Kate and Brian Chong couldn't have known they would become parents during a pandemic, but they were more prepared than most for a difficult pregnancy.
Brian donated a kidney to his wife about three years ago and the couple from Coquitlam, B.C., says they drew on that experience to stay positive while getting ready for the birth of their first child last month.
"Kate and I have learned how to support each other already through those difficult times," said Brian. "If we didn't have those learned experiences, I don't know if things would have ended as successfully as they did for us."
Kate, 35, was diagnosed with kidney disease about a decade ago. She switched medications after the couple decided they wanted to try to have a baby, which led to complications that meant Kate required a kidney transplant.
Brian, 39, was a match and the couple underwent surgery a little more than two years before they became pregnant last October.
Their daughter Adelynn was born four weeks early on June 14 among clinicians suited up in protective gear at St. Paul's Hospital in Vancouver.
Kate's immune system is weakened by the anti-rejection medication she takes following the kidney transplant, so throughout her pregnancy the couple stepped up the measures they were taking to protect their health.
But Kate said her anxieties stemmed mostly from the risks associated with kidney disease and pregnancy, rather than COVID-19.
Meanwhile, early results from a Canada-wide survey of pregnant women show expectant mothers are reporting elevated levels of anxiety and depression compared with data on pregnancy and mental health prior to the pandemic.
The survey began on April 5 and the early results are based on responses from nearly 2,000 women, but the study is ongoing and about 4,000 more women have participated since then, said Catherine Lebel, who's leading the project.
"It's scary for individuals to think about getting COVID but I think it's especially scary when you're growing another human being and you don't know how that's going to impact that fetus," said Lebel, Canada Research Chair in Pediatric Neuroimaging and a professor in the radiology department at the University of Calgary.
"We're looking at rates of anxiety and depression symptoms that are three to four times higher than normal."
The survey includes questions about the women's level of concern over contracting COVID-19 and how they felt about the prenatal care they were receiving, as well as their financial circumstances, occupation and relationship status.
The health restrictions imposed because of the pandemic added a second layer of stress, said Lebel, as women reported stronger-than-normal feelings of social isolation. That sense of isolation was associated with higher levels of anxiety and depression, she said, while better sleep and support from partners and social networks helped moderate those symptoms.
About 20 per cent of women typically experience anxiety during pregnancy based on studies over the past 40 years, said Lebel, while nine to 11 per cent experience depression.
So far, 57 per cent of women who responded to the survey reported clinically elevated symptoms of anxiety, while 37 per cent reported symptoms of depression.
It could be even worse, said Lebel, since the respondents so far comprise a "low risk sample." Their average age is over 30, education levels are fairly high and the vast majority of respondents are married or in common-law relationships.
Lebel said the researchers are trying to reach a greater diversity of respondents in rural and ethnically diverse areas, as well as working with community organizations that serve women who are vulnerable and less likely to access prenatal care.
They follow up with the women every month during their pregnancy, after delivery, and three months later to see how the baby is developing and how the family is doing overall, said Lebel.
While there is still much to learn about mental health during pregnancy and how it affects health outcomes for mothers and their babies, Lebel said elevated symptoms of mental illness are associated with pre-term birth and lower birth weight.
In the longer term, kids whose mothers experienced anxiety or depression during pregnancy are more likely have behavioural problems, she said, adding her team is exploring how to offer support to the women who have responded to their survey.
They're also working with researchers in Vancouver who plan to link the survey responses from women in B.C. to their administrative health records in order to dig deeper into mental health challenges during pregnancy and the possible developmental consequences for children.
Those records contain detailed information about prenatal care, labour and delivery, infant and neonatal outcomes and health throughout early childhood, said Gillian Hanley, an assistant professor in the department of obstetrics and gynecology at the University of British Columbia.
The pandemic is like a "natural experiment" that allows researchers to assess the impacts of abrupt changes in circumstances on pregnant women's mental health, said Hanley, who also works as an affiliate investigator with the BC Children's Hospital.
It's an opportunity to learn about why some women who experience mental health challenges during pregnancy continue to struggle after delivering their baby while others do not, she said, noting mental illness is often compounded by external stressors.
"We need to do this kind of work in order to better understand exactly what these relationships are so that we can best target our interventions to women and families who need them most and provide them with the best possible care," said Hanley.
Although they're resilient, Brian and Kate said they were sad they could not share their pregnancy with family and friends in person as they would have before the pandemic.
Kate's parents live in Alberta and the couple said they connected virtually until health restrictions loosened enough to allow Kate's mother to visit for a drive-by baby shower, along with physically distant meetings with some members of Brian's family who live locally.
Brian said he also missed hearing Adelynn's heartbeat during several ultrasound appointments that only Kate was allowed to attend, and it's strange not to know what the doctors and nurses who cared for them look like without masks.
Ultimately, though, Kate said she's grateful that her kidney function is stabilizing and Adelynn is doing well.
"For me, Brian gave me this gift so we could provide this gift to the world of Adelynn."