Women Pregnant During COVID-19 Pandemic Experienced More Stress, Depression Symptoms

Authors: Alison E. Hipwell, Irene Tung, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

What were the study results?

This study compared ECHO participants who were pregnant during the COVID-19 pandemic with participants who were pregnant before the pandemic. Participants who were pregnant during the pandemic reported more stress and symptoms of depression. Lower levels of physical activity were associated with more distress, and higher levels of emotional support were associated with less distress during pregnancy for both groups. The results also showed that pregnancies during the pandemic were slightly shorter on average but there was no impact on infant birth weight.

What was the study's impact?

This study highlights the importance of providing access to emotional support and mental health care during pregnancy and identifying ways to promote physical activity to help improve maternal health and well-being, regardless of external conditions like the pandemic.

Why was this study needed?

Previous studies on the effects of the COVID-19 pandemic on pregnancy outcomes have been mixed. This is partly because background information about pregnant participants has been missing and partly because the effects of the pandemic are different for different populations across the country. This study involved pregnant participants from across the United States and collected information about their mental health and well-being along with data on their pregnancy outcomes. The study also focused on positive factors that can be used to improve pregnancy health and birth outcomes, such as physical activity and emotional support.

Who was involved?

This study included 501 pregnant participants who gave birth during the COVID-19 pandemic (between March 12, 2020 and May 30, 2021) and 501 pregnant participants who gave birth before the pandemic (prior to March 11, 2020). Participants were 31 years old on average and enrolled in one of 16 ECHO research sites across the United States.

What happened during the study?

Participants answered questions about their experiences with stress and depression, reported on their physical activity, and described the emotional support they received during pregnancy. The researchers also collected information on participants’ birth outcomes from medical records and maternal reports.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What happens next?

More research is needed to understand how social support and physical activity during pregnancy may protect pregnant women from stress or depression during difficult times. Future research may look for more details about the types of experiences during the COVID-19 pandemic that had the most influence on pregnancy health and well-being.

Where can I learn more?

Access the full journal article, titled “Impact of Sedentary Behavior and Emotional Support on Prenatal Psychological Distress and Birth Outcomes During the COVID-19 Pandemic,” in Psychological Medicine.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published March 8, 2023

Access the associated article.

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Women Pregnant During COVID-19 Pandemic Experienced More Stress, Depression Symptoms

ECHO Researchers Investigate Link Between Mental Health and Pregnancy During the COVID-19 Pandemic

Posted on March 8, 2023April 2, 2025 by Jodi Snare

Collaborative ECHO research led by Alison Hipwell, PhD, ClinPsyD, of the University of Pittsburg, and Irene Tung, PhD, of California State University Dominguez Hills, found that being pregnant during the COVID-19 pandemic was associated with higher levels of stress and depression symptoms. The researchers found that participants who reported more emotional support and engaged in physical activity before and during the pandemic had less stress and fewer symptoms of depression. The results also showed that pregnancies during the pandemic were slightly shorter on average but there was no impact on infant birth weight. This study highlights the importance of providing access to emotional support and mental health care during pregnancy and identifying ways to promote physical activity to help improve maternal health and well-being, regardless of external conditions like the pandemic. This research, titled “Impact of Sedentary Behavior and Emotional Support on Prenatal Psychological Distress and Birth Outcomes During the COVID-19 Pandemic,” is published in Psychological Medicine.

The study included 501 pregnant participants who gave birth during the COVID-19 pandemic (between March 12, 2020 and May 30, 2021) and 501 pregnant participants who gave birth before the pandemic (prior to March 11, 2020). Participants were 31 years old on average and enrolled in one of 16 ECHO research sites across the United States. Participants answered questions about their experiences with stress and depression, reported on their physical activity and described the emotional support they received during pregnancy. The researchers also collected information on participants’ birth outcomes from medical records and maternal reports.

“More research is needed to understand how social support and physical activity may protect pregnant women during difficult times,” said Alison Hipwell, PhD, ClinPsyD, of the University of Pittsburgh. “Future research may look at what types of experiences during the pandemic had the most influence on pregnancy health and well-being.”

Read the research summary.

NIH Study Finds Screen Time Increases in Children During the Pandemic Persisted After Restrictions Lifted

Posted on February 15, 2023August 27, 2025 by Jodi Snare

FOR IMMEDIATE RELEASE

Increases in screen time among children persisted more than one year into the pandemic, after many COVID restrictions had been lifted, according to a new study funded by the Environmental influences on Child Health Outcomes Program (ECHO) at the National Institutes of Health.

Excessive screen time may be associated with obesity-promoting health behaviors and adverse mental health. The COVID-19 pandemic initially led to widespread school closures, shelter-in-place laws, closures of recreational facilities and cancellation of youth sports, increases in the number of parents working from home, and social distancing recommendations, all of which may have impacted screen time among children.

“Our findings can help inform clinical guidelines that could aid parents and their children in re-establishing healthy media use habits,” said Monique Hedderson, PhD, of the Kaiser Permanente Northern California Division of Research. “Pediatricians can help parents reset family media use priorities and limits that may have relaxed during the early stages of the COVID-19 pandemic using tools like the American Academy of Pediatrics Family Media Plan.”

The study included 228 children between ages 4 to 12 and their parents from three ECHO cohorts across the United States. ECHO researchers surveyed parents about their children’s total, educational (not including remote school), and recreational screen time and examined trends in screen use before and at two points during the pandemic.

Dr. Hedderson and Assiamira Ferrara, MD, PhD, ECHO Program investigators at the Kaiser Permanente Northern California Division of Research, led this collaborative research published in JAMA Network Open.

Hedderson, M. et al. “Trends in screen time use among children during the COVID pandemic, July 2019 through August 2021.” JAMA Network Open. DOI: 10.1001/jamanetworkopen.2022.56157

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About ECHO: ECHO is a nationwide research program supported by the NIH. Launched in 2016, ECHO aims to enhance the health of children for generations to come. ECHO investigators study the effects of a broad range of early environmental influences on child health and development. For more information, visit echochildren.org.

About the NIH: NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information, visit www.nih.gov.

Media Contacts

For information or to request an interview, contact Rebekah Yeager, rebekah.yeager@nih.gov.

If you are not a member of the media, but have a general inquiry, please contact NIHKidsandEnvironment@od.nih.gov.

Connect With Us

Check out the recent issues of our bi-monthly newsletter, the ECHO Connector, for program news and the latest research findings.

To receive the ECHO Connector through email, subscribe here.

Follow @ECHOChildHealth for the latest ECHO Program updates on Twitter.

Screen Time for Children Rose During COVID-19 Pandemic, Remained High After Restrictions Lifted

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Screen Time for Children Rose During COVID-19 Pandemic, Remained High After Restrictions Lifted

Authors: Monique Hedderson, Assiamira Ferrara, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of The Director, National Institutes of Health supported this research.

What were the study results?

Total screen time among children ages 4 to 12 increased during the early stages of the COVID-19 pandemic as lockdowns and school closures were widespread. Screen time remained higher in the later pandemic, even after several restrictions had been lifted. The study found that children used screens an average of 1.75 hours/day more during the early pandemic (December 2020 – April 2021) compared to before the pandemic (July 2019 – March 2020). During the later pandemic (May 2021 – August 2021), screen time remained on average 1.11 hours/day higher than the pre-pandemic average. Both recreational and educational screen time increased during the COVID-19 pandemic.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

The study shows that increases in screen time among children persisted more than one year into the pandemic, after many COVID restrictions had been lifted. These findings can help inform clinical guidelines that could aid parents and their children in re-establishing healthy media use habits. Pediatricians can help parents reset family media use priorities and limits that may have changed during the early stages of the COVID-19 pandemic using tools like the American Academy of Pediatrics Family Media Plan.

Why was this study needed?

Excessive screen time among children may be associated with obesity-promoting health behaviors and adverse mental health. The COVID-19 pandemic initially led to widespread school closures, shelter-in-place laws, closures of recreational facilities and cancellation of youth sports, increases in number of parents working from home, and social distancing recommendations, all of which may have impacted screen time among children. Prior studies have reported screen time levels during the pandemic but were unable to document changes in screen time because most lacked pre-pandemic assessments. This study is among a handful of ECHO studies to include pre-pandemic assessments of screen use in order to document changes during the pandemic.

Who was involved?

The study included 228 parent-child pairs from three ECHO cohorts across the United States (Colorado, California, and South Dakota). Parents reported their children’s screen time. The geographically, racially, and ethnically diverse participants ranged in age from 4 to 12 at the start of the study.

What happened during the study?

ECHO researchers surveyed parents about their children’s media use before, during the early, and later periods of the pandemic. The study assessed total, educational (not including remote school), and recreational screen time and examined trends in screen use before and at two points during the pandemic.

What happens next?

Additional studies are needed to determine whether the increases in screen time among children during the pandemic impacted longer term obesity and mental health outcomes in children. Future studies can also clarify whether specific types of screen time adversely impacted children’s health during the pandemic.

Where can I learn more?

Access the full journal article, titled “Trends in screen time use among children during the COVID pandemic, July 2019 through August 2021” in JAMA Network Open.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published February 15, 2023

Access the associated article.

Download this summary

Screen Time for Children Rose During COVID-19 Pandemic, Remained High After Restrictions Lifted

New ECHO Research Investigates Increase in Screen Time for Children During the Pandemic

Posted on February 15, 2023December 5, 2023 by Jodi Snare

Collaborative ECHO research led by Monique Hedderson, PhD and Assiamira Ferrara, MD, PhD, of the Division of Research at Kaiser Permanente Northern California, investigates the changes in screen time habits of children during the COVID-19 pandemic. The study found that total screen time among children ages 4 to 12 increased between December 2020 and April 2021 when school closures and lockdowns were widespread and remained even after several restrictions were lifted. The research, titled “Trends in screen time use among children during the COVID pandemic, July 2019 through August 2021,” is published in JAMA Network Open.

The study included 228 parent-child pairs from three ECHO cohorts across the United States (Colorado, California, and South Dakota). Parents reported their children’s screen time. The geographically, racially, and ethnically diverse participants ranged in age from 4 to 12 at the start of the study. ECHO researchers surveyed parents about their children’s media use before, during the early, and later periods of the pandemic. The study assessed total, educational (not including remote school), and recreational screen time and examined trends in screen use before and at two points during the pandemic.

Excessive screen time is associated with obesity-promoting health behaviors and adverse mental health. The COVID-19 pandemic initially led to widespread school closures, shelter-in-place laws, closures of recreational facilities and cancellation of youth sports, increases in parents working from home, and social distancing recommendations, all of which may have impacted screen time among children.

“Our findings can help inform clinical guidelines that could aid parents and their children in re-establishing healthy media use habits,” said Dr. Hedderson. “Pediatricians can help parents reset family media use priorities and limits that may have relaxed during the early stages of the COVID-19 pandemic using tools like the American Academy of Pediatrics Family Media Plan.”

Prior studies have reported screen time levels during the pandemic but were unable to document changes in screen time because most lacked pre-pandemic assessments. This study is among a handful of ECHO COVID-19 studies to include pre-pandemic assessments of screen use in order to document changes during the pandemic.

More studies are needed to determine whether the increases in screen time among children during the pandemic impacted longer term obesity and mental health outcomes in children. Future studies can also clarify whether there were specific types of screen time that adversely impacted children’s health during the pandemic.

Read the research summary.

ECHO Study Suggests COVID-19 Pandemic Contributed to Developmental Delays in Infants, Toddlers

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ECHO Study Suggests COVID-19 Pandemic Contributed to Developmental Delays in Infants, Toddlers

Authors: Sara Nozadi, Johnnye Lewis, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

What were the study results?

In this study, up to 15% of infants and toddlers who were developmentally on track prior to the COVID-19 pandemic showed signs of developmental delays during the pandemic. Male children showed more delays than female children, and language was the most affected developmental area. Families from minority communities and those with lower socioeconomic status were more likely to experience pandemic-related hardships. However, financial and social pandemic-related hardships were not associated with the individual changes observed in children’s developmental progress.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

This study highlights the importance of early developmental screening during times of adversity, such as pandemics, in order to identify delays and connect children to supportive services. Previous studies have shown negative impacts of the pandemic on overall child development but have not looked at the effects of the pandemic on individual children’s development over time.

Why was this study needed?

Many studies have focused on the COVID-19 pandemic’s effects on the development of school-aged children, evaluating the effects of the pandemic on academic performance and behavior problems. Fewer studies have examined the pandemic’s effects on the developmental progress of infants and toddlers, whose needs are different than those of school-aged children. During this study, researchers examined whether the negative developmental effects observed in school-aged children over the course of the pandemic could also be seen in infants and toddlers.

Who was involved?

The study included 684 children between the ages of 2 months and 4 years from 8 ECHO cohort research sites across the United States. Researchers included children whose parents had filled out the Ages and Stages Questionnaire (ASQ), which uses parent-reported information to pinpoint a child’s developmental progress, within the 18-month period before and after March 2020. Parents of participating children were also asked about financial hardship, defined as at least one parent experiencing job loss or change, or social hardships, defined as families’ quarantining from household members or extended family and friends, during the pandemic.

What happened during the study?

Parents answered 30 questions before and during the pandemic to determine whether their child had achieved developmental milestones in language, motor, cognitive or problem solving, and socioemotional development. Researchers also used the ECHO COVID-19 survey that was developed in April 2020 to gauge pandemic-related financial and social stress on families.

What happens next?

Future research can follow the developmental patterns in these children over time to determine if COVID-19 related delays are lasting or reversible. Studies may also focus on pandemic-related stressors that could particularly effect infants and toddlers, such as family dynamics, parent-child interactions and parental stress.

Where can I learn more?

Access the full journal article, titled “Effects of COVID-19 financial and social hardships on infants’ and toddlers’ development in the ECHO program,” in the International Journal of Environmental Research and Public Health.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published January 5, 2023

Access the associated article.

Download this summary

ECHO Study Suggests COVID-19 Pandemic Contributed to Developmental Delays in Infants, Toddlers

ECHO Researchers Investigate How Changes in Family Situations Due to the COVID-19 Pandemic are Linked to Children’s Behaviors

Posted on December 30, 2022December 5, 2023 by Jodi Snare

Collaborative ECHO research led by Traci Bekelman, PhD, MPH and Katherine Sauder, PhD of the University of Colorado, Anschutz Medical Campus, investigates whether parents’ coping strategies, stress, and financial strain affected their children’s health behaviors during the first seven months of the COVID-19 pandemic. The researchers found that children with parents who were able to change their work schedules to care for their children during the pandemic had less screen time and slept longer at night, while children with parents who were unable to adjust their work schedules due to stress about money and access to food drank more sugary drinks, were less active, and slept less at night. This research, titled “Sociodemographic Variation in Children’s Health Behaviors During the COVID-19 Pandemic,” is published in Childhood Obesity.

This study included 3,315 children between 3 and 17 years old from 50 ECHO cohorts across the United States. Parents answered questions about their child’s diet, physical activity, screen time, and sleep during the first seven months of the COVID-19 pandemic. Additionally, the parents reported how they personally coped with the pandemic and what their largest sources of stress was.

The COVID-19 pandemic significantly changed many families’ routines and financial situations, causing an increase in parents’ stress and affecting children’s diet, physical activity, and sleep behaviors. “Parents stressed about money may need additional resources to help their children to eat healthier, increase their physical activity and sleep, and decrease their screen time,” said Dr. Bekelman. “Going forward, we will continue to look at how financial stress and parents’ work schedules affect children’s health behaviors to help guide the design of future interventions that can encourage healthy behaviors among children, especially during stressful times like a pandemic.”

Read the research summary.

NIH Program Study Finds Life Changes During the COVID-19 Pandemic Contribute to Mothers’ Traumatic Stress

Posted on December 16, 2022June 7, 2023 by Jodi Snare

FOR IMMEDIATE RELEASE

Mothers who experienced more life changes during the pandemic reported more symptoms of traumatic stress, according to a new study funded by the Environmental influences on Child Health Outcomes Program (ECHO) at the National Institutes of Health.

Mothers with higher incomes and higher education tended to experience more changes and reported more symptoms of traumatic stress. Additionally, these mothers were more likely to report financial concerns as a cause of that stress.

“Our study found that mothers who had the most changes to their work, health, and social support systems also reported the highest amount of traumatic stress due to the pandemic,” said Tracy Bastain, PhD, MPH, an ECHO Program investigator from the University of Southern California.

This study included 11,473 mothers from 62 ECHO cohorts across the U.S. and Puerto Rico and investigated the potential impacts of the COVID-19 pandemic on maternal mental health from April 2020 through August 2021. ECHO researchers examined patterns of pandemic-associated changes in maternal health and health behaviors, healthcare visits, work and finances, and coping strategies. The researchers used cluster analysis to group the mothers based on their pandemic experiences and then examined whether these groups reported higher or lower symptoms of traumatic stress related to the pandemic.

Dr. Bastain and Amy Margolis, PhD, an ECHO Program investigator from Columbia University, led this collaborative research published in JAMA Network Open.

Bastain, T. et al. COVID-19 Pandemic Experiences and Symptoms of Pandemic-Associated Traumatic Stress Among Mothers in the US. JAMA Network Open. DOI:10.1001/jamanetworkopen.2022.47330

###

About ECHO: ECHO is a nationwide research program supported by the NIH. Launched in 2016, ECHO aims to enhance the health of children for generations to come. ECHO investigators study the effects of a broad range of early environmental influences on child health and development. For more information, visit echochildren.org.

About the NIH: NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information, visit www.nih.gov.

Media Contacts

For information or to request an interview, contact Rebekah Yeager, rebekah.yeager@nih.gov.

If you are not a member of the media, but have a general inquiry, please contact NIHKidsandEnvironment@od.nih.gov.

Connect With Us

Check out the recent issues of our bi-monthly newsletter, the ECHO Connector, for program news and the latest research findings.

To receive the ECHO Connector through email, subscribe here.

Follow @ECHOChildHealth for the latest ECHO Program updates on Twitter.

Mothers Who Experience More Life Changes Due to the COVID-19 Pandemic Reported More Symptoms of Traumatic Stress

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Mothers Who Experience More Life Changes Due to the COVID-19 Pandemic Reported More Symptoms of Traumatic Stress

Authors: Tracy Bastain, Amy Margolis, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of The Director, National Institutes of Health supported this research.

What were the study results?

The study identified two groups of mothers based on their pandemic experiences. One of these groups experienced more changes to their daily life routines, more isolation from friends and family, and more changes to their health behaviors, when compared to the other group who experienced fewer pandemic-related changes in their lives.

Mothers who reported more life changes also reported more symptoms of traumatic stress due to the pandemic. The mothers who fell into the group that experienced more changes and reported more symptoms of traumatic stress tended to be women with higher incomes and higher education. Sixty-six percent of the women in the high change group were white. The women in the high change group were more likely to report financial concerns as a cause of stress. They were also more likely to report that the pandemic affected their healthcare.

In contrast, the group that reported fewer changes tended to have lower education and lower income. The women in this group were primarily Black and Native American. Hispanic women were split evenly between the two groups.

Both groups reported similar rates of COVID-19 infection in the household and similar work changes.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

Impact

As compared to fathers, during the COVID-19 pandemic more mothers have been affected by job and income losses, taken on more childcare burdens related to remote schooling, and have made major adjustments to their daily routines. This study found that mothers who had the most changes to their work, health, and social support systems also reported the highest amounts of traumatic stress due to the pandemic. These findings suggest that the association between sociodemographic, stressful life events, and mental health should be considered in future studies examining the long-term outcomes of the COVID-19 pandemic.

Why was this study needed?

The goal of this study was to better understand the mental health impacts of the COVID-19 pandemic on mothers in the United States and Puerto Rico.

Who was involved?

This study included 11,473 mothers from 62 ECHO cohorts across the U.S. and Puerto Rico.

What happened during the study?

ECHO researchers investigated the potential impacts of the COVID-19 pandemic on maternal mental health, from April 2020 through August 2021. The researchers looked for patterns of pandemic-related changes in maternal health and health behaviors, healthcare visits, work and finances, and coping strategies. They then used these data to group the mothers by those who had more or fewer pandemic-related changes to examine whether these groups reported higher or lower symptoms of traumatic stress related to the pandemic.

What happens next?

Future studies could examine how changes over the course of the pandemic affect mothers’ stress and well-being.

Where can I learn more?

Access the full journal article, titled “COVID-19 Pandemic Experiences and Symptoms of Pandemic-Associated Traumatic Stress Among Mothers in the US,” in JAMA Network Open.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published December 16, 2022

Access the associated article.

Download this summary

Mothers Who Experience More Life Changes Due to the COVID-19 Pandemic Reported More Symptoms of Traumatic Stress

ECHO Researchers Investigate the Mental Health Effects of Life Changes Related to the COVID-19 Pandemic

Posted on December 16, 2022December 5, 2023 by Jodi Snare

Collaborative ECHO research led by Tracy Bastain, PhD, MPH of the University of Southern California and Amy Margolis, PhD of Columbia University, investigates the mental health impacts of the COVID-19 pandemic on mothers in the United States. The study found that mothers who reported more life changes during the pandemic also reported more symptoms of traumatic stress. This research, titled “COVID-19 Pandemic Experiences and Symptoms of Pandemic-Associated Traumatic Stress Among Mothers in the US,” is published in JAMA Network Open.

This study included 11,473 mothers from 62 ECHO cohorts across the U.S. and Puerto Rico and investigated the potential impacts of the COVID-19 pandemic on maternal mental health from April 2020 through August 2021. ECHO researchers examined patterns of pandemic-associated changes in maternal health and health behaviors, healthcare visits, work and finances, and coping strategies. The researchers used cluster analysis to group the mothers based on their pandemic experiences and then examined whether these groups reported higher or lower symptoms of traumatic stress related to the pandemic.

“As compared to fathers, during the COVID-19 pandemic more mothers have been affected by job and income losses, taken on more childcare burdens related to remote schooling, and have made major adjustments to their daily routines,” said Dr. Margolis.

The mothers who fell into the group that experienced more changes and reported more symptoms of traumatic stress tended to be women with higher incomes and higher education, and these women were more likely to report financial concerns as a cause of that stress. In contrast, mothers who had lower education and lower income were more likely to report fewer pandemic-related changes.

“Our study found that mothers who had the most changes to their work, health, and social support systems also reported the highest amount of traumatic stress due to the pandemic,” said Dr. Bastain.

The study results suggest that the association between sociodemographic, stressful life events and mental health should be considered in future studies examining the long-term outcomes of the COVID-19 pandemic. Future research could examine how changes over the course of the pandemic affect mothers’ stress and well-being.

Read the research summary.