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Published in final edited form as: Int Perspect Psychol. 2024 Jul 1;13(3):119–127. doi: 10.1027/2157-3891/a000104

Gendered Racism in Pregnancy and Stress among Women in the United States during the COVID-19 Pandemic

Emily Rehbein 1, Amanda Levinson 2, Heidi Preis 1,3, Brittain Mahaffey 2, Marci Lobel 1,3
PMCID: PMC12323830  NIHMSID: NIHMS2041725  PMID: 40765891

Abstract

High stress experienced during pregnancy increases risk for adverse birth outcomes such as low birthweight and preterm birth that occur disproportionately among women of color in the United States. Prior research has identified a distinct form of discrimination, gendered racism in pregnancy (GRiP), that likely elevates stress and is suspected to contribute to racial disparities in birth outcomes among American women. We investigated associations of GRiP experiences and distress with two types of stress, pregnancy related and pandemic related, among 2,995 women in the U.S. pregnant at the height of the COVID-19 pandemic, a time when health care restrictions, social contact limitations, and concerns about COVID-19 infection created added stress for pregnant women. Using data collected online during the second U.S. pandemic surge (December 2020), we found that pregnant self-identified Hispanic/Latina (n = 233), Non-Hispanic/Latina Black/African American (n = 182), and Multiracial/Other (n =201) women experienced greater GRiP and greater stress of both types than Non-Hispanic/Latina White women. Structural equation modeling indicated a strong association of racial/ethnic identity with prenatal stress that was mediated by GRiP, independent of other contributors to prenatal stress. Focusing on the harmful impact of gendered racism coupled with culturally-informed individual interventions and change at multiple societal levels and institutions may help reduce the poorer reproductive outcomes that are disproportionately common among communities of color in the U.S. Addressing and alleviating discrimination can improve reproductive justice for all who choose to give birth throughout the world, regardless of their race, ethnicity, nationality, or other identities.

Keywords: pregnancy, gendered racism, COVID-19 pandemic, prenatal stress, discrimination

The COVID-19 pandemic produced higher rates of infection, morbidity, mortality, and related adversity in marginalized racial and ethnic communities across the U.S. (Andrasfay & Goldman, 2021; Blitz et al., 2020; Mackey et al., 2021). These impacts are of particular concern for pregnant women*, who are more vulnerable to the SARS-CoV-2 virus (Sakowicz et al., 2020; Wadman, 2020) and who experienced substantial stress because of restricted access to healthcare and limitations on social contact, especially during the first year of the pandemic (Bruno et al., 2021; Masters et al., 2021; Preis, Mahaffey, et al., 2020b). High prenatal stress is a potent contributor to adverse birth outcomes (e.g., Beydoun & Saftlas, 2008; Lobel & Dunkel Schetter, 2016) and is implicated in disproportionately high rates of low birthweight and preterm birth among African Americans (Giscombé & Lobel, 2005; Larrabee Sonderlund et al., 2021). Accumulating evidence also indicates that pregnant women of color face unique discrimination that heightens stress and may exacerbate their risk of poor birth outcomes (Rosenthal & Lobel, 2011, 2016, 2020). We hypothesized that this type of discrimination, gendered racism in pregnancy, would contribute to stress in pregnant women during the COVID-19 pandemic. Thus, the present study investigated whether pregnant women of color in the U.S. experienced elevated stress during the height of the pandemic compared to Non-Hispanic/Latina White women, and the extent to which stress resulted from gendered racism in pregnancy.

Gendered Racism

Intersectional frameworks (Cole, 2009; McCall, 2005) that highlight oppression due to the confluence of people’s race/ethnicity, sex/gender, and other identities, are particularly valuable to understand health disparities (e.g., Matsui et al., 2020; Rosenthal, 2016). Gendered racism in pregnancy has multiple manifestations, including poorer obstetric care, conflicting societal messages about motherhood, and disparaging stereotypes about the sexuality of women of color (Braveman et al., 2021; Rosenthal & Lobel, 2011, 2016). The COVID-19 pandemic may have intensified discrimination and distress for women of color (Michaels et al., 2022; Yudell et al., 2016; Zambrana & Williams, 2022). Pandemic conditions exacerbated longstanding U.S. disparities in access to health care, employment, education, and other social determinants of health (Riehm et al., 2021; Riley et al., 2021). Widespread civic unrest also co-occurred with the pandemic, a response to police brutality against people of color and other toxic impacts of systemic racism in American society (Buchanan et al., 2021; Palermo, 2021; Roberts et al., 2020).

Prenatal Stress

Pregnancy is often stressful because of extensive changes and uncertainty before, during, and after this major life event (Ibrahim & Lobel, 2020; Lobel & Dunkel Schetter, 2016). High prenatal stress is a risk factor for poorer maternal and infant birth outcomes including preterm delivery, low birthweight, and impaired postpartum health (Bussieres et al., 2015; Christian, 2012; Schetter & Tanner, 2012), and has long-term ramifications for child and adult health (Barker, 1990; Hocher, 2014). The onset of the COVID-19 pandemic created a host of additional stressors for pregnant women, including uncertainty about the effect of the SARS-COV-2 virus, disruptions to prenatal care, and mitigation measures creating limited access to social support (Ahlers-Schmidt et al., 2020; Preis, Mahaffey, et al., 2020a, 2020b). The pandemic onset was an especially distressing time for pregnant women, provoking high levels of anxiety and depressive symptoms, which are themselves risk factors for adverse maternal, infant, and child outcomes (Lebel et al., 2020; Moyer et al., 2020; Nowacka et al., 2021).

The Current Study

Group differences in stress are suspected to contribute to racial/ethnic disparities in maternal health that persist in the U.S. and are thought to originate in part from the discrimination that women of color experience during pregnancy (Giscombé & Lobel, 2005; Rosenthal & Lobel, 2011). However, there have been few rigorous comparisons of prenatal maternal stress in different racial/ethnic groups in this country. We examined stress related to pregnancy and stress specific to being pregnant during the pandemic. Founded in convergent evidence and theory that suggest individuals exposed to discrimination experience higher stress (e.g., Clark et al., 1999; Woods-Giscombé & Lobel, 2008), we hypothesized that women of color – those who self-identified as Black/African American, Hispanic/Latina, Multiracial, or Other Non-White – would report experiencing more gendered racism in pregnancy than self-identified Non-Hispanic/Latina White women; that women of color would report experiencing greater prenatal stress than Non-Hispanic/Latina White women; and that controlling for other predictors of prenatal stress, the association between racial/ethnic identity and prenatal stress would be mediated by gendered racism in pregnancy. We allowed for the possibility that pregnant White women experience gendered racism, as White women may be immigrants, non-native English speakers, with a non-White partner, or possessing characteristics that may lead others to subject them to gendered racism in pregnancy.

Methods

Participants and Procedure

This report is based on data from one timepoint of the Stony Brook COVID-19 Pregnancy Experiences (SB-COPE) Project, a longitudinal investigation of U.S. women who were pregnant during the COVID-19 pandemic. Participants were recruited through social media (Facebook, Instagram, and Reddit). Those who met inclusion criteria – currently pregnant, 18+ years old, able to read and write English – were invited to complete a baseline questionnaire. The present analyses are from 2,995 women who completed the baseline questionnaire between December 1st and 21st, 2020 during the second U.S. COVID-19 surge. Participants were entered into a raffle with a 1/100 chance to win a $100 gift card.

Measures

Gendered Racism in Pregnancy (GRiP)

was assessed with three items adapted from an existing measure (Rosenthal & Lobel, 2016, 2020). Participants rated the frequency of each item (“How often do you feel that… people make negative assumptions about you/health care providers make negative assumptions about you/health care providers give you poorer medical care… based on being a pregnant woman of your racial/ethnic background?”) on a four-point scale from 0 (Never) to 3 (Often). For every item endorsed with a score greater than 0, participants rated their level of distress (“How much does this bother, upset, or worry you?”) on a 4-point scale from 1 (Not at All) to 4 (Very Much). For each item on which a respondent reported no gendered racism experience (and therefore were not asked about related distress), we assigned a value of 0 to the follow-up distress question. Scores were calculated separately for GRiP-Experiences and GRiP-Distress by averaging across all constituent items. Both GRiP-Experiences and GRiP-Distress had good internal consistency (sample α = 0.84 and α = 0.85, respectively). Internal consistency was lower but still good for White women (α = .71 GRiP-Experiences; α = .74 GRiP-Distress), reflecting the likelihood that White women may have experienced and been distressed by fewer than all 3 types of discrimination.

Prenatal Stress

was assessed with two well-validated measures, one unrelated to the pandemic, and one related. On the 17-item Revised Prenatal Distress Questionnaire (NuPDQ; Ibrahim & Lobel, 2020), respondents report whether they are feeling “bothered, upset, or worried” on a three-point scale from 0 (Not at All) to 2 (Very Much) about various aspects of pregnancy (e.g., “whether you might have an unhealthy baby”, “physical symptoms of pregnancy”, “what will happen during labor and delivery”). The NuPDQ has well-established reliability and validity (Ibrahim & Lobel, 2020) and was internally consistent in this study (sample α = 0.83; nearly identical across racial/ethnic groups).

The Pandemic-Related Pregnancy Stress Scale (PREPS) (Preis, Mahaffey, & Lobel, 2020) assessed stress related to being pregnant during the COVID-19 pandemic. Seven items measure stress associated with birth preparedness (PREPS-Preparedness; e.g., “I am worried I will not be able to have someone with me during the delivery”); five items measure stress associated with infection (PREPS-Infection; e.g., “I am worried that my baby could get COVID-19 at the hospital after birth”). Responses are 1 (Very Little) to 5 (Very Much). PREPS-Preparedness (α = 0.83) and PREPS-Infection (α = 0.85) were internally consistent, with nearly identical internal consistency in each racial/ethnic group.

Results

Sample Characteristics and Bivariate Analyses

Using responses to the two race and ethnicity questions (see Table 1), the following groups were created: Hispanic/Latina of any racial background (n = 233); Non-Hispanic/Latina Black/African American (n = 182); Native American, Asian American, Other, or identified with 3+ racial categories (“Multicultural/Other”, n = 201); and Non-Hispanic/Latina White (n = 2,360). We defined women of color to be those in any group other than Non-Hispanic/Latina White (n = 616). Racial/ethnic groups differed in some sample characteristics (see Table 2); these informed the selection of covariates for testing hypothesized associations between GRiP and stress by racial/ethnic group.

Table 1.

Participant Characteristics and Sociodemographic Factors (N = 2995)

Age (years): M = 30.6; SD = 4.7
Gestational Age (weeks): M = 24.5; SD = 8.7
n (%)
Race
   Native American 85 (2.8)
   Asian American 91 (3.0)
   Black/African American 220 (7.3)
   White 2,687 (89.7)
   Other 86 (2.9)
Hispanic/Latina
   No 2,707 (90.4)
   Yes 285 (9.5)
   Missing 3 (0.1)
Education
   Less than high school 32 (1.1)
   High school 181 (6.0)
   Some college 593 (19.8)
   Bachelor’s degree 920 (30.7)
   Graduate degree 1,269 (42.4)
Relationship Status
   Married or cohabiting 2,633 (87.9)
   Serious Relationship 240 (8.0)
   Single/no relationship 113 (3.8)
   Other 9 (0.3)
Health Insurance
   Private 2,396 (80.0)
   Medicaid 565 (18.9)
   Not insured 34 (1.1)
Financial Status
   Below average 641 (21.4)
   Average 1,661 (55.5)
   Above average 693 (23.1)
Parity
   Nullipara 1,596 (53.3)
   Multipara 1,368 (45.7)
   Missing 31 (1.0)
High-risk Pregnancy
   No 1,922 (64.2)
   Yes 825 (27.5)
   Unsure 248 (8.3)
Planned Pregnancy
   No 829 (27.7)
   Yes 2,166 (72.3)
Income Loss due to COVID-19
   No 1,679 (56.1)
   Yes 1,316 (43.9)
Outdoor Access
   Rarely 73 (2.4)
   Sometimes 210 (7.0)
   Yes, whenever I want 2,712 (90.6)
Suspected COVID-19 Infection
   No 2,158 (72.1)
   Yes 354 (11.8)
   Unsure 425 (14.2)
   Missing 58 (1.9)
Canceled Prenatal Appointments
   No 2,146 (71.7)
   Yes 849 (28.3)
Past Abuse
   No 2,422 (80.9)
   Yes 572 (19.1)
   Missing 1 (<0.0)
Chronic Illness
   No 2,158 (72.1)
   Yes 835 (27.9)
Engagement in Healthy Behaviors
   Very Little 54 (1.8)
   Little 252 (8.4)
   Somewhat 1,313 (43.9)
   Much 1,000 (33.4)
   Very Much 375 (12.5)
   Missing 1 (<0.0)
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Table 2.

Sample Characteristics by Racial/Ethnic Group

Non-Hispanic/Latina
White		 Non-Hispanic/Latina
Black/African American		 Hispanic/Latina Multiracial/Other
Age 30.76±4.52a 29.84±5.20a 30.39±5.13b 30.22±4.95c F(3, 2972)=3.09*
History of Abuse 18.3%a 20.4%b 20.6%c 26.4%a X2(3)=8.36*
Multiparity 44.9%a 58.1%ab 50.6%c 44.2%b X2(3)=13.97**
High-Risk Pregnancy 25.8%a 39.0%a 31.8%b 33.3%c X2(3)=20.99***
Chronic Illness 28.6%a 24.7%b 25.8%c 26.4%d X2(3)=0.53
Healthy Behavior 3.49±0.85a 3.25±1.02ab 3.43±0.9b 3.38±0.98c F(3, 2971)=5.03**
Pandemic-Related 41.3%abc 56.6%a 52.8%b 52.2%c X2(3)=31.47***
Income Loss
Outdoor Access 2.90±0.36abc 2.78±0.55a 2.83±0.50b 2.83±0.46c F(3, 2971)=8.40***
Suspected COVID 25.0%a 32.2%b 29.4%c 34.0%a X2(3)=12.26**
Appt Cancellations 27.4%a 34.6%b 28.3%c 32.8%d X2(3)=6.53
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Note. Values within a row that are not significantly different at p < 0.05 share a subscript. *p < 0.05, **p < 0.01, ***p < 0.001.

Omnibus tests revealed support for hypothesized racial/ethnic differences in stress variables and GRiP (see Table 3, all p’s < 0.05). Scheffé tests indicated that Non-Hispanic/Latina White pregnant women reported fewest GRiP-Experiences, followed by Multicultural/Other, Hispanic/Latina, and Non-Hispanic/Latina Black/African American women, who reported the most GRiP-Experiences. All three groups of women of color reported significantly greater GRiP-Distress than Non-Hispanic/Latina White women. Additionally, Non-Hispanic/Latina Black/African American women reported greater GRiP-Distress than Hispanic/Latina women. Pregnancy-specific stress (NuPDQ) scores were equally high in all three groups of women of color, and significantly higher than for Non-Hispanic/Latina White women. Hispanic/Latina women reported significantly greater PREPS-Preparedness and PREPS-Infection stress than Non-Hispanic/Latina White women. No other pairwise comparisons were statistically significant.

Table 3.

GRiP and Prenatal Stress Values by Racial/Ethnic Group

Measure Non-Hispanic/Latina
White		 Non-Hispanic/Latina
Black/African American		 Hispanic/Latina Multiracial/Other
M SD M SD M SD M SD F
GRiP-Experiences 0.14a 0.36 1.32b 0.96 0.60c 0.71 0.73d 0.80 434.77***
GRiP-Distress 0.66a 0.80 1.36b 0.92 1.00c 0.85 1.13bc 0.90 34.11***
NuPDQ 0.88a 0.40 0.99b 0.40 1.00b 0.36 1.00b 0.38 15.21***
PREPS-Preparedness 3.10a 0.93 3.22ab 1.04 3.34b 0.93 3.19ab 0.94 6.08***
PREPS-Infection 3.10a 0.97 3.13ab 1.10 3.30b 0.99 3.24ab 0.98 4.33**
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Note. Results of post-hoc comparisons are shown with subscripts. Means within a row that are not significantly different at p < 0.05 share a subscript. *p < 0.05, **p < 0.01, ***p < 0.001.

Structural Equation Modeling

Data were missing completely at random (Little’s MCAR; X2(27) = 30.20, p = 0.31); therefore, we used maximum likelihood estimation for missing data on endogenous variables. Participants missing data on exogenous variables (n =110) were excluded from the analysis. Structural equation modeling (SEM) for the resulting n = 2,885 was conducted with the Lavaan package (version 0.6-9; Rosseel, 2012) in R Studio (R Core Team, 2021). We first constructed two latent factors: a GRiP factor with three subfactors comprised of each pair of GRiP-Experiences and GRiP-Distress items, and a Prenatal Stress factor with three subfactors corresponding to the NuPDQ, PREPS-Preparedness, and PREPS-Infection scales. The measurement model for the GRiP latent factor suggested good fit (CFI = 0.97, TLI = 0.92, RMSEA = 0.192, SRMR = 0.011, χ2(6 = 665.02, p < 0.001); the Prenatal Stress factor exhibited adequate model fit (CFI = 0.76, TLI = 0.74, RMSEA = 0.081, and SRMR = 0.063, χ2(374 = 7,656.92, p < 0.001).

Racial/ethnic groups were dummy coded to enable comparison of each racial/ethnic group of color to the Non-Hispanic/Latina White identifying group. In the hypothesized structural model, these dummy-coded racial/ethnic variables were included as exogenous variables, latent GRiP was a mediating variable, and latent Prenatal Stress was the outcome variable. Initial covariates were sociodemographic, obstetric, and pandemic-related factors that differed by racial/ethnic group (see Figure 1) and/or that were previously shown to be associated with prenatal stress in pregnant women during the COVID-19 pandemic (Preis, Mahaffey, et al., 2020b). We then removed any of these variables that did not significantly predict latent pregnancy stress within the model. Standard errors were bootstrapped 1000 times.

Figure 1. Prediction of Prenatal Stress by Racial/Ethnic Identification and Gendered Racism in Pregnancy.

Figure 1

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Note. There were significant indirect associations of Non-Hispanic/Latina Black/African American identification (Indirect effect estimate = 0.64, SE = 0.09, 95% CIs 0.48 to 0.83), Hispanic/Latina identification (Indirect effect estimate = 0.21, SE = 0.03, 95% CIs 0.14 to 0.28), and Multiracial/Other identification (Indirect effect estimate = 0.32, SE = 0.05, 95% CIs 0.23 to 0.42) with Prenatal Stress through the GRiP latent factor.

Fit indices for the structural model (Figure 1) provide mixed evidence of model fit (CFI = 0.80, TLI = 0.80, RMSEA = 0.062, and SRMR = 0.058, χ2(992) = 11914.89, p < 0.001). Nonetheless, the a priori model was retained without modification to avoid overfitting. Significant paths from the Non-Hispanic/Latina Black/African American, Hispanic/Latina, and Multiracial/Other variables to GRiP indicated higher levels of GRiP for all three groups compared to Non-Hispanic/Latina White women. The direct path from the Multiracial/Other variable to Prenatal Stress was not significant; the remaining two paths from racial/ethnic groups to Prenatal Stress were statistically significant, although these associations were modest and in opposite directions, indicating higher stress in Hispanic/Latina women and lower stress in Non-Hispanic/Latina Black/African American women. Prenatal Stress was predicted directly by the GRiP latent factor and indirectly through GRiP by Non-Hispanic/Latina Black/African American identification, by Hispanic/Latina identification, and by Multiracial/Other identification.

Discussion

As hypothesized, we found that pregnant women of color were subjected to greater gendered racism in pregnancy and experienced greater prenatal stress than Non-Hispanic/Latina White women. Specifically, Non-Hispanic/Latina Black/African American reported more experiences of gendered racism than other women; additionally, all three groups of women of color reported greater distress associated with gendered racism than Non-Hispanic/Latina White women. Similarly, all women of color experienced greater pregnancy-specific stress (unrelated to the pandemic) than did Non-Hispanic/Latina White women. Only Hispanic/Latina women reported higher levels of prenatal stress related to the pandemic compared with Non-Hispanic/Latina White women.

Results of the structural model suggest that the association between racial/ethnic identity and prenatal stress was mediated by gendered racism in pregnancy. There were significant indirect associations of racial/ethnic identification with prenatal stress through gendered racism for all women of color. After adjusting for this indirect association, the model revealed a modest but significant direct association of Hispanic/Latina identification with greater prenatal stress, and an unexpected inverse association of Non-Hispanic/Latina Black/African American identification with stress. This association may reflect adaptive ways of coping among pregnant Black/African American women (Rehbein et al., 2023) or resilience that is conferred through Black/African American cultural identity (Abrams et al., 2019; Nelson et al., 2024; Woods-Giscombé, 2010) but undercut by exposure to gendered racism. The present study was not designed to examine such processes, but it supports the possibility that if Black/African American women were not exposed to gendered racism in pregnancy, they might experience less stress than other women in this study.

The latent prenatal stress factor in the study was a combination of stress related to the pandemic as well as aspects of pregnancy unrelated to the pandemic that are commonly experienced as stressful. It is particularly notable that gendered racism accounted for more of the variance in the prenatal stress factor than all covariates included in the structural model other than nulliparity. The covariates included – especially high-risk pregnancy and health problems – tend to receive considerable attention in research and clinical services designed to alleviate stress in pregnant women. Our results highlight the additional importance of identifying pregnant women who are targets of gendered racism. Overlooking stress that originates from exposure to discrimination likely results in unmet needs of pregnant women of color and other marginalized groups. Because elevated prenatal stress is a significant predictor of adverse maternal and child outcomes, focusing on the harmful impact of gendered racism may improve racial/ethnic disparities in reproductive outcomes.

Strengths and Limitations

The study’s reliance on correlational data prevents drawing causal conclusions, although this research is grounded in well-accepted theory and relevant evidence. Incorporating latent factors that minimize measurement error and enhance reliability, as well as controlling for additional contributors to stress, offered a robust test of study hypotheses. Online survey methods and recruiting through social media enabled pregnant women across the U.S. to participate, overcoming logistical, health, and safety considerations that prevented in-person participation, but only individuals with Internet access could participate. An additional limitation to generalizability was the sample’s restricted sociodemographic composition: A majority were Non-Hispanic/Latina White women, and generally socioeconomically advantaged. While White women’s GRiP experience and distress scores as a group were predictably lower than those of the other groups in this study, they were non-zero. This suggests that each GRiP item was relevant to at least some of the White participants. Too few participants identified as Asian or Asian American for us to examine their unique experiences, an important limitation given the rise of anti-Asian racism in the U.S. during the COVID-19 pandemic (Lee & Waters, 2021; Nguyen et al., 2020). Finally, the study was conducted with pregnant women in the U.S. during conditions that existed in this country at the height of the COVID-19 pandemic; the generalizability of results to pregnant women in other nations and at other times is indeterminate.

Conclusions

Study results corroborate that pregnant women of color in the U.S. experienced more gendered racism that contributed to higher levels of prenatal stress during the COVID-19 pandemic compared to Non-Hispanic/Latina White women. Although the study focused on groups that are marginalized in the U.S., recognizing the existence and harmful impacts of discrimination throughout the world is imperative to improve reproductive justice for all pregnant women, a vital step in meeting United Nations Sustainable Development Goals. Discrimination and reproductive injustices are strong contributors to poor maternal health globally. For example, racial/ethnic disparities in adverse birth outcomes also exist in nations including Brazil, the United Kingdom, and the Netherlands, where migrant populations from the African continent experience widespread discrimination (Small et al., 2017; Souza et al., 2024). Yet recognition of discrimination is not sufficient; it must be followed by appropriate individual care and intervention, and change at multiple community and societal levels. Health care providers can be trained to evaluate stress among racially/ethnically and other marginalized pregnant women, to advocate for their patients and refer them to appropriate resources, and to foster adaptive ways of coping with stress while delivering culturally and racially informed care. Measures to alleviate stress can benefit pregnant women of all racial/ethnic and national identities. These are especially critical during the highly stressful circumstances of a health crisis such as a global pandemic. Beyond the health care setting, it is our responsibility as psychologists and fellow citizens to work toward a just society in which gendered racism and discrimination of any sort are diminished and all individuals who choose to give birth can do so with the resources and care that they need for a healthy pregnancy and child, regardless of their race, ethnicity, gender, nationality, or other identities.

Impact and Implications.

Reproductive justice for pregnant women requires recognition of the harms imposed by structural and societal systems that elevate stress and resulting health risks, especially for marginalized groups. Study results confirm that gendered racism experienced in pregnancy by American women of color is associated with greater stress, and highlights the likely impact of discrimination on reproductive health disparities in this country and among marginalized communities across the world. This study addresses United Nations Sustainable Development Goals (SDGs) #3 good health and well-being; #5 gender equality; #10 reduced inequalities; and #16 peace, justice, and strong institutions.

Acknowledgments

We thank study participants for their contribution to this research, especially during the highly stressful circumstances of a global pandemic. The SB-COPE Project was supported by a Stony Brook University Office of the Vice President for Research and Institute for Engineering-Driven Medicine COVID-19 Seed Grant and by the National Institutes of Health Office of the Director, IMPROVE Initiative (R21DA049827). Neither funding source had any bearing on the collection of data, their analysis and interpretation, or the approval or disapproval of publication.

Funding

Initial funding for the SB-COPE Project was provided by a Stony Brook University Office of the Vice President for Research and Institute for Engineering-Driven Medicine COVID-19 Seed Grant and by the National Institutes of Health (NIH) Office of the Director Implementing a Maternal Health and Pregnancy Outcomes Vision for Everyone (IMPROVE) Initiative (R21DA049827). During their work on this article, Emily Rehbein was supported by a Dr. W. Burghardt Turner Fellowship and United States Department of Education Graduate Assistance in Areas of National Need (GAANN) Fellowship, Brittain Mahaffey received support from NIH Grant K23HD092888, and both Heidi Preis and Marci Lobel received support from NIH Grant R21DA049827.

Footnotes

Conflict of Interest

The authors report there are no competing interests to declare.

Publication Ethics

Informed consent was obtained from all participants included in the study. All procedures in studies involving human participants were performed in accordance with the ethical standards of Stony Brook University’s Institutional Review Board (IRB2020-00227).

Open Data

Data and material are available from the authors upon reasonable request.

*

We use terms such as woman, mother, and maternal to refer to an individual who is capable of pregnancy and childbirth.

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