Associations Between Breastfeeding, Maternal Emotional Availability, and Infant-Mother Attachment: The Role of Coparenting.

BACKGROUND: Breastfeeding is a parenting practice that combines close intimate contact with the opportunity to be sensitive and responsive to the infant, and may have direct and indirect relations with infant attachment. However, researchers have produced inconsistent findings, suggesting there may be other mechanisms involved. Coparenting may play a significant role, as it has been consistently associated with mother-infant relationships. RESEARCH AIMS: The aims of this study were to examine: (1) whether breastfeeding would be directly associated with infant-mother attachment; (2) whether this association was also indirect, through mothers' quality of caregiving; and (3) whether partners' coparenting support moderates breastfeeding's indirect association with attachment. METHODS: This was a prospective, longitudinal study that drew data from a larger NIH-funded study on sleep and family relationships (R01HD052809). Mothers reported on their feeding practices and coparenting relationships. Independent observations were used to assess mothers' emotional availability toward infants. A separate team of observers assessed infant-mother attachment. RESULTS: Exclusive breastfeeding during the first 6 months, and longer duration of any breastfeeding across the 1st year, were directly associated with more secure infant-mother attachment. These associations were also indirect, through maternal emotional availability. Coparenting was a significant moderator, such that the influence of longer breastfeeding duration on improved emotional availability, and, in turn, on more secure attachment, was significant only for mothers who perceived coparenting quality to be low. CONCLUSION: Findings highlighted the importance of breastfeeding on both the quality of mothering and infant attachment, but also emphasized that coparenting support may be particularly important for mothers who are unable to breastfeed.

Coparenting as a family-level construct: Parent and child inputs across the first two years.

This study examined the effects of infant negative affectivity (NA) and maternal and paternal depressive symptoms on fathers' and mothers' perceptions of coparenting across the first 2 years following an infant's birth. A total of 147 two-parent families (most couples were White, married, and living together) with healthy, full-term infants were recruited. At each time point, fathers and mothers separately reported their coparenting perceptions via the Coparenting Relationship Scale and their depressive symptoms using the depression subscale of Symptom Checklist-90-Revised. Mothers also reported their children's NA via the Infant Behavior Questionnaire-Revised at 3 to 12 months and the Early Child Behavior Questionnaire at 18 and 24 months. Findings from growth curve models in an actor-partner interdependence model framework suggested that among parents with higher depression, there were steeper declines in coparenting quality reported by parents and their spouses across 3-24 months. In addition, three separate two-way interactions between variables including higher-than-usual parental and spousal depression, as well as higher-than-usual infant NA predicted poorer-than-usual coparenting experiences. Findings indicate that coparenting is a dynamically unfolding construct that is impacted by ongoing changes in the parents' social-ecological niche and suggest the need to consider both parent and child characteristics, and to include spousal influences, to get a comprehensive, whole-family understanding of levels and changes in coparenting relationships. The findings also confirm that coparenting dynamics may benefit from interventions engaging both couples and addressing multiple risk factors from both parents (e.g., depression) and children (e.g., NA).

Iron Deficiency is Related to Depressive Symptoms in United States Nonpregnant Women of Reproductive Age: A Cross-Sectional Analysis of NHANES 2005-2010.

BACKGROUND: Findings of the association between iron status and depressive symptoms in nonpregnant women of reproductive age (WRA) are equivocal, limited by a small sample size, or did not consistently control for confounders. OBJECTIVE: We tested the association between iron status and depressive symptoms in WRA with the NHANES data (2005-2010). METHODS: Nonpregnant WRA (20-44 y) with complete data on iron (ferritin and transferrin receptor (TfR)) and anemia (hemoglobin) biomarkers, depressive symptoms (Patient Health Questionnaire-9), and sociodemographic variables were included. Logistic and negative binomial regressions were used to estimate presence (odds ratios) and magnitude (prevalence ratios), respectively, for depressive symptoms by iron deficiency (ID)/anemia/ID anemia in the total sample and stratified by poverty:income ratio (≤ 1.85 or >1.85). RESULTS: Among 2516 females, the prevalence of ID was 8 to 16% (depending on the iron biomarker used), of anemia 8%, of which 52 to 65% were also ID. The prevalence of depressive symptoms was 10%. Crude logistic models showed that females with ID (TfR ≥ 8.3 mg/L or body iron <0 mg/kg) from the total sample had 1.82 (95% confidence interval [CI]: 1.24, 2.68) and 1.62 (95% CI: 1.05, 2.48), respectively, higher odds of depressive symptoms than females with iron sufficiency; these associations were attenuated after adjustments for confounders. Adjusted negative binomial models showed that females with ID (TfR ≥ 8.3 mg/L) from the total and low-income samples showed 1.19 (95% CI: 1:00, 1.40) and 1.27 (95% CI: 1.03, 1.58), respectively, higher prevalence ratios of depressive symptoms scores than females with iron sufficiency. CONCLUSIONS: These nationally representative data indicate that nonpregnant WRA with ID (based on high TfR) in the United States have higher prevalence of somatic depressive symptoms scores than those with iron sufficiency, especially if they are of low income.

Cesarean Section and Child Development at 3 Years: A Prospective Cohort Study of First Births in Pennsylvania.

OBJECTIVES: The rising cesarean birth rate globally has led to increasing concern about long-term unintended consequences, with particular focus on child neurodevelopmental outcomes. This study investigated the association between cesarean birth and early child neurodevelopment, measured at 3 years of age. METHODS: This was a large multicenter longitudinal prospective cohort study of first-time mothers and their offspring in Pennsylvania. Mothers completed adapted versions of two measures of child development at 36- months postpartum: the modified Parents' Evaluation of Developmental Status (M-PEDS) and a shortened Ages and Stages Questionnaire (S-ASQ). Logistic regression models were used to assess the association between mode of delivery and delayed child development, controlling for confounding variables. RESULTS: There were 695 (29.3%) children born by cesarean delivery and 1676 (70.7) born vaginally. Children born by cesarean had increased odds of scoring as developmentally delayed on both measures of child development: the M-PEDS (8.9% cesarean and 5.1% vaginal, adjusted odds ratio [aOR] = 1.58, 95% confidence interval [CI] = 1.11-2.24)) and the S-ASQ (6.3% cesarean and 3.3% vaginal, aOR = 1.66, 95% CI = 1.09-2.54). Additional factors associated with developmental delay were male sex, and the maternal factors of high pre-pregnancy body mass index, thyroid disorder, and diabetes. CONCLUSION: In this large prospective cohort study of first-time mothers and their offspring, cesarean delivery was found to be associated with an elevated risk of delayed child development at age 3 years. This analysis highlights the importance of continued research to understand the impact of cesarean delivery on child development.

Maternal use of acetaminophen during pregnancy and neurobehavioral problems in offspring at 3 years: A prospective cohort study.

BACKGROUND: Acetaminophen is one of the most commonly used drugs during pregnancy globally. Recent studies have reported associations between prenatal exposure to acetaminophen and neurobehavioral problems in children, including attention-deficit hyperactivity disorders. Little research has investigated these associations in preschool-age children or the potential confounding effects of prenatal stress. The purpose of this study was to examine associations between prenatal acetaminophen exposure and offspring neurobehavioral problems at the age of 3 years, with a focus on the potentially confounding effects of prenatal stress. METHODS: We used data from the First Baby Study, a prospective cohort study conducted in Pennsylvania, USA, with 2,423 mother-child pairs. Women reported medication use and completed a prenatal stress inventory during their third trimester. Child behavioral problems were measured at the age of 3 years, using the 7 syndrome scale scores from the Child Behavior Checklist (CBCL) for ages 1 ½ to 5. RESULTS: There were 1,011 women (41.7%) who reported using acetaminophen during pregnancy. Children who were exposed to acetaminophen during pregnancy scored significantly higher on 3 of the 7 CBCL syndrome scales: withdrawn, sleep problems and attention problems. Scores on all 7 of the CBCL syndrome scales were significantly associated with prenatal stress. After adjustment for prenatal stress and other confounders, 2 syndrome scales remained significantly higher in children exposed to acetaminophen: sleep problems (aOR = 1.23, 95% CI = 1.01-1.51) and attention problems (aOR = 1.21, 95% CI = 1.01-1.45). CONCLUSIONS: These findings corroborate previous studies reporting associations between prenatal exposure to acetaminophen and attention problems in offspring and also show an association with sleep problems at age 3 years. Because use of acetaminophen during pregnancy is common, these results are of public health concern and suggest caution in the use of medications containing acetaminophen during pregnancy.

Infant sleep arrangements, infant-parent sleep, and parenting during the first six months post-partum.

The present study of 124 families examined linkages between patterns of sleep arrangement use across the first 6 months post-partum and (a) family socio-demographics, (b) nighttime sleep of infants, mothers, and fathers, and (c) coparenting distress, and mothers' emotional availability with infants and bedtime. Families were recruited when infants were 1-month-old, and infants were classified, from video data available at 3 and 6 months post-partum, into one of three sleep arrangement pattern groups: Solitary sleep, cosleeping, and cosleeping (at 3 months)-to-solitary sleep (at 6 months). Mothers in cosleeping arrangements were more likely to be at higher socioeconomic risk, non-White, unemployed, and to have completed fewer years of education. Controlling for these variables and for duration of breast feeding and parental depressive and anxiety symptoms, subsequent 3 (sleep arrangement pattern) X 2 (infant age: 3 and 6 months) mixed-model analyses of covariance revealed that sleep arrangement patterns were more robustly linked with maternal sleep than with infant and father sleep. Mothers in cosleeping arrangements experienced more fragmented sleep and greater variability in fragmented sleep relative to mothers of infants in solitary sleep, and fathers in cosleeping arrangements showed greater variability across the week in the number of minutes of nighttime sleep. Cosleeping was associated with mother reports of less positive and more negative coparenting, and mothers in cosleeping arrangements were independently observed to be less emotionally available with their infants at bedtime compared to mothers in the other two sleep arrangement groups. These linkages were largely upheld after statistically controlling for mothers' stated preference for sleep arrangements they were using.

Sleep Duration and Kindergarten Adjustment.

OBJECTIVES: The current study examined longitudinal linkages between child sleep duration and children's socioemotional, learning engagement, executive functioning, and academic outcomes across the full kindergarten (K) year. METHODS: A measurement-burst design was employed to examine 3 different measures of child sleep duration in 7-day bursts at pre-K (July-August), early K (late September), mid-K (late November), and late K (mid-to-late April), using wrist actigraphy. These measures included mean amounts of child sleep per 24-hour period across the full week, proportion of 24-hour periods per week that children slept 10 or more hours, and proportion of nighttime sleep periods per week that children slept 10 or more hours. Children's outcomes at early, mid-, and late K were provided by their K teachers blind to children's sleep histories, and by assessments administered by project staff. RESULTS: Among the 3 sleep measures examined, regularity of nighttime sleep in which children slept 10 or more hours per night, especially at pre-K, consistently predicted more favorable K outcomes in both socioemotional, learning engagement, and academic domains. Results suggested that establishing healthy nighttime sleep habits before K start was especially promotive of better K adjustment across the full K year. These findings were controlled for income-to-poverty threshold ratios, child health status, and number of missed school days. CONCLUSIONS: Efforts to promote a favorable transition to first-time schooling should pay particular attention to sleep hygiene and regularity of 10-plus hours of nightly child sleep established before the start of K.

Maternal nighttime sleep and infant-mother attachment security: The mediating role of maternal parenting quality during bedtime and free play.

The present study examined mothers' emotional availability (EA) during daytime free play and bedtime as a mediator of linkages between maternal nighttime sleep and infant-mother attachment. Participants included 153 mothers (85% White) with infants (53% female). When infants were 1, 3, 6, 9, and 12 months, maternal sleep was assessed using actigraphy and daily sleep diaries for 7 consecutive days. At each time point, mothers' EA was scored from one observation of daytime free play and from one evening observation of infant bedtime by trained observers who were blind to all other participant information. Average scores were created for maternal sleep and EA across the five occasions in the first year. At 12 and 18 months, infant-mother attachment security in the home was scored by blind observers using the Attachment Q-Set, averaged across the two age points, and used in analyses. Mediational analyses revealed that mothers who experienced highly variable sleep and had poor sleep quality were less emotionally available with infants at bedtime during infants' first year of life, which in turn was predictive of lower infant-mother attachment security in the second year, supporting mediation. Linkages between maternal sleep characteristics and daytime EA were less evident. Later maternal sleep timing was also directly predictive of low attachment security, after accounting for maternal EA. Findings emphasize that poor parental sleep places both parenting and infant socioemotional development at risk, and that parental sleep hygiene and sleep habits should be a salient focus of parenting intervention. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Ecological validity in measuring parents' executive function.

Parents' executive functions (EFs), or cognitive skills facilitating thought and behavior management, are meaningful correlates of parenting behavior. EFs are theorized to support parents in inhibiting reactive responses, managing information during parent-child interactions, and adapting to novel developmental demands. Less effective EFs associate with risk for harsh parenting and physical abuse, underscoring the importance of research on parental EFs in promoting healthy child development. Yet, despite the strong theory, findings are mixed and reveal only modest effect sizes in relations between EFs and parenting. One explanation may be a lack of ecological validity in measuring parental EFs. Traditional measures of adult EFs have been used, but these are decontextualized and do not reflect the cognitively and emotionally demanding nature of parenting. In this article, we argue that new and adapted measures are needed. We discuss the role of EFs in parenting, review measurement, and offer suggestions for improvements in ecological validity.

The role of household chaos on levels and trajectories of socioemotional behavior in the second year.

The second year of life is a time of formative developmental change as basic behavioral systems undergo rapid integration and expansion. This study examined the developmental trajectories of social-emotional (SoE) outcomes and the effects of infant sex and household chaos (HC) on the development of SoE outcomes across the second year of life. The participating families (N = 143) were ethnically homogenous (88% Caucasian) but economically diverse (31% low-to-very-low income). Mothers reported on their children's SoE outcomes including externalizing, internalizing, dysregulating problem behaviors as well as SoE competence when infants (54% girls) were 12, 18, and 24 months old. At each age point, HC was assessed through observations during home visits and compliance to the study protocols. Multilevel modeling revealed increasing developmental trajectories in all of the domains of SoE outcomes across the second year of life, reflecting the premise that these behavioral systems continue to form and become increasingly part of the infant's behavioral repertoire as development unfolds. However, compared to infants in less chaotic homes, infants in more chaotic households experienced steeper increases in both externalizing and internalizing problem behaviors across the second year, and girls showed higher levels of internalizing problem behaviors compared to boys. Results emphasize the increasing trajectories of problem behaviors in relation to ongoing chaotic caregiving environment among infants as young as 2 years of age. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Household chaos mediates the link between family resources and child sleep.

PURPOSE: This study examined the mediational role of household chaos in the link between family resources and child sleep outcomes during the transition to kindergarten. PROCEDURES: Participants included 230 families of children entering kindergarten (50% female) who participated in an 8-day measurement burst at pre-kindergarten (July-August), early kindergarten (September/October), and mid-kindergarten (November/December). At pre-kindergarten, mothers completFed the Family Resources Scale-Revised (FRS-R), while at pre- and early-kindergarten, trained observers assessed household chaos using the Descriptive In-Home Survey of Chaos-Observer ReporteD (DISCORD). To better understand perturbations in child sleep during this transition, actiwatches (AW Spectrum Plus, Philips/Respironics, Murrysville, PA) were used to measure both child sleep duration and proportion of recommended sleep duration (9+ hours per night) at early- and mid-kindergarten. MAIN FINDINGS: Results found that family resources were more clearly predictive of child sleep outcomes than household income. Controlling for quality of coparenting and maternal depressive symptoms, household chaos mediated the link between family resources and child sleep duration at both early and mid-kindergarten, the link between family resources and the proportion of recommended sleep duration in mid-kindergarten, and the change in proportion of recommended sleep from pre-kindergarten to early-kindergarten. CONCLUSIONS: Findings highlight household chaos as a mechanism by which family resources, a metric of socioeconomic risk, influences child sleep during the transition to kindergarten.

Socioeconomic status and infant nighttime sleep across the second year of life: The moderating role of infant attachment security.

This study examined socioeconomic status (SES) and attachment security as predictors of infant nighttime sleep during the second year. Participants included 128 mothers (86% White) with infants (48.4% boys). Data collection took place between April, 2009 and February, 2014. At 12, 18, and 24 months, infant sleep was assessed via actigraphy and daily diaries, and attachment with the Attachment Q-Set. SES indicators included income-to-needs ratios and education. Lower SES predicted greater variability in sleep duration and later sleep timing only for less secure infants. Less secure attachment was associated with poorer sleep at both between- and within-person levels, especially when infants were 12 months of age. Results emphasize the complex interactive effects of environmental and relational factors on infant sleep.

New conceptualizations and directions in the study of family context.

The manner in which family contexts place constraints on the universality of theoretical predictions has been of long-standing interest to developmental and family scientists. Current conceptualizations about family context, however, are evolving. Innovative thinking is emerging about how family contexts can be characterized, and there is growing appreciation that family contexts are dynamic, change across varying time scales, and that the manner in which they change impacts and alters trajectories of individual and family development. The present set of articles reflects these innovations and exemplifies how a systematic study of family context can further a richer and more comprehensive understanding of family life. We advocate a position in which the study of family context becomes a field of study in its own right and that approaching context and fit from a systems perspective will advance developmental and family science in exciting new directions. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Quality of coparenting and infant-mother attachment: The mediating role of maternal emotional availability.

Increasing attention has been paid to the influence of family contextual factors in predicting infant attachment security. However, little is known about the influence of coparenting quality on attachment. The goal of the present study was to examine the associations among parental perceptions of coparenting quality, quality of mothering (as indexed by maternal emotional availability), and infant-mother attachment. Parental reports of positive and negative coparenting quality, maternal emotional availability, and infant-mother attachment were assessed in 152 infants and their parents at 1, 3, 6, 9, and 12 months postpartum. Direct and indirect effects were assessed within a structural equation modeling framework to examine: (a) direct effects of mother-reported coparenting on infant-mother attachment, (b) indirect effects of mother-reported coparenting on infant-mother attachment through maternal emotional availability, and (c) indirect effects of father-reported coparenting on infant-mother attachment through maternal emotional availability. Results indicated that there was an indirect, but not direct, association between mother-reported coparenting quality across the first year of life and infant-mother attachment at 1 year through maternal emotional availability across the first year. Father-reported coparenting across infants' first year was not associated with infant-mother attachment at 1 year. Post hoc analyses revealed that mothers' perceptions of coparenting at 1 month were indirectly linked to attachment at 1 year through maternal emotional availability across the first year. Findings highlight the importance of coparenting quality, especially in the early postpartum, in organizing quality of parenting and infant attachment. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The contributory role of the family context in early childhood sleep health: A systematic review.

Sleep-wake regulation is established during early childhood and contributes to life-long health. The family context is critical to the development of child sleep-wake regulation. The primary aim of this systematic review was to elucidate family-level constructs (outside of bedtime parenting) that contribute to early childhood (age 0-5 years) sleep health. We identified empirical research articles that investigate these relationships through systematically searching PubMed, Web of Science, and PsycINFO databases. The transactional model of sleep-wake regulation guided the selection of family-level search terms, including socioeconomic status (SES), family structure, household chaos, marital, co-parenting, and social relationships. Sleep search terms included sleep problems, duration, timing, and variability. We searched sleep and family terms in combination with infant, toddler, or preschool developmental age. Sixteen studies satisfied criteria for inclusion. Results indicated that the presence of household chaos and poor quality marital relationships were directly associated with early childhood sleep problems and variable sleep timing. Higher marital satisfaction and the presence of household routines were positively associated with sleep duration. Several, but not all, studies showed an association between lower SES and poor child sleep health. There were no significant direct associations for family structure and limited findings for the role of perceived social support and co-parenting relationship quality. Overall, operationalization and measurement of family and sleep constructs varied across studies, decreasing our ability to make comparisons and draw robust conclusions. Future research should identify modifiable family-level factors that can be targeted, in addition to bedtime parenting, to improve sleep-wake regulation development.

Maternal sleep patterns and parenting quality during infants' first 6 months.

The present study examined both between- and within-person effects of maternal sleep patterns on quality of mothering at bedtime during infants' first 6 months. Participants included 142 mothers who reported on their daily fall asleep and wake times across seven consecutive days with a daily sleep diary when infants were 1, 3, and 6 months old. At each age point, maternal emotional availability during one night of infant bedtime was observed and scored by trained observers who were blind to maternal sleep patterns. Multilevel modeling revealed that mothers with irregular sleep patterns, especially later average fall asleep times and greater average variability in sleep period across three age points, showed poorer parenting quality with infants at bedtime than other mothers. In addition, both between- and within-person effects of maternal sleep on bedtime parenting quality changed with infant age. Compared to mothers' individual averages across 1, 3, and 6 months, maternal short average sleep period, increased variability in sleep period, and later fall asleep times predicted poorer bedtime parenting quality at 6 months, but not at 1 or 3 months. Results emphasize the importance of maternal sleep regulation and sleep hygiene for maternal parenting quality, especially as infants get older. (PsycInfo Database Record (c) 2020 APA, all rights reserved).