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

The study investigates whether pandemic-related worries during pregnancy prospectively predict child development at 12 months, and whether parental emotion regulation buffers these effects. Early 2020 COVID-19 disruptions disproportionately affected pregnant individuals due to medical risks and rapidly changing prenatal, labor, and delivery guidelines. Prior literature links perinatal distress and pregnancy-related anxiety to poorer offspring outcomes (cognitive, psychiatric, socioemotional, behavioral). However, prospective evidence on how prenatal pandemic-specific worries relate to later development is limited. The authors hypothesized: (1) greater pandemic-related worries (especially pregnancy-specific worries) would predict poorer child socioemotional and general development at 12 months across parent-report and observational methods, controlling for maternal mental health; and (2) higher parental emotion regulation in the early postpartum period would buffer these associations. Exploratory analyses examined whether associations differed by parent race (Black vs Non-Latinx White).

The paper summarizes evidence that prenatal stress and pregnancy-related anxiety are associated with adverse child outcomes, including cognitive deficits, socioemotional and behavioral problems, and increased risk of psychiatric disorders. Historical disaster and pandemic studies (e.g., 1918 Influenza, Hurricane Katrina, Quebec Ice Storm) show transgenerational impacts on offspring cognition, education, and mental health. During COVID-19, perinatal individuals experienced elevated anxiety/depression and disruptions in care; children born during the pandemic have shown lower developmental scores in some domains. Pregnancy-related anxiety is a distinct construct from general anxiety and is robustly linked to maternal-infant bonding and child development. Emotion regulation is highlighted as a resilience factor associated with better parental mental health and child outcomes and may buffer the effects of prenatal stress on development.

Design: Prospective longitudinal sub-study (Prenatal to Preschool; P2P) of a larger perinatal cohort. Surveys collected during pregnancy (Time 1: Apr 17–Jul 8, 2020), early postpartum (Time 2: 10–15 weeks postpartum; Aug 11, 2020–Mar 2, 2021), and 12 months postpartum (Time 3: Jun 17, 2021–Mar 23, 2022), with a virtual laboratory visit at Time 3 including parent-child interaction tasks.

Participants: From 1,173 individuals surveyed at Time 1, 833 at Time 2 (76% retention). Time 3 recruited 219 dyads for virtual visits/surveys (4 surveys only). Final analyzed sample n = 184 after excluding those completing child measures outside 12–14 months (n=20) and preterm births GA < 37 weeks (n=13). Mean child age at Time 3 = 13.6 months (SD=1.5). Racial composition: Non-Latinx White (52.2%), Black (47.8%), with 1.6% Black and Latinx per EHR.

Procedures: Virtual Three Bags-style parent-child interaction tasks (storybook and free play). Materials mailed to families. Interactions coded by trained raters.

Measures:

• Pandemic-related worries (Time 1): Six general COVID-19 worries and four pregnancy-specific COVID-19 worries; internal consistency α=.84 (general), α=.82 (pregnancy-specific). Higher scores indicate greater worry.
• Maternal mental health: GAD-7 for anxiety; PHQ-2 for depression at Time 1; EPDS for postpartum depression at Time 3 (self-harm item excluded).
• Emotion regulation (Time 2): 5-item scale from the Brief Risk and Resilience Battery, adapted from DERS (α=.84); higher scores = better regulation.
• Parent-reported general developmental milestones (Time 3): SWYC 12-month Milestones (α=.73); higher scores = more advanced development.
• Parent-reported socioemotional development (Time 3): ASQ:SE-2; items coded so higher scores reflect better socioemotional development.
• Observed socioemotional development (Time 3): Child engagement ratings during storybook and free play on 1–7 scale; higher = greater engagement. Inter-rater reliability: ICC=.84 (free play), .80 (storybook); scores moderately correlated (r=.39, p<.001) and combined.
• Demographic covariates: Child age (months), sex; parent age, parity, EHR race; socioeconomic disadvantage composite from census-based geocoding (alternative: parent-reported income at Time 2).

Video data availability: n=132 (free play), n=138 (storybook), n=113 both tasks; n=27 no usable video. Missingness unrelated to key predictors (all ps>.31).

Analytic strategy: Path modeling in Mplus v8 using full-information maximum likelihood with robust SEs. Three correlated dependent variables: parent-reported socioemotional development, observed socioemotional development, and parent-reported developmental milestones. Predictors: pregnancy-specific and general pandemic worries, with covariates as above. Robustness checks controlled for anxiety/depression at Time 1 (exposure) and Time 3 (outcome), and used alternative SES (income). Moderation: Added main effect of emotion regulation and interaction terms (ER x pregnancy-specific worries; ER x general worries). Significant interactions probed using established procedures.

• Pregnancy-specific pandemic worries during pregnancy prospectively predicted lower child socioemotional development at 12 months:
  • Parent-reported socioemotional development: B = -1.13, SE = 0.43, β = -0.21, p = .007 (also reported as p = .01 in table).
  • Observed socioemotional development: B = -0.13, SE = 0.07, β = -0.21, p = .045 (also reported as p = .03–.04 in table variations).
  • No association with parent-reported general developmental milestones: B = -0.06/ -0.07, SE = 0.07, β ≈ -0.08, p = .31–.35.
• General pandemic worries were not significantly associated with observed socioemotional development or general milestones; the bivariate link with parent-reported socioemotional development was attenuated when pregnancy-specific worries were included.
• Covariates:
  • Greater socioeconomic disadvantage predicted lower parent-reported socioemotional development (e.g., B = -4.89 to -5.83, SE ≈ 1.55–1.62, β ≈ -0.23 to -0.28, p < .001).
  • Being identified as Black (vs Non-Latinx White) associated with lower parent-reported socioemotional development (e.g., B ≈ -5.33 to -6.15, p ≈ .04–.09).
  • Older child age predicted more general developmental milestones (B ≈ 0.31, SE = 0.08, β ≈ 0.29, p < .001).
• Results robust when controlling for maternal anxiety and depression at Time 1 and Time 3; concurrent depression (B = -0.94, SE = 0.33, β = -0.21, p < .001) and anxiety (B = -0.61, SE = 0.30, β = -0.13, p = .04) were related to lower parent-reported socioemotional development.
• No significant interactions between pandemic worries and parent race for any outcome.
• Emotion regulation (ER) in early postpartum:
  • Main effects: Higher ER predicted better parent-reported socioemotional development (B = 0.90, SE = 0.36, β = 0.19, p = .01) and more general developmental milestones (B = 0.13, SE = 0.06, β = 0.17, p = .02); not related to observed socioemotional development.
  • Moderation: ER buffered the effect of pregnancy-specific worries on parent-reported socioemotional development (interaction B = 0.22, SE = 0.09, β = 0.19, p = .02). Simple slopes: low ER B = -0.40, SE = 0.12, t = -3.60, p < .001; mean ER B = -0.21, SE = 0.08, t = -2.75, p = .01; high ER B = -0.02, SE = 0.10, t = -0.14, p = .89.

Findings indicate that pregnancy-specific worries during the COVID-19 pandemic were prospectively associated with poorer socioemotional development in children at 12 months, across both parent-reported and observed measures, even after accounting for maternal mental health at exposure and outcome. Effects were specific to socioemotional development and not general developmental milestones. The specificity to pregnancy-related worries (over general worries) suggests that stressors directly tied to pregnancy, childbirth, and early caregiving experiences may be particularly impactful on socioemotional outcomes, potentially via pathways involving increased parenting-related stress, reductions in sensitive/nurturing parenting, altered social milieus and reduced infant social exposure during the pandemic, and/or prenatal biological programming mechanisms. Parental emotion regulation in early postpartum functioned as a protective factor, buffering the adverse association between pregnancy-specific worries and child socioemotional development, consistent with theories and evidence that parental ER supports positive parenting and the development of child ER via modeling and emotion socialization. The results underscore the importance of targeting parental resilience, particularly emotion regulation, to mitigate the developmental impact of prenatal stress exposures.

This study contributes prospective evidence that pregnancy-specific pandemic worries predict poorer socioemotional development at 12 months, while parental emotion regulation in early postpartum serves as a resilience factor that buffers this risk. Implications include prioritizing screening for pregnancy-specific distress (over and above general anxiety), and developing/implementing interventions to enhance parental emotion regulation to support child socioemotional development following prenatal stress. Future research should: use larger and more representative samples; include multi-informant and clinical assessments; examine timing effects across trimesters; incorporate standardized measures of pregnancy-related anxiety; and evaluate whether cohorts born during the pandemic require targeted supports to prevent persistent socioemotional or general developmental delays.

• Reliance on parent-report measures for several constructs may introduce shared method variance and reporting biases; although an observational socioemotional measure and controls for maternal anxiety/depression were included, parent-reported and observed socioemotional measures were not significantly correlated.
• Sample focused on Non-Latinx White and Black participants and may not generalize to other racial/ethnic groups; race/ethnicity from EHR may differ from self-report.
• Exclusion of preterm births limits generalizability to full-term cohorts.
• Limited ability to assess effects by timing within pregnancy due to few first-trimester respondents at Time 1.
• No standard pregnancy-related anxiety measure was used; unclear whether pregnancy-specific pandemic worries index general pregnancy-related anxiety versus pandemic-specific concerns.
• Potential limited power and restricted child age range may have constrained detection of associations with general developmental milestones.