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A Longitudinal Examination of Maternal Attachment on Neonatal and Early C h ildhood Outcomes

A Longitudinal Examination of Maternal Attachment on Neonatal and Early C h ildhood Outcomes. 2012 State of the Science Congress on Nursing Research Jeanne Alhusen 1 , Deborah Gross 1 , Matthew Hayat 2 , and Phyllis Sharps 1 1 Johns Hopkins University School of Nursing, Baltimore, MD

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A Longitudinal Examination of Maternal Attachment on Neonatal and Early C h ildhood Outcomes

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  1. A Longitudinal Examination of Maternal Attachment on Neonatal and Early Childhood Outcomes 2012 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, MD 2 Rutgers University College of Nursing, Newark, NJ

  2. 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 Nursing • National Center for Research Resources (5KL2RR025006), a component of the NIH, and the NIH Roadmap for Medical Research

  3. Dissertation Study Purpose & Rationale Study 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

  4. 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 design • Maternal data collected at 24-28 weeks gestation • Neonatal 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)

  5. Results: Socio-demographics (n=166) 93% African American 88% Not Married 94% High School Diploma or less 86% Total Household Income <$20,000

  6. Major Dissertation Study Results • Maternal Mental Health Outcomes • 59% (n=98) high depressive symptoms • 48% (n=79) high PTSD symptoms • 19% (n=32) reported physical abuse during this pregnancy • Neonatal Outcomes • 41% of neonates classified as having adverse outcome (SGA, LBW, PTB)

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

  8. Major Dissertation Study Results • Women 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.

  9. 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

  10. 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) Why Maternal Attachment during Early Child is Important

  11. Overview of Follow -up Study (2011-2012) • Purpose • To understand the role of maternal attachment style on early childhood developmental outcomes • Design/Methods (n=81) • Extension of longitudinal study • Maternal-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)

  12. 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 Assessment • 30% delayed in communication skills • 26% delayed in problem solving skills • 21% delayed in gross motor skills • 17% delayed in fine motor skills • 14% delayed in personal-social skills

  13. Bivariate Correlations (n=81) *p < 0.001

  14. GLM Predicting Early Childhood Development (n=81)a,b,c aGLM= Generalized Linear Model with Gamma Distribution and Log Link Function b Adjusted for marital status, education, income, and adverse neonatal outcome c AIC 358.4

  15. 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

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