Stress and coping in parents of newly born twins

Objective: Research indicates that parents of twins have poorer psychosocial outcomes than parents of singletons. Parents who have conceived using assisted reproductive technology (ART) have been found to be at higher risk of negative psychosocial outcomes compared to parents who have conceived spontaneously. The current study aimed to model the factors associated with parenting stress of newly-born twins, using the Transactional Model of Stress.

Methods: Data were collected using a cross-sectional survey design with participants identified from delivery records across Northern Ireland. Mothers and fathers (n?=?104) of twins aged between 1 and 12 months old returned a questionnaire pack containing the Parenting Stress Index, Impact on the Family Scale-Financial Burden, Coping Orientation to Problems Experienced – Brief Version, Multidimensional Scale of Perceived Social Support, General Health Questionnaire and a demographic questionnaire.

Results: There were no differences on psychological outcomes between parents who had conceived via ART and those who conceived spontaneously. Regression analyses found that social interaction and support is an important variable in terms of the psychological outcomes experienced by parents of twins.

Conclusion: Parents of newly-born twins regardless of the mode of conception should be considered an at risk group for parental distress. Support groups such as the Twins and Multiple Births Association could be important in providing that crucial social interaction and support that seems to be important in the emotional well-being of parents of twins.     

Network support and parenting in mothers and fathers who conceived spontaneously or through assisted reproduction

Background: Little is known about the contribution of other significant relationships beyond the partnership for parental adjustment and care in parents who conceived through Assisted Reproductive Technologies (ART). Objective: This study examined the role of perceived network support on parenting stress and investment in the child in parents who conceived spontaneously or through ART, during their transition to parenthood. Methods: Thirty‐five couples who conceived through ART and 31 couples who conceived spontaneously completed self‐report questionnaires regarding perceived emotional and instrumental support from their social network members (i.e. nuclear and extended family members and friends) during pregnancy (twenty‐fourth week) and regarding parenting stress and investment in the child four months after the partum. Results: Regardless of method‐of‐conception, instrumental support from the nuclear family was positively associated with maternal investment in the child and emotional and instrumental support from the extended family were positively associated with paternal stress while support from friends was negatively associated with it. Conclusion: Results suggest that parents who conceive through ART and spontaneously are alike in that their adjustment to parenthood and the quality of the care they provide to their children depends on perceived support from nuclear and extended family and friends.     

Psychological assessment of mothers and their assisted reproduction triplets at age 3 years

The aim of this study was to examine the psychological well-being of mothers and the psychological development of their 3-year-old triplet children conceived by in-vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). Comparisons were carried out between a sample of 10 families with IVF/ICSI triplets and matched groups of 15 families with IVF/ICSI twins and 30 families with IVF/ICSI singletons. The families were recruited from Follow-Up, a national organization in France that was established to study children conceived by assisted reproduction. Standardized measures of the mother's emotional well-being and of the children's psychological development were administered. Mothers with a multiple birth were found to experience greater difficulties in parenting than mothers of singletons, with no differences between mothers of triplets and mothers of twins. Regarding the children, there were no differences in emotional or behavioural problems between triplets, twins and singletons. However, the triplets and twins showed a delay in some aspects of language development in comparison with the singleton children.     

Emotional adaptation following successful in vitro fertilization

OBJECTIVE: To assess the emotional impact of infertility after successful IVF and to compare parents who have undergone IVF (IVF parents) and parents who have not undergone IVF (non-IVF parents) regarding parental stress and the marital relationship during the transition to parenthood. DESIGN: A study with qualitative and longitudinal quantitative assessments. SETTING: University IVF clinics and antenatal clinics in Stockholm. PATIENT(S): Fifty-five IVF mothers, 53 IVF fathers, 40 non-IVF mothers, and 36 non-IVF fathers. INTERVENTION(S): IVF parents were interviewed. All subjects completed self-rating scales in early pregnancy and at 2 and 6 months postpartum. MAIN OUTCOME MEASURE(S): Interviews about perception of infertility and scalar measurement of parental stress and the marital relationship. RESULT(S): Negative feelings related to infertility were not easily overcome among the IVF parents. Their levels of stress related to parenthood were similar to those of non-IVF parents, and both groups reported decreased satisfaction with the marital relationship during the transition to parenthood. CONCLUSION(S): The inability to conceive naturally continues to affect the current lives of a proportion of IVF parents. The results suggest that IVF parents may benefit from counseling with regard to the potential long-term impacts of infertility, disclosure issues, and decisions regarding future children. However, levels of parental stress and patterns of partner satisfaction are similar to those of parents with children conceived "naturally."     

Experience of pregnancy and delivery after ART

Differences in the experience of pregnancy and birth after ART compared to spontaneous conception are of interest for the developmental pyschologist. Studies performed to date have compared mainly the psychological aspects of experiencing the singleton pregnancy and the single birth. Couples after ART are at higher anxiety levels compared to those who have conceived naturally in the early stages of pregnancy. Individual experiences with infertility in those affected have often led to states of anxiety, low self-esteem and low confidence, but this does not seem to persist in pregnancy. Higher anxiety symptoms occur primarily. Increased symptoms of anxiety are found in pregnant women and their partners who have undergone the high stress of infertility. Pregnant women after ART are less concerned about the physical changes during pregnancy. Couples with previous ART mediated more harmony on the first impression, however, on the other hand being less communicative. A long duration of infertility (7 years or more) was associated with the expression of a large birth anxiety. Postpartum disorders such as depression are influenced by the interaction of several risk factors, particularly prematurity, multiple births and caesarean sections reinforce the emotional problems. Studies have confirmed an emotional well-being and a happy pregnancy with a satisfying mother-child relationship. However, where fears about the foetal surival are higher, postpartum difficulties are greater and self-esteem is lower after ART. Fears about the foetal survival and postnatal educational difficulties were greater after the application of assisted reproduction and the self-esteem lower. Pregnancy and parenthood after assisted reproduction may be idealised and is associated with a difficult transition to parenthood.     

Parental adjustment and attitudes to parenting after in vitro fertilization

OBJECTIVE: To examine the psychosocial and parenthood-specific adjustment and attitudes to parenting at 1 year postpartum of IVF parents. DESIGN: Prospective, controlled study. SETTING: Volunteers in a teaching hospital environment. PATIENT(s): Sixty-five primiparous women with singleton IVF pregnancies and their partners, and a control group of 61 similarly aged primiparous women with no history of infertility and their partners. INTERVENTION(s): Completion of questionnaires and interviews. MAIN OUTCOME MEASURE(s): Parent reports of general and parenthood-specific adjustment and attitudes to parenting. RESULT(s): The IVF mothers tended to report lower self-esteem and less parenting competence than control mothers. Although there were no group differences on protectiveness, IVF mothers saw their children as significantly more vulnerable and "special" compared with controls. The IVF fathers reported significantly lower self-esteem and marital satisfaction, although not less competence in parenting. Both IVF mothers and fathers did not differ from control parents on other measures of general adjustment (mood) or those more specific to parenthood (e.g., attachment to the child and attitudes to child rearing). CONCLUSION(s): The IVF parents' adjustment to parenthood is similar to naturally conceiving comparison families. Nonetheless, there are minor IVF differences that reflect heightened child-focused concern and less confidence in parenting for mothers, less satisfaction with the marriage for the fathers, and vulnerable self-esteem for both parents.     

Developmental outcome of very low birth weight twins conceived by assisted reproduction techniques.

OBJECTIVE: To evaluate the differences in developmental outcomes between very low birth weight twins conceived by assisted reproduction techniques and those conceived spontaneously. STUDY DESIGN: Twenty-two sets of very low birth weight twins were evaluated by the Kyoto Scale for Psychological Development at 36 months of corrected age. Total developmental quotient and developmental quotient (DQ) for three subscales, posture-motor, cognition-adaptation and language-social, were evaluated. RESULTS: Twins conceived with medical assistance demonstrated a higher incidence of total DQ below 85 with lower DQ for cognition-adaptation and language-social skills than spontaneously conceived twins, whereas the quotient for posture-motor skills in medically assisted twins was comparable to that of spontaneously conceived twins. CONCLUSION: At 3 years of age very low birth weight twins conceived by assisted reproduction techniques demonstrated lower cognitive and language skills than twins conceived naturally.     

Offspring created as a result of donor insemination: a study of family relationships, child adjustment, and disclosure

OBJECTIVE: To compare the quality of family relationships and children's socioemotional adjustment in families created by donor insemination where parents tended either toward disclosure or nondisclosure. DESIGN: A study of 46 families with a child aged 4-8 years who was conceived through donor insemination. The study used standardized interview data from mothers and fathers, teachers, and the children themselves. SETTING: An assisted conception unit endorsing openness. PATIENT(S): Parents and their 4- to 8-year-old child conceived through donor insemination. INTERVENTION(S): Parents were interviewed, and children were administered psychological tests. MAIN OUTCOME MEASURE(S): Interviews and questionnaires assessing the quality of the marital relationship, parent-child relationships, and child psychological adjustment. RESULT(S): Mothers from disclosing families reported significantly less frequent and less severe arguments with their children and considered their children to show a lower level of conduct problems and to be less of a strain. The disclosing parents viewed themselves as more competent at parenting. CONCLUSION(S): The differences that were identified indicated more positive parent-child relationships in the disclosing than in the nondisclosing families. However, this did not represent dysfunctional relationships in the nondisclosing families but instead reflected particularly positive ratings in the disclosing group.     

‘Living each week as unique’: Maternal fears in assisted reproductive technology pregnancies

Objectiveto explore women's fears during pregnancy following conception via assisted reproductive technology (ART).Methods19 expectant first-time mothers were interviewed during the third trimester of pregnancy using a semi-structured schedule. Perceptions of and feelings about pregnancy were assessed. Content analysis was used to identify themes and subthemes.Findingsfour overarching themes emerged: the baby's survival, the health of the baby, the efficacy of the mother and childbirth. Of these, the most commonly reported fears were related to miscarriage or fetal death, and the baby being born with an abnormality.Conclusions and implicationsin addition to fears that are experienced by some women who conceived spontaneously, the women in this study who conceived via ART reported other fears, such as miscarriage or fetal death, that are more specific to this context. This suggests that these concerns should be taken into consideration when providing psychological support for ART mothers.     

Outcome of twin pregnancies after assisted reproductive techniques--a comparative study

OBJECTIVE: To compare obstetrical and perinatal outcome of twin pregnancies after assisted reproductive techniques (ART) with that of twins conceived spontaneously. STUDY DESIGN: Hospital based retrospective study. RESULTS: There were 132 twin deliveries of which 36 were conceived after ART. Patients of the ART group were mostly nulliparous and slightly older. There was no statistically significant difference in the frequency of preterm delivery or mean gestational age at delivery. Elective Caesarean delivery was more frequent in twin pregnancies conceived after ART, and there were no other differences in maternal complications. There was also no difference in the mean birth weight or frequency of neonatal complication between the two groups. CONCLUSION: In this comparative study, the obstetric and neonatal outcomes between spontaneous twins and those conceived after ART are similar except for higher operative deliveries in the latter group of twins.     

Maternal Mental Health in Assisted and Natural Conception: A Prospective Cohort Study

ObjectiveThis study sought to compare the pregnancy and postpartum self-reported mood and mental health status of women who conceived with assisted reproductive technology (ART) with those of women who conceived spontaneously.MethodsIn this prospective cohort study, 1176 pregnant women from prenatal clinics in the Ontario Birth Study were enrolled. In the pregnancy and the postpartum period, women who conceived with ART, including in vitro fertilization and intrauterine insemination, were compared with women who conceived spontaneously regarding depression and anxiety at 12–16 weeks and 24–28 weeks gestation and 6–10 weeks postpartum. The following main outcome measures were used: Edinburgh Postnatal Depression Scale, two-item Patient Health Questionnaire, State Trait Anxiety Inventory six-item scale, and two-item Generalized Anxiety Disorder scale (Canadian Task Force Classification II-2).ResultsWomen who conceived with ART demonstrated a decreased likelihood of depression compared with women who spontaneously conceived (SC) at 24–28 weeks gestation (Edinburgh Postnatal Depression Scale: ART 3.6% vs. SC 15%; P < 0.01; two-item Patient Health Questionnaire: ART 0.0% vs. SC 4.0%; P = 0.027), as well as decreased perceived stress (mean score: ART 3.25 vs. SC 4.02; P < 0.01). Women in the ART group also had a lower percentage of positive two-item Generalized Anxiety Disorder scores (ART 2.7% vs. SC 7.5%; P = 0.049). There was no difference in self-reported depression, anxiety, or perceived stress between groups at 12–16 weeks gestation or at 6–10 weeks postpartum.ConclusionWomen who conceived using ART reported decreased rates of depressive symptoms, perceived stress, and generalized anxiety during the second trimester of pregnancy compared with women who had SC pregnancies, and both groups experienced similar mental health status earlier in gestation and in the postpartum period.     

Gay men seeking surrogacy to achieve parenthood

Assisted reproduction technologies have developed at an extraordinary rate in recent years. This, combined with the changing landscape of legal, technical and social possibilities, enables gay men to consider their options for fatherhood as new opportunities emerge for them to create families. Media coverage of gay celebrities embracing surrogacy as a way of having a family and high-profile legal cases have raised awareness of surrogacy across the world. However, gay fatherhood achieved through assisted reproduction is a highly under-researched area, both in the UK and internationally. The research that currently exists on gay fatherhood is largely related to gay men who become parents through processes such as adoption and fostering and children conceived through previous heterosexual relationships. Much of this evidence has centred on parenting experiences, the outcomes for children or the legal perspectives. This paper outlines the different types of surrogacy and the legal issues facing gay men who choose this route to parenthood, summarizes the limited research on gay men and surrogacy and discusses gaps in the current knowledge base.Assisted reproduction technologies have developed at an extraordinary rate in recent years. This, combined with recent legal, technical, and social changes has produced new possibilities and opportunities for gay men to become fathers and create their families. Media coverage of gay celebrities embracing surrogacy as a way of having a family and high-profile legal cases have raised awareness of surrogacy across the world. However, gay fatherhood achieved through assisted reproduction is a highly under-researched area in both the UK and internationally. The research that currently exists on gay fatherhood is largely related to gay men who become parents through processes such as adoption and fostering and children conceived through previous heterosexual relationships. Much of this evidence has centred on parenting experiences, the outcomes for children or the legal perspectives. This paper outlines the different types of surrogacy and the legal issues facing gay men who choose this route to parenthood, summarizes the limited research on gay men and surrogacy and discusses gaps in the current knowledge base.     

Post-neonatal health and development of children born after assisted reproduction: a systematic review of controlled studies

Long-term follow-up studies on the health and the development of children conceived by assisted reproduction (ART) are mandatory to assess the safety of ART. Meanwhile, different aspects of health of these children have been studied. To put these results together, we performed a systematic review of these publications. A Pubmed search and a hand-search of the abstract books from the annual meeting of the European Society of Human Reproduction and Embryology and the American Society of Reproductive Medicine were performed for controlled studies on the developmental outcome of children after ART, which include a matching for plurality of gestation. Regarding general health, growth, mental and psychomotor development IVF children do not differ from spontaneously conceived (SC) children. An increased need for surgical interventions may be due to an increase in the malformation rate. However, a lower birth weight and lower gestational age compared to matched controls may contribute to some health problems observed. The increased risk of neurological problems found in some large registry-based studies can partly be explained by the higher frequency of twins born, by low birth weight, and by low gestational age also found in singletons. But an effect of IVF, the parents' infertility or other factors not adjusted for in the studies cannot be excluded. In addition to this reporting bias caused by concerned parents cannot be excluded, either. To conclude, children born after assisted reproductive techniques are generally healthy and are developmentally similar to children born after SC. However, low birth weight and prematurity contributes to health care problems. An increase of neurological problems by IVF cannot be excluded. Further prospective studies on the neurological outcome are needed.     

High-risk pregnancies,psychological distress,and dyadic adjustment

The objective of the present study was to examine the effects of a high-risk pregnancy on the psychological well-being and marital adjustment of parents. Gender differences in the adaptation process of parents to this potentially stressful change in their life conditions were also investigated. Global findings showed no differences in the average psychological and marital adjustment scores of high- and low-risk parents during this transition. However, findings did suggest that high- and low-risk parents differed in the way they adapt to parenthood. Results also supported the hypothesized gender differences in the adaptation process of both women and men.     

Mode of conception,placental morphology and perinatal outcome of twin gestations

OBJECTIVE: To compare the perinatal outcome and placental morphology of twins conceived by assisted reproductive technologies (ART) or natural conception (NC). METHODS: The present retrospective study included 88 twin pairs. Methods of ART included in vitro fertilization, intrauterine insemination, embryo transfer and induced ovulation. Placental morphology was described by chorionicity, amnionicity, placental weight, umbilical cord insertion and the number of cord vessels. Perinatal outcomes included maternal age, gestational age, birth weight (BW), BW discordance and mode of delivery. RESULTS: The mothers of ART twins were 4 years older than NC mothers. ART twins delivered 2.2 weeks earlier than NC twins. The BW of ART twins A and B were less than NC twins A and B. There was no difference in the proportion of discordant twins in either group. Dichorionic diamniotic (DD) placentas accounted for the majority of placentas in both groups. There were no monochorionic-monoamniotic placentas in ART pairs, but there were 2.9% in NC pairs. Mode of conception had no effect on placental weight in DD or monochorionic-diamniotic twins in either group except for larger DD fused placentas in the ART group. CONCLUSION: ART twin pairs were delivered at an earlier gestational age at lower birth weights to older mothers predominantly by cesarean section. This perinatal outcome was not reflected by placental morphology.     

Successful parents of in vitro fertilization (IVF): The social repercussions

A matched comparison was made of 157 parents of preschool twins conceived by one of the following: in vitro fertilization (IVF), infertility workup combined with infertility drug treatment, or spontaneously. The Interview Schedule for Social Interaction was used to examine systematically a comprehensive range of social relationships and the asymmetries therein. Overall, IVF parents reported having deficient social relationships compared with non-IVF parents, and this deficiency was both in size and in affective quality of their available relationships. As anticipated, mothers reported less adequate and available social relationships when compared with their spouses. In the event of a significant finding, mothers from the three groups always had lower mean scores than the fathers. The finding of the extent to which IVF parents were not as socially integrated, compared with the other families of preschool twins, highlights the need to strengthen through mutual aid IVF parents' social networks. The data also suggest the need for ongoing patient care by IVF teams and for support groups to be established exclusively for IVF parents of twins.     

Spontaneous conception after a successful attempt at in vitro fertilization/intracytoplasmic sperm injection

OBJECTIVE: To determine the incidence of spontaneous pregnancy in women who were not actively undergoing therapy after a successful attempt at IVF/intracytoplasmic sperm injection and to characterize its pattern of occurrence. DESIGN: Retrospective postal questionnaire. SETTING: An assisted reproduction unit at a university-based teaching hospital. PATIENT(s): Five hundred thirteen replies were received from 530 questionnaires mailed. INTERVENTION(s): None. MAIN OUTCOME MEASURE(s): Spontaneous pregnancy. Women who did and did not conceive spontaneously after successful IVF treatment were compared in terms of their age, duration of infertility, previous reproductive history, and indication for treatment at the time of assisted reproduction. RESULT(s): The rate of spontaneous conception among the survey respondents was 20.7%. Younger women (相似文献   

Nuchal translucency in dichorionic twins conceived after assisted reproduction

OBJECTIVES: As opposed to biochemical markers of Down syndrome, nuchal translucency (NT) was once thought to be a more reliable screening marker for high order multiple pregnancies and pregnancies conceived after assisted conception. Recent data suggested that NT in singleton fetuses from assisted reproduction technology (ART) was thicker than those from singleton pregnancies. The present study compared the thickness of NT in dichorionic twins from natural conception and assisted reproduction. METHODS: A retrospective analysis for comparison of NT thickness on 3319 spontaneous singletons, 19 pairs of spontaneous twins and 27 pairs of assisted reproduction twins was performed. RESULTS: The median NT multiple of median (MoM) of spontaneous singletons was 1.00. For twins, the median NT MoM for pregnancies after assisted reproduction and natural conception were 1.02 and 1.07 respectively. There was no statistical difference in the NT thickness among the three pregnancy groups. CONCLUSION: Contrary to the observed increase in NT in singleton pregnancies from assisted reproduction, the NT in dichorionic twins was comparable to the spontaneous ones. The mode of conception appears to impose differential influence on singletons and twins. Copyright (c) 2006 John Wiley & Sons, Ltd.     

RETRACTED ARTICLE: Perinatal and first year outcomes of spontaneous versus assisted twins: a single center experience

OBJECTIVE: The aim is to compare naturally conceived twins with twins conceived by assisted reproductive techniques (ART) by means of perinatal outcome, behavioural patterns and psychomotor development. MATERIAL AND METHODS: Three hundred and five spontaneous and 119 assisted twins were compared in aspects of behavioural patterns, mental and psychomotor development, as well as maternal and gestational age, foetal presentation, birth weight, sex, Apgar scores, perinatal complications, delivery route, and admission to neonatal intensive care unit (NICU) RESULTS: Although the maternal age was higher in assisted twins, the mean gestational age and birth weight of assisted twins were significantly less than those of spontaneous twins. The assisted twins did not differ from the naturally conceived twins in aspects of presentation, Apgar scores, admission to NICU and perinatal complications. However, caesarean section rate and the delivery rate of male foetuses were significantly higher in assisted twins. During the first year of life, retardation in mental and psychomotor development was more pronounced in assisted twins. Also assisted twins experienced behavioural problems and difficulties in parent-child interactions more frequently. CONCLUSIONS: Although twins born to assisted pregnancies had significantly shorter duration of gestation and thus less birth weight, their perinatal outcome was similar to that of spontaneous twins. The mothers of assisted twins may be keener on getting intensive prenatal care, which might in turn help to diminish any possible maternal and foetal risks. However, assisted twins showed significantly retarded psychomotor and mental development and experienced problems with environmental factors more frequently during their first year.     

Reproduction in same sex couples: quality of parenting and child development

PURPOSE OF REVIEW: Same sex couples are steadily becoming more open about their relationships. One consequence of this growing openness is that more couples of the same sex are choosing to have children and infertility treatment centers are increasingly faced with requests for assistance in creating these families. The aim of this review is to address new trends in reproduction in same sex couples, to consider the quality of parenting in lesbian mother and gay father households, and to review the literature on the development of children raised by same sex couples. RECENT FINDINGS: The current literature on these families is limited by small sample sizes and a predominance of studies of lesbian mothers and their children, with few studies of gay fathers and their children. A recent study of adolescents living with same sex parents recruited from a large national sample supports the notion that adolescents raised by same sex couples are doing well psychologically and are not more likely to be homosexual. The authors concluded that it was the quality of parenting, not parental sexual orientation that accounted for developmental differences. SUMMARY: The literature supports the notion that children of lesbian mothers and gay fathers are not more likely to become homosexual and are not measurably different from children raised by heterosexual parents in terms of personality development, psychological development, and gender identity. Larger longitudinal studies of same sex parents, particularly gay men, are needed, including those who choose to become parents through the use of assisted reproduction.