Project Summary/Abstract Beyond the grave health threats posed by COVID-19, this world-wide pandemic has also dramatically increased psychological distress among much of the population. For those particularly vulnerable to stress-related disorders, COVID-19 represents an unprecedented challenge. Individuals both directly and indirectly affected by the virus are forced to navigate through a range of hardships, including social isolation, financial insecurity, and uncertainty about the health and safety of self and loved ones. High on the list of psychologically vulnerable groups are pregnant women. Psychological distress may be compounded both by the uncertainty surrounding COVID-19's vertical transmission and by the potential effects of maternal distress on fetal brain development. Numerous studies have reported strong associations between maternal stress during pregnancy and disruptions in child development. The effects of maternal psychological stressors on fetal and infant development have been demonstrated across multiple levels, including disrupted fetal brain maturation, alterations in miRNA expression and DNA methylation, and increased risks for altered developmental outcomes and neuropsychiatric disorders (Babenko, 2015; Bick & Nelson, 2016; Hackman et al., 2010; Nelson, 2020; Lupien et al., 2019; McEwen, 2012, 2017; Vanderberg et al., 2017; Laplante et al., 2015; Wu et al., 2020). Previous work supports that mothers who experienced either a bacterial or viral infection and elevated stress during pregnancy were more likely to have an adolescent child diagnosed with depression (Murphy et al., 2017). Similarly, children exposed to a prenatal infection of the 2001 H1N1 virus displayed slightly delayed development (Borren et al, 2018).With these findings in mind, it is critical to determine the extent to which a COVID-19 exposure and related prenatal stress affects infant development in order to provide appropriate treatment and interventions. At Boston Children's Hospital, we are in the unique position to build on our current funding (R34 DA050289) to study infants born to COVID-19-positive women. Among our Boston-based collaborative group, we estimate that over the next 6 months we should be able to enroll 75 pregnant women, limiting ourselves to just one Harvard-affiliated hospital, Brigham and Women's Hospital (BWH). Our plan is to administer a number of questionnaires to these women prior to giving birth. At birth, we will work with the OB team to decide which mothers to approach about seeking consent to perform an MRI on their newborns, as well as 2 follow up visits to the PI's lab at Boston Children's Hospital.

Narrative: The COVID-19 pandemic has reached nearly every continent across the globe with a profound impact in the United States. There is limited information regarding the susceptibility of pregnant women to experience more severe illness, with corresponding implications for their child. While there is uncertainty surrounding the evidence of vertical transmission, consequential stress of contracting the infection while pregnant may pose a unique set of challenges for new infants and mothers in the current global, national, and local environments. Beyond the physical effects of the illness, contracting the virus during pregnancy is undoubtedly stressful.