Impact of Prenatal Group Healthy Relationship Education on Postpartum Contraception.

Objective: We aimed to evaluate the impact of an antenatal group healthy relationship education program on the postpartum use of long-acting reversible contraception (LARC). Materials and Methods: This is a planned subgroup analysis of a larger randomized controlled trial. Pregnant and newly parenting women were randomized to either group healthy relationship education, "MotherWise," or no additional services. An evidence-based healthy relationship education program and individual case management sessions were provided. The program did not include any prenatal care or contraception counseling. This subgroup analysis included those participants with a nonanomalous gestation randomized at <40 weeks who received care and delivered at a single safety-net hospital and were discharged home with a live infant(s). Results: From September 2, 2016 to December 21, 2018, 953 women were randomized in the larger trial; 507 met inclusion criteria for this study; 278 randomized to program and 229 controls. Participants were mostly young, parous, Hispanic, publicly insured women. Participants randomized to program were more likely to take a prescription medicine and be delivered through cesarean; there were not any other significant differences in baseline, antenatal, or perinatal outcomes. Those randomized to program were more likely to be discharged home with immediate postpartum LARC in place (odds ratio [OR] 1.87; confidence interval [CI] 1.17-3.00), and more likely to be using LARC at the postpartum visit (OR 2.19; CI 1.34-3.56). Conclusion: Antenatal group healthy relationship education provided separately from prenatal care is associated with a twofold increase in the use of postpartum LARC. Clinical Trial Registration: ClinicalTrials.gov NCT02792309; https://clinicaltrials.gov/ct2/show/NCT02792309?term=NCT02792309&draw=2&rank=1.

Parent-Child Relationship Quality in the Family of Origin and Later Romantic Relationship Functioning: A Systematic Review.

A large and diverse literature has shown that parent-child relationship quality shapes development to affect later romantic relationship functioning. Guided by the developmental psychopathology framework, the current systematic review aimed to characterize the links between two major subtypes of parent-child relationship quality (parent-child attachment security and interaction quality) and several romantic relationship outcomes (i.e., adjustment, attachment security, aggression, and observed interaction quality), as well as to identify mechanisms accounting for these associations. We focused on studies that included both members of a couple/partnership for dyadic assessment of romantic relationship functioning, to more accurately and fully capture both partners' perspectives. A total of 40 articles met inclusion criteria, most of which sampled early/emerging adult couples between the ages of 18 and 26 years. Findings suggest that parent-child attachment security and interaction quality have similar associations with dyadic romantic relationship functioning, with the strongest evidence of effects on romantic relationship adjustment and observed interactions between romantic partners. Many studies found gender differences in effects, as well as cascading effects across development and over the course of a relationship. We argue that it is important for future studies to explore effects of one partner's parent-child relationship quality history on the other partner's romantic relationship adjustment and behavior, and to evaluate the extent to which parent-child attachment security mediates associations between parent-child interaction quality and romantic relationship functioning.

Se ha demostrado en publicaciones completas y variadas que la calidad de la relación entre padres e hijos determina el desarrollo de una manera que influye en el funcionamiento posterior de las relaciones amorosas. Guiado por el marco de la psicopatología evolutiva, el presente análisis sistemático tuvo como finalidad caracterizar los vínculos entre dos grandes subtipos de calidad de la relación entre padres e hijos (seguridad en el apego entre padres e hijos y calidad de la interacción) y varias consecuencias en las relaciones amorosas (p. ej.: adaptación, seguridad en el apego, agresión y calidad de la interacción observada), así como identificar los mecanismos que dan cuenta de estas asociaciones. Nos centramos en estudios que incluyeron tanto a integrantes de una pareja/asociación para la evaluación diádica del funcionamiento de las relaciones amorosas con el fin de captar más precisa y completamente las perspectivas de ambos integrantes de la pareja. Cuarenta artículos en total cumplieron con los criterios de inclusión, la mayoría de los cuales usaron como muestras a parejas de adultos emergentes de entre 18 y 26 años. Los resultados indican que la seguridad en el apego entre padres e hijos y la calidad de la interacción tienen asociaciones similares con el funcionamiento diádico de las relaciones amorosas, y que los indicios más claros de los efectos están en la adaptación de las relaciones amorosas y las interacciones observadas entre los integrantes de la relación amorosa. En muchos estudios se hallaron diferencias de género en los efectos, así como efectos dominó a lo largo del desarrollo y durante el transcurso de una relación. Sostenemos que es importante para estudios futuros analizar los efectos del historial de la calidad de la relación entre padres e hijos de uno de los integrantes de la pareja en la adaptación a la relación amorosa y la conducta del otro integrante de la pareja, y evaluar hasta qué punto la seguridad en el apego entre padres e hijos actúa como mediadora de las asociaciones entre la calidad de la interacción entre padres e hijos y el funcionamiento de la relación amorosa.

Supporting Romantic Relationships During COVID-19 Using Virtual Couple Therapy.

The novel coronavirus disease pandemic (COVID-19) has profoundly impacted people's lives, resulting in economic turmoil, death and suffering, and drastic changes to everyday life. The adjustment and strain of such challenges can spill over into couples' relationship processes, including how partners spend time together, talk to one another, and manage conflict. Drawing from our experiences conducting virtual couple therapy (VCT) in a university-based training clinic and community-based clinic, as well as themes from an informal survey of 29 couple therapy clinicians, the current paper discusses the unique challenges that couples face in therapy during COVID-19. Such challenges include renegotiating quality time together, navigating less personal space and time alone, experiencing individual anxiety and stress prompted by the pandemic, and increases in conflict. We discuss our clinical recommendations for addressing these challenges for couples and utilize clinical case examples to illustrate our points. Despite these challenges, we also comment on several positive aspects of COVID-19 on couple relationships. Guided by these considerations and recommendations, our observations suggest that clinicians can effectively support couples' growth and progress using VCT during COVID-19.

Coparenting and parenting outcomes of online relationship interventions for low-income couples.

Web-based relationship programs are effective in improving low-income couples' relationship functioning. However, little is known about: (a) whether parenting couples presenting for relationship help also have difficulties in coparenting and parenting, (b) whether relationship-focused programs can improve these two domains, and (c) whether program effects differ across baseline levels of those domains. We examined these questions in a parenting subsample (Nindividuals = 934) and a coparenting subsample (Ndyads = 342) of low-income couples participating in a randomized controlled trial of two web-based relationship education programs-the OurRelationship (OR) program and the ePREP program. Although the majority of participants were relationally distressed at baseline, most coparents (83%) reported parenting well together. Parents "often" engaged in nurturing behaviors and "hardly ever" or "sometimes" felt overwhelmed by their parenting responsibilities. Among parents who had engaged in the harsh verbal discipline (59%) and physical discipline (28%) in the past month, the average frequency was 4.08 and 5.50 times per month, respectively. Moreover, compared to waitlist control parents, parents in OR but not ePREP reported significantly greater improvements in parental nurturance and harsh verbal discipline during the program. There was no evidence of program effects on coparenting, physical discipline, or parenting stress for OR or ePREP, nor was there any evidence of baseline functioning moderating program effects. Findings suggested that most low-income parents seeking relationship help did not have severe problems in coparenting or parenting and that effective relationship programs without a focus on coparenting and/or parenting had somewhat limited effects on these domains. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Having a Baby: Impact on Married and Cohabiting Parents' Relationships.

The current study evaluates the effects of having a baby on relationship quality and stability, contrasting married and unmarried cohabiting parents (N = 179; 38% unmarried cohabiting). Participants provided several waves of data, including time points before, during, and after pregnancy. Results indicated that cohabiting parents broke up at a significantly higher rate after having a baby compared to married parents. In terms of relationship quality, interrupted time-series analyses indicated that negative communication significantly increased after baby regardless of marital status. In addition, married parents had significantly higher levels of relationship satisfaction and commitment before baby compared to cohabiting parents but experienced modest declines in relationship satisfaction after baby. Cohabiting parents did not show such declines but remained lower in satisfaction throughout the study. Gender moderated commitment trajectories, such that married and cohabiting women demonstrated decreased commitment after baby, but married and cohabiting men demonstrated no significant changes in commitment. This study adds to the literature by examining both relationship stability and relationship quality trajectories from before pregnancy to after the birth of a baby among married and cohabiting parents in the same sample. Implications of these findings for practice and future research are discussed.

El presente estudio evalúa los efectos de tener un bebé en la calidad y la estabilidad de la relación, contrastando los padres casados y los concubinos convivientes (N = 179; 38 % concubinos convivientes). Los participantes proporcionaron varias series de datos que incluyeron momentos antes, durante y después del embarazo. Los resultados indicaron que los padres concubinos se separaron a un índice considerablemente mayor después de tener un bebé en comparación con los padres casados. En cuanto a la calidad de la relación, los análisis de series de tiempo interrumpido indicaron que la comunicación negativa aumentó considerablemente después del bebé independientemente del estado civil. Además, los padres casados tuvieron niveles considerablemente más altos de satisfacción con la relación y de compromiso antes del bebé en comparación con los padres concubinos, pero tuvieron leves reducciones de la satisfacción con la relación después del bebé. Los padres concubinos no demostraron esas disminuciones pero mantuvieron una satisfacción más baja a lo largo del estudio. El género moderó las trayectorias de compromiso, de manera que las mujeres casadas y las concubinas demostraron un menor compromiso después del bebé, pero los hombres casados y los concubinos no demostraron cambios significativos en el compromiso. Este estudio enriquece la bibliografía analizando tanto las trayectorias de estabilidad de la relación como de calidad de la relación desde antes del embarazo hasta después del nacimiento de un bebé entre padres casados y padres concubinos en la misma muestra. Se debaten las consecuencias de estos resultados para la práctica y las futuras investigaciones.

The influence of maternal care and overprotection on youth adrenocortical stress response: a multiphase growth curve analysis.

We examined the association between two dimensions of maternal parenting style (care and overprotection) and cortisol response to an acute laboratory-induced stressor in healthy youth. Forty-three participants completed the Parental Bonding Instrument and an adapted version of the Trier Social Stress Test-Child (TSST-C). Nine cortisol samples were collected to investigate heterogeneity in different phases of youth's stress response. Multiphase growth-curve modeling was utilized to create latent factors corresponding to individual differences in cortisol during baseline, reactivity, and recovery to the TSST-C. Youth report of maternal overprotection was associated with lower baseline cortisol levels, and a slower cortisol decline during recovery, controlling for maternal care, puberty, and gender. No additive or interactive effects involving maternal care emerged. These findings suggest that maternal overprotection may exert a unique and important influence on youth's stress response.

Association of Lower Socioeconomic Position in Pregnancy with Lower Diurnal Cortisol Production and Lower Birthweight in Male Infants.

PURPOSE: Low maternal socioeconomic position (SEP) has been associated with adverse neonatal outcomes, including preterm birth, low birthweight, intrauterine growth restriction, and infant mortality. A key biological mechanism that has been proposed to explain this association is hypothalamic-pituitary-adrenal (HPA) activity, yet the association between SEP and HPA activity in pregnancy has received little attention. In this study we aimed to examine the associations between SEP and 2 forms of maternal cortisol regulation-diurnal slope and wakening response-across pregnancy. Furthermore, we aimed to assess whether these associations differed by the sex of the fetus. METHODS: A total of 217 pregnant women aged 18 to 40 years with singleton pregnancies participated. Women were excluded from participating if they were aged <18 or >40 years and if they were at risk for maternal or obstetric complications. Women provided information on socioeconomic characteristics of adults contributing to the participants' household to compute a Hollingshead Four Factor Index of Social Status score of SEP. Women provided salivary cortisol samples on awakening, 30 minutes after wakeup, and at bedtime, at 3 times over pregnancy and once 30 days postpartum to calculate the diurnal slope and cortisol awakening response (CAR). Using linear regression analyses, we examined the relationships between maternal SEP and maternal diurnal slope and CAR. We explored the relationships between maternal SEP and cortisol by fetal sex using linear regression analyses. We also explored links between maternal SEP, maternal cortisol, and infant birth outcomes. FINDINGS: Women of lower SEP displayed smaller awakening responses and less change over the day compared with women of higher SEP. SEP was significantly associated with attenuated diurnal slope only among women carrying female fetuses, whereas for CAR, the association between SEP and attenuated CAR was significant only for women carrying male fetuses. Lower SEP was associated with decreased birthweight, and this association was partially explained by maternal HPA activity in pregnancy. IMPLICATIONS: Women of low SEP displayed attenuated HPA activity across the perinatal period, and patterns varied by fetal sex and cortisol metric. Findings are in need of replication. More research is needed to understand the links between SEP, HPA activity, and neonatal health.