Helping Us Grow Stronger (HUGS/Abrazos): COVID-19 in pregnancy and reducing toxic stress in mother-infant dyads

PROJECT SUMMARY Pregnancy and early childhood mark a unique period when two lives can be permanently impacted by the presence of maternal stressors such as economic instability, poor mental health, and social inequities, all of which have been amplified by the COVID-19 pandemic. The COVID pandemic has also collided with the epidemics of racism and maternal mortality plaguing the United States, to disproportionately impact already- marginalized Black and Latinx pregnant individuals in the greater Boston area. In the absence of protective buffers, prolonged exposure to excessive adversity ("toxic stress") can lead to poor health outcomes for both mothers and infants. Effective interventions to improve maternal mental health and mitigate social determinants of health in individuals with COVID-19 in pregnancy are therefore urgently needed. Helping Us Grow Stronger (HUGS/Abrazos) is a community-based program, designed and launched during the COVID pandemic. HUGS/Abrazos combines emergency relief, patient navigation, and direct behavioral health support to foster resilience and mitigate the negative impacts of COVID-related toxic stress on pregnant and postpartum women and their families. Participants enrolled in Massachusetts General Hospital's COVID-19 Pregnancy Biorepository will be referred to the HUGS/Abrazos program if they test positive for SARS-CoV-2. Using validated survey instruments, we will assess the extent to which the program improves maternal stress, anxiety, depression, quality of life, food insecurity, and experiences of racism and discrimination in this high-risk pregnant population. We will also assess the impact of maternal COVID-19-associated inflammation on behavioral health outcomes using cytokine analysis of banked serum samples from the participants. This urgent competitive revision of the R01 "Fetal Brain-Placental Immune Activation in Maternal Obesity" is aligned with the R01's long-term translational goals: to understand how in utero exposure to maternal inflammation and immune activation impacts fetal programming, in order to create targeted interventions that can improve short- and long-term maternal and child health outcomes in the face of maternal exposures. This work will generate key knowledge about the efficacy of a novel community-based intervention to reduce the adverse impact of maternal SARS-CoV-2 infection on the mother-infant dyad, and improve transgenerational outcomes.