Distinct effects of general psychological distress and COVID-19-specific fear during pregnancy on gestational age and infant birth weight

Objective To disentangle the independent and shared contributions of maternal general psychological distress (GPD) and COVID-19-specific fear (CSF) during pregnancy to gestational age at birth and infant birth weight. Methods This study utilized secondary data from the prospective Canadian “Pregnancy during the COVID-19 Pandemic” cohort. The final analytic sample comprised 5,658 pregnant individuals. GPD was a latent variable indicated by the Edinburgh Postnatal Depression Scale (EPDS) and Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety scores. CSF was a latent variable indicated by three items assessing pandemic-related fears for self and baby. Structural equation modeling (SEM) examined associations with gestational age and birth weight, controlling for maternal age, income, and education. Results The SEM demonstrated good fit. Higher GPD independently predicted shorter gestational age (standardized β = –.048, p = .002) but not lower infant birth weight ( p = .632) after accounting for CSF. Higher CSF independently predicted both shorter gestational age (standardized β = –.058, p < .001) and lower infant birth weight (standardized β = –.058, p < .001), controlling for GPD and covariates. GPD and CSF were positively correlated (standardized covariance = .419, p < .001). Conclusion COVID-19-specific fear is a unique and significant risk factor for shorter gestational age and lower infant birth weight, distinct from general psychological distress. These findings highlight the need to assess and address pandemic-specific fears in perinatal populations to mitigate adverse birth outcomes during public health crises. Targeted interventions for specific fears may be necessary beyond general mental health support.