Late preterm birth is a strong predictor of maternal stress later in life: Retrospective cohort study in school-aged children

Mothers' experiences of a new early collaborative intervention, the EACI, in the neonatal period: A qualitative study

AIM

To explore mothers' experiences of the EArly Collaborative Intervention.

BACKGROUND

Preterm birth puts a considerable emotional and psychological burden on parents and families. Parents to moderate and late premature infants have shorter stays at the neonatal intensive care unit and have described a need for support. The EArly Collaborative Intervention was developed to support parents with preterm infants born between gestational Weeks 30 to 36. In this study, mothers' experiences of the new intervention were explored.

DESIGN

A qualitative design guided by a reflexive thematic analysis according to Braun and Clarke. Interviews were individually performed with 23 mothers experienced with the EArly Collaborative Intervention. Data were identified, analysed and reported using reflexive thematic analysis. The COREQ checklist was used preparing the manuscript.

RESULTS

Two main overarching themes were constructed. The first theme, 'mothers' feelings evoked from the EArly Collaborative Intervention' describes the emotions raised by the intervention and how the intervention affected their parental role. Their awareness of the preterm baby's behaviour increased, and the intervention helped the parents to communicate around their baby's needs. The second theme, 'based on the preterm baby's behavior', describes experiences of the provision and the learning process about their preterm baby's needs and communication. The intervention was experienced as helpful both immediately and for future interaction with the baby.

CONCLUSIONS

Mothers found the intervention to be supportive and encouraging. They came to look upon their baby as an individual, and the new knowledge on how to care and interact with their baby affected both their own and their baby's well-being. Furthermore, the intervention felt strengthening for their relationship with the other parent.

RELEVANCE TO CLINICAL PRACTICE

The EArly Collaborative Intervention can support parents' abilities as well as their relation to their baby and may thereby contribute to infant development, cognition and well-being.

A Chatbot to Engage Parents of Preterm and Term Infants on Parental Stress, Parental Sleep, and Infant Feeding: Usability and Feasibility Study

BACKGROUND

Parents commonly experience anxiety, worry, and psychological distress in caring for newborn infants, particularly those born preterm. Web-based therapist services may offer greater accessibility and timely psychological support for parents but are nevertheless labor intensive due to their interactive nature. Chatbots that simulate humanlike conversations show promise for such interactive applications.

OBJECTIVE

The aim of this study is to explore the usability and feasibility of chatbot technology for gathering real-life conversation data on stress, sleep, and infant feeding from parents with newborn infants and to investigate differences between the experiences of parents with preterm and term infants.

METHODS

Parents aged ≥21 years with infants aged ≤6 months were enrolled from November 2018 to March 2019. Three chatbot scripts (stress, sleep, feeding) were developed to capture conversations with parents via their mobile devices. Parents completed a chatbot usability questionnaire upon study completion. Responses to closed-ended questions and manually coded open-ended responses were summarized descriptively. Open-ended responses were analyzed using the latent Dirichlet allocation method to uncover semantic topics.

RESULTS

Of 45 enrolled participants (20 preterm, 25 term), 26 completed the study. Parents rated the chatbot as "easy" to use (mean 4.08, SD 0.74; 1=very difficult, 5=very easy) and were "satisfied" (mean 3.81, SD 0.90; 1=very dissatisfied, 5 very satisfied). Of 45 enrolled parents, those with preterm infants reported emotional stress more frequently than did parents of term infants (33 vs 24 occasions). Parents generally reported satisfactory sleep quality. The preterm group reported feeding problems more frequently than did the term group (8 vs 2 occasions). In stress domain conversations, topics linked to "discomfort" and "tiredness" were more prevalent in preterm group conversations, whereas the topic of "positive feelings" occurred more frequently in the term group conversations. Interestingly, feeding-related topics dominated the content of sleep domain conversations, suggesting that frequent or irregular feeding may affect parents' ability to get adequate sleep or rest.

CONCLUSIONS

The chatbot was successfully used to collect real-time conversation data on stress, sleep, and infant feeding from a group of 45 parents. In their chatbot conversations, term group parents frequently expressed positive emotions, whereas preterm group parents frequently expressed physical discomfort and tiredness, as well as emotional stress. Overall, parents who completed the study gave positive feedback on their user experience with the chatbot as a tool to express their thoughts and concerns.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03630679; https://clinicaltrials.gov/ct2/show/NCT03630679.

Trajectories of Overprotective Parenting and Hyperactivity-Impulsivity and Inattention Among Moderate-Late Preterm Children: A Population-Based Study

Parents of preterm children are more likely to adopt non-optimal parenting behaviors than parents of full-term (FT) children. However, there is a lack of studies on parents of children born moderate to late preterm (MLP; 32-36 gestational weeks). In this study, we aimed to examine: (1) the association between MLP birth status and the trajectory of parental overprotection throughout preschool years, and (2) the role of parental overprotection, MLP birth status, and their interaction in the prediction of the trajectories of hyperactivity-impulsivity and inattention throughout childhood. Data comes from a Canadian representative population-based cohort including 2028 FT, 100 MLP children, and their parents. Overprotective parenting was measured when children were 5, 17, and 29 months old. Hyperactivity-impulsivity and inattention symptoms were measured repeatedly from 4 to 8 years of age. Trajectories of parents' overprotectiveness and children's hyperactivity-impulsivity and inattention were modeled. MLP birth status was associated with an increase in parental overprotectiveness across the preschool period. MLP birth status and parental overprotection were both found to be associated with higher levels of hyperactivity-impulsivity symptoms across childhood. No interaction was found between birth status and parental overprotection. The results suggest that parents of MLP children become more overprotective across time compared to parents of FT children and that children born MLP and/or exposed to higher levels of parental overprotection demonstrated higher levels of hyperactivity-impulsivity symptoms across childhood.

Preterm Birth and Maternal Mental Health: Longitudinal Trajectories and Predictors

OBJECTIVE

To examine trajectories of psychological distress in mothers of children born very preterm (VPT, <30 weeks gestation) and full term from 2 to 13 years after the birth, and examine predictors of maternal psychological distress over time within the VPT group.

METHODS

Mothers of children born VPT (n = 159) and full term (n = 71) completed questionnaires assessing their psychological distress when their child was 2, 7, and 13 years of age. Mixed models were used to examine differences between groups in maternal psychological distress over time. Family social risk, child neonatal medial risk, child sex, multiple pregnancy, and child's neurodevelopmental impairment in early childhood were examined as potential predictors of maternal psychological distress within the VPT group.

RESULTS

Mothers of children born VPT displayed elevated psychological distress compared with mothers of full-term children, and this difference was consistent over time. Higher family social risk was associated with elevated maternal psychological distress throughout childhood across all time-points. There was evidence that mothers of children at higher neonatal medical risk displayed increasing psychological distress over time.

CONCLUSIONS

Mothers of children born VPT show prolonged psychological distress. Mothers from socially disadvantaged background and those whose child has neonatal medical complications may require extensive support to prevent prolonged psychological distress and promote optimal outcomes for children and families.

What's going on in my baby's mind? Mothers' executive functions contribute to individual differences in maternal mentalization during mother-infant interactions

Maternal mentalization refers to a mother's capacity to understand mental-states of herself and her child and to regard her child as a psychological agent. In mother-infant interactions, this capacity is commonly conceptualized as maternal mind-mindedness, which can be divided into two dimensions: appropriate and nonattuned interpretations of the infants' mental-states. Appropriate mind-mindedness refers to interpretations that seem to be compatible with the infant's behaviors, whereas nonattuned mind-mindedness refers to noncompatible interpretations. The aim of this study was to investigate the cognitive mechanisms that contribute to mind-mindedness. Specifically, we investigated the role of executive functions in appropriate and nonattuned mind-mindedness, and the moderating roles of two infant-related factors, prematurity (as a stressful context) and child temperament (as a context of unpredictability and negative emotionality). To this end, mother-infant free play interactions were coded for mind-mindedness in a sample of 102 mothers and their 6-month-old infants (61 preterm, 41 full-term). When children were 66-months old, mothers completed cognitive tasks that assessed working memory updating, resistance to interference, response inhibition, and shifting. Appropriate mind-mindedness was positively associated with updating, and this link was stronger when infant temperament was rated as more difficult. Furthermore, among mothers of full-term infants, mothers' resistance to interference was negatively associated with nonattuned mind-mindedness. This link was not evident in the stressful context of premature birth. Mothers' response inhibition and shifting were not associated with either of the mind-mindedness dimensions. Implications on understanding variability in maternal mentalization during mother-infant interactions and the roles of executive functions in parenting are discussed.

Emotional and behavioral outcomes and quality of life in school-age children born as late preterm: retrospective cohort study

Aim

To determine the effect of late preterm birth and treatment at the intensive care unit (ICU) on school-age children’s emotional and behavioral problems and quality of life (QoL).

Methods

Emotional and behavioral problems and QoL were investigated in 6-12-year-olds who were born late preterm at the University Hospital Center Split in the period from January 2002 to March 2008. The study included 126 late preterm children treated in ICU (LP-ICU group), 127 late preterm children not treated in ICU (LP-non-ICU group), and 131 full-term children treated in ICU (FT-ICU group). Emotional and behavioral difficulties were assessed using the Child Behavior Checklist. QoL was evaluated with the Royal Alexandra Hospital for Children Measure of Function questionnaire. The data was collected via telephone interview with mothers during 2014.

Results

Late preterm children had a nearly 5-fold risk for internalizing problems in comparison with FT-ICU children (OR 4.76, 95% confidence interval [CI] 2.37-9.56 and OR 4.82, 95% CI 2.25-10.37 in LP-ICU and LP-non-ICU children, respectively). They also had a greater risk for externalizing problems (OR 3.08, 95% CI 1.44-6.61 and OR 2.68, 95% CI 1.14-6.28, respectively) and total problems (OR 6.29, 95% CI 2.86-13.83 and OR 7.38, 95% CI 3.08-17.69, respectively) and a considerably increased risk for lower QoL (OR 12.79, 95% CI 5.56-29.41 and OR 5.05, 95% CI 2.04-12.48, respectively).

Conclusion

Children born late preterm had a greater risk for emotional and behavioral problems and lower QoL during childhood than their full-term born peers and they experienced serious health problems upon birth.

Risk factors for postpartum depression among Chinese women: path model analysis

Background

Postpartum depression causes harm to both mothers and infants. The purpose of this study was to find out several potential risk factors, and to identify the intrinsic interrelationships between factors and postpartum depression by constructing a path model. The results of this study may help to control the increasing incidence of maternal postpartum depression.

Methods

The study was based on a sample of mothers from a cross-sectional study which was set up at 4 weeks after a mother had childbirth and was conducted in three streets at Kaifu District of Changsha in Hunan province from January to December 2015. Questionnaires were distributed to subjects who responded to questions concerning factors related to pregnancy, delivery and infants within 4 weeks after childbirth. The Edinburgh Postnatal Depression Scale (EPDS) was used to measure postpartum depression. Chi-square test was used to detect significant differences between non-postpartum depression group and postpartum depression group. A path model was constructed to explore the interrelationships between variables, and to verify the relationships between variables and postpartum depression.

Results

The proportion of maternal postpartum depression was 6.7%. Univariate analysis showed that there were significant differences between non-postpartum depression group and postpartum depression group (all P-values <0.05) on the part of maternal age, parity, frequent exposure to mobile phone during pregnancy, gestational hypertensive disorders, fetus number, premature delivery, birth weight, initiation of breastfeeding, mode of feeding, infant illness within 4 weeks after delivery and infant weight at 4 weeks. Path analysis results showed that the final model could be fitted well with sample data (P = 0.687, CMIN/DF = 0.824, NFI = 0.992, RFI = 0.982, IFI = 1.002, TLI =1.004, CFI = 1.000 and RMSEA < 0.001). Frequent exposure to mobile phone during pregnancy, maternal age and gestational hypertensive disorders had both direct and indirect effects on postpartum depression. Mode of feeding and infant weight at 4 weeks, which was the most total effect on postpartum depression, had only a direct impact on postpartum depression. Fetus number, premature delivery, initiation of breastfeeding and birth weight had only an indirect influence on postpartum depression.

Conclusion

The findings of this study suggest that constructing a path analysis model could identify potential factors and explore the potential interrelations between factors and postpartum depression. It is an effective way to prevent maternal postpartum depression by taking appropriate intervention measures and carrying out health education for pregnant women.

Electronic supplementary material

The online version of this article (doi:10.1186/s12884-017-1320-x) contains supplementary material, which is available to authorized users.