Impact of sedentary behavior and emotional support on prenatal psychological distress and birth outcomes during the COVID-19 pandemic

Alison E. Hipwell, Irene Tung, Phillip Sherlock, Xiaodan Tang, Kim Mckee, Monica Mcgrath, Akram Alshawabkeh, Tracy Bastain, Carrie V. Breton, Whitney Cowell, Dana Dabelea, Cristiane S. Duarte, Anne L. Dunlop, Assiamira Ferrera, Julie B. Herbstman, Christine W. Hockett, Margaret R. Karagas, Kate Keenan, Robert T. Krafty, Catherine MonkSara S. Nozadi, Thomas G. O'connor, Emily Oken, Sarah S. Osmundson, Susan Schantz, Rosalind Wright, Sarah S. Comstock

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background Studies have reported mixed findings regarding the impact of the coronavirus disease 2019 (COVID-19) pandemic on pregnant women and birth outcomes. This study used a quasi-experimental design to account for potential confounding by sociodemographic characteristics. Methods Data were drawn from 16 prenatal cohorts participating in the Environmental influences on Child Health Outcomes (ECHO) program. Women exposed to the pandemic (delivered between 12 March 2020 and 30 May 2021) (n = 501) were propensity-score matched on maternal age, race and ethnicity, and child assigned sex at birth with 501 women who delivered before 11 March 2020. Participants reported on perceived stress, depressive symptoms, sedentary behavior, and emotional support during pregnancy. Infant gestational age (GA) at birth and birthweight were gathered from medical record abstraction or maternal report. Results After adjusting for propensity matching and covariates (maternal education, public assistance, employment status, prepregnancy body mass index), results showed a small effect of pandemic exposure on shorter GA at birth, but no effect on birthweight adjusted for GA. Women who were pregnant during the pandemic reported higher levels of prenatal stress and depressive symptoms, but neither mediated the association between pandemic exposure and GA. Sedentary behavior and emotional support were each associated with prenatal stress and depressive symptoms in opposite directions, but no moderation effects were revealed. Conclusions There was no strong evidence for an association between pandemic exposure and adverse birth outcomes. Furthermore, results highlight the importance of reducing maternal sedentary behavior and encouraging emotional support for optimizing maternal health regardless of pandemic conditions.

Original languageEnglish
Pages (from-to)6792-6805
Number of pages14
JournalPsychological Medicine
Issue number14
StatePublished - 8 Oct 2023


  • Birth outcomes
  • depression
  • pandemic
  • pregnancy
  • stress


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