Geotemporal analysis of perinatal care changes and maternal mental health: an example from the COVID-19 pandemic

Cassandra L. Hendrix, Denise Werchan, Carly Lenniger, Jennifer C. Ablow, Ananda B. Amstadter, Autumn Austin, Vanessa Babineau, G. Anne Bogat, Leigh Anne Cioffredi, Elisabeth Conradt, Sheila E. Crowell, Dani Dumitriu, Amy J. Elliott, William Fifer, Morgan Firestein, Wei Gao, Ian Gotlib, Alice Graham, Kimberly D. Gregory, Hanna GustafssonKathryn L. Havens, Christine Hockett, Brittany R. Howell, Kathryn L. Humphreys, Nancy Jallo, Lucy S. King, Patricia A. Kinser, Alytia A. Levendosky, Joseph S. Lonstein, Maristella Lucchini, Rachel Marcus, Catherine Monk, Sara Moyer, Maria Muzik, Amy K. Nuttall, Alexandra S. Potter, Cynthia Rogers, Amy Salisbury, Lauren C. Shuffrey, Beth A. Smith, Christopher D. Smyser, Lynne Smith, Elinor Sullivan, Judy Zhou, Natalie H. Brito, Moriah E. Thomason

Research output: Contribution to journalArticlepeer-review


Our primary objective was to document COVID-19 induced changes to perinatal care across the USA and examine the implication of these changes for maternal mental health. We performed an observational cross-sectional study with convenience sampling using direct patient reports from 1918 postpartum and 3868 pregnant individuals collected between April 2020 and December 2020 from 10 states across the USA. We leverage a subgroup of these participants who gave birth prior to March 2020 to estimate the pre-pandemic prevalence of specific birthing practices as a comparison. Our primary analyses describe the prevalence and timing of perinatal care changes, compare perinatal care changes depending on when and where individuals gave birth, and assess the linkage between perinatal care alterations and maternal anxiety and depressive symptoms. Seventy-eight percent of pregnant participants and 63% of postpartum participants reported at least one change to their perinatal care between March and August 2020. However, the prevalence and nature of specific perinatal care changes occurred unevenly over time and across geographic locations. The separation of infants and mothers immediately after birth and the cancelation of prenatal visits were associated with worsened depression and anxiety symptoms in mothers after controlling for sociodemographic factors, mental health history, number of pregnancy complications, and general stress about the COVID-19 pandemic. Our analyses reveal widespread changes to perinatal care across the US that fluctuated depending on where and when individuals gave birth. Disruptions to perinatal care may also exacerbate mental health concerns, so focused treatments that can mitigate the negative psychiatric sequelae of interrupted care are warranted.

Original languageEnglish (US)
Pages (from-to)943-956
Number of pages14
JournalArchives of Women's Mental Health
Issue number5
StatePublished - Oct 2022


  • Coronavirus
  • Depression
  • Mental health
  • Postpartum
  • Pregnancy
  • Prenatal care

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Psychiatry and Mental health


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