Maternal Caregiving Ameliorates the Consequences of Prenatal Maternal Psychological Distress on Child Development

Children exposed to prenatal maternal psychological distress are at elevated risk for a range of adverse outcomes; however, it remains poorly understood whether postnatal influences can ameliorate impairments related to prenatal distress. The current study evaluated if sensitivematernal care during the first postnatal year could mitigate child cognitive and emotional impairments associated with prenatal psychological distress. Prenatal maternal psychological distress was assessed via self-reports of anxiety, depression, and perceived stress for 136 mothers at five prenatal and four postpartum time points. Quality of maternal care (sensitivity to nondistress, positive regard, and intrusiveness reverse-scored) were assessed during a mother–child play interaction at 6 and 12 months. Child cognitive function and negative emotionality were assessed at 2 years, using The Bayley Scales and the Early Childhood Behavior Questionnaire. Elevated prenatal distress was associated with poorer child cognitive function and elevated negative emotionality. Children exposed to elevated prenatal maternal distress did not, however, display these outcomes if they received high-quality caregiving. Specifically, maternal care moderated the relation between prenatal psychological distress and child cognitive function and negative emotionality. This association remained after consideration of postnatal maternal psychological distress and relevant covariates. Sensitive maternal care was associated with altered offspring developmental trajectories, supporting child resilience following prenatal distress exposure

Can Placental Corticotropin-Releasing Hormone Inform Timing of Antenatal Corticosteroid Administration?

Context Antenatal corticosteroids are commonly administered to pregnant women at risk for delivering between 23 and 34 gestational weeks; they provide crucial benefits to fetal lung maturation and reduce risk for neonatal morbidity and mortality. Corticosteroids are maximally efficacious for lung maturation when administered within 2 to 7 days of delivery. Accurately identifying the timing of preterm delivery is thus critical to ensure that antenatal corticosteroids are administered within a week of delivery and to avoid unnecessary administration to women who will deliver at term. A plausible biomarker for predicting time of delivery is placental corticotropin-releasing hormone (pCRH). Objective To assess whether pCRH concentrations predict time to delivery and specifically which women will deliver within a week of treatment. Design pCRH concentrations were evaluated before administration of the corticosteroid betamethasone, and timing of delivery was recorded. Participants A total of 121 women with singleton pregnancies who were prescribed betamethasone. Results Elevated pCRH concentrations were associated with a shorter time from treatment to delivery. Receiver-operating characteristic curves revealed that pCRH may improve the precision of predicting preterm delivery. Conclusions In the current sample, pCRH concentrations predicted the likelihood of delivering within 1 week of corticosteroid treatment. Current findings suggest that pCRH may be a diagnostic indicator of impending preterm delivery. Increasing the precision in predicting time to delivery could inform when to administer antenatal corticosteroids, thus maximizing benefits and reducing the likelihood of exposing fetuses who will be delivered at term

Can Placental Corticotropin-Releasing Hormone Inform Timing of Antenatal Corticosteroid Administration?

Context Antenatal corticosteroids commonly are administered to pregnant women at risk of delivering between 23 and 34 gestational weeks, providing crucial benefits to fetal lung maturation and reducing risk of neonatal morbidity and mortality. Corticosteroids are maximally efficacious for lung maturation when administered within 2 to 7 days of delivery. Accurately identifying the timing of preterm delivery is thus critical to ensure that antenatal corticosteroids are administered within a week of delivery and to avoid unnecessary administration to women who will deliver at term. A plausible biomarker for predicting time of delivery is placental corticotropin-releasing hormone (pCRH). Objective The current study assesses whether pCRH concentrations predict time to delivery, and specifically which women will deliver within a week of treatment. Design pCRH concentrations were evaluated prior to administration of the corticosteroid betamethasone and timing of delivery was recorded. Participants 121 women with singleton pregnancies who were prescribed betamethasone. Results Elevated pCRH concentrations were associated with a shorter time from treatment to delivery. ROC curves revealed that pCRH may improve the precision of predicting preterm delivery. Conclusions In the current sample, pCRH concentrations predicted the likelihood of delivering within one week of corticosteroid treatment. Current findings suggest that pCRH may be a diagnostic indicator of impending preterm delivery. Increasing the precision in predicting time to delivery could inform when to administer antenatal corticosteroids, thus maximizing benefits and reducing the likelihood of exposing fetuses who will be delivered at term

Trait coping styles and the maternal neural and behavioral sensitivity to an infant

During the postpartum period, new mothers experience drastic changes in their body, brain, and life circumstances. Stress from the emotional and physical demands of caring for an infant is associated with negative mood and parenting outcomes. The use of active coping strategies can increase mothers&rsquo; resilience during the postpartum period. However, little is known about the association between coping styles and maternal brain responses to infant cues. In the current study, we examined the associations among trait coping style, maternal brain responses, and behavioral sensitivity in a socioeconomically diverse sample of first-time mothers (N&thinsp;=&thinsp;59). The use of more active trait coping strategies compared to passive coping strategies was associated with increased brain responses to infant cry sounds in brain regions that are critically involved in motivation and emotion regulation&mdash;substantia nigra, anterior cingulate gyrus, and inferior frontal gyrus. Increased brain activations in the midbrain and anterior cingulate gyrus were further associated with higher levels of maternal sensitivity observed during interactions with the infant. Thus, the findings provide support for mothers&rsquo; use of more active coping styles to promote neural and behavioral resilience for a positive transition to parenthood. &nbsp;</p

Missed Opportunities: Family History and Behavioral Risk Factors in Breast Cancer Risk Assessment Among a Multiethnic Group of Women

BACKGROUND: Clinician’s knowledge of a woman’s cancer family history (CFH) and counseling about health-related behaviors (HRB) is necessary for appropriate breast cancer care. OBJECTIVE: To evaluate whether clinicians solicit CFH and counsel women on HRB; to assess relationship of well visits and patient risk perception or worry with clinician’s behavior. DESIGN: Cross-sectional population-based telephone survey. PARTICIPANTS: Multiethnic sample; 1,700 women from San Francisco Mammography Registry with a screening mammogram in 2001–2002. MEASUREMENTS: Predictors: well visit in prior year, self-perception of 10-year breast cancer risk, worry scale. Outcomes: Patient report of clinician asking about CFH in prior year, or ever counseling about HRB in relation to breast cancer risk. Multivariate models included age, ethnicity, education, language of interview, insurance/mammography facility, well visit, ever having a breast biopsy/follow-up mammography, Gail-Model risk, Jewish heritage, and body mass index. RESULTS: 58% reported clinicians asked about CFH; 33% reported clinicians ever discussed HRB. In multivariate analysis, regardless of actual risk, perceived risk, or level of worry, having had a well visit in prior year was associated with increased odds (OR = 2.3; 95% CI 1.6, 3.3) that a clinician asked about CFH. Regardless of actual risk of breast cancer, a higher level of worry (OR = 1.9; 95% CI 1.4, 2.6) was associated with increased odds that a clinician ever discussed HRB. CONCLUSIONS: Clinicians are missing opportunities to elicit family cancer histories and counsel about health-related behaviors and breast cancer risk. Preventive health visits offer opportunities for clinicians to address family history, risk behaviors, and patients’ worries about breast cancer

Perinatal Promotive and Protective Factors for Women with Histories of Childhood Abuse and Neglect

Background Integrative research summarizing promotive and protective factors that reduce the effects of childhood abuse and neglect on pregnant women and their babies’ healthy functioning is needed. Objective This narrative systematic review synthesized the quantitative literature on protective and promotive factors that support maternal mental health and maternal-infant bonding among women exposed to childhood adversity, including childhood abuse and neglect. Methods Using a comprehensive list of key terms related to the perinatal period, childhood adversity, and protective/promotive factors, 8423 non-duplicated articles were identified through database searches in PsychInfo and Web of Science, and references in retrieved articles. Thirty-seven full text articles were inspected; of those 18 were included. Results Protective and promotive factors fell into three categories: a) women’s internal capacities (e.g., self-esteem, coping ability), b) external early resources (e.g., positive childhood experiences) and c) external contemporaneous resources (e.g., social support). Although all three categories were associated with more resilient outcomes, external contemporaneous factors, and specifically, social support, were the most commonly-studied protective and/or promotive factor. Social support from family and romantic partners during the perinatal period was particularly protective for women with histories of childhood abuse and neglect and was examined across several dimensions of support and contexts. Conclusions The presence of women’s internal capacities, and external early and contemporaneous resources help to foster more positive outcomes during the perinatal period for women with histories of childhood adversity. Future research should study co-occurring multilevel promotive and protective factors to inform how they integratively deter the intergenerational transmission of risk

Can Placental Corticotropin-Releasing Hormone Inform Timing of Antenatal Corticosteroid Administration?

Context Antenatal corticosteroids are commonly administered to pregnant women at risk for delivering between 23 and 34 gestational weeks; they provide crucial benefits to fetal lung maturation and reduce risk for neonatal morbidity and mortality. Corticosteroids are maximally efficacious for lung maturation when administered within 2 to 7 days of delivery. Accurately identifying the timing of preterm delivery is thus critical to ensure that antenatal corticosteroids are administered within a week of delivery and to avoid unnecessary administration to women who will deliver at term. A plausible biomarker for predicting time of delivery is placental corticotropin-releasing hormone (pCRH). Objective To assess whether pCRH concentrations predict time to delivery and specifically which women will deliver within a week of treatment. Design pCRH concentrations were evaluated before administration of the corticosteroid betamethasone, and timing of delivery was recorded. Participants A total of 121 women with singleton pregnancies who were prescribed betamethasone. Results Elevated pCRH concentrations were associated with a shorter time from treatment to delivery. Receiver-operating characteristic curves revealed that pCRH may improve the precision of predicting preterm delivery. Conclusions In the current sample, pCRH concentrations predicted the likelihood of delivering within 1 week of corticosteroid treatment. Current findings suggest that pCRH may be a diagnostic indicator of impending preterm delivery. Increasing the precision in predicting time to delivery could inform when to administer antenatal corticosteroids, thus maximizing benefits and reducing the likelihood of exposing fetuses who will be delivered at term