Maternal Early Life Experiences and Perinatal Hypertensive Disorders Predict Parenting Stress, Efficacy, and Responsiveness

• In Event: Disrupting the Cycle of Intergenerational Adversity through Parenting: A Multidisciplinary Approach

Abstract

Maternal history of adverse childhood experiences (ACEs) is associated with obstetric illness, including hypertensive disorders of pregnancy (HDP), and problematic parenting behaviors. However, it is unknown if ACEs and HDP interact to predict parenting. HDP may contribute to impaired ability to manage parenting challenges and may signify greater levels of overall stress.
This study represents a novel effort to delineate the effects of ACEs, maternal care experiences in mothers’ families of origin, and pre- and postpartum hypertensive disorders on a range of parenting outcomes over the first year of life.

Two hundred ninety-five mothers were recruited from Women, Infants, and Children clinics and were assessed prenatally and at 6 and 12 months postpartum. 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. At the prenatal enrollment visit, mothers reported on their ACEs, maternal care, and depressive symptoms. At 6- and 12-months postpartum mothers reported on their parenting stress and parenting efficacy; responsiveness was observationally rated during mother-infant free play. Mothers reported on their physical health at all three time points, including whether they had been diagnosed with a hypertensive disorder.

Significant main effects at 6 months postpartum. After adjusting for demographic covariates, postpartum hypertensive disorders (HD), and body mass index, higher perceived maternal care in childhood was associated with less parenting stress (β=-1.16, p<.05), while HDP was associated with greater parenting stress (β=9.69, p< .05). Both ACEs (β=-.58, p<.01) and HDP (β=-.17, p<.01) were negatively associated with parenting efficacy. Only HDP was associated with less responsiveness (β=-0.30, p<.05). Significant interactions at 6 months postpartum. As depicted in Figure 1a, ACEs were negatively associated with parenting efficacy among mothers with no HDP (b=-.05, p<.001) whereas mothers with HDP had consistently low parenting efficacy (b=.25, p<.21). As depicted in Figure 1b, perceived maternal care was negatively associated with responsiveness among mothers with HDP (b=.34, p<.01) whereas mothers without HDP had consistently high responsiveness (b=.12, p<.11). Follow-up analyses revealed that mothers with HDP and perceived high maternal care in childhood were also more likely to have an infant with a feeding difficulty at 6 months postpartum, which may have contributed to difficulty bonding and influenced responsiveness.

Significant main effects at 12 months postpartum. After adjusting for demographic covariates, HDP, and body mass index, HD was negatively associated with responsiveness (β=-0.14, p=.03). Significant interactions at 12 months postpartum. As depicted in Figure 2, perceived maternal care was positively associated with responsiveness among mothers with HD (b=.97, p<.01) whereas mothers without HD had consistently high parenting responsiveness (b=.41, p<.25).

Findings demonstrated that maternal early life experiences, the presence of perinatal hypertensive disorders, and their interactions, differentially predicted parenting stress, parenting efficacy, and observed maternal responsiveness across the postpartum period. Identifying specific factors, including novel cardiovascular targets, that contribute to adaptive or maladaptive parenting can guide prevention and intervention efforts aimed at facilitating more positive, responsive parenting strategies within high-risk families.

Authors

• Lindsay Huffhines, Brown University Medical School
  Presenting Author

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

• Margaret Bublitz, The Miriam Hospital
  Non-Presenting Author

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

• Stephanie H Parade, Brown University
  Non-Presenting Author