The association between maternal interaction and infant cortisol stress reactivity among preterm and full term infants at 4 months adjusted age

The purpose of this study was to assess the association between maternal interactive behavior and infant cortisol stress reactivity in response to the Still Face paradigm (SF) in a cohort of four-month old infants (adjusted age) born preterm (<32 weeks gestation, N = 22) compared with infants born full term (>37 weeks gestation, N = 28). Infant cortisol reactivity was calculated as area under the curve (AUC) from baseline to the third cortisol sample (30 min post-SF) using the trapezoidal rule, while the percent of time mothers spent using a contingent interaction style was measured (0–100%) during episodes 1 (Play; baseline), 3 (Reunion#1), and 5 (Reunion#2) while mother-infant dyads participated in the SF paradigm. We hypothesized that because infants born preterm are at increased risk for dysregulation, they would show, compared to full-term infants, a blunted stress response, involving under-responsiveness. We found blunted cortisol stress reactivity among the preterm infants. We also found that mothers of preterm infants demonstrated less contingent maternal interaction during Renion#1 of the SF; and that contingent maternal interaction at Reunion#2 of the SF was protective against cortisol stress reactivity in response to the SF. However, we did not find that the influence of maternal interaction on cortisol reactivity was moderated by gestational age group (full term vs preterm): the association between contingent maternal interaction and stress reactivity was similar for both gestational groups across episodes. In order to improve self-regulation and longer term social and cognitive developmental outcomes in medically at-risk infants, future research is warranted to determine how these findings relate to infants’ stress reactions in naturalistic settings, and the directionality and temporal relationship between cortisol stress responses and maternal interactive behavior.     

Maternal concepts and expectations regarding a preterm infant

The objective of the present study was: (a) to identify the concerns, verbally expressed, of 50 mothers regarding their preterm infants (PT) and then compare their verbal expression with those of 25 mothers of full-term infants (FT); and (b) to correlate the mothers' verbal expressions with maternal and infant variables. The following instruments were used to compose and characterize the sample: Structure Clinical Interview for DSM III-R Non-Patient (SCID/NP), State-Trait Anxiety Inventory (STAI), Beck Depression Inventory (BDI), and medical charts. Results showed that there was no difference between groups in term of mothers' expectations and conceptualizations; both groups exhibited predominantly positive expectations and concepts. In comparison with FT mothers, PT mothers verbally expressed more feelings and reactions predominantly negative or conflicting in relation to infant birth. Higher levels of maternal anxiety and depression in the PT Group were correlated with more verbal expressions about negative or conflicting emotions. In addition, lower birth weight, higher neonatal risk and longer length of stay in intensive care nursery of the infants were related with more negative or conflicting concepts by the mothers.     

Vocal responsiveness of preterm infants to maternal infant-directed speaking and singing during skin-to-skin contact (Kangaroo Care) in the NICU

Vocalizations of full-term newborns occur in a short latency time during the neonatal period. Contingent response time of preterm babies is still unknown. An increase of preterm babies’ vocalizations following exposure to parental speech was also observed. Mothers and babies co-modulate their vocalizations in preterm dyads. Purpose: To observe temporal features of maternal and infants’ vocalizations in speaking and singing conditions in preterm dyads. Methods: In a NICU mothers (N = 36) were invited to speak and to sing to their preterm infants during Kangaroo Care. Microanalysis of temporal units were performed with ELAN Software. Results and conclusions: Preterm infants vocalize less often while their mothers speak and sing than during baseline and their vocalizations tend to be more alternating in the speaking condition and more overlapping in the singing condition. It is also concluded that preterm infants take more time to respond to maternal speaking than to maternal singing.     

Early interactive behaviours in preterm infants and their mothers: Influences of maternal depressive symptomatology and neonatal birth weight

The study evaluated the quality of preterm infant–mother interactions, considering severity of birth weight (ELBW and VLBW) and maternal depression, compared to full term babies. 69 preterm infants (29 ELBW and 40 VLBW) and 80 full-term (FT) infants and their mothers were recruited. At 3 months of corrected age, the quality of mother–infant interaction was evaluated through Global Rating Scales; moreover, infant level of development and maternal depression were assessed through Griffith Development Mental Scales and Edinburgh Postnatal Depression Scale. Results showed adequate sensitivity in preterm infants’ mothers and higher involvement with their infants, compared to full term mothers, but ELBW ones exhibited an intrusive interactive pattern and a higher prevalence of depressive symptoms. The study underlined the relevance of paying special attention to both ELBW infants and their mothers, in order to support the parenting role and the co-construction of early interactions.     

Attachment representations in mothers of preterm infants

The aim of the study was to assess attachment representations in mothers of preterm infants using the Working Model of Child Interview (WMCI) at the 12 months of the infant's corrected age. In addition, the relation between WMCI representation categories and the Edinburgh Postnatal Depression Scale score at 6 months of the infant's corrected age was studied. There were 38 mothers of preterm infants (<1500 g or <32 gestational weeks) and 45 mothers of full-term infants. The results showed no differences between the study groups in the distribution of the three main representation categories (balanced, disengaged and distorted). However, there were qualitative differences in representations between the groups. Furthermore, maternal depression symptoms were associated with distorted representation category. We suggest that despite the qualitative differences in the mothers’ representations, mothers of preterm infants are as likely to form balanced attachments with their infants as mothers of full-term infants.     

From prematurity to parenting stress: The mediating role of perinatal post-traumatic stress disorder

Preterm delivery may lead to the emergence of symptoms of Post-Traumatic Stress disorder (PTSD), which may, in turn, affect the quality of the mother-child relationship. The aim of this study is to shed light on the development of parenting stress in mothers of preterm and full-term children. It is hypothesized that PTSD symptoms mediate the relationship between preterm/full-term birth and the levels of parenting stress. Perinatal PTSD, parenting stress and social support were assessed in 156 mothers of full-term children and 87 mothers of preterm children. Mothers of preterm children experienced more post-traumatic stress and parenting stress than mothers of full-term children. However, the relationship between preterm delivery and subsequent levels of parenting stress was mediated by PTSD symptoms. These findings suggest that the maternal perception of childbirth as a traumatic experience and the subsequent development of PTSD symptoms are pivotal in the emergence of parenting stress.     

Does early responsive parenting have a special importance for children's development or is consistency across early childhood necessary?

The role of early versus ongoing maternal responsiveness in predicting cognitive and social development was examined in home visits for mothers, full-term children (n = 103), and medically low-risk (n = 102) and high-risk (n = 77) preterm children at 5 ages. There were 4 maternal clusters based on warm and contingent responsiveness behaviors observed early (at 6, 12, and 24 months) and late (at 3 and 4 years): high early, high late; high early, low late; low early, moderate late; and low early, low late. Children, especially preterm children, showed faster cognitive growth when mothers were consistently responsive. Social growth was similar in the consistently responsive (high-high) and the early-responsive inconsistent (high-low) clusters, but greater deceleration at 4 years among children with mothers in the inconsistent cluster refuted the notion of a unique role for early responsiveness. The importance of consistent responsiveness, defined by an affective-emotional construct, was evident even when a broader constellation of parenting behaviors was considered.     

Determinants of maternal self-esteem in the neonatal period

The purpose of this study was to determine whether maternal perceptions of infant health and behavior made a unique contribution in understanding maternal self-esteem beyond what could be achieved from objective measures. The Perception of Infant Health (POIH) questionnaire and the Bates ICQ captured the perception of infant health and temperament. Standard medical variables including the Hobel Medical Risk Summary measured the objective aspect of infant health. The Brazelton Neonatal Behavioral Assessment (NBAS) measured objective infant behavior. The Maternal Self-Report Inventory measured self-esteem. Eighty mother-infant dyads, which included healthy, middle socioeconomic class mothers of both full-term, neurologically normal and preterm infants with a range of medical problems were studied. Negative maternal perceptions of infant health and behavior as well as poorer objective health status were associated with decreased maternal self-esteem. Perceptual variables of temperament and health made a unique contribution to maternal self-esteem scores. Regression analysis indicated fussy/difficult, POIH, and NBAS autonomic scores explained a significant amount of variance in maternal self-esteem.     

Preterm birth and maternal sensitivity: Findings from a non-western country

IntroductionAlthough there are several studies on maternal sensitivity of preterm-born children conducted in Western countries, the factors affecting the sensitivity of mothers of preterm infants have not been investigated outside the Western context.ObjectivesThis study aimed to compare maternal sensitivity of preterm children at 18 months of corrected age with their healthy term-born peers and explore the factors associated with maternal sensitivity in a middle-income non-Western country. Moreover, the associations of maternal sensitivity with socio-demographic factors, maternal depression, and social-emotional competency and behavior problems of infants were investigated.MethodsIn total, 70 (40 preterm-born and 30 term-born) mother-child dyads participated in this study. An observation-based measurement tool, Maternal Sensitivity Scale, was used to assess maternal sensitivity. Social-emotional competency and behavior problems of infants were evaluated via The Turkish version of the Brief Infant-Toddler Social Emotional Assessment. Maternal depressive symptoms were assessed via the Beck Depression Inventory. In addition, a demographic information form was filled out by the mothers.ResultsMaternal sensitivity scores of preterm infants were significantly lower compared to term infants. Depressive symptoms scores and employment status of mothers, socio-economic status (SES), gestational age, breastfeeding duration, and behavior problems of children were the factors related to maternal sensitivity scores. In hierarchical regression analysis, SES and gestational age were the strongest predictors of maternal sensitivity. After controlling SES and gestational age, maternal depressive symptoms scores negatively predicted maternal sensitivity scores.ConclusionThis study pointed out the factors associated with the maternal sensitivity of preterm infants outside the Western context. Interventions to improve sensitive parenting behaviors of preterm infants are needed, especially in socio-economically disadvantaged groups.     

Comparison of Maternal Perceptions of Preterm and Fullterm Infants

We compared maternal attitudes and feelings in two groups of mother–infant dyads: 25 mothers with preterm newborns (M=30.9 weeks of gestational age) and 25 mothers with fullterm newborns (M=39.7 weeks of gestational age). Both groups were matched for infant sex, age (corrected in preterms) and birth order as well as for maternal age and education. Semi-structured interviews were used to collect data on maternal attitudes and feelings about pregnancy and the first contacts with the newborn. Mothers completed rating scales to indicate the specific behavioural problems they perceived in their infants at 6 weeks and 3 months of (corrected) age. Observations of infant responses to visual and/or auditory stimuli were made at 6 weeks and 3 months in a laboratory setting. At 3 months, each infant was administered the Bayley Scale of Mental Development. There were no differences in maternal attitudes and feelings between the two groups of mothers prior to the birth. However, significant differences appeared after birth and indicated increased anxiety in mothers of preterm infants. Significantly more 6-week-old preterm infants were perceived by their mothers as irritable and to cry more than fullterm infants. At the age of 3 months, both groups of infants differed only in terms of irritability. Differences between the two groups of mother–infant dyads, age-related changes in these differences and relationships between maternal evaluations and the laboratory-based assessments are discussed in the context of contrasts in the stability of behavioural regulation in preterm and fullterm infants.     

The effect of mother-infant skin-to-skin contact on plasma cortisol and β-endorphin concentrations in preterm newborns

The aim of this study was to assess the effect of mother-infant skin-to-skin contact on plasma β- endorphin and cortisol concentrations in stable, preterm infants on a newborn intensive care unit. Blood samples were obtained before and at the end of a 20-min period of skin-to-skin contact. Similarly paired samples, obtained at the same times and after the same interval, without skin-to- skin contact, were obtained on another day and served as controls. Both cortisol and β-endorphin concentrations fell significantly after the skin-to-skin session (cortisol: geometric mean change 66%, p=0.008; β-endorphin: geometric mean change 74%, p=0.002). There was also a significant fall in cortisol levels during the control session (geometric mean change 78%, p=0.02), in contrast to β-endorphin levels, in which there was no significant change. Analysis of variance showed that the fall in β-endorphin, but not the fall in cortisol, during the skin-to-skin session was significant when compared with the control session. These results emphasize the hormonal responsiveness of the preterm newborn to relatively minor interventions. We conclude that maternal skin-to-skin contact results in a significant reduction in circulating β-endorphin in the newborn; there was no evidence of any adverse effect.     

MATERNAL SELF‐REPORTED DEPRESSIVE SYMPTOMS AND MATERNAL CORTISOL LEVELS INTERACT TO PREDICT INFANT CORTISOL LEVELS

Three basic findings have emerged from research on maternal depressive symptoms and offspring hypothalamic–pituitary–adrenal functioning: (a) Mothers’ depressive symptoms are positively associated with their offsprings’ cortisol stress response, (b) numerous individual and interpersonal maternal characteristics moderate this association, and (c) maternal and infant cortisol levels are highly correlated. In combination, these findings have suggested that maternal cortisol levels may moderate the relation between maternal depressive symptoms and infant cortisol responsivity; the current study assessed this hypothesis. Participants were 297 mother–infant dyads who were recruited from the community. Maternal depressive symptoms were assessed via self‐report. Dyads participated in two differentially stressful infant challenges when infants were 16 and 17 months old. Mother and infant salivary cortisol was collected before and after challenges. Results indicate that maternal cortisol levels moderated associations between maternal depressive symptoms and infant cortisol levels across both challenges. Infants showed higher cortisol levels if their mothers had both higher depressive symptoms and higher cortisol levels, as compared to infants of mothers with higher depressive symptoms and lower cortisol, and to infants of mothers with lower depressive symptoms and either higher or lower cortisol levels. We discuss findings in relation to environmental and biological factors that may contribute to the intergenerational transmission of depressive symptoms.     

An experimental study on mother-infant skin-to-skin contact in full-terms

In premature infants, daily skin-to-skin contact (SSC) has various beneficial effects on the health of the infant and the mother. These beneficial effects might extend to full-term infants. This experimental within-subject study examines the immediate effects of SSC on full-terms’ cortisol physiology during SSC and subsequent physiological and behavioral reactions to a mild stressor (a bathing session). Additionally, the effects of SSC on the quality of maternal behavior are examined.Between 5 and 7 weeks postpartum, 17 full-term infant-mother dyads were visited at home twice. During one home visit, a bathing session was proceeded by 50 min of mother-infant SSC, while during the other visit the bathing session was proceeded by 50 min of the infant resting alone. The order of the home visits was counterbalanced. Infant salivary cortisol measures were taken to measure the cortisol response to the experimental condition (SSC versus solitary resting) and the bathing session. Furthermore, infant behavioral distress and the quality of maternal behavior during the bathing session were scored from videotapes.Two-way within-subject repeated measures ANOVA’s showed that, when compared to solitary resting, full-terms’ cortisol concentrations significantly decreased during SSC, followed by higher cortisol reactivity in response to the subsequent bathing session. No effects of SSC on infant behavioral distress and maternal caregiving behavior were found. Apparently, a single session of mother-infant SSC can affect infant cortisol physiology in full-term infants. Future SSC research is needed to investigate the neurobiological mechanisms and dose-response relations in full-term infants.     

Effects of an early intervention on maternal post-traumatic stress symptoms and the quality of mother–infant interaction: The case of preterm birth

Preterm birth may represent a traumatic situation for both parents and a stressful situation for the infant, potentially leading to difficulties in mother–infant relationships. This study aimed to investigate the impact of an early intervention on maternal posttraumatic stress symptoms, and on the quality of mother–infant interactions, in a sample of very preterm infants and their mothers. Half of the very preterm infants involved in the study (n = 26) were randomly assigned to a 3-step early intervention program (at 33 and 42 weeks after conception and at 4 months’ corrected age). Both groups of preterm infants (with and without intervention) were compared to a group of full-term infants. The impact of the intervention on maternal posttraumatic stress symptoms was assessed 42 weeks after conception and when the infants were 4 and 12 months of age. The impact of the intervention on the quality of mother–infant interactions was assessed when the infants were 4 months old. Results showed a lowering of mothers’ posttraumatic stress symptoms between 42 weeks and 12 months in the group of preterm infants who received the intervention. Moreover, an enhancement in maternal sensitivity and infant cooperation during interactions was found at 4 months in the group with intervention. In the case of a preterm birth, an early intervention aimed at enhancing the quality of the mother–infant relationship can help to alleviate maternal post-traumatic stress symptoms and may have a positive impact on the quality of mother–infant interactions.     

Maternal Sensitivity: a Resilience Factor against Internalizing Symptoms in Early Adolescents Born Very Preterm?

Compared with full-terms, preterm individuals are more at risk from infancy to adulthood for developing internalizing symptoms. Early maternal interactive behavior, especially maternal sensitivity, has been found to be a resilience factor in the developmental outcome of preterm children. The present longitudinal study aimed at examining whether early interactive parenting behaviors have a long term impact on the internalizing symptoms of preterm-born young adolescents. A total sample of 36 very preterm and 22 full-term children participated in an 11-year follow-up study. Maternal interactive behavior was assessed during a mother–infant interaction when the infant was 18 months old. At 11 years, internalizing symptoms were assessed with the Child Behavior Checklist (CBCL). Hierarchical regression analyses revealed that the interaction between groups (preterm/full-term) and maternal sensitivity at 18 months significantly explained CBCL internalizing symptoms at 11 years (β = ?0.526; p < 0.05). Specifically, although prematurity was related to internalizing problems, preterm children with higher maternal sensitivity did not differ from their full-term-born peers on the CBCL internalizing problems domain. These results suggest that maternal sensitivity is a long-term resilience factor preventing the development of internalizing problems at early adolescence in very preterm individuals.     

Relation of birth weight, maternal intelligence and mother–child interactions to cognitive and play competence of Jamaican two-year old children

The present study assessed whether birth weight, maternal child rearing behaviors, and maternal intelligence combine in an additive or in a non-linear interactive fashion to influence cognitive performance in a sample of 24-month old full-term appropriate and low birth weight Jamaican children. Child cognitive performance was measured using the Griffiths Scale and a laboratory based assessment of the amount of time the child utilized different levels of play behavior. Mothers were videotaped while playing with their children under different instructional conditions and videotapes were coded for 8 maternal interaction patterns. Maternal verbal intelligence was assessed using the PPVT. Results supported the operation of both additive co-action as well as non-linear interactive processes. Birth weight, maternal behaviors toward her child and maternal intelligence predicted child cognitive performance. In addition, low birth weight infants were either less sensitive to facilitative aspects of maternal behaviors and/or more sensitive to maternal inhibitory behaviors than were appropriate birth weight infants. Further, child rearing behaviors of more intelligent mothers were a stronger influence on their child's cognitive performance than those of less intelligent mothers, even when there were no differences in the level of behaviors of more or less intelligent mothers.     

The effects of maternal employment and non-maternal infant care on development at two and four years

Differences in maternal employment during children's first year of life and children's entry into non-maternal care before the age of 1 year failed to predict differences in cognitive and socioemotional development at 2 and 4 years of age, after family background variables were controlled. Two samples were studied: a population sample of 1100 Bermudian children and a smaller subsample of children most of whom were determined to be at risk for developmental problems. To assess the effects of maternal employment, we compared infants with mothers who worked 20 or more hours a week to infants with mothers who worked less than 20 hours a week. To assess the effects of entry into non-maternal care before the age of one, we compared infants who were placed in regular non-maternal care before the age of one versus infants who did not experience regular non-maternal care before the age of one. The results revealed that family background variables frequently predicted many child outcome measures in both the total sample and the smaller research sample. After controlling for family characteristics, no differences were found between children whose mothers worked 20 or more hours a week when they were infants and children with mothers who worked less than 20 hours a week in either sample. In addition, age of entry into non. maternal care before the age of one did not significantly predict any child outcome measures.     

Cortisol Rhythm in Preschoolers: Relations with Maternal Depression and Child Temperament

Evidence supports associations between deviations from the normative daily cortisol rhythm and depression. We examined associations between multiple indices of daily cortisol in 146 preschool-aged children and two well-established risk factors for depression: maternal depression and early child temperament (negative emotionality/NE and positive emotionality/PE). Offspring of mothers with current depression demonstrated lower waking cortisol and lower total post-awakening cortisol. Child PE was negatively associated with waking cortisol. The combination of maternal depression history and high child NE was associated with higher levels of evening cortisol. Findings suggest that an interplay between familial risk for depression and child temperamental vulnerability may be related to neuroendocrine functioning in young children and highlight important methodological considerations in the assessment of children’s basal cortisol activity. It will be critical for future research to map the developmental progression from early disruptions in children’s cortisol rhythm to the emergence of psychopathology.     

What Do Mothers Make Adolescents Feel Guilty About? Incidents,Reactions, and Relation to Depression

We found mothers’ history of depression and symptoms of depression among their adolescent children were both associated with the type of events that mothers made adolescents feel guilty about and with the mothers’ reactions to those events. Adolescents (20 male, 23 female) described incidents in which their mothers made them feel guilty and what happened afterward. Offspring of mothers with (versus without) a history of depression more often reported guilt when not at fault and over failing to meet maternal needs; reactions did not resolve matters and involved unregulated maternal emotions. Adolescents of mothers without a depression history more often felt guilty about specific events (e.g., breaking rules, bad grades) and reactions resulted in closure (through discipline, apologies, or forgiveness). Adolescents’ depressive symptoms were more severe when incidents were unresolved and involved maternal emotions and less severe when incidents were specific. In addition, maternal use of self-serving forms of guilt induction related to adolescent and parent depression.     

Maternal anxiety and depression and development of prematurely born infants in the first year of life

The purpose of this study was: (a) to assess and to compare anxiety and depression symptoms in mothers of preterm neonates during hospitalization in the Neonatal Intensive Care Unit, after discharge, and at the end of the infants' first year of life; and (b) to assess the child's development at 12 months of chronological corrected age (CCA). Thirty-six mothers, with no psychiatric antecedents assessed with the SCID-NP, were evaluated by STAI and BDI. The infants were assessed with Bayley-II Scales. There was a significant decrease in clinical symptoms of state-anxiety in mothers (p = .008), comparing the period during hospitalization and after discharge of the infants. Clinical symptoms of anxiety and depression were observed in 20% of the mothers at the end of the infants' first year of age. The majority of the infants exhibited normal development on Bayley-II at 12 months CCA; however, 25% of the infants displayed cognitive problems and 40% motor problems. The mothers' anxiety and depression symptoms decreased at the end of the first year of life of the pre-term infants and the children showed predominately normal development at this phase.