Date of Award

1-1-2022

Language

English

Document Type

Dissertation

Degree Name

Doctor of Public Health (DrPH)

College/School/Department

Department of Health Policy, Management and Behavior

Content Description

1 online resource (viii, 334, [4] pages) : illustrations (some color)

Dissertation/Thesis Chair

Christine T Bozlak

Committee Members

Allison A Appleton, Martha Wojtowycz

Keywords

COVID-19 pandemic, Maternal and Child Health, Mixed Methods, Prenatal Care, Psychosocial Factors, Premature infants, Pregnant women, COVID-19 (Disease)

Subject Categories

Public Health

Abstract

Background: Preterm birth (PTB), defined as births that occur prior to 37 completed weeks of gestation, and low birth weight (LBW), defined as an infant born with a birthweight of < 5.5 lbs or 2,500 grams, have been identified as significant contributors to the high infant morbidity and mortality rate in the United States (U.S.). The etiology of PTB and LBW is complex, and multifaceted. Linkages have been made to several categorical risk factors related to socio-demographics, medical, behavioral, psychosocial, and environmental pathways. Given the known risk factors, the current COVID-19 pandemic has raised concerns from public health officials and clinicians about the short-and long-term impact on the health and well-being of pregnant women and their birth outcomes. Study Purpose: The purpose of the study was to: 1) examine the impact of the COVID-19 pandemic on preterm birth (PTB) and low birthweight (LBW) in Onondaga County, NY; and 2) determine the potential impact of psychosocial factors, particularly maternal depression and social support, on PTB and LBW. Guided by the Integrated Socio-Environmental Model of Health and Well-being (ISEM), The Life Course Perspective (LCP), concepts of allostatic load and the weathering hypothesis, the study recognizes the numerous factors, over the life course, that co-occur and can synergistically contribute to or moderate the impact of the COVID-19 pandemic on birth outcomes. Methodology: The study utilized a mixed methods approach to answer the four research questions. For the quantitative component, the study utilized relevant data elements obtained from the Statewide Perinatal Data System (SPDS) during February 1, 2019 through March 31, 2021 for secondary data analysis. For the qualitative component, 20 key informant interviews were conducted to investigate and describe the health care and social support experiences of individuals who delivered in Onondaga County, NY before and during the COVID-19 pandemic. Results: Results from the bivariate analysis indicated a statistically significant association between lack of prenatal care, lack of social support, maternal depression and both PTB and LBW (all p <.0001). Exposure to the COVID-19 pandemic was not significantly associated with either LBW or PTB (p=0.2289 and p=0.2932, respectively). The analysis yielded no statistically significant difference in the rates of LBW (p= 0.2289) or PTB (p=0.2932) between the two cohorts. The major themes that emerged from the interviews related to prenatal care experience were: Preparing for Pregnancy, Feeling Supported by their Health Care Provider, Restrictive COVID-19 Policies, Dealing with the Unknown, and Self-Advocacy. The major themes related to social support experience were: Personal Relationships during Pregnancy, Forms of Social Support during pregnancy, and Pandemic Impact on Social Support. Overlapping themes were identified between the two cohorts. Study Significance: The findings from this study have implications for public health and clinical practice, public health policy, and future research. The findings from this study emphasize the need for a range of accessible, affordable options for pregnancy-related care and social support, especially during stressful life events, like a pandemic. This study contributes to the growing literature on the COVID-19 pandemic by providing an analysis of the factors (risk and protective) which could moderate or mediate the effects of a public health crisis on birth outcomes. The strength of the study lies in the triangulation of data to research a persistent public health issue and health disparity during a widespread public health crisis.

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