By Daniel Dunaief

Pregnant women with access to the outdoors are less stressed during the pandemic.

In fact, according to an unpublished finding that isn’t yet peer reviewed, pregnant women who had outdoor access were 67 percent less likely to worry about contracting the virus and 63 percent less likely to feel stress about being unprepared for the birth.

Stony Brook University recently awarded a project led by Dr. Heidi Preis in the Department of Psychology, with co-Principal Investigators Dr. Marci Lobel in the Department of Psychology and Dr. Brittain Mahaffey in the Department of Psychiatry and Behavioral Health that explored the link between stress and pregnancy. The researchers are hoping to identify what helps pregnant women and what may make them more vulnerable to the impacts of stress.

Stony Brook provided a total of $398,200 in seed funding to 17 research projects in response to the pandemic. Researchers at Stony Brook had put together 63 submissions, using a peer review process to choose the projects to fund, including the COVID-19 Pregnancy Experiences (or COPE) Study. The funding, which is for one year, is designed to provide the kind of seed funding that will lead to further research and that other funding agencies will support.

The COPE study tapped into a global network of collaborators that Lobel, who is the Director of the Stress and Reproduction Lab at SBU, established over the past 30 years to compare the different factors that mitigate or exacerbate stress for pregnant women in Spain, Israel, Italy, Germany Poland and Switzerland.

“The biological impact of COVID-19 is getting the lion’s share of attention, as it should,” said Lobel. “We don’t yet know enough about how the psychological impact will affect vulnerable groups, like pregnant women.”

Indeed, Lobel has spent three decades studying the effect of stress and related psychological factors on pregnancy. In other studies, major stressors, such as earthquakes, ice storms, and periods of warfare, confirm the toxic impact of prenatal stress, particularly for preterm births and low birth weight, she said.

Lobel and her colleagues created a self-report instrument called the Pandemic-Related Pregnancy Stress Scale, or PREPS, in which women report their specific concerns or anxieties caused by COVID-19.

Throughout the United States, the team sought responses from about 4,500 women recruited through social media at the end of April and the beginning of May.

Among the women in the study, just over half of them were pregnant with their first child. In many studies that predated the current work, including some from her own research group, Lobel said women pregnant with their first child had higher levels of stress.

In some preliminary findings, 21.7 percent of pregnant women in the study reported severe levels of anxiety. “I think that is higher than what we typically would find in a population study of pregnant women,” Lobel said.

Women with a history of interpersonal violence also reported higher levels of stress and those whose prenatal appointments were canceled or altered were 1.78 times more likely to experience high stress related to a lack of preparedness and 1.49 times more likely to experience high stress related to worries about perinatal infection.

Some women in the study have found ways to reduce the accumulating stress about the health care crisis. The techniques that work for some women, Lobel said, may not work for others, suggesting that stress relief is specific to the individual and is usually determined by the situation itself.

“I don’t recommend any particular way of coping,” Lobel said. “What works for one may not work for another. It’s good to have a tool kit with lots of ways of coping.”

Indeed, some of the techniques pregnant women have found helpful include meditation, prayer, and faith-based practices. Pregnant women have also benefited from social support, which is particularly important during the pandemic when some women may feel “literally and figuratively isolated from others,” Lobel said.

Of all the research Lobel has done, the one that has received the most attention and landed her in the bible for pregnant women, “What to Expect When You’re Expecting,” was a study on optimism. She found that women who were more optimistic had better birth outcomes due in part to the better are they took of their health during pregnancy.

Coping with stress by avoidance predicts increases in emotional distress, Lobel explained. This corroborates much research which shows that avoidance is usually an ineffective way to cope with stress, except in limited cases such as when a stressful situation is brief and uncontrollable.

When people avoid the things that bother them, they can do it cognitively or through alcohol, which is especially dangerous for pregnant women and their developing fetuses. Avoidance can also involve excessive sleeping, as pregnant women may decide they don’t want to deal with life and stay in bed all day.

The scientists plan to collect a second set of data from these women, who were recruited through social media and who represent a diverse socioeconomic background, race and ethnicity, sexual orientation, and other factors, on July 15th.

Lobel said she already has some preliminary, unpublished findings from Poland, which are showing the same kinds of stressors and distress among pregnant women. Polish women have expressed stress related to worries about lack of preparation for birth during the pandemic and stress related to worries about infection.

Lobel said the researchers hope to explore a host of questions as they collect more information. They hope to look at obsessions and compulsions and would like to measure anger. They also will measure levels of depression and anxiety and will compare that to the norms for non-pregnant women.

On the other side of the stress meter, the group will study how being pregnant during the pandemic may help some women appreciate their pregnancy more. For some women, the pregnancy may give them strength to deal with the pandemic, as they focus on having a baby.

The researchers will also explore the level of control women feel over the outcome of their pregnancy and the health of their baby. Feeling in control can create a positive response associated with lower distress.

While Lobel and her colleagues won’t answer all these questions in a year, they hope their initial studies will lead to more funding and research. “Hopefully, we’ll get a [National Institutes of Health] grant to follow up these women for a couple of years to study them and their children to see if there are any developmental or mental or physical health effects” of the pandemic.