Maternal postpartum bonding impairment and increased substance use to cope with pandemic-related stress.

Substance use rates, particularly among women, increased substantially during the COVID-19 pandemic. Psychological and economic risks disproportionately experienced by women were associated with increase in substance use patterns during the pandemic. Using substances (i.e., tobacco, alcohol, cannabis) to cope with stress is well-documented; what is less known are protective factors that were associated with less substance use during the pandemic. We examined whether mothers of young children (N = 96) who reported postpartum bonding impairment before the start of the pandemic reported greater substance use during the pandemic as a means to cope. Results from linear regression analyses found that mothers who reported higher levels of pre-pandemic mother-infant bonding impairments reported greater use of alcohol and other substances as a means to cope with pandemic stressors. These findings suggest that social connections might be a strategy to reduce substance use as a maladaptive coping behavior, especially during widespread crises such as the recent pandemic or for mothers of young children. In particular, promoting postpartum bonding through interventions might help to reduce substance use among new mothers.

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.

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.

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.

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.

Pregnancy intendedness and happiness as predictors of maternal-foetal bonding: evidence for mediation.

INTRODUCTION: Prior research has identified associations between pregnancy intendedness and maternal-foetal bonding, but no studies have examined the potential mediation of pregnancy happiness on the development of the maternal-infant relationship. METHODS: In 2017-2018, a clinic-based pregnancy cohort of 177 low-income and racially diverse women in a South-Central U.S. state participated in a study examining their pregnancy intentions, attitudes and behaviours. Pregnancy intentions and happiness and demographic characteristics were measured during the first trimester assessment, and maternal-foetal bonding was measured with the Prenatal Attachment Inventory (PAI) during the second trimester. Structural equation modelling was used to examine the associations between intendedness, happiness and bonding. RESULTS: Findings indicate positive associations between intended pregnancies and pregnancy happiness and pregnancy happiness to bonding. The direct effect from intended pregnancy to maternal-foetal bonding was not significant, providing evidence for full mediation. We did not find any associations between pregnancies that were unintended or ambivalent with pregnancy happiness or maternal-foetal bonding. CONCLUSIONS: Pregnancy happiness provides one potential explanation for the association between intended pregnancies and maternal-foetal bonding. These findings have implications for research and practice, as inquiring about mothers' pregnancy attitudes (e.g. how happy they are about their pregnancy) may be more important for maternal psychological health outcomes, such as the maternal-child relationship, than whether or not their pregnancies were intended.

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.

Immigration Enforcement and Hispanic Youth Substance Use: Is Depression a Mediator?

Hispanic adolescents report earlier onset and higher substance use rates than their non-Hispanic White and Black peers. This study examines the associations between the immigration-related arrest of a family member and substance use among Hispanic early adolescents and explores the mediating role of depressive symptoms as the mechanism explaining the association. We apply a mediated multiple linear regression analysis on 661 Hispanic youth attending 7th grade in an urban school district in a south-central, new arrival state. We found that Hispanic early adolescents who experienced the immigration-related arrest of a family member reported significantly higher substance use than Hispanic youth who did not experience the arrest of a family member due to immigration enforcement. Moreover, we found this relationship to be fully mediated by depressive symptoms. Findings suggest that even though the majority of Hispanic youth in the U.S. are citizens, experiencing the immigration-related arrest of a family member is not uncommon and has critical implications for poor mental health and maladaptive coping behaviors.

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.

Is Reproductive Orientation Associated with Sexual Satisfaction Among Partnered U.S. Women?

Little is known about how "reproductive orientation" (i.e., trying to get pregnant, ambivalent about pregnancy, trying to avoid pregnancy, or having had a sterilization surgery) is associated with sexual satisfaction among women of childbearing age. Using data from the National Survey of Fertility Barriers (N = 2811), we examined the association of reproductive orientation with sexual satisfaction, adjusting for relationship characteristics including union type (cohabitation versus marriage), quality, and length; infertility history; and demographic characteristics including age, parity, and race/ethnicity. Results indicated that women who were ambivalent or trying to get pregnant reported significantly higher levels of sexual satisfaction than women who were sterile in the unadjusted model, but not in the models that included relationship quality. The association of reproductive orientation and sexual satisfaction depended upon relationship quality; among women with lower relationship quality, "trying" was associated with higher, and among those with higher relationship quality, with lower sexual satisfaction.

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.

Pregnancy intendedness, maternal-fetal bonding, and postnatal maternal-infant bonding.

This study models associations between pregnancy intendedness and prenatal maternal-fetal bonding with postnatal maternal-infant bonding. Unintended pregnancies are associated with disruptions in maternal-infant bonding, which has long-term adverse implications for maternal and child well-being. Given the high proportion of births that are unintended in the United States, identifying protective factors is critical. Pregnant women (ages 16-38) were recruited from two prenatal clinics in a metropolitan city in the South Central United States at their first prenatal visit and followed throughout pregnancy and postbirth. Multiple regression analyses examined associations, mediation, and moderation. Results indicate that the more unintended/unwanted women reported their pregnancies to be, the lower they reported their maternal-infant bonding postbirth, and higher maternal-fetal bonding scores are associated with higher postnatal maternal-infant bonding. An interaction revealed that a higher level of prenatal bonding is protective for postnatal bonding among those with unintended/unwanted pregnancies. Because prenatal bonding can be enhanced through intervention, it is a promising target to reduce the risks associated with unintended pregnancy.

Este estudio modela asociaciones entre la intencionalidad de quedarse embarazada y la vinculación materno-fetal prenatal con la vinculación postnatal entre madre e infante. Los embarazos no intencionales se asocian con una vinculación entre madre e infante desorganizada, lo cual tiene implicaciones adversas a largo plazo para el bienestar materno y del niño. Dada la alta proporción de embarazos no intencionales en los Estados Unidos, es esencial identificar factores de protección. Se reclutaron mujeres embarazadas (edades de 16 a 38 años) de dos clínicas prenatales en una ciudad metropolitana en el centro sur de Estados Unidos, en su primera visita prenatal y con seguimiento a lo largo del embarazo y posterior al nacimiento. Los análisis de regresión múltiple examinaron las asociaciones, la mediación y la moderación. Los resultados indican que mientras menos intencional o deseado es el embarazo según lo reportado por las mujeres, más baja es la vinculación posterior al nacimiento tal como lo reportaron ellas, y más altos puntajes de vinculación materno-fetal se asocian con una más alta vinculación postnatal entre madre e infante. Una interacción reveló que un más alto nivel de vinculación prenatal es un factor de protección para la vinculación postnatal entre aquellas con embarazos no intencionales/deseados. Debido a que la vinculación prenatal puede mejorarse a través de la intervención, reducir los riesgos asociados con el embarazo no intencional es una meta prometedora.

Cette étude modèle les liens entre l'intention de la grossesse et le lien prénatal maternel-fœtal avec le lien maternel-nourrisson postnatal. Les grossesses indésirées sont liées à des perturbations du lien maternel-nourrisson, ce qui a des implications défavorables à long terme pour le bien-être maternel et de l'enfant. Etant donnée la grande proportion de naissances indésirables aux Etats-Unis, l'identification de facteurs protecteurs est critique. Des femmes enceintes (âgées de 16 à 38 ans) ont été recrutées dans deux cliniques prénatales d'une ville urbaine de la région Sud-Centrale des Etats-Unis à leur première prénatale et ont été suivies au travers de leur grossesse et après la naissance. Des analyses de régression multiple ont examiné les liens, la médiation et la modération. Les résultats indiquent que plus les femmes faisaient état de grossesses indésirées/non voulues, le moins elles faisaient état de leur lien maternel-nourrisson après la naissance. Les liens maternel-fœtal élevés étaient liés à un lien maternel-nourrisson postnatal plus élevé. Une interaction a révélé qu'un niveau de lien prénatal plus élevé est protecteur pour le lien postnatal chez celles avec des grossesses indésirées/non voulues. Parce que le lien prénatal peut être amélioré au travers de l'intervention cela en fait une cible prometteuse afin de réduire les risques liés à une grossesse indésirée.

Trauma exposure and adolescent attitudes toward having a baby: An exploratory survey.

OBJECTIVES: To examine the association between childhood trauma exposure (i.e., extent of interpersonal trauma experienced in childhood) and attitudes toward teen parenthood. STUDY DESIGN: We used a cross-sectional sample of 416 urban middle and high school male and female students from Tulsa, OK recruited through a local public school district mailing list. Multinomial logistic regression analyses were used to examine odds of reporting having a baby would make life worse, better, or cause no change according to childhood trauma score. RESULTS: Approximately 8% of students and their guardians responded to the mailed survey invitation. Among the students, 67% reported having a baby would make their lives worse; 17% reported it would not change their lives much, and 16% reported having a baby would make their lives better. Each increase in trauma score was associated with a 9% increase in reporting an indifferent attitude (p < 0.001) and a 15% increase in reporting a positive attitude toward having a baby (p < 0.01). After controlling for a wide range of sociodemographic, attitudinal, and sexual history variables, childhood trauma remained associated with a positive attitude toward having a baby (p<.01), but not an indifferent attitude toward having a baby. CONCLUSIONS: Greater childhood trauma exposure is associated with indifferent and positive attitudes toward having a baby during adolescence. IMPLICATIONS: Screening for childhood trauma and utilizing interventions designed to reduce the harmful effects of trauma exposure in childhood may offer a more targeted approach to adolescent pregnancy prevention strategies.

Childhood Adversity and Perceived Distress from the COVID-19 Pandemic.

Childhood exposure to adversity may increase an individual's reactivity to subsequent stressors. In this paper, we examine how adverse childhood experiences (ACEs) are associated with experiencing greater perceived distress during the pandemic. In this volunteer clinical cohort study, 177 pregnant women (ages 16-38) were recruited from two university-affiliated perinatal clinics located in a small metropolitan city between October 2017 and May 2018. Longitudinal data collection is ongoing. The current study includes the 101 women who participated through the eighth and most recent survey conducted in mid-April 2020. OLS regression analyses were used to examine the association between childhood adversity and pandemic-related distress. We found that ACE scores were associated with higher levels of distress (b = .08; se = .03; p < .01) when controlling for demographic characteristics. The addition of loneliness to the model fully mediates the association between ACEs score and distress. Findings suggest that adverse childhood experiences influence COVID-19-related distress due to greater social isolation. Those who had greater adversity during childhood may be less likely to have the social connectedness needed to reduce distress due to the pandemic.

Is a dyadic stressor experienced as equally distressing by both partners? The case of perceived fertility problems.

Using data from a population survey, this article explores whether perceptions of having a fertility problem among 926 U.S. couples in heterosexual relationships (women aged 25-45 and male partners) are associated with distress. Most couples did not perceive a fertility problem (58%). In almost a third (30%) of the couples, only women perceived a fertility problem; in 4%, only the men; and in nearly a fifth (19%), both perceived a problem. Adjusted for characteristics associated with fertility problems and depressive symptoms, those who perceived a problem exhibited significantly more depressive symptoms than those who did not. Fertility problems are sometimes experienced as individual because in some couples only one partner perceives a problem or has higher distress in response to their own rather than to their partners' perceived problems. For women, fertility problems are experienced as a couple phenomenon because women were more distressed when both partners perceive a problem. The perception of fertility problems is gendered in that women were more likely to perceive a problem than men. Furthermore, men are most distressed when they perceive a problem and their partner does not.

Best Practices for Engaging Pregnant and Postpartum Women at Risk of Substance Use in Longitudinal Research Studies: a Qualitative Examination of Participant Preferences.

There are significant barriers in engaging pregnant and postpartum women that are considered high-risk (e.g., those experiencing substance use and/or substance use disorders (SUD)) into longitudinal research studies. To improve recruitment and retention of this population in studies spanning from the prenatal period to middle childhood, it is imperative to determine ways to improve key research engagement factors. The current manuscript uses a qualitative approach to determine important factors related to recruiting, enrolling, and retaining high-risk pregnant and postpartum women. The current sample included 41 high-risk women who participated in focus groups or individual interviews. All interviews were analyzed to identify broad themes related to engaging high-risk pregnant and parenting women in a 10-year longitudinal research project. Themes were organized into key engagement factors related to the following: (1) recruitment strategies, (2) enrollment, and (3) retention of high-risk pregnant and parenting women in longitudinal research studies. Results indicated recruitment strategies related to ideal recruitment locations, material, and who should share research study information with high-risk participants. Related to enrollment, key areas disclosed focused on enrollment decision-making, factors that create interest in joining a research project, and barriers to joining a longitudinal research study. With regard to retention, themes focused on supports needed to stay in research, barriers to staying in research, and best ways to stay in contact with high-risk participants. Overall, the current qualitative data provide preliminary data that enhance the understanding of a continuum of factors that impact engagement of high-risk pregnant and postpartum women in longitudinal research with current results indicating the need to prioritize recruitment, enrollment, and retention strategies in order to effectively engage vulnerable populations in research.

Does Self-Identifying as Having a Health Problem Precede Medical Contact? The Case of Infertility.

Studies of medical help-seeking presume that self-identifying as having a health problem precedes medical contact, but this ordering of the identity-behavior relationship has not been systematically examined. We used longitudinal data from the National Survey of Fertility Barriers (2004 to 2010) on 412 women with infertility to document the temporal relationship between self-identifying as having a fertility problem and making medical contact. The symbolic interactionist perspective suggests that infertility will be perceived as identity disruption and that in response women will align self-identity and medical behavior over time. Cross-tabulation analysis indicated that more women do self-identify as having a fertility problem first (24 percent) as opposed to making medical contact first (5.5 percent). There was also a tendency toward aligning self-identification and behavior over time. Latent class analyses revealed six patterns: 1) consistently involved, 2) early consulters, 3) consistently uninvolved, 4) consistent perceivers, 5) medical dropouts, and 6) early perceivers. Strong fertility intent and primary infertility, two identity-relevant characteristics, had the strongest associations with latent class membership. The relationship between self-identification and medical help-seeking is thus dynamic and complex.

The role of pregnancy intendedness and prenatal contraceptive counseling on postpartum contraceptive use.

BACKGROUND: The study was conducted to prospectively examine how pregnancy intendedness and prenatal provider counseling about postpartum contraceptive options are associated with lack of contraception use at 6 months post-birth (e.g., increased risk for a short interpregnancy interval). METHODS: Logistic regression models were used to examine risk for no postpartum contraception use among a sample of low-income and racially/ethnically diverse women recruited from two metropolitan perinatal clinics in Tulsa, OK. RESULTS: Women who reported that they were trying to get pregnant or "okay either way" about getting pregnant had significantly lower odds of using contraception at 6 months post childbirth than those who had unintended pregnancies. Having providers who discussed postpartum contraceptive options during pregnancy significantly increased the odds of contraceptive uptake among those who were planning or ambivalent about their pregnancies. CONCLUSIONS: Intentions of a current pregnancy and provider contraceptive counseling matter for postpartum contraceptive use and the associated risk for a short interval subsequent pregnancy. Provider contraceptive counseling that accounts for the intendedness of a current pregnancy may offer a more targeted approach to prevent a short interval subsequent pregnancy.

Is infertility resolution associated with a change in women's well-being?

STUDY QUESTION: Is giving birth associated with improved subjective well-being among involuntarily childless women? SUMMARY ANSWER: Resolution of infertility is associated with increased life satisfaction and self-esteem, but not with a decrease in depressive symptoms. WHAT IS KNOWN ALREADY: Cross-sectional data and studies of treatment-seekers show that infertility is associated with lower subjective well-being. Childless women with infertility tend to report lower subjective well-being than women who experience secondary infertility, but a prospective study using a random sample of involuntarily childless women over time has not previously been conducted. STUDY DESIGN, SIZE, DURATION: The sample for the current study includes all women without children who met medical criteria for infertility or perceived a fertility problem (N = 283) at baseline and who were interviewed in both waves (3 years apart) of the National Survey of Fertility Barriers (NSFB), in a random-digit dialing telephone survey. It is therefore possible to explore here whether there are differences in the association of infertility resolution and subjective well-being among women who do and do not perceive themselves as having a fertility problem. PARTICIPANTS/MATERIALS, SETTING, METHODS: Depressive symptoms (as measured by the Center for Epidemiologic Studies-Depression Scale), self-esteem (as measured by a modified version of the Rosenberg Self-esteem Scale) and life satisfaction (as measured by a modified version of the Satisfaction with Life Scale) were assessed for all 283 participants at both waves. For all three variables, change scores of 47 involuntarily childless women who resolved their infertility through a live birth were compared to the scores for the 236 women who remained childless. A number of variables shown to be associated with subjective well-being among infertile women were included as controls. MAIN RESULTS AND THE ROLE OF CHANCE: No relationship between infertility resolution and change in depressive symptoms was observed (b = -0.04; P > 0.05). Involuntarily childless women who resolved their infertility improved in self-esteem (b = 0.74; P < 0.01) and life satisfaction (b = 1.06; P < 0.01). LIMITATIONS, REASONS FOR CAUTION: Women were measured at only two time points. Only 47 women had a live birth between waves. While it is common practice to make causal interpretations based on panel data, such interpretations should be made with caution. In addition, the NSFB was conducted in the USA where medical expenditures are high and most fertility treatment expenses are not covered by insurance. Thus it may not be possible to generalize the findings to other modern industrialized societies. WIDER IMPLICATIONS OF THE FINDINGS: Knowing that resolution of infertility is associated with improved subjective well-being is important for infertile couples and infertility professionals alike. STUDY FUNDING/COMPETING INTEREST(S): This research was supported in part by NICHD grant R01-HD044144 and NIGMS grant P20-GM109097 from the National Institutes of Health. The authors have no competing interests.