Trajectories of illness uncertainty among parents of children with atypical genital appearance due to differences of sex development.

OBJECTIVE: The present study aimed to identify distinct trajectories of parental illness uncertainty among parents of children born with atypical genital appearance due to a difference of sex development over the first year following diagnosis. It was hypothesized that four trajectory classes would emerge, including "low stable," "high stable," "decreasing," and "increasing" classes, and that select demographic, familial, and medical factors would predict these classes. METHODS: Participants included 56 mothers and 43 fathers of 57 children born with moderate to severe genital atypia. Participants were recruited from eleven specialty clinics across the U.S. Growth mixture modeling (GMM) approaches, controlling for parent dyad clustering, were conducted to examine classes of parental illness uncertainty ratings over time. RESULTS: A three-class GMM was identified as the best-fitting model. The three classes were interpreted as "moderate stable" (56.8%), "low stable" (33.0%), and "declining" (10.3%). Findings suggest possible diagnostic differences across trajectories. CONCLUSIONS: Findings highlight the nature of parents' perceptions of ambiguity and uncertainty about their child's diagnosis and treatment the year following their child's birth/diagnosis. Future research is needed to better understand how these trajectories might shift over the course of the child's development. Results support the development of tailored, evidence-based interventions to address coping with uncertainty among families raising a child with chronic health needs.

The Protective Role of Maternal-Fetal Bonding for Postpartum Bonding Following a NICU Admission.

INTRODUCTION: Admission of a newborn to a neonatal intensive care unit (NICU) can be a highly stressful event that affects maternal psychological well-being and disrupts the early maternal-infant bonding relationship. Determining factors that promote maternal-infant bonding among those with a NICU admission is essential for the development of effective interventions. METHODS: Using a longitudinal clinic-based sample of diverse and low-income pregnant women, we examined whether maternal-fetal bonding measured during the second trimester moderated the association between NICU admission and postpartum bonding measured at six months post birth, controlling for demographic characteristics. RESULTS: Approximately 18% of the sample experienced a NICU admission at birth. NICU admission was associated with lower postpartum bonding (b = -8.74; p < .001, Model 1), whereas maternal-fetal bonding was associated with higher bonding reported at six months postpartum (b = 3.74, p < .001, Model 2). Results of the interaction revealed that women who reported higher maternal-fetal bonding reported higher postnatal bonding regardless of NICU admission status. DISCUSSION: Because maternal-fetal bonding can be enhanced through intervention, it is a promising target for reducing the risks of NICU admission for the early maternal-infant relationship.

Adverse Birth Experiences and Parent Adjustment Associated With Atypical Genital Appearance Due to Differences of Sex Development.

OBJECTIVE: Differences/disorders of sex development (DSDs) are rare, congenital conditions involving discordance between chromosomes, gonads, and phenotypic sex and are often diagnosed in infancy. A key subset of parents of children newly diagnosed with a DSD experience clinically elevated distress. The present study examines the relationship between perinatal factors (i.e., gestational age, delivery method) and trajectories of parental adjustment. METHODS: Parent participants (mothers = 37; fathers = 27) completed measures at baseline, 6- and 12-month follow-up. Multilevel linear regression controlled for clustering of the data at three levels (i.e., time point, parent, and family) and examined the relationship between perinatal factors and trajectories of depressive and anxious symptoms. Two-way interactions between perinatal factors and parent type were evaluated. RESULTS: Overall depressive and anxious symptoms decreased over time. There were significant interactions between gestational age and parent type for depressive and anxious symptoms, with younger gestational age having a stronger negative effect on mothers vs. fathers. There was a significant interaction between time and gestational age for depressive symptoms, with 36 weeks' gestational age demonstrating a higher overall trajectory of depressive symptoms across time compared to 38 and 40 weeks. Findings for the delivery method were not significant. CONCLUSIONS: Findings uniquely demonstrated younger gestational age was associated with increased depressive symptoms, particularly for mothers compared to fathers. Thus, a more premature birth may predispose parents of infants with DSD to distress. Psychosocial providers should contextualize early diagnosis-related discussions within stressful birth experiences when providing support.

Maternal childhood adversity and prenatal depression: the protective role of father support.

Depression during pregnancy is common, and previous research suggests childhood adversity may increase the risk for prenatal depression. Support during pregnancy can buffer these risks, and paternal support is associated with improved maternal well-being during pregnancy. There is evidence to suggest that increased support from fathers may be particularly helpful in combatting depressive symptoms for mothers with adverse childhood experiences. The study aims to explore the role of biological father support as a protective factor against the risks associated with childhood adversity for maternal prenatal depression. Sample included 133 pregnant women recruited from two university-affiliated OB-GYN clinics serving diverse and low-income patients. Participants completed measures on childhood adversity, prenatal depressive symptoms, and father support. Results showed a significant moderating effect of father support on the relation between maternal ACEs and prenatal depressive symptoms, suggesting that higher levels of father support are protective against prenatal depressive symptoms, specifically in mothers with low-to-moderate ACEs. These results highlight the positive impact of paternal support for maternal well-being during pregnancy. Although mothers with low-to-moderate ACEs experience a buffering effect of father support, mothers with high levels of childhood adversity remain at elevated risk for prenatal depressive symptoms even with high father support. As such, screening mothers for ACEs in addition to father support may help identify those at higher risk of prenatal depression.

Maternal childhood adversity and pregnancy intentions as predictors of pregnancy happiness.

OBJECTIVES: Nearly half of all pregnancies in the U.S. are classified as unintended (e.g. unplanned, mistimed, or unwanted), which have been linked to numerous adverse consequences for maternal and child outcomes. Recent evidence suggests that happiness about a pregnancy is often a better predictor of maternal and infant health outcomes than pregnancy intentions, but few studies have examined maternal predictors of pregnancy happiness. METHODS: Using a clinic-based sample of pregnant women (n = 177), we apply multiple regression analysis to examine the association between maternal adverse childhood experiences and pregnancy happiness, as well as the moderating role of pregnancy intentions. RESULTS: Women with more childhood adversity and pregnancies that were unplanned and mistimed or unwanted reported lower levels of pregnancy happiness, compared with women with less childhood adversity and intended pregnancies. However, pregnancy intentions did not moderate the relationship between maternal adverse childhood experiences and pregnancy happiness. CONCLUSION: Our results suggest that pregnancy happiness is lower among mothers with a history of childhood adversity and pregnancies classified as unplanned and mistimed or unwanted. Understanding the factors that impact pregnancy happiness is critical to inform prenatal clinical practice and health policy, particularly when caring for those with a history of adversity.

Mindful acceptance, not awareness, associated with lower food susceptibility.

PURPOSE: Food susceptibility refers to an individual's thoughts, feelings, and motivations when highly palatable foods are available. Mindfulness, or the practice of paying attention, non-judgmentally, in the present moment, is a key element in acceptance-based programs, which have been shown to benefit those with high food susceptibility. This study examined the relationship between food susceptibility and (1) trait mindfulness and (2) mindfulness facets (i.e., awareness, acceptance) in daily life. METHODS: Participants were 108 adults with overweight/obesity (45.56 ± 11.41 years old, 75.9% white, 72.2% female) enrolled in a weight loss trial (Clinical Trials.gov Identifier: NCT02786238). Food susceptibility was measured with the Power of Food Scale (PFS). Mindfulness was assessed using the Philadelphia Mindfulness Scale (PHMS) and its two subscales: PHMS-Awareness and PHMS-Acceptance. Two regressions examined the associations of (1) total PHMS on PFS, and (2) simultaneous PHMS subscales on PFS. Covariates were age, sex, race, and education. RESULTS: Regression results revealed, after adjustment for covariates, that Total PHMS was significantly negatively associated with PFS scores (ß = - 0.258, p = 0.001), but only one of the PHMS subscales, Acceptance, was significantly associated with PFS scores (ß = - 0.328, p < 0.001). PHMS-Awareness was not related to PFS scores. CONCLUSION: Greater levels of mindfulness were associated with lower food susceptibility in treatment-seeking adults with overweight/obesity. Mindful acceptance may be the driving factor in this relationship, suggesting that awareness alone is not sufficient for promoting healthier appetite regulation. Interventions aimed to reduce food susceptibility and improve coping with cravings may benefit from an enhanced focus on teaching mindful-acceptance skills. LEVEL OF EVIDENCE: Level III, observational cohort study.

Maternal Childhood Adversity as a Risk for Perinatal Complications and NICU Hospitalization.

OBJECTIVE: To examine maternal childhood adversity in relation to increased risk for maternal and infant perinatal complications and newborn Neonatal Intensive Care Unit (NICU) admittance. METHODS: A sample of 164 women recruited at their first prenatal appointment participated in a longitudinal study through 6 weeks postdelivery. Participants self-reported on their adverse childhood experiences (ACEs), negative health risks (overweight/obesity, smoking, and alcohol use), adverse infant outcomes, NICU admittance, and maternal perinatal complications across three pregnancy assessments and one post-birth assessment. Logistic binomial regression analyses were used to examine associations between maternal ACEs and adverse infant outcomes, NICU admittance, and maternal perinatal complications, controlling for pregnancy-related health risks. RESULTS: Findings showed that women with severe ACEs exposure (6+ ACEs) had 4 times the odds of reporting at least one adverse infant outcome (odds ratio [OR] = 4.33, 95% CI: 1.02-18.39), almost 9 times the odds of reporting a NICU admission (OR = 8.70, 95% CI: 1.34-56.65), and 4 times the odds of reporting at least one maternal perinatal outcome (OR = 4.37, 95% CI: 1.43-13.39). CONCLUSIONS: The findings demonstrate the extraordinary risk that mothers' ACEs pose for infant and maternal health outcomes over and above the associations with known maternal health risks during pregnancy, including overweight/obesity, smoking, and alcohol use. These results support a biological intergenerational transmission framework, which suggests that risk from maternal adversity is perpetuated in the next generation through biophysical and behavioral mechanisms during pregnancy that negatively affect infant health outcomes.

Neonatal intensive care unit admission and maternal postpartum depression.

Objective: This study aimed to examine the impact of newborns' Neonatal Intensive Care Unit (NICU) admittance on maternal postpartum depression. Background: Prior research on the parental psychological impacts of a NICU admittance typically includes a hospital sample of parents following birth, so the causality of NICU admittance and maternal depressive symptomatology is unclear. Methods: 127 women across 38 counties in a South Central US state participated in online surveys in their third trimester and approximately six weeks post-birth in 2016. Pre- and post-birth assessments of depression were measured with the Center for Epidemiologic Studies Depression Scale (CES-D). NICU admittance was asked in the post-birth survey. t-Tests and multivariable regression analyses were used to determine predictors of NICU admittance and postnatal depressive symptomatology. Results: Findings indicate that prenatal depression does not differ significantly between mothers by NICU admission status, but NICU admission is a significant predictor of postpartum depressive symptomatology. Conclusions: Having a newborn admitted to the NICU is a risk factor for maternal postpartum depression. These findings have implications for practice; screening mothers in the NICU for depression as a target for intervention has the potential to improve maternal well-being, which in turn should enhance subsequent infant developmental outcomes.

Adolescents from upper middle class communities: Substance misuse and addiction across early adulthood.

In this prospective study of upper middle class youth, we document frequency of alcohol and drug use, as well as diagnoses of abuse and dependence, during early adulthood. Two cohorts were assessed as high school seniors and then annually across 4 college years (New England Study of Suburban Youth younger cohort [NESSY-Y]), and across ages 23-27 (NESSY older cohort [NESSY-O]; ns = 152 and 183 at final assessments, respectively). Across gender and annual assessments, results showed substantial elevations, relative to norms, for frequency of drunkenness and using marijuana, stimulants, and cocaine. Of more concern were psychiatric diagnoses of alcohol/drug dependence: among women and men, respectively, lifetime rates ranged between 19%-24% and 23%-40% among NESSY-Os at age 26; and 11%-16% and 19%-27% among NESSY-Ys at 22. Relative to norms, these rates among NESSY-O women and men were three and two times as high, respectively, and among NESSY-Y, close to one among women but twice as high among men. Findings also showed the protective power of parents' containment (anticipated stringency of repercussions for substance use) at age 18; this was inversely associated with frequency of drunkenness and marijuana and stimulant use in adulthood. Results emphasize the need to take seriously the elevated rates of substance documented among adolescents in affluent American school communities.

When Mothers and Fathers Are Seen as Disproportionately Valuing Achievements: Implications for Adjustment Among Upper Middle Class Youth.

High achievement expectations and academic pressure from parents have been implicated in rising levels of stress and reduced well-being among adolescents. In this study of affluent, middle school youth, we examined how perceptions of parents' emphases on achievement (relative to prosocial behavior) influenced youth's psychological adjustment and school performance, and examined perceived parental criticism as a possible moderator of this association. The data were collected from 506 (50 % female) middle school students from a predominately white, upper middle class community. Students reported their perceptions of parents' values by rank ordering a list of achievement- and prosocial-oriented goals based on what they believed was most valued by their mothers and fathers for them (the child) to achieve. The data also included students' reports of perceived parental criticism, internalizing symptoms, externalizing symptoms, and self-esteem, as well as school-based data on grade point average and teacher-reported classroom behavior. Person-based analyses revealed six distinct latent classes based on perceptions of both mother and father emphases on achievement. Class comparisons showed a consistent pattern of healthier child functioning, including higher school performance, higher self-esteem, and lower psychological symptoms, in association with low to neutral parental achievement emphasis, whereas poorer child functioning was associated with high parental achievement emphasis. In variable-based analyses, interaction effects showed elevated maladjustment when high maternal achievement emphasis coexisted with high (but not low) perceived parental criticism. Results of the study suggest that to foster early adolescents' well-being in affluent school settings, parents focus on prioritizing intrinsic, prosocial values that promote affiliation and community, at least as much as, or more than, they prioritize academic performance and external achievement; and strive to limit the amount of criticism and pressure they place on their children.

Reciprocity among maternal distress, child behavior, and parenting: transactional processes and early childhood risk.

Transactional theories support that parent-child processes are best studied in conjunction with one another, addressing their reciprocal influence and change across time. This study tested a longitudinal, autoregressive model exploring bidirectional relations among maternal symptomatology, child internalizing/externalizing symptoms, and maternal sensitivity during the preschool period (child ages 3 to 5 years), comparing relations among families of typically developing children and children with developmental risk. This study included 250 families, 110 of which had a child with early developmental delay. Analyses utilized data from maternal report, father report, and observational methods. The results indicated significant stability in maternal symptomatology, child internalizing/externalizing symptoms, and maternal sensitivity over time. Support for bidirectional effects between maternal symptomatology and child internalizing symptoms was found specifically for mothers of children with developmental risk. Maternal symptomatology was found to mediate the influence of child internalizing and externalizing symptoms on maternal sensitivity. The findings underscore critical transactional processes within families of children with early developmental risk that connect increased maternal symptomatology to emerging child internalizing symptoms during the preschool period.

Maternal periconception food insecurity and postpartum parenting stress and bonding outcomes.

Food insecurity during pregnancy is associated with various adverse pregnancy outcomes for the mother and infant, but less is known about the role of periconception food insecurity and its links to maternal and child wellbeing in the postpartum period. In a sample of 115 diverse (41% white) and predominately low-income mothers, results of hierarchical regression analyses showed that periconception food insecurity was positively associated with parenting stress at 2 months postpartum. A negative association between food insecurity and maternal-infant bonding at 6 months postpartum was mediated after controlling for prenatal depression, social support, and demographic factors. Findings highlight the need for maternal linkage to effective food security programs, such as United States-based Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), for women during their childbearing years due to the critical importance of food security for maternal and infant well-being.

Biobehavior Life Regulation (BLR) scale for living well in chronic pain: Preliminary scale development and validation.

Currently available pain assessment scales focus on pain-related symptoms and limitations imposed by pain. Validated assessment tools that measure how pain is regulated by those who live well with pain are missing. This study seeks to fill this gap by describing the development and preliminary validation of the Biobehavior Life Regulation (BLR) scale. The BLR scale assesses engagement, social relatedness, and self-growth in the presence of chronic pain and the unpredictability of chronic pain. Sources for items included survivor strategies, patient experiences, existing scales, and unpredictable pain research. Review for suitability yielded 52 items. Validation measures were identified for engagement, social relatedness, self-growth, and unpredictability of pain. The study sample (n = 202) represented patients treated in the Phoenix VA Health Care System (n = 112) and two community clinics (n = 90). Demographic characteristics included average age of 52.5, heterogeneous in ethnicity and race at the VA, mainly Non-Hispanic White at the community clinics, 14 years of education, and pain duration of 18 years for the VA and 15.4 years for community clinics. Exploratory factor analysis using Oblimin rotation in the VA sample (n = 112) yielded a two-factor solution that accounted for 48.23% of the total variance. Confirmatory factor analysis (CFA) in the same sample showed high correlations among items in Factor 1, indicating redundancy and the need to further reduce items. The final CFA indicated a 2-factor solution with adequate fit to the data. The 2-factor CFA was replicated in Sample 2 from the community clinics (n = 90) with similarly adequate fit to the data. Factor 1, Pain Regulation, covered 8 items of engagement, social relatedness, and self-growth while Factor 2, Pain Unpredictability, covered 6 items related to the experience of unpredictable pain. Construct validity showed moderate to higher Pearson correlations between BLR subscales and relevant well-established constructs that were consistent across VA and community samples. The BLR scale assesses adaptive regulation strategies in unpredictable pain as a potential tool for evaluating regulation resources and pain unpredictability.

Associations between adverse childhood experiences and history of weight cycling.

Background: Adverse childhood experiences (ACEs) predict obesity onset; however, the relationship between ACEs and history of weight cycling has not been adequately explored. This gap is problematic given the difficulty in weight loss maintenance and the impact of ACEs on obesity development, chronicity, and associated weight stigma. The objective of this study was to examine associations between self-reported history of ACEs and weight cycling in a sample of weight loss treatment-seeking adults with overweight/obesity. Methods: The number of participants in the analyzed sample was 78, mostly white educated adult women (80% female, 81% Caucasian, 75% ≥ bachelor's degree) with excess adiposity enrolled in the Cognitive and Self-regulatory Mechanisms of Obesity Study. ACEs were measured at baseline using the ACEs Scale. History of weight cycling was measured using the Weight and Lifestyle Inventory that documented weight loss(es) of 10 or more pounds. Results: Higher ACE scores were associated with a greater likelihood of reporting a history of weight cycling. Participants with four or more ACEs had 8 times higher odds (OR = 8.301, 95% CI = 2.271-54.209, p = 0.027) of reporting weight cycling compared with participants with no ACEs. The association of weight cycling for those who endorsed one to three ACEs was not significant (OR = 2.3, 95% CI = 0.771-6.857, p = 0.135) in this sample. Conclusions: The role of ACEs in health may be related to associations with weight cycling. Results indicated that those who reported four or more ACEs had significantly higher odds of reporting weight cycling compared with those with no ACEs. Further research is needed to further explore how ACEs predict the likelihood of weight cycling, which may be prognostic for sustained weight loss treatment response and weight stigma impacts.

Capturing the complexity of child behavior and caregiver-child interactions in the HEALthy Brain and Child Development (HBCD) Study using a rigorous and equitable approach.

The HEALthy Brain and Child Development (HBCD) Study, a multi-site prospective longitudinal cohort study, will examine human brain, cognitive, behavioral, social, and emotional development beginning prenatally and planned through early childhood. This article outlines methodological considerations and the decision-making process for measurement selection for child behavior, parenting/caregiver-child interactions, and the family/home environment for HBCD. The decision-making process is detailed, including formation of a national workgroup (WG-BEH) that focused on developmentally appropriate measures that take a rigorous and equitable approach and aligned with HBCD objectives. Multi-level-observational and caregiver-report measures were deemed necessary for capturing the desired constructs across multiple contexts while balancing the nuance of observational data with pragmatic considerations. WG-BEH prioritized developmentally sensitive, validated assessments with psychometrics supporting use in diverse populations and focused on mechanistic linkages and prediction of desired constructs. Other considerations included participant burden and retention, staff training needs, and cultural sensitivity. Innovation was permitted when it was grounded in evidence and filled key gaps. Finally, this article describes the rationale for the selected constructs (e.g., temperament, social-emotional development, parenting behaviors, family organization) and corresponding measures chosen for HBCD visits from early infancy through 17 months of age.

Effects of a Mindfulness-Based Parental Reflection Intervention on Pregnancy-Related Distress: A Pilot Study.

Background: Mindfulness-based interventions have been shown to be efficacious for reducing psychological distress and mental health symptoms and promoting well-being, including during pregnancy and postpartum. There is promising, though limited, evidence showing that interventions that focus on improving the mother-infant relationship are associated with improvements in both the mother-infant relationship and maternal mental health symptoms. The current study examines the effects of a prenatal mindfulness-based, reflective intervention designed to enhance maternal-fetal bonding on pregnancy-related distress and prenatal depressive symptoms. Methods: Out of a larger sample of 130 pregnant women in their second trimester, 15 women were recruited to participate in a 2-week long mindfulness-based, reflective intervention with daily short (<5-minute) activities. Multiple linear regression analyses were conducted to examine associations between the intervention and pregnancy-related distress and depression during the third trimester of pregnancy, controlling for race, age, education, union status, and first trimester depressive symptoms. Results: Results indicate that women who participated in the intervention during their second trimester reported lower pregnancy-related distress in their third trimester but no differences in depressive symptoms. Conclusions: A brief, mindfulness-based intervention delivered during pregnancy via cellphone texts can be a useful tool to reduce maternal distress related to pregnancy. Additional reflective exercises that address mood and global stress, as well as increasing the amount and/or frequency of the intervention, may be important for promoting maternal mental health more globally.

Maternal Adverse Childhood Experiences and Perceived Stress During Pregnancy: The Role of Personality.

This study explores the role of personality traits in the relationship between maternal adverse childhood experiences (ACEs) and perceived stress during pregnancy. Pregnancy can be a stressful time for new mothers. ACEs have been associated with elevated levels of pregnancy stress, and have also been linked to the Big Five dimensions of personality, including a positive association with neuroticism. The Big Five have also been associated with perceptions of stress, and there is evidence to suggest that personality may be one mechanism through which ACEs disrupt psychosocial functioning during pregnancy. The sample included 177 pregnant girls and women (ages 15-40) from two prenatal clinics serving diverse and low-income patients. Participants completed online questionnaires on perceived stress, ACEs, and the Ten Item Personality Inventory. Results of a path analysis and test of mediation showed significant indirect effects from ACEs to perceived stress mediated independently by neuroticism and conscientiousness. Mothers with high ACEs reported higher neuroticism and lower conscientiousness, and in turn, experienced high levels of perceived stress during pregnancy. High neuroticism and low conscientiousness associated with early adverse experiences increase the risk for perceived stress during pregnancy. Screening for ACEs may help identify mothers at risk for perinatal stress and provide the opportunity for additional support for maternal emotion regulation and mental health.

What is already known on this subject?Research has shown that experiencing adversity during childhood is associated with higher levels of stress during pregnancy. Early life adversity has also been associated with all Big Five personality traits and personality has been implicated as an important factor contributing to psychosocial functioning and well-being.What this study adds?Findings from the current study indicated that experiences of childhood adversity were associated with perceived stress during pregnancy, with significant indirect effects through the personality dimensions of neuroticism and conscientiousness. That is, mothers with high ACEs reported higher neuroticism and lower conscientiousness, and in turn, reported experiencing high levels of perceived stress during pregnancy.

The Family Biorhythm: Contributions of the HPA and HPG Axes to Neuroendocrine Attunement.

Objective: The vast majority of research on biobehavioral influences on development has focused on mothers and infants, whereas research on paternal biobehavioral influences remains sparse. This study aims to increase understanding of paternal influences on the biobehavioral dynamics of the family unit, using a multi-system approach. Methods: Participants consisted of 32 predominantly high-risk families recruited during pregnancy who completed monthly questionnaires and in-home visits when infants were 4, 12, and 18 months of age. In-home visits included semi-structured interaction tasks and saliva samples for cortisol and progesterone assays. Results: Mothers and infants, but not fathers and infants, showed adrenocortical attunement, with the strongest attunement at 18 months. Second, mothers' couple satisfaction did not significantly impact infants' cortisol levels or mother-infant cortisol attunement, but mothers' progesterone moderated the relationship between couple satisfaction and infant cortisol levels such that mothers with low couple satisfaction, but high progesterone, had infants with lower cortisol levels. Finally, mothers' and fathers' progesterone levels were attuned across the time points. Conclusions: This is some of the first evidence of the establishment of the family biorhythm and suggests that fathers play an indirect role in facilitating mother-infant adrenocortical attunement. Supplementary Information: The online version contains supplementary material available at 10.1007/s40750-023-00215-0.