Maternal, infant and social determinants of maternal sensitivity in a very preterm cohort: Association with cognitive outcomes at 2 years.

© 2016 Dr. Carmel Marie Ferretti-BergagnaMaternal sensitivity, a concept coined by Mary Ainsworth (Ainsworth et al., 1978) has been regarded as noteworthy in the assessment of mother-infant interaction. It encompasses four essential components; a mother’s awareness of her infant’s signals; her accurate interpretation of those signals, her appropriate response to those signals, and the promptness of her response. While past research has demonstrated the importance of maternal sensitivity in infant development, the determinants of maternal sensitivity have not been fully explored for a preterm population. The study’s primary aim was to examine an explanatory transactional model of maternal sensitivity in mothers of very preterm infants born less than 30 weeks. It included three proposed sources of influence; mother, child and social contextual factors at two time-points. Maternal factors measured were psychological distress, personality traits, attachment representations (mother’s perception of her own received parenting in the past and her present attachment to her preterm infant) and finally, her sense of competence in the parenting role. The infant factors were an infant’s temperament and medical risk status. Finally, social contextual factors assessed were socio-demographic factors, parenting stress, social support and life events. Subsidiary aims included the investigation of the continuity of maternal sensitivity from infancy to 2 years of age, its association to child cognitive outcomes at 2 years and finally the evaluation of the effectiveness of a hospital-based intervention (PremieStart) in the NICU in enhancing maternal sensitivity. The results found partial support for the transactional model of maternal sensitivity. All three levels of influence within a social ecological model were found to be important determinants of maternal sensitivity. A mother’s level of psychological distress, her personality trait of Agreeableness, her positive past attachment representations of received parenting care and a mother’s level of overall synchrony, and the infant’s biological status (gestational age) were found to be predictive of maternal sensitivity. The family’s economic status (family income) was the only social contextual factor found to be of importance. In assessing the continuity of maternal assessment over time, some continuity in synchronous interactions (Overall Maternal Synchrony) in early infancy (at 40 weeks) between a mother and her very preterm infant and sensitivity at 2 years was found. However, maternal sensitivity as measured by a factor score at 40 weeks, the preterm infant’s full-term equivalent age, was not found to be associated with sensitivity at 2 years. Sensitivity measured at 2 years was found to be associated with improved cognitive development at 2 years, consistent with past findings. Findings also supported the importance of a hospital based NICU intervention (PremieStart) with promising results demonstrated in the short-term (at full-term equivalent age). Mothers in the intervention group had enhanced their ability to be sensitive and to recognise and understand very preterm infant behaviour. Benefits of the intervention were also demonstrated by the reduced level of maternal psychological distress shown in the intervention group compared to the control group at 2 years. However, the intervention did not have an effect on cognitive outcomes for the preterm infants at 2 years. The findings highlight the complexities of the construct of maternal sensitivity and raise the issue of measurement as a feasible explanation for the differences found in the continuity of maternal sensitivity over time. In addition, some stable maternal traits conducive to maternal sensitivity such as the expression of maternal warmth and a mother’s level of empathy were found to be important dimensions when assessing this construct over time. Lastly, a new parent-infant interaction scale designed for preterm infants to assess maternal sensitivity (the PREMIIS Scale) in early infancy showed promise