The Effects of a Prenatal Mindfulness Intervention on Infant Autonomic and Behavioral Reactivity and Regulation

From inner to dyadic connection: the role of mindfulness in mother-infant interaction during the first year of life

Introduction

Mother-infant attunement is fundamental to supporting infant socio-emotional development. Based on the assumption that we connect better with others if we are aware of and connected with our own experience, mindfulness could affect the maternal ability to attune to the infant. However, little is known about this topic in the first year of life. Study 1 aimed to investigate the role of maternal dispositional mindfulness and mindful parenting in mother-infant physiological and behavioral attunement at 3 months of age. Study 2 aimed to explore the effect of a mindfulness-based intervention not specific to parenting experience on mother-infant behavioral and physiological attunement and on maternal wellbeing at 9 months of age.

Methods

In Study 1, mother-infant (n = 67) behavioral and physiological attunement (i.e., co-regulation and RSA) were collected simultaneously each 20 s during face-to-face interaction. Mothers completed questionnaires about their dispositional mindfulness and mindful parenting. In Study 2, mother-infant dyads were randomly divided into a control (n = 20) and an intervention group (n = 29). The intervention group attended a 5-week mindfulness-based intervention. At T1 and T2, the same procedure described in Study 1 was applied and mothers reported about their wellbeing.

Results

Results showed that maternal mindfulness was associated with high physiological and behavioral attunement at 3 months and with more positive maternal behaviors and less stress at 9 months. Analysis evidenced a slight improvement in the intervention group in maternal dispositional mindfulness and a reduction in parenting stress at T2.

Discussion

Findings from both studies suggested that maternal mindfulness could represent a protective factor that could support mothers in fostering better dyadic interactions with their infants. The implementation of mindfulness-based interventions for mothers could have preventive and clinical implications.

Effects of Mediterranean Diet or Mindfulness-Based Stress Reduction during Pregnancy on Fetal Brain Development Detected by Neurosonography: A Secondary Analysis of a Randomized Clinical Trial (IMPACT BCN)

INTRODUCTION

We investigated whether structured maternal lifestyle interventions based on Mediterranean diet or stress reduction influence fetal-infant neurodevelopment detected by detailed fetal neurosonography and Ages and Stages Questionnaires 3rd edition (ASQ) at 12 months old.

METHODS

This was a secondary analysis of a randomized clinical trial (2017-2020), including 1,221 singleton pregnancies at high risk for small-for-gestational age. Participants were randomized into three groups at 19-23 weeks' gestation: Mediterranean diet intervention, stress reduction program, or usual care. A detailed neurosonography was performed on 881 participants at mean (SD) 33.4 (1.1) weeks' gestation. Neurosonographic measurements were done offline. ASQ was performed on 276 infants at 1 year of corrected age.

RESULTS

Biparietal diameter was similar among study groups. Mediterranean diet group fetuses had deeper insula (26.80 [1.68] versus 26.63 [1.75], mm, p = 0.02) and longer corpus callosum (42.98 [2.44] versus 42.62 [2.27], mm, p = 0.04), with a lower rate of suboptimal score infants in ASQ problem-solving domain (6.2 vs. 16.3%, p = 0.03). Stress reduction group fetuses had deeper insula (26.90 [1.75] versus 26.63 [1.75], mm, p = 0.04) and lower rates of suboptimal score infants in ASQ fine motor domain (4.3 vs. 12.8%, p = 0.04), compared to usual care group fetuses.

CONCLUSION

Maternal structured intervention during pregnancy of the trial has the potential to modify offspring's neurodevelopment.

Do dyadic interventions impact biomarkers of child health? A state-of-the-science narrative review

BACKGROUND

Early life adversity is related to numerous poor health outcomes in childhood; however, dyadic interventions that promote sensitive and responsive caregiving may protect children from the negative consequences of such exposures. To date, quasi-experimental and randomized controlled trials (RCTs) have examined the impact of dyadic interventions on a range of individual biomarkers in children, which may elucidate the relation between early stress exposure and transdiagnostic risk factors for prospective poor health. However, the content of interventions, analytic strategies, and findings vary widely across studies, obscuring key themes in the science and hindering policy and research efforts.

METHODS

We use a narrative approach to review findings from methodologically rigorous (predominantly RCT) studies of dyadic interventions' impacts on different biomarkers in children, including indicators of the hypothalamic-pituitary-adrenal (HPA) axis, parasympathetic (PNS) and sympathetic nervous systems (SNS), brain development, inflammation, and intracellular DNA processes. We contribute to this important area of inquiry through integrating findings across biological systems and identifying contextual and mechanistic factors to depict the current state of the field.

RESULTS

Evidence suggests dyadic interventions improved PNS functioning and advanced brain maturation. Some studies indicated interventions reduced hair cortisol concentrations, systemic inflammation, and resulted in differences in DNA methylation patterns. Findings did not support main effect-level change in salivary measures of HPA axis activity, SNS activity, or telomere length. Importantly, reviewed studies indicated significant heterogeneity in effects across biological systems, underscoring the importance of contextual factors (e.g., adversity subtype and severity) as potential moderators of effects. Further, findings suggested enhanced parenting behaviors may be a mechanism through which dyadic interventions operate on biomarkers.

CONCLUSIONS

We close with future policy and research directions, emphasizing the promise of biologically-informed dyadic interventions for understanding and ameliorating the effects of early adversity on transdiagnostic biomarkers of health.

Programming the next generation of prenatal programming of stress research: A review and suggestions for the future of the field

In this article, I highlight core ideas, empirical findings, and advances in the study of how stress during pregnancy may prenatally program child neurodevelopmental, psychopathological, and health outcomes, emphasizing reviews, metanalyses, and recent contributions of conceptual and empirical work. The article offers a perspective on the history of this area of science, the underrecognized contributions of influential scholars from diverse fields of study, what we know from the evidence to date, the persistent challenges in sorting through what is left to learn, and suggestions for future research. I include sections focused on promoting resilience, pregnancy interventions that demonstrate positive effects across two generations, and the translational implications of the accruing data for practice and policy, highlighting opportunities for integrating across a range of fields and sectors. In the concluding sections, I discuss lessons learned from conducting this work and provide a closing summary of progress and future directions. The goal of this writing was to provide a viewpoint on some ways that emerging intergenerational transmission scholars might responsibly contribute to the future of the field of developmental psychopathology.

The Impact of Mindfulness Treatment on Maternal Inflammation and Fetal Neurodevelopment Among Participants with Histories of Hypertensive Disorders

This was a secondary analysis of a prenatal mindfulness training (MT) RCT versus treatment as usual (TAU) on neutrophil-to-lymphocyte ratio (NLR), a measure of maternal inflammation, and fetal head circumference. Fifteen participants were randomized to MT and 14 to TAU. NLR in third trimester was significantly lower in the MT group (F = 7.11, p = 0.019) relative to those in TAU. Higher NLR values in second (r = -0.644, p = 0.013) and third trimesters (r = -0.601, p = 0.030) were associated with lower fetal HC%. There was no group difference in fetal HC%. A future, fully powered study is needed to replicate these findings. Clinical Trials Number: NCT03679117.

Effect of a Mediterranean Diet or Mindfulness-Based Stress Reduction During Pregnancy on Child Neurodevelopment: A Prespecified Analysis of the IMPACT BCN Randomized Clinical Trial

Importance

Maternal suboptimal nutrition and high stress levels are associated with adverse fetal and childhood neurodevelopment.

Objective

To test the hypothesis that structured interventions based on a Mediterranean diet or mindfulness-based stress reduction (MBSR) during pregnancy improve child neurodevelopment at age 2 years.

Design, Setting, and Participants

This was a prespecified analysis of the parallel-group Improving Mothers for a Better Prenatal Care Trial Barcelona (IMPACT BCN) randomized clinical trial, which was conducted at a university hospital in Barcelona, Spain, from February 2017 to March 2020. A total of 1221 singleton pregnancies (19 to 23 weeks' gestation) with high risk of delivering newborns who were small for gestational age were randomly allocated into 3 groups: a Mediterranean diet intervention, an MBSR program, or usual care. A postnatal evaluation with the Bayley Scales of Infant and Toddler Development, 3rd Edition (Bayley-III), was performed. Data were analyzed from July to November 2022.

Interventions

Participants in the Mediterranean diet group received monthly individual and group educational sessions and free provision of extra virgin olive oil and walnuts. Those in the stress reduction group underwent an 8-week MBSR program adapted for pregnancy. Individuals in the usual care group received pregnancy care per institutional protocols.

Main Outcomes and Measures

Neurodevelopment in children was assessed by Bayley-III at 24 months of corrected postnatal age.

Results

A total of 626 children (293 [46.8%] female and 333 [53.2%] male) participated at a mean (SD) age of 24.8 (2.9) months. No differences were observed in the baseline characteristics between intervention groups. Compared with children from the usual care group, children in the Mediterranean diet group had higher scores in the cognitive domain (β, 5.02; 95% CI, 1.52-8.53; P = .005) and social-emotional domain (β, 5.15; 95% CI, 1.18-9.12; P = .01), whereas children from the stress reduction group had higher scores in the social-emotional domain (β, 4.75; 95% CI, 0.54-8.85; P = .02).

Conclusions and Relevance

In this prespecified analysis of a randomized clinical trial, maternal structured lifestyle interventions during pregnancy based on a Mediterranean diet or MBSR significantly improved child neurodevelopmental outcomes at age 2 years.

Trial Registration

ClinicalTrials.gov Identifier: NCT03166332.

A Multi-Cohort Examination of the Independent Contributions of Maternal Childhood Adversity and Pregnancy Stressors to the Prediction of Children's Anxiety and Depression

Women's social experiences can have long-term implications for their offspring's health, but little is known about the potential independent contributions of multiple periods of stress exposures over time. This study examined associations of maternal exposure to adversity in childhood and pregnancy with children's anxiety and depression symptoms in a large, sociodemographically diverse sample. Participants were 1389 mother-child dyads (child age M = 8.83 years; SD = 0.66; 42% Black, 42% White; 6% Hispanic) in the ECHO-PATHWAYS Consortium's three U.S. pregnancy cohorts. Women reported their exposure to childhood traumatic events (CTE) and pregnancy stressful life events (PSLE). Children self-reported on their symptoms of anxiety and depression at age 8-9 years. Regression analyses estimated associations between maternal stressors and children's internalizing problems, adjusting for confounders, and examined child sex as a modifier. Exploratory interaction analyses examined whether geospatially-linked postnatal neighborhood quality buffered effects. In adjusted models, PSLE counts positively predicted levels of children's anxiety and depression symptoms ([ßAnxiety=0.08, 95%CI [0.02, 0.13]; ßDepression=0.09, 95%CI [0.03, 0.14]); no significant associations were observed with CTE. Each additional PSLE increased odds of clinically significant anxiety symptoms by 9% (95%CI [0.02, 0.17]). Neither sex nor neighborhood quality moderated relations. Maternal stressors during pregnancy appear to have associations with middle childhood anxiety and depression across diverse sociodemographic contexts, whereas maternal history of childhood adversity may not. Effects appear comparable for boys and girls. Policies and programs addressing prevention of childhood internalizing symptoms may benefit from considering prenatal origins and the potential two-generation impact of pregnancy stress prevention and intervention.

Long-term effects of a prenatal mindfulness intervention on depressive symptoms in a diverse sample of women

OBJECTIVE

Depression is a public health crisis, and scalable, affordable interventions are needed. Although many psychosocial interventions are effective, there is little research investigating their sustained, long-term influence on well-being. The purpose of this study was to examine whether a prenatal mindfulness intervention with demonstrated benefit for women's depressive symptoms during the early postpartum period would exert effects through 8 years.

METHOD

The sample of 162 lower income women was racially and ethnically diverse. Women were assigned to receive an 8-week mindfulness-based intervention during pregnancy (MIND) or treatment as usual (TAU). Repeated assessments of depressive symptoms were collected using the Patient Health Questionnaire-9 at baseline, postintervention, and following childbirth (1, 2, 3-4, 5, 6, and 8 years from baseline). The most recent assessment of depressive symptoms was collected during the COVID-19 pandemic.

RESULTS

MIND and TAU women were equivalent on sociodemographic factors and depressive symptoms at baseline. Depressive symptoms at all follow-up assessments through 8 years were significantly lower among women in MIND compared to TAU. The odds of moderate or higher depressive symptoms were greater among TAU compared to MIND women at all time points except the 6-year assessment. By Year 8, 12% of women in MIND reported moderate or more severe depressive symptoms compared to 25% of women in TAU.

CONCLUSIONS

Results suggest the effects of a group-based psychosocial intervention during pregnancy may endure for years, well beyond the initial perinatal period. Investing in prevention and intervention efforts for mental health during pregnancy may have sustained benefits for the well-being of women. (PsycInfo Database Record (c) 2023 APA, all rights reserved).