The Influence of Pandemic-Related Worries During Pregnancy on Child Development at 12 Months

The COVID-19 pandemic significantly impacted global populations, posing particular challenges for pregnant individuals. They faced increased risks of severe COVID-19 symptoms, complications, and mortality, along with continually evolving and often confusing guidelines regarding prenatal care, labor, childbirth, and postpartum care. These uncertainties led to heightened anxiety and distress. Prior research established links between perinatal distress and negative child outcomes, including cognitive impairment, psychiatric disorders, and socioemotional/behavioral problems. Pregnancy-related anxiety, specifically, has been associated with developmental delays and emotional/behavioral problems in offspring. This study aimed to investigate whether pandemic-related stress during pregnancy prospectively predicted later child development disruptions and whether emotion regulation acted as a resilience factor mitigating these negative effects. The study leveraged data from a larger longitudinal perinatal cohort, focusing on a sub-study of Black and Non-Latinx White participants. Data collection involved online surveys during pregnancy and early postpartum, and a virtual laboratory visit at 12 months postpartum, including parent-child interaction tasks.

Existing literature extensively documents the negative consequences of the COVID-19 pandemic on pregnant individuals, including increased rates of perinatal anxiety and depression. Studies prior to the pandemic showed a strong correlation between perinatal distress and various negative child developmental outcomes, such as cognitive deficits, psychiatric disorders, and socioemotional/behavioral problems. Pregnancy-specific anxiety has been uniquely linked to negative developmental outcomes in offspring. Although the pandemic's impact on perinatal mental health is well-established, less is known about its long-term effects on child development. This study addresses this critical gap by exploring the prospective relationship between pandemic-related worries during pregnancy and child development at 12 months.

This study used a prospective longitudinal design, drawing data from a sub-study (n=184 parent-infant dyads) of a larger longitudinal cohort (n=1173). The sub-study focused on Black and Non-Latinx White individuals. Data were collected at three time points: during pregnancy (April 17 – July 8, 2020), early postpartum (August 11, 2020 – March 2, 2021), and 12 months postpartum (June 17, 2021 – March 23, 2022). At each time point, participants completed online surveys using REDCap. The 12-month postpartum assessment also included a virtual laboratory visit involving parent-child interaction tasks (adapted Three Bags procedure). Measures included self-reported pandemic worries (general and pregnancy-specific), maternal mental health (anxiety and depression), emotion regulation (postpartum), parent-reported general developmental milestones (12 months), and parent-reported and observed socioemotional development (12 months). Observed socioemotional development was assessed through a team of trained researchers coding parent-child interactions during the virtual laboratory visit. Inter-rater reliability was high for social engagement. Data analyses used path models in Mplus, employing full-information maximum likelihood estimation with robust standard errors. Models controlled for relevant covariates (child age, sex, maternal age, parity, race, socioeconomic disadvantage) and maternal mental health at both the time of exposure and outcome assessment. Interactions were probed to investigate the moderating role of emotion regulation.

The path model analysis revealed that higher pregnancy-specific pandemic worries during pregnancy were significantly associated with lower levels of child socioemotional development at 12 months, as assessed by both parent report (B = -1.13, SE = .43, p = .007) and observer ratings (B = -.13, SE = .07, p = .045). This association was not observed for parent-reported general developmental milestones. General pandemic worries, while correlated with lower parent-reported socioemotional development in bivariate models, were not significant predictors in the path model. Importantly, parental emotion regulation in the early postpartum period significantly moderated the association between pregnancy-specific pandemic worries and parent-reported socioemotional development. The negative relationship between pregnancy-specific worries and child socioemotional development was only present at low and average levels of maternal emotion regulation. At high levels of emotion regulation, this link was buffered (B = -.02, SE = .10, p = .89). Findings remained consistent after controlling for maternal anxiety and depression at both time points and using an alternative measure of socioeconomic disadvantage. No significant interaction effects were found between race and pandemic worries in relation to child developmental outcomes.

This study demonstrates a significant link between pregnancy-specific pandemic-related worries and impaired child socioemotional development at 12 months. The specificity of the findings to pregnancy-related concerns highlights the unique stressors faced by pregnant individuals during the pandemic. The findings extend prior research showing developmental disruptions in children born during the pandemic, and specifically support the idea that pregnancy-related anxiety may be a key factor contributing to poor outcomes. The moderating role of parental postpartum emotion regulation offers crucial insights into potential resilience factors. This finding emphasizes the importance of interventions aimed at improving parental emotion regulation skills to mitigate the impact of prenatal stress on child development. Such interventions could enhance positive parenting practices, potentially promoting better child socioemotional outcomes.

This study provides evidence that pregnancy-specific pandemic-related worries negatively affect child socioemotional development. However, the negative effect is buffered by high maternal emotion regulation in the postpartum period. These findings underscore the importance of addressing perinatal mental health, particularly focusing on enhancing emotion regulation skills to promote optimal child development. Future research should investigate the long-term effects of pandemic-related stress on child development, explore potential mechanisms underlying these relationships, and evaluate the effectiveness of interventions targeting parental emotion regulation.

The study primarily relied on parent-reported measures, which could introduce method variance or informant bias. Although an observational measure of child socioemotional development was included and maternal mental health was controlled for, future research using clinical assessments and data from alternative caregivers would strengthen the findings. The sample, while including equal numbers of Black and Non-Latinx White participants, is not fully representative of the broader population, limiting the generalizability of the results. The exclusion of preterm births also restricts the generalizability. Further, the lack of a standard measure of pregnancy-related anxiety limits the precise interpretation of the pregnancy-specific worries measure.