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Implications of Maternal Psychiatric Symptomatology for Preterm Infant Development. Simran K. Sabherwal, MHS 13 th Annual MCH Epidemiology Conference Atlanta, Georgia December 14, 2007 Acknowledgements: Pamela K. Donohue, ScD Marilee C. Allen, MD Aynur Unalp-Arida, MD PhD.
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Implications of Maternal Psychiatric Symptomatology for Preterm Infant Development Simran K. Sabherwal, MHS 13th Annual MCH Epidemiology Conference Atlanta, Georgia December 14, 2007 Acknowledgements: Pamela K. Donohue, ScD Marilee C. Allen, MD Aynur Unalp-Arida, MD PhD
Presentation Overview • Background • Research Question • Data Source • Methods • Results • Discussion
Background • Recent recognition of the importance of addressing maternal mental health • Most studies on postpartum mental health among mothers of preterm babies have focused solely on depression • Maternal mental health impacts maternal well-being and child development • Little has been studied about this association in preterm children
Findings of Other Studies • Prevalence of perinatal depression: • 10-15% of women (range: 5-25%) • nearly 30% of women living in poverty • Postpartum women have 3 times the risk of experiencing depressive symptoms compared to women in the general population • Prematurely born infants are at greater risk for developing serious health problems, including mental retardation and developmental disability • Effective treatment for postpartum depression is not enough to improve the mother-child relationship and child outcomes
Research Question • What are the mean maternal total and subscale psychiatric index scores at 4 and 12 months from term and how do these scores compare to normative scores? • What are the average child language and motor development scores at 4 and 12 months from term and how do these scores compare to normative scores? • What is the impact of maternal psychiatric symptomatology on preterm infant language and motor development?
Data Source:Preterm Assessment of Neurodevelopment and Achievement (PANDA) Study • Sponsored by the USDHHS HRSA Maternal and Child Health Bureau • Data collected from Feb 2003- Oct 2006 • Study criteria: • Preterm infants with birth weight < 1500 g or gestational age < 33 weeks • Infants born at or transferred to Johns Hopkins Hospital or Johns Hopkins Bayview Medical Center within 1 month of birth • Maternal psychiatric status and child development were evaluated by maternal self-reporting at 4 and 12 months via phone administered surveys
Evaluation Tools • Psychiatric Symptom Index (PSI)- 29 items • Anxiety (11) • Depression (10) • Anger (4) • Cognitive Disturbance (4) • Clinical Linguistic and Auditory Milestone Scale (CLAMS)- 32 items • Motor Milestone Attainment- 20 items
Methods • PANDA dataset: 176 parent-child pairs • Exclusion criteria: • missing interview dates at 4 and 12 months; • different respondents for both interviews; • infants with gestational ages over 33 weeks • N=103 mother-child pairs
Analyses • Data were analyzed using Stata Statistical Software: Release 9.0 • Logistic regression model: adjusted for maternal education, race, age, employment status, history of depression, and infant sex and birth weight • Categorizations of Main Variables: • Maternal PSI Scores: low-moderate (<20) vs high symptomatology (≥ 20) • CLAMS: normal (>85) vs suspect/mental retardation (≤ 85) • Motor Milestones: normal (≥ 50) vs delay (<50)
Results: What are the mean maternal total and subscale psychiatric index scores at 4 and 12 months from term and how do these scores compare to normative scores?
PSI Score Ranges: 0-9: Low 10-19: Moderate 20-100: High
PSI Score Ranges: 0-9: Low 10-19: Moderate 20-100: High
Results (cont.): What are the average child language and motor development scores at 4 and 12 months from term and how do these scores compare to normative scores?
Results (cont.):What is the impact of maternal psychiatric symptomatology on preterm infant language and motor development? • Association between maternal mental health and child development did not reach statistical significance • Most factors were not predictive of child developmental delay at 4 or 12 months after correcting for degree of prematurity
Strengths • Longitudinal, prospective data • Investigates impact of maternal mental health on preterm child development • More broad consideration of maternal mental health than other studies
Limitations • Sociodemographic sample restricts generalizability to more diverse regions • Focus on mothers • Child language and motor development assessed via maternal self-reporting • Social support variable • Small sample
Public Health Implications • Double jeopardy • Influence of findings in this area on family-centered health policy and health care
Recommendations • Further research • Universal screening for postpartum episodes as early as 2 weeks following delivery and no later than 12 weeks postpartum • Educating health care providers in how to incorporate maternal mental health screening during women’s health and/or child exams
Thank you! Contact Information: Simran K. Sabherwal Philip R. Lee Institute for Health Policy Studies University of California, San Francisco (UCSF) Simran.Sabherwal@ucsf.edu