Beyond Early Adversity: The Role of Parenting in Infant Physical Health

Love on the developing brain: Maternal sensitivity and infants' neural responses to emotion in the dorsolateral prefrontal cortex

Infancy is a sensitive period of development, during which experiences of parental care are particularly important for shaping the developing brain. In a longitudinal study of N = 95 mothers and infants, we examined links between caregiving behavior (maternal sensitivity observed during a mother-infant free-play) and infants' neural response to emotion (happy, angry, and fearful faces) at 5 and 7 months of age. Neural activity was assessed using functional Near-Infrared Spectroscopy (fNIRS) in the dorsolateral prefrontal cortex (dlPFC), a region involved in cognitive control and emotion regulation. Maternal sensitivity was positively correlated with infants' neural responses to happy faces in the bilateral dlPFC and was associated with relative increases in such responses from 5 to 7 months. Multilevel analyses revealed caregiving-related individual differences in infants' neural responses to happy compared to fearful faces in the bilateral dlPFC, as well as other brain regions. We suggest that variability in dlPFC responses to emotion in the developing brain may be one correlate of early experiences of caregiving, with implications for social-emotional functioning and self-regulation.

Maternal recognition of positive emotion predicts sensitive parenting in infancy

Research on parent-child relationships demonstrates the importance of maternal sensitivity for the development of children's emotion regulation, social competence, and health; thus, it is important to understand the emotional-cognitive capacities underlying maternal sensitivity. We followed 120 mothers and their full-term infants from the newborn period to 5 months postpartum. Mothers' emotion recognition during the newborn period was measured using a validated facial emotion recognition task assessing discrimination (d') of six facial expressions of emotion: happiness, fear, anger, sadness, disgust, and neutrality. Maternal behavior at 5 months postpartum was coded from a mother-infant free-play session using Ainsworth's Sensitivity Scales. Preregistered analyses revealed that mothers' ability to detect happiness specifically (but not other emotions such as fear or sadness) in the neonatal period predicted greater observed sensitivity 4 months later, β = .30, p = .002, ΔR² = .08. Results suggest that maternal recognition of positive emotion may be uniquely predictive of sensitive behavior in low-stress parent-infant interaction contexts. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Antibiotic Consumption, Illness, and Maternal Sensitivity in Infants with a Disorganized Attachment

Prior research found an association between mother-infant attachment and antibiotic use. Ambivalent-attached infants are more likely to take antibiotics than other infants, and their mothers tend to be less sensitive to their needs than most. This finding is important because it shows the association between psychological processes, early relationships, and health outcomes. We aim to learn about children with high-risk attachment relationships, such as disorganized-attached infants. This study compares antibiotic use, infant-mother interactive behavior, and health indicators according to infant attachment patterns (including disorganized attachment). For this purpose, we observed mothers-infants' interactive behavior in free play at nine months and infants' attachment in the Ainsworth Strange Situation at twelve months. Participants included 77 girls and 104 boys (full-term and preterm) and their mothers. Paradoxically, mothers of disorganized-attached infants reported that their children were ill only 1.56 times on average, but 61% of their children used antibiotics in the first nine months. The other mothers reported that their children were sick 5.73 times on average, but only 54% of their children used antibiotics in the same period. Infants with disorganized attachment had mothers who were more literate and less sensitive. These results add to a body of research that shows that early high-risk relationships affect children's lives at multiple levels.

An Evaluation of Food and Nutrient Intake among Pregnant Women in The Netherlands: A Systematic Review

Nutritional deficiencies during pregnancy can have serious consequences for the health of the (unborn) child. This systematic review provides an updated overview of the available food and nutrient intake data for pregnant women in The Netherlands and an evaluation based on the current recommendations. Embase, MEDLINE, and national institute databases were used. Articles were selected if they had been published since 2008 and contained data on food consumption, nutrient intake, or the status of healthy pregnant women. A qualitative comparison was made with the 2021 Dutch Health Council recommendations and reference values. A total of 218 reports were included, representing 54 individual studies. Dietary assessments were primarily performed via food frequency questionnaires. Protein, vitamin A, thiamin, riboflavin, vitamin B₆, folate, vitamin B₁₂, vitamin C, iron, calcium, and magnesium intakes seemed to be adequate. For folate and vitamin D, supplements were needed to reach the recommended intake. The reasons for concern are the low intakes of fruits, vegetables, and (fatty) fish, and the intakes of alcohol, sugary drinks, and salt. For several foods and nutrients, no or limited intake data were found. High-quality, representative, and recent data are needed to evaluate the nutrient intake of pregnant women in order to make accurate assessments and evaluations, supporting scientific-based advice and national nutritional policies.

The Association between Prematurity, Antibiotic Consumption, and Mother-Infant Attachment in the First Year of Life

Antibiotics have individual and public-health drawbacks. Nevertheless, mother-infant attachment quality and maternal sensitivity are associated with antibiotic use. Ambivalent-attached infants are more likely to consume antibiotics than other infants. Conceivably, the emotional over-externalization of ambivalent-attached infants and maternal anxiety when infants are ill raise concerns in healthcare professionals, leading to antibiotic over-prescriptions. However, because infants prematurely born, particularly those with less than 32 weeks of gestation, are under more accurate health vigilance, the impact of infant and maternal behavior on antibiotic prescription may vanish in this sample. To test this hypothesis, we performed a longitudinal study to compare antibiotic use and the quality of mother-infant attachment in three groups: 86 infants born at full-term, 44 moderate-to-late preterm infants (32-36 gestation weeks), and 58 very-to-extreme preterm infants (<32 gestation weeks). Infants' attachment was observed with the Ainsworth Strange Situation's experimental paradigm at 12 months of corrected age. Findings indicate that infant attachment strategy is associated with antibiotics uptake, but results vary across samples. The proportion of infants that used antibiotics is highest among ambivalent-attached infants in the full-term sample but highest among avoidant-attached infants in the very-to-extreme premature sample. Moreover, higher infant gestational age and lower maternal sensitivity determine higher antibiotic use.

Psychological and cultural factors influencing antibiotic prescription

Humans have inundated the environment worldwide with antimicrobials for about one century, giving selective advantage to antibiotic-resistant bacteria. Therefore, antibiotic resistance has become a public health problem responsible for increased mortality and extended hospital stays because the efficacy of antibiotics has diminished. Hospitals and other clinical settings have implemented stewardship measures to reduce antibiotic administration and prescription. However, these measures demand multifactorial approaches, including multidisciplinary teams in clinical settings and the education of professionals and patients. Recent studies indicate that individual factors, such as mother-infant attachment and parenting styles, play a critical role in antibiotic use. Also, macrocontextual factors, such as economic, social, or cultural backgrounds, may impact antibiotic use rates. Therefore, research aiming to ameliorate stewardship measures must include psychologically and sociologically based research.

Maternal perinatal hypertensive disorders and parenting in infancy

Maternal mental health strongly influences parenting during infancy. However, it is unclear whether maternal physical health conditions in the perinatal period may also impact parenting. Examining the association of hypertensive disorders - a common physical health problem in pregnancy - with subsequent parenting behaviors is an important first step in understanding the connection between maternal physical health and parenting during this critical developmental period. This study evaluated whether hypertensive disorders of pregnancy (HDP) and hypertensive disorders (HD) diagnosed after the birth of the infant were associated with parenting self-efficacy, parenting stress, and observed parental responsiveness during mother-infant interactions at 6 and 12 months postpartum among a sample of racially and ethnically diverse mothers and their infants (N = 295). Results showed that mothers with an HDP or HD diagnosis had lower levels of parenting self-efficacy, higher levels of parenting stress, and lower levels of observed parental responsiveness compared to mothers without an HDP or HD diagnosis. Given that women with childhood adversity are at higher risk for experiencing HDP/HD and may have more difficulties with parenting compared to women without childhood adversity, we utilized a sample of mothers wherein most had experienced at least one form of adversity in their childhoods. Exploratory analyses revealed that HDP/HD moderated the relation between early life experiences and parenting outcomes in all but one model. Associations between HDP/HD and parenting are discussed, with implications for how we understand maternal physical health as a determinant of parenting in the perinatal period.

Examining the Role of Socioeconomic Status and Maternal Sensitivity in Predicting Functional Brain Network Connectivity in 5-Month-Old Infants

Infancy is a sensitive period of human brain development that is plastically shaped by environmental factors. Both proximal factors, such as sensitive parenting, and distal factors, such as socioeconomic status (SES), are known predictors of individual differences in structural and functional brain systems across the lifespan, yet it is unclear how these familial and contextual factors work together to shape functional brain development during infancy, particularly during the first months of life. In the current study, we examined pre-registered hypotheses regarding the interplay between these factors to assess how maternal sensitivity, within the broader context of socioeconomic variation, relates to the development of functional connectivity in long-range cortical brain networks. Specifically, we measured resting-state functional connectivity in three cortical brain networks (fronto-parietal network, default mode network, homologous-interhemispheric connectivity) using functional near-infrared spectroscopy (fNIRS), and examined the associations between maternal sensitivity, SES, and functional connectivity in a sample of 5-month-old infants and their mothers (N = 50 dyads). Results showed that all three networks were detectable during a passive viewing task, and that maternal sensitivity was positively associated with functional connectivity in the default mode network, such that infants with more sensitive mothers exhibited enhanced functional connectivity in this network. Contrary to hypotheses, we did not observe any associations of SES with functional connectivity in the brain networks assessed in this study. This suggests that at 5 months of age, maternal sensitivity is an important proximal environmental factor associated with individual differences in functional connectivity in a long-range cortical brain network implicated in a host of emotional and social-cognitive brain processes.

Understanding links between maternal perinatal posttraumatic stress symptoms and infant socioemotional and physical health

Maternal posttraumatic stress symptoms (PTSS) are associated with adverse consequences for older children, but very few studies have examined links between perinatal maternal PTSS and infant outcomes. Trauma exposure and psychopathology, including PTSS, is often heightened for women during pregnancy through 1 year postpartum. Therefore, the perinatal period may be a critical time for understanding the risk maternal PTSS and other mental health factors pose to the socioemotional and physical health of infants. The present study explored the relation between maternal PTSS and infant socioemotional and physical health problems in a sample of racially and ethnically diverse mother-infant dyads (N = 295) assessed prenatally and at 12 months postpartum. This study also examined whether there are: (1) moderating effects of maternal depressive symptoms and parenting stress on these associations and (2) indirect effects of PTSS on infant outcomes through observed maternal sensitivity. Results indicated that postpartum depressive symptoms and parenting stress, rather than PTSS, were associated with greater infant socioemotional health problems. However, prenatal PTSS were associated with greater infant physical health problems when mothers also reported clinically significant levels of postpartum depressive symptoms. Maternal sensitivity was not associated with maternal PTSS, depressive symptoms, or parenting stress, nor was it related to infant socioemotional and physical health; thus, maternal sensitivity was not tested as an intermediary mechanism linking maternal mental health with infant outcomes. Implications for promoting maternal mental health in the perinatal period to bolster socioemotional and physical health of infants are discussed.