The Disproportionate Burden of the COVID-19 Pandemic Among Pregnant Black Women

Abstract

The COVID-19 pandemic has disproportionately impacted the well-being of vulnerable populations in the US, including Black people. The impact on pregnant women is of special concern for the intrauterine and post-natal development of their offspring. We evaluated in an online survey a sample of 913 pregnant women, 216 Black, 571 White, 126 Other, during a 2-week stay-at-home mandate in the Philadelphia region. We applied logistic regression models and analysis of covariance to examine general and pregnancy-specific worries and negative consequences arising from the COVID-19 pandemic, symptoms of anxiety and depression, and resilience. Black pregnant women reported greater likelihood of having their employment negatively impacted, more concerns about a lasting economic burden, and more worries about their prenatal care, birth experience, and post-natal needs. In the full sample, 11.1% of women met screening criteria for anxiety and 9.9% met criteria for depression. Black women were more likely to meet criteria for depression than White women, but this difference was not significant accounting for covariates. Resilience factors including self-reliance and emotion regulation were higher in Black women. Racial disparities related to COVID-19 in pregnant women can advance the understanding of pregnancy related stressors and improve early identification of mental health needs.

Pandemic Birthing: Childbirth Satisfaction, Perceived Health Care Bias, and Postpartum Health During the COVID-19 Pandemic

“…Our finding that Black and Latina women were more likely to report perceived health care discrimination during childbirth fuels concerns that the co-pandemics of COVID-19 and racism may exacerbate existing racial-ethnic disparities in adverse maternal outcomes (Howell et al, 2020 ; Lemke & Brown, 2020 ). Women of color are more likely to be infected with SARS-CoV-2 during pregnancy (Emeruwa et al, 2020 ), suffer from higher risk of COVID-19 disease and adverse outcomes (Woodworth et al, 2020 ), and experience higher rates of COVID-19 pandemic stress and anxiety (Gur et al, 2020 ; Preis et al, 2020 ). Reduced childbirth satisfaction and increased healthcare bias could add to these risks.…”

Adverse Perinatal Outcomes Predicted by Prenatal Maternal Stress Among U.S. Women at the COVID-19 Pandemic Onset

“…African American women in our study were more than twice as likely to deliver preterm than other study participants; their rate of preterm birth (20.5%) was higher than prepandemic U.S. population rates for African American women (14.4%) [ 52 ], although this should be interpreted with caution due to the small number of African American women in our sample ( n = 39). Emerging evidence suggests that pregnant African American women and other women of color are being disproportionately affected during the COVID-19 pandemic [ 40 ], including evidence that SARS-CoV-2 [ 10 ] and pandemic-related restrictions on prenatal care have exacerbated longstanding racial inequities [ 41 ]. There is also growing recognition that pregnant Black women in the U.S. experience high levels of stress, including a potent type of stress that is unique to their intersecting gender, race, and pregnant status (sometimes labeled gendered racism in pregnancy ), and that stress elevates African American women’s risk of adverse outcomes—including preterm birth [ 37–39 ].…”

“…Additionally, known social determinants of health may be putting particular groups of pregnant women at greater risk during the pandemic and exacerbating already stressful conditions. Reports indicate that pregnant African American women, and other women of color, who were under regular circumstances experience barriers to prenatal care and disproportionately high rates of adverse perinatal outcomes [ 37–39 ], have been particularly burdened by pandemic restrictions, and have higher rates of COVID-19 infection than other groups of pregnant women [ 40 , 41 ].…”

Racial/Ethnic Disparities in Very Preterm Birth and Preterm Birth Before and During the COVID-19 Pandemic

“… 9 However, any benefit from COVID-19–related restrictions may be less prevalent among Black and Latina women in NYC, who may be more likely to be essential workers 12 and to experience higher rates of COVID-19 pandemic–related stress, anxiety, and food insecurity. 4 , 13 , 14 Black and Latina women are also more likely than White women to experience loss and trauma due to COVID-19. 15 Decreased access to prenatal care, increased incidence of pregnancy complications, or decreased control of chronic conditions may also play a role.…”