Adipokines measured during pregnancy and at birth are associated with infant negative affect.

BACKGROUND: Increased adiposity during pregnancy may be related to offspring risk for mental health disorders, although the biological mechanisms are poorly understood. One promising hypothesis is that factors secreted from adipocytes such as leptin and adiponectin may explain this association. The current study examined whether pregnancy or umbilical cord blood concentrations of leptin and/or adiponectin a) predict elevated infant negative affect at 6 months (an early life marker of risk for psychopathology); and b) help explain the association between pregnancy adiposity and increased infant negative affect. METHODS: Data came from a prospective cohort (N = 305) of pregnant individuals and their offspring. Second trimester adiposity was assessed using air displacement plethysmography. Concentrations of leptin and adiponectin were measured in second trimester plasma and umbilical cord plasma. Infant negative affect was assessed by standardized observation at 6 months. Second trimester inflammation was assessed using a comprehensive panel of cytokines. RESULTS: Lower second trimester adiponectin was associated with elevated infant negative affect, and mediated the effect of pregnancy adiposity on infant negative affect. This association was independent of the effect of second trimester inflammation. Umbilical cord leptin also predicted higher infant negative affect and mediated the association between pregnancy adiposity and infant negative affect. CONCLUSIONS: This is the first study to link pregnancy adiponectin or cord blood leptin to infant markers of risk for psychopathology, and the first to demonstrate that these adipokines mediate the association between pregnancy adiposity and offspring behavioral outcomes, suggesting novel markers of risk and potential mechanisms of effect.

Geotemporal analysis of perinatal care changes and maternal mental health: an example from the COVID-19 pandemic.

Our primary objective was to document COVID-19 induced changes to perinatal care across the USA and examine the implication of these changes for maternal mental health. We performed an observational cross-sectional study with convenience sampling using direct patient reports from 1918 postpartum and 3868 pregnant individuals collected between April 2020 and December 2020 from 10 states across the USA. We leverage a subgroup of these participants who gave birth prior to March 2020 to estimate the pre-pandemic prevalence of specific birthing practices as a comparison. Our primary analyses describe the prevalence and timing of perinatal care changes, compare perinatal care changes depending on when and where individuals gave birth, and assess the linkage between perinatal care alterations and maternal anxiety and depressive symptoms. Seventy-eight percent of pregnant participants and 63% of postpartum participants reported at least one change to their perinatal care between March and August 2020. However, the prevalence and nature of specific perinatal care changes occurred unevenly over time and across geographic locations. The separation of infants and mothers immediately after birth and the cancelation of prenatal visits were associated with worsened depression and anxiety symptoms in mothers after controlling for sociodemographic factors, mental health history, number of pregnancy complications, and general stress about the COVID-19 pandemic. Our analyses reveal widespread changes to perinatal care across the US that fluctuated depending on where and when individuals gave birth. Disruptions to perinatal care may also exacerbate mental health concerns, so focused treatments that can mitigate the negative psychiatric sequelae of interrupted care are warranted.

Behavioral coping phenotypes and associated psychosocial outcomes of pregnant and postpartum women during the COVID-19 pandemic.

The impact of COVID-19-related stress on perinatal women is of heightened public health concern given the established intergenerational impact of maternal stress-exposure on infants and fetuses. There is urgent need to characterize the coping styles associated with adverse psychosocial outcomes in perinatal women during the COVID-19 pandemic to help mitigate the potential for lasting sequelae on both mothers and infants. This study uses a data-driven approach to identify the patterns of behavioral coping strategies that associate with maternal psychosocial distress during the COVID-19 pandemic in a large multicenter sample of pregnant women (N = 2876) and postpartum women (N = 1536). Data was collected from 9 states across the United States from March to October 2020. Women reported behaviors they were engaging in to manage pandemic-related stress, symptoms of depression, anxiety and global psychological distress, as well as changes in energy levels, sleep quality and stress levels. Using latent profile analysis, we identified four behavioral phenotypes of coping strategies. Critically, phenotypes with high levels of passive coping strategies (increased screen time, social media, and intake of comfort foods) were associated with elevated symptoms of depression, anxiety, and global psychological distress, as well as worsening stress and energy levels, relative to other coping phenotypes. In contrast, phenotypes with high levels of active coping strategies (social support, and self-care) were associated with greater resiliency relative to other phenotypes. The identification of these widespread coping phenotypes reveals novel behavioral patterns associated with risk and resiliency to pandemic-related stress in perinatal women. These findings may contribute to early identification of women at risk for poor long-term outcomes and indicate malleable targets for interventions aimed at mitigating lasting sequelae on women and children during the COVID-19 pandemic.

Predicting child effortful control: An integrative analysis of child physiological, familial, and community factors.

Effortful control (EC) is a regulatory capacity that refers to children's ability to inhibit a dominant response to perform a subdominant response. Although attempts have been made to identify early predictors of children's EC, the confluence and interaction of child-, familial-, and community factors has not been pursued adequately. This study investigated how predictors from different aspects of children's rearing environment interacted to predict later EC. In a sample of 88 primiparous women with elevated depressive symptomotology and low household income, we examined how children's own psychobiology (baseline cortisol), familial relationship (mother-child attachment), and community resources (social support) at 17 months independently and jointly predicted EC at age 5. Our results showed that, controlling for maternal depressive symptomotology and household income, predictors from child-, familial-, and community-aspect function integratively, rather than independently, in predicting later EC. Specifically, within the context of a secure attachment relationship, baseline cortisol positively predicts later EC only for children of mothers who reported low social support. Whereas within the context of an insecure attachment relationship, baseline cortisol negatively predicts later EC, regardless of the perceived social support levels. Our results highlighted the importance of taking into consideration predictors from multiple aspects for intervention designs.

Correction to: Emotion Regulation via the Autonomic Nervous System in Children with Attention-Deficit/Hyperactivity Disorder (ADHD).

This erratum reports an error in Musser, E. D., Backs, R. W., Schmitt, C. F., Ablow, J. C., Measelle, J. R., & Nigg, J. T. (2011). Emotion regulation via the autonomic nervous system in children with attention-deficit/hyperactivity disorder (ADHD).

Contributions of early adversity to pro-inflammatory phenotype in infancy: the buffer provided by attachment security.

Adversity early in life is associated with systemic inflammation by adolescence and beyond. At present, few studies have investigated the associations between different forms of adversity and inflammation during infancy, making it difficult to specify the origins of disease vulnerability. This study examined the association between multiple forms of early adversity - socioeconomic status disadvantage, familial stress, maternal depression, and security of attachment - and individual differences in a composite measure of pro-inflammatory cytokines (IL-1ß, IL-6, IL-8, and tumor necrosis factor-alpha) and the inflammatory protein C-reactive protein that were collected via saliva when (n = 49) children were 17 months old. In addition to gauging the direct effects of adversity, we also tested the hypothesis that infants' attachment relationship with their mother might buffer infants against the immunologic effects of early adversity. Results show that familial stress, maternal depression, and security of attachment were directly associated with infant salivary inflammation and that attachment status moderated the effect of maternal depression. The findings suggest that exposure to certain forms of adversity very early in life may engender a pro-inflammatory phenotype with possible life-long implications for health.

Mothers Who Were Neglected in Childhood Show Differences in Neural Response to Their Infant's Cry.

The present study used functional magnetic resonance imaging to investigate how a mother's experience of neglect in her own childhood is associated with her neural response to her infant's distress cues. During scanning, 22 high-risk primiparous mothers were exposed to both their own 18-month-old infant's cry sound and a control sound. Mothers' continuous Neglect subscale scores from the Childhood Trauma Questionnaire were examined as a predictor of their neural response to own infant cry > control sound. Mothers who reported high levels of neglect from childhood showed regions of hyperactivation to their infant's cry (relative to control sound) in the anterior and posterior cingulate cortices and insula as well as specific prefrontal (precentral gyrus) and parietal (posterior supramarginal gyrus) areas. These results may suggest how important early life experiences are for future parenting responses and behaviors.

Links between early baseline cortisol, attachment classification, and problem behaviors: A test of differential susceptibility versus diathesis-stress.

The purpose of the current study was to predict concurrent levels of problem behaviors from young children's baseline cortisol and attachment classification, a proxy for the quality of caregiving experienced. In a sample of 58 children living at or below the federal poverty threshold, children's baseline cortisol levels, attachment classification, and problem behaviors were assessed at 17 months of age. We hypothesized that an interaction between baseline cortisol and attachment classification would predict problem behaviors above and beyond any main effects of baseline cortisol and attachment. However, based on limited prior research, we did not predict whether or not this interaction would be more consistent with diathesis-stress or differential susceptibility models. Consistent with diathesis-stress theory, the results indicated no significant differences in problem behavior levels among children with high baseline cortisol. In contrast, children with low baseline cortisol had the highest level of problem behaviors in the context of a disorganized attachment relationship. However, in the context of a secure attachment relationship, children with low baseline cortisol looked no different, with respect to problem behavior levels, then children with high cortisol levels. These findings have substantive implications for the socioemotional development of children reared in poverty.

Increased levels of inflammation among infants with disorganized histories of attachment.

Early life adversity is associated with adult elevations of inflammatory markers such as circulating levels of C-reactive protein (CRP). Few studies have examined inflammation levels during infancy nor the associations between sources of adversity and concurrent inflammation early in life. Existing evidence suggests that early adversity in the form of compromised caregiving relationships can embed itself into young children's biology with implications for lifelong development. This study examined the association between infants' histories of attachment with their mothers and salivary concentrations of CRP, all of which were assessed when infants were 17 months of age. Results show that infants with disorganized attachments histories and those exhibiting disorganized and avoidant regulatory behaviors when faced with an attachment stressor were all associated with significantly elevated levels of salivary CRP. These results suggest that exposure to significant interpersonal adversity very early in life may engender a proinflamotry phenotype with life-long implications for health.

Shaping emotion regulation: attunement, symptomatology, and stress recovery within mother-infant dyads.

The foundations of emotion regulation are organized, in part, through repeated interactions with one's caregiver in infancy. Less is known about how stress physiology covaries between a mother and her infant within these interactions, leaving a gap in our understanding of how the biological basis of emotion regulation develops. This study investigated physiological attunement between mothers and their 5-month-old infants, as well as the influence of maternal depression and anxiety, during stress recovery. During the reengagement phase of the Still Face Paradigm, mother-infant dyads exhibited negative attunement, as measured by inverse covariation of respiratory sinus arrhythmia (RSA). Increases in maternal RSA corresponded to decreases in infant RSA, underscoring dyadic adjustment during recovery. Moreover, infant regulation differed as a function of maternal anxiety, with more anxious mothers having infants with higher RSA during reengagement. Implications for the consolidation of regulatory capabilities within the context of the early caregiving relationship are discussed.

The eye of the begetter: predicting infant attachment disorganization from women's prenatal interpretations of infant facial expressions.

Infant-caregiver attachment disorganization has been linked to many long-term negative psychosocial outcomes. While various prevention programs appear to be effective in preventing disorganized attachment, methods currently used to identify those at risk are unfortunately either overly general or impractical. The current investigation tested whether women's prenatal biases in identifying infant expressions of emotion--tendencies previously shown to relate to some of the maternal variables associated with infant attachment, including maternal traumatization, trauma symptoms, and maternal sensitivity--could predict infant attachment classification at 18 months postpartum. Logistic regression analyses revealed that together with women's adult history of high betrayal traumatization, response concordance with a normative reference sample in labeling infant expressions as negatively valenced, and the number of infant facial expressions that participants classified as "sad" and "angry" predicted subsequent infant attachment security versus disorganization. Implications for screening and prevention are discussed.

Little tyrants or just plain tired: evaluating attributions for caregiving outcomes across the transition to parenthood.

There is now substantial evidence that parental attributions for power over negative caregiving outcomes play an important role in the intergenerational transmission of child maltreatment. Despite the substantial research and clinical significance of this construct, and the widely held assumption that it represents a trait-like attributional style, there is a lack of empirical support for its long-term stability, especially over the transition to parenthood. The present study examined the stability of 88 at-risk women's perceived power over caregiving failure from the 3rd trimester of their 1st pregnancy to 18 months postnatal. Although results showed no significant change in overall self-reported perceived power over caregiving failure across time, subcomponents that separately assess perceived importance of adult and child factors both decreased over time, driven by increasing external attributions. Examination of subscale scores further revealed consistency in women's attributional style for their own and their child's behavior, and for positive and negative events, over time. Individual differences in these patterns suggested that past and present difficulties interfered with normative shifts such that maternal stress and history of trauma were associated with an increased sense that children control problematic events while decreasing mothers' own sense of control. Research and clinical implications are discussed.

In an idealized world: can discrepancies across self-reported parental care and high betrayal trauma during childhood predict infant attachment avoidance in the next generation?

Adult caregivers' idealization of their parents as assessed by the Adult Attachment Interview is a risk factor for the intergenerational transmission of the insecure-avoidant attachment style. This study evaluated a briefer screening approach for identifying parental idealization, testing the utility of prenatal maternal self-report measures of recalled betrayal trauma and parental care in childhood to predict observationally assessed infant attachment avoidance with 58 mother-infant dyads 18 months postpartum. In a logistic regression that controlled for maternal demographics, prenatal psychopathology, and postnatal sensitivity, the interaction between women's self-reported childhood high betrayal trauma and the level of care provided to them by their parents was the only significant predictor of 18-month infant security versus avoidance. Results suggest that betrayal trauma and recalled parental care in childhood can provide a means of identifying caregivers whose infant children are at risk for avoidant attachment, potentially providing an efficient means for scientific studies and clinical intervention aimed at preventing the intergenerational transmission of attachment problems.

Associations between first-time expectant women's representations of attachment and their physiological reactivity to infant cry.

Associations among 53 primiparous women's Adult Attachment Interview classifications (secure-autonomous vs. insecure-dismissing) and physiological and self-reported responses to infant crying were explored. Heart rate, skin conductance levels, and respiratory sinus arrhythmia (RSA) were recorded continuously. In response to the cry, secure-autonomous women demonstrated RSA declines, consistent with approach-oriented responses. Insecure-dismissing women displayed RSA and electrodermal increases, consistent with behavioral inhibition. Furthermore, insecure-dismissing women rated the cries as more aversive than secure-autonomous women. Nine months postpartum, secure-autonomous women, who prenatally manifested an approach-oriented response to the unfamiliar cry stimulus, were observed as more sensitive when responding to their own distressed infant, whereas women classified prenatally as insecure-dismissing were observed as less sensitive with their own infants.

Mothers' vagal regulation during the Still-Face Paradigm: normative reactivity and impact of depression symptoms.

This study examined mothers' physiological reactivity in response to infant distress during the Still-Face Paradigm. We aimed to explore normative regulatory profiles and associated physiological and behavioral processes in order to further our understanding of what constitutes regulation in this dyadic context. We examined physiological patterns--vagal tone, indexed by respiratory sinus arrhythmia (RSA)--while mothers maintained a neutral expression over the course of the still face episode, as well as differential reactivity patterns in mothers with depression symptoms compared to non-depressed mothers. Behavioral and physiological data were collected from mothers of 5-month-old infants during the emotion suppression phase of the Still-Face Paradigm. We used Hierarchical Linear Modeling to examine changes in mothers' RSA during infant distress and explored maternal depression as a predictor of physiological profiles. Mothers were generally able to maintain a neutral expression and simultaneously demonstrated a mean-level increase in RSA during the still face episode compared to baseline, indicating an active regulatory response overall. A more detailed time-course examination of RSA trajectories revealed that an initial RSA increase was typically followed by a decrease in response to peak infant distress, suggesting a physiological mobilization response. However, this was not true of mothers with elevated depressive symptoms, who showed no change in RSA during infant distress. These distinct patterns of infant distress-related physiological activation may help to explain differences in maternal sensitivity and adaptive parenting.

A face a mother could love: depression-related maternal neural responses to infant emotion faces.

Depressed mothers show negatively biased responses to their infants' emotional bids, perhaps due to faulty processing of infant cues. This study is the first to examine depression-related differences in mothers' neural response to their own infant's emotion faces, considering both effects of perinatal depression history and current depressive symptoms. Primiparous mothers (n = 22), half of whom had a history of major depressive episodes (with one episode occurring during pregnancy and/or postpartum), were exposed to images of their own and unfamiliar infants' joy and distress faces during functional neuroimaging. Group differences (depression vs. no-depression) and continuous effects of current depressive symptoms were tested in relation to neural response to own infant emotion faces. Compared to mothers with no psychiatric diagnoses, those with depression showed blunted responses to their own infant's distress faces in the dorsal anterior cingulate cortex. Mothers with higher levels of current symptomatology showed reduced responses to their own infant's joy faces in the orbitofrontal cortex and insula. Current symptomatology also predicted lower responses to own infant joy-distress in left-sided prefrontal and insula/striatal regions. These deficits in self-regulatory and motivational response circuits may help explain parenting difficulties in depressed mothers.

Poverty, problem behavior, and promise: differential susceptibility among infants reared in poverty.

Do infants reared in poverty exhibit certain physiological traits that make them susceptible to the positive and negative features of their caregiving environment? Guided by theories of differential susceptibility and biological sensitivity to context, we evaluated whether high baseline respiratory sinus arrhythmia (RSA) operates as a susceptibility factor among infants reared in poverty (N = 73). Baseline RSA at 5 months, the quality of the attachment relationship at 17 months, and the interaction of these two factors were included in our models as predictors of problem behavior at 17 months. Consistent with theory, results showed no significant differences in problem behavior among infants with low baseline RSA; however, infants with high baseline RSA exhibited the lowest levels of problem behavior if reared in an environment that fostered security, and they exhibited the highest levels of problem behavior if reared in an environment that fostered disorganization. These results have important implications for the psychological health of infants living in poverty.

The missing link: mothers' neural response to infant cry related to infant attachment behaviors.

This study addresses a gap in the attachment literature by investigating maternal neural response to cry related to infant attachment classifications and behaviors. Twenty-two primiparous mothers and their 18-month old infants completed the Strange Situation (SS) procedure to elicit attachment behaviors. During a separate functional MRI session, mothers were exposed to their own infant's cry sound, as well as an unfamiliar infant's cry and control sound. Maternal neural response to own infant cry related to both overall attachment security and specific infant behaviors. Mothers of less secure infants maintained greater activation to their cry in left parahippocampal and amygdala regions and the right posterior insula consistent with a negative schematic response bias. Mothers of infants exhibiting more avoidant or contact maintaining behaviors during the SS showed diminished response across left prefrontal, parietal, and cerebellar areas involved in attentional processing and cognitive control. Mothers of infants exhibiting more disorganized behavior showed reduced response in bilateral temporal and subcallosal areas relevant to social cognition and emotion regulation. No differences by attachment classification were found. Implications for attachment transmission models are discussed.

The neural correlates of maternal sensitivity: an fMRI study.

Research on maternal neural response to infant distress highlights circuits that may underlie differences in quality of maternal behavior. However, it is far from clear which circuits are relevant to maternal sensitivity, as opposed to other maternal behavioral dimensions, particularly after the early postpartum. This study examined maternal sensitivity, intrusiveness, and mother-infant dyadic harmony as correlates of mothers' neural responses to the cries of their own infants. Twenty-two primiparous mothers were observed during an interaction with their infants at 18 months postpartum. In a separate functional neuroimaging session, mothers were exposed to their own infant's cry sound, as well as unfamiliar infant's cry and control sounds. Mothers who displayed more sensitive behaviors with their infant exhibited greater activation to their own infant's cry compared to that of an unfamiliar infant in the right frontal pole and inferior frontal gyrus. Mothers who displayed more intrusive behaviors with their infant showed greater activation in the left anterior insula and temporal pole, while mothers who had more harmonious interactions with their infant displayed greater activation in left hippocampal regions. The roles of these areas in the regulation of maternal emotion and stress, self and other awareness, and empathy are examined.

Respiratory control when measuring respiratory sinus arrhythmia during a talking task.

The current study explored the effects of talking on respiratory sinus arrhythmia (RSA) during a semi-structured emotional interview (Adult Attachment Interview) using 76 female undergraduates. The effectiveness of 2 different methodological approaches (i.e. talking baseline or transfer function) was explored as respiratory control during talking tasks. RSA was collected during resting baseline, talking baseline, and interview conditions. Subjective reports of distress were higher in the interview than in the other 2 conditions. Mean RSA levels were significantly lower in the 2 talking tasks than in the resting baseline. After applying a transfer function for respiratory control, there were no significant differences between the 3 conditions. Moderator analyses yielded lower RSA values in the talking baseline and interview conditions for participants who reported greater distress during the interview. It was concluded that respiratory controls are likely necessary when using RSA in talking paradigms and that both approaches appeared to be adequate.