The impact of COVID-19 prenatal stress on child development

Given the huge disruptions the COVID-19 pandemic has caused in our lives, many caregivers, educators, and researchers are asking themselves this question: When it comes to children, what will be the long-term impacts of these disruptions? As researchers studying the influence of prenatal and postnatal environments on children’s brain development, we have a strong professional interest in this question. As mothers (one of whom was pregnant during the pandemic), we also have a strong personal interest.

Research on this topic is beginning to emerge. Studies have revealed brain alterations related to prenatal stress, as well as a slightly higher risk for developmental delay among children born during the pandemic. While most children will continue to develop well, early interventions are important for those experiencing delays, and healthcare and education systems need to be prepared to handle a slight increase in the number of children experiencing difficulties.

Symptoms of depression and anxiety (collectively called psychological distress) are common during pregnancy, affecting approximately 10-20% of individuals. The COVID-19 pandemic and associated restrictions have substantially exacerbated feelings of psychological distress for many, including pregnant people, causing these rates to more than double.

“For me, the early pandemic initially seemed to be a good time to be pregnant; if I felt tired or sick, the flexibility of being at home was ideal. My rose-coloured outlook quickly faded, though, when I had my first ultrasound at 12 weeks, alone. My eyes frantically darted across the ultrasound screen, expecting to recognise something, but all I saw was noise. The technician left to get the doctor, and I waited for over an hour alone in the room, growing more anxious by the minute. I ultimately received devastating news about my pregnancy, but even in the case of routine, positive prenatal appointments, many people have struggled with a lack of social and practical support, changes in care, fears about how the virus might affect fetal development, and disruptions to work and leisure activities. All of these things have led to drastic increases in depression and anxiety symptoms.” Anonymous

Prenatal depression and anxiety can have long-lasting consequences for children’s development. Exposure to prenatal distress increases the risks of behaviour problems in children and later mental illness in adolescence and adulthood. Prenatal distress is also associated with changes in the brain from infancy to young adulthood, particularly in regions supporting emotion and behaviour. Natural disasters provide further evidence of lasting effects of prenatal stress: Children who were in utero during the 1998 ice storms in eastern Canada or the 2011 floods in Queensland, Australia were more likely to experience brain and behaviour changes during childhood and adolescence.

“Exposure to prenatal distress increases the risks of behaviour problems in children and later mental illness in adolescence and adulthood.”

Relatively few studies have yet been conducted on children born during the pandemic, but the early data suggest a slightly higher risk of developmental delays. For example, two studies of children born during the pandemic, one focusing on 6-month-olds and the other on 12-month-olds, showed that these children had poorer motor and personal-social skills than children born before the pandemic. In a Canadian sample of children born prior to the pandemic, approximately 1-7% screened positive for risk of developmental delay at 1 year – whereas in a very similar cohort of children born during the pandemic, 2-10% screened positive. Although this is a small difference, it suggests that more children will need support from healthcare and educational systems, especially as they enter school. It is important to note, however, that most children are still developing typically.

The reasons for these delays are not fully clear, but in a recent study, we showed that prenatal distress experienced during the pandemic is associated with altered infant brain structure and function at 3 months of age. Specifically, there were changes in the connections between the amygdala and prefrontal cortex, two brain areas related to emotion processing. These changes suggest that these children may be at higher risk for subsequent behaviour or mental health problems. Importantly, this effect was lessened by social support: Individuals who reported better social support during pregnancy gave birth to children with more ‘typical’ brain patterns, even if those individuals had experienced high levels of distress. This shows how critical it is to maintain easy access to supports during pregnancy (e.g., allowing support people to attend prenatal care appointments and delivery; promoting social groups for expectant parents; maintaining safe outdoor spaces for people to gather, even during a pandemic) to provide help for the pregnant individual and mitigate potential effects of stress on the developing baby.

“As a society, we need to provide better support for pregnant individuals to reduce distress and mitigate transmission of that distress to children.”

So, if you’re a parent worried about your developing child, rest assured that everything is most likely fine. But if there are signs of delay, early supports and interventions can help.

As a society, we need to provide better support for pregnant individuals to reduce distress and mitigate transmission of that distress to children. And we need to make sure our healthcare and education systems are equipped to support a slight increase in developmental problems in the generation born during the pandemic. In doing so, we can help all children to thrive.