6/7: 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 consequences fortheir 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, OregonHealth Sciences University, Washington University in St. Louis, University of Pittsburgh, Cedars Sinai MedicalCenter, University of Vermont and Northwestern University. We will enroll pregnant and postpartum women intoa multi-wave study in which we assess medical, economic, psychosocial and substance use risk acrosspregnancy and the perinatal period, studying associations of these factors to infant neurobehavioral developmentduring the first year of life. Our central hypotheses include: 1) individual variation in perinatal COVID-19 relatedstress leads to differences in birth outcomes, parenting stress and infant temperament and neurodevelopmentand 2) substance use, mental health and economic risk enhance susceptibility to negative COVID-19 relatedhealth and psychosocial outcomes. To pursue these aims, prospective longitudinal survey, birth and postpartumdata will be obtained across a 3-month period in N=100 pregnant and new mothers per site (providing a totalconsortium sample of N=700) to generate individual temporal profiles of COVID-19 related experiences andresponses, comparing outcomes with existing data from maternal-infant cohorts obtained prior to the pandemic.Further, to identify avenues for intervention, will evaluate substance use, poor mental health and lowsocioeconomic status as risk factors and coping, agency and utilization of resources as resilience factors thatinfluence COVID-19 related maternal stress and child health and neurobehavioral outcomes. The effects ofgeographic location will be used to examine the influence of pandemic severity, variation in local governmentpolicies and resource availability on these outcomes. Finally, we will collect and bank longitudinal perinatalbiospecimens in N=40 women per site that will provide a foundation for future studies to evaluate the biologicalmechanisms through which the effects on maternal psychological and physical health influence offspring brainand behavioral development. Through this analysis of COVID-19 related stress, contextual factors and childoutcomes, we will develop a comprehensive understanding of effects and modifiers of this event on healthoutcomes in individuals that vary in dispositional risk during perinatal life, one of the most sensitive timepoints inhuman development.