Objective
The objective of this study was to evaluate the stress levels measured objectively (saliva cortisol) and subjectively (questionnaires) during the COVID-19 pandemic compared to a period prior to the pandemic and its effect on obstetric and neonatal outcomes.
Study Design
This prospective, case-control study included 36 women who delivered during COVID-19 pandemic and 49 women who delivered before the pandemic. All participants had low-risk, singleton, term deliveries at a tertiary academic center. Physiological stress was evaluated by salivary cortisol measurements and emotional stress by questionnaire (stress scale ranging from 0 to 10) during the active phase, full dilation stages of labor and 2 minutes after delivery. Cord blood cortisol and pH were also obtained. Mode of delivery, complications during labor and delivery, and early neonatal outcomes were evaluated.
Results
Psychological stress was significantly higher for the COVID-19 group compared to the control during full dilation phase (6.2 ± 3.4 Vs. 4.2 ± 3, p=0.009). A significantly higher level of cord blood cortisol was found in the control group (7.3 mcg/dl vs. 13.6 mcg/dl, p=0.001). No difference was found between the groups regarding cortisol level in the saliva at each assessment time: Active labor, full dilation and 2 minutes after the delivery (p=0.584, p=0.254, p=0.829, respectively). No difference was found in the percentage of patients with cord blood pH below 7.1 (p=0.487), in 1 minute and 5-minute Apgar below 7 (p=0.179) and in neonatal weight (p=0.958).
Conclusion
Women delivered during COVID-19 pandemic have higher stress level expressed in psychologic questionnaires and in lower cord blood cortisol levels that might reflect an exposure to a chronic stressor event.
