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Principal Investigator: DANI DUMITRIU
Organization: COLUMBIA UNIVERSITY HEALTH SCIENCES
Fiscal Year: 2021
Award: $881,466
Funding agency: National Institute of Mental Health
ABSTRACT
The COVID-19 pandemic has highlighted and exacerbated health disparities related to structural racism and
discrimination (SRD), economic marginalization, and other social determinants of health (SDOH). Pregnant
and postpartum women face unique social and health vulnerabilities related to the pandemic, including risk for
stigma, housing, food, income and employment insecurity, psychological distress, and even mortality – risks
and consequences which are disproportionately significant and adverse for women of color and low
socioeconomic status (SES). However, the collision of these multiple intersecting 21st century public health
crises have not yet been empirically or rigorously studied for inequities in maternal mental health and severe
morbidity. The COVID-19 Mother Baby Outcome (COMBO) initiative is a large multidisciplinary collaborative
established at Columbia University Irving Medical Center to follow SARS-CoV-2 exposed laboring mothers and
their newborns and compare their long-term health and wellbeing to case-matched dyads without prenatal
exposure. The focus of the parent NIMH ‘COMBO’ R01 MH126531 is to understand the effects of SARS-CoV-
2 on mother-infant brain-behavior functioning in a subset of 100 COMBO-enrolled dyads with and without
prenatal SARS-COV-2 infections. Responding to key priorities of NOSI NOT-OD-21-071 and leveraging
COMBO’s robust infrastructure, this administrative supplement (PA-20-272) expands the parent R01 to study
the independent and interactive effects of SRD/SDOH and SARS-CoV-2 on inequities in maternal mental
health, taking advantage of COMBO’s unique setting (first pandemic epicenter) and understudied socially
disadvantaged sample (>600 mother-infant dyads enrolled to-date, with 63% mothers identifying as
racial/ethnic minority and/or low-SES women). By expanding parent R01 brain imaging, surveys, semi-
structured interviews, and electronic health record (EHR) extraction, we will test the overarching hypothesis
that SRD/SDOH and SARS-CoV-2 independently and additively increase risk of adverse maternal mental
health outcomes, with the magnitude of the negative impact being greatest for women of social disadvantage
and the health disparity gap ballooning during – and persisting post – the pandemic. Findings will inform
patient-centered, multi-level interventions to ameliorate the intersecting epidemics of SRD/SDOH and SARS-
CoV-2 and their mental health sequelae for women of social disadvantage in NYC and beyond.
Terms: <0-4 weeks old><2019 novel corona virus><2019 novel coronavirus><2019-nCoV><Acculturation><Administrative Supplement><Affect><Antibodies><Anxiety><Bio-Informatics><Bioinformatics><Brain><Brain Nervous System><Brain imaging><Buffers><COVID crisis><COVID epidemic><COVID pandemic><COVID-19><COVID-19 crisis><COVID-19 diagnosis><COVID-19 epidemic><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health crisis><COVID-19 infection><COVID-19 pandemic><COVID-19 positive><COVID-19 positivity><COVID-19 public health crisis><COVID-19 virus><COVID19><COVID19 crisis><COVID19 diagnosis><COVID19 epidemic><COVID19 global health crisis><COVID19 global pandemic><COVID19 health crisis><COVID19 infection><COVID19 pandemic><COVID19 positive><COVID19 positivity><COVID19 public health crisis><COVID19 virus><CV-19><CV19><CoV-2><CoV2><Cognitive Discrimination><Color><Communities><Cultural Assimilation><Data><Diagnosis><Discipline of Nursing><Discipline of obstetrics><Discrimination><Distress><ED visit><ER visit><Economic Income><Economical Income><Economics><Electronic Health Record><Elements><Emergency care visit><Emergency department visit><Emergency hospital visit><Emergency room visit><Employment><Encephalon><Enrollment><Epidemic><Ethnic Origin><Ethnicity><Event><Face><Female Health><Food><Food or Food Product><Gestation><Health><Housing><Human Rights><Income><Infant><Infrastructure><Institution><Insurance Coverage><Insurance Status><Intervention><Intervention Strategies><Interview><Language><Latinx><Laws><Leadership><MR Imaging><MR Tomography><MRI><Magnetic Resonance Imaging><Maternal Health><Maternal Mortality><Measures><Medical Imaging, Magnetic Resonance / Nuclear Magnetic Resonance><Medical center><Mental Depression><Mental Health><Mental Hygiene><Methods><Minority><Morbidity><Morbidity - disease rate><Mothers><NIH><NIMH><NMR Imaging><NMR Tomography><National Institute of Mental Health><National Institutes of Health><Neighborhoods><Neurosciences><New York City><Newborn Infant><Newborns><Nuclear Magnetic Resonance Imaging><Nursing><Nursing Field><Nursing Profession><Obstetrics><Outcome><Parents><Perinatal><Peripartum><Personal Satisfaction><PhenX Toolkit><Phenx><Policies><Post-partum Women><Postpartum><Postpartum Period><Postpartum Women><Pregnancy><Pregnant Women><Psychological Health><Psychoses><Public Health><QOC><Quality of Care><Race><Racial Group><Racial Stocks><Research><Risk><SARS corona virus 2><SARS-CoV-2><SARS-CoV-2 diagnosis><SARS-CoV-2 epidemic><SARS-CoV-2 exposure><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 infection><SARS-CoV-2 pandemic><SARS-CoV-2 positive><SARS-CoV-2 positivity><SARS-CoV2><SARS-CoV2 epidemic><SARS-CoV2 exposure><SARS-CoV2 infection><SARS-CoV2 pandemic><SARS-associated corona virus 2><SARS-associated coronavirus 2><SARS-coronavirus-2><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><SARS-related corona virus 2><SARS-related coronavirus 2><SARSCoV2><Sampling><Severe Acute Respiratory Distress Syndrome CoV 2><Severe Acute Respiratory Distress Syndrome Corona Virus 2><Severe Acute Respiratory Distress Syndrome Coronavirus 2><Severe Acute Respiratory Syndrome CoV 2><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe Acute Respiratory Syndrome-associated coronavirus 2><Severe Acute Respiratory Syndrome-related coronavirus 2><Severe acute respiratory syndrome associated corona virus 2><Severe acute respiratory syndrome corona virus 2><Severe acute respiratory syndrome coronavirus 2><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 exposure><Severe acute respiratory syndrome coronavirus 2 infection><Severe acute respiratory syndrome coronavirus 2 pandemic><Severe acute respiratory syndrome coronavirus 2 positive><Severe acute respiratory syndrome coronavirus 2 positivity><Severe acute respiratory syndrome related corona virus 2><Social Discrimination><Social support><Socio-economic status><Socioeconomic Status><Structural Racism><Structure><Survey Instrument><Surveys><Techniques><Temporal trend><Testing><Time><Time trend><Translations><Trends over time><United States National Institutes of Health><Universities><Vaccines><Woman><Women Status><Women's Health><Wuhan coronavirus><Zeugmatography><adverse consequence><adverse outcome><brain behavior><brain visualization><cohort><community based participatory research><community led research><community participatory research><community research><coping><corona virus disease 2019><corona virus disease 2019 epidemic><corona virus disease 2019 pandemic><coronavirus disease 2019><coronavirus disease 2019 crisis><coronavirus disease 2019 diagnosis><coronavirus disease 2019 epidemic><coronavirus disease 2019 global health crisis><coronavirus disease 2019 global pandemic><coronavirus disease 2019 health crisis><coronavirus disease 2019 infection><coronavirus disease 2019 pandemic><coronavirus disease 2019 positive><coronavirus disease 2019 positivity><coronavirus disease 2019 public health crisis><coronavirus disease 2019 virus><coronavirus disease crisis><coronavirus disease epidemic><coronavirus disease pandemic><data harmonization><death risk><depression><diagnosed with COVID-19><diagnosed with COVID19><diagnosed with SARS-CoV-2><diagnosed with coronavirus 2019><diagnosed with coronavirus disease 2019><disparity in health><electronic health care record><electronic healthcare record><enroll><ethnic minority><ethnic minority population><ethnoracial><expectant mother><expecting mother><experience><exposed in utero><exposure to SARS-CoV-2><exposure to SARS-CoV2><exposure to Severe acute respiratory syndrome coronavirus 2><faces><facial><fetal exposure><food insecurity><hCoV19><harmonized data><health disparity><in utero exposure><indexing><infected with COVID-19><infected with COVID19><infected with SARS-CoV-2><infected with SARS-CoV2><infected with coronavirus disease 2019><infected with severe acute respiratory syndrome coronavirus 2><interventional strategy><intra-uterine environmental exposure><intrauterine environmental exposure><low SES><low socio-economic position><low socio-economic status><low socioeconomic position><low socioeconomic status><marginalization><maternal death><maternal morbidity><mortality risk><multidisciplinary><nCoV2><neuro-imaging><neuroimaging><newborn child><newborn children><novel><pandemic><pandemic disease><participatory action research><patient centered><patient oriented><perceived stress><perinatal mental health><post-partum><pregnant><pregnant mothers><prenatal><prenatal exposure><prenatally exposed><programs><psychiatric emergency><psychological distress><racial and ethnic><resilience><severe acute respiratory syndrome coronavirus 2 diagnosis><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><social><social determinants><social disadvantage><social disparities><social epidemiology><social exclusion><social health determinants><social stigma><social support network><socio-economic position><sociodeterminant><socioeconomic position><statistics><stigma><stress buffering><stress management><theories><unborn><well-being><wellbeing>