The transition to motherhood is one of the most complex and overlooked topics in modern science. Research in this area has only recently gained momentum, and has gradually changed common beliefs about giving birth from a totally idyllic period of life to one of potential psychological vulnerability. Indeed, it is estimated that more than 10% of perinatal women worldwide suffer from mental illness. In addition to influencing the well-being of new mothers, perinatal depression, anxiety and trauma-related disorders can negatively influence children’s development. Thus, it is important to understand the factors that contribute to women’s perinatal mental health.

The COVID-19 pandemic is likely to have led to additional stress for pregnant women and new mothers. For example, the high death rate from COVID-19 might have increased concerns about women’s own health, as well as the health of their family and friends. In addition, the birth experience was substantially altered at the height of the pandemic because partners were not allowed to be present during labour, and friends and family were not allowed to make in-person visits. This loss of shared experiences related to important birth and postpartum routines might have caused women to feel grief. These health worries and grief owing to COVID-19 might have increased the risk of birth-related psychological disorders, especially for women with pre-existing diagnoses of mental illness that could have been exacerbated during the pandemic and who might have found it difficult to seek psychological support.

The article by Liu and colleagues was one of the first to investigate maternal mental health during the COVID-19 pandemic (from May to August 2020). Women in the US over the age of 18 years who were in their second trimester of pregnancy onwards, or who had given birth in the previous six months, completed an online survey that included standardized measures for assessing COVID-19-related experiences (health worries for oneself or for family and friends, and maternal feelings of grief and perceived loss of meaningful experiences) and health outcomes (depression, generalized anxiety and post-traumatic stress disorder (PTSD)) as well as self-reported history of mental health conditions.

Among the large sample of respondents (n = 1,123), 36.4%, 22.7% and 10.3% reported clinically significant levels of depression, generalized anxiety and PTSD, respectively. Women with previous diagnoses of mental illness were 1.5 to almost 4 times more likely to have clinically significant levels of depression, generalized anxiety and PTSD. Approximately 18% of respondents reported high levels of COVID-19-related health worries and were 2.5 to 4 times more likely to score above the clinical threshold for symptoms of mental illness. Around 9% of respondents expressed high levels of grief and were four to five times more likely to report symptoms of mental illness above clinical thresholds. Importantly, those negatively affected by the pandemic according to their reported worry and grief were more likely to have elevated psychiatric distress, regardless of whether or not they had a pre-existing mental illness.

The paper by Liu et al. theoretically advances the perinatal psychological risk-and-resilience field by providing an overview of perinatal women’s mental health both with and without previous psychopathology, and by identifying potential risk factors for perinatal women’s mental health during an unprecedented time such as the COVID-19 pandemic. The findings also have practical implications for health professionals and policymakers. For example, the results suggest that routine mental health screening should be incorporated in obstetric and pediatric settings and that strategies should be developed to help perinatal women cope with health-related worry and grief.

“a post-COVID landscape might offer the opportunity to reorganize and restructure perinatal mental health services”

Overall, the paper by Liu et al. suggests that perinatal women have always required assistance, but a post-COVID landscape might offer the opportunity to reorganize and restructure perinatal mental health services. The time to act is now.