Examining implications of the developmental timing of maternal trauma for prenatal and newborn outcomes.

Separate literatures have demonstrated that mothers' experiences with trauma during childhood or pregnancy are associated with maternal prenatal health risks, adverse childbirth outcomes, and offspring internalizing and externalizing disorders. These literatures largely align with the intergenerational transmission or fetal programming frameworks, respectively. However, few studies have tested the effects of maternal childhood and prenatal trauma simultaneously on mothers' and infants' health outcomes, and no studies have examined these effects on newborn neurobehavioral outcomes. Thus, in the present study, we examined how the developmental timing of pregnant women's traumatic life experiences associated with their physical health and psychopathology (Aim 1) as well as their newborns' birth and neurodevelopmental outcomes (Aim 2; for pre-registered aims and hypotheses, see https://osf.io/ygnre/?view_only=cbe17d0ac7f24af5a4d3e37e24eebead). One hundred and fifty-two 3rd trimester pregnant women (Mage = 29 years; 17.1% Hispanic/Latina) completed measures of trauma history and psychopathology. Then, 24-48 h after birth, trained clinicians conducted newborn neurobehavioral exams (n = 118 newborns; 52.6% female). Results indicated that lifetime traumatic experiences associated with multiple prenatal maternal health outcomes, including depression, anxiety, emotion dysregulation, and pregnancy complications. Pregnant women's experiences with childhood trauma, but not adulthood or prenatal trauma, predicted higher neurobehavioral attention scores among female newborns. Our discussion highlights the importance of considering the developmental timing of maternal trauma on perinatal outcomes and contextualizes our findings within the intergenerational transmission and fetal programming literatures. DATA AVAILABILITY: Data pertaining to R01MH119070 (MPIs Crowell & Conradt) and that support these findings are uploaded to the NIMH repository.

Mental health symptom changes in pregnant individuals across the COVID-19 pandemic: a prospective longitudinal study.

BACKGROUND: Initial studies found that mental health symptoms increased in pregnant and postpartum individuals during the COVID-19 pandemic. Less research has focused on if these putative increases persist over time and what factors influence these changes. We examined the longitudinal change in mental health symptoms in pregnant and postpartum individuals and investigated moderation by maternal emotion dysregulation and the incidence of coronavirus. METHODS: Pregnant and postpartum individuals at the University of Utah were invited to join the COVID-19 and Perinatal Experiences (COPE) Study. Beginning on April 23, 2020 participants were sent a survey comprised of demographics, medical and social history, pregnancy information and self-assessments (Time 1). Participants were contacted 90 days later and invited to participate in a follow-up questionnaire (Time 2). Daily coronavirus case counts were accessed from the state of Utah and a 7-day moving average calculated. Within-subject change in mental health symptom scores, as measured by the Brief Symptom Inventory, was calculated. Linear mixed effects regression modeling adjusted for history of substance abuse and mental health disorders. RESULTS: 270 individuals responded between April 23rd, 2020 and July 15th, 2021. Mental health symptom scores improved by 1.36 points (0.7-2.0 p < 0.001). The decrease in mental health symptoms was not moderated by the prevalence of COVID-19 cases (p = 0.19) but was moderated by emotion dysregulation (p = 0.001) as defined by the Difficulties in Emotion Regulation Scale short form. Participants with higher emotion dysregulation also had higher mental health symptom scores. CONCLUSION: Mental health symptoms improved over the course of the pandemic in the same pregnant or postpartum participant. Our findings do not negate the importance of mental health care during the pandemic. Rather, we believe this identifies some aspect of resiliency and adaptability. Examining emotion dysregulation, or asking about a history of mental health, may be helpful in identifying persons at higher risk of heightened responses to stressors.

Developmental foundations of physiological dynamics among mother-infant dyads: The role of newborn neurobehavior.

This study tested whether newborn attention and arousal provide a foundation for the dynamics of respiratory sinus arrhythmia (RSA) in mother-infant dyads. Participants were 106 mothers (Mage  = 29.54) and their 7-month-old infants (55 males and 58 White and non-Hispanic). Newborn attention and arousal were measured shortly after birth using the NICU Network Neurobehavioral Scale. Higher newborn arousal predicted a slower return of infant RSA to baseline. Additionally, greater newborn attention predicted mothers' slower return to baseline RSA following the still-face paradigm, and this effect only held for mothers whose infants had lower newborn arousal. These findings suggest that newborn neurobehavior, measured within days of birth, may contribute to later mother-infant physiological processes while recovering from stress.

Prenatal paternal stress predicts infant parasympathetic functioning above and beyond maternal prenatal stress.

BACKGROUND: Paternal stress is often assessed by maternal report and is posited to influence infant development indirectly by contributing to a mother's stress and experiences during pregnancy. Far less is known about how direct effects of prenatal paternal stress, as described by fathers themselves, are related to an infant's physiological functioning. We assessed fathers' own experiences of stress and examined its direct impact on infant respiratory sinus arrhythmia (RSA), a biological index of self-regulation, at seven-month postpartum. METHOD: During the third trimester of pregnancy, the UCLA Life Stress Interview was conducted to assess chronic stress in mothers and fathers (N = 90). Infant baseline RSA and RSA reactivity in response to the Still-Face paradigm were assessed at seven-month postpartum. RESULTS: Infants of fathers with high prenatal stress showed lower baseline RSA, possibly reflective of poor infant psychophysiological regulation. The predictive role of paternal stress remained significant after controlling for maternal stress. CONCLUSIONS: Our findings provide emerging empirical evidence to support the influence of prenatal paternal stress on infant RSA, highlighting the important role of fathers for child development.

Bringing the laboratory into the home: A protocol for remote biobehavioral data collection in pregnant women with emotion dysregulation and their infants.

Pregnant women struggling with emotion dysregulation may be more likely to engage in a wide range of health risk behaviors. This protocol describes a study on intergenerational transmission of emotion dysregulation from the third trimester of pregnancy to 18 months postpartum. Biobehavioral markers of emotion dysregulation are typically measured in laboratory settings which was prohibited by many universities during the COVID-19 pandemic. We describe how markers of emotion dysregulation (e.g. maternal, fetal, and infant heart rate variability) are collected remotely. We detail how data collection can be augmented to reach diverse populations who may not otherwise participate in laboratory-based research.

Adapting psychophysiological data collection for COVID-19: The "Virtual Assessment" model.

The COVID-19 pandemic has significantly disrupted research activities globally. Researchers need safe and creative procedures to resume data collection, particularly for projects evaluating infant mental health interventions. Remote research is uniquely challenging for psychophysiological data collection, which typically requires close contact between researchers and participants as well as technical equipment frequently located in laboratory settings. In accordance with public health guidance, we adapted procedures and developed novel protocols for a "virtual assessment" in which women and infants provided behavioral and psychophysiological data from their own homes while researchers coordinated remotely. Data collected at virtual visits included video-recorded parent-child interactions and autonomic nervous system data. Adaptations were designed to optimize safety and data quality while minimizing participant burden. In the current paper, we describe these adaptations and present data evaluating their success across two sites in the United States (University of Delaware and University of Utah), focusing specifically on autonomic nervous system data collected during the well-validated Still-Face Paradigm (SFP). We also discuss advantages and challenges of translating traditional lab procedures into the virtual assessment model. Ultimately, we hope that disseminating these procedures will help other researchers resume safe data collection related to infant mental health during the COVID-19 pandemic and beyond.

La pandemia del COVID-19 ha interrumpido significativamente las actividades de investigación globalmente. Los investigadores necesitan procedimientos seguros y creativos para reasumir la recolección de información, particularmente para proyectos con los que se evalúan intervenciones de salud mental infantil. La investigación remota es particularmente desafiante para recoger información psicofisiológica, lo cual típicamente requiere contacto cercano entre investigadores y participantes, así como también equipo técnico frecuentemente localizado en centros de laboratorio. De acuerdo con las directrices de salud pública, adaptamos procedimientos y desarrollamos protocolos novedosos para una "evaluación virtual," en la cual mujeres e infantes aportaron datos de conducta y psicofisiológicos desde sus propias casas mientras que los investigadores coordinaban remotamente. La información recogida en las visitas virtuales incluyó interacciones progenitor-niño grabadas en video e información del sistema nervioso autónomo. Se diseñaron las adaptaciones para optimizar la seguridad y la calidad de la información mientras que se reducía al mínimo la carga que conlleva la participación. En el presente estudio, describimos estas adaptaciones y presentamos información evaluativa del éxito en dos lugares de Estados Unidos (la Universidad de Delaware y la Universidad de Utah), con enfoque específico en la información obtenida acerca del sistema nervioso autónomo durante el ya bien validado Paradigma del Rostro Inmóvil. Discutimos también las ventajas y retos para transferir los procedimientos tradicionales de laboratorio al modelo de evaluación virtual. En última instancia, esperamos que al diseminar estos procedimientos ayudaremos a otros investigadores a reasumir la segura recolección de información relacionada con la salud mental infantil durante la pandemia del COVID-19 y posteriormente.

La pandémie du COVID-19 a perturbé de manière importante les activités de recherche au niveau global. Les chercheurs ont besoin de procédures sûres et créatives pour reprendre la collecte de données, particulièrement pour des projets évaluant des interventions en santé mentale du nourrisson. Les recherches à distance présentent un défi unique pour la collecte de données psychophysiologiques, qui typiquement exige un contact proche entre les chercheurs et les participants ainsi qu'un équipement technique fréquemment situé en contextes de laboratoire. En accord avec les directives de santé publique nous avons adapté les procédures et développés de nouveaux protocoles pour une « évaluation virtuelle ¼ durant laquelle les femmes et les bébés ont présenté des données comportementales et psychophysiologiques depuis leurs propres domiciles alors que les chercheurs coordonnaient le tout à distance. Les données recueillies durant les visites virtuelles ont inclus des interactions parent-enfant enregistrées à la vidéo et des données liées au système nerveux autonome. Les adaptations ont été conçues afin d'optimiser la sécurité et la qualité des données tout en minimisant le fardeau pour les participants. Dans cet article nous décrivons ces adaptations et présentons les données évaluant leur succès au travers de deux sites aux Etats-Unis (University of Delaware et University of Utah), en s'attachant plus spécifiquement aux données sur le système nerveux autonome obtenues durant le Paradigme de Visage Inexpressif, qui est bien validé. Nous discutons également les avantages et des défis qu'il y a à traduire des procédures traditionnelles de laboratoire en un modèle d'évaluation virtuel. Finalement nous espérons que le fait de disséminer ces procédures aidera d'autres chercheurs à reprendre de manière sûre la collecte de données liées à la santé mentale du nourrisson durant la pandémie du COVID-19 et plus loin.

Influences of adversity across the lifespan on respiratory sinus arrhythmia during pregnancy.

There is limited understanding of factors across the lifespan that influence pregnant women's respiratory sinus arrhythmia (RSA), which could have implications for their health and offspring development. We examined associations among 162 English- and Spanish-speaking pregnant women's childhood maltreatment history, emotion dysregulation, recent life stress, and resting RSA during the third trimester. Moderated mediation analyses indicated that more severe childhood maltreatment history (95% confidence interval (CI) [0.26, 0.63]) and higher emotion dysregulation (95% CI [0.001, 0.006]) predicted more stress during pregnancy, and childhood maltreatment history interacted with emotion dysregulation to predict resting RSA (95% CI [-0.04, -0.0003]). Exploratory analyses revealed that women's health-related stress during pregnancy mediated the relation between emotion dysregulation and RSA regardless of childhood maltreatment severity (95% CI [-0.007, -0.002]). These findings suggest that women's resting RSA during pregnancy may reflect physical and emotional stress accumulation across the lifespan and that relations between early life adversity and prenatal psychophysiology may be buffered by protective factors, such as emotion regulation. In addition, these findings underscore the importance of distinguishing between types of prenatal stress. Given the implications for women's health and offspring development, we urge researchers to continue exploring factors associated with pregnant women's psychophysiology.

Behavioral and physiological stress responses: Within-person concordance during pregnancy.

During pregnancy, a woman's emotions can have longstanding implications for both her own and her child's health. Within-person emotional concordance refers to the simultaneous measurement of emotional responses across multiple levels of analysis. This method may provide insight into how pregnant women experience emotions in response to stress. We enrolled 162 pregnant women and assessed concordance through autonomic physiology (electrodermal activity [EDA], respiratory sinus arrhythmia [RSA]), and coded behavior (Prosocial, Flight, Displacement) during the Trier Social Stress Test-Speech. We used multilevel models to examine behavioral-physiological concordance and whether self-reported emotion dysregulation moderated these effects. Participants exhibited EDA-Prosocial concordance, suggesting that prosocial behavior may be a marker of stress. Emotion dysregulation did not moderate concordance. These findings provide novel information about behavioral coping to stress in pregnancy. Given the importance of observed behavior in the maintenance and treatment of psychopathology, these findings may provide a launchpad for future perinatal intervention research.

Intergenerational transmission of emotion dysregulation: Part I. Psychopathology, self-injury, and parasympathetic responsivity among pregnant women.

The World Health Organization recently reported that maternal mental health is a major public health concern. As many as one in four women suffer from psychiatric disorders at some point during pregnancy or the first postpartum year. Furthermore, self-injurious thoughts and behaviors (SITBs) represent one of the leading causes of death among women during this time. Thus, efforts to identify women at risk for serious forms of psychopathology and especially for SITBs are of utmost importance. Despite this urgency, current single-diagnostic approaches fail to recognize a significant subset of women who are vulnerable to perinatal stress and distress. The current study was among the first to investigate emotion dysregulation-a multilevel, transdiagnostic risk factor for psychopathology-and its associations with stress, distress, and SITBs in a sample of pregnant women (26-40 weeks gestation) recruited to reflect a range of emotion dysregulation. Both self-reported emotion dysregulation and respiratory sinus arrhythmia, a biomarker of emotion dysregulation, demonstrated expected associations with measures of mental health, including depression, anxiety, borderline personality pathology, and SITBs. In addition, self-reported emotion dysregulation was associated with blunted respiratory sinus arrhythmia responsivity to an ecologically valid infant cry task. Findings add to the literature considering transdiagnostic risk during pregnancy using a multiple-levels-of-analysis approach.