A Longitudinal Examination of Maternal Attachment on Neonatal and Early Childhood Outcomes2012 State of the Science Congress on Nursing Research

Jeanne Alhusen1, Deborah Gross1, Matthew Hayat2, and Phyllis Sharps1

1 Johns Hopkins University School of Nursing, Baltimore, MD2 Rutgers University College of Nursing, Newark, NJ

Funding Acknowledgements

National Institute of Mental Health (T32 MH020014) National Institute of Nursing Research (F31NR010957)Morton and Jane Blaustein Fellowship in Mental Health and Psychiatric NursingNational Center for Research Resources (5KL2RR025006), a component of the NIH, and the NIH Roadmap for Medical Research

Dissertation Study Purpose & RationaleStudy Purpose:

To understand the role of maternal-fetal attachment (MFA) on neonatal outcomes in a sample of low income, African American women at increased risk for adverse neonatal outcomes

Study Rationale:Persistent racial disparities in low birth weight and infant mortality rate in the U.S

Disparities persist beyond neonatal period

Overview of Dissertation Study (2008-2001)Purpose

To understand the role of maternal-fetal attachment (MFA) on neonatal outcomes

Design/Methods (n=166)Prospective longitudinal concurrent mixed methods designMaternal data collected at 24-28 weeks gestationNeonatal data collected within 48 hrs postpartum

Primary Variables (measures)MFA (MFAS)Maternal Mental Health (EPDS, PPP, DTS)Intimate Partner Violence (AAS)Health Practices (HPQ-II)Neonatal Outcomes (BW and GA)

Results: Socio-demographics (n=166)Demographic n %

Race African American White non-Hispanic Other

15592

9352

Marital Status Single Partnered/Not Married Married or Other

905620

543412

Education Less than High School HS grad/GED Some College/Trade School College/Trade School grad

1104556

672733

Household Income Under $10,000 $10,000 - $20,000 $20,001-$30,000 >$30,001

76661212

464077

93%African

American

88% NotMarried

94% HighSchool

Diploma or less

86% TotalHousehold

Income<$20,000

Major Dissertation Study Results

Maternal Mental Health Outcomes59% (n=98) high depressive symptoms48% (n=79) high PTSD symptoms19% (n=32) reported physical abuse during this pregnancy

Neonatal Outcomes41% of neonates classified as having adverse outcome (SGA, LBW, PTB)

Results: Adverse Neonatal Outcomes in Study Sample vs. National Average

PERC

ENTI

LE

Major Dissertation Study ResultsWomen reporting higher MFA had a decreased likelihood of delivering a neonate with an adverse outcome (OR .91, CI 0.88-0.94)Women reporting more depressive symptoms had lower MFA scores than women with less depressive symptoms (b=-1.02, CI -1.32, -.73)Qualitative participants discussed the links between depression, MFA, and neonatal outcomes

Alhusen, J., et al. (2012). The influence of maternal-fetal attachment on neonatal outcomes among low income, African American women. Research in Nursing and Health, 35, 112-120.

Alhusen, J., et al. (2012). The role of mental health on maternal-fetal attachment in low-income women, JOGNN, epub ahead of print.

Follow-up Study (2011-2012)

Follow-Up Study Purpose (n=81):

To understand the role of maternal attachment style on early childhood outcomes in a sample of low income, predominantly African American women and children at increased risk for adverse physical and mental health outcomes

Why Maternal Attachment during Early Child is Important

Attachment between a mother and a child is a biologically-driven process

May be adapted or modified by experience

A child’s ability to develop a secure attachment is nurtured in early interactions with parents

Significant differences in early care giving → early childhood health and developmental outcomes

(Naber et al., 2010; Feldman et al., 2010; Bowlby, 1969)

PurposeTo understand the role of maternal attachment style on early childhood developmental outcomes

Design/Methods (n=81)Extension of longitudinal studyMaternal-child data collected during home visits

Children age 14-26 months

Primary Variables (Measures)Attachment Style (Attachment Style Questionnaire)Maternal Depression (EPDS)Early Childhood Developmental Outcomes (Ages & Stages Questionnaires)

Overview of Follow -up Study (2011-2012)

Major Follow-up Study Results (n=81)No differences between follow up and original sample on background characteristics

36% of mothers scored high for depressive symptoms

Early Childhood Developmental Assessment30% delayed in communication skills26% delayed in problem solving skills21% delayed in gross motor skills17% delayed in fine motor skills14% delayed in personal-social skills

Bivariate Correlations (n=81)Variable Avoidant

AttachmentPostpartumDepression

Adverse Neonatal Outcomes

Early Childhood

Dev.

MFA -.62* -.61* -.55* .58*

AvoidantAttachment

- .85* .35* -.83*

PostpartumDepression

- .39* -.82*

AdverseNeonatal Outcomes

- -.50*

*p < 0.001

GLM Predicting Early Childhood Development (n=81)a,b,c

Predictor Exp β 95%CI p value

Model 1

Maternal-Fetal Attachment 1.02 [1.01, 1.03] <0.001

Model 2Avoidant AttachmentPost-partum Depression

.98

.97[.97, .99][.96, .99]

<0.001<0.001

Model 3

Maternal-Fetal AttachmentAvoidant AttachmentPost-partum Depression

1.00 .98.98

[.99, 1.00][.97, .99][.96, .99]

0.07 <0.001

0.018

aGLM= Generalized Linear Model with Gamma Distribution and Log Link Functionb Adjusted for marital status, education, income, and adverse neonatal outcomec AIC 358.4

Implications of the Research (2008-2012)Success of early intervention programs may be affected by maternal attachment style

More research needed on the role of maternal attachment and child outcomes in vulnerable populations

Further research on neuroendocrinological processes

Alterations in oxytocin functioning