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Recommendations for Clinical Practice, Research, and Policy to Address the Effects of the COVID-19 Pandemic on Anxiety Symptoms in Immigrant and U.S.-Born Latina Mothers

Published:April 20, 2021DOI:https://doi.org/10.1016/j.whi.2021.03.004
      More than one-half of pregnant women experience some level of anxiety symptoms (
      • Meades R.
      • Ayers S.
      Anxiety measures validated in perinatal populations: A systematic review.
      ), with 20%–35% of women reporting high anxiety or evidence of an anxiety disorder (
      • Fawcett E.J.
      • Fairbrother N.
      • Cox M.L.
      • White I.R.
      • Fawcett J.M.
      The prevalence of anxiety disorders during pregnancy and the postpartum period: A multivariate Bayesian meta-analysis.
      ;
      • Koelewijn J.M.
      • Sluijs A.M.
      • Vrijkotte T.G.
      Possible relationship between general and pregnancy-related anxiety during the first half of pregnancy and the birth process: A prospective cohort study.
      ;
      • Nakić Radoš S.
      • Tadinac M.
      • Herman R.
      Anxiety during pregnancy and postpartum: Course, predictors and comorbidity with postpartum depression.
      ). Experiencing anxiety during pregnancy is associated with pregnancy complications (
      • Kurki T.
      • Hiilesmaa V.
      • Raitasalo R.
      • Mattila H.
      • Ylikorkala O.
      Depression and anxiety in early pregnancy and risk for preeclampsia.
      ;
      • Tomfohr-Madsen L.
      • Cameron E.E.
      • Dunkel Schetter C.
      • Campbell T.
      • O'Beirne M.
      • Letourneau N.
      • Giesbrecht G.F.
      Pregnancy anxiety and preterm birth: The moderating role of sleep.
      ), postnatal depressive symptoms (
      • Coelho H.F.
      • Murray L.
      • Royal-Lawson M.
      • Cooper P.J.
      Antenatal anxiety disorder as a predictor of postnatal depression: A longitudinal study.
      ), adverse fetal and neonatal development—including preterm birth, low birth weight (
      • Rondó P.H.
      • Ferreira R.F.
      • Nogueira F.
      • Ribeiro M.C.
      • Lobert H.
      • Artes R.
      Maternal psychological stress and distress as predictors of low birth weight, prematurity and intrauterine growth retardation.
      ;
      • Rose M.S.
      • Pana G.
      • Premji S.
      Prenatal maternal anxiety as a risk factor for preterm birth and the effects of heterogeneity on this relationship: A systematic review and meta-analysis.
      ;
      • Uguz F.
      • Yakut E.
      • Aydogan S.
      • Bayman M.G.
      • Gezginc K.
      The impact of maternal major depression, anxiety disorders and their comorbidities on gestational age, birth weight, preterm birth and low birth weight in newborns.
      ), and impaired fetal growth (
      • Henrichs J.
      • Schenk J.
      • Roza S.
      • Lambregtse-van den Berg M.
      • Schmidt H.
      • Steegers E.
      • Tiemeier H.
      Maternal psychological distress and fetal growth trajectories: The Generation R Study.
      )—and longer term adverse developmental outcomes (
      • Irwin J.L.
      • Davis E.P.
      • Hobel C.J.
      • Coussons-Read M.
      • Schetter C.D.
      Maternal prenatal anxiety trajectories and infant developmental outcomes in one-year-old offspring.
      ). One of the largest contributors to maternal anxiety is experiencing stress during pregnancy, and prenatal anxiety is a salient risk factor for postpartum anxiety (
      • Aris-Meijer J.
      • Bockting C.
      • Stolk R.
      • Verbeek T.
      • Beijers C.
      • van Pampus M.
      • Burger H.
      What if pregnancy is not seventh heaven? The influence of specific life events during pregnancy and delivery on the transition of antenatal into postpartum anxiety and depression.
      ;
      • Huizink A.
      • Menting B.
      • De Moor M.
      • Verhage M.
      • Kunseler F.
      • Schuengel C.
      • Oosterman M.
      From prenatal anxiety to parenting stress: A longitudinal study.
      ). Postpartum anxiety can lead to disruption of the mother–infant bond and problems with breastfeeding and sleep, as well as long-term adverse effects on child well-being and risk for psychopathology (
      • Fallon V.
      • Groves R.
      • Halford J.C.
      • Bennett K.M.
      • Harrold J.A.
      Postpartum anxiety and infant-feeding outcomes.
      ;
      • Field T.
      Postnatal anxiety prevalence, predictors and effects on development: A narrative review.
      ;
      • Prenoveau J.M.
      • Craske M.G.
      • West V.
      • Giannakakis A.
      • Zioga M.
      • Lehtonen A.
      • Stein A.
      Maternal postnatal depression and anxiety and their association with child emotional negativity and behavior problems at two years.
      ;
      • Tietz A.
      • Zietlow A.L.
      • Reck C.
      Maternal bonding in mothers with postpartum anxiety disorder: The crucial role of subclinical depressive symptoms and maternal avoidance behaviour.
      ). Living through large-scale stressful events such as natural disasters (
      • King S.
      • Laplante D.P.
      The effects of prenatal maternal stress on children's cognitive development: Project Ice Storm.
      ;
      • Tees M.T.
      • Harville E.W.
      • Xiong X.
      • Buekens P.
      • Pridjian G.
      • Elkind-Hirsch K.
      Hurricane Katrina-related maternal stress, maternal mental health, and early infant temperament.
      ), terrorist attacks (
      • Maslow C.B.
      • Caramanica K.
      • Li J.
      • Stellman S.D.
      • Brackbill R.M.
      Reproductive outcomes following maternal exposure to the events of September 11, 2001, at the World Trade Center, in New York City.
      ), health emergencies (
      • Preis H.
      • Mahaffey B.
      • Heiselman C.
      • Lobel M.
      Pandemic-related pregnancy stress and anxiety among women pregnant during the coronavirus disease 2019 pandemic.
      ;
      • Preis H.
      • Mahaffey B.
      • Heiselman C.
      • Lobel M.
      Vulnerability and resilience to pandemic-related stress among US women pregnant at the start of the COVID-19 pandemic.
      ), and other catastrophic emergencies may increase the risk for developing maternal anxiety symptoms. The novel coronavirus disease-2019 (COVID-19) pandemic has been shown to increase anxiety symptoms on a global scale (
      • Salari N.
      • Hosseinian-Far A.
      • Jalali R.
      • Vaisi-Raygani A.
      • Rasoulpoor S.
      • Mohammadi M.
      • Khaledi-Paveh B.
      Prevalence of stress, anxiety, depression among the general population during the COVID-19 pandemic: A systematic review and meta-analysis.
      ).
      Some populations experience more prenatal anxiety than others. Latinas report some of the highest levels of anxiety symptoms (20%–36%) (
      • Lara-Cinisomo S.
      • Fujimoto E.M.
      • Oksas C.
      • Jian Y.
      • Gharheeb A.
      Pilot study exploring migration experiences and perinatal depressive and anxiety symptoms in immigrant Latinas.
      ) compared with the general population (15%–20%) (
      • Fairbrother N.
      • Janssen P.
      • Antony M.M.
      • Tucker E.
      • Young A.H.
      Perinatal anxiety disorder prevalence and incidence.
      ), and they are one of the fastest-growing populations in the United States—a trend driven by high birth rates rather than immigration (
      • Stepler R.
      • Brown A.
      Statistical Portrait of Hispanics in the United States.
      ). Additionally, although Latinas may experience the aforementioned large-scale stressful events, they also are exposed to various daily psychosocial and sociocultural stressors that may predispose them to anxiety symptoms during the perinatal period (i.e., pregnancy to the first year after childbirth). Latinas are disproportionately likely to have low socioeconomic status (
      • Bernstein R.
      Minority population tops 100 million.
      ;
      • Stepler R.
      • Brown A.
      Statistical Portrait of Hispanics in the United States.
      ;
      • Williams D.R.
      • Mohammed S.A.
      • Leavell J.
      • Collins C.
      Race, socioeconomic status and health: Complexities, ongoing challenges and research opportunities.
      ), less access to insurance (
      American College of Obstetricians and Gynecologists (ACOG)
      Guidelines for perinatal care.
      ;
      • Rutledge M.S.
      • McLaughlin C.G.
      Hispanics and health insurance coverage: The rising disparity.
      ), and barriers to prenatal care (
      • Osterman M.J.
      • Martin J.A.
      Epidural and spinal anesthesia use during labor: 27-state reporting area, 2008.
      ). Additionally, sociocultural stressors such as acculturative stress, the psychological distress associated with the process of adapting to a new culture (
      • Berry J.
      Acculturative Stress.
      ), and perceived discrimination have been associated with elevated anxiety trajectories across pregnancy (
      • Preciado A.
      • D’Anna-Hernandez K.
      Acculturative stress is associated with trajectory of anxiety symptoms during pregnancy in Mexican-American women.
      ). This commentary highlights the complex factors that increase the risk of perinatal anxiety among immigrant and U.S.-born Latinas during the pandemic and provides recommendations to address those risk factors to ensure their short- and long-term well-being.
      The global pandemic of COVID-19 has resulted in devastating rates of illness and death in the United States and across the globe (
      World Health Organization
      WHO Coronavirus disease (COVID-19) dashboard.
      ). By early February 2021, the United States had reported more than 449,000 deaths in the United States alone, with significant racial/ethnic inequities (
      Centers for Disease Control and Prevention
      CDC COVID data tracker: Demographic trends.
      ). The CDC data indicate that Latino Americans represent 20.7% of COVID-19 cases (where race/ethnicity data are available) and 38% of COVID-19 age-adjusted deaths, but comprise only 19.4% of the (age-standardized) U.S. population (
      Centers for Disease Control and Prevention
      CDC COVID data tracker: United States COVID-19 cases and deaths by state.
      ;
      Centers for Disease Control and Prevention
      Data on COVID-19 during pregnancy: severity of maternal illness.
      ). Since the start of the pandemic, Latinos in the United States have experienced the greatest increase in COVID-19–related deaths (53.6%), which is nearly five times the increase seen in non-Latino White Americans (11.9%) (
      • Rossen L.
      • Branum A.
      • Ahmad F.
      • Sutton P.
      • Anderson R.
      Excess deaths associated with COVID-19, by age and race and ethnicity — United States, January 26–October 3, 2020. MMWR Morbidity Mortality Weekly Report.
      ). More than 10% of pregnant Latina women were exposed to the coronavirus during summer 2020, as measured by antibody total levels, which was five times the rate of White women in a Philadelphia-based study (
      • Flannery D.D.
      • Gouma S.
      • Dhudasia M.B.
      • Mukhopadhyay S.
      • Pfeifer M.R.
      • Woodford E.C.
      • Hensley S.E.
      SARS-CoV-2 seroprevalence among parturient women in Philadelphia.
      ). In early February 2021, a CDC report showed that pregnant Latinas had the highest number (n = 14,423 [31.5%]) of positive COVID-19 cases compared with non-White racial and ethnic groups in the United States (
      Centers for Disease Control and Prevention
      Health disparities: Race and Hispanic origin.
      ). Both Black and Latino people face increased risks of coronavirus exposure because structural racism and discrimination have limited their housing and employment prospects in ways that make it harder for them to follow recommendations for physical distancing. Black and Latino people are more likely to live in crowded conditions and have jobs deemed essential, including in transportation and food service (
      • Shah M.
      • Sachdeva M.
      • Dodiuk-Gad R.P.
      COVID-19 and racial disparities.
      ), and they are less often permitted to work from home (
      U.S. Bureau of Labor Statistics
      Economic news release.
      ).
      For immigrant Latinos in particular, racism, discrimination, and fear of deportation have also increased under the current sociopolitical climate (
      • Williamson V.
      • Gelfand I.
      Trump and racism: What do the data say?.
      ). These factors contribute to worse mental health (
      • Williams D.R.
      Stress and the mental health of populations of color: Advancing our understanding of race-related stressors.
      ) and decreased access to care among marginalized communities (
      • Martinez O.
      • Wu E.
      • Sandfort T.
      • Dodge B.
      • Carballo-Dieguez A.
      • Pinto R.
      • Chavez-Baray S.
      Evaluating the impact of immigration policies on health status among undocumented immigrants: A systematic review.
      ). Recent studies have shown a significant and positive association between current immigration policies and anxiety in Latina women compared with men (
      • Becerra D.
      • Hernandez G.
      • Porchas F.
      • Castillo J.
      • Nguyen V.
      • Perez González R.
      Immigration policies and mental health: Examining the relationship between immigration enforcement and depression, anxiety, and stress among Latino immigrants.
      ). Some communities even reported fearing deportation more than COVID-19 (
      • Alvarado I.
      “Le temo más a la deportación que al coronavirus”: Dice enfermera con TPS que trabaja en un asilo en California.
      ). A previous study showed that deportation fears were significantly associated with an increased risk of anxiety in prenatal Latinas (
      • Lara-Cinisomo S.
      • Fujimoto E.M.
      • Oksas C.
      • Jian Y.
      • Gharheeb A.
      Pilot study exploring migration experiences and perinatal depressive and anxiety symptoms in immigrant Latinas.
      ). Furthermore, Latina women have been particularly vulnerable to job loss during the pandemic, as 11% remain unemployed as of October 2020—more than double the pre-pandemic rate—despite national September employment gains for all other groups (
      • Ewing-Nelson C.
      Four times more women than men dropped out of the labor force in September. National Women's Law Center.
      ). All of these psychosocial stressors may lead to increased mental health disorders among Latina women. A June CDC survey of more than 5,000 participants indicated that reporting at least one adverse mental and behavioral health symptom was highly prevalent among Latinos during the pandemic (51.9%), and 18.6% had suicidal thoughts in the last 30 days (
      • Czeisler M.E.
      • Lane R.I.
      • Petrosky E.
      • Wiley J.F.
      • Christensen A.
      • Njai R.
      • Rajaratnam S.M.W.
      Mental health, substance use, and suicidal ideation during the COVID-19 pandemic — United States, June 24–30, 2020. Morbidity and Mortality Weekly Reports.
      ). Thus, for Latina mothers, the combined effects of disproportionately higher rates of COVID-19 and subsequent effects on socioeconomic conditions may exacerbate ongoing immigrant and minority-related stressors, leading to a potentially higher risk of mental health disorders in the future.

      Recommendations for Clinical Practice

      Early detection and intervention can help address the mental health needs of immigrant and U.S.-born perinatal Latinas, but distancing measures to reduce COVID-19 transmission may limit opportunities to evaluate them for anxiety. Fears about contagion and deportation may also decrease health care system contact in Latina mothers, particularly among immigrant and undocumented women. Although assessing anxiety symptoms can be quick when using effective screeners that are available in English and Spanish, such as the State-Trait Anxiety Inventory (
      • Spielberger C.D.
      • Gorsuch R.L.
      • Lushene R.
      • Vagg P.R.
      • Jacobs G.A.
      Development of the Spanish edition of the State–Trait Anxiety Inventory.
      ,
      • Spielberger C.D.
      • Gorsuch R.L.
      • Lushene R.
      • Vagg P.R.
      • Jacobs G.A.
      Manual for the State-Trait Anxiety Inventory.
      ) and the Generalized Anxiety Disorder 7- and 2-item versions (
      • García-Campayo J.
      • Zamorano E.
      • Ruiz M.A.
      • Pardo A.
      • Pérez-Páramo M.
      • López-Gómez V.
      • Rejas J.
      Cultural adaptation into Spanish of the generalized anxiety disorder-7 (GAD-7) scale as a screening tool.
      ;
      • Plummer F.
      • Manea L.
      • Trepel D.
      • McMillan D.
      Screening for anxiety disorders with the GAD-7 and GAD-2: A systematic review and diagnostic metaanalysis.
      ), health care professionals may have limited time owing to other medical demands related to the pandemic. Therefore, we recommend a multipronged approach that can be cost effective, increase reach, and promote help-seeking behaviors.
      For instance, by using reliable and credible information, public health and health care professionals can provide clear and concrete information using social media about anxiety, including the presentation of symptoms, how anxiety can be detected, and information on where to seek help. Indeed, a recent commentary suggested using social media to reduce anxiety during a pandemic (
      • Wiederhold B.K.
      Using social media to our advantage: Alleviating anxiety during a pandemic.
      ). However, prior research has shown that health messages must use culturally relevant language, originate from trusted sources, and aim to reach patients using trusted media outlets (
      • Clayman M.L.
      • Manganello J.A.
      • Viswanath K.
      • Hesse B.W.
      • Arora N.K.
      Providing health messages to Hispanics/Latinos: Understanding the importance of language, trust in health information sources, and media use.
      ). Latinos “less comfortable” speaking English have been shown to have lower use of internet, radio, and weekly newspapers compared with Latinos more comfortable with English (
      • Clayman M.L.
      • Manganello J.A.
      • Viswanath K.
      • Hesse B.W.
      • Arora N.K.
      Providing health messages to Hispanics/Latinos: Understanding the importance of language, trust in health information sources, and media use.
      ), and others have found lower levels of media trust in Latinos compared with non-Latino White people (
      • Monforti J.L.
      • Marichal J.
      The role of digital skills in the formation of generalized trust among Latinos and African Americans in the United States.
      ). However, a recent report shows a surge in the use of social media since the COVID-19 pandemic for Latinos compared with non-Latinos (
      • Acevedo N.
      Latinos rely more on social media as a coronavirus lifeline, Nielsen report finds.
      ). Therefore, we encourage public health professionals and health care providers to use social media to provide psychoeducation about anxiety that targets English- and Spanish-speaking immigrant and U.S.-born perinatal Latina women. We also encourage health care providers working directly or indirectly through other patient contacts (e.g., pediatric visits) to provide these women with resources regarding anxiety symptoms, prevention, and treatment options.
      In addition to providing psychoeducation regarding anxiety, we urge public health professionals and health care providers to be aware of the stressors, such as increased deportation efforts and heightened racial profiling of Latinos (
      • Becerra D.
      • Hernandez G.
      • Porchas F.
      • Castillo J.
      • Nguyen V.
      • Perez González R.
      Immigration policies and mental health: Examining the relationship between immigration enforcement and depression, anxiety, and stress among Latino immigrants.
      ;
      • Lara-Cinisomo S.
      • Fujimoto E.M.
      • Oksas C.
      • Jian Y.
      • Gharheeb A.
      Pilot study exploring migration experiences and perinatal depressive and anxiety symptoms in immigrant Latinas.
      ), that may increase Latinas’ risk. Therefore, we recommend that health care providers remind perinatal Latina women about patient confidentiality and boundaries that protect patient information (e.g., The Health Insurance Portability and Accountability Act) and when information about the patient requires further action, such as when a woman discloses suicidal thoughts. We also recommend frequent screening for anxiety symptoms throughout the perinatal period to ensure early detection and appropriate referral and treatment (
      • Gregory K.D.
      • Chelmow D.
      • Nelson H.D.
      • Van Niel M.S.
      • Conry J.A.
      • Garcia F.
      • Ramos D.
      Screening for anxiety in adolescent and adult women: A recommendation from the Women's Preventive Services Initiative.
      ) and decrease the negative effects of anxiety on the fetus and child (
      • Field T.
      Prenatal anxiety effects: A review.
      ).
      Although early detection and reliable information about anxiety can help to inform women about the risk of anxiety, research must also assess the factors that increase perinatal Latinas’ risk during the pandemic. Research that evaluates the unique and combined effects of psychosocial factors (e.g., financial strain), cultural stressors (e.g., acculturative stress), sociopolitical stressors (e.g., deportations), and socioeconomic changes owing to the pandemic on anxiety symptoms in this population is needed. Several research teams have developed measures that are specific to the pandemic (
      • Briggs-Gowan M.J.
      • Drury S.S.
      • Carter A.S.
      • Muzik M.
      • Friedman L.
      • O’Neill P.
      • Grasso D.J.
      The Epidemic – Pandemic Impacts Inventory Prenatal Module (EPII-P).
      ;
      • Drury S.D.
      • Johnson A.
      • Lara-Cinisomo S.
      • Hodnett D.
      • Gaston-Hawkins L.
      • Liu C.
      • Carter A.S.
      The brief assessment of perinatal healthcare equity.
      ) and we encourage researchers to collaborate to ensure a comprehensive understanding of how these factors affect mental health and to foster the development of responsive and appropriate early interventions and treatments.

       Recommendations for Research

      To elucidate the effects of the pandemic on anxiety symptoms among perinatal Latinas, we recommend an increase in federal funding to ensure research teams have the necessary resources to develop measures, gather data across sites, and analyze data promptly. We urge the National Institutes of Health and other federal funding agencies to provide emergency and timely funding to investigators, particularly those of Latino origin with established records of research working with Latino communities, to conduct culturally and linguistically appropriate studies. Because Latinas are not a monolithic group, researchers should examine how the pandemic has affected the various subgroup of Latinas in the United States. Of the 14 largest Latino subgroups in the United States, Mexicans comprise the largest proportion at 64.9% (
      • Motel S.
      • Patten E.
      The 10 Largest Hispanic origin groups: Characteristics, rankings, top counties.
      ;
      • Stepler R.
      • Brown A.
      Statistical Portrait of Hispanics in the United States.
      ). Although Latinos share a language and many cultural values, the 2020 Presidential election showed that political views and voting behaviors are not homogenous (
      • Sonneland H.K.
      Chart: How U.S. Latinos voted in the 2020 Presidential election.
      ). Latino subgroups also differ in key demographic characteristics that have implications for exposure to structural, psychosocial, and sociopolitical stressors, such as employment security owing to immigration status. Therefore, we encourage researchers and clinicians to be mindful of these differences when exploring how best to study and address the mental health needs of perinatal Latinas in the United States.

       Policy-Related Recommendations

      Because policies at the local, state, and federal levels can, directly and indirectly, affect the well-being of mothers, we recommend the following policies to reduce and address anxiety in immigrant and U.S.-born perinatal Latinas in the United States. First, additional funding must be allocated to support the growing need for mental health providers owing to the negative effects of the pandemic on mental health. Local, state, and federal resources should be directed to support bilingual and diversity-trained mental health professionals who are prepared to address the unique and complex mental health needs of perinatal Latinas during a pandemic. For instance, rather than requiring states to provide matching funds for interpreters, such as required for Medicaid recipients, the federal government should earmark specific funds for those services because state resources may be depleted meeting other patient needs. Also, the Health Resources and Services Administration should make existing grant funds for language access services more accessible to small and large health care providers. Second, we recommend increased funding to enable mental health providers and community workers to reach out to and serve vulnerable communities where large numbers of perinatal Latinas who are essential workers reside so they have accessible services, potentially through added telehealth services. For example, the Health Resources and Services Administration Telehealth Network Grant Program should be expanded to support urban and rural regions in the country. This factor is particularly important, given perinatal Latinas' exposure to high-risk jobs and competing family demands. Third, state and federal officials should increase the enforcement of safe workplace standards to ensure that employers are limiting workers’ risks of virus exposure, and consider adopting new COVID-19 occupational health standards, like California, Michigan, Oregon, and Virginia have done (
      • Michaels D.
      • Wagner G.R.
      Occupational Safety and Health Administration (OSHA) and worker safety during the COVID-19 pandemic.
      ). Federal agencies such as the Occupational Safety and Health Administration and the CDC should develop tools and recommendations to protect workers from exposure to the coronavirus and not rely on existing standards (
      • Michaels D.
      • Wagner G.R.
      Occupational Safety and Health Administration (OSHA) and worker safety during the COVID-19 pandemic.
      ). Fourth, COVID-19 legislation should provide stimulus packages to all who are eligible, regardless of whether they are in mixed status families, where some family members are U.S. citizens and others are not. The Coronavirus Aid, Relief, and Economic Security Act (CARES Act) excluded mixed status families (
      Migration Policy Institute
      Mixed-status families ineligible for CARES Act Federal pandemic stimulus checks.
      ;
      National Immigration Forum, N. I.
      Fact sheet: Mixed status families and COVID-19 economic relief.
      ), exposing 16.2 million people in the United States to more economic hardship and distress because an estimated 37% of unauthorized immigrants are parents to U.S.-born children (
      • Passell J.S.
      • Taylor P.
      III. Household structure; Mixed families.
      ). In one example of a solution, a COVID-19 stimulus payment introduced by Republican senators known as the Coronavirus Assistance for American Families (CAAF) Act (S.4381) would allow for economic relief payments to individuals with a social security number in mixed status homes (
      • Cassidy B.
      • Daines S.
      • Romney M.
      • Rubio M.
      The Coronavirus Assistance for American Families Act.
      ). If passed, this legislation could help an estimated 26.6 million adult Latino U.S. citizens and 17.3 million child U.S. citizens living in mixed status households (
      • Asad A.L.
      Latinos’ deportation fears by citizenship and legal status, 2007 to 2018.
      ).
      Immediate changes to immigration policy are also critical for the well-being of Latinos in general and perinatal Latinas specifically. In addition to providing much-needed financial relief, we urge elected officials to halt deportations and reunite families separated at the U.S.–Mexico border. Our research shows that deportation threats increase anxiety in prenatal women and those effects are likely to persist for many years (
      • Lara-Cinisomo S.
      • Fujimoto E.M.
      • Oksas C.
      • Jian Y.
      • Gharheeb A.
      Pilot study exploring migration experiences and perinatal depressive and anxiety symptoms in immigrant Latinas.
      ). Deportations also threaten the safety and health of immigrants because of the increased risk of exposure to COVID-19 in already poorly managed detention centers (
      • Keller A.S.
      • Wagner B.D.
      COVID-19 and immigration detention in the USA: Time to act.
      ).

      Conclusions

      Like many perinatal women, immigrant and U.S.-born Latinas encounter various stressors that increase their risk for perinatal anxiety, and the pandemic has increased the risk in women across the globe (
      • Durankuş F.
      • Aksu E.
      Effects of the COVID-19 pandemic on anxiety and depressive symptoms in pregnant women: A preliminary study.
      ;
      • Liu X.
      • Chen M.
      • Wang Y.
      • Sun L.
      • Zhang J.
      • Shi Y.
      • Baker P.N.
      Prenatal anxiety and obstetric decisions among pregnant women in Wuhan and Chongqing during the COVID-19 outbreak: A cross-sectional study.
      ;
      • Salehi L.
      • Rahimzadeh M.
      • Molaei E.
      • Zaheri H.
      • Esmaelzadeh-Saeieh S.
      The relationship among fear and anxiety of COVID-19, pregnancy experience, and mental health disorder in pregnant women: A structural equation model.
      ). Latinas in the United States have also had to endure racist attacks encouraged by the Trump administration, separations of families at the U.S.–Mexico border, increased deportation threats, elevated exposure to the coronavirus, and unequal access to federal funding under laws such as the CARES Act. As the Biden–Harris administration begins implementing its policy priorities, we urge all elected officials to provide much-needed resources to clinicians working directly with perinatal Latinas, researchers working to understand the effects of the pandemic on these women, and the perinatal Latinas who are fighting to keep themselves and their families safe on all fronts.

      Acknowledgments

      Sandraluz Lara-Cinisomo would like to thank the University of Illinois at Urbana-Champaign , United States for its support of this article.

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      Biography

      Sandraluz Lara-Cinisomo, PhD, is an Assistant Professor at the University of Illinois at Urbana-Champaign. Her research focuses on addressing mental health disparities in racially and ethnically diverse women as well as military populations.

      Biography

      Kimberly D'Anna-Hernandez, PhD, is a neuroscientist with expertise in mental health and biomarkers. She has a well-established record of research focused on the negative effects of discrimination and acculturative stress on maternal mental health in mothers of Mexican descent.

      Biography

      Amy L. Non, PhD, is a genetic anthropologist whose research focuses on how the biological embedding of stress may contribute to racial health disparities. She leads a study of stress about epigenetic and hair cortisol variation in Mexican immigrant mothers and their children.