Family-building and parenting considerations for people with cystic fibrosis

As people with cystic fibrosis (CF) live longer and healthier lives, increasing numbers are considering the full range of reproductive options for their futures, including parenthood, pregnancy, or pregnancy prevention. As the face of CF changes, the CF care model must adapt to meet the reproductive health needs of both parents and nonparents with CF. This article summarizes the reproductive goals and family-building concerns faced by people with CF, including fertility, pregnancy, and alternative paths to parenthood, the impact of parenthood on mental and physical health, and important future research.

Diverging destinies: 'social' data within the TwinsUK cohort

Background: Twins offer social scientists a unique opportunity to understand the interplay of social factors and physical and mental well-being. TwinsUK is the largest UK registry of adult mono- and dy-zygotic twins, but most of the research that utilises the cohorts' data to date has focused on the genetic underpinnings of complex disease. Methods: Following formal unstructured discussions with social scientists we identified key areas of research interest and annotated the historical data collections in TwinsUK where they could be applied to these research aims. Results: We present a summary of variables identified as of key interest to researchers from the social science sphere, spanning the following domains: 1: Parenting, child rearing and pregnancies; 2: Working habits and patterns; 3: Sleeping habits and patterns; 4: Social support; 5: Negative life events; 6: Spousal relationships. Conclusions: TwinsUK has a wide range of genetic and health data that would allow investigation of research questions focusing on these domains.

"Mom and dad = cis woman + cis man" and the stigmatization of trans parents: an empirical test of norm-centered stigma theory

Background: Empirical research on transgender individuals and their families is growing but investigations of attitudes toward trans parents are sparse. This gap is especially important to address because transgender parents face unique strains due to their violations of hetero-cis-normativity and the "Mom and Dad = Cis Woman + Cis Man" stereotype. Methods: Using a sample of adults aged 18-64 stratified by U.S. census categories of age, gender, race/ethnicity and census region collected from online panelists (N = 2,948), this study provides an intersectional investigation of Norm-Centered Stigma Theory (NCST) with hetero-cis-normativity (a system of norms, privilege, and oppression that situates heterosexual cisgender people above all others) as the centralized overarching concept that helps us to understand negativity directed toward transgender parents. Specifically, social power axes including gender identity (cisgender woman, cisgender man, nonbinary; trans people were excluded from the current study), sexual identity (heterosexual, lesbian, gay, bisexual), and interactions among these axes of social power are investigated. Results: Findings indicate that hetero-cis-normativity is strongly related to negativity toward trans mothers and fathers and that there is overall greater stigma toward trans dads when compared to trans moms. In addition, gender, sexual identity, and interactions among these experiences of social power have complex relationships with the stigmatization of trans parents. Conclusion: Results provide support for the use of Norm-Centered Stigma Theory to help us best understand the constellation of hostilities directed toward trans people and their families.

United States Normative Attitudes for Pursuing Parenthood as a Function of Gender, Sexual Orientation, and Age

Decisions about whether or not to become a parent are significant parts of normative human development. Many studies have shown that married different-sex couples are expected to become parents, and that many social pressures enforce this norm. For same-sex couples, however, much less is known about social norms surrounding parenthood within marriage. This study examined injunctive norms and descriptive norms for the pursuit of parenthood as a function of age, gender, and sexual orientation. Participants in an internet survey included 1020 (522 heterosexual, 498 lesbian/gay) cisgender people from across the United States Findings showed that norms, especially descriptive norms, for the pursuit of parenthood for heterosexual people were much stronger than those for lesbian women and gay men, and that norms for lesbian women were stronger than those for gay men. These differences were more pronounced for older, heterosexual, and male participants. However, lesbian and gay participants, especially gay men, reported that lesbian and gay people ought to become parents to the same extent as heterosexual people. Overall, the results indicated that, regardless of sexual orientation, adults report that lesbian and gay married people ought to become parents, but that they expect only a minority of these couples will pursue parenthood. This research provided a glimpse into how Americans are envisioning family formation among same-sex couples today.

Interprofessional Teamwork to Promote Health: First-Time Parents' Experiences of a Combined Home Visit by Midwife and Child Health Care Nurse

BACKGROUND

To achieve the requisites for a child's healthy development and to reduce health inequalities, it is important to promote health initiatives at an early stage in a child's life and to include the parents. Home visits by healthcare professionals have been found to have positive health effects for both the baby and the parents. From an extended home visit programme in Sweden, our aim was to illuminate first-time parents' experience of a home visit conducted by a midwife and a child health care nurse 1-2 weeks postnatal.

METHODS

Data was collected by interviews (n = 13) with first-time parents. The transcribed texts were analyzed using inductive content analysis.

RESULTS

The participants' experiences could be understood from the two themes, A trust in the professionals and Feeling safe as a new parent. The participants experienced that the midwives and the child health care nurses complemented each other and appreciated to get knowledge and information from both professions. In their own home, they felt secured and relaxed, and the professionals could help them provide a safe home environment for the child.

CONCLUSION

By meeting both professionals at the same time and in their own home, the participants experienced that the needs of the baby and their needs and concerns as new parents were included and supported.

Association between Parenthood and Health Behaviour in Later Life-Results from the Population-Based CARLA Study

Previous research has focused on comparing health behaviour between parents and non-parents at younger ages, while little is known about the impact of being a parent on health behaviours in later life. We studied whether parenthood is associated with later physical activity (PA), dietary pattern, smoking status and alcohol consumption in German adults of middle and old age. We used data from the baseline examination of the population-based CARLA-study in Halle (Saale), comprising 1779 adults aged 45-83. Linear and logistic regression analyses assessed the relationship between parenthood and health behaviours while controlling for age, partner status, education, income, occupational position, socioeconomic status in childhood, and number of chronic diseases. Of the participants, 89.1% had biological children. Being a father was associated with higher PA in sports (sport index ß = 0.29, 95% confidence interval [0.14; 0.44]), but not with PA in leisure time (excluding sports), dietary pattern, consumption of alcohol and smoking status. No associations were found between being a mother with all outcome variables. Provided that PA of fathers is typically reduced when the children are young, the development towards higher PA at later age needs to be studied in more detail.

Measuring and Predicting Maturity to Parenthood: What Has Personality Got to Do with It?

Maturity to parenthood is essential for taking on parental roles but remains an understudied issue. Still, close relations between maturity and personality dimensions are commonly emphasized. Thus, conducting research on maturity in context of personality seems a valuable research direction. The present research consists of two studies, focusing on the development and validation of Maturity to Parenthood Scale (MPS), in relation to personality, emotional regulation, coping with challenges, and intimate relationship satisfaction. In both studies, childless adults aged 20-35 years took part: (1) 718 participants (Mage = 25.49; SD = 2.89; 479 women), (2) 150 participants (Mage = 23.69; SD = 3.15; 104 women). All the participants had been in an intimate relationship for at least six months at the time of the study, the majority declared their willingness to have children in the future, had higher education, and were professionally active. The results showed that MPS is a reliable, valid measure comprising the following three subscales: valence, behavioral, and cognitive-emotional maturity to parenthood. The findings also confirmed the importance of broad- and narrow-band individual differences and contextual factors for maturity. MPS may be used in psychoeducation, supporting the transition to biological or adoptive/foster parenthood, as well as in medical and psychological care.

Striving for motherhood after uterus transplantation: a qualitative study concerning pregnancy attempts, and the first years of parenthood after transplantation

STUDY QUESTION

How do women experience attempts to become pregnant, and the first years of motherhood, after uterus transplantation (UTx)?

SUMMARY ANSWER

Women who try to become pregnant after UTx experience the general strains typically associated with infertility and childlessness, such as failure of embryo transfer (ET), and specific worries about graft survival but when they become mothers they essentially feel like other mothers, with the associated rewards and stresses.

WHAT IS KNOWN ALREADY

UTx has proven to be a successful treatment for absolute uterine factor infertility (AUFI). Although UTx seems to have a positive effect on self-image there is a lack of knowledge about how women who have received uterine grafts experience pregnancy attempts, pregnancy itself and the first years of motherhood.

STUDY DESIGN, SIZE, DURATION

This prospective cohort study included the seven participants in the first UTx trial who had experienced surgically successful grafts. Pregnancy was attempted using ET 12 months after transplantation. Structured interviews were performed once a year for 5 years after transplantation.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Six of the seven participants (mean age 29.3 years at UTx) had AUFI owing to the congenital absence of the uterus, while the seventh woman had undergone a hysterectomy. Post-transplantation, yearly interviews (2013-2018) were performed, comprising a total of 34 interviews. Interview data were analysed thematically.

MAIN RESULTS AND THE ROLE OF CHANCE

All seven participants achieved pregnancy during the study period and six became mothers. Experiencing the previously unimaginable was classed as an overarching theme with the following underlying themes: The yoke of childlessness; Going through the impossible and Motherhood as surreal and normal. The results showed that the women who try to achieve motherhood after UTx generally describe their situation as manageable and present strains comparable to other women undergoing infertility treatments.

LIMITATIONS, REASONS FOR CAUTION

The fact that all participants came from one centre is a limitation.

WIDER IMPLICATIONS OF THE FINDINGS

There are real psychological strains in motherhood after UTx, such as the concern the women expressed relating to health of the child and the effects of immunosuppressants. These findings are in line with those of other women who became pregnant after transplantation of organs other than the uterus. The results show that extra psychological support and attention should be given to those with repeated pregnancy failures or unsuccessful outcomes. In the cases where women became mothers, attention needs to be given to the possible worries connected to the UTx, but in other respects, they should be treated like any mother-to-be.

STUDY FUNDING/COMPETING INTEREST(S)

Funding was received from the Jane and Dan Olsson Foundation for Science; Knut and Alice Wallenberg Foundation. A.L.F. grant from the Swedish state under an agreement between the government and the county councils; Swedish Research Council. The authors have no competing interests.

TRIAL REGISTRATION NUMBER

NCT01844362.

Challenges to Navigating Pregnancy and Parenthood for Physician Parents: a Framework Analysis of Qualitative Data

BACKGROUND

Some gender-based disparities in medicine may relate to pregnancy and parenthood. An understanding of the challenges faced by pregnant physicians and physician parents is needed to design policies and interventions to reduce these disparities.

OBJECTIVE

Our objective was to characterize work-related barriers related to pregnancy and parenthood described by physicians.

DESIGN

We performed framework analysis of qualitative data collected through individual, semi-structured interviews between May and October 2018. Data related to pregnancy or parenthood were organized chronologically to understand barriers throughout the process of pregnancy, planning a parental leave, taking a parental leave, returning from parental leave, and parenting as a physician.

PARTICIPANTS

Physician faculty members of all genders, including parents and non-parents, from a single department at a large academic medical school in Canada were invited to participate in a department-wide study broadly exploring gender equity.

APPROACH

Thematic analysis guided by constructivism.

KEY RESULTS

Twenty-eight physicians were interviewed (7.2% of eligible physicians), including 22 women and 6 men, of which 18 were parents (15 mothers and 3 fathers). Common barriers included a lack of systems-level guidelines for pregnancy and parental leave, inconsistent workplace accommodations for pregnant physicians, a lack of guidance and support for planning parental leaves, and difficulties obtaining clinical coverage for parental leave. Without systems-level guidance, participants had to individually navigate challenges and resolve these difficulties, including negotiating with their leadership for benefits. This led to stress, wasted time and effort, and raised questions about fairness within the department.

CONCLUSIONS

Physician parents face unique challenges navigating institutional policies as well as planning and taking parental leave. Systems-level interventions such as policies for pregnancy, parental leave, and return to work are needed to address barriers experienced by physician parents.

Parenting Fears and Concerns during Pregnancy: A Qualitative Survey

Previous research on the fears and anxieties of expectant mothers has focused mostly on their fears about giving birth rather than parenting. This study aims to describe mothers' fears and concerns about parenthood during pregnancy and to examine the similarities and differences in the perspectives of primiparous and multiparous mothers. The qualitative research for this study was conducted in three postpartum units in Finland and focused on the responses to an open-ended question about parenting fears and concerns that was part of a questionnaire given to 250 mothers after they had given birth. The responses from the 128 mothers who answered this question were subject to inductive content analysis. Fears and concerns on parenthood included worries about coping with the future and everyday life with their new baby, the psychological burden of parenthood, their maternal resources and self-efficacy, meeting their baby's needs, their baby's health, concerns about their relationship with their partner and financial issues. Primiparous and multiparous mothers shared many of the same concerns, but some differences emerged. The findings contribute an interesting perspective to the social debate about declining birth rates and their psychosocial causes. Further studies are needed to examine the fears and concerns of younger adults, and even teens, about parenthood.

Welcoming new life under lockdown: Exploring the experiences of first-time mothers who gave birth during the COVID-19 pandemic

Objectives

This study aimed to explore how first‐time mothers in the UK experienced new parenthood during the coronavirus (COVID‐19) pandemic.

Design

This study used a cross‐sectional exploratory, qualitative interview design.

Methods

Semi‐structured interviews were conducted with ten first‐time mothers who had given birth since COVID‐19 was declared as a pandemic. Verbatim transcripts were analysed using reflexive thematic analysis.

Result

Experiences of new, first‐time mothers during the COVID‐19 pandemic were organized around two themes. First, new mothers felt an overwhelming sense of responsibility for their baby which was heightened by the pandemic. The challenge of meeting this responsibility was heightened in the context of societal expectations to do the ‘right’ thing and uncertainty and distrust around official guidance about COVID‐19. Secondly, the expected transition into motherhood was altered by the pandemic. Disruption to the birthing experience, an inability to connect with close friends and family, and limited healthcare support was perceived to be detrimental. However, altered social expectations and the increased presence of the partner were perceived as positives.

Conclusion

Many of the common challenges experienced by new, first‐time mothers have been amplified by the COVID‐19 pandemic. Public policy and scientific research must target this group in order to protect this population from the negative impact of the remaining COVID‐19 pandemic and any future pandemics.

Parental-couple separation during the transition to parenthood

AIM

To evaluate factors associated with parental separation during the parenthood transition.

DESIGN

Prospective, longitudinal and explorative.

METHODS

This is a quantitative longitudinal study of N784 subjects throughout the pregnancy journey with multivariate regression analysis of survey data derived from three validated measurement scales; the Sense of Coherence scale, the Multidimensional Scale of Perceived Social Support and the Perceived Quality of the Dyadic Relationship scale conducted 2014-2016.

RESULTS

N17 participants separated at 2 years. Parental separation was significantly greater for those women and partners with low or changing sense of coherence, perceived social support and perceived quality of the parental-couple relationship indexes. Partners with a change in sense of coherence (p: .003) and perceived quality of the parental-couple relationship (p: .020) between 1 week and 2 years were at greater risk for separation. Attending professional preparatory support with a partner for women (p: .013) and attending the "Inspirational Lecture" for partners (p: .046) were, to a lesser extent, associated with a risk of parental separation.

Fertility preservation and management of pregnancy in melanoma patients requiring systemic therapy

Melanoma is one of the most common cancers in adolescents and adults at fertile age, especially in women. With novel and more effective systemic therapies that began to profoundly change the dismal outcome of melanoma by prolonging overall survival, the wish for fertility preservation or even parenthood has to be considered for a growing portion of melanoma patients-from the patients' as well as from the physicians' perspective. The dual blockade of the mitogen-activated protein kinase pathway by B-Raf proto-oncogene serine/threonine kinase and mitogen-activated protein kinase inhibitors and the immune checkpoint inhibition by anti-programmed cell death protein 1 and anti-cytotoxic T-lymphocyte-associated protein-4 monoclonal antibodies constitute the current standard systemic approaches to combat locally advanced or metastatic melanoma. Here, the preclinical data and clinical evidence of these systemic therapies are reviewed in terms of their potential gonadotoxicity, teratogenicity, embryotoxicity and fetotoxicity. Recommendations for routine fertility and contraception counseling of melanoma patients at fertile age are provided in line with interdisciplinary recommendations for the diagnostic work-up of these patients and for fertility-protective measures. Differentiated recommendations for the systemic therapy in both the adjuvant and the advanced, metastatic treatment situation are given. In addition, the challenges of pregnancy during systemic melanoma therapy are discussed.

The development of life goals over the adult lifespan

OBJECTIVES

Life goals are important organizing units for individual agency in development. On a societal level, they align with age-normative developmental tasks; on the individual level, they guide people's attempts at shaping their own development. This study investigates the development of life goals across the adult lifespan with a focus on differences regarding gender, parental status, education, and region.

METHOD

Using longitudinal data from the German Socio-Economic Panel study (SOEP, N=52,052; age range: 18-84 years), we estimated the developmental trajectories of importance ratings for nine life goals across the adult lifespan using multiple-group latent growth curve modelling.

RESULTS

Having a happy relationship or marriage, having children, and being there for others are the life goals rated as most important across almost the entire adult lifespan. Having a happy relationship or marriage differed strongly by gender. Up to middle adulthood it was more important for women but more important for men in late adulthood. Parental status amplified gender differences in the work and family domain. Low education was associated with a higher perceived importance of being there for others. The largest regional differences (East vs. West) were found for home ownership.

DISCUSSION

Although the importance of some life goal trajectories reflects typical age-grading in developmental tasks, other life goals (e.g., having children) remain important even after goal attainment or after developmental deadlines have passed.

Work-Family Guilt in Spanish Parents: Analysis of the Measurement, Antecedents and Outcomes from a Gender Perspective

This research work had three objectives: (1) to analyze the psychometric properties of the Spanish version of the Work–Family Guilt Scale, (2) to examine its invariance according to gender, and (3) to study the relationship between work–family guilt (WFG) and the different proposed antecedent (e.g., hours spent working, social support, rumination, and personality) or consequential factors (e.g., life satisfaction), noting any gender differences. The incidental sample comprised 225 parents who were in paid work and had at least one child attending nursery school (49.1% women; age of total sample = 36.88 on average). Multiple-group and confirmatory factor analyses, correlations, multiple regression, and moderation analyses were carried out. The WFGS reflected the same factorial structure in men and women, with two main factors: work interfering with family guilt (WIFG) and family interfering with work guilt (FIWG). No gender differences were found. The discrepancy associated with perfectionism was the only variable that was found to be a predictor of FIWG. The major predictors of WIFG were brooding from rumination and the number of hours spent working. WIFG was also associated with lower life satisfaction in women. The implications of these results are discussed, stressing the need to promote work–family reconciliation policies.

Pediatric Trainees as Parents: Perspectives From a Pandemic

OBJECTIVES

Resident parents are at the intersection of converging challenges during the coronavirus disease 2019 (COVID-19) pandemic, and their perspective has yet to be explored. This qualitative study aimed to identify themes related to the experience of pediatric resident parents during the COVID-19 pandemic.

METHODS

We performed semistructured interviews with pediatric residents who were also parents. Using thematic analysis, transcripts were analyzed iteratively until theoretical sufficiency was achieved.

RESULTS

Twelve residents were interviewed from 9 pediatric residency programs. Five major themes, representing conflicts or tensions experienced by participants, were defined by the data: 1) Duty as a doctor versus duty as a parent; 2) Balance of work obligations versus childcare challenges; 3) Appreciation of added support versus worry about peers' perceptions of accommodations; 4) Gratitude for the recognition of challenges faced by resident parents versus fear of reversion to the norm; and 5) Protective impact of parenthood versus challenges to mental health.

CONCLUSIONS

Both parents and healthcare workers faced innumerable challenges during the COVID-19 pandemic, and this exploration of the experiences of pediatric resident parents provides a unique lens for examining the tensions that this group faced. Our results may allow residency programs to better support their pediatric resident parents during this crisis.

Pediatric Trainees as Parents: Perspectives on Parenthood From Pediatric Resident Parents

OBJECTIVES

Prior work across medical and surgical specialties shows that parenthood during residency training is associated with challenges including limited parental leave, lack of accommodations for breastfeeding, and concerns about career impact. Less is known about the experience of parenthood during pediatric residency training. The objective of this study was to identify themes related to the experience of parenthood during pediatric residency.

METHODS

In this qualitative study using thematic analysis, we performed semistructured interviews with participants who were currently in pediatric residency or had graduated in the previous 3 years and were parents during residency. Participants were recruited by e-mail. Data were collected and analyzed iteratively until thematic saturation was achieved. Two independent reviewers coded each transcript. Codes were grouped into categories and then into dominant themes.

RESULTS

Thirty-one residents were interviewed from 13 pediatric residency programs. Four major themes regarding the experience of parenthood during pediatric residency were defined by the data: 1) the struggles of parenthood and residency exacerbate each other; 2) institutional modifiers strongly influence the experiences of resident parents; 3) resident parents develop skills and perspectives that enhance their pediatric training; and 4) although levels of support for pediatric resident parents vary, the culture of pediatrics positively influences the experience of parenthood in residency.

CONCLUSIONS

There are numerous challenges navigating parenthood and residency, but institutional policies and culture can modify the experience. Importantly, the educational value of parenthood to pediatric training was immense. Our findings may be used to design interventions to support parenting during residency.

Experiencing loneliness in parenthood: a scoping review

AIMS

Chronic loneliness is experienced by around a third of parents, but there is no comprehensive review into how, why and which parents experience loneliness. This scoping review aimed to provide insight into what is already known about parental loneliness and give directions for further applied and methodological research.

METHODS

Searches for peer-reviewed articles were undertaken in six databases: PsycINFO, Medline, CINAHL, Embase, Web of Science and Scopus, during May 2019 to February 2020. We searched for English studies which examined loneliness experienced during parenthood, including studies that involved parents with children under 16 years and living at home and excluding studies on pregnancy, childbirth or postbirth hospital care.

RESULTS

From 2566 studies retrieved, 133 were included for analysis. Most studies (n = 80) examined the experience of loneliness in specific groups of parents, for example, teenage parents, parents of a disabled child. Other studies examined theoretical issues (n = 6) or health and wellbeing impacts on parents (n = 16) and their offspring (n = 17). There were 14 intervention studies with parents that measured loneliness as an outcome. Insights indicate that parental loneliness may be different to loneliness experienced in other cohorts. There is evidence that parental loneliness has direct and intergenerational impacts on parent and child mental health. Some parents (e.g. with children with chronic illness or disability, immigrant or ethnic minority parents) also appear to be at increased risk of loneliness although evidence is not conclusive.

CONCLUSION

This work has identified key gaps with further international, comparative and conceptual research needed.

Juvenile Idiopathic Arthritis, Marriage and Parenthood: A Nationwide Matched Cohort Study

Objectives

To compare trajectories of marriage and parenthood in individuals with JIA vs the general population.

Methods

Patients with JIA (n = 4399) were identified in the Swedish National Patient Register (2001–2016) and individually matched to up to five general population comparators on birthyear, sex and residence county (n = 21 981). Marriage and parenthood data were retrieved from the Total Population Register from age 18 y, and parenthood from the Multigeneration Register from age 15 y, respectively. Hazard ratios (HRs) were estimated using Cox regression adjusted for parental education, parental marital status and number of siblings.

Results

During a median of 6.3 years of follow-up, 362 patients with JIA and 1744 comparators got married (12.9 vs. 12.5 per 1000 person-years; HR 1.03, 95%CI 0.93-1.15). During a median of 8.8 years of follow-up, 680 patients with JIA and 3477 matched comparators became parents (17.1 vs 17.8 per 1000 person-years; HR 0.94, 95%CI 0.87-1.01). In the subgroup of patients with systemic onset JIA (SJIA), the adjusted hazard ratios for marriage and parenthood were 0.79 (95%CI 0.53-1.17) and 0.73 (95%CI 0.55-0.97), respectively.

Conclusion

The times to first marriage and first parenthood are similar for patients with JIA and the general population, suggesting that adolescents with JIA transition into family life along a trajectory resembling their community peers. One exception is the subgroup of patients with systemic onset JIA, who become parents for the first time at a lower rate than general population comparators.

[The support of the paediatric nurse in the paediatric emergency rapid response unit]

When a newborn baby is in need of rapid care outside the hospital where the mother has given birth, the nursery nurses work specifically to support the baby during the separation from its parents. They intervene before, during and after the separation of mother and child, particularly during the transfer of the baby to the mobile paediatric emergency and resuscitation unit.

[Maternity, a necessary consideration of its psychological dimension]

The birth of a child is always an upheaval for a woman, a couple and a family. This revolution will be more easily channelled if it is accompanied by attentive professionals, in the clinical sense, and present to welcome the mother's emotions, thus allowing the baby to build itself more serenely and the mother to develop her skills.

Uterus transplantation and pregnancy induction: Approved protocol at the Royal Prince Alfred Hospital

Absolute uterine factor infertility (AUFI) is defined as the absence of a uterus or the presence of a non-functional uterus. Before the first live birth from a uterus transplant in 2014, the only fertility options for women with AUFI were surrogacy and adoption. In November 2019, our team was granted approval for the first uterus transplant trial in Australia using known living donors. Our program is based on that of our overseas collaborators in Dallas, Texas; this team will also be proctoring us for our first two cases.

Pathways into childbearing delay of men and women in Australia

Childbearing delay is a pervasive feature of Australian society, but little research has been conducted to examine how socio-economic factors are linked to childbearing timing among Australian men and women. This paper addresses this by analysing the timing of first childbirth for a large sample of Australian residents (N = 4,444). The findings indicate that childbearing delay is socially patterned and that life course experiences shape the risk of delaying childbearing across genders. Having a tertiary qualification delays the transition to parenthood, especially for women. An uninterrupted career prolongs time to parenthood for women but accelerates it for men. Low occupational prestige, being married and having been in only one co-residential union are associated with earlier parenthood for both men and women. For each increase in education level, not being married is associated with increasing levels of childlessness. Clear-cut gender differences are found in the relationship between childlessness and childbearing delay.

Locus of Control and Negative Cognitive Styles in Adolescence as Risk Factors for Depression Onset in Young Adulthood: Findings From a Prospective Birth Cohort Study

Whilst previous observational studies have linked negative thought processes such as an external locus of control and holding negative cognitive styles with depression, the directionality of these associations and the potential role that these factors play in the transition to adulthood and parenthood has not yet been investigated. This study examined the association between locus of control and negative cognitive styles in adolescence and probable depression in young adulthood and whether parenthood moderated these associations. Using a UK prospective population-based birth cohort study: the Avon Longitudinal Study of Parents and Children (ALSPAC), we examined the association between external locus of control and negative cognitive styles in adolescence with odds of depression in 4,301 young adults using logistic regression models unadjusted and adjusted for potential confounding factors. Interaction terms were employed to examine whether parenthood (i.e., having become a parent or not) moderated these associations. Over 20% of young adults in our sample were at or above the clinical threshold indicating probable depression. For each standard deviation (SD) increase in external locus of control in adolescence, there was a 19% (95% CI: 8-32%) higher odds of having probable depression in young adulthood, after adjusting for various confounding factors including baseline mood and different demographic and life events variables. Similarly, for each SD increase in negative cognitive styles in adolescence, there was a 29% (95% CI: 16-44%) higher odds of having probable depression in the adjusted model. We found little evidence that parenthood status moderated the relationship between external locus of control or negative cognitive styles in adolescence and probable depression following adjustment for confounding factors. Effect estimates were comparable when performed in the complete case dataset. These findings suggest that having an external locus of control and holding negative cognitive styles in mid- to late adolescence is associated with an increased likelihood of probable depression in young adulthood.

Pregnancy and Parenthood Among Autistic Adults: Implications for Advancing Maternal Health and Parental Well-Being

Background

Strikingly little research has considered how autistic adults experience pregnancy and parenthood, two key transition periods in adult development with potentially far-reaching implications for physical and psychosocial health outcomes across the lifespan. This article reviews the research on pregnancy and parenthood among autistic adults, to summarize existing research and identify future directions to advance this critical area of study.

Methods

We conducted a systematic review of the literature on pregnancy and parenthood among autistic adults. Researchers extracted selected articles for key information, including methodology and sample size, study location, demographic characteristics of participants, measurement approaches, and key study findings.

Results

Overall, we identified 13 studies that used a range of quantitative and qualitative approaches to study pregnancy experiences and outcomes and parenthood among autistic adults. The findings show that autistic adults (1) experience difficulties and dissatisfaction communicating with health care providers throughout pregnancy and birth, (2) are more likely to experience depression during and after pregnancy, and (3) experience higher rates of pregnancy complications, including preterm birth, cesarean delivery, and pre-eclampsia. During parenthood, autistic adults report lower parenting competence, experience parenthood as isolating, have difficulty communicating with professionals about their child and are questioned by providers about their ability to parent, experience high rates of involvement with child protective services, and express a desire for increased parenting support. Autistic adults also reported parenting strengths, including high levels of finding parenthood rewarding and putting their children's needs ahead of their own.

Conclusions

A key limitation of the literature is the significant lack of sociodemographic diversity among participants, the small number of existing studies, and reliance on cross-sectional mono-method designs. Future research should be conducted in partnership with autistic adults to develop assessment and intervention approaches for supporting pregnancy health and parental well-being among diverse and underserved communities.

Lay summary

Why is this topic important?: Very little is known about how autistic adults experience pregnancy and parenthood. Better understanding these experiences is important, because pregnancy and parenthood are key transition periods in adult development that are associated with a range of health outcomes later in life.What is the purpose of this article?: This article reviews the existing research on pregnancy and parenthood among autistic adults. We wanted to summarize what is already known, evaluate how that knowledge was created, and consider who has and who has not been included in this research to inform future research. We summarized 13 studies that considered pregnancy or parenthood among autistic adults.What did the authors find about pregnancy among autistic adults?: One study used data from hospital and birth records in Sweden, and showed that autistic women experience higher rates of pregnancy complications, such as preterm birth (early delivery before 37 weeks), cesarean delivery, and pre-eclampsia (a condition defined by high blood pressure during pregnancy). Two studies had autistic and nonautistic adults fill out online surveys about their experiences, and found that autistic adults are more likely to have depression during and after pregnancy, have more difficulty interacting with health care professionals at pregnancy appointments and during the birth process, and feel that information and support services for pregnancy do not always meet their needs. Autistic women also reported that sensory differences can make health care visits during pregnancy especially difficult, and described that they may experience anxiety and confusion when interacting with health care staff.What did the authors find about parenthood among autistic adults?: The research we reviewed showed that autistic adults experience strengths and difficulties in parenting. Many autistic adults found parenthood rewarding, but also felt isolated as parents and had difficulty communicating with health care professionals about their children. Autistic adults also had high rates of interacting with child protective services (CPS). Some research also found that autistic adults had lower self-confidence in parenting, although findings are mixed.What are the recommendations for future research and practice?: We need to develop support strategies to promote pregnancy health and parenting satisfaction in partnership with autistic adults. For example, it may be helpful to develop communication tools that can support autistic adults during pregnancy, labor, and birth. We also recommend that future research develop questionnaires to ask autistic adults about their pregnancy and parenting experiences in sensitive ways, so that in the future providers can regularly ask autistic adults about their support needs. Most importantly, it is critical that future research also include more diverse autistic participants in their research, including racial/ethnic and sexual and gender minorities.How will these findings help autistic adults now or in the future?: We hope that this article will help guide future research that strives to better understand how autistic adults experience pregnancy and parenthood. Ultimately, we believe this research can lead to supports and intervention strategies that can improve pregnancy health and parental well-being for autistic adults.