The relation of infant attachment to attachment and cognitive and behavioural outcomes in early childhood

Background

In China, research on the relation of mother–infant attachment to children's development is scarce.

Aims

This study sought to investigate the relation of mother–infant attachment to attachment, cognitive and behavioural development in young children.

Study design

This study used a longitudinal study design.

Subjects

The subjects included healthy infants (n = 160) aged 12 to 18 months.

Outcome measures

Ainsworth's “Strange Situation Procedure” was used to evaluate mother–infant attachment types. The attachment Q-set (AQS) was used to evaluate the attachment between young children and their mothers. The Bayley scale of infant development-second edition (BSID-II) was used to evaluate cognitive developmental level in early childhood. Achenbach's child behaviour checklist (CBCL) for 2- to 3-year-olds was used to investigate behavioural problems.

Results

In total, 118 young children (73.8%) completed the follow-up; 89.7% of infants with secure attachment and 85.0% of infants with insecure attachment still demonstrated this type of attachment in early childhood (κ = 0.738, p < 0.05). Infants with insecure attachment collectively exhibited a significantly lower mental development index (MDI) in early childhood than did infants with secure attachment, especially the resistant type. In addition, resistant infants were reported to have greater social withdrawal, sleep problems and aggressive behaviour in early childhood.

Conclusion

There is a high consistency in attachment development from infancy to early childhood. Secure mother–infant attachment predicts a better cognitive and behavioural outcome; whereas insecure attachment, especially the resistant attachment, may lead to a lower cognitive level and greater behavioural problems in early childhood.     

Maternal interactive behaviour as a predictor of preschoolers' attachment representations among full term and premature samples

Background

Associations between maternal sensitivity and child attachment have been established in many samples, but the strength of the association varies across populations. The sensitivity–attachment link has never been examined at the level of representations nor among premature samples.

Objective

The present study is aimed at exploring associations between maternal interactive behaviour and children's attachment representations in a population of preterm and full-term infants.

Method

Maternal interactive behaviour was assessed at 6 and 18 months (Ainsworth Sensitivity Scale & Care Index) and children's attachment representations were measured at 42 months (Attachment Story Completion Task) in a sample of preterm (N = 48) and full-term (N = 23) infants.

Results

Maternal unresponsiveness at 6 months and sensitivity at 18 months explained 54% of the variance of disorganized attachment representations in the full-term group but was not significantly related to attachment patterns in the preterm group.

Conclusion

These results corroborate previous work on the causes of disorganized attachment and also point to the need to consider the development of attachment differently for children evolving in specific developmental contexts. They especially stress the importance of distinguishing between risk factors associated with the mother as opposed to the child.     

Social competence of preschool children born very preterm

Background

Relatively little is known about the early social development of children born very preterm despite clear suggestions of later interpersonal difficulties.

Aims

To compare the social competence of very preterm (VPT) and full term (FT) born children at age 4 and identify infant, social and family factors associated with later risk.

Study design

Prospective longitudinal study.

Subjects

A regionally representative cohort of 103 VPT (≤ 32 weeks gestation) children and a comparison group of 105 FT children (36–41 weeks gestation) born between 1998 and 2000.

Outcome measures

At corrected age 4 years, a range of parent report, observational and laboratory measures assessed children's emotional and behavioral adjustment, emotional regulation, social interactive behavior and theory of mind understanding. Extensive perinatal, social background and family functioning data were also available from birth to age 4.

Results

Compared to their FT peers, VPT born children had poorer emotional and behavioral adjustment, were less effective in regulating their emotions, had lower levels of positive peer play and had less synchronous interactions with their parents. Within the VPT group, predictors of poor social competence included family socioeconomic disadvantage, extreme prematurity, severity of cerebral white matter abnormalities and early childhood exposure to high levels of maternal anxiety and negative parenting.

Conclusions

VPT pre-schoolers are characterized by a range of subtle social difficulties likely to adversely affect their ability to establish and maintain positive relationships with others. These difficulties need to be monitored alongside other potential neurodevelopmental concerns and parents supported to actively nurture child social competence.     

Évaluer les difficultés interactives entre une mère déprimée et son bébé de 3 mois au moyen de l’échelle GRMII de Fiori-Cowley et Murray

Background and aim

Early detection of postnatal depression and mother–infant interactive difficulties are major issues not only for the emotional and cognitive development of the infant, but also for the implementation of early prevention of interactive disorders. This study examined the characteristics of mother–infant interactions in a free play situation, when infants were 3 months old, in case of maternal postnatal depression, and in a control group. The quality of interactions was assessed using the Global Ratings of Mother–Infant Interactions by Fiori–Cowley and Murray (GRMII).

Methods

The sample was composed of 90 mothers with their infants, including 39 mothers with postnatal depression and 51 without mood disorders. Affective disorder was assessed by the Montgomery and Asberg Depression Rating Scale (MADRS). Mothers and their 3-month-old infants were invited to play freely, in a room dedicated to parent–infant observation in the laboratory. Free play sequences were video recorded and a posteriori coded by two trained clinicians blind to maternal affective status, with the GRMII.

Results and conclusion

Analyses show that for all items of the GRMII, non-depressed mothers and their infant obtained higher scores i.e. better scores than depressed mothers and their infant. However, significance was evidenced only for 8 items of the grid: 3 on the maternal sensitivity scale, 2 on signs of depression, and 3 on the interactive dimension. Results thus show that at 3 months postpartum, depression appeared to have already affected interaction with the infant. Main differences were observed in mother's active engagement, acceptation, sensitivity and ability to provide adjusted responses to her infant. Analysis of maternal intrusiveness and remoteness did not yield significant findings, but conversely maternal sensitivity was negatively impacted. The GRMII appeared as an easy-to-use and objective tool to detect specificities of early depressed mother–infant interactions, adapted to a clinical setting. Early detection of interactive distortion gives a window of opportunity for a clinical intervention focused not only on maternal depressive symptoms, but also on the dyad itself.     

Parental psychological distress during pregnancy and childhood cardiovascular development. The Generation R Study

Background

Maternal psychological distress during pregnancy might lead to higher fetal cortisol exposure, which subsequently leads to fetal cardiovascular developmental adaptations and cardiovascular dysfunction in later life.

Aims

We examined whether maternal and paternal psychological distress was associated with the cardiovascular outcome measurements in school age children.

Study design and subjects

In a population-based prospective cohort study among 4831 children, we assessed maternal and paternal psychological distress during pregnancy by questionnaire, using the Brief Symptom Inventory (see Fig. 1).

Outcome measures

At the child age of six years, we performed blood pressure and carotid–femoral pulse wave velocity measurements, and M-mode measurements of left cardiac structures and fractional shortening.

Results

We did not observe associations of high maternal and paternal psychological symptom scores with childhood blood pressure and carotid–femoral pulse wave velocity after adjustment for potential confounders. Maternal overall psychological symptoms were associated with a lower childhood left ventricular mass (difference − 1.10 g (95% confidence interval − 2.13 to − 0.07) between mothers with high scores and normal scores), but not with other cardiac structures and fractional shortening. Paternal overall psychological symptoms showed a similar association with childhood left ventricular mass (difference − 1.34 grams (95% confidence interval − 3.69 to 1.02) between fathers with high scores and normal scores).

Conclusions

Our results do not support the hypothesis that maternal psychological distress affects cardiovascular development in early life. Similar associations of maternal and paternal psychological distress with left ventricular mass suggest that these associations could be due to unmeasured social and environmental factors, rather than direct intra-uterine effects.     

Infant developmental outcomes following prenatal exposure to antidepressants,and maternal depressed mood and positive affect

Background

Prenatal exposure to serotonin reuptake inhibitor (SRI) antidepressants has been associated with delays in early developmental milestones, but there remains uncertainty. Even among a subset of studies examining the Bayley Scales of Infant Development (BSID), some have reported normal mental and psychomotor development while others have suggested a delay in motor development. Given an increasing number of infants exposed to SRIs, furthering our understanding of the possible developmental implications of SRI exposure in utero is critical.

Aims

To examine the effects of prenatal serotonin reuptake inhibitor exposure and maternal mood on infant developmental outcomes at 10 months of age.

Study design

Prospective study of mothers and their 10-month-old infants.

Subjects

We examined 31 mother–child pairs exposed prenatally to SRIs and 52 mother–child pairs who were nonexposed.

Outcome measure

The Bayley Scales of Infant Development (third edition) scores.

Results

Infants exposed prenatally to SRIs scored significantly lower than nonexposed infants on gross motor (P = 0.03), social–emotional (P = 0.04) and adaptive behavior (P = 0.05) subscales of the BSID-III, controlling for pre- and postnatal maternal depressed mood, smoking and alcohol use during pregnancy. No significant differences in any of the BSID-III subscales were observed between infants exposed and infants nonexposed to pre and postnatal maternal depressed mood (P > 0.05). Increased levels of maternal positive affect at 10 months predicted increased social–emotional scores (P = 0.03).

Conclusions

Infants prenatally exposed to SRIs score significantly lower on the gross motor, social–emotional and adaptive behavior subscales of the BSID-III, and this was not explained by underlying maternal depression.     

Comparison of two strategies to improve infant sleep problems, and associated impacts on maternal experience, mood and infant emotional health: a single case replication design study

Background

Infant sleep problems (ISP) are common and have known effects on parental mood. There is debate as to whether treatment strategies may impact on the infant's emotional health.

Aims

To compare the effectiveness of two treatment strategies for ISP on the infant's sleep, maternal mood, and the infant's emotional health. The two strategies are 1) systematic ignoring with minimal check (‘SI-mc’: commonly known as ‘controlled crying’), and 2) a new, but similar, method where parents feign sleep inside the infant's room before intervening (parental presence with minimal check: ‘PP-mc’).

Design

Participants were randomised to one of the two conditions. Measures were taken at baseline, then three weeks and four months post-intervention.

Subjects

Data were collected from 16 families with infants aged 6–18 months who were seeking professional help with their infant's sleep difficulties.

Outcome measures

Measures of infant sleep, maternal experiences and mood, and infant emotional health were collected.

Results

Both treatments were effective, with a third to a half of families reporting decreased ISP by 3 week post intervention, and nearly all reporting decreased ISP by follow-up. Similarly, most mothers in both treatments reported improvements to their experiences or mood, and there was no discernable disruption to infant emotional health.

Conclusions

These findings support previous research into the effectiveness of SI-mc. The study also expands the research into the effectiveness of parental presence by showing that with the inclusion of the minimal check component, which may be preferred by both parents and clinicians over non-responding to the crying infant, the strategy is as effective as SI-mc.     

Study of mother-infant attachment patterns and influence factors in Shanghai

Background

In contrast to the considerable volume of international research on infant attachment development, significantly less research has been conducted in China.

Aim

The present study was designed to identify the patterns of mother–infant attachment in Shanghai and to explore the influence factors.

Study design and subjects

The subjects included 160 healthy infant–mother dyads. Infant attachment and temperament were assessed with the Strange Situation Procedure and Carey's temperament questionnaire, respectively; the mother's personality, maternal sensitivity and marital satisfaction were assessed with Eysenck's personality questionnaire, Maternal Behavior Q-sort Manual Version 3.1 and Olson's marital questionnaire, respectively. A self-formulated questionnaire of family environment factors was completed by the infant's mother.

Results

Of the 160 infants, 68.2% were rated as securely attached (B) and 31.8% as insecurely attached. Of those infants rated as insecurely attached, 7.5% were characterized as avoidant (A), 21.8% as resistant (C) and 2.5% as disorganized (D). Maternal sensitivity and marital satisfaction as well as the approachability dimension of infant temperament, were significantly different between securely attached infants and insecurely attached infants. From a temperament perspective, resistant infants showed higher-level intensity of reaction than avoidant infants. Moreover, multiple caregivers in the family and infant's sleeping with other caregivers at night were more likely to be associated with insecure mother–infant attachment.

Conclusion

There exist certain cultural characteristics in mother–infant attachment patterns in Shanghai. The influence factors are related with the high involvement of non-mother caregivers as well as maternal sensitivity, marital satisfaction and infant's temperament characteristics.     

Maternal sensitivity and infant autonomic and endocrine stress responses

Background

Early environmental exposures may help shape the development of the autonomic nervous system (ANS) and hypothalamic–pituitary–adrenal (HPA) axis, influencing vulnerability for health problems across the lifespan. Little is known about the role of maternal sensitivity in influencing the development of the ANS in early life.

Aims

To examine associations among maternal sensitivity and infant behavioral distress and ANS and HPA axis reactivity to the Repeated Still-Face Paradigm (SFP-R), a dyadic stress task.

Study design

Observational repeated measures study.

Subjects

Thirty-five urban, sociodemographically diverse mothers and their 6-month-old infants.

Outcome measures

Changes in infant affective distress, heart rate, respiratory sinus arrhythmia (RSA), and T-wave amplitude (TWA) across episodes of the SFP-R were assessed. A measure of cortisol output (area under the curve) in the hour following cessation of the SFP-R was also obtained.

Results

Greater maternal insensitivity was associated with greater infant sympathetic activation (TWA) during periods of stress and tended to be associated with greater cortisol output following the SFP-R. There was also evidence for greater affective distress and less parasympathetic activation (RSA) during the SFP-R among infants of predominantly insensitive mothers.

Conclusions

Caregiving quality in early life may influence the responsiveness of the sympathetic and parasympathetic branches of the ANS as well as the HPA axis. Consideration of the ANS and HPA axis systems together provides a fuller representation of adaptive versus maladaptive stress responses. The findings highlight the importance of supporting high quality caregiving in the early years of life, which is likely to promote later health.     

Smoking overrules many other risk factors for small for gestational age birth in less educated mothers

Background

Although there is convincing evidence for the association between small for gestational age (SGA) and socioeconomic status (SES), it is not known to what extent explanatory factors contribute to this association.

Aim

To examine to what extent risk factors could explain educational inequalities in SGA.

Study design

In this study fully completed data were available for 3793 pregnant women of Dutch origin from a population-based cohort (ABCD study). Path-analysis was conducted to examine the role of explanatory factors in the relation of maternal education to SGA.

Results

Low-educated pregnant women had a higher risk of SGA offspring compared to the high-educated women (OR 1.98, 95% CI 1.35–2.89). In path-analysis, maternal cigarette smoking and maternal height explained this association. Maternal age, hypertension, chronic disease, late entry into antenatal care, neighborhood income, underweight, environmental cigarette smoking, drug abuse, alcohol use, caffeine intake, fish intake, folic acid intake, anxiety, and depressive symptoms did not play a role in the association between maternal education and SGA birth.

Conclusion

Among a large array of potential factors, the elevated risk of SGA birth among low-educated women appeared largely attributable to maternal smoking and to a lesser extent to maternal height. To reduce educational inequalities more effort is required to include low-educated women especially in prenatal intervention programs such as smoking cessation programs instead of effort into reducing other SGA-risk factors, though these factors might still be relevant at the individual level.     

Maternal sensitivity moderates the impact of prenatal anxiety disorder on infant mental development

Background

Animal studies have shown that postnatal rearing style can modify the association between prenatal stress exposure and offspring neurodevelopmental outcomes. However, little is known about how parenting quality impacts the association between maternal prenatal anxiety and development in human infants.

Aim

This prospective study examined the impact of maternal prenatal anxiety disorder and maternal caregiving sensitivity on cognitive and psychomotor development in healthy, full-term, 7-month-old infants.

Measures

Women completed a clinical interview during the third trimester of pregnancy to assess anxiety symptoms meeting DSM-IV diagnostic criteria. At infant age 7 months, maternal sensitivity to infant distress and non-distress were observed and coded during the still-face procedure. Maternal postnatal (concurrent) anxiety and depression were also assessed at this time. Infant mental and psychomotor development was assessed at infant age 7 months using the Bayley Scales of Infant Development II.

Results

Analyses were based on 77 mother-infant dyads. Maternal sensitivity to infant distress moderated the association between maternal prenatal anxiety disorder and infant mental development, F (1, 77) = 5.70, p = .02. Whereas there was a significant positive association between sensitivity and mental development among infants whose mothers were anxious during pregnancy, sensitivity had little impact on mental development among infants of control (non-anxious) women. Results were independent of prenatal depression and postnatal anxiety and depression. A caregiving moderation effect was not found for infant psychomotor development, p > .10.

Conclusions

These findings are consistent with a cumulative risk model suggesting that maternal prenatal anxiety and quality of maternal care act in concert to shape infant outcomes.     

Mothers' postpartum psychological adjustment and infantile colic

Background

Infantile colic is a common problem of early infancy. There is limited data on the relation between postpartum maternal psychological problems and colic.

Aim:

To investigate whether infantile colic is associated with postpartum mood disorders or insecure adult attachment style of the mother.

Methods

Seventy eight mothers and newborns were enrolled in this prospective, longitudinal study. Maternal depressive symptoms were screened with Edinburgh Postpartum Depression Score (EPDS) and maternal anxiety was assessed with State‐Trait Anxiety Inventory (STAI). The Adult Attachment Scale was used to determine the attachment style of the mother. Infantile colic was defined according to Wessel criteria.

Results

Infantile colic was present in 17 infants (21.7%); 12.9% of the mothers had an EPDS ⩾13. The mean EPDS of the mothers whose infants had infantile colic (10.2±6.0) was significantly higher than that of the mothers of infants without colic (6.3±4.0). Among infants with infantile colic, 62.5% had mothers who had insecure attachment style, whereas only 31.1% of mothers had insecure attachment when the infant did not have infantile colic.

Conclusion

Postpartum maternal depressive symptoms and insecure attachment style are associated with infantile colic. Screening and early intervention of postpartum depression might promote the health of both the mother and infant.     

Mode of delivery may influence neonatal responsiveness to maternal separation

Introduction

Maternal–infant separation (MIS) is a highly stressful situation for the neonate.

Materials and methods

A study was conducted to observe and describe the reactions of term neonates to brief maternal separation and restoration of skin contact within the first 48 h of life, and to assess whether the mode of delivery influences neonatal responsiveness. A brief maternal–infant separation situation was videotaped to observe the reactions of the newborns within the first 12–48 h of life. Characteristics observed in the newborns were: the Moro reflex, spreading out arms and feet, looking at the mother, presence/lack of crying, and some dichotomous variables (present or lacking); in mothers: adult speech, “motherese” speech, speaking to another adult present in the room, singing, clicking, tapping on the diaper, rocking, kissing the baby, touching toes, touching hands, changing position, making loving comments, calling the newborn by his/her name and touching his/her back. Crying on restoration of contact was measured.

Results

Ten neonates born by planned C-section and 21 neonates born by oxytocin-induced vaginal delivery were included. No behavioral differences were observed according to the mode of delivery. Neonates born by vaginal delivery took longer (64.8 ± 8.6 s) to calm down than those born by C-section (0.9 ± 1.4 s) (p = 0.004). A correlation was observed between cortisol concentrations at birth and the time required to calm the baby down (r = 0.41; p = 0.02).

Conclusion

Neonates born by a planned C-section cried much less on maternal separation, which might indicate an altered attachment behavior and altered response to stress. Further studies are needed to determine the potential long-term implications of variations in mother–infant attachment during the first days of life.     

Postnatal depression mediates the relationship between infant and maternal sleep disruption and family dysfunction

Background

Previous research has linked family sleep disruption and dysfunction in children; however, the mechanism is unknown.

Aims

This study examined whether maternal sleep and postnatal depression (PND) mediate the relationship between infant sleep disruption and family dysfunction.

Study design and participants

Mothers of infants aged 12 months old (N = 111; 48% male) completed infant and parent sleep surveys, the Edinburgh Postnatal Depression Scale and the Family Assessment Device.

Results

Poor infant sleep was related to poor maternal sleep, which was associated with higher PND and higher level of family dysfunction.

Conclusions

Results are consistent with the proposition that identification of both infant and maternal sleep problems during infancy can be relevant to reduction of PND and improved family functioning.     

Maternal emotional availability at bedtime and infant cortisol at 1 and 3 months

Background

Previous work has shown that early experience influences infant cortisol secretion. Few studies, however, have examined associations between parenting quality and cortisol levels and patterning in very young infants.

Aims

This study examined linkages between maternal emotional availability (EA) during a routine caregiving task, bedtime, and infant cortisol in the first 3 months of life. Concurrent and longitudinal associations between maternal EA and infant cortisol were examined.

Study design

Families were visited when their infants were 1 and 3 months old. Video equipment was set up in order to record the infant's bedtime routine. Parents were provided with materials with which to take saliva samples from their infants at late afternoon, bedtime, and the following morning.

Subjects

At 1 month, participants were 96 mothers and infants living in a rural U.S. state. Data were available for 88 mothers and infants at 3 months.

Outcome measures

Maternal EA was scored from videotapes of bedtime at each age point. Infant cortisol was assessed from the saliva samples taken by parents.

Results

Regression analyses indicated that at 1 and 3 months of age, infants of more emotionally available mothers showed lower levels of cortisol secretion across the night than infants of less emotionally available mothers. Additionally, multilevel model analyses indicated that infants of more emotionally available mothers showed greater evidence of a decline in their cortisol levels across the evening, followed by an increase across the nighttime into the morning in their cortisol at 3 months.

Conclusions

Findings suggest that maternal care in the context of a routine caregiving task is associated with lower stress reactivity and with earlier circadian patterning in very young infants.     

The association between maternal country of birth and neonatal intensive care unit outcomes

Background

Immigration is increasingly common worldwide and its impact on neonatal intensive care unit outcomes is uncertain.

Aims

To determine the outcomes of children of immigrant mothers admitted to NICUs in New South Wales (NSW), Australia, between 2000 and 2006.

Study design

Record linkage study of routinely collected state-based health databases.

Subjects

Infants of Australian-born (9813, 81.9%) and overseas born mothers (2166, 18.1%).

Outcome measures

NICU and childhood outcomes to a maximum 5 years of age.

Results

Immigrant mothers came from 122 countries, 897 (44%) from high income regions. Australian born mothers were more likely to be teenaged (Odds Ratio, 95% confidence interval: 3.07, 2.21–4.26), use drugs (3.55, 2.49–5.06) and suffer an antepartum hemorrhage (1.29, 1.14–1.48). They were less likely to have gestational diabetes (0.45, 0.38–0.54), fetal distress (0.75, 0.66–0.85) and intrauterine growth restriction (0.80, 0.67–0.93). Their infants were more likely to be admitted to the NICU for prematurity but less likely to have low 5 min Apgar scores (0.81, 0.69–0.93) or a congenital abnormality (0.79, 0.70–0.90). Infants of Middle-Eastern mothers had the lowest hospital survival rate (88.5%). Children of immigrant Asian mothers were least likely to be rehospitalized after NICU discharge (1.66, 1.27–2.17).

Conclusions

NICU outcomes are affected by maternal country of birth even within the same ethnic group. Further study regarding the impact of paternal race and immigration status and duration of residency will provide data for the changing cultural environment of global perinatal care.     

Maternal diet and breastfeeding: a case for rethinking physiological explanations for breastfeeding determinants

Background

Although some authors explain determinants of breastfeeding that occur in a dose–response manner as evidence of causality, we argue that dose–response relationships are not proof of a biological relationship between the variables. The relationship between maternal smoking and breastfeeding and maternal obesity and breastfeeding are similar: increasing levels of smoking or obesity are associated with shorter duration of breastfeeding. However, maternal infant feeding intention is a strong predictor of breastfeeding duration.

Aims

In this paper we present data on another variable with a clear dose–response relationship with breastfeeding duration – maternal diet – as a case study to argue that a dose–response relationship does not imply causality.

Study design

Secondary analysis of cross-sectional survey.

Subjects

Nationally representative sample of 3544 singleton infants in Longitudinal Study of Australian Children, 2004.

Outcome measures

Maternal intake of fruit and vegetables; breastfeeding duration.

Results

Adjusted Odds Ratios (AOR) for breastfeeding at 6 months for daily maternal fruit and vegetable intake (reference group = no fruit/vegetables): 1 serve AOR 1.6 (95%CI 1.0, 2.6); 2 serves AOR 2.3 (1.5, 3.5); and 6 or more serves AOR 4.4 (2.8, 6.8).

Conclusions

Although higher maternal intake of fruit/vegetables is associated with longer breastfeeding duration, this is not a biological causal relationship. There are possible biological explanations for altered milk supply in women who smoke or are obese, but not for fruit/vegetable intake. We call for a broader understanding of the social determinants of infant feeding and suggest that all breastfeeding studies measure maternal infant feeding intention as an important determinant.     

A prospective study of maternal anxiety, perceived stress, and depressive symptoms in relation to infant cognitive development

Aim

Our objective was to examine the associations between maternal psychological health (trait anxiety, perceived stress, and depressive symptoms) during pregnancy or postpartum and infant visual, language, motor, and overall cognitive development.

Study Design and Methods

In the prospective Pregnancy, Infection, and Nutrition Study (2001-2006), central North Carolina women completed self-administered questionnaires during pregnancy to assess trait anxiety and depressive symptoms. An in-person interview assessed maternal perceived stress and depressive symptoms in the 4th postpartum month. Infant development was assessed at 12 months using the Mullen Scales of Early Learning (n = 358). Multiple linear regression with restricted cubic splines was used to examine potential non-linear associations between trait anxiety, perceived stress, and depressive symptoms in relation to Mullen sub-scales and Composite scores.

Results

Increasing maternal anxiety was associated with poorer overall cognition (adjusted β for Composite = − 0.2, 95% CI: −0.4, 0.0). Postpartum stress was positively associated with language development and general cognition (adjusted β for Expressive Language = 0.2, 95% CI: 0.0, 0.4; adjusted β for Composite = 0.3, 95% CI: 0.0, 0.6). Elevated depressive symptoms throughout pregnancy and postpartum were associated with better fine motor skills (adjusted β = 9.7, 95% CI: 3.9, 15.5). Anxiety, postpartum depressive symptoms and stress were associated with gross motor skills in a non-linear fashion, as were postpartum depressive symptoms and stress with expressive language.

Conclusions

Maternal trait anxiety, depressive symptoms and stress had little negative influence on infant cognitive development. In fact, moderate psychosocial distress may slightly accelerate motor development in particular, and some aspects of language.     

Parenting stress in mothers of very preterm infants — Influence of development,temperament and maternal depression

Objective

To measure levels of parenting stress and postnatal depression in mothers of very preterm infants in comparison with mothers of infants born at term is the objective of this study. The study also aimed to explore factors associated with parenting stress in the mothers of the preterm infants.

Methods

One hundred and five mothers who delivered 124 babies at ≤ 30 weeks gestation were enrolled together with 105 term mothers who delivered 120 babies. At one year of age (corrected for prematurity for the preterm cohort), the mothers completed the Parenting Stress Index Short Form (PSI), the Edinburgh Postnatal Depression Scale (EPDS) and the Short Temperament Scale for Toddlers. The infants had neurodevelopmental assessment. The preterm and term groups were compared.

Results

Questionnaires were completed by 101 of the preterm mothers and 98 of the term mothers. The mean PSI Total Stress score was significantly higher for the preterm mothers (70.28 vs 64.52, p = 0.022), with 19% of the preterm group and 9% of the term group having high scores (p = 0.038).There was no group difference on the EPDS or measures of temperament, with disability being greater in the preterm infants. For the preterm group, maternal depression and infant temperament were independent predictors of Total Stress scores on multivariate analysis.

Conclusions

Parenting stress in mothers of preterm infants at one year of age is significantly greater than that found in mothers of term infants. For preterm mothers, symptoms of depression and infant temperament are independent risk factors for higher levels of parenting stress.