The Decision to Continue a Pregnancy Affected by Down Syndrome: Timing of Decision and Satisfaction with Receiving a Prenatal Diagnosis

In order to provide the best genetic counseling possible for women who learn of a diagnosis of Down syndrome prenatally, we sought to assess the timing of the decision to continue a pregnancy and the satisfaction these women had with learning this information. Fifty-six mothers of children with Down syndrome diagnosed prenatally between 2007 and 2010 completed a survey regarding their experience with decision-making after prenatal diagnosis. Approximately one third (17/56) of participants reported they knew before getting pregnant that they would not terminate for any reason, and almost half of the participants (24/56) reported they did not decide to continue their pregnancy until after the diagnosis. Many participants (82 %; 42/56) stated that learning the diagnosis during pregnancy increased their anxiety. The majority (88 %; 45/56) also reported that if they could do it over again, they would undergo prenatal testing for preparation purposes, despite increased anxiety. Religious and spiritual beliefs as well as feeling attached to the baby were the personal factors that had the greatest impact on most women’s decision-making. Despite increased anxiety caused by learning the diagnosis prenatally, most women favored prenatal diagnosis as it allowed them time to process the information and prepare for the birth of their child.     

Prenatal and postnatal anxiety in Mexican women giving birth in Los Angeles

Examined psychosocial factors related to prenatal and postnatal anxiety in 291 primiparous Mexican women giving birth in Los Angeles. Characteristics of health care providers preferred by more anxious and less anxious women were also assessed. Higher prenatal anxiety was associated with less desire for an active role during labor, lower assertiveness, higher pain expectation at delivery, lack of support from family members other than the husband, and preferences for health care providers who are female and Latino. All groups of women preferred health care providers who provided good medical explanations and who were knowledgeable, friendly, and sympathetic. Postnatal anxiety was significantly lower than prenatal anxiety. Negative attitudes toward the baby and number of complications during labor and delivery, however, were related to postnatal anxiety adjusted for prenatal anxiety.     

Thinking ahead: complexity of expectations and the transition to parenthood

This study examined the integrative complexity of thinking in individuals making the transition to parenthood, and the relationship between complexity and adjustment during this period. Sixty-nine couples were interviewed 3 months before their babies were born, and 6 months after the birth. The prenatal interview focussed on individuals' expectations about what it would be like being a parent; the postnatal interview focussed on individuals' actual experiences as parents. In addition, participants completed measures of depression, self-esteem, and marital satisfaction after each interview, and a measure of stress after the 6-month postnatal interview. Both men and women demonstrated a significant increase in the complexity of their thinking from the prenatal to the postnatal interview, with women demonstrating higher levels of complexity at both times. In addition, women with more complex expectations demonstrated better adjustment after their babies were born than did women with simpler expectations; these results were not obtained for men. Results are discussed with regard to the way in which thinking about the self changes as one negotiates major life transitions, and the way in which complex thinking can help counter some of the stresses that individuals may experience at these times.     

Association between chemosensory stimuli and cesarean delivery in rat fetuses: neonatal presentation of similar stimuli increases motor activity

Recent studies conducted in this laboratory indicated that prenatal chemosensory stimulation followed by cesarean delivery strongly affected postnatal responsiveness to odors derived from the administered substances. The present experiments were performed in order to examine if an associative process was responsible for such effects. In Experiment 1 rat fetuses during Gestational Day 21 were exposed to a tenuous alcohol solution or to a lemon-containing solution either 40 or 10 min prior to cesarean delivery. All subjects were subsequently tested in terms of changes in neonatal motor activity when confronted with the odor of alcohol or lemon. Rats experiencing prenatal cues 10 min prior to delivery exhibited higher and differential responsiveness to the smell of these cues when compared to those experiencing similar solutions 40 min prior to delivery. In Experiment 2 each fetus sequentially experienced both cues. Subsequent tests confirmed that the delay between prenatal sensory experience and birth induction was critical in terms of significantly affecting olfactory-mediated motor responses. The results suggest that consequences related with cesarean delivery act as an unconditioned stimulus capable of being associated with orosensory cues present in the amniotic fluid.     

Correlates of neonatal morbidity: maternal characteristics and family resources

The association of mental characteristics, family resources, and receipt of prenatal care with infant birth weight, gestational age, and Apgar scores was assessed in a retrospective review of an extant computerized data base of admissions to a neonatal intensive care unit (NICU; n = 3,818). Prediction variables included mother's age, marital status, health insurance, parity, prenatal health problems, and prenatal drug use. Less favorable infant birth status was associated with prenatal health problems, being single, not having private insurance, obtaining a prior elective abortion, prenatal drug use, and not receiving prenatal care. Stepwise multiple regressions of predictor variables to birth weight and lack of prenatal care were performed. Low birth weight was associated with being single, receiving no prenatal care, and being Black. Lack of prenatal care was associated with mother's age, high parity, prenatal health problems, and prenatal illicit drug use. Pediatric interventions assessing maternal social and behavioral characteristics are proposed.     

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.     

Father locus of control and child emotional and behavioral outcomes: a prospective study

In a prospective longitudinal study the authors examined the associations between parent locus of control of reinforcement (LOCR), measured before the birth of a child, and behavioral-emotional outcomes in that child at age 7 years. A total of 307 couples completed questionnaires regarding their emotional status and LOCR at their first prenatal care appointment. When their children turned 7 years old, teachers completed questionnaires regarding each participating child's behavior. Findings indicate significant associations between fathers' prenatal LOCR and child outcomes, particularly hyperactivity in sons. Hyperactivity and behavioral-emotional problems in girls, in contrast, were better predicted by maternal prenatal emotional distress. Results provide evidence that paternal and maternal characteristics that predate the birth of a child relate to later behavioral outcomes in that child. Implications for prevention of child psychopathology are discussed.     

Preference for consonance over dissonance by hearing newborns of deaf parents and of hearing parents

Behavioral preferences for consonance over dissonance were tested in hearing infants of deaf parents and in hearing infants of hearing parents when they were 2 days old. Using a modified visual-fixation-based, auditory-preference procedure, I found that both 2-day-old infants of deaf parents and those of hearing parents looked longer at a visual stimulus when looking produced the original version of a Mozart minuet as opposed to a version altered to contain many dissonant intervals. The relative magnitude of such preference did not significantly differ whether their parents were deaf or hearing. Infants prefer consonance over dissonance, and the preference is present from birth and is not dependent on any specific prenatal or early postnatal experience.     

Prenatal maternal stress during the COVID-19 pandemic and birth outcomes: Is the newborn spared?

The COVID-19 pandemic has generated numerous stressors among the general population, but more specifically in pregnant women because of disruptions in prenatal care and delivery conditions. Studies suggest that prenatal maternal stress increased during the pandemic (Berthelot et al., 2020; Perzow et al., 2021; Tomfohr-Madsen et al., 2021). Considering what is known about the fetal programming potential of prenatal maternal stress, several researchers, early in the pandemic, raised concerns over the significant negative consequences that the pandemic context could have on birth outcomes. Studies comparing birth outcomes during versus before the pandemic suggest a marginal increase in birthweight and a significant decrease in preterm birth (Yang et al., 2022), but individual variations in prenatal maternal stress during the pandemic have received less attention. The objective of the present study is to examine the association between prenatal maternal stress during the COVID-19 pandemic and birth outcomes. During pregnancy, 195 expecting mothers reported on their general and pandemic-related stress. When their child was 6 months old, mothers completed a questionnaire collecting information on birth outcomes (gestational age, birthweight, head circumference and Apgar scores). Hierarchical linear regressions show that none of the maternal prenatal stress variables significantly predicted variations in birth outcomes. Potential pandemic-related protective factors (e.g., changes in life and hygiene habits, rest imposed by lockdowns) and the need to offer support to pregnant women are discussed.     

Maternal depression and dyadic interaction: the role of maternal attachment style

Maternal mental health and the contents of her representational world are important determinants of early parent–child relationship. We examined, first, the role of prenatal and postnatal depressive symptoms and maternal attachment style in predicting the quality of mother–child interaction. Second, we analysed whether the secure‐autonomous attachment style can protect the dyadic interaction from the negative effects of maternal depression. The participants were 59 mother–infant pairs examined during pregnancy (T1), 4–5 months postpartum (T2) and when the children were approximately 14 months old (T3). Maternal attachment style was assessed with a modified Adult Attachment Interview ‐procedure, depressive symptoms with Edinburgh Postnatal Depression Scale, and observed mother–child interaction with Care Index. The results show that autonomous mothers were more sensitive and responsive and their children more co‐operative than dyads with dismissing maternal attachment style. As hypothesized, mothers with the combination of both prenatal and postpartum depressive symptoms were highly unresponsive in their dyadic interaction. Further, prenatal depressive symptoms had a stronger impact on maternal unresponsiveness than postnatal symptoms. As hypothesized, mother's autonomous attachment style protected the mother–child interaction from the negative impact of maternal postnatal depressive symptoms, whereas dyads with preoccupied mothers were especially at risk for interaction problems when mothers had postpartum depressive symptoms. Copyright © 2010 John Wiley & Sons, Ltd.     

U.S.- and Mexico-born Hispanic teen mothers: a descriptive study of factors that relate to postpartum compliance

Compliance with postpartum visits after teenage births in the US was examined among 289 Hispanic teenagers, of whom 127 were born in Mexico or border towns, who delivered at Harris County Hospital District and scheduled postpartum appointments at the Teen Health Clinic. The mean age was 17.31 years for mothers and 21.95 years for fathers. 56.7% (164) were married. 49.8% lived with husbands, 25.8% with parents, 22.3% with friends/relatives, and 2.1% alone. 74.7% stated that they had no social supports. 88.9% had a term delivery, 8.3% a preterm delivery, and 2.8% a fetal loss. 67.5% were first births, 5.5% had a previous abortion, and 3.1% had a previous miscarriage. 23.2% had a previous child, and 0.7% had a previous preterm delivery. Some form of prenatal care was received by 85.1%. 34.3% reported no further educational plans. 17.3% (50) returned for a scheduled postpartum visit. Mothers with a prior history of a premature birth or miscarriage were more likely to return postpartum compared to mothers with a first or prior birth. The differences are marginally significant. None of the mothers with a prior abortion returned. 34.9% of the returning teen mothers were more likely to have had prenatal care. Returning mothers also were a larger percentage of those with no future educational plans. 13.4% of returning mothers had an available social support system. Country of origin was not associated with support systems, prenatal care, return status, educational plans, pregnancy history, or current birth outcome. Out of the 50 returning, 20 were Mexican-born and married. Only Mexican marital status was found to be a significant variable explaining differences. Marital status had no effect on the 26 US native-born returnees. 92% of the Mexican-born teens were married and had a support system. The most dramatic feature of this study is the high level of noncompliance among both US-born and Mexican-born adolescents. There were few distinguishing features between these two groups. Return status was affected by very few features and was achieved by a very small percentage of the study population. The suggestion is made that poverty, a lack of health insurance, and poor knowledge of English, as representative of cultural dissimilarity, may be responsible for poor use of preventive care.     

Maternal distress during pregnancy and language development in preschool age: A population-based cohort study

Recent studies have emphasized the importance of the prenatal period for children's cognitive development. Prenatal exposure to psychological distress has been identified as one potential agent affecting neurodevelopment, although research in this area has been marked by some contradictory findings and methodological limitations. This study aimed to investigate the effect of maternal distress during pregnancy on language development of preschool children. This study was based on the Norwegian Mother and Child Cohort Study conducted at the Norwegian Institute of Public Health. The sample was composed of 34,089 women and their children. We assessed the role of maternal prenatal distress on child language over and above that of premature low birth weight (PLBW) status and postnatal maternal distress. Fear of giving birth had a negative impact on language outcome at age three over and above the effect of PLBW status and postnatal maternal distress. However, this effect was of minimal magnitude. Moreover, when examining whether differences in language skills between siblings were associated with differences in experienced levels of prenatal stress across pregnancies (sibling fixed-effects models), no significant effects were found. Our study suggests that prenatal distress within moderate limits does not seem to have an independent impact on child language performance in the preschool years and emphasizes the importance of considering the contextual role played by more stable maternal and family characteristics.     

Prenatal maternal stress and prematurity: a prospective study of socioeconomically disadvantaged women.

Developed and tested a biopsychosocial model of birthweight and gestational age at delivery using structural equation modeling procedures. The model tested the effects of medical risk and prenatal stress on these indicators of prematurity after controlling for whether a woman had ever given birth (parity). Subjects were 130 women of low socioeconomic status interviewed throughout pregnancy in conjunction with prenatal care visits to a public clinic. The majority of women were Latino or African-American. Half were interviewed in Spanish. Lower birthweight was predicted by earlier delivery and by prenatal stress. Earlier delivery was predicted by medical risk and by prenatal stress. Parity was not related to time of delivery or to birthweight. Implications of results for the development of biopsychosocial research on pregnancy and on stress are discussed.     

Experiences of Prenatal Diagnosis of Spina Bifida or Hydrocephalus in Parents Who Decide to Continue with Their Pregnancy

The current study aimed to gain an understanding of the perspectives of those parents provided with a prenatal diagnosis of spina bifida or hydrocephalus and who decided to continue with their pregnancy. Qualitative interviews were conducted with 15 parents who learned of their unborn child’s spina bifida and/or hydrocephalus in the prenatal period. The interviewer asked parents about their experiences of receiving a prenatal diagnosis and their experience of coping throughout the remainder of the antenatal period. Parents’ reactions and experiences fell into five domains: response to diagnosis, experience of medical systems, information gathering, decision-making regarding continuation of the pregnancy following diagnosis and responses of significant others. Each of these domains is explicated. The findings derived from the current study have implications for professionals who provide support to parents during the prenatal period. Future research needs to further explore the common and unique issues for parents living in both urban and rural areas.     

Prenatal experience with low-frequency maternal-voice sounds influence neonatal perception of maternal voice samples

By sucking on a nonnutritive nipple in the presence of one discriminative stimulus, newborns were reinforced with a low-pass filtered tape recording of their mothers' voices. Sucking in the presence of a different discriminative stimulus was reinforced with unfiltered maternal-voice recordings. Filtered versions simulated maternal-voice sounds that were available before birth and unfiltered versions simulated maternal-voice sounds available after birth. Newborns in the control group could be reinforced with the same stimuli in the same way, but the voices were unfamiliar to them. Infants hearing their mothers' voices had no preference for either version, but infants hearing the unfamiliar voices preferred the unfiltered version. The difference in the between-groups responsiveness to the low-pass voice samples is consistent with the hypothesis that prenatal experience with low-frequency characteristics of maternal voices influences early postnatal perception of maternal voices.     

Perception of genetic risk among genetic counselors

A mailed survey of female prenatal genetic counselors, obstetric nurses, and high school biology teachers was conducted to determine if these groups hold different attitudes toward genetic risk and to investigate the extent to which any differences result from the effect of different professional experiences. In this study, the participants were 166 genetic counselors, 116 obstetric nurses, and 78 biology teachers (n = 360). Survey participants completed a written questionnaire designed to assess their numeric estimate of the empiric risk for birth defects/genetic problems, their subjective perception of this risk, and their personal use of prenatal diagnosis. Genetic counselors were found to be less likely than the other groups to consider the frequency of birth defects/genetic problems as rare and were 10 times more likely than nurses and 8 times more likely than teachers to have had prenatal diagnosis. Furthermore, more than half of the prenatal diagnosis procedures had by genetic counselors were not medically indicated. These results suggest that genetic counselors have an increased perception of genetic risks relative to nurses or teachers. Possible explanations for this finding are discussed, and the potential role of discordant risk perception in creating biases in the genetic counseling process is explored.     

Maternal representations and emotional availability among drug‐abusing and nonusing mothers and their infants

Both negative and idealized maternal prenatal representations may constitute a risk for mother–infant interaction. This study analyzed the role of maternal prenatal representations and pre‐ to postnatal representational change in predicting mother–infant emotional availability (EA) among 51 drug‐abusing mothers and their infants who participated in either psychodynamic group therapy (PGT) or received psychosocial support (PSS) and among 50 nonusing comparison dyads. Maternal representations of her child, the child's father, her own mother, self‐as‐mother, and self‐as‐woman were measured during pregnancy and at 4 and 12 months' postpartum with the Interview of Maternal Representations (M. Ammaniti et al., 1992 ; M. Ammaniti, R. Tambelli, & P. Perucchini, 1998). EA was measured with the Emotional Availability Scales, fourth edition (Z. Biringen, 2008 ) at 4 and 12 months. The results showed that drug‐abusing mothers had more negative prenatal representations of the self‐as‐woman and of the child's father. Postnatally, PSS mothers tended to first idealize their child, but later to experience disillusionment of idealization. Both negative and idealized prenatal representations of the self‐as‐mother predicted mother–infant EA problems, but only among the PGT mothers. For all mothers, negative representational change was detrimental for the mother–infant EA whereas for drug‐abusing mothers, also increasing idealization from the prenatal period to the postnatal period was harmful. Clinicians working with drug‐abusing mothers should aim at supporting the development of a realistically positive view of motherhood.     

Attitudes Toward Autism Spectrum Disorders Among Students of Allied Health Professions

The prevalence of autism has increased dramatically. The objectives of this study were to explore attitudes toward prenatal diagnosis to detect autism prenatally and avoid having an affected child and to understand social acceptability of these disorders among students of allied health professions. In this study, college students of nursing and health systems management answered a structured self-report questionnaire (n?=?305). The first part addressed the respondent’s personal data. The second part targeted the respondent’s attitudes toward prenatal diagnosis of non-life-threatening disorders, including autism spectrum disorders. We found that almost two thirds of the students responded that they would not proceed with a pregnancy if the child were diagnosed with autism, and more than half thought that they would not continue with a pregnancy if the fetus were diagnosed with Asperger’s. Age, level of religiosity, and years of education were influential. This study is limited in scope; however, the positive attitude of the students toward prenatal diagnosis to avoid having an affected child might also reflect a negative view of autism spectrum disorders in future health care professionals. Further research of attitudes and the social acceptability of autism spectrum disorders, particularly among health care professionals, is required.     

Experiences of Women Who Have Had Carrier Testing for Duchenne Muscular Dystrophy and Becker Muscular Dystrophy During Adolescence

Duchenne muscular dystrophy (DMD) and Becker muscular dystrophy (BMD) are X-linked recessive degenerative muscular conditions. Carrier testing is available to at-risk females. Though carrier testing is often offered to adolescent females, it raises ethical issues related to autonomy. This study aimed to address the impact of DMD/BMD carrier testing during adolescence, to elucidate what motivates adolescents to seek testing, and to assess the carrier testing experience. Retrospective semi-structured telephone interviews were conducted with 12 women out of 28 initially contacted. Data were coded using thematic analysis. For most (8/12) participants, discovering their carrier status during adolescence appeared to have helped alleviate uncertainty. The majority (9/12) of participants felt that they had made an autonomous decision and most (10/12) seemed to have adjusted well to their test result. Reproductive factors were framed as having been a key motivator prior to testing. However, following testing, participants’ views on prenatal diagnosis seemed more closely linked to their lived experience than to their test result. Just over half (7/12) the participants reported having not had the opportunity for genetic counseling prior to testing and after receiving their result, an issue that warrants further consideration.