Reasons and Justifications for Considering Pregnancy Among Women Living with HIV/AIDS

Despite the risks associated with pregnancy, available data suggest that HIV-infected women are no less likely to become pregnant than uninfected women. To understand HIV-infected women's reasons for wanting to have a child, focused interviews were conducted with a predominantly minority sample of 51 HIV-infected women in New York City. They were noted to actively weigh both the potential risks and benefits of their pregnancy decisions. Women reported three major reasons for wanting a child: (1) her husband/boyfriend really wants children, (2) having missed out on raising her other children, and (3) believing that a child would make her feel complete, fulfilled, and happy. Women also reported several justifications which they believed offset the risks of pregnancy, including: (1) other HIV-infected women were having healthy babies, (2) feeling optimistic about having a healthy baby due to the prophylactic effects of AZT (zidovudine), (3) having faith that God will protect the child, (4) being young and "healthy" will prevent transmission, and (5) feeling that she is better able to raise a child now. These findings suggest that to make fully informed pregnancy decisions, women should be encouraged to explore their reasons for wanting pregnancy, as well as discuss the potential risks.     

Maternal-infant bonding and partner support during pregnancy and postpartum: Associations with early child social-emotional development

The first 1000 days after conception are considered critical for healthy development and well-being throughout life. Fundamental to health practices during pregnancy and positive parenting after birth is the development of maternal-infant bonding. Previous research has demonstrated the importance of having an involved partner during pregnancy and in parenting for optimal maternal-infant bonding. The current study examined maternal-infant bonding and partner support during pregnancy and the postpartum period, and their associations with early child social-emotional development. A total of 227 women completed the Pre- and Postnatal Bonding Scale (PPBS) and Tilburg Pregnancy Distress Scale (TPDS) during pregnancy (32 weeks of gestation) and at 8 months postpartum, assessing maternal-infant bonding and partner support. Additionally, a questionnaire on social-emotional behavior of the Bayley Scales of Infant and Toddler Development was administered to mothers to measure child development at 2 years of age. Path analyses revealed an indirect positive effect of prenatal maternal-infant bonding on child social-emotional development through postnatal maternal-infant bonding, as well as mediating effects of pre- and postnatal maternal-infant bonding on the association between pre- and postnatal partner support and child social-emotional development. Our findings support the notion that an emotional connection from mother to child originates in pregnancy and that experiencing positive feelings towards the fetus promotes positive maternal-infant bonding after birth and social-emotional capacities of the child. Additionally, having a supportive partner during pregnancy and postpartum, might be essential for the development of optimal maternal-infant bonding.     

The link between maternal and child verbal abilities: An indirect effect through maternal responsiveness

Language abilities in early childhood show stability over time and play an important role in the development of other cognitive processes. Identifying modifiable environmental risk factors is important to informing prevention and early intervention efforts. Maternal verbal ability has been previously linked to child verbal ability. The current study examined whether maternal and child verbal abilities were linked indirectly through early childhood maternal responsiveness. Data come from a longitudinal birth cohort study. Participants included 133 mothers and their children recruited from maternity wards shortly after birth. Maternal verbal ability was measured using the Vocabulary subtest from the Wechsler Abbreviated Scale of Intelligence, Second Edition (child age 8 months). Child verbal ability was assessed using the Peabody Picture Vocabulary Test (36 months). A latent maternal responsiveness variable was estimated using three developmentally sensitive indicators; one during infancy (child age 8 months) and two when children were 36 months. Results of a structural equation model indicated a significant indirect effect from maternal verbal abilities to child verbal abilities through maternal responsiveness. This indirect path was significant even after inclusion of another indirect path from maternal executive functioning to child verbal ability through maternal responsiveness (which was not significant). Future studies will benefit from experimental, genetically sensitive and/or cross‐lagged designs to allow for conclusions related to directionality and causality. This body of research has implications for the study of the intergenerational transmission of verbal abilities and associated skills, behaviours and adaptive outcomes.     

Trait Forgiveness and Dyadic Adjustment Predict Postnatal Depression

The birth of a first child can be stressful on intimate partner relationships and the women having their first child. Conflict can occur, and hurts might be experienced, which could lead to post-partum depression. Thus, capacity for forgiveness with specific hurts might affect post-partum depression. We investigated women having their first child (N?=?52), and examined whether dyadic adjustment, trait forgiveness, and situational forgiving during pregnancy predicted postpartum depression. This study found that marital forgiveness predicted lower levels of depression above and beyond the effects of general dyadic adjustment. Dyadic adjustment and trait forgiveness predicted postpartum depression while situational forgiving was mixed. Postpartum depression researchers are encouraged to consider the inclusion of positive psychology variables, such as forgiveness, in future research studies.     

Shock,Adjust, Decide: Reproductive Decision Making in Cystic Fibrosis (CF) Carrier Couples—A Qualitative Study

Cystic fibrosis (CF) is the most common recessive condition affecting the White British population. Facilitating reproductive decision making for couples at genetic risk for CF is an important aspect of genetic counseling practice in the UK. The purpose of this study was to explore the reproductive decision making process for 31 members of CF carrier couples (15 men and 16 women) with or without an affected child. The design involved a qualitative approach consisting of semi-structured interviews and data analysis informed by grounded theory methodology. Sex and personal experience of CF were identified as factors that may influence reproductive decision making. Findings suggest these hypotheses: (1) CF carrier couples who have an affected child/pregnancy, are more likely to embark on another pregnancy than couples who have a healthy child from an at-risk pregnancy, and (2) men and women play different roles in the reproductive decision making process. Data analysis resulted in development of a structured framework modeling the reproductive decision making process, which may be helpful in guiding genetic counseling with CF carrier couples and other at risk couples making reproductive decisions.     

Handedness differences in information framing

Previous research has shown that strength of handedness predicts differences in sensory illusions, Stroop interference, episodic memory, and beliefs about body image. Recent evidence also suggests handedness differences in the susceptibility to common decision biases such as anchoring and sunk cost. The present paper extends this line of work to attribute framing effects. Sixty-three undergraduates were asked to advise a friend concerning the use of a safe allergy medication during pregnancy. A third of the participants received negatively-framed information concerning the fetal risk of the drug (1–3% chance of having a malformed child); another third received positively-framed information (97–99% chance of having a normal child); and the final third received no counseling information and served as the control. Results indicated that, as predicted, inconsistent (mixed)-handers were more responsive than consistent (strong)-handers to information changes and readily update their beliefs. Although not significant, the data also suggested that only inconsistent handers were affected by information framing. Theoretical implications as well as ongoing work in holistic versus analytic processing, contextual sensitivity, and brain asymmetry will be discussed.     

Nausea During Pregnancy: Relation to Early Childhood Temperament and Behavior Problems at Twelve Years

Associations between maternal nausea during pregnancy and child behavioral outcomes were investigated in a large birth cohort. Generally, 2nd- and 3rd-trimester nausea were more predictive of child outcomes than 1st-trimester nausea. Children whose mothers reported nausea in middle or late pregnancy had lower sensory thresholds and higher levels of activity and emotional intensity in infancy and were reported to be lower in task persistence at age 5. At age 12, these children were viewed by teachers as more careless with their school work and as having more attentional and learning problems.     

Perceptions of Deservedness of Social Aid as a Function of Prenatal Diagnostic Testing1

This study examined whether judgments of deservedness of social aid subsequent to the birth of a disabled child vary as a function of prenatal diagnostic testing (PDT) use as predicted by the attribution‐affect‐action model (Weiner, 1980). A sample of family physicians/obstetricians (n= 341) and a university employee sample (n= 281) made attribution ratings in 3 scenarios in which an at‐risk pregnant woman gave birth to a disabled child. The findings indicate that women who chose not to use PDT or who chose to continue the pregnancy following a diagnosis were judged more responsible, more to blame, and less deserving of both sympathy and social aid subsequent to giving birth to a disabled child than were women to whom testing was not made available.     

Placement shift, sibling relationship quality, and child outcomes in foster care: a controlled study.

Sibling unity during family transitions is considered a protective factor for child behavior problems, but there is little empirical support for the widespread child protection policy of placing siblings together in foster care. In a prospective study of 156 maltreated children, siblings were classified in 1 of 3 placement groups: continuously together (n = 110), continuously apart (n = 22), and disrupted placement (siblings placed together were separated; n = 24). Changes in child adjustment as a function of sibling relationship and placement group were examined. Sibling positivity predicted lower child problems at follow-up (about 14 months later), while sibling negativity predicted higher child problems. Placement group did not affect child behavior problems at follow-up; however, compared to siblings in continuous placement (either together or apart), siblings in disrupted placement with high initial behavior problems were rated as having fewer problems at follow-up, while siblings in disrupted placement with low initial behavior problems were rated as having more problems at follow-up. These findings highlight the importance of considering relationships between siblings and the risk that one poses to another before early placement decisions are made.     

Family planning needs and behavior of Mexican American women: a study of health care professionals and their clientele

"A random sample of Mexican American women and a sample of family planning health care professionals, both from two major southwestern cities in the United States, were compared in terms of their reports of birth control methods used, problems in obtaining family planning services, and values involved in making fertility-related decisions, within the Mexican American population.... While there were points of agreement between the two samples, discrepancies were found in reports of problems in obtaining family planning services, fertility-related values, and in the acceptability of female sterilization as a birth control method. It was concluded that family planning professionals in these service areas tend to stereotype Mexican American women, and may not yet realize that the family planning attitudes and behavior of these women are probably changing in significant ways." (SUMMARY IN SPA)     

Support Needs and Satisfaction in Foster Care: Differences Between Foster Mothers and Foster Fathers

Family foster care is a vulnerable youth care intervention. The recruitment and retention of foster parents causes concerns. Offering support to foster mothers and foster fathers can augment the satisfaction and the intent of continuing fostering. Clearer understanding of the support needs of foster parents and their satisfaction with the foster care placement can lead to the identification of ways to improve the support offered. Although differences between foster mothers and foster fathers regarding their support needs and satisfaction can be expected, knowledge about these differences is nonexistent. Differences in support needs and satisfaction between 86 foster mothers and foster fathers who reported on 120 foster children were examined. No differences between foster mothers and foster fathers were found. Both foster parents had higher support needs regarding dealing with the birth parents compared to support needs in handling problem behavior of the foster child. For both foster mothers and foster fathers satisfaction with collaboration with the foster care worker, satisfaction with recognition experienced and satisfaction with reunification of the foster child, did not differ across these aspects. Satisfaction of foster parents can be increased by keeping in balance the rights and needs of birth parents and those of foster parents. Acknowledging that foster parents are experts on their foster child and consulting them on important decisions will also contribute significantly to their satisfaction.     

Understanding and predicting parental decisions about early childhood immunizations.

This research investigated the factors that influence decisions about immunizations. Women in the third trimester of pregnancy (N=195) rated their likelihood of immunizing their child; stated their reasons for and against immunizing; and rated their perceptions of the benefits and risks of immunization, feelings of responsibility, and anticipated regret if harm occurred. Immunization status was determined at follow-up. Stepwise regression analyses demonstrated that immunization decisions are strongly influenced by omission bias factors such as anticipated responsibility and regret variance (which explained more than 50% of variance). It is suggested that parents may benefit from antenatal decision aids that address omission bias and encourage them to assess benefits and risks of immunizations on the basis of scientific evidence.     

Why Do Parents Want to Know their Child’s Carrier Status? A Qualitative Study

When a child is identified with a genetic condition, some parents want to know the carrier status of their other children. There has been little exploration of why parents want this information. To address this question, semi-structured interviews were conducted with parents of 32 children with cystic fibrosis, haemophilia, and Duchenne muscular dystrophy who wanted to know the carrier status of their other children. Data was analyzed using inductive content analysis. Parents expressed a range of reasons for desiring their child’s carrier status, which fell into two broad categories: 1) benefit for the parents and 2) perceived benefit to the child. Parents discussed the desire for certainty and peace of mind derived from having knowledge of their child’s status. The most commonly expressed reason for wanting to know their child’s carrier status was in order to communicate the information to their child to provide them with the ability to make informed reproductive decisions. These reasons suggest parents are seeking their children’s carrier information both as a coping strategy and to communicate carrier information as part of their role as a parent. This has important implications for genetic counseling practice, especially as international guidelines generally recommend against carrier testing in children.     

Marital satisfaction across the transition to parenthood.

The purpose of the present study was to discriminate between the 2 dominant perspectives governing research on the nature of marital change over the transition to parenthood. Progress can be made in understanding this transition by recognizing the role of uncontrolled sources of variability in research designs, defining and using control groups, and timing of data collection around the child's arrival, and the authors conducted a study incorporating these methodological refinements. Growth curve analyses were conducted on marital satisfaction data collected twice before and twice after the birth of the 1st child and at corresponding points for voluntarily childless couples (N = 156 couples). Spouses who were more satisfied prior to pregnancy had children relatively early in marriage, and parents experienced greater declines in marital satisfaction compared to nonparents. Couples with planned pregnancies had higher prepregnancy satisfaction scores, and planning slowed husbands' (but not wives') postpartum declines. In sum, parenthood hastens marital decline--even among relatively satisfied couples who select themselves into this transition--but planning status and prepregnancy marital satisfaction generally protect marriages from these declines.     

Changes in the marital relationship during the transition to first time motherhood: effects of violated expectations concerning division of household labor

This research combined cross-sectional and longitudinal analyses to evaluate the hypothesis that violated expectations with respect to sharing child care and housekeeping responsibilities contribute to women's dissatisfactions with their marital relationships after the birth of their first child. The cross-sectional sample consisted of 670 women who completed questionnaires at one of six phases in relation to birth. The longitudinal sample consisted of 48 women who filled out questionnaires late in pregnancy and at three periods postpartum. The results showed, consistent with previous findings, that women reported less positive feelings about their husbands during the postpartum period than during pregnancy, and that women reported doing much more of the housework and child care than they had expected. Moreover, regression analyses indicated, as predicted, that violated expectations concerning division of labor were related to negative feelings postpartum concerning some aspects of the marital relationship. Additional findings suggested that the negative implications of the birth of a baby for the marital relationship may not be as great as has been emphasized in previous literature, and that expectancy violations affect some parts of the relationship but not necessarily the core affective feeling.     

Decisions Regarding Pregnancy Termination Due to β-Thalassemia Major: a Mixed-Methods Study in Sistan and Baluchestan,Iran

In the present study, an embedded design was applied in order to conduct a one-year cross-sectional audit of chorionic villus sampling (CVS) and foetal outcomes affected by β-thalassemia major (β-TM) in a prenatal diagnosis (PND) setting. In addition, we explored the decisions regarding pregnancy termination among women whose pregnancy (or child) was affected by β-TM. In the quantitative phase, the available data in the clients’ medical records were analysed, while the qualitative phase was performed using a grounded theory method. Interviews were performed with nine pregnant women who had decided against pregnancy termination despite positive CVS results, 11 mothers who had admitted their child to the thalassemia ward for blood transfusion, and 19 mothers who had received positive CVS results and had decided against pregnancy termination in the preceding year. Over one year, 18.6 % of women decided against pregnancy termination despite positive CVS results. Two main themes related to decisions against pregnancy termination emerged from the qualitative data: 1) Cognitive factors (questioning the reliability of the tests or doubts about the accuracy of the results, understanding disease recurrence, curability, perceived severity of the disease, and lack of “real-life experiences”); and 2) Sociocultural responsiveness (family opposition, responsibility before God, and self-responsiveness). All of the mentioned factors could intensify fear of abortion in couples due to possible regret, and encourage a decision against pregnancy termination.     

Emotion During Pregnancy and Delivery as a Function of Repression-Sensitization and Number of Childbirths

Two hundred pregnant women were asked, before and after child delivery, to fill out a questionnaire about their feelings during pregnancy and childbirth. A day after delivery, they filled out the revised repression-sensitization (R-S) scale (Byrne, Barry, and Nelson, 1963). Results of the study showed four factors in the women's feelings during pregnancy and child delivery: (1) feelings of pain and anxiety during pregnancy, as well as evaluation of the pain they had suffered during delivery; (2) anxiety in the labor room; (3) fear of giving birth to a defective child: and (4) pain in the labor room. Repressors scored lower on the first three-factors than sensitizers; no significant differences were found between them in the fourth factor. Repressors also indicated that the birth pangs would influence them to postpone their next pregnancy to a lesser extent than did sensitizers. However, both indicated the same actual length of waiting time till their next pregnancy. A possible difference in time perspective between the two groups was suggested to explain this apparent inconsistency. Results also showed that primiparae scored lower on the first factor and higher on the fourth factor than did muitiparae.     

Information-seeking and maternal self-definition during the transition to motherhood

The self-definitional processes accompanying the transition to motherhood were examined in this study. A cross-sectional sample of more than 600 women who were planning to get pregnant within 2 years, pregnant, or in the postpartum stage completed extensive questionnaires pertaining to their experiences of pregnancy and motherhood. On the basis of the assumption of the "self-socialization" perspective that individuals actively construct their identities in response to life transitions, our analyses focused on the role of information-seeking in the developing self-definitions of women becoming mothers. As predicted, (a) women actively sought information in anticipation of a first birth, (b) they used this information to construct identities incorporating motherhood, and (c) after the birth the determinants of their self-definitions shifted from indirect sources of information to direct experiences with child care. Hence, consistent with the self-socialization perspective, information-seeking did play an important role in the women's developing self-conceptions during this life transition. Mechanisms by which information gathered may alter self-conception are discussed.     

Children prenatally exposed to maternal anxiety devote more attentional resources to neutral pictures

Maternal anxiety during pregnancy can negatively affect fetal neurodevelopment, predisposing the offspring to a higher risk of behavioral and emotional problems later in life. The current study investigates the association between maternal anxiety during pregnancy and child affective picture processing using event‐related brain potentials (ERPs). Mothers reported anxiety during the second trimester using the anxiety subscale of the Symptom Checklist (SCL‐90). At age 4 years, child affective picture processing (N = 86) was measured by recording ERPs during viewing of neutral, pleasant, and unpleasant pictures selected from the International Affective Pictures System. The late positive potential (LPP)—an ERP component reflecting individual differences in affective processing—was used as child outcome. The expected positive association between maternal anxiety and LPP amplitude for unpleasant pictures was not found. Nevertheless, we found a positive association between maternal anxiety during pregnancy and LPP amplitudes for neutral pictures in the middle and late time window at anterior locations (all p < .05). These associations remained significant after adjusting for maternal postnatal anxiety and gestational age at birth and after FDR correction for multiple comparisons. Our study provides neurophysiological evidence that children prenatally exposed to higher maternal anxiety devote more attentional resources to neutral pictures, but not to unpleasant pictures. Possibly, these children show enhanced vigilance for threat when viewing neutral pictures. Although useful in dangerous environments, this enhanced vigilance may predispose children prenatally exposed to higher maternal anxiety to developing behavioral and/or emotional problems later in life. A video abstract of this article can be viewed at: https://www.youtube.com/watch?v=kEzYi6IS2HA     

Adjunct Prenatal Testing: Patient Decisions Regarding Ethnic Carrier Screening and Fluorescence In Situ Hybridization

Little has been reported regarding how women make decisions about genetic carrier screening for Ashkenazi Jewish genetic disease and cystic fibrosis (CF), and for fluorescent in situ hybridization (FISH) during pregnancy. Thirty-seven women who underwent genetic counseling and prenatal diagnosis were interviewed about their prenatal decision making. Respondents were largely Caucasian (95%), and undergoing prenatal diagnosis because of maternal age (78%). Sixty-three percent of those who reported having genetic carrier screening correctly defined it; 83% felt positively about it. Primary reasons reported for electing screening were: to get information, to be prepared, perception of risk, wanting peace of mind and percieved inability to care for an affected child. Women who declined screening felt they had very little or no risk, and some were deterred by cost. Ninety-five percent of respondents elected to have FISH; most were motivated by its speed in providing information and peace of mind or by timing of when the procedure was performed. Those who declined FISH reported being less concerned about having an affected child, receiving bad news, or waiting 2 weeks for results and slightly less affected by their feelings toward medical testing or physician's suggestion. These findings suggest decision-making factors differ between those electing and declining adjunct prenatal testing and increased knowledge about these factors may impact the way in which these services are offered by health care professionals. Prospective research with a larger population will be useful in further delineating the factors that influence prenatal decisions about adjunct testing measures.