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