COVID-19 Pandemic-Related Loneliness as a Potential Risk Factor for Worse Outcomes Among Pregnant and Postpartum People

Context: The long-term effects of the COVID-19 pandemic-related isolation continue to unfold. Perinatal people may be especially susceptible to the impacts of social isolation and loneliness.

Objective: Explore the COVID-19 pandemic-related impact on loneliness and other health determinants and better understand ways to support vulnerable perinatal people during times of crisis.

Study Design/Analysis: Cross-sectional survey to assess the COVID-19 pandemic impact on perinatal people. Characteristics were compared between respondents who screened positive versus negative for loneliness using Wilcoxon, Fisher’s, or Pearson’s tests. Variables differing (p<0.05) between lonely and non-lonely subgroups were included in multivariate logistic regression analysis to assess factors associated with loneliness.

Population Studied: Perinatal people who completed an electronic survey between 8/4/20 and 11/24/20 in Pennsylvania and 1/15/21 and 4/15/21 in Wisconsin.

Intervention/Instrument: Anonymous survey containing questions across 8 health and health behavior domains, collecting quantitative and qualitative responses.

Outcome Measures: Loneliness was assessed as a dichotomized variable (“lonely” vs. “not lonely”) according to total score on the 3-item UCLA Loneliness Scale: >5 versus ≤ 5 points, respectively.

Results: Among 613 respondents, 48.8% were categorized as lonely. Lonely individuals were more likely to be postpartum (p=0.005), nulliparous (p=0.038), have more pregnancy complications (p=0.049), have a diagnosed mood disorder (p<0.001), receive mental health care (p<0.001), have elevated depression (p<0.001), anxiety (p<0.001), and stress scores (p<0.001), rate their social status as lower (p<0.001), and endorse a worse pandemic-life impact (p<0.001). In multivariate analysis assessing correlates of loneliness status, being postpartum (OR 0.59, 95% CI [0.40-0.87]), and having worse depression (OR 1.24, 95% CI [1.13-1.36]), stress (OR 0.41, 95% CI [0.28-0.60]), perceived social status (OR 0.83, 95% CI [0.73-0.95]), and pandemic-life impact (OR 1.79, 95% CI [1.11-2.93]) persisted as statistically significant.

Conclusion: Among a group of perinatal people surveyed early during the COVID-19 pandemic, screening positive for loneliness was associated with a worse bio-psycho-social profile and more pregnancy complications. Focusing efforts on preventing loneliness may help improve other outcomes critical for maternal-fetal and child health.