Cardiovascular-related pregnancy complications: Associations with health behaviors and mental health during the covid-19 pandemic

Phipps, J. E.; Wilson, M. D.; Ebong, I. A.; Hedriana, H. L.; Simmons, L. A.

Pregnancies with cardiovascular (CV) complications are more likely to involve additional complications, poorer short and long-term health, and worse fetal outcomes. Additionally, CV complications are associated with poorer mental health, lower socioeconomic status, and non-White race/ethnicity. The COVID-19 pandemic has had negative effects on mental well-being and disproportionately affects people of lower socioeconomic status and non-White race/ethnicity. Thus, we hypothesized that the pandemic would differentially affect pregnant people with and without CV complications. We performed a cross-sectional survey of 465 pregnant people in California from June 6 through July 29, 2020. Twenty-three participants reported CV complications (e.g., hypertensive disorders, gestational diabetes) and 29 participants reported non-CV complications. The CV group was 56.5% (13 of 23) Latinx and 43.5% (10 of 23) White versus the uncomplicated pregnancy group, which was 33.7% (137 of 407) Latinx and 66.3% (270 of 407) White (chi-square, p=0.03;6 respondents did not answer). The CV complications group was 9.5% (2 of 21) African American and the uncomplicated pregnancy group was 4.9% (19 of 392) African American (Fisher's Exact, p=0.053;23 respondents did not answer). We assessed 64 health behaviors reported on a Likert scale with the Wilcoxon 2-Sample Test and found the CV group reported more healthpromoting behaviors, including: less likely to eat sweets (p=0.004), more likely to sanitize frequently used areas in their homes and their groceries (p=0.049 and 0.069, respectively). However, they were also more likely to smoke cigarettes (p=0.02). While the two groups did not differ significantlyon stress, depression, or anxiety, the CV group was more likely to worry that their babies may behospitalized after birth (p=0.01) and their provider may be unavailable during delivery (p=0.047).Concerns for self and baby trended towards significance for the CV group, which reported beingmore likely to worry about getting sick (p=0.077) and their babies being born early (p=0.079) orgetting sick (p=0.098). While preliminary, these data suggest that COVID-19 disproportionatelyaffects pregnant people with prenatal CV complications. Given limited research on pregnancy duringCOVID-19 and the primary focus on biological outcomes, these findings indicate a clear need toaddress the pandemic's influence on behavioral and emotional health during pregnancy-especiallyfor those with CV complications who are at higher risk of poor maternal and fetal outcomes.