Protective and vulnerability personality traits associated with PTSD diagnosis after preterm delivery.

Giving birth prematurely is a traumatic event that has many consequences for the mother but also for her baby and their family. Studies have shown that about a quarter of these mothers will suffer from post-traumatic stress disorder (PTSD) as a result. This study aims to identify internal personality factors associated with the development of PTSD in mothers who gave birth before 33 weeks. The results revealed significant correlations between two personality dimensions (neuroticism and extraversion) and the likeliness of developing PTSD in mothers who gave birth prematurely. Neuroticism is positively liked with the disorder while extraversion is negatively correlated with it. Studies should now focus on early detection of PTSD and better interventions for these mothers.

Women's experience of preterm birth in an East African context: a qualitative study.

Background: Approximately 15 million children are born each year prematurely, representing more than 10 percent of all childbirths worldwide. Prematurity is an acute event and the leading cause of death among newborns and children under five. Sixty percent of these premature deaths occur in Sub-Saharan Africa and Southeast Asia. Objective: The current study aimed to explore and understand women's experiences and perceptions regarding giving birth prematurely at the National Hospital of Muhimbili in Dar es Salaam, Tanzania. Method: A qualitative method, using Interpretive Phenomenological Analysis approach was chosen to understand and describe the women's experiences. A semi-structured guide was used during the interviews. All interviews were audio-recorded and transcribed verbatim. Findings: Eight in-depth interviews were conducted. The analysis revealed three superordinate themes: (a) Emotional turmoil: unmet expectations shattering maternal identity, emotional distress, and loss of hope; (b) Adapting to preterm birth and challenges: the unexpected situation, lack of proper care, strenuous breastfeeding routines, and socioeconomic challenges; (c) Significance of proper care and emotional support: good maternal care, mother-to-mother and family support. Conclusion: This study provided a deeper understanding of women's experiences and perceptions of premature childbirth. The current study indicated the importance of caregivers' awareness of the women's emotional distress, their need to adapt to a sudden unexpected situation, and the necessity of emotional support.

A Patient Interview-Based Needs Assessment and Evaluation of Experiences with Periviable Pregnancies.

Given the complex ethical and emotional nature of births during the periviable period for both health care providers and families, this investigation sought to identify strategies for improved counseling of pregnant patients facing preterm birth at the cusp of viability at a tertiary care center in Hawai'i. As part of a larger quality improvement project on periviability counseling, 10 patients were interviewed during either individual or small focus groups using a progression of hypothetical scenarios. Interviews were analyzed independently by 3 investigators to identify themes of patient experience and potential areas for improvement when counseling patients who are carrying periviable pregnancies. Several common themes emerged from the interviews. Patients expressed the desire for more information throughout the process delivered in a jargon-free manner with unified messaging from the medical teams, and emotional support. These findings add to a limited body of literature which addresses patient perceptions of interactions with health care providers in the face of uncertainty, particularly in a Pacific Islander population. The authors recommend increasing provider training and developing a more structured process to counsel pregnant women facing periviable pregnancy loss to improve the patient experience.

Patient perspectives and preferences on cerclage and preterm birth: a focus group study.

AIM: This qualitative focus group study aims to asses cerclage-related symptoms, the impact of a cerclage on daily functioning and patient perspectives of their healthcare experience. This study extends beyond the current focus on surgical and obstetric outcomes of a cerclage, thereby contributing to a more comprehensive understanding of the challenges faced by individuals in the context of extreme preterm birth and fetal loss and the impact of a cerclage on multiple facets in life. METHODS: Participants were recruited from the Amsterdam University Medical Center, Amsterdam, the Netherlands or via the website of a Dutch patient organization for (extreme) preterm birth. Eligible participants were ≥ 18 years old with a previous vaginal and/or abdominal cerclage with a subsequent delivery at ≥ 34 weeks of gestation with neonatal survival. Two focus group discussions (FGD) were performed. A predefined format was used, which was identical for both the vaginal and abdominal cerclage group. The International Classification of Functioning, Disability and Health (ICF-DH) was used to provide structure. Outcomes were a broad range of participants reported perspectives on physical, emotional, and social-related quality of life. RESULTS: In the Vaginal Cerclage Group (VCG) and Abdominal Cerclage Group (ACG), respectively, 11 and 8 participants were included. Fear for a subsequent pregnancy loss was the most limiting factor to perform daily activities during pregnancy in all participants with a cerclage. Fear to conceive again because of prior second-trimester fetal loss was experienced by 27% in the VCG and 13% in the ACG. The majority of participants experienced a reduction in anxiety after placement of their cerclage (VCG = 64%, ACG = 75%). Decreased mobility/bedrest (VCG = 100%, ACG = 75%) and blood loss (VCG = 55%, ACG = 13%) were frequently mentioned complaints during pregnancy with cerclage. Other aspects mentioned in both groups were social isolation, the lack of societal participation, and the perceived need to quit work and sports. All participants in the abdominal cerclage group reported a lack of comprehensible and unambiguous information about obstetric management and expectations during pregnancy in secondary care hospitals. Clear communication between secondary and tertiary care hospitals about obstetric management following an abdominal cerclage, for example, about the need for cervical length measurements by ultrasound, the need for bedrest or advice concerning sexual activity was missing (63%). Psychologic support was desired in half of all participants, but was not offered to them. CONCLUSIONS: The fear of a subsequent pregnancy loss was reported as the most limiting factor in daily life by all participants. Cerclage placement resulted in the reduction of anxiety. Participants mentioned a significant impact of bedrest and activity restriction during pregnancy with cerclage on social participation and daily activities. Unfortunately, no high level evidence is available on this matter. Patients might even benefit from appropriate levels of physical activity throughout their pregnancy to promote their overall well-being. More evidence is needed to determine the optimal level of physical activity. There is a need for clear and unambiguous patient information about obstetric management.

The knowledge about long-term consequences of preterm birth among health professionals, educational professionals, and parents in Slovenia.

AIM: To assess the knowledge about the long-term consequences of preterm birth and the need for training and information among various professionals working with preterm children and parents of preterm children. METHODS: In February and March 2018, physicians, psychologists, special education needs teachers, teachers, preschool teachers, and parents (N=488) filled in the Preterm Birth-Knowledge Scale and a survey regarding their perceptions and attitudes toward working with preterm children. RESULTS: Physicians and psychologists were most knowledgeable among the groups about the long-term consequences of preterm birth. Teachers, preschool teachers, and parents had significantly lower knowledge (F=23.18, P<0.001). The majority of professionals indicated that they did not feel adequately equipped to support the learning and development of preterm children and that they had not received sufficient training in this area. More than half indicated that they had received no formal training. In general, the participants tended to underestimate the long-term problems of preterm children. CONCLUSION: The findings underscore the importance of integrating the issue of the long-term outcomes of preterm birth and working with preterm children into formal education, and in other forms of educational activities.

Stress and anxiety during pregnancy and length of gestation: a federated study using data from five Canadian and European birth cohorts.

While its etiology is not fully elucidated, preterm birth represents a major public health concern as it is the leading cause of child mortality and morbidity. Stress is one of the most common perinatal conditions and may increase the risk of preterm birth. In this paper we aimed to investigate the association of maternal perceived stress and anxiety with length of gestation. We used harmonized data from five birth cohorts from Canada, France, and Norway. A total of 5297 pregnancies of singletons were included in the analysis of perceived stress and gestational duration, and 55,775 pregnancies for anxiety. Federated analyses were performed through the DataSHIELD platform using Cox regression models within intervals of gestational age. The models were fit for each cohort separately, and the cohort-specific results were combined using random effects study-level meta-analysis. Moderate and high levels of perceived stress during pregnancy were associated with a shorter length of gestation in the very/moderately preterm interval [moderate: hazard ratio (HR) 1.92 (95%CI 0.83, 4.48); high: 2.04 (95%CI 0.77, 5.37)], albeit not statistically significant. No association was found for the other intervals. Anxiety was associated with gestational duration in the very/moderately preterm interval [1.66 (95%CI 1.32, 2.08)], and in the early term interval [1.15 (95%CI 1.08, 1.23)]. Our findings suggest that perceived stress and anxiety are associated with an increased risk of earlier birth, but only in the earliest gestational ages. We also found an association in the early term period for anxiety, but the result was only driven by the largest cohort, which collected information the latest in pregnancy. This raised a potential issue of reverse causality as anxiety later in pregnancy could be due to concerns about early signs of a possible preterm birth.

[Parenthood put to the test by average prematurity]. / La parentalité à l'épreuve de la moyenne prématurité.

Any premature birth can be traumatic, and a risk factor for the parenting process and the quality of parent-baby interactions. Average prematurity is no exception. It can undermine essential parenting functions, such as availability and sensitivity to the child, and generate interactive dysfunctions within parent-baby dyads. In some cases, it can lead to genuine psychopathological states.

Parental stress and mental health outcomes following very preterm birth: A systematic review of recent findings.

BACKGROUND: In recent years, there has been a wide array of research studies published on parental mental health and stress following very preterm birth. This review aims at reviewing the prevalence and risk factors of long-term parental depression, anxiety, post-traumatic stress symptoms and parenting stress following very preterm birth. METHODS: We searched PubMed, PsychINFO and Web of Science for descriptive, cross-sectional and longitudinal studies published between January 2013 and August 2022. RESULTS: 45 studies met our inclusion criteria. In the first two years, depression, anxiety, post-traumatic stress symptoms and parenting stress were present in ∼20 % of mothers of extreme and very low birth weight (E/VLBW) infants. Long-term psychological distress symptoms could be observed, although few studies have focused on symptoms into school age and longer. Fathers of VLBW infants might experience more psychological distress as well, however, they were only included in ten studies. We found that parental distress is more common when the co-parent is struggling with mental health symptoms. Many risk factors were identified such as social risk, history of mental illness, interpersonal factors (i.e. social support) and child-related factors (i.e. intraventricular hemorrhage, disability, use of medical equipment at home). LIMITATIONS: Several studies have methodological issues, such as a lack of control of known confounders and there is a large variety of measures employed. CONCLUSION: Important risk factors for stress and mental health symptoms were identified. More evidence is needed to determine if long-term symptoms persist into school age. Research should focus on taking a family-based approach in order to identify preventive strategies and resilience factors in parents of VLBW infants.

Effects of psychosocial work factors on preterm birth: systematic review and meta-analysis.

OBJECTIVES: Preterm birth is one of the global public health issues that result in high rates of infant mortality and long-term health complications. We sought to explore the association between psychosocial work factors and preterm birth. STUDY DESIGN: Systematic review and meta-analysis. METHODS: This systematic review and meta-analysis searched relevant literature from electronic databases to explore the association between psychosocial work factors and preterm birth. The methodological quality of the included studies was evaluated through the Joanna Briggs Institute's critical appraisal method. We performed a meta-analysis using a random-effects model to combine odds ratios (ORs) from studies with similar definitions of exposure and outcome. The quality of the evidence was evaluated using the GRADE (Grade of recommendation, Assessment, development, and Evaluation) method to assess. RESULTS: Ten studies were included, with a total of 92,815 participants. Moderate evidence indicated a positive association between high psychosocial job strain and preterm birth. The result from the meta-analysis supported the statistical significance of this relationship (OR 1.32 [95% CI (1.22-1.44)]). CONCLUSIONS: Pregnant women who experience high levels of psychosocial job strain are more likely to give birth prematurely. In order to decrease this risk, employers should prioritise creating supportive work environments, government bodies should enact protective policies and regulations, and clinicians should give advice to pregnant working women. Pregnant women should be aware of the risk of preterm birth from psychosocial work factors.

Evaluating multidimensional facets of the maternal experience after preterm birth.

OBJECTIVE: Describe self-relating (self-criticism, self-compassion) and parenting competence (satisfaction, self-efficacy) in mothers of children born preterm, and their associations with child characteristics, maternal sociodemographics at childbirth, and maternal concurrent well-being. STUDY DESIGN: The sample comprised 1926 biological mothers of 3- to18-year-old children born preterm with self-ratings on the standardized Forms of Self-Criticising/Attacking & Self-Reassuring Scale, Self-Compassion Scale, and Parenting Sense of Competence Scale. RESULTS: Mothers of children in early childhood reported significantly (p < 0.05) lower self-compassion than in middle childhood and adolescence. They also reported significantly lower parenting satisfaction than mothers of adolescents and higher self-efficacy than their middle childhood counterparts. Maternal psychosocial well-being was most strongly associated with self-compassion, parenting satisfaction, and self-efficacy after accounting for maternal psychopathology, child gestation, and child age. CONCLUSION: Longer-term associations of preterm birth with maternal self-relating and parenting competence emphasize broadening the scope of neonatal follow-up services, extending beyond child neurodevelopmental surveillance and postpartum psychopathology screening.

Parent-infant conversations are differentially associated with the development of preterm- and term-born infants.

Preterm birth is a risk factor for language difficulties. To better understand the language development of preterm-born infants, the current study investigated the concurrent associations between parent-infant conversations and the development of 22 preterm-born and 25 term-born infants at 2 years of age. Conversations occurring during mother/father-infant free-play interactions were analyzed to characterize features of parental speech (volubility, speech rate, lexical diversity, and morphosyntactic complexity) and parent-infant exchanges (parent responsiveness, turn-taking, and conversational balance). The infants' language development (receptive communication and expressive communication) and non-language development (cognitive, social-emotional, and executive function) was assessed using standardized measures. Parent-infant conversations were associated with both language and non-language development. This suggests that parent-infant conversations may support language development directly and/or through advancing non-language skills that could promote language learning. The associations between parent-infant conversations and development varied as a function of birth status (preterm or term). This finding may signal the operation of different developmental processes within preterm- and term-born groups. Finally, infant development was differentially associated with mother-infant and father-infant conversations. This may point to the distinct contributions made by mothers and fathers to the development of both preterm- and term-born infants. To optimize language outcomes, these findings indicate that families should be guided to tailor parent-infant conversations to the unique developmental needs and processes of preterm-born infants. Families should also be supported to leverage the distinct developmental contributions of mothers and fathers. Future recommendations are made regarding how to investigate the proposed preterm-term differences in language development processes and the differential developmental contribution of mothers and fathers.

Young adult outcomes following premature birth: A Western Australian experience.

BACKGROUND: Childhood outcomes following preterm birth are widely published, however long-term adult outcomes are less well described. We aimed to determine the quality of life and burden of co-morbidities experienced by preterm-born young adults in Western Australia. METHODS: A retrospective observational study was conducted. Participants born at 23-33 weeks gestation cared for at King Edward Memorial Hospital during 1990 and 1991 were recruited from a historical birth cohort. Participants completed general, medical and reproductive health questionnaires. Results were compared with contemporaneous cohort data and/or population statistics. RESULTS: Questionnaires were received from 73 young adults aged 28 to 30 years. The majority of respondents completed high school (94.5 %), were employed fulltime (74.0 %) and had close friends and family relationships. Almost all the participants considered their health to be good (94.0 %) and participated in light exercise (90.0 %). Increased hypertension, hypercholesterolaemia, asthma, neuropsychiatric conditions and visual impairment were reported. Depression Anxiety and Stress Scale (DASS-21) scoring identified increased mild anxiety. Increased consultation with healthcare workers and use of prescription medications were reported. CONCLUSION: The group of preterm-born adults surveyed reported a good quality of life, supportive interpersonal relationships and they provided significant contributions to society. They did report increased medical and psychological conditions than the general population.

Indirect evidence for altered dopaminergic neurotransmission in very premature-born adults.

While animal models indicate altered brain dopaminergic neurotransmission after premature birth, corresponding evidence in humans is scarce due to missing molecular imaging studies. To overcome this limitation, we studied dopaminergic neurotransmission changes in human prematurity indirectly by evaluating the spatial co-localization of regional alterations in blood oxygenation fluctuations with the distribution of adult dopaminergic neurotransmission. The study cohort comprised 99 very premature-born (<32 weeks of gestation and/or birth weight below 1500 g) and 107 full-term born young adults, being assessed by resting-state functional MRI (rs-fMRI) and IQ testing. Normative molecular imaging dopamine neurotransmission maps were derived from independent healthy control groups. We computed the co-localization of local (rs-fMRI) activity alterations in premature-born adults with respect to term-born individuals to different measures of dopaminergic neurotransmission. We performed selectivity analyses regarding other neuromodulatory systems and MRI measures. In addition, we tested if the strength of the co-localization is related to perinatal measures and IQ. We found selectively altered co-localization of rs-fMRI activity in the premature-born cohort with dopamine-2/3-receptor availability in premature-born adults. Alterations were specific for the dopaminergic system but not for the used MRI measure. The strength of the co-localization was negatively correlated with IQ. In line with animal studies, our findings support the notion of altered dopaminergic neurotransmission in prematurity which is associated with cognitive performance.

The Bayley Social-Emotional Scale and the Assessment of Preterm Infants: a systematic review / Escala Socioemocional Bayley e Avaliação de Bebês Prematuros: uma revisão sistemática / Escala Socioemocional de Bayley y Evaluación para Bebés Prematuros: una revisión sistemática

The Bayley scale is one of the most widely used instruments for assessing infant development. This article aimed to systematically review the contribution of the Bayley social-emotional scale in the assessment of social-emotional development in preterm infants. This systematic review followed PRISMA guidelines and was registered in PROSPERO. According to the inclusion criteria, 19 articles were selected from electronic databases. The results indicate reduced rates in evaluating the scale for children with lower gestational age, birth weight, and the association with environmental, biological, and hospital clinical factors. However, no analysis was found between the axes that guide the social-emotional development milestones present in the Bayley assessment and the developmental outcomes of preterm children. Bayley's social-emotional scale and other assessment methods can jointly compose a detailed and sensitive protocol for preterm infants regarding early childhood emotional health care. (AU)

A escala Bayley é um dos instrumentos mais utilizados para avaliação do desenvolvimento infantil. O objetivo deste artigo foi realizar uma revisão sistemática sobre a contribuição da escala socioemocional, pertencente à Bayley, na avaliação de crianças prematuras. A revisão seguiu as recomendações PRISMA e foi registrada no PROSPERO. Conforme critérios de inclusão, 19 artigos foram selecionados a partir de bancos de dados eletrônicos. Os resultados indicam índices reduzidos na avaliação da escala para crianças com menor idade gestacional, peso ao nascer e a associação com fatores ambientais, biológicos e clínicos hospitalares. No entanto, não foram encontradas análises entre os eixos que orientam os marcos de desenvolvimento socioemocional, presentes na avaliação Bayley e os resultados do desenvolvimento das crianças prematuras. A escala socioemocional da Bayley e outros métodos de avaliação podem conjuntamente compor um protocolo detalhado e sensível destinado ao cuidado da saúde emocional de crianças nascidas prematuras. (AU)

La escala Bayley es uno de los instrumentos más utilizados para la evaluación del desarrollo infantil. El propósito del artículo fue revisar sistemáticamente la contribución de la escala socioemocional de Bayley en la evaluación de bebés prematuros. La revisión siguió las recomendaciones PRISMA y fue registrada en PROSPERO. Según los criterios de inclusión, se seleccionaron 19 artículos de bases de datos electrónicas. Los resultados indican índices reducidos en la evaluación de la escala para niños con menor edad gestacional, peso al nacer asociaciados con factores ambientales, biológicos y clínicos hospitalarios. Sin embargo, no se encontraron análisis entre los ejes que orientan los hitos del desarrollo socioemocional, presentes en la evaluación Bayley, y los resultados del desarrollo de los niños prematuros. La Escala Socioemocional de Bayley y otros métodos de evaluación pueden formar en conjunto un protocolo detallado y sensible para el cuidado de la salud emocional de niños prematuros. (AU)

Effect of prematurity and temperament on the mother-infant interaction / Efeito da prematuridade e temperamento na interação mãe-bebê / Efecto de la prematurez y el temperamento en la interacción madre-bebé

Abstract We evaluated the effect of prematurity and the infant's temperament on the mother-infant behaviors in the Face-to-Face Still-Face Paradigm (FFSF). The study included 75 mothers and their infants (37 preterm and 38 term) between three and four months of age (corrected age for preterm infants). The mothers responded to a perception scale of the infants' temperament and the dyads were observed in a structured condition (FFSF). The FFSF Paradigm, divided into three episodes, made it possible to analyze the behaviors of: Positive Social Orientation, Negative Social Orientation and Self-comfort. The averages recorded for these categories were analyzed in a Multivariate ANOVA (factors: prematurity and temperament). Temperament had more effect on maternal and infant behaviors, suggesting that this factor may influence mother-infant interaction. The results can guide possible interventions with families. (AU)

Resumo Buscou-se avaliar o efeito da prematuridade e do tipo de temperamento do bebê sobre a interação mãe-bebê por meio do Paradigma do Face-to-Face Still-Face (FFSF). Participaram do estudo 75 mães e seus bebês (37 pré-termo e 38 a termo), entre três a quatro meses de vida (idade corrigida para bebês pré-termo). As mães responderam a uma escala de percepção do temperamento dos bebês e as díades foram filmadas em condição estruturada (FFSF). A filmagem, dividida em três episódios, possibilitou a análise de comportamentos de: Orientação Social Positiva, Orientação Social Negativa e Autoconforto. As médias registradas para essas categorias foram submetidas à Anova Multivariada (fatores: prematuridade e temperamento). O temperamento apresentou mais efeito sobre os comportamentos maternos e dos bebês, sugerindo que esse fator pode influenciar a interação diádica. Os resultados podem nortear possíveis intervenções junto às famílias.(AU)

Resumen Se buscó evaluar el efecto de la prematuridad y el tipo de temperamento del bebé en la interacción madre-bebé a través del Paradigma Face-to-Face Still-Face (FFSF). En el estudio participaron 75 madres y sus bebés (37 prematuros y 38 a término), con edades comprendidas entre los tres y los cuatro meses (edad corregida para bebés prematuros). Las madres respondieron a una escala de percepción del temperamento de los bebés y las díadas fueron filmadas en una condición estructurada (FFSF). El rodaje, dividido en tres episodios, permitió analizar los comportamientos de: Orientación Social Positiva, Orientación Social Negativa y Autoconfort. Los promedios registrados para estas categorías fueron sometidos al ANOVA Multivariado (factores: prematuridad y temperamento). El temperamento tuvo más efecto en los comportamientos maternos e infantiles, lo que sugiere que este factor puede influir en la interacción diádica. Los resultados pueden orientar posibles intervenciones con las familias. (AU)

Associations between maternal awakening salivary cortisol levels in mid-pregnancy and adverse birth outcomes.

PURPOSE: Elevated levels of maternal cortisol have been hypothesized as the intermediate process between symptoms of depression and psychosocial stress during pregnancy and adverse birth outcomes. Therefore, we examined associations between cortisol levels in the second trimester of pregnancy and risks of three common birth outcomes in a nested case-control study. METHODS: This study was embedded in the PRIDE Study (n = 3,019), from which we selected all cases with preterm birth (n = 64), low birth weight (n = 49), and small-for-gestational age (SGA; n = 65), and 260 randomly selected controls, among the participants who provided a single awakening saliva sample in approximately gestational week 19 in 2012-2016. Multivariable linear and logistic regression was performed to assess the associations between continuous and categorized cortisol levels and the selected outcomes. RESULTS: We did not observe any associations between maternal cortisol levels and preterm birth and low birth weight. However, high cortisol levels (≥ 90th percentile) seemed to be associated with SGA (adjusted odds ratio 2.1, 95% confidence interval 0.9-4.8), in particular among girls (adjusted odds ratio 3.7, 95% confidence interval 1.1-11.9, based on eight exposed cases) in an exploratory analysis. CONCLUSION: The results of this study showed no suggestions of associations between maternal awakening cortisol levels in mid-pregnancy and adverse birth outcomes, except for an increased risk of SGA.

Psychological well-being of women at high risk of spontaneous preterm birth cared for in a specialised preterm birth clinic: a prospective longitudinal cohort study.

OBJECTIVES: To assess the psychological well-being of pregnant women at increased risk of spontaneous preterm birth, and the impact of care from a preterm birth clinic. DESIGN: Single-centre longitudinal cohort study over 1 year, 2018-2019. SETTING: Tertiary maternity hospital in Auckland, New Zealand. PARTICIPANTS: Pregnant women at increased risk of spontaneous preterm birth receiving care in a preterm birth clinic. INTERVENTION: Participants completed three sets of questionnaires (State-Trait Anxiety Inventory, Edinburgh Postnatal Depression Scale, and 36-Item Short Form Survey)-prior to their first, after their second, and after their last clinic appointments. Study-specific questionnaires explored pregnancy-related anxiety and perceptions of care. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was the mean State-Anxiety score. Secondary outcomes included depression and quality of life measures. RESULTS: 73/97 (75.3%) eligible women participated; 41.1% had a previous preterm birth, 31.5% a second trimester loss and 28.8% cervical surgery; 20.6% had a prior mental health condition. 63/73 (86.3%) women completed all questionnaires. The adjusted mean state-anxiety score was 39.0 at baseline, which decreased to 36.5 after the second visit (difference -2.5, 95% CI -5.5 to 0.5, p=0.1) and to 32.6 after the last visit (difference -3.9 from second visit, 95% CI -6.4 to -1.5, p=0.002). Rates of anxiety (state-anxiety score >40) and depression (Edinburgh Postnatal Depression Scale score >12) were 38.4%, 34.8%, 19.0% and 13.7%, 8.7%, 9.5% respectively, at the same time periods. Perceptions of care were favourable; 88.9% stated the preterm birth clinic made them significantly or somewhat less anxious and 87.3% wanted to be seen again in a future pregnancy. CONCLUSIONS: Women at increased risk of spontaneous preterm birth have high levels of anxiety. Psychological well-being improved during the second trimester; women perceived that preterm birth clinic care reduced pregnancy-related anxiety. These findings support the ongoing use and development of preterm birth clinics.

Mathematical skills of 11-year-old children born very preterm and full-term.

Preterm birth affects the academic development of children, especially in mathematics. Remarkably, only a few studies have measured specific effects of preterm birth on mathematical skills in primary school. The aim of this study was to compare 11-year-old children, with an IQ above 70, born very preterm (N = 64) and full-term (N = 72) on a variety of 5th grade mathematical skills and cognitive abilities important for mathematical learning. The measures were spontaneous focusing on numerosity (SFON), spontaneous focusing on quantitative relations (SFOR), arithmetic fluency, mathematics achievement, number line estimation, rational number magnitude knowledge, mathematics motivation, reading skills, visuospatial processing, executive functions, and naming speed. The children born very preterm and full-term differed in arithmetic fluency, SFON and SFOR. Domain general cognitive abilities did not fully explain the group differences in SFON and SFOR. Retrospective comparisons of the samples at the age of five years showed large group differences in early mathematical skills and cognitive abilities. Despite lower early mathematical skills, the children born very preterm reached peer equivalent performance in many mathematical skills by the age of 11 years. Nevertheless, they appear less likely to focus on implicit mathematical features in their everyday life.

Maternal postpartum depressive symptoms partially mediate the association between preterm birth and mental and behavioral disorders in children.

Preterm birth has been linked with postpartum depressive (PPD) disorders and high symptom levels, but evidence remains conflicting and limited in quality. It remains unclear whether PPD symptoms of mothers with preterm babies were already elevated before childbirth, and whether PPD symptoms mediate/aggravate the effect of preterm birth on child mental disorders. We examined whether preterm birth associated with maternal PPD symptoms, depressive symptoms trajectories from antenatal to postpartum stage, and whether PPD symptoms mediated/aggravated associations between preterm birth and child mental disorders. Mothers of preterm (n = 125) and term-born (n = 3033) children of the Prediction and Prevention of Preeclampsia and Intrauterine Growth Restriction study reported depressive symptoms four times within 8 weeks before and twice within 12 months after childbirth. Child mental and behavioral disorder diagnoses until age 8.4-12.8 years came from medical register. Preterm birth associated with higher PPD symptoms (mean difference = 0.19 SD, 95% CI 0.01, 0.37, p = 0.04), and higher odds (odds ratio = 2.23, 95% CI 1.22, 4.09, p = 0.009) of the mother to belong to a group that had consistently high depressive symptoms levels trajectory from antenatal to postpartum stage. PPD symptoms partially mediated and aggravated the association between preterm birth and child mental disorders. Preterm birth, maternal PPD symptoms and child mental disorders are associated, calling for timely prevention interventions.

Maternal Mental Health Disorders Following Very Preterm Birth at 5 Years Post-Birth.

OBJECTIVE: Mothers of children born very preterm (VP) are at increased risk of developing postnatal depression, anxiety, and post-traumatic stress symptoms. However, mental health disorder rates are rarely assessed in this population compared with full-term peers, and it is unclear if postnatal distress symptoms precede higher rates of maternal mental health disorders at 5 years post-birth in both birth groups. METHODS: Mothers of children born VP (n = 65; mean [SD] age at birth, 33.9 [5.0]; 72.1% tertiary educated) and full-term (n = 90; mean [SD] age at birth, 33.4 [4.0]; 88.2% tertiary educated) completed questionnaires assessing symptoms of depression, anxiety, and trauma within 4 weeks of birth. At 5 years post-birth, they participated in a structured diagnostic interview assessing mood, anxiety, and trauma-related mental health disorders, both current and over the lifetime. RESULTS: There was little evidence for differences between mothers in the VP and full-term groups in rates of any mental health disorder at 5 years (VP = 14%, full-term = 14%) or lifetime (VP = 41%, full-term = 37%). In mothers of children born VP, elevated postnatal post-traumatic stress symptoms were associated with higher rates of mental health disorders at 5 years (odds ratio = 21.5, 95% confidence interval = 1.35-342). CONCLUSIONS: Findings suggest that preterm birth may not lead to increased odds of later developing maternal mental health disorders, despite known risks of elevated postnatal distress following a VP birth. However, those with post-traumatic stress symptoms following a VP birth could be more vulnerable, and assessment and monitoring is recommended.