Brenda Baker, PhD, RNC, CNS

Jacqueline McGrath, PhD, RN, FNAP, FAANRita Pickler, PhD, RN, PNP-BC, FAAN

Nancy Jallo, PhD, RNC, FNP-BC, WHNP-BC, CNSStephen Cohen, MD, MHA

Acknowledgment: Supported by National Institute of Health, Ruth L. Kerschstein National Research Service Award Individual Fellowship F31NRo11268-02

Understanding Mothers of Late Preterm Infants

Examine maternal competenceand responsiveness to the infantin mothers of late preterm infantscompared to mother of full term infants

Specific Aims

Infants born between 34 and 36 6/7 weeks gestation

Account for: 75% of preterm births (Dong, 2011)9% of all births

Have limited compensatory resources that increase the risk of:Temperature instabilityHypoglycemiaRespiratory instabilitySepsisFeeding difficulties

Who are Late Preterm Infants?

Longitudinal study 767 LPIs delays in reading and math were significant through 5th grade (Chyi, 2008)

Systematic review of 10 studies examining early childhood outcomes of LPIs through age 7 identified:• more neurodevelopmental disabilities • delayed educational ability • greater need for early-intervention • more medical disabilities • delayed physical growth (McGowan, 2011)

Long Term Effects of Late Preterm Birth

Defined as maternal intelligence that influences infant development and includes elements of sensitivity, responsiveness, and synchrony. Maternal competence continually changes as the infant grows and is based on verbal and non-verbal feedback from the infant.

Maternal competence is influenced by:

• infant behavior• support from others and • maternal well-being (Teti, 1991, Tarkka, 2003)

Maternal Competence

No difference in development of maternal competence based on: • infant gender (Flagler, 1988)• pregnancy risk status (Mercer, 1994)• experienced versus first time mothers (Mercer,

1995)• marital status, married versus single

(Copeland, 2004)

We also know

The mothers ability to be warm and soothing with her infant, leading to a synchronous relationship where the mother reads her infant’s cues, is responsive to the infant’s needs, sees her infant respond with positive behaviors and over time influences development of the relationship and ultimately growth and development of the infant.

Maternal Responsiveness

Influenced by:Satisfaction with life Self-esteem Number of childrenSupport from others (Drake, 2007, Amankwaa,

2007)

What do we know about Maternal Responsiveness?

Mothers typically are the primary caregiverMaternal competence and responsiveness is

based on a mother’s perception of her infant Form a dynamic relationship that facilitates

growth and development of the infantTrustAttachmentLanguage skills

Why Does Maternal Competence and Responsiveness Matter?

Infants respond to their mothers with verbal cues and behaviors that indicate their needs for nutrition, sleep, stimulation and safety are met

Infant cues, behaviors, weight gain and achievement of developmental milestones are positive reinforcements to a mother that she knows her infant and is meeting their needs

Leading to development of maternal competence

How does Maternal Competence Develop?

Non-experimental cross-sectional, repeated measures design

Two data collection points• Postpartum prior to discharge from the

hospital• 6 weeks postpartum

Study Design

Study ParticipantsInclusion/Exclusion Criteria Postpartum mothers delivering

at VCUHS 34-36 6/7 weeks gestation or

37-41 weeks gestation First time and experienced

mothers Maternal age > 18 years Read and speak English Singleton birth, birth weight

appropriate for age No known congenital

anomalies No perinatal complications

that interfere with postpartum transition

Number recruited & enrolled – 116Completed Time One Survey – 109

Term – 77Late Preterm Infant – 32

Completed Time Two Survey – 71Term – 52LPI - 19

Recruitment

Maternal Experience

Ethnicity of the Sample

Marital Status of the Sample

Infant Characteristics

Gestation Term and LPI Complications Term and LPI

Maternal Competence – ANOVA Repeated Measures Demonstrated

No statistical significance Between term or late preterm

mothers Measurement points

Maternal Responsiveness – ANOVA Repeated Measures Demonstrated

No statistical significance Between term or late preterm mothers Measurement points

Maternal Factors Influencing Development of Maternal Competence and Responsiveness

No statistical significance Between term or late preterm mothers Measurement points

Infant Factors Influencing Development of Maternal Competence and Responsiveness

No statistical significance Between term or late preterm

mothers Measurement points

Factors most predictive of maternal competence at Postpartum:• LPI -Postpartum support • Term - Satisfaction with life

Factors most predictive of maternal responsiveness at postpartum:• LPI - Infant temperament

- Self-esteem - Stress

• Term - Self-esteem

Factors Predictive of Competence & Responsiveness – Regression Analysis

Survey instruments - socially desirable answers versus true feelings

Reading level Participant burden – 176 items Sample size - attrition Hospital environment

• VCUHS late preterm population - approximately 5% of all births compared to the national average of 8%

• Change in care – decreased LPI births 6-weeks second survey time

• Mothers returning to work• LPI’s adjusted age

English language only• 1/5 of the available population were non-English speaking

Limitations