Pregnant women's experiences during a public health emergency: A cross-sectional analysis of the COVID-19 Pregnancy Risk Assessment Monitoring System COVID-19 supplement.

OBJECTIVES

The COVID-19 pandemic was associated with increased maternal morbidity and mortality, with racially minoritized women having worse outcomes than other women in the United States. However, there is little understanding of pandemic-specific stressors that may contribute to disparate outcomes. Thus, this analysis provides descriptive statistics of COVID-19 pandemic related factors among a sample of women who recently gave birth in the United States that can inform future public health disaster preparedness.

STUDY

DESIGN

Cross-sectional analysis of secondary data.

METHODS

Analysis of 2020-2021 Pregnancy Risk Assessment Monitoring System COVID-19 supplement data (weighted n = 453,231) identified five pandemic experience factors through factor analysis: family household stressors, housing instability, COVID prevention measures, COVID household exposure, and external exposure. Prevalence of each factor was estimated overall and by demographic factors.

RESULTS

Family household stressors affected 42.1% of women, including increased anxiety (48.5%) and job loss (29.9%). Housing instability impacted 11.3%, while 35.2% struggled accessing prevention supplies. Significant disparities emerged: Black and Hispanic women experienced highest family stress rates (48.5%, 48.0%); American Indian/Alaska Native women faced greatest housing instability (21.6%). Younger, unmarried women and those with lower education, Medicaid enrollment, or pre-existing vulnerabilities experienced disproportionate burdens.

CONCLUSIONS

Findings necessitate targeted emergency preparedness protocols prioritizing pregnant women's social support infrastructure, including housing assistance programs, expanded childcare services, and guaranteed access to prevention resources. The pandemic exacerbated maternal health disparities, with marginalized communities bearing the greatest burden. Medicaid expansion and culturally-responsive interventions should be implemented to support vulnerable populations during public health crises.