The Impact of the COVID-19 Pandemic on Postpartum Health Behaviors and Outcomes, PRAMS 2016-2020 Open Access

Abstract

Background  

The onset of the COVID-19 pandemic brought swift and unprecedented changes in policy and behaviors that profoundly influenced how those who were pregnant and postpartum interacted with the healthcare system. While factors such as uncertainty, stress, increased responsibility, social isolation, supply chain disruptions, and reallocation of providers might have negatively impacted postpartum outcomes, expansion of telehealth services, increased family time, and resiliency may have mitigated negative effects.  

 

Methods  

We analyzed 2016-2020 data from the Pregnancy Risk Assessment Monitoring System (PRAMS), a population-based survey for women following a live birth to evaluate whether the first 10 months of the COVID-19 pandemic impacted selected postpartum indicators: breastfeeding, contraceptive use, postpartum check-up attendance, and postpartum depression. Log-binomial regression was used to estimate state-adjusted prevalence ratios (aPR) and 95% confidence intervals (95% CI) for these associations across 41 PRAMS sites (unweighted analytic sample = 187,262).  

 

Results

Overall, the onset of the COVID-19 pandemic did not influence breastfeeding initiation, postpartum contraceptive use, or postpartum check-up attendance. There was, however, a small increase in the prevalence of PPD during the COVID-era (aPR = 1.12; 95% CI: 1.11-1.13). This association was amplified for those with a prior history of depression (aPR = 9.0; 95% CI: 8.9-9.1). 

 

Conclusion  

Those with a previous depression diagnosis were particularly vulnerable to the changes that occurred early in the COVID-19 pandemic. Further research into the long-term impacts of the COVID-19 pandemic on postpartum well-being is needed. 

Table of Contents

Background 1

       Breastfeeding 2

       Contraceptive Use 4

       Postpartum Depression 5

       Postpartum Visit 7

       Rationale for Study 7

Methods 8

       Data Source 8

       Exposure 9

       Outcomes 9

       Covariates 11

       Analytic Strategy 11

       Exclusion Criteria 12

Results 13

Discussion 14

       Consistency with the Broader Literature 16

       Strengths & Limitations 20

       Public Health Implications 22

Conclusion 23

References 24

Tables 31

About this Master's Thesis

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	PRAMS Postpartum Visit Contraceptive Use Breastfeeding Postpartum Depression COVID-19 Postpartum Health
Committee Chair / Thesis Advisor	Christiansen-Lindquist, Lauren, Emory University

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