Yksisikiöisen koeputkihedelmöityshoitoraskauden kulkuun ja raskauskokemukseen vaikuttavat tekijät

Singleton pregnancies achieved by means of assisted reproductive treatment (ART) are associated with increased obstetric and neonatal risks in comparison with spontaneously conceived singleton pregnancies. The impact of infertility- and treatment-related factors on these risks is not properly understood. In addition, the psychological effects of infertility and its treatment on the experience of pregnancy have scarcely been studied. Thus, the aim of the present study was to evaluate the importance of infertility- and treatment-related factors on prediction of pregnancy outcome, obstetric and neonatal risks, fear-of-childbirth and pregnancy-related anxiety. The subjects consisted of infertile women who achieved a singleton pregnancy by means of in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI). The control groups comprised spontaneously conceiving women with singleton gestations. Early pregnancy outcome was assessed by means of assay of serum human chorionic gonadoptrophin (hCG) in single samples. Other outcome data were collected from patient records, national Health Registers and via prospective questionnaire surveys. Viable pregnancies were associated with significantly higher serum hCG levels 12 days after embryo transfer than non-viable pregnancies. Among singleton pregnancies, aetiological subgroup, treatment type or the number of transferred embryos did not impair the predictive value of single hCG assessment. According to the register-based data, age-, parity- and socioeconomic status- adjusted risks of gestational hypertension, preterm contractions and placenta praevia were more frequent in the ART pregnancies than in the control pregnancies. Significantly higher rates of induction of delivery and Caesarean section occurred in the ART group than in the control group. The risks of preterm birth and low birth weight (LBW) were increased after ART pregnancy. Duration or aetiology of infertility, treatment type (fresh or frozen IVF or ICSI) or rank of treatment did not contribute to the risks of preterm birth or LBW. In addition, the risks of preterm birth and LBW remained elevated in spite of of the number of transferred embryos. Although mean duration of pregnancy was shorter and mean birth weight lower in the ART pregnancies than in the control pregnancies, these differences were hardly of clinical significance. Fear-of-childbirth and pregnancy-related anxiety were equally common to women conceiving by means of ART, or spontaneously. Partnership of five to ten years appeared to be protective as regards severe fear-of-childbirth, whereas long preceding infertility (≥ seven years) had the opposite effect. In conclusion, an early hCG assessment maintained its good predictive value regardless of infertility- or patient-related factors. Further, we did not recognise any infertility- or patient-related factors that would expose infertile women to increased obstetric or neonatal risks. However, a long period of infertility was associated with severe fear-of-childbirth.Koeputkihedelmöityshoito sovellutuksineen on vakiintunut tahattoman lapsettomuuden tehokkaimmaksi hoitokeinoksi. Nykyään lähes 3 % Suomessa vuosittain syntyneistä lapsista on saanut alkunsa koeputkihedelmöityshoidolla. Suomi on ollut maailmanlaajuisesti edelläkävijä yhden alkion siirtojen toteuttajana. Yhden alkion siirrolla voidaan tehokkaasti vähentää monisikiöraskauksien osuutta ja siten myös koeputkihedelmöityshoitoihin liittyvien raskausongelmien määrää. Kuitenkin kohdunulkoisen raskauden riski on suurempi, ja raskauden aikainen verenpaineen nousu, verinen vuoto, etisistukka ja keisarinleikkaussynnytykset ovat yleisempiä yksisikiöisissäkin koeputkihedelmöityshoitoraskauksissa kuin ilman hoitoa alkaneissa raskauksissa. Lisäksi ennenaikaisesti syntyvien ja pienipainoisten lasten osuus on suurempi. Toistaiseksi yksisikiöisen koeputkihedelmöityshoitoraskauden kulkuun vaikuttavia tekijöitä tunnetaan puutteellisesti. Ei myöskään tiedetä miten tieto lisääntyneistä raskausongelmista, lapsettomuuden syy tai annettu hoito vaikuttavat raskauskokemukseen. Tämän väitöskirjatutkimuksen aiheena oli selvittää miten hoitoa saaneen pariskunnan lapsettomuuden tausta ja heidän saamansa hoitomuoto vaikuttavat raskaustuloksen arvioon, raskauden kulkuun sekä synnytyspelon ja raskausahdistuksen esiintyvyyteen yksisikiöissä koeputkihedelmöityshoitoraskauksissa. Väitöstutkimuksessa todettiin, että laajalti käytetyn seerumin istukkahormonitason (human chorionic gonadotrophin; hCG) määritys 12 vuorokautta alkion siirron jälkeen soveltui raskaustuloksen luotettavaksi arviointimenetelmäksi riippumatta lapsettomuuden taustasta, hoitomuodosta tai siirrettyjen alkioiden lukumäärästä. Aiempien tutkimustulosten kaltaisesti raskauden aikainen verenpaineen nousu (8 % vrt. 4 %), istukan kiinnittyminen kohdunsuun eteen (2.6 % vrt. 0.4 %) ja keisarinleikkaukset (26 % vrt. 17 %) olivat yleisempiä koeputkihedelmöitysraskauksissa kuin verrokkiraskauksissa. Myös ennenaikaisesti syntyneitten (8-12 % vrt. 4-5 %) ja pienipainoisten lasten osuus (7 % vrt. 3 %) oli suurempi koeputkihedelmöityshoitoa saaneiden ryhmässä kuin verrokkiryhmässä. Lapsettomuuden tausta, saatu hoitomuoto tai siirrettyjen alkioiden lukumäärä eivät vaikuttaneet edellä mainittuihin lisääntyneisiin raskausongelmiin. Synnytyspelko ja raskausahdistus olivat yhtä yleisiä koeputkihedelmöityshoidoilla raskaaksi tulleitten naisten kuin ilman hoitoa raskaaksi tulleitten naisten keskuudessa. Pitkä edeltävä lapsettomuus (> 6 vuotta) lisäsi vakavan synnytyspelon riskiä. Yhteenvetona todetaan, että vaikka väitöstutkimuksessa havaittiin tiettyjen raskausongelmien olevan yleisempiä koeputkihedelmöityshoitoraskauksissa kuin verrokkiraskauksissa, on näitten havaintojen kliininen merkitys suhteellisen vähäinen. Havaittujen raskausriskien ei todettu liittyvän mihinkään tiettyyn potilasryhmään tai koeputkihedelmöityshoitomuotoon. Verrokkien kaltainen synnytyspelon ja raskausahdistuneisuuden esiintyvyys ei selitä suurempaa keisarinleikkausten osuutta koeputkihedelmöityshoitoryhmässä. Pitkä lapsettomuus oli vakavan synnytyspelon itsenäinen riskitekijä, mikä korostaa riittävän psykososiaalisen tuen antamisen tärkeyttä hedelmöityshoitojen jälkeen

Adolescent Attachment Profiles Are Associated With Mental Health and Risk-Taking Behavior

This person-oriented study aimed to identify adolescents’ hierarchical attachment profiles with parents and peers, and to analyze associations between the profiles and adolescent psychosocial adjustment. Participants were 449 Finnish 17–19-year-olds reporting their attachments to mother, father, best friend, and romantic partner and details on mental health (internalizing symptoms, inattention/hyperactivity, and anger control problems) and risk-taking behavior (substance use and sexual risk-taking). Attachment was measured with Experiences in Close Relationships – Relationship Structures (ECR-RS); internalizing, inattention/hyperactivity, and anger control problems with Self-Report of Personality — Adolescent (SRP—A) of the Behavior Assessment System for Children, third edition (BASC-3); substance use with the Consumption scale of the Alcohol Use Disorders Identification Test (AUDIT-C) and items from the Finnish School Health Promotion Study; and sexual risk-taking behavior with the Cognitive Appraisal of Risky Events (CARE). Latent profile analysis identified five attachment profiles: “All secure” (39%), “All insecure” (11%), “Parents insecure – Peers secure” (21%), “Parents secure – Friend insecure” (10%), and “Parents secure – Partner insecure” (19%). “All insecure” adolescents showed the highest and “All secure” adolescents the lowest levels of mental health problems and substance use. Further, parental attachment security seemed to specifically prevent substance use and anger control problems, while peer attachment security prevented internalizing problems. Our findings help both understand the organization of attachment hierarchies in adolescence and refine the role of specific attachment relationships in psychosocial adjustment, which can be important for clinical interventions in adolescence.Peer reviewe

Determinants of adolescent sleep : Early family environment, obstetric factors, and emotion regulation

Peer reviewe

Do family members sleep alike? Sleep features among mothers, fathers, and adolescents

Objective: To identify within-family groups according to sleep schedule, problems, and impact, reflecting similarities or differences in adolescents, mothers, and fathers and to examine how mental health and attachments associate with these triadic sleep groups. Background: Family relationships shape sleeping, but within-family research in adolescence is scarce. Method: Adolescents (17–18 years; 60% girls; n = 438), mothers (n = 448), and fathers (n = 358) filled in the Pittsburgh Sleep Quality Index. The adolescents reported mental health problems by the Behavior Assessment System and the parents by the General Health Questionnaire. All reported attachments by the Experiences in Close Relationships. Results: Cluster analysis identified four triadic sleep groups: “Good family sleep” (47%), “Poor adolescent and maternal sleep” (29%), “Poor paternal sleep” (16%), and “Poor family sleep” (8%). Adolescents in the “Poor family sleep” group had more mental health problems than they did in other groups, and fathers in the “Poor paternal sleep” group showed higher psychiatric symptoms than in the “Good family sleep” or “Poor adolescent and maternal sleep” groups. Adolescents in the “Poor family sleep” group reported higher insecure–anxious attachments than they did in other groups, and fathers reported higher insecure–avoidant and insecure–anxious attachments in the “Poor paternal sleep” than they did in other groups. Conclusion: A family systems approach provides new insight into sleep, mental health, and attachments. Implications: Interventions to improve sleep quality should consider family dynamics that may underlie potential sleep problems, and sleep as a public health issue can benefit from knowledge about family mental health and attachments.publishedVersionPeer reviewe

Do family members sleep alike? Sleep features among mothers, fathers, and adolescents

Objective To identify within-family groups according to sleep schedule, problems, and impact, reflecting similarities or differences in adolescents, mothers, and fathers and to examine how mental health and attachments associate with these triadic sleep groups.Background Family relationships shape sleeping, but within-family research in adolescence is scarce.Method Adolescents (17-18 years; 60% girls; n = 438), mothers (n = 448), and fathers (n = 358) filled in the Pittsburgh Sleep Quality Index. The adolescents reported mental health problems by the Behavior Assessment System and the parents by the General Health Questionnaire. All reported attachments by the Experiences in Close Relationships.Results Cluster analysis identified four triadic sleep groups: "Good family sleep" (47%), "Poor adolescent and maternal sleep" (29%), "Poor paternal sleep" (16%), and "Poor family sleep" (8%). Adolescents in the "Poor family sleep" group had more mental health problems than they did in other groups, and fathers in the "Poor paternal sleep" group showed higher psychiatric symptoms than in the "Good family sleep" or "Poor adolescent and maternal sleep" groups. Adolescents in the "Poor family sleep" group reported higher insecure-anxious attachments than they did in other groups, and fathers reported higher insecure-avoidant and insecure-anxious attachments in the "Poor paternal sleep" than they did in other groups.Conclusion A family systems approach provides new insight into sleep, mental health, and attachments.Implications Interventions to improve sleep quality should consider family dynamics that may underlie potential sleep problems, and sleep as a public health issue can benefit from knowledge about family mental health and attachments.</p

How do early family systems predict emotion recognition in middle childhood?

Facial emotion recognition (FER) is a fundamental element in human interaction. It begins to develop soon after birth and is important in achieving developmental tasks of middle childhood, such as developing mutual friendships and acquiring social rules of peer groups. Despite its importance, FER research during middle childhood continues to be rather limited. Moreover, research is ambiguous on how the quality of one's early social-emotional environment shapes FER development, and longitudinal studies spanning from infancy to later development are scarce. In this study, we examine how the cohesive, authoritarian, disengaged and enmeshed family system types, assessed during pregnancy and infancy, predict children's FER accuracy and interpretative biases towards happiness, fear, anger and sadness at the age of 10 years (N = 79). The results demonstrated that children from disengaged families (i.e., highly distressed relationships) show superior FER accuracy to those from cohesive families (i.e., harmonious and stable relationships). Regarding interpretative biases, children from cohesive families showed a greater fear bias compared to children from disengaged families. Our findings suggest that even in a relatively low-risk population, variation in the quality of children's early family relationships may shape children's subsequent FER development, perhaps as an evolution-based adaptation to their social-emotional environment.Peer reviewe

Determinants of adolescent sleep: Early family environment, obstetric factors, and emotion regulation

Optimal sleep quality fosters adolescents' wellbeing and, therefore, learning about its developmental determinants is essential. We examined how early family environment (i.e., parent-reported parenting, marital relationship quality, and mothers' mental health), obstetric factors (i.e., infertility history and assisted reproductive treatments, and pre- and perinatal complications and health risks), and children's emotion regulation in middle childhood predicted adolescents' sleep quality. We also tested the mediating role of emotion regulation in linking early determinants to adolescent sleep. Finnish families (N = 984) participated during pregnancy, infancy, middle childhood, and late adolescence. Results showed that only early maternal mental health problems predicted poor adolescent sleep quality. Contrary to hypotheses, emotion regulation did not mediate the effects of early family environment and obstetric factors on later sleep quality. Supporting the early family environment through improving maternal mental health can have long-term positive developmental impacts, including sleep.</p

Adolescent attachment to parents and peers in singletons and twins born with assisted and natural conception

Study question: Does adolescent attachment to parents and peers differ between singletons and twins born with ART or natural conception (NC)?Summary answer: Adolescent attachment anxiety with the father was higher among NC singletons than among ART and NC twins, whereas attachment avoidance with the father was higher in ART singletons than in NC singletons and NC twins. No differences were found in attachment to the mother, best friend or romantic partner.What is known already: Most studies have not found differences between ART and NC singletons in parent-adolescent relationships, but twin relationships may be more at risk. No previous study has examined all four groups in the same study, or specifically looked at attachment relationships.Study design size duration: This was an 18-year, prospective and controlled longitudinal study with families of 496 ART singletons, 101 ART twin pairs, 476 NC singletons and 22 NC twin pairs. Families were recruited during the second trimester of pregnancy; the ART group was recruited from five infertility clinics in Finland and the control group was recruited from a hospital outpatient clinic during a routine visit.Participants/materials setting methods: Mothers and fathers gave background information for this study during pregnancy, and during the child's first year and early school age (7-8 years). For the ART group, infertility characteristics and prenatal medical information was also obtained from the patient registry of the infertility clinics. Children (originally 50% girls) filled in electronic questionnaires related to their attachment to mother, father, best friend and romantic partner (Experiences in Close Relationships-Relationship Structures) at 17-19 years of age.Main results and the role of chance: Adolescent attachment anxiety to father was higher in NC singletons than in ART twins, P = 0.004 and marginally higher than in NC twins, P = 0.06. Adolescent attachment avoidance to father was higher in ART singletons than in NC singletons, P = 0.006 and marginally higher than in NC twins, P = 0.055.Limitations reasons for caution: The sample size was small especially in the NC twin group and there was drop-out over the 18-year time period, especially among boys and families with lower parental education level. The study only included native Finnish-speaking families. The results could differ in a more diverse population. ART singletons were younger and had fewer siblings than ART twins and NC children, and ART and NC twins had more newborn health risks than ART and NC singletons.Wider implications of the findings: The study adds to a growing body of evidence that neither ART treatments nor being a twin places mother-child relationships or peer relationships at long-term risk. However, in our study, which was the first to examine both ART and twinhood simultaneously, we found that there may be more problems in father-adolescent relationships, but only in ART singletons and only related to attachment avoidance. Our findings suggest that men, as well as women, should receive enough support in pre- and peri-natal health care during and after infertility treatments.Study funding/competing interests: This study was funded by Academy of Finland (grant number 2501308988), the Juho Vainio Foundation and the Finnish Cultural Foundation. The authors report no conflict of interest.</p

Developmental Stage-Specific Effects of Parenting on Adolescents' Emotion Regulation: A Longitudinal Study From Infancy to Late Adolescence

The quality of parenting shapes the development of children's emotion regulation. However, the relative importance of parenting in different developmental stages, indicative of sensitive periods, has rarely been studied. Therefore, we formulated four hypothetical developmental timing models to test the stage-specific effects of mothering and fathering in terms of parental autonomy and intimacy in infancy, middle childhood, and late adolescence on adolescents' emotion regulation. The emotion regulation included reappraisal, suppression, and rumination. We hypothesized that both mothering and fathering in each developmental stage contribute unique effects to adolescents' emotion regulation patterns. The participants were 885 families followed from pregnancy to late adolescence. This preregistered study used data at the children's ages of 1 year, 7 to 8 years, and 18 years. At each measurement point, maternal and paternal autonomy and intimacy were assessed with self- and partner reports using the Subjective Family Picture Test. At the age of 18 years, adolescents' reappraisal and suppression were assessed using the Emotion Regulation Questionnaire and rumination using the Cognitive Emotion Regulation Questionnaire. Stage-specific effects were tested comparing structural equation models. Against our hypotheses, the results showed no effects of mothering or fathering in infancy, middle childhood, or late adolescence on adolescents' emotion regulation patterns. The results were consistent irrespective of both the reporter (i.e., self or partner) and the parental dimension (i.e., autonomy or intimacy). In addition to our main results, there were relatively low agreement between the parents in each other's parenting and descriptive discontinuity of parenting across time (i.e., configural measurement invariance). Overall, we found no support for the stage-specific effects of parent-reported parenting in infancy, middle childhood, or late adolescence on adolescents' emotion regulation. Instead, our findings might reflect the high developmental plasticity of emotion regulation from infancy to late adolescence.</p

How do early family systems predict emotion recognition in middle childhood?

Facial emotion recognition (FER) is a fundamental element in human interaction. It begins to develop soon after birth and is important in achieving developmental tasks of middle childhood, such as developing mutual friendships and acquiring social rules of peer groups. Despite its importance, FER research during middle childhood continues to be rather limited. Moreover, research is ambiguous on how the quality of one's early social-emotional environment shapes FER development, and longitudinal studies spanning from infancy to later development are scarce. In this study, we examine how the cohesive, authoritarian, disengaged and enmeshed family system types, assessed during pregnancy and infancy, predict children's FER accuracy and interpretative biases towards happiness, fear, anger and sadness at the age of 10 years (N = 79). The results demonstrated that children from disengaged families (i.e., highly distressed relationships) show superior FER accuracy to those from cohesive families (i.e., harmonious and stable relationships). Regarding interpretative biases, children from cohesive families showed a greater fear bias compared to children from disengaged families. Our findings suggest that even in a relatively low-risk population, variation in the quality of children's early family relationships may shape children's subsequent FER development, perhaps as an evolution-based adaptation to their social-emotional environment