Data come from the COVID-19 and Reproductive Effects (CARE) study, an online survey that was administered to a convenience sample recruited primarily through social media (i.e., Twitter and Facebook) and via dissemination to U.S.-based contacts working in maternal health. Surveys were completed between April 16th -30th 2020. The target population for the CARE study were US-based pregnant women aged 18 years or older, while the present analysis focuses specifically on those participants who were currently working. This study received ethical approval from Dartmouth College (STUDY00032045). Informed consent was collected by participants clicking a box saying that they consent to the information provided on the consent form. Participants were informed that the survey would take approximately 10–15 minutes to complete and were provided with details about data storage, data security, PI information, and the purpose of the study. Only survey site visitors who met the inclusion criteria were eligible to participate in the survey. The survey was administered in REDCap, which automatically captures survey responses.
Completion of the survey was voluntary, and participants were allowed to skip any questions they did not want to answer. Only individuals who completed the survey (went through to the end of the questionnaire, even if they were missing data on individual questions) were included in the analysis. Of 2,467 people who consented to take the survey, 1,970 completed it (80%). Of the complete surveys, 1,600 women were currently working and therefore eligible for inclusion in these analyses.
COVID-19 pandemic effects on work-plans: Participants were asked “Has the pandemic changed your plans for how long you plan to work during your pregnancy?” (yes/no)
Work-plan uncertainty: If participants reported that COVID-19 had changed their work-plans, they were then prompted to qualitatively describe how their work-plans were affected. From the 438 participants who provided a qualitative response, we identified participants who indicated they were uncertain of how their work-plans would be affected by the pandemic (N = 30), since uncertainty could contribute to increased emotional distress (Shihata et al 2016).
Work location: Participants who reported that they were currently working were asked to identify their work location (from home; outside the home; or both).
Depression symptoms: Depression symptoms were screened for using the Edinburgh Postnatal Depression Survey (EPDS) (Cox et al 1987). Depression symptoms were analyzed according to clinically-significant depression criteria for pregnant women (cut-point ≥ 15) (Matthey et al 2006).
Age: Participants self-reported their age in years.
Education: Participants selected their highest completed education from the following options: Some high school, no diploma (1) High school graduate, diploma or the equivalent (for example: GED) (2) Some college credit, no degree (3) Trade/technical/vocational training (4) Associate degree (5) Bachelor’s degree (6) Master’s degree (7) Professional degree (8) Doctorate degree (9). A composite education variable was created for analysis: less than a bachelor’s degree, a bachelor’s degree, or a degree beyond a bachelor’s degree.
Household income: Participants indicated their annual household income (USD) from the following options: Less than $10,000 (1); $10,000 - $19,999 (2); $20,000 - $34,999 (3); $35,000 - $49,999 (4); $50,000 - $74,999 (5); $75,000 - $99,999 (6); $100,000+ (7). A composite household income variable was created for analysis: <$49,999, $50,000-$99,999, and $100,000+.
Race/ethnicity: Race/ethnicity were self-reported and measured according to the Office of Management and Budget Standards (Office of Management and Budget 1997). Native Hawaiian/Pacific Islander participants were re-classified as “Other” due to a small sample size (N = 3).
Current gestational week: Participants indicated their current gestational week.
High-risk pregnancy: Women were asked whether their pregnancy had been classified as “high-risk” by their maternity care provider or if they were aged 35 or older.
Self-reported health: Women were asked whether they would describe their health as poor, fair, good, or excellent. This was re-categorized into good/excellent vs poor/fair.
Statistical analysis: Data analyses were conducted using Stata 15.1. All continuous variables exhibited normal distributions, with skewness values within approximately +/-0.5 and kurtosis values within approximately +/-3. Multicollinearity was not detected between any variables; all VIF values were in an acceptable range of 1.03-1.75. Sample descriptive statistics were calculated and bivariate analyses were conducted to evaluate significant differences in study covariates according to COVID-19-associated work-plan changes. A multivariate logistic regression was used to evaluate whether work-plan changes predicted a clinically-significant depression score (EPDS>=15; yes/no). We then repeated this analysis to evaluate whether there was an association between depression and work-plan uncertainty (i.e., whether women were unsure how their work-plans would be affected). All regression models were adjusted for maternal age, education, income, week of pregnancy at time of survey, self-rated health, race/ethnicity, and “high-risk” pregnancy.