PROJECT SUMMARY Children of women exposed to childhood abuse exhibit increased risk for a wide array of neurodevelopmental deficits and are at elevated risk of anxiety, depression, autism, and attention deficit disorder (ADHD). The parent grant seeks to identify biological dysregulation during pregnancy that may cause this increased risk. Inflammation and hormonal dysregulation harms offspring neurodevelopment and is present in adults who have experienced childhood abuse, yet it is unknown whether dysregulation in these systems continues during the pregnancies of women exposed to abuse, the critical time for effects on offspring brains. The parent grant collects biological samples during pregnancy to measure inflammation and hormonal dysregulation in a large, prospective cohort of women. Women with histories of childhood abuse experience more stressors during pregnancy, and Aim 2 of the parent grant posits that these stressors may partially account for pregnancy biological dysregulation. In this administrative supplement, we propose to augment the study to capture key and time sensitive data on the COVID-19 pandemic. We hypothesize that pandemic-related adverse events and stress will be more common in women exposed to child abuse and will increase risk for biological dysregulation during pregnancy that is harmful to offspring development. Adverse events during pregnancy and psychological reactions to them have been linked to pregnancy complications, prematurity, low birth weight, and offspring neurodevelopmental deficits. Vulnerable populations, including women exposed to childhood abuse, are likely to experience more of these adverse events and be more negatively impacted by them. Forecasting models suggest that in the absence of a vaccine, SARS-CoV-2 is likely to continue circulating for the foreseeable future, highlighting the urgent need for robust research on the long-term health effects of the pandemic on pregnant women and their offspring. Participants enrolled via the parent award are members of the Nurses' Health Study 3, and most are clinically active, thus this study has the advantage of having direct access to a large population with high risk of occupational exposure to SARS-CoV-2. At the same time, they are vulnerable to healthcare sector downsizing and job loss, making the cohort ideal for studying the effects of pandemic-related stressors on pregnancy and birth outcomes. The supplement will collect data on COVID-19-related adverse events and COVID-19-related stress at both pre-pregnancy and pregnancy, including fear of infection, financial stress, pandemic-related depression, parenting stress, and illness and death of loved ones. This research will address the NICHD's core mission to ensure that “all children have the chance to achieve their full potential for healthy and productive lives” by identifying factors, “starting before conception, [that] can influence development across the life course and across generations.”

PROJECT NARRATIVE The proposed supplement will augment an ongoing study of pregnant women to examine whether women exposed versus unexposed to childhood abuse experience more pandemic-related adverse events and more stress. The supplement will further determine effects of COVID-19 pandemic-related adverse events and stress on two systems know to affect offspring neurodevelopment: 1) endocrine dysfunction during pregnancy, 2) inflammation during pregnancy. Investigating the extent and mechanisms of the COVID-19 pandemic's effects on maternal and child health, including child neurodevelopment, will inform public health interventions to protect the healthy development of children, specifically: 1) identify targets for prenatal intervention, and 2) identify at-risk newborns.