Factors associated with parenting stress in parents of 18-month-old children: Parenting stress in parents of toddlers.

AIM: Parenting stress is associated with less optimal outcomes for children. Risk factors contributing to parenting stress in healthy toddlers have received little empirical attention. This study sought to determine the factors that are associated with parenting stress in parents of 18-month-old children. METHODS: We analysed cross-sectional survey data from a prospective cohort study focused on parent-child mealtime interactions. Families with an 18-month-old child were recruited in Columbus, Ohio, USA, between December 2017 and May 2019. Adjusted stepwise linear regression models estimated associations between child factors (e.g., temperament), parental factors (e.g., depressive symptoms), quality of romantic relationship factors (e.g., adult attachment style) and home environment factors (e.g., household income) and parenting stress (Parental Distress subscale of the Parenting Stress Index-4 Short Form). RESULTS: The 299 children included 129 (43%) females. Parents were on average 30.6 (SD 6.1) years old and included a diverse racial/ethnic cohort. Mean Parental Distress score was 24.3 (SD 6.8; score range 12-60). Higher Parental Distress scores were associated with greater parental depressive symptoms (B = 5.1 [95% CI: 2.4, 7.7]) and avoidant (B = 2.8 [95% CI: 0.9, 4.6]) attachment style. Other child, parental and home environment factors did not demonstrate statistically significant relationships with parental distress in the final model. CONCLUSION: Our findings align with recommendations for paediatric providers to screen for parenting stress and mental health.

A mixed methods analysis of environmental and household chaos: considerations for early-childhood obesity research.

BACKGROUND: Chaos has implications for child health that may extend to childhood obesity. Yet, results from studies describing associations between chaos and childhood obesity are mixed. New approaches to studying the environments of young children may help to clarify chaos-obesity relationships. METHODS: We conducted a concurrent mixed methods analysis of quantitative and qualitative data describing home and neighborhood chaos among a diverse cohort of 283 caregiver-toddlers dyads from Ohio. We examined the underlying structure of environmental and household chaos using exploratory factor analysis then sought to validate the structure using qualitative field notes. We generated total scores for factors of chaos and described their distributions overall and according to cohort characteristics. Additionally, we conducted a thematic content analysis of brief ethnographies to provide preliminary construct validity for our indicators of chaos. RESULTS: Dyads varied according to household composition, income, education, and race/ethnicity. We found evidence for a multi-factor structure for chaos, which included disorganization and neighborhood noise. Household disorganization scores ranged from 0 to 7.3 and were on average 2.1 (SD = 1.8). Neighborhood noise scores ranged from 0 to 4 and were on average 1.1 (SD = 1.1). Both disorganization and neighborhood noise were associated with indicators of socioeconomic disadvantage, such as lower educational attainment and household income. Qualitative data from households with high and low scores on the two identified factors were aligned in ways that were supportive of construct validity and further contextualized the social and material environments in which chaos occurred. CONCLUSIONS: Chaos represents a complex construct with implications spanning various disciplines, including childhood obesity research. Previous studies suggest challenges associated with measuring chaos may limit the conclusions that can be drawn about which aspect of chaos (if any) matter most of early childhood weight development. We advance the literature by demonstrating chaos may be comprised of conceptually distinct subdomains. Future childhood obesity prevention research may benefit from more contemporary measure of chaos, such as those relying on direct observations that account for a multifaceted underlying structure.

Attachment quality assessed from children's family drawings links to child conduct problems and callous-unemotional behaviors.

OBJECTIVE: Recently, there has been considerable research on the origins of childhood conduct problems (CP) and callous-unemotional (CU) behaviors. This study examined associations between children's attachment representations and CP and CU behaviors during middle childhood. METHOD: At 1st grade, 1,292 children (57% European American, 42.5% African American, 0.5% other race; 50.9% girls) completed a drawing of their family, which was coded by trained raters to assess attachment representations. Primary caregivers reported on children's CP and CU behaviors. RESULTS: Children with disorganized representations showed more CP and CU behaviors than children with secure and resistant representations. They were also more likely than those with secure representations to show elevated CP without CU behaviors, CU behaviors only, and co-occurring CP and CU behaviors. CONCLUSION: These findings provide support for attachment disorganization as a correlate of CP and CU behaviors and suggest that attachment representations are likely important proximal influences on children's behavior.

Associations between parenting behavior and executive function among preschool-aged children born very preterm.

The objective of the current study was to determine whether three domains of observed parenting behavior were associated with executive function in preschool-aged children born very preterm (<30 completed weeks' gestation). Executive function of 41 preschool-aged (3.5 to 4.5 years) children was assessed using a standardized protocol (gift delay) and by parent-report (Behavior Rating Inventory of Executive Function-Preschool, BRIEF-P). Observational protocols were used to determine parental sensitivity, harsh intrusiveness, and dyadic mutuality in a semi-structured play task. Parental sensitivity and mutuality were rated as higher, and harsh intrusiveness was rated as lower for children high in executive function on the gift delay task. Similarly, correlations between the three parenting scales and the BRIEF-P Global Executive Composite t-score were in the expected direction though not always statistically significant. Findings suggest that very preterm children who experienced sensitive parenting and were rated as having greater mutuality in their interactions with their caregivers scored higher on executive function tasks. These findings add to the growing literature on the key role that sensitive parenting and mutually responsive, harmonious interactions between caregivers and children may play in the development of executive function in very preterm children.

Mothers' and Fathers' Sensitivity and Children's Cognitive Development in Low-Income, Rural Families.

This study examines associations between maternal and paternal sensitive parenting and child cognitive development across the first 3 years of life using longitudinal data from 630 families with co-residing biological mothers and fathers. Sensitive parenting was measured by observational coding of parent-child interactions and child cognitive development was assessed with the Bayley Scales of Infant Development and the Wechsler Preschool and Primary Scales of Intelligence. There were multiple direct and indirect associations between parenting and cognitive development across mothers and fathers, suggesting primary effects, carry-forward effects, spillover effects across parents, and transactional effects across parents and children. Associations between parenting and cognitive development were statistically consistent across mothers and fathers, and the cumulative effects of early parenting on later cognitive development were comparable to the effects of later parenting on later cognitive development. As interpreted through a family systems framework, findings suggest additive and interdependent effects across parents and children.

The Interdependence of Adult Relationship Quality and Parenting Behaviours among African American and European Couples in Rural, Low-Income Communities.

The present study extends the spillover and crossover hypotheses to more carefully model the potential interdependence between parent-parent interaction quality and parent-child interaction quality in family systems. Using propensity score matching, the present study attempted to isolate family processes that are unique across African American and European American couples that are independent of other socio-demographic factors to further clarify how interparental relationships may be related to parenting in a rural, low-income sample. The Actor-Partner Interdependence Model (APIM), a statistical analysis technique that accounts for the interdependence of relationship data, was used with a sample of married and non-married cohabiting African American and European American couples (n = 82 dyads) to evaluate whether mothers' and fathers' observed parenting behaviours are related to their behaviours and their partner's behaviours observed in a couple problem-solving interaction. Findings revealed that interparental withdrawal behaviour, but not conflict behaviour, was associated with less optimal parenting for fathers but not mothers, and specifically so for African American fathers. Our findings support the notion of interdependence across subsystems within the family and suggest that African American fathers may be specifically responsive to variations in interparental relationship quality.

Association between maternal closeness with parents and mother-toddler relationship quality.

Objective: Understanding how positive parenting is conveyed across generations informs early childhood policy. Background: The extant literature has focused on how a mother's relationship with her own mother sets the stage for her parenting of her own children, yet less understood is how a mother's relationship with her father supports her responsive parenting and potentially informs her child's attachment security. Method: We analyzed data from 6,400 mothers of singleton infants participating in the Early Childhood Longitudinal Study, Birth Cohort. We examined whether a mother's closeness with her own mother and father (Generation 1) related to her responsiveness and child attachment security (Generation 3) at age 24 months. Results: Most mothers reported being extremely (25.7%) or at least quite close (25.1%) with both their mother and father. How close mothers felt to their own parents was not associated with their observed level of responsiveness to their toddler or their toddler's attachment security, adjusting for sociodemographic covariates. Maternal education was the strongest predictor of responsiveness and attachment security. Conclusion: Maternal education is strongly related to responsiveness, and to a lesser extent, child attachment security, in toddlerhood. Implications: Programs aimed at addressing the challenges of caregiving may overcome the limitations of lower education status.

Household chaos, child temperament, and structure-related feeding practices in toddlerhood: A moderation analysis.

Structure-related feeding practices may promote intuitive child eating behaviors and foster responsiveness to internal cues of hunger and satiety. Caregivers' ability to engage in structure-related feeding practices likely depends on a complex ecology of factors, including household- and child-characteristics. This study examined associations between household chaos and structure-related feeding practices, and the moderating effect of child temperament. Data were from 275 caregiver-toddler dyads from central Ohio. Child temperament was reported by caregivers when children were 18 months of age, whereas household chaos and structure-related feeding practices were reported by caregivers when children were 36 months of age. Multivariable linear regression models were constructed to assess the relationship between chaos and structure-related feeding practices. Interaction terms between household chaos and three dimensions of child temperament were tested to determine whether temperament moderated the relationship between chaos and structure-related feeding practices. Household chaos was not independently associated with structure-related feeding practices, but higher levels of child effortful control were associated with greater mealtime structure. There was a statistically significant interaction between household chaos and child temperamental surgency, such that greater levels of chaos were associated with less structured mealtimes, but only when children had low-surgency. Findings suggest household chaos and child temperament inform caregiver feeding practices, but the influence of chaos may depend on more proximal factors, like child temperament. Recommendations to improve caregiver-child feeding interactions should be sensitive to characteristics of the broader family home environment.

Childhood maltreatment predicts maternal sensitivity to distress: Negative attributions during the transition to parenthood.

Childhood maltreatment is a predictor of subsequent parenting behaviors; however, the mechanisms explaining this association have been understudied. The present study examined the indirect effect of childhood maltreatment on maternal sensitivity to distress via (a) emotion regulation difficulties, (b) negative attributions about infant crying, (c) minimizing attributions about infant crying, and (d) situational attributions about infant crying. The sample included 259 primiparous mothers (131 Black and 128 White) and their 6-month-old infants (52% female). Mothers retrospectively reported on their childhood history of maltreatment when their infants were about 2 years old. Emotion regulation difficulties and causal attributions about infant crying were assessed prenatally. Maternal sensitivity to distress was rated during three distress-eliciting tasks when children were 6 months old. Results from the structural equation model demonstrated that maternal childhood maltreatment was significantly positively associated with negative attributions about infant crying but not with emotion regulation difficulties, minimizing attributions, or situational attributions about crying. Furthermore, negative attributions about crying were associated with lower sensitivity to distress, and there was an indirect effect of childhood maltreatment on sensitivity to distress via negative attributions about infant distress. These effects were significant above and beyond the effects of coherence of mind, concurrent depressive symptoms, infant affect, maternal age, race, education, marital status, and income-to-needs ratio. The results suggest that altering negative attributions about infant crying may be an important area to intervene during the prenatal period to reduce continuity in maladaptive parenting across generations. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Self-Compassion and Depressive Symptoms as Determinants of Sensitive Parenting: Associations with Sociodemographic Characteristics in a Sample of Mothers and Toddlers.

Parenting that is sensitive and responsive to children's needs has been shown to support children's optimal growth and development in many cultural contexts. Numerous studies suggest that self-compassion is positively related to sensitive parenting. Despite growing research interest linking self-compassion to responsive parenting, there are considerable gaps in the literature. The current study examined the associations between self-compassion, depressive symptoms, socioeconomic status, and sensitive parenting. Data was obtained from a cohort study of 300 families in central Ohio enrolled when children were a mean (SD) calendar age of 18.2 (0.7) months. Children of all gestational ages at birth are included, and 37% were born preterm (<37 weeks' gestation). Observational protocols were used to determine maternal sensitivity in a semi-structured play setting. Self-compassion was assessed with the Self-Compassion Scale when children were 24 months old. Self-compassion was not associated with sociodemographic characteristics including maternal education, household income, child sex and gestational age. In unadjusted regression models, depressive symptoms were related to sensitive parenting (B = -0.036, SE = 0.016, p = 0.03), but self-compassion was not a statistically significant predictor (p = 0.35) of sensitivity, and neither self-compassion nor depressive symptoms were statistically significant predictors of sensitive parenting after adjustment for covariates. Considerations for future studies are discussed.

Household chaos as a moderator of the link between parents' inhibitory control and parenting quality.

This study considered how mothers' and fathers' inhibitory control, an aspect of executive functioning (EF) that reflects how well an individual can suppress a dominant response to perform a subdominant response, is associated with observations of their parenting quality when children were 7.5 years old. Furthermore, aspects of the daily home environment may strengthen or undermine parents' ability to draw on their inhibitory control and exhibit high-quality parenting. Household chaos, including clutter, confusion, and ambient noise, may impair parents' ability to successfully activate inhibitory control and engage in high-quality parenting. Thus, additional analyses examined whether parents' perceptions of household chaos moderated associations between inhibitory control and parenting. Data came from a sample of approximately 102 families headed by different-sex parents (n = 99 mothers; n = 90 fathers) of 7.5-year-old children who participated in a study of family development. Findings from multilevel models indicated that inhibitory control predicted greater positive-sensitive parenting in contexts of low household chaos. Associations between inhibitory control and parenting quality were not statistically significant in contexts of average or high household chaos. These findings highlight the importance of considering household chaos and inhibitory control as factors associated with parenting quality for fathers and mothers. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Perinatal Factors and Emotional, Cognitive, and Behavioral Dysregulation in Childhood and Adolescence.

OBJECTIVE: This cohort study assessed perinatal factors known to be related to maternal and neonatal inflammation and hypothesized that several would be associated with emotional, cognitive, and behavioral dysregulation in youth. METHOD: The Environmental influences on Child Health Outcomes (ECHO) is a research consortium of 69 pediatric longitudinal cohorts. A subset of 18 cohorts that had both Child Behavior Checklist (CBCL) data on children (6-18 years) and information on perinatal exposures including maternal prenatal infections was used. Children were classified as having the CBCL-Dysregulation Profile (CBCL-DP) if the sum of their T scores for 3 CBCL subscales (attention, anxious/depressed, and aggression) was ≥180. Primary exposures were perinatal factors associated with maternal and/or neonatal inflammation, and associations between these and outcome were assessed. RESULTS: Approximately 13.4% of 4,595 youth met criteria for CBCL-DP. Boys were affected more than girls (15.1% vs 11.5%). More youth with CBCL-DP (35%) were born to mothers with prenatal infections compared with 28% of youth without CBCL-DP. Adjusted odds ratios indicated the following were significantly associated with dysregulation: having a first-degree relative with a psychiatric disorder; being born to a mother with lower educational attainment, who was obese, had any prenatal infection, and/or who smoked tobacco during pregnancy. CONCLUSION: In this large study, a few modifiable maternal risk factors with established roles in inflammation (maternal lower education, obesity, prenatal infections, and smoking) were strongly associated with CBCL-DP and could be targets for interventions to improve behavioral outcomes of offspring. DIVERSITY & INCLUSION STATEMENT: We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. We actively worked to promote sex and gender balance in our author group. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.

Play & Grow: prospective observational cohort of toddlers to inform obesity prevention, Columbus, Ohio, USA.

PURPOSE: Obesity prevention is increasingly focused on early childhood, but toddlers have not been well-studied, and children born preterm are frequently excluded. The Play & Grow Cohort was established to investigate child growth in relation to parent-child interactions in mealtime and non-mealtime settings. PARTICIPANTS: Between December 2017 and May 2019, 300 toddlers and primary caregivers were recruited from records of a large paediatric care provider in Columbus, Ohio, USA. This report describes recruitment of the cohort and outlines the data collection protocols for two toddler and two preschool-age visits. The first study visit coincided with enrolment and occurred when children (57% boys) were a mean (SD) calendar age of 18.2 (0.7) months. FINDINGS TO DATE: Children in the cohort are diverse relative to gestational age at birth (16%, 28-31 completed weeks' gestation; 21%, 32-36 weeks' gestation; 63%, ≥37 weeks' gestation) and race/ethnicity (8%, Hispanic; 35%, non-Hispanic black; 46%, non-Hispanic white). Caregivers enrolled in the cohort are primarily the child's biological mother (93%) and are diverse in age (range 18-54 years), education (23%, high school or less; 20% graduate degree) and annual household income (27%,

Eating Competence Among Caregivers of Toddlers: Associations With Caregiver and Child Overweight/Obesity.

OBJECTIVE: To examine the association between caregiver eating competence and child overweight/obesity and caregiver obesity. DESIGN: Longitudinal cohort. SETTING: A large US children's hospital. PARTICIPANTS: Caregiver-child dyads (n = 288 with complete data at 2 time points) were sampled in 2017-2019 from those who received care at Nationwide Children's Hospital. MAIN OUTCOME MEASURE(S): Child overweight/obesity at 24 months of age (body mass index [BMI]) z-score >2 per World Health Organization standards and caregiver weight status (underweight/healthy [BMI < 25 kg/m2], overweight [BMI ≥ 25 and < 30 kg/m2], or obese [BMI ≥ 30 kg/m2]). ANALYSIS: Log-binomial models examined the relationship between caregiver eating competence (ecSatter Inventory) at 18 months and child overweight/obesity at 24 months of age. Proportional odds models investigated the relationship between caregivers' eating competence and weight status. RESULTS: Eating competent caregivers had more than twice the odds (odds ratio, 2.11; 95% confidence interval, 1.30-3.42) of having a lower BMI category and had lower average BMI than noneating competent caregivers. Child overweight/obesity at 24 months did not differ by caregiver eating competence. CONCLUSIONS AND IMPLICATIONS: Although child overweight/obesity did not vary by caregiver eating competence, caregiver eating competence was related to their weight status. Longer-term studies are needed to clarify the role of caregiver eating competence as children develop. Promoting caregivers' eating competence may translate into healthier behaviors and skills for caregivers and their children long term.

Intimate Partner Violence, Parenting, and Children's Representations of Caregivers.

Children's representational models of self and relationship quality with caregivers in the context of intimate partner violence (IPV) were investigated using family drawings created by children in their first-grade year. The present study examines the mediating role of mothers' and fathers' sensitive parenting behaviors in the relations between IPV and children's representations of relationship quality with mothers and fathers. The sample (N = 947) is drawn from a longitudinal study of rural poverty exploring the ways in which child, family, and contextual factors shape development over time. Results of analyses indicate significant associations between IPV, sensitive parenting, and children's representation of relationship quality with mothers and fathers. There was a significant indirect effect from IPV on children's representation of relationship quality with fathers through paternal parenting behaviors. The findings from this study suggest that exposure to violence may affect how children view their family relationships and that fathers' parenting behavior is a key mediating process. Implications of the findings and directions for future study are proposed.

Knowledge of Infant Development and Parent Well-Being: Cross-Sectional Analysis of Toddlers.

OBJECTIVE: Knowledge about child development is associated with parenting and children's outcomes. Parents with less accurate knowledge about developmental milestones may have unrealistic expectations for their child's behavior, which may affect parent well-being. Limited research has examined this topic relative to depression, but other aspects of parent well-being (e.g., parenting stress) are unexplored. METHODS: Cross-sectional analysis of an ongoing prospective cohort study of 300 families in central Ohio enrolled when children were a mean (SD) calendar age of 18.2 (0.7) months. Children of all gestational ages at birth are included, and 37% were born preterm (<37 weeks' gestation.) Primary caregivers (93% mothers) completed the 20-item Knowledge of Infant Development Index (KIDI) and questionnaires for child temperament and 3 aspects of parent well-being (depressive and anxious symptoms, parenting stress, and general health). Covariate-adjusted regression models assessed relationships between the KIDI score and each well-being outcome. We hypothesized that parents with less knowledge would have more symptoms of depression and anxiety, greater parenting stress, and poorer health. Whether associations were stronger for parents of children born preterm or who had high negative affect was explored. RESULTS: Knowledge of Infant Development Index scores were associated with sociodemographic characteristics, child temperament, and gestational age (more knowledge: higher socioeconomic position, less child negative affect, and full-term birth). KIDI scores did not predict any aspect of parent well-being, and there was no evidence that child temperament or preterm birth altered these findings. CONCLUSION: In this sample of parents of toddlers assessed in 2018/19, greater knowledge of infant development was not associated with parent well-being.

Parent Self-Compassion and Supportive Responses to Child Difficult Emotion: An Intergenerational Theoretical Model Rooted in Attachment.

Self-compassion is an adaptive way of self-relating that entails tending to one's emotional pain with understanding and care. In this paper, we propose an intergenerational model explaining how self-compassion develops within the context of the parent-child relationship. Specifically, we posit that parents who have had supportive experiences with their own childhood caregivers develop a secure attachment and a high level of self-compassion. In turn, we propose that high self-compassion in parents promotes the parents' capacity to support their child when he or she experiences difficult emotions (e.g., anger, sadness). These responses promote the child's secure attachment, high self-compassion development and positive behavioral outcomes. A key area for future research is examining the potential link between parent self-compassion and responses to difficult emotions in the child. Given self-compassion can be enhanced through intervention, support for this model will have broad implications for interrupting intergenerational cycles of dysfunction caused by insecure attachment.

Positive Emotions During Infant Feeding and Breastfeeding Outcomes.

BACKGROUND: Few studies have examined the role of maternal emotions in breastfeeding outcomes. RESEARCH AIM: We aimed to determine the extent to which positive maternal emotions during human milk feeding at 2 months were associated with time to any and exclusive human milk feeding cessation and overall breastfeeding experience. METHODS: A sample of 192 women intending to breastfeed for at least 2 months was followed from the third trimester until 12 months postpartum. Positive emotions during infant feeding at 2 months were measured using the modified Differential Emotions Scale. Cox proportional hazards regression was used to estimate adjusted hazard ratios (aHR) for time to any and exclusive human milk feeding cessation associated with a 1-point increase in positive emotions. Linear regression was used to estimate the association between positive emotions and maternal breastfeeding experience reported at 12 months. RESULTS: Among those human milk feeding at 2 months, positive emotions during feeding were not associated with human milk feeding cessation by 12 months (aHR = 0.94, 95% CI [0.64, 1.31]). However, among women exclusively human milk feeding at 2 months, a 1-point increase in positive emotions was associated with a 35% lower hazard of introducing formula or solid foods by 6 months (aHR = 0.65, 95% CI [0.46, 0.92]). Positive emotions were associated with a significantly more favorable maternal report of breastfeeding experience at 12 months. Results were similar in sensitivity analyses using maternal feelings about breastfeeding in the first week as the exposure. CONCLUSIONS: A positive maternal emotional experience of feeding is associated with breastfeeding outcomes.

Medication-assisted treatment vs. detoxification for women who misuse opioids in pregnancy: Associations with dropout, relapse, neonatal opioid withdrawal syndrome (NOWS), and childhood sexual abuse.

The American College of Obstetricians and Gynecologists recommends medication-assisted treatment (MAT) for pregnant women who misuse opioids rather than detoxification because of possible relapse and dropout from treatment (ACOG, 2017). In a prospective study, fifty-five pregnant women with an opioid use disorder were offered a choice of MAT or detoxification. Ethical concerns precluded random assignment. We assessed dropout, treatment outcome, relapse, other illicit drug use, infant neonatal opioid withdrawal syndrome (NOWS), and childhood sexual abuse. Of 55 women, 13 initially chose MAT and 42 women chose detoxification. All women received behavioral support. No one dropped out of treatment prior to delivery. All women who chose MAT initially remained on MAT. Of women who chose detoxification, 23% switched to MAT, 30% tapered below initial MAT doses, and 45% fully detoxified by delivery. There was a significant difference in opioid relapse between women on MAT (26%) and those who detoxified (0%), but no differences for other illicit drug use. Infants of women on MAT were more likely to have neonatal NOWS (91%) than infants of women who tapered below initial MAT doses but did not fully detoxify (62%). Infants of mothers who tapered (62%) were more likely to have NOWS than infants of women who fully detoxified (0%). Women on MAT reported significantly lower sexual abuse severity than did women who tapered or detoxified. It is critical to replicate the current findings and to follow up with mothers and their infants postpartum to ascertain the long-term impact of tapering or detoxification during pregnancy.

Pregnant women's history of childhood maltreatment and current opioid use: The mediating role of reflective functioning.

There is an association between the experience of childhood maltreatment and opioid misuse in adults, especially for women. However, we know little about this association in pregnancy, and less about processes that could be the target of interventions to help women better parent their infants. We examined reflective functioning as a putative process. Reflective functioning is the ability to interpret one's own and others' behavior in terms of underlying mental states, e.g., emotions, motivations, and beliefs. We sampled 55 pregnant women who misused opioids and 38 women at high risk due to medical factors, e.g., heart disease. We assessed maltreatment with the Maltreatment and Abuse Chronology of Exposure (MACE; Teicher & Parigger, 2015), and reflective functioning with the Reflective Functioning Questionnaire (RFQ; Fonagy et al., 2016). Maltreatment variables included the sum of severity across all subtypes, number of subtypes experienced, and severity of sexual, physical, and emotional abuse, and of neglect. We created a categorical opioid user group variable: women who used opioids in pregnancy vs. high-risk medical comparisons. We found that women who used opioids in pregnancy had poorer reflective functioning than did high-risk medical comparisons. We also created an opioid use severity scale (ranging from 0 to 3) from urine assays and history of prescribed opioids from medical records. Using Hayes (2012)'s bootstrapping PROCESS macro, we found that reflective functioning mediated the association between all maltreatment variables and opioid use severity. We discuss the results in terms of how best to intervene to improve women's reflective functioning, which may help their ability to parent.