Changes in Pregnant Patients' Beliefs About COVID-19.

COVID-19 is a novel coronavirus with data suggesting a more serious clinical course in pregnancy. We aimed to assess changes in knowledge, behaviors, and intentions of pregnant women regarding COVID-19. This was a cross-sectional survey study of 58 and 77 predominantly African-American and Afro-Caribbean pregnant patients presenting for prenatal care in Brooklyn, NY in 2020 (during the first surge of the pandemic) and 2021, respectively. Descriptive and inferential statistics were performed. Many beliefs and intentions were unchanged between 2020 and 2021 (e.g. believing pregnant women were at higher risk of COVID-19 infection and subsequent ICU admission due to pregnancy, having the desire to breastfeed, among others). Other beliefs and behaviors changed between 2020 and 2021 (fewer women believed they received information from their provider regarding COVID-19 and fewer would miss a prenatal visit for fear of COVID-19 contagion). Patients' behaviors and intended behaviors in both 2020 and 2021 were directly influenced by their beliefs, many of which were based on unsupported data regarding COVID-19 and pregnancy (ie: babies were at increased risk of being born with congenital malformation following a mother's COVID-19 infection). Patients who held these beliefs were more likely to say that they did not attend prenatal visits and did not receive information from their provider regarding COVID-19. Knowledge of patient beliefs is useful for structuring care as the pandemic evolves. This study demonstrates that pregnant patients make decisions regarding behaviors based on beliefs grounded in misinformation. Accordingly, it is the provider's responsibility to ensure that beliefs regarding COVID-19 are based in fact, so patients can make informed decisions.

Social determinants of perinatal mental health.

Social inequities and mental health are public health and medical conditions that are inextricably linked. Perinatal mental health is influenced by social, physical, and biological factors, with additional stressors related to pregnancy. The social determinants of health (SDOH) encompasses all conditions in which people live and grow, inclusive of cultural norms that reflect the diverse populations we serve. To best understand the mechanisms by which the SDOH affects perinatal mental health, we introduce the Urban Stress Model and describe the link between urban realities to stress response and potential mechanisms that link urban living to increased risk of adverse perinatal mental health. Given the increased diversity of patient populations, cultural considerations are paramount in understanding the utility and best practices in screening and interventions among ethnically diverse communities. Building on our Urban Stress Model and a structural determinants of health framework, we present examples of interventions to address the social inequities of perinatal mental health from the policy to community levels.