) Mental health of pregnant and postpartum women during the coronavirus disease 2019 pandemic: a systematic review and meta-analysis. Front Psychol 11:617001. https://doi.org/10.3389/fpsyg.2020.617001
Lautarescu A, Craig MC, Glover V (2020) Prenatal stress: Effects on fetal and child brain development. International review of neurobiology. Elsevier, Amsterdam, pp 17–40
Robinson LR, Bitsko RH, Thompson RA et al (2017) CDC grand rounds: addressing health disparities in early childhood. MMWR Morb Mortal Wkly Rep 66:769–772. https://doi.org/10.15585/mmwr.mm6629a1
Sandman CA, Davis EP, Buss C, Glynn LM (2012) Exposure to prenatal psychobiological stress exerts programming influences on the mother and her fetus. Neuroendocrinology 95:8–21. https://doi.org/10.1159/000327017
Masten AS, Osofsky JD (2010) Disasters and their impact on child development: introduction to the special section: disasters and their impact on child development. Child Dev 81:1029–1039. https://doi.org/10.1111/j.1467-8624.2010.01452.x
Schoenmakers S, Verweij EJ, Beijers R et al (2022) The impact of maternal prenatal stress related to the COVID-19 pandemic during the first 1000 days: a historical perspective. IJERPH 19:4710. https://doi.org/10.3390/ijerph19084710
Squires K, Hookway E, Márquez-Grant N (2022) Don’t forget the children! a review of the consequences of natural disasters and epidemics on childhood health and mortality in the past. Child Past. https://doi.org/10.1080/17585716.2022.2036299
Macy ML, Huetteman P, Kan K (2020) Changes in primary care visits in the 24 weeks after COVID-19 stay-at-home orders relative to the comparable time period in 2019 in Metropolitan Chicago and Northern Illinois. J Prim Care Community Health 11:2150132720969557. https://doi.org/10.1177/2150132720969557
Calvano C, Engelke L, Di Bella J et al (2022) Families in the COVID-19 pandemic: parental stress, parent mental health and the occurrence of adverse childhood experiences—results of a representative survey in Germany. Eur Child Adolesc Psychiatry 31:1–13. https://doi.org/10.1007/s00787-021-01739-0
Chanchlani N, Buchanan F, Gill PJ (2020) Addressing the indirect effects of COVID-19 on the health of children and young people. CMAJ 192:E921–E927. https://doi.org/10.1503/cmaj.201008
Deoni SC, Beauchemin J, Volpe A et al (2021) Impact of the COVID-19 pandemic on early child cognitive development: initial findings in a longitudinal observational study of child health. Pediatrics. https://doi.org/10.1101/2021.08.10.21261846
Duguay G, Garon-Bissonnette J, Lemieux R et al (2022) Socioemotional development in infants of pregnant women during the COVID-19 pandemic: the role of prenatal and postnatal maternal distress. Child Adolesc Psychiatry Ment Health 16:28. https://doi.org/10.1186/s13034-022-00458-x
Shakiba N, Perlstein S, Powell T et al (2022) Prospective associations between pandemic-related adversity, harsh parenting, and the development of prosociality across middle to late childhood. Dev Psychol. https://doi.org/10.1037/dev0001475
Shuffrey LC, Firestein MR, Kyle MH et al (2022) Association of birth during the COVID-19 pandemic with neurodevelopmental status at 6 months in infants with and without in utero exposure to maternal SARS-CoV-2 infection. JAMA Pediatr. https://doi.org/10.1001/jamapediatrics.2021.5563
Waller R, Powell T, Rodriguez Y et al (2021) The impact of the COVID-19 pandemic on children’s conduct problems and callous-unemotional traits. Child Psychiatry Hum Dev 52:1012–1023. https://doi.org/10.1007/s10578-020-01109-y
Giesbrecht RL, Patel S et al (2022) Fear of COVID-19, mental health, and pregnancy outcomes in the pregnancy during the COVID-19 pandemic study. J Affect Disord 299:483–491. https://doi.org/10.1016/j.jad.2021.12.057
Glover V (2015) Prenatal stress and its effects on the fetus and the child: possible underlying biological mechanisms. In: Antonelli MC (ed) Perinatal Programming of Neurodevelopment. Springer, New York, pp 269–283
Bale TL, Baram TZ, Brown AS et al (2010) Early life programming and neurodevelopmental disorders. Biol Psychiat 68:314–319. https://doi.org/10.1016/j.biopsych.2010.05.028
Van den Bergh BRH, van den Heuvel MI, Lahti M et al (2020) Prenatal developmental origins of behavior and mental health: the influence of maternal stress in pregnancy. Neurosci Biobehav Rev 117:26–64. https://doi.org/10.1016/j.neubiorev.2017.07.003
Porter E, Lewis AJ, Watson SJ, Galbally M (2019) Perinatal maternal mental health and infant socio-emotional development: a growth curve analysis using the MPEWS cohort. Infant Behav Dev 57:101336. https://doi.org/10.1016/j.infbeh.2019.101336
Kingston D, Tough S (2014) Prenatal and postnatal maternal mental health and school-age child development: a systematic review. Matern Child Health J 18:1728–1741. https://doi.org/10.1007/s10995-013-1418-3
Bayrampour H, Ali E, McNeil DA et al (2016) Pregnancy-related anxiety: a concept analysis. Int J Nurs Stud 55:115–130. https://doi.org/10.1016/j.ijnurstu.2015.10.023
Shao SS, Huang K, Yan SQ et al (2021) A cohort study of maternal pregnancy-related anxiety at different trimesters and infants’ neurobehavioral development. Chin J Preventive Med 55:177–183. https://doi.org/10.3760/cma.j.cn112150-20200713-00998
Wang X, Xie J, Wu Y et al (2021) Gender-specific effect of pregnancy-related anxiety on preschooler’s emotional and behavioral development: a population-based cohort study. J Affect Disord 279:368–376. https://doi.org/10.1016/j.jad.2020.10.014
Gross JJ (1998) The emerging field of emotion regulation: an integrative review. Rev Gen Psychol 2:271–299. https://doi.org/10.1037/1089-2680.2.3.271
Thompson RA (1994) Emotion regulation: a theme in search of definition. Monogr Soc Res Child Dev 59:25. https://doi.org/10.2307/1166137
Webb TL, Miles E, Sheeran P (2012) Dealing with feeling: a meta-analysis of the effectiveness of strategies derived from the process model of emotion regulation. Psychol Bull 138:775–808. https://doi.org/10.1037/a0027600
Byrd AL, Lee AH, Frigoletto OA et al (2021) Applying new RDoC dimensions to the development of emotion regulation: examining the influence of maternal emotion regulation on within-individual change in child emotion regulation. Dev Psychopathol 33:1821–1836. https://doi.org/10.1017/S0954579421000948
Morelen D, Shaffer A, Suveg C (2016) Maternal emotion regulation: links to emotion parenting and child emotion regulation. J Fam Issues 37:1891–1916. https://doi.org/10.1177/0192513X14546720
Tan L, Smith CL (2019) Intergenerational transmission of maternal emotion regulation to child emotion regulation: moderated mediation of maternal positive and negative emotions. Emotion 19:1284–1291. https://doi.org/10.1037/emo0000523
Selden TM, Berdahl TA (2020) COVID-19 and racial/ethnic disparities in health risk, employment, and household composition: study examines potential explanations for racial-ethnic disparities in COVID-19 hospitalizations and mortality. Health Aff 39:1624–1632. https://doi.org/10.1377/hlthaff.2020.00897
Tai DBG, Shah A, Doubeni CA et al (2021) The disproportionate impact of COVID-19 on racial and ethnic minorities in the United States. Clin Infect Dis 72:703–706. https://doi.org/10.1093/cid/ciaa815
(2022) US Census Bureau COVID-19 Site. https://covid19.census.gov/. Accessed 12 Jan 2022
Brady-Smith C, O’Brien C, Berlin L, et al (1999) Child-parent interaction rating scales for the three-bag assessment 24-month wave
NICHD Early Child Care Research Network (1997) The effects of infant child care on infant-mother attachment security: results of the NICHD study of early child care NICHD early child care research network. Child Dev 68:860–879. https://doi.org/10.1111/j.1467-8624.1997.tb01967.x
Whalen DJ, Gilbert KE (2017) Dyadic interaction coding manual: PCIT-ED Edition. Washington University, St. Louis
Barzilay R, Moore TM, Greenberg DM et al (2020) Resilience, COVID-19-related stress, anxiety and depression during the pandemic in a large population enriched for healthcare providers. Transl Psychiatry 10:291. https://doi.org/10.1038/s41398-020-00982-4
Njoroge W, Forkpa M, Bath E (2021) impact of racial discrimination on the mental health of minoritized youth. Curr Psychiatry Rep. https://doi.org/10.1007/s11920-021-01297-x
Spitzer RL, Kroenke K, Williams JBW, Löwe B (2006) A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 166:1092. https://doi.org/10.1001/archinte.166.10.1092
Carey M, Boyes A, Noble N et al (2016) Validation of the PHQ-2 against the PHQ-9 for detecting depression in a large sample of Australian general practice patients. Aust J Prim Health 22:262. https://doi.org/10.1071/PY14149
Cox J, Holden J (2003) Perinatal mental health: a guide to the Edinburgh postnatal depression scale (EPDS). Royal College Psychiatrists
White LK, Barzilay R, Moore TM et al (2022) Risk and resilience measures related to psychopathology in youth. Child Psychiatry Hum Dev. https://doi.org/10.1007/s10578-021-01296-2
Moore TM, White LK, Barzilay R et al (2020) Development of a scale battery for rapid assessment of risk and resilience. Psychiatry Res 288:112996. https://doi.org/10.1016/j.psychres.2020.112996
Gratz KL, Roemer L (2004) Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale. J Psychopathol Behav Assess 26:41–54. https://doi.org/10.1023/B:JOBA.0000007455.08539.94
Sheldrick RC, Perrin EC (2013) Evidence-based milestones for surveillance of cognitive, language, and motor development. Acad Pediatr 13:577–586. https://doi.org/10.1016/j.acap.2013.07.001
Squires J, Bricker D, Twombly E (2015) Ages & stages questionnaires®: social-emotional, second edition (ASQ®:SE-2): a parent-completed child monitoring system for social-emotional behaviors. Paul H. Brookes Publishing Co. Inc, Baltimore
Waller R, Paz Y, Himes MM, et al (In Revision) Observations of positive parenting from online parent-child interactions at age 1. Parenting: Sci Practice
Shrout PE, Fleiss JL (1979) Intraclass correlations: uses in assessing rater reliability. Psychol Bull 86:420–428. https://doi.org/10.1037/0033-2909.86.2.420
Moore TM, Martin IK, Gur OM et al (2016) Characterizing social environment’s association with neurocognition using census and crime data linked to the Philadelphia neurodevelopmental cohort. Psychol Med 46:599–610. https://doi.org/10.1017/S0033291715002111
Betancourt LM, Avants B, Farah MJ et al (2016) Effect of socioeconomic status (SES) disparity on neural development in female African-American infants at age 1 month. Dev Sci 19:947–956. https://doi.org/10.1111/desc.12344
Gottfried AW, Gottfried AE, Bathurst K et al (2003) Socioeconomic status in children’s development and family environment: Infancy through adolescence. Socioeconomic status, parenting, and child development. Lawrence Erlbaum Associates Publishers, Mahwah, pp 189–207
Luby JL, Constantino JN, Barch DM (2022) Poverty and Developing Brain. Cerebrum 2022:cer-04–22
Murtha K, Larsen B, Pines A et al (2022) Associations between neighborhood socioeconomic status, parental education, and executive system activation in youth. Cereb Cortex. https://doi.org/10.1093/cercor/bhac120
Muthén LK, Muthén BO (1998) Mplus User’s Guide, 8th edn. Muthen & Muthen, Los Angeles
Enders C, Bandalos D (2001) The relative performance of full information maximum likelihood estimation for missing data in structural equation models. Struct Equ Model 8:430–457. https://doi.org/10.1207/S15328007SEM0803_5
Preacher KJ, Curran PJ, Bauer DJ (2006) Computational tools for probing interactions in multiple linear regression, multilevel modeling, and latent curve analysis. J Educ Behav Stat 31:437–448. https://doi.org/10.3102/10769986031004437
(2019) RStudio Team. https://www.rstudio.com/. Accessed 1 Nov 2022
Abrams EM, Greenhawt M, Shaker M et al (2022) The COVID-19 pandemic. Ann Allergy Asthma Immunol 128:19–25. https://doi.org/10.1016/j.anai.2021.10.022
Hadfield K, Akyirem S, Sartori L et al (2022) Measurement of pregnancy-related anxiety worldwide: a systematic review. BMC Pregnancy Childbirth 22:331. https://doi.org/10.1186/s12884-022-04661-8
Lebel C, MacKinnon A, Bagshawe M et al (2020) Elevated depression and anxiety symptoms among pregnant individuals during the COVID-19 pandemic. J Affect Disord 277:5–13. https://doi.org/10.1016/j.jad.2020.07.126
Moyer CA, Compton SD, Kaselitz E, Muzik M (2020) Pregnancy-related anxiety during COVID-19: a nationwide survey of 2740 pregnant women. Arch Womens Ment Health 23:757–765. https://doi.org/10.1007/s00737-020-01073-5
Behrendt HF, Scharke W, Herpertz-Dahlmann B et al (2019) Like mother, like child? maternal determinants of children’s early social-emotional development. Infant Ment Health J 40:234–247. https://doi.org/10.1002/imhj.21765
Li F, Luo S, Mu W et al (2021) Effects of sources of social support and resilience on the mental health of different age groups during the COVID-19 pandemic. BMC Psychiatry 21:16. https://doi.org/10.1186/s12888-020-03012-1
White LK, Kornfield SL, Himes MM, et al (2023) The impact of postpartum social support on postpartum mental health outcomes during the COVID-19 pandemic. Arch Womens Ment Health. 2023:1–11. https://doi.org/10.1007/s00737-023-01330-3
Bandura A (1977) Social learning theory. Prentice Hall, Englewood Cliffs
Woszidlo A, Kunkel A (2017) An emphasis on modeling in parent-child relationships. Engaging theories in family communication, 2nd edn. Routledge, Milton Park
Madigan S, Oatley H, Racine N et al (2018) A meta-analysis of maternal prenatal depression and anxiety on child socioemotional development. J Am Acad Child Adolesc Psychiatry 57:645–657.e8. https://doi.org/10.1016/j.jaac.2018.06.012
Miguel PM, Pereira LO, Silveira PP, Meaney MJ (2019) Early environmental influences on the development of children’s brain structure and function. Dev Med Child Neurol. https://doi.org/10.1111/dmcn.14182
O’Donnell KJ, Meaney MJ (2017) Fetal origins of mental health: the developmental origins of health and disease hypothesis. Am J Psychiatry 174:319–328. https://doi.org/10.1176/appi.ajp.2016.16020138
Hajal NJ, Paley B (2020) Parental emotion and emotion regulation: a critical target of study for research and intervention to promote child emotion socialization. Dev Psychol 56:403–417. https://doi.org/10.1037/dev0000864
Morris AS, Silk JS, Steinberg L et al (2007) The role of the family context in the development of emotion regulation. Soc Dev 16:361–388. https://doi.org/10.1111/j.1467-9507.2007.00389.x
Crandall A, Deater-Deckard K, Riley AW (2015) Maternal emotion and cognitive control capacities and parenting: a conceptual framework. Dev Rev 36:105–126. https://doi.org/10.1016/j.dr.2015.01.004
Morris AS, Cui L, Steinberg L (2013) Parenting research and themes: What we have learned and where to go next. In: Larzelere RE, Morris AS, Harrist AW (eds) Authoritative parenting: synthesizing nurturance and discipline for optimal child development. American Psychological Association, Washington, pp 35–58
Cprek SE, Williams CM, Asaolu I et al (2015) Three positive parenting practices and their correlation with risk of childhood developmental, social, or behavioral delays: an analysis of the national survey of children’s health. Matern Child Health J 19:2403–2411. https://doi.org/10.1007/s10995-015-1759-1
Kaiser Family Foundation (2022) COVID-19 Cases and Deaths by Race/Ethnicity: Current Data and Changes Over Time. In: KFF. https://www.kff.org/coronavirus-covid-19/issue-brief/covid-19-cases-and-deaths-by-race-ethnicity-current-data-and-changes-over-time/. Accessed 3 Jan 2023
Adams-Chapman I, Stoll BJ (2006) Neonatal infection and long-term neurodevelopmental outcome in the preterm infant. Curr Opin Infect Dis 19:290–297. https://doi.org/10.1097/01.qco.0000224825.57976.87
Havighurst SS, Wilson KR, Harley AE et al (2013) “Tuning into Kids”: reducing young children’s behavior problems using an emotion coaching parenting program. Child Psychiatry Hum Dev 44:247–264. https://doi.org/10.1007/s10578-012-0322-1
Nunnery R, Fauser M, Hatchuel E, Jones M (2021) The use of dialectical behavioral therapy (DBT) techniques creatively in the treatment of perinatal mood and anxiety disorders. J Couns Res Practice. https://doi.org/10.56702/UCKX8598/jcrp0602.3
Porzig-Drummond R, Stevenson RJ, Stevenson C (2014) The 1–2-3 Magic parenting program and its effect on child problem behaviors and dysfunctional parenting: a randomized controlled trial. Behav Res Ther 58:52–64. https://doi.org/10.1016/j.brat.2014.05.004
Gratz KL, Weiss NH, Tull MT (2015) Examining emotion regulation as an outcome, mechanism, or target of psychological treatments. Curr Opin Psychol 3:85–90. https://doi.org/10.1016/j.copsyc.2015.02.010
Amani B, Krzeczkowski JE, Savoy C et al (2023) The impact of peer-delivered cognitive behavioral therapy for postpartum depression on infant emotion regulation. J Affect Disord 338:380–383. https://doi.org/10.1016/j.jad.2023.05.096
Krzeczkowski JE, Schmidt LA, Van Lieshout RJ (2021) Changes in infant emotion regulation following maternal cognitive behavioral therapy for postpartum depression. Depress Anxiety 38:412–421. https://doi.org/10.1002/da.23130
Acknowledgements
We thank the study participants and the research teams.
Funding
The study was supported by the Lifespan Brain Institute of Penn Medicine and Children’s Hospital of Philadelphia and the following grants: NIMH R01 MH125904 (PI: Waller), NIMH R01 MH128593 (PI: Njoroge), and NIMH K08MH129657 (PI: Chaiyachati).
Author information
Authors and Affiliations
Contributions
LKW RW WFMN BHC RB SLK HHB JS JPM AFD and REG conceived the development of the longitudinal study. LKW MMH RW and AFD conceived the specific set of analyses and wrote the main manuscript text, RW and LKW performed the analyses, MMH and RW prepared tables and figures. All authors edited and reviewed the manuscript.
Corresponding author
Ethics declarations
Conflicts of interest
Authors have no conflicts of interest to disclose.
Ethical Approval
All study procedures were approved through IRBs at the University of Pennsylvania and Children’s Hospital of Philadelphia.
Participant Consent
Participants provided consent prior to completing each assessment.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
White, L.K., Himes, M.M., Waller, R. et al. The Influence of Pandemic-Related Worries During Pregnancy on Child Development at 12 Months. Child Psychiatry Hum Dev (2023). https://doi.org/10.1007/s10578-023-01605-x
Accepted:
Published:
DOI: https://doi.org/10.1007/s10578-023-01605-x