The coronavirus disease 2019 (COVID-19) pandemic turned the lives of many all over the world upside down. Nowhere has this been more obvious than the interactions between parents and children, beginning during pregnancy, over the past year of the pandemic. A new study, by a team of researchers from the University of Cambridge, The Cambridge University Hospitals Trust and the University of Oxford, will explore the reality of changes in this area, and how they have impacted early human development.

A pre-print version of the study’s outline and aims is available on the medRxiv* server, while the article undergoes peer review.

Study: The COVID in the Context of Pregnancy, Infancy and Parenting (CoCoPIP) Study: protocol for a longitudinal study of parental mental health, social interactions, physical growth, and cognitive development of infants during the pandemic. Image Credit: Pixel-Shot / Shutterstock

Background

The study, called the COVID in the Context of Pregnancy, Infancy and Parenting (CoCoPIP) study, was thought necessary because of the many ways in which the pandemic altered social life, health experiences, and financial wellbeing among parents. The researchers want to find out how these changes affected the mental health of parents expecting a baby to be born during this time. This includes the period of pregnancy and afterward, as well as how parents related to the child socially, under these changed circumstances.

They also want to know if these drastic changes would change fetal and infant development in any way.

Study details

The CoCoPIP study is designed in the form of a national survey to be administered online. The first survey was carried out in July 2020, involving 1,700 families. It collects data on the loss of income, the incidence of COVID-19, the availability of support before and after childbirth, and the levels of parental stress in response to all these variables.

The survey also explores how parents felt during this period and the effect of all this on the growth and development of the infant. Finally, measures of variability in child social and cognitive development are collected to help understand if they show marked differences in children born during lockdown and social distancing measures.

All families were followed from pregnancy to up to 18 months after the baby's birth, during the course of the pandemic. Besides quantitative data, the survey allows for individuals to answer in the free text to better understand the experiences that different families went through.

All data will be self-reported since no staff will directly evaluate either parental mental health or child development. A range of families is taking part, with diverse levels of deprivation and geographic location.

Pandemic could affect infant development

The COVID-19 pandemic deserves such study because of its similarity to other large-scale disasters that have long-term consequences for the early health and development of children born in these times.

As the researchers note, this is because:

The fetal physiological environment and infant caregiving and social environment are now recognised to play a key role in influencing later biological, physical and neurodevelopmental outcomes.”

The unique characteristic of the current pandemic is the social distancing and isolation that have become its hallmark. Such isolation has led, in turn, to unintended adverse impacts on the mental wellbeing of pregnant women, and of parents with newborn babies, thus affecting the environment in which the child has to grow and develop.

For instance, pregnant women and new parents may have come to feel more at the mercy of unpredictable illnesses or crises in the lives of the baby or mother, simply because they were socially cut off and perhaps, poorer than before.

Again, such groups were forced to be vigilant about the possibility of contracting COVID-19 during antenatal visits and delivery. This ensured that routine assessment visits to their healthcare providers became a high-stress situation, and were, in fact, often dropped altogether.

COVID-19 effects on pregnant women

Earlier studies in the UK showed that both pregnant and new mothers described themselves as more anxious and depressed than expected, due to the operation of these unusual sources of physical and mental stress. They also reported that they were unable to get the usual care and support from their family and caregivers.

In addition, many women have found themselves with even more on their plate during the pandemic. They have been expected to be caregivers for children who are no longer in schools and for other family members. They cannot let off stress by time out of the house with friends or family because of social distancing precautions.

Reduced financial stability and higher levels of stress between people, or being more vulnerable to violence within close relationships due to all these factors, has impacted relatively higher numbers of women in the reproductive age group compared to others.

Impact of COVID-19 on parents and children

In the UK, the National Health Service (NHS) produced COVID-19 guidelines whereby midwives operating in hospitals temporarily withdrew permission for partners to accompany patients during routine visits as well as during ultrasounds. A host of community-based health services were terminated, leaving only antenatal and well-baby visits.

Even these were restricted as far as possible to virtual visits. Maternal mental health assessments were carried out only if deemed to be urgently required.

The result was that unwittingly, not only did pregnancy-related stress increase, but support systems were withdrawn simultaneously. The immediate fallout was a four-fold higher increase in stillbirths, thought to be due to inadequate antenatal care; loss of permission for partners to be present at the birth of the child, or at most, only until the birth; and little access to the baby after birth if neonatal intensive care unit admission became necessary.

Postnatal visits have also declined, largely for fear of infection.

Impact on early fetal and infant experience

There is little data on how children born to such parents, and at such a time, fared.

During the first nationwide lockdown, there was significantly more stress for pregnant women related to fears of giving birth amid the pandemic and getting the infection during the period surrounding childbirth. About a third of pregnant women said they suffered both types of fears.

Over half of women, in another survey, said they were worried about food stocks, household income, or job loss, as well as childcare facilities closing down. Over a third said they were under stress because of increased fighting in the family. Almost all reported they were worried about getting the infection.

Other Canadian and UK surveys have shown a high prevalence of clinical symptoms, indicating a two-fold risk of depression and anxiety in pregnancy compared to non-pregnant women.

A similar picture is coming to light in the UK, with half the mothers of newborn babies in 2020 describing anxious and depressed feelings, especially if the baby was born preterm, or if the mother is part of a low-income household, or goes out to work. Similarly, negative perceptions were described by the majority of mothers in an Australian survey.

This is concerning because fetal development is affected by the presence of such mental ill-health in the mother. The increased occurrence of preterm birth, low birth weight, and behavioral problems during childhood, have all been related to psychological ill-health in the mother.

Depression leads to less bonding with the infant and a more negative tone to the interactions between the mother and the baby. This loss of emotional sympathy may reflect impaired relationships within the mother-child dyad.

The babies share their feelings less, interact less, show lower levels of concentration and tend to respond more negatively to strangers. They were consistently less securely attached at one year and 18 months, and as they grew, such children were >40% more likely to be depressed by the time they were 16 years.

Expected significance

Some pandemic studies explored immediate postnatal interactions and the effects of the pandemic on breastfeeding practices. This study takes things further to examine the impact of the pandemic-induced social isolation of such babies from other babies as well as non-household members. It also looks at how babies who only experience others outside the household wearing masks will understand what they see and how they communicate with others.

The study covers the crucial blind-spot period between pregnancy to 24 months, when a major part of the child’s cognitive and social development occurs. The results will be important to understand more about the extended impact of the pandemic on the youngest and most vulnerable members of society, mediated by and despite their caregivers.

*Important Notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.