1 INTRODUCTION

The COVID‐19 pandemic has substantially impacted the lives and health of people worldwide; with millions of confirmed cases and thousands of deaths, the immediate medical effects of the pandemic are obvious and substantial. However, the COVID‐19 pandemic will likely continue to negatively impact human health for years to come, especially among individuals experiencing pandemic‐related stress during sensitive periods of the life course, including pregnancy and early development. In this brief commentary, we focus on how the COVID‐19 pandemic is currently disrupting maternity care and affecting well‐being among pregnant women, thereby increasing the risk of poor future health for both mother and child.

Human biologists have long been interested in understanding the pathways by which early life experience—including in utero—can impact future health outcomes (eg, metabolic and cardiovascular disease later in life), especially if experienced during key developmental periods (Kuzawa & Quinn, 2009). Pregnancy represents an especially vulnerable period, with women at an increased risk for developing mood disorders (eg, depression) and health conditions (eg, gestational diabetes, preeclampsia) that can impair longer‐term mental and physical health (Bauer, Knapp, & Parsonage, 2016; Damm et al., 2016; Nahum Sacks et al., 2018). Moreover, evidence indicates that adverse conditions experienced during pregnancy—such as high levels of psychosocial stress—are linked with increased risk of negative birth outcomes (Aizer, Stroud, & Buka, 2016; Kinsella & Monk, 2009; Nepomnaschy et al., 2006; Pike, 2005; Thayer, Bécares, & Atatoa Carr, 2019). Cumulatively, these exposures can also increase the risk of poor offspring health (eg, elevated stress reactivity, higher body mass index, and greater chronic disease risk) and increased mortality risk across the life course (Dancause et al., 2015; Farewell, Thayer, Tracer, & Morton, 2018; Gluckman, Hanson, & Beedle, 2007; Thayer & Kuzawa, 2015).

Elevated psychosomatic stress linked with the COVID‐19 pandemic may therefore negatively impact maternal and infant health; however, these effects are currently not well understood. The few existing maternal and infant health studies have predominantly focused on treatment of pregnant women suffering from COVID‐19 (Liang & Acharya, 2020; Pereira et al., 2020; Rasmussen, Smulian, Lednicky, Wen, & Jamieson, 2020), the risk of virus transmission from mother to baby (Chen et al., 2020; Pereira et al., 2020; Qiao, 2020; Rasmussen et al., 2020; Schwartz, 2020), and the biological effects of COVID‐19 during pregnancy (Shanes et al., 2020). While there is currently little evidence of vertical viral transmission or poor birth outcomes (eg, restricted growth or premature birth) as a result of maternal SARS‐CoV‐2 infection (Pereira et al., 2020; Qiao, 2020; Schwartz, 2020; Shanes et al., 2020; Walker et al., 2020), recent work indicates that COVID‐19 may be linked with increased risk for placental injury, preeclampsia, preterm birth, and low birth weight (Abbas, Ahmed, & Shaltout, 2020; Narang et al., 2020; Shanes et al., 2020). These emerging findings led the CDC to add pregnancy as a risk factor for severe COVID‐19 symptoms on June 25, 2020 (CDC, 2020).

However, given that most studies to date have been small and focused on immediate health outcomes, additional work is needed to understand how the pandemic may shape maternal and infant health, aside from the direct effects of the virus itself. A biocultural perspective will be especially important, as pandemic‐related economic and social changes will likely shape prenatal and early life experiences in ways that alter later health. For example, the pandemic has drastically strained the American healthcare system (Emanuel et al., 2020). These strains have had substantial effects on access to quality prenatal care for pregnant women, an important determinant of maternal health and birth outcomes (Kozhimannil, Hardeman, & Henning‐Smith, 2017; Loveland Cook, Selig, Wedge, & Gohn‐Baube, 1999).

A shift to telehealth appointments, the loss of in‐person labor and delivery courses, and restrictions on the ability for support persons to attend prenatal appointments may prevent women from feeling well‐informed and supported by their providers and others. In addition, crowded hospitals, overworked staff, and a lack of medical equipment have led to drastic changes in the experience of labor and delivery. These changes include reduced support persons in labor and, in some instances, separation of newborns from their mothers in the case of suspected or confirmed maternal COVID‐19 status (Davis‐Floyd, Gutschow, & Schwartz, 2020; de Carvalho et al., 2020). Yet the mental and physical health effects of COVID‐19 associated maternity care changes have not been adequately addressed, despite the clear implications for maternal and infant well‐being.

Negative maternal and infant health outcomes linked with the pandemic are likely to disproportionally impact ethnic minority communities, including Black, Indigenous, and People of Color (BIPOC). For instance, COVID‐19‐associated disruptions to prenatal care, lack of access to the technology or safe spaces needed to facilitate telehealth, loss of medical insurance, and inability to access preferred and trusted care providers are all expected to increase the risk of poor birth outcomes and differentially affect BIPOC (Minkoff, 2020; Onwuzurike, Meadows, & Nour, 2020). Racism, which shapes birth experiences and outcomes even outside of the pandemic (Conching & Thayer, 2019; McLemore et al., 2018; Thayer et al., 2019; Vedam et al., 2019), can have important consequences on COVID‐19‐related policy decisions as well.

In a particularly egregious instance documented in a piece of investigative journalism, women described as having a Native American “appearance” and who were found to be living in a zip code associated with one of New Mexico's Pueblo reservations were treated as a “person under investigation” for COVID‐19 and separated from their newborns at birth if still awaiting COVID‐19 test results, even when mothers exhibited no symptoms (Furlow, 2020). Maternal separation from newborns can negatively affect both maternal and newborn health, including temperature regulation for newborns, increased risk for postpartum depression for mothers, and decreased breastfeeding success (Stuebe, 2020). Additional work is needed to identify the different ways that the COVID‐19 pandemic has differentially affected maternal and child health among socially disadvantaged groups.

Here, we present the COVID‐19 and Reproductive Effects (CARE) project as a case study documenting the complex COVID‐19‐linked factors impacting prenatal care and birth experiences. We also discuss other human biology studies that similarly use biocultural approaches to understand the impacts of the COVID‐19 pandemic. Finally, we consider future research needed to document the downstream health effects of the COVID‐19 pandemic on pregnant women and their children.

中文翻译：

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COVID-19大流行期间的母婴健康：人类生物学领域的贡献

1引言

COVID-19大流行严重影响了全球人民的生活和健康；大流行的确诊病例数以百万计，有数千人死亡，大流行的直接医疗效果是显而易见的。但是，COVID-19大流行可能会在未来几年继续对人类健康产生负面影响，尤其是在生命过程的敏感时期（包括怀孕和早期发育）中经历与大流行相关的压力的人群中。在这篇简短的评论中，我们关注COVID-19大流行目前如何破坏产妇保健并影响孕妇的福祉，从而增加母婴未来健康状况不佳的风险。

长期以来，人类生物学家一直对了解早期生命经历（包括子宫内）影响未来健康结局（例如，生命后期的代谢和心血管疾病）的途径感兴趣，特别是如果在关键的发育时期经历过（Kuzawa＆Quinn，2009））。怀孕是一个特别脆弱的时期，妇女罹患情绪障碍（例如抑郁症）和健康状况（例如妊娠糖尿病，先兆子痫）的风险增加，这会损害长期的心理和身体健康（Bauer，Knapp和Parsonage） ，2016 ; Damm等，2016 ; Nahum Sacks等，2018）。此外，有证据表明，怀孕期间经历的不利状况（例如较高的社会心理压力）与负出生结局的风险增加相关（Aizer，Stroud和Buka，2016年； Kinsella和Monk，2009年； Nepomnaschy等人，2006年）；派克（Pike），2005年；塞耶（Thayer），贝卡尔斯（Bécares ）和阿塔托亚卡尔（Atatoa Carr），2019年）。累积地，这些暴露也可能增加后代健康状况不佳的风险（例如，应激反应性增强，体重指数升高和慢性病风险增加），并在整个生命过程中增加死亡风险（Dancause等人，2015； Farewell，Thayer） ，Tracer和Morton，2018年； Gluckman，Hanson和Beedle，2007年; Thayer和Kuzawa，2015年）。

因此，与COVID-19大流行相关的心身压力升高可能会对母婴健康产生负面影响；但是，目前尚不清楚这些效果。现有的少数母婴健康研究主要集中于治疗COVID-19的孕妇（Liang＆Acharya，2020 ; Pereira等，2020 ; Rasmussen，Smulian，Lednicky，Wen，＆Jamieson，2020）。病毒从母体传播到婴儿的风险（Chen等，2020； Pereira等，2020；乔，2020； Rasmussen等，2020； Schwartz，2020），以及怀孕期间COVID-19的生物学作用（ Shanes等，2020年）。虽然目前几乎没有证据表明由于母亲SARS-CoV-2感染而导致垂直病毒传播或不良的出生结局（例如，生长受限或早产）（Pereira等，2020；乔，2020；施瓦茨，2020；P。Shanes等人，2020年； Walker等人，2020年），最近的研究表明，COVID-19可能与胎盘损伤，先兆子痫，早产和低出生体重的风险增加有关（Abbas，Ahmed和Shaltout，2020年） ; Narang等人，2020 ; Shanes等人，2020）。这些新发现促使CDC于2020年6月25日将怀孕增加为严重COVID-19症状的危险因素（CDC，2020年）。

但是，鉴于迄今为止的大多数研究规模很小，并且只关注直接的健康后果，因此除了病毒本身的直接影响之外，还需要开展更多的工作来了解大流行可能如何影响母婴健康。生物文化的观点将尤其重要，因为与大流行相关的经济和社会变化将可能以改变后期健康的方式影响产前和早期生活。例如，大流行使美国的医疗体系严重紧张（Emanuel等，2020）。这些菌株对孕妇获得优质产前护理产生了重大影响，这是孕产妇健康和出生结局的重要决定因素（Kozhimannil，Hardeman和Henning-Smith，2017年; Loveland Cook，Selig，Wedge和Gohn-Baube，1999）。

转向远程医疗任命，失去亲自分娩和分娩课程，以及对支持人员参加产前任命的能力的限制可能会阻止妇女感到其提供者和其他人的消息灵通和得到支持。此外，医院拥挤，工作人员劳累以及医疗设备不足导致劳动和分娩的经历发生了巨大变化。这些变化包括减少了劳动支持人员的负担，在某些情况下，如果怀疑或确认了母亲的COVID-19身份，则新生儿与母亲的分离（Davis-Floyd，Gutschow和Schwartz，2020年； de Carvalho等人，2020年）。尽管COVID-19对产妇保健产生了明显的影响，但仍未充分解决COVID-19相关产妇保健改变对精神和身体健康的影响。

与大流行相关的不利于母婴健康的结果可能会对少数民族社区产生不成比例的影响，包括黑人，土著人和有色人种（BIPOC）。例如，与COVID-19相关的产前护理中断，无法获得促进远程医疗所需的技术或安全空间，医疗保险的丧失以及无法获得首选和可信赖的护理提供者的情况，都将增加贫困人口的风险。出生结局并对BIPOC有不同的影响（Minkoff，2020 ; Onwuzurike，Meadows，＆Nour，2020）。种族主义甚至在大流行之外也影响着出生经历和结局（Conching＆Thayer，2019 ; McLemore等人，2018 ; Thayer等人，2019; Vedam等人，2019）也可能对COVID-19相关的政策决策产生重要影响。

在一项调查性新闻报道中记载的一个特别令人震惊的例子中，被描述为具有美洲原住民“外表”并被发现居住在与新墨西哥州一个普韦布洛保留区有关的邮政编码中的妇女被视为“接受调查的人”。对于COVID-19，即使在母亲没有任何症状的情况下，如果仍在等待COVID-19测试结果，则在出生时与新生儿分开（Furlow，2020年）。母体与新生儿分离会对母体和新生儿健康产生不利影响，包括新生儿的体温调节，母亲产后抑郁的风险增加以及母乳喂养成功率下降（Stuebe，2020年））。需要做更多的工作来确定COVID-19大流行对社会弱势群体中母婴健康的不同影响方式。

在这里，我们以案例研究的形式展示COVID-19和生殖影响（CARE）项目，该案例记录了影响产前护理和出生经历的复杂的COVID-19相关因素。我们还将讨论其他人类生物学研究，这些研究同样使用生物文化方法来了解COVID-19大流行的影响。最后，我们认为需要进行进一步的研究，以记录COVID-19大流行对孕妇及其子女的健康影响。