Abstract
As the world faces the health crisis of a global pandemic—with healthcare protocols in overhaul, and patients and care teams experiencing unprecedented levels of stress and unpredictability—we predict that current knowledge gaps in maternal health will inevitably have a lasting impact on the health of women giving birth now and in the near future. Since we are decades away from closing the knowledge gaps we need filled today, we recommend shifting thinking toward a comprehensive conceptual model that merges knowledge of stress physiology, neurobiology, and pregnancy physiology. The model we present here, the Maternal Reactive Scope Model, is an expansion of the Reactive Scope Model built upon the concept of Homeostasis and Allostasis. The model provides a framework to consider pathways and interactions across physiological systems to attribute a physiological basis for considering stress exposure and bridge research gaps on mechanisms to measure or target for treatment. Our intention is to provide an adaptable, heuristic framework for discussion of research considerations and new healthcare models that aim to provide the best care for new mothers during and after the COVID-19 pandemic.
Highlights
The COVID-19 pandemic has exposed pregnant women to an unprecedented level of stress and unpredictability
Due to the limitations on research addressing the links between stress, human pregnancy physiology, and maternal health, those caring for the pregnant population during this crisis are working with an incomplete model of true risk and potential solutions
Our hope is that a conceptual framework will allow for care considerations that look beyond the current knowledge gaps in maternal health and provide an intellectually satisfying merge between
Summary
The COVID-19 pandemic has exposed pregnant women to an unprecedented level of stress and unpredictability. This prediction may apply to the effects of birth-related stress—in a meta-analysis of maternal stress studies, researchers found that birth-related stress (fear of birth, previous birth trauma) was 2–3x more likely to lead to negative outcomes for baby (low birth weight, preterm birth) than extreme, traumatic events [10]. For some individuals (e.g., person z, Figure 1H), the levels of physiological mediators required to maintain Predictive or Reactive Homeostasis and support pregnancy, naturally cross into Homeostatic Overload at some point in pregnancy and lead to illness and/or complications for mother, baby or the maternal/fetal unit. In times of pandemic crisis and restructuring of prenatal healthcare, we must consider all sources of stress to better care for the most impacted and at-risk individuals and communities
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