The postpartum period represents a major state of medical and social vulnerability for women as they navigate both physiologic and psychological changes.1 The competing priorities of managing their own health in addition to caring for a newborn may have a compounding effect on mental health, manifested as depression or anxiety. Previous studies have demonstrated that poor maternal mental health adversely impacts maternal–infant bonding.2 During the coronavirus disease 2019 (COVID-19) pandemic, postpartum women experience challenges that may put them at elevated risk for mental health problems.3,4 The added challenges of the pandemic have heightened concerns about the potential deleterious effects on maternal–infant bonding. The study by Liu et al. contributes to the existing evidence by exploring relationships between mental health symptoms, psychological experiences, COVID-19-related concerns, and reported maternal–infant bonding experiences among postpartum women.5 The authors conducted a cross-sectional study of an online survey from the PEACE (Perinatal Experiences and COVID-19 Effects) Study. The primary dependent variable was maternal–infant bonding and independent variables consisted of COVID-19-related health, COVID-19-related grief, depression symptoms, anxiety symptoms, maternal self-efficacy, and social support. Consistent with the existing literature, the study found that postpartum women’s depressive symptoms were associated with lower quality maternal–infant bonding. Maternal self-efficacy was positively related to maternal–infant bonding. COVID-19-related grief was significantly associated with lower bonding. However, COVID-19-related worries were associated with higher levels of maternal–infant bonding. The findings from this study are noteworthy in that they provide greater understanding of how the pandemic has impacted postpartum women, and consequently, maternal–infant bonding.

Liu et al. are to be commended for conducting this clinically relevant study and giving insights to a complex set of findings that have substantial implications for child neurodevelopment and the overall intergenerational health of families during the pandemic. In addition to contextualizing their results within the literature on maternal–infant bonding, the authors also provide key considerations for health care providers and areas for further study. They highlight (1) screening for postpartum depression during maternal follow-up visits and well-child visits; (2) focusing on dyadic interventions that increase maternal self-efficacy; and (3) assessing the unique COVID-19-related health and grief concerns of families. While the authors articulate an evidence-informed template for future clinical and research investments to transform practice, they do not address the critical role of policy in ameliorating postpartum psychological risks to mother-infant bonding. In this commentary, we focus on the expansion of postpartum Medicaid coverage as a policy strategy to combat postpartum morbidity and mortality and simultaneously improve child health.

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