2/7: Longitudinal evaluation of the impact of the COVID-19 pandemic on high-risk new and expectant mothers

The COVID-19 pandemic represents the most significant environmental event in living history and is leading tounprecedented social, economic and health consequences. There is an urgent need to longitudinally study theimpact of the pandemic on pregnant women and the care they receive, and to understand the consequencesfor their children's birth outcomes and neurobehavioral development. Importantly, women with pre-existingsubstance use, mental health conditions and limited economic resources may be at increased risk for the wide-ranging, deleterious sequelae of the pandemic. The proposed project seeks to address these critical gaps bybuilding upon ongoing harmonized research efforts across seven geographically-representative sites from theNIH HEALthy Brains and Cognitive Development study (HBCD) initiative, including New York University,Oregon Health Sciences University, Washington University in St. Louis, University of Pittsburgh, Cedars SinaiMedical Center, University of Vermont and Northwestern University. We will enroll pregnant and postpartumwomen into a multi-wave study in which we assess medical, economic, psychosocial and substance use riskacross pregnancy and the perinatal period, studying associations of these factors to infant neurobehavioraldevelopment during the first year of life. Our central hypotheses include: 1) individual variation in perinatalCOVID-19 related stress leads to differences in birth outcomes, parenting stress and infant temperament andneurodevelopment and 2) substance use, mental health and economic risk enhance susceptibility to negativeCOVID-19 related health and psychosocial outcomes. To pursue these aims, prospective longitudinal survey,birth and postpartum data will be obtained across a 3-month period in N=100 pregnant and new mothers persite (providing a total consortium sample of N=700) to generate individual temporal profiles of COVID-19related experiences and responses, comparing outcomes with existing data from maternal-infant cohortsobtained prior to the pandemic. Further, to identify avenues for intervention, will evaluate substance use, poormental health and low social economic status as risk factors and coping, agency and utilization of resources asresilience factors that influence COVID-19 related maternal stress and child health and neurobehavioraloutcomes. The effects of geographic location will be used to examine the influence of pandemic severity,variation in local government policies and resource availability on these outcomes. Finally, we will collect andbank longitudinal perinatal biospecimens in N=40 women per site that will provide a foundation for futurestudies to evaluate the biological mechanisms through which the effects on maternal psychological andphysical health influence offspring brain and behavioral development. Through this analysis of COVID-19related stress, contextual factors and child outcomes, we will develop comprehensive understanding of effectsand modifiers of this event on health outcomes in individuals that vary in dispositional risk during perinatal life,one of the most sensitive timepoints in human development.