Higher Depression Scores Found in Pregnant Women With Exercise Routines Disrupted by Pandemic

A newly published study found that pregnant women whose exercise routines were disrupted by the COVID-19 pandemic reported significantly higher depression scores than those whose routines did not change. In this Q&A, researchers Theresa Gildner, PhD, MA, and Zaneta Thayer, PhD, explain the impetus for the research, details of the findings, and their clinical significance as the pandemic continues.

Q: What led you and your colleagues to research the link between exercise routines and depression scores in pregnant women during the COVID-19 pandemic?

A: We started the COVID-19 and Reproductive Effects (CARE) Study in April 2020 to investigate how the COVID-19 pandemic has affected the well-being of pregnant women living in the United States. One outcome of particular interest is depression, since pregnant women experience an increased risk of depression, compared with the general public. We were primarily interested in understanding how pandemic-associated disruptions to daily life have impacted mental health among pregnant women in the US.

The pandemic has affected many aspects of daily life, but in this study we focused specifically on pandemic-related exercise disruptions. Moderate exercise is recommended during pregnancy to support both physical and mental health. But regular exercise routines have likely been affected by the pandemic, especially for those living in densely populated areas where space to exercise safely indoors or outdoors is limited. We therefore tested whether exercise disruptions were associated with higher depression symptom scores, and whether this varied according to living in a metropolitan or nonmetropolitan area.

Q: Please briefly describe the study method and your key finding(s).

A: To test whether exercise disruptions were linked with depression scores, we used data from an online survey of 1862 pregnant women in the United States. Participants were recruited April-June 2020 on social media platforms (eg, Facebook and Twitter) and via contacts working in maternity care and public health. Depression symptoms were screened using the Edinburgh Postnatal Depression Scale (EPDS), the gold standard for measuring maternal depression. Participants were also asked “has your exercise routine changed at all since the COVID-19 pandemic began?”. Finally, we collected ZIP code data so we could assess whether location influenced the likelihood of exercise disruption; specifically, we used the ZIP code information to determine each participant’s Rural-Urban Continuum Code (ie, a classification of “metro” or “nonmetro” based on population size in the given ZIP code).

We found that women who reported exercise changes during the pandemic exhibited significantly higher depression scores, compared with those reporting no changes. Moreover, individuals living in metro areas of all sizes were approximately 2 times more likely to report exercise changes as women living in nonmetro areas.

Q: Were any of the outcomes particularly surprising?

A: We thought participants might report walking more as an alternative form of exercise during the pandemic. While we didn’t ask about this explicitly, respondents were asked to describe how their exercise routines had changed and only a handful of women reported that they were walking more now. Rather, a high percentage of participants (47.2%) stated they were exercising less following the onset of the pandemic. Several respondents stated that they were not comfortable going outside to walk during the pandemic, especially those in metropolitan areas.

(Page 2 of 2)

Q: In light of the study results, what recommendations would you give clinicians treating pregnant women during the pandemic?

A: Our findings suggest that providers should explicitly ask women how the pandemic has impacted their exercise routines and consider this a risk factor for depression. Efforts should also be made to recommend exercises that are tailored to individual living conditions (such as whether they can safely exercise outdoors and how much space is available for exercise in their home), as well as physical health and ability to exercise.

For instance, our results indicate that women living in metro areas were significantly more likely to report exercise routine changes during the pandemic than women living in nonmetro areas. Exercise recommendations—especially in urban areas—should therefore focus on simple exercises that can safely be performed at home without specialized equipment or a lot of space (including squats, lunges, side-lying leg lifts, or virtual prenatal yoga). These recommendations may be most effective if communicated by providers who understand the personal health and space limitations of each individual patient. Overall, these findings support the idea that exercise represents a potential tool to support both mental and physical health among pregnant women, both during and after the pandemic.

Q: Are there any other studies you feel are needed on this topic?

A: It would be helpful to collect data over time from the same participants to confirm that disrupted exercise routines are causing increased depression scores. It is also possible that depression leads to disrupted exercise; long-term data can help to better understand the directionality of these associations.

In addition, the sample used in this study is not representative of the US population as a whole; white, educated, wealthy women are overrepresented in the sample. Additional work is needed to determine whether the associations observed here are also evident across a more representative, diverse sample of the US population.

Q: Is there anything else pertaining to your research and findings that you would like to add?

A: These data were collected from women living in the US, the country hardest hit by the COVID-19 pandemic so far. The prolonged nature of the lockdowns and current uptick of infections in many parts of the country will likely continue to disrupt normal routines, including ability to exercise, for months to come. Finding ways to encourage and promote safe exercise for pregnant women will be important for improving mental health during these challenging times.

Reference

Gildner TE, Laugier EJ, Thayer ZM. Exercise routine change is associated with prenatal depression scores during the COVID-19 pandemic among pregnant women across the United States. PLOS ONE. 2020 15(12):e0243188.

Theresa Gildner, PhD, MA, is an assistant professor of biological anthropology at Washington University in St. Louis. Her research focuses on the effects of human behavior and the environment on human health, particularly infectious disease. She is also interested in the various ways people respond to disease risk, including during the COVID-19 pandemic. Her work utilizes a biocultural approach to examine how interactions between social factors and individual biology shape health outcomes, with implications for the design of more effective medical care.

Zaneta Thayer, PhD, is an assistant professor of biological anthropology at Dartmouth College. She has spent the last 12 years investigating how maternal stress and well-being in pregnancy impacts maternal and child health. The majority of her work has been conducted in New Zealand, where the maternal care landscape differs substantially relative to the United States. This prior work has set her up well for the CARE study, since it has highlighted how patterns of maternity care, which are being greatly affected by the COVID-19 pandemic, can affect maternal well-being and labor and delivery outcomes. Dr. Thayer is the 2020 recipient of the Michael A. Little Early Career Award for the Human Biology Association.