Posttraumatic Stress in Pregnancy and Infant Socioemotional and Physical Health: The Role of Maternal Sensitivity

• In Event: Maternal Adversity and Child Psychopathology in the First Years of Life: Parenting Difficulties as Mechanisms

Abstract

Maternal exposure to adversity either before or during pregnancy can have profound effects on infant development, with consequences in multiple domains. However, studies investigating whether prenatal posttraumatic stress symptoms (PTSS) in mothers are associated with socioemotional and physical health problems in infants are notably absent from the literature. Postnatal experiences may also have a critical moderating influence on prenatal PTSS, suggesting the importance of examining other factors endemic in mothers with PTSS, such as depressive symptoms and parenting stress, to better understand the prenatal-postnatal interplay on infant outcomes. Furthermore, the potential mechanisms through which maternal PTSS shape infant outcomes have yet to be fully elucidated. Parenting behavior is likely one key mechanism that may underlie the link between maternal PTSS and infant socioemotional and health outcomes, given that mothers with PTSS are often less able to demonstrate sensitivity towards their children. The present study addresses these research gaps by examining whether maternal PTSS has indirect effects on infant socioemotional and physical health problems via maternal sensitivity, and if maternal depressive symptoms and parenting stress moderate the relation between PTSS and maternal sensitivity.
Participants included 295 mothers and their infants, recruited from Women, Infants, and Children clinics. Mothers were racially and ethnically diverse (40% Hispanic, 42% White, 19% Black, 7% biracial, 32% other races), 60% had less than or equal to a high school diploma, and 65% were unemployed in pregnancy. Infants were 53% female. At the prenatal visit, mothers reported on their PTSS and depressive symptoms. At 12-months postpartum, mothers reported on their PTSS, depressive symptoms, and parenting stress, and on their infants’ socioemotional problems using the Brief Infant-Toddler Social and Emotional Assessment. Infants’ chronic physical health problems were obtained from maternal interview and summed. Maternal sensitivity was observationally rated during mother-infant free play.
While controlling for demographic covariates and 12-month PTSS, we examined three sets of predictors on infant outcomes: (1) the interaction of prenatal PTSS and prenatal depressive symptoms, (2), the interaction of prenatal PTSS and 12-month depressive symptoms, and (3), the interaction of prenatal PTSS and 12-month parenting stress. In model 1, prenatal depressive symptoms were positively associated with socioemotional problems only (β=.25, p<.05). In model 2, 12-month depressive symptoms were positively associated with socioemotional problems (β=.42, p<.01). Prenatal PTSS was positively associated with physical health problems (β=.10, p<.01), and this main effect was qualified by the significant interaction between prenatal PTSS and 12-month depressive symptoms (β=.03, p<.01). Simple slope analyses indicated that the link between PTSS and physical health problems was strongest when mothers reported high, but not low, depressive symptoms (Figure 1). In model 3, parenting stress was positively associated with socioemotional problems only (β=.13, p<.001). Bias-corrected bootstrapping tests indicated that indirect pathways were non-significant for all models.
Findings revealed that although observed maternal sensitivity is not an explanatory mechanism, prenatal PTSS, pre- and postnatal depressive symptoms, and parenting stress impacts infants’ functioning. Results will be discussed in relation to clinical implications for promoting maternal perinatal mental health to improve infant mental and physical health.

Authors

• Lindsay Huffhines, Brown University Medical School
  Presenting Author

• Jesse L Coe, Centers for Disease Control and Prevention
  Non-Presenting Author

• Ronald Seifer, University of North Carolina at Chapel Hill
  Non-Presenting Author

• Stephanie H Parade, Brown University
  Non-Presenting Author