Maternal Lifetime Trauma Exposure,Prenatal Cortisol,and Infant Negative Affectivity

Little research has examined the impact of maternal lifetime trauma exposure on infant temperament. We examined associations between maternal trauma history and infant negative affectivity and modification by prenatal cortisol exposure in a sociodemographically diverse sample of mother–infant dyads. During pregnancy, mothers completed measures of lifetime trauma exposure and current stressors. Third‐trimester cortisol output was assessed from maternal hair. When infants were 6 months old, mothers completed the Infant Behavior Questionnaire‐Revised. In analyses that controlled for infant sex and maternal age, education, race/ethnicity, and stress during pregnancy, greater maternal trauma exposure was associated with increased infant distress to limitations and sadness. Higher and lower prenatal cortisol exposure modified the magnitude and direction of association between maternal trauma history and infant rate of recovery from arousal. The association between maternal trauma history and infant distress to limitations was somewhat stronger among infants exposed to higher levels of prenatal cortisol. The analyses suggested that maternal lifetime trauma exposure is associated with several domains of infant negative affectivity independently of maternal stress exposures during pregnancy and that some of these associations may be modified by prenatal cortisol exposure. The findings have implications for understanding the intergenerational impact of trauma exposure on child developmental outcomes.     

Alternative prenatal care interventions to alleviate Black–White maternal/infant health disparities

This paper attempts to forward the maternal health literature that critiques standard prenatal care in the United States by drawing on intersectionality, medicalization, and fundamental causation theories. We argue that these theories deepen our understanding of the maternal health experiences of Black women and can help explain why alternative prenatal care interventions have value for Black pregnant women. Alternative models of prenatal care, which include the use of midwives, doulas, and group prenatal care, are associated with equal or better health outcomes for infants and mothers compared to the standard prenatal model in the United States. We begin by drawing on these sociological perspectives to identify gaps in the maternal health literature that is critical of standard biomedical maternal health approaches. We then go on to describe select alternative methods of prenatal care and then provide a summary of the epidemiological literature as it relates to sociodemographic trends in usage and the relative effectiveness of alternative models compared to standard care. We conclude by arguing that a joint, critical application of these three theories can help scholars explain the utility of alternative interventions for African American maternal/infant health and can inform policies that aim to alleviate Black–White maternal/infant health disparities.     

The Impact of Maternal Characteristics and Sensitivity on the Concordance Between Maternal Reports and Laboratory Observations of Infant Negative Emotionality

The moderating role of maternal characteristics and maternal sensitivity on the concordance between maternal reports and laboratory observations of negative emotionality was examined. Participants were 90 primiparous mothers and their infants. Mothers completed questionnaires about remembered care from their own parents and their depressive symptoms prenatally, infant temperament (distress to novelty and distress to limitations), and depressive symptoms postnatally. Mothers and infants participated in a laboratory assessment of infant temperament (distress to novelty and limitations) and maternal sensitivity at 6 months postpartum. Several factors that moderate the degree of concordance between maternal reports and behavioral observations were identified, as predicted. Novelty concordance was higher when mothers reported having their emotional needs met in childhood and low prenatal depressive symptoms. Limitations concordance was higher when mothers were less sensitive during the observational tasks. Methodological and theoretical implications are discussed.     

Effects of prenatal care on maternal postpartum behaviors

Most research on the effectiveness of prenatal care has focused on birth outcomes and has found small or no effects. It is possible, however, that prenatal care is “too little too late” to improve pregnancy outcomes in the aggregate, but that it increases the use of pediatric health care or improves maternal health-related parenting practices and, ultimately, child health. We use data from the Fragile Families and Child Wellbeing birth cohort study that have been augmented with hospital medical record data to estimate effects of prenatal care timing on pediatric health care utilization and health-related parenting behaviors during the first year of the child’s life. We focus on maternal postpartum smoking, preventive health care visits for the child, and breastfeeding. We use a multi-pronged approach to address the potential endogeneity of the timing of prenatal care. We find that first trimester prenatal care appears to decrease maternal postpartum smoking by about 5 percentage points and increase the likelihood of 4 or more well-baby visits by about 1 percentage point, and that it may also have a positive effect on breastfeeding. These findings suggest that there are benefits to standard prenatal care that are generally not considered in evaluations of prenatal care programs and interventions.     

Predicting Maternal Resolution of Preterm Birth at One Month Corrected Age

Early maternal resolution with preterm birth was assessed at one month corrected age (CA), and potential maternal and infant characteristics that may be associated with early resolution were examined. Fifty‐five mothers of preterm infants (≤34 weeks) participated. Data regarding pregnancy, prenatal risk, delivery, infant's medical risk, maternal well‐being status, and infant's early developmental status were collected. Resolution was examined using the Reaction to Diagnosis Interview (RDI). A total of 38.2% of the mothers were classified as resolved. Only completion of antenatal corticosteroids (ACS) treatment and high prenatal risk significantly predicted maternal resolution. Early maternal resolution of preterm birth is associated with early knowledge regarding the preterm birth.     

Patterns of positivity: Positive affect trajectories among infants of mothers with a history of depression

This study examined positive affect (PA) trajectories over the first year of life among infants of mothers with a history of depression (N = 191) as well as predictors (i.e., maternal prenatal and postpartum depression symptoms, maternal parenting behaviors) of those trajectories. Infant PA was observed in play and feeding tasks during laboratory visits at 3, 6, and 12 months of age; parenting behaviors were observed at 3 months. Mothers completed questionnaires regarding their symptoms of depression throughout the prenatal period and during the first 3 months postpartum. Growth curve analyses indicated that infant PA increased across time, and this finding replicated across both the play and feeding tasks, though increases slowed over time. Neither maternal prenatal nor postpartum depression symptoms predicted infants' PA trajectories, but mothers' PA, positive parenting, and disengaged parenting were associated with infant PA during the play task. Our finding that infant PA increased over the first year postpartum suggests PA trajectories among infants of mothers with a history of depression may be indices of resilience, despite risks associated with their mothers' history of depression. Furthermore, this study highlights parenting behaviors that may be important targets of prevention and early intervention efforts to bolster infant PA.     

Neurobehavioral Consequences of Prenatal Exposure to Smoking at 6 to 8 Months of Age

Between 400,000 and 800,000 infants are born in the United States each year to women who smoked cigarettes during their pregnancy. Whereas the physical health consequences to infants of prenatal exposure to smoking are well established, the early neurobehavioral consequences are less well understood. This study investigated the neurobehavioral consequences of prenatal exposure to smoking using an epidemiologically derived sample of 454 infants who were drawn from a larger sample of 1,292 infants whose families were recruited at birth. Results indicated that, on average, infants who were exposed to higher levels of prenatal smoking exhibited less positive affect and greater irritability. Moreover, among male infants, elevated levels of prenatal exposure to smoking were associated with lower levels of approach, gross motor movement, reactivity, and attention. There was no evidence that the effects of prenatal exposure to smoking on infant neurobehavioral functioning were mediated by physical growth parameters (infant weight and head circumference) that are also known to be affected by prenatal exposure to smoking.     

Culturally-Protective Health Practices

ABSTRACT

Everyday pregnancy care may play an important role in explaining why Mexican immigrant women have positive birth outcomes despite relatively low incomes, low formal education levels, and lack of access to medical care. The paper is based on findings from a qualitative study utilizing in-depth ethnographically-in-formed interviews with 41 Mexican immigrant women in Chicago who had recently given birth. Results indicate that everyday pregnancy care guides maternal behaviors in pregnancy and has important effects on birth weight. Implications for the design of prenatal health care and social services for immigrant women are discussed.     

Maternal Tactile Stimulation and the Neurodevelopment of Low Birth Weight Infants

The purpose of this study was to determine the relationship of early maternal touch to the neurodevelopmental status of low birth weight (LBW) infants. One hundred and eight LBW infants and their mothers were videotaped during a typical feeding when the infant was 3 months old. This tape was used to analyze both the mother's touch and other facets of caregiving behavior using standardized coding systems. Data on perinatal medical risk were also acquired through chart review, and neurodevelopmental tests were administered to the infants at age 1 year. Results indicate that infants whose mothers used more stimulating touch during caregiving had better visual‐motor skills at 1 year of age. In addition, infants of mothers who touched them frequently had more advanced gross motor development. Findings suggest that stimulating and frequent touch may help to compensate for early neurosensory deficits and promote neurodevelopment for LBW infants. Infant birth weight made the strongest contribution to all measures of infant neurodevelopmental status at age 1 year.     

Birth weight and mothers' adverse employment change

Low birth weight has been linked at the aggregate level to unemployment rates and at the individual level to subjective distress. We hypothesize that maternal underemployment, including unemployment, involuntary part-time work, and low wage work predicts decreased birth weight. The relationship of birth weight to maternal employment changes during pregnancy was studied prospectively in 1,165 singleton first births in the National Longitudinal Survey of Youth data set. Controlling for other significant risk factors, women who shifted from adequate employment to underemployment had significantly lighter babies. Plausible mediators of this relationship were explored, including prenatal health care, gestational age, and mother's weight gain, with results varying by type of underemployment. Two interactions also suggested that underemployment reduced the beneficial effect of mother's weight gain on birth weight. These findings were partially replicated for low birth weight (< 2,500 grams), indicating the medical significance of the effect.     

A socio-medical study of infant mortality among disadvantaged blacks

This report profiles the woman at highest risk of a low birthweight delivery and infant death, in a generally disadvantaged, Black population in a major northeastern city which maintains one of the highest infant mortality rates in the nation. It discusses the existence of a very high risk subpopulation which contributes disproportionately and repeatedly to the infant and perinatal death statistics. If adequately identified, these women can be subject to intervention programs. Results show that within an inner-city Black population, where educational levels are relatively low and much of the reproductive segment is young and unmarried, the standard identification criteria of age, education, and marital status do not vary with poor pregnancy outcome. Furthermore, certain factors associated stereotypically with inner city lifestyle, such as drug abuse and venereal disease, also fail to distinguish women having normal and very low birthweight infants. Instead, alcoholism, smoking, low maternal weight at delivery, hypertension history, migrant status, ineffective contraception, prenatal care, violence, and relatively poor psychological adjustments and social support systems distinguish the study samples.     

Infant Behavior and Competence Following Prenatal Exposure to a Natural Disaster: The QF2011 Queensland Flood Study

This study utilized a natural disaster to investigate the effects of prenatal maternal stress (PNMS) arising from exposure to a severe flood on maternally reported infant social–emotional and behavioral outcomes at 16 months, along with potential moderation by infant sex and gestational timing of flood exposure. Women pregnant during the Queensland floods in January 2011 completed measures of flood‐related objective hardship and posttraumatic stress (PTS). At 16 months postpartum, mothers completed measures describing depressive symptoms and infant social–emotional and behavioral problems (n = 123) and competence (n = 125). Greater maternal PTS symptoms were associated with reduced infant competence. A sex difference in infant behavioral problems emerged at higher levels of maternal objective hardship and PTS; boys had significantly more behavioral problems than girls. Additionally, greater PTS was associated with more behavioral problems in boys; however, this effect was attenuated by adjustment for maternal depressive symptoms. No main effects or interactions with gestational timing were found. Findings highlight specificity in the relationships between PNMS components and infant outcomes and demonstrate that the effects of PNMS exposure on behavior may be evident as early as infancy. Implications for the support of families exposed to a natural disaster during pregnancy are discussed.     

Father involvement,child health and maternal health behavior

This paper uses data from the baseline Fragile Families and Child Well-being Study to examine the level and effects of father-involvement on child's birth weight and mother's health behavior during pregnancy (prenatal care, drinking, drug use and smoking). The findings indicate that most fathers, including unwed fathers, are involved with their children at birth and have intentions to remain involved. The effects of father involvement on health and health behavior depend, however, on how the construct is measured. When measured as parent's relationship status (married, cohabiting, romantic or non-romantic), the effects of marriage are beneficial for all but one outcome, the effects of cohabitation are positive for prenatal care only, and the effects of romantic involvement are negative for child's birth weight. When measured as paternity acknowledgement, contributions during pregnancy and intentions to contribute, unmarried father involvement has no effect on child's birth weight, a strong effect on early prenatal care and a variable but overall positive effect on mother's health behaviors. Furthermore, the effects of father involvement do not vary systematically by fathers' earnings potential and psychosocial attributes. While these results support the notion that fathers can influence mothers to maintain or adopt healthy pregnancy behaviors, they do not indicate that father-involvement improves birth outcomes.     

Social support and outcome in teenage pregnancy

This paper presents information on the role and significance of social support for the occurrence of health and birth problems among adolescent mothers and their babies. Pregnant teenagers (N = 268) were interviewed during the course of pregnancy and again approximately four weeks after delivery, and hospital records were abstracted. The significance of family support, friend support, and partner support, assessed during the pregnancy, were examined in relation to infant and mother outcomes assessed at or after the birth. Infant outcome was indexed by birth weight, with gestational age controlled; mother outcome in terms of psychological adaptation was indexed by depressive symptomatology among adolescent mothers. Socioeconomic background was found to influence relationships between social support and both infant and mother outcomes.     

Maternal Postpartum Depression Increases Vulnerability for Toddler Behavior Problems through Infant Cortisol Reactivity

The current study examined the role of hypothalamic‐pituitary‐adrenal reactivity (a physiological indicator of stress) in early infancy as a mediator of the relationship between maternal postpartum depression and toddler behavior problems. Participants were 137 at‐risk mothers and their children participating in a longitudinal study of intergenerational transmission of risk. Mothers’ depression was measured five times during the infants’ first 18 months. Infant cortisol was collected during a social stressor (the still‐face paradigm) when infants were 6 months old, and mothers reported on toddlers’ internalizing and externalizing symptoms at 18 months. Among this sample of high‐risk mother–infant dyads, early postpartum depression predicted atypical infant cortisol reactivity at 6 months, which mediated the effect of maternal depression on increased toddler behavior problems. Clinical implications are discussed.     

Mental disease postpartum and parent‐infant interaction—evaluation of videotaped sessions

In order to investigate the influence of maternal mental illness postpartum on mother‐infant and father‐infant interaction, infants of 14 mentally ill women admitted to hospital within 6 months after delivery were compared to infants of 22 women who had been somatically ill. Videotaped sessions when the infant was 10 months old revealed that mothers in the psychiatric sample showed less sensitivity in comparison to mothers in the somatic sample. When the infant was 2 years old, mothers in the psychiatric sample showed less positive affect and less link‐infant follow (stimulation dimension) as compared to the somatic mothers. However, there were no differences between fathers in the psychiatric sample and fathers in the somatic sample in any of the interaction variables. In the psychiatric sample, fathers showed more warmth as compared to mothers. In the somatic sample, fathers scored higher than mothers on autonomy but lower than mothers on link‐infant follow (stimulation dimension). A possible interpretation of our data was that the mental illness of the mothers may lead to a more active parenting role of the father in order to buffer the deficit in the mother‐infant relation. Copyright © 2001 John Wiley & Sons, Ltd.     

Initiating a Caregiving Relationship: Pregnancy and Childbirth Factors as Predictors of Maternal Sensitivity

The aim of this study was to investigate the relations between pregnancy and childbirth factors and subsequent quality of maternal interactive behavior in a sample of 116 full‐term infants and their mothers. Mothers reported on the conditions of childbirth when infants were 6–8 months of age, and their interactive behavior was observed during a home visit at 12 months. Results showed that mothers who did not report health problems during pregnancy and who had longer pregnancies, shorter hospital stays, natural deliveries, and infants with greater birthweight were found to be more sensitive during interactions with infants at 12 months. All these relations held after accounting for socio‐economic factors and maternal psychological distress, except for the effect of type of delivery. This pattern of results, however, was almost exclusively due to mothers who already had at least one other child. Very few such relations were found among primiparous mothers.     

The impact of emotional and physical violence during pregnancy on maternal and child health at one year post-partum

Intimate partner violence (IPV) during pregnancy is increasingly recognized as having a negative impact on both the mother and her unborn child. The current study extends previous work to examine the impact of both physical and emotional IPV separately and cumulatively on the mother and her child. Specifically, we used the Fragile Families dataset (N = 3961) to determine the effect of emotional and physical IPV on women and children at one year postpartum. Analyses revealed that both physical and emotional victimization have independent and negative impacts on mothers and their children. Emotional victimization was associated with poorer overall health for the mother, elevated maternal depression, poorer overall health for the child, and difficult child temperament. Experiencing a combination of physical and emotional victimization resulted in more problematic outcomes. Implications for practice and research are discussed.     

Child protection pathways for newborn infants: A multi-disciplinary retrospective chart review of an Irish maternity hospital’s records

In Ireland, little is known about mothers and infants where child welfare and protection concerns arise during the perinatal period. This study explores, for the first time, perinatal child protection. A retrospective audit was carried out of a large maternity hospital's medical social work, neonatal and psychiatric files for a five-year period from 2016 to 2020. The study identified 99 children, born to 86 mothers, who were either subject to a child protection conference; placed for adoption; discharged to someone other than the mother; or discharged home under supervision. The study found that two-thirds of the children were discharged to their mother's care. When compared to national data, the health indicators for this cohort of mothers and children painted a grim picture. The maternal profiles identified high prevalence of mental health and addiction difficulties and domestic violence. The study found evidence of supports provided to the mothers to enable them to care for their infants while they remained in the hospital and during an initial discharge from hospital. However, a significant number of the mothers were not caring for their children when viewed across a longer time frame. Dedicated multi-disciplinary clinics and improved data systems were identified as of importance.     

Persistent symptoms of maternal post-traumatic stress following childbirth across the first months postpartum: Associations with perturbations in maternal behavior and infant avoidance of social gaze toward mother

Recent literature identifies childbirth as a potentially traumatic event, following which mothers may develop symptoms of Post-Traumatic-Stress-Following-Childbirth (PTS-FC). The current study examines whether stable symptoms of PTS-FC during the early postpartum period may impose risk for perturbations in maternal behavior and infant social-engagement with mother, controlling for comorbid postpartum internalizing symptoms. Mother-infant dyads (N = 192) were recruited from the general population, during the third trimester of pregnancy. 49.5% of the mothers were primipara, and 48.4% of the infants were girls. Maternal PTS-FC was assessed at 3-day, 1-month and 4-month postpartum, via self-report and clinician-administered interview. Latent Profile Analysis generated two profiles of symptomology: “Stable-High-PTS-FC” (17.0%), and “Stable-Low-PTS-FC” (83%). Membership in the “Stable-High-PTS-FC” profile associated with perturbed maternal sensitivity, which was in turn significantly associated with infant avoidance of social gaze toward mother (Indirect effect β = −0.15). Results suggest the need for early screening and inform the planning of early preventive interventions.