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Alisha Bradshaw doesn’t know what it’s like to be pregnant without the added worry of a global health crisis.
She had her first child, a healthy baby girl, in the summer of 2016, when a single mosquito bite could mean transmission of Zika – a virus known to cause devastating birth defects.
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Four years later, Bradshaw, 44, of Brandywine, Md., Was pregnant with her second child. This time it was during the COVID-19 pandemic. While a box of bug spray gave her a measure of control to protect herself against Zika, the coronavirus left her feeling particularly vulnerable.
“There were so many unknowns,” Bradshaw said. “You just don’t know who has them and who doesn’t. You can take any precaution to keep your family safe, but you just don’t know.”
Unlike Zika, there is no evidence that infection with COVID-19 during pregnancy has a direct impact on the growing fetus.
But the stress of being pregnant during the pandemic could.
“There are many publications that support the idea that stressors during pregnancy can have a deleterious effect on fetal brain development,” said Charles Nelson, professor of pediatrics and neuroscience at Harvard Medical School and the United States. Boston Children’s Hospital.
Nelson explained that during times of extreme distress, the body releases a cascade of hormones into the bloodstream. These stress hormones, including cortisol, have the ability to cross the placental barrier between mother and baby.
Certain areas of the fetal brain are quite receptive to stress hormones. One of these areas is the hippocampus, which plays a major role in learning and memory. A study published earlier this year in JAMA Pediatrics found marked differences in fetal brain growth in pregnant women who suffered from psychological distress.
“Among those pregnant women with high levels of stress,” said study author Catherine Limperopoulos, “we might see negative impacts on the fetal brain,” including disruption in brain biochemistry.
The study results were limited to pregnant women whose babies had developed congenital heart disease in utero, which can be a major source of stress for women during pregnancy.
Limperopoulos, who also heads the Center for the Developing Brain at the Children’s National Health System in Washington, DC, has regularly asked pregnant women about their stress levels since 2014. Based on 163 previous responses to the pandemic, 18% reported high levels of anxiety; 12 percent reported symptoms of depression; and 26% said they felt stressed.
When the pandemic struck, her team repeated the survey of 35 pregnant women. The results have been striking, doubling and almost tripling these percentages.
Of the 35 responses, 50% had moderate to high levels of anxiety; 35 percent felt depressed; and 71 percent were moderately to very stressed.
“Even in a low-risk pregnancy, where the mother has no risk factors and the baby is developing well,” Limperopoulos said, “there really is an alarming prevalence of mental health problems reported by these women.”
Keri Toner, 33, of Washington, DC, said the pandemic has added unprecedented levels of stress. His daughter, Lennon, was born a month ago.
It was her first pregnancy, which was “already a stressful time,” Toner recalls. “Then the pandemic hit. You really feel like you’ve lost control.”
For Bradshaw of Maryland, the sources of stress from COVID-19 during her pregnancy were staggering. Six of her family, including her husband, fell ill with the coronavirus after attending a funeral in March.
At least three family members had to be hospitalized. Two of those relatives have died, including Bradshaw’s stepfather. Hospital rules prohibited his family from being with him when he died. He did not live to meet his grandson, Emmanuel, born in June.
The experience “was devastating,” Bradshaw said. It is not known if she too was infected. Her doctor refused to test her because she had no symptoms of COVID-19.
The coronavirus has had a disproportionate impact on racial minorities, particularly black Americans. The Centers for Disease Control and Prevention reported that the proportion of blacks with severe COVID-19 is higher than that of whites. Pre-existing conditions such as type 2 diabetes, high blood pressure and obesity are all more prevalent in black communities and all increase the risk of complications from COVID-19.
Bradshaw and Toner need to pay special attention to their mental health now that they’re both postpartum. Even under normal circumstances, the extreme exhaustion and the physical cost of having a newborn baby can be especially daunting.
Building on previous research that has shown a link between maternal stress and impaired fetal brain development, Limperopoulos and her team at Children’s National are now focusing on ways to reduce stress during pregnancy.
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“Stress is a modifiable risk factor,” she says. The group has started a study called Project RESCUE, which aims to recruit up to 500 women.
Study participants will be randomized into different programs, such as mindfulness, yoga, breathing techniques, and sleep health.
The research project will follow women and their babies up to the age of 3. “Our hope is to show that reducing stress and anxiety levels can also have a positive effect on the baby’s development,” Limperopoulos said.
Bradshaw partly relied on friends who let her vent her frustrations – virtually, of course. (Even Bradshaw’s baby shower had to be done via Zoom.)
But Bradshaw said his faith and the practice of meditation helped the most.
“Even if it’s only 10 minutes,” Bradshaw said, walking away to meditate “can help you gain some kind of stability when your day is chaotic, just being able to breathe.”
“I might be stressed,” she said, “but I don’t need to let the stress catch up with me”.
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