Multiple Social-Environmental Risks and Mother-Infant Interaction among Mother-Premature Infant Dyads

Kristin Rankin, PhD

Camille Fabiyi, MPH

Kathleen Norr, PhD

Rosemary White-Traut, PhD, RN, FAAN

University of Illinois at Chicago

Presenter Disclosures

(1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:

Kristin Rankin

No relationships to disclose

Background

Premature infants with biologic risk plus social-environmental risks have poorer health and development than: – Premature infants in less stressed

families– Full term infants in families with

multiple social-environmental risks

Prematurity and social-environmental risks both lead to lower quality of mother-infant interaction

Poor mother-infant interaction is associated with poorer infant health and development

Purpose

To examine the association between social-environmental (SE) risks and the quality of mother-premature infant interaction

The relative importance of the following will be compared: – Individual risk factors– Cumulative # of factors– Specific patterns of risk factors

Design and Procedure

Randomized clinical trial at two community-based hospitals

Recruitment and enrollment of mothers shortly after the birth of a premature infant

Inclusion criteria: Otherwise healthy infants, 29-34 weeks gestational age; Mothers with at least 2 of 10 baseline social-environmental risk factors, e.g. poverty, minority status, mental health issues

Maternal intake interview to assess socio-demographic characteristics, baseline mental health and social support

Follow-up interviews in hospital before infant’s discharge and at six weeks corrected age

Dependent Variable: Mother Infant Interaction

Mother-infant interaction during feeding: NCAST (Nursing Child Assessment Satellite Training – Feeding Scale)– Scored for maternal and infant

behaviors on 76-item scale – Maternal sensitivity to cues, response

to child’s distress, social-emotional and cognitive growth fostering

– Infant clarity of cues and responsiveness to mother

Assessed from a videotaped feeding session in the hospital, just before infant’s discharge

Independent Variables:Social Environmental Risk Factors

SE Risk Definition Sample Prevalence

%

Minority status African-American or Latina 100

Teen birth Age at delivery < 20 19

Low education Teens: <HS and not in school20 and older: <High School 23

Poverty Household income < 185% FPL and/or WIC participation 89

Independent Variables:Social Environmental Risk Factors

SE Risk Definition Sample Prevalence

%

Childcare burden

Previous child <24 months or ≥ 4 children in household 35

Not living with baby’s father Self-report 44

Resides in disadvantaged neighborhood

Index of Neighborhood Disadvantage Score > 0 38

Independent Variables:Social Environmental Risk Factors

SE Risk Definition Sample Prevalence

%

DepressionSelf-reported history,CES-D score ≥ 16, orPDSS score ≥ 60

42

High trait anxiety STAI Y-2 (highest quartile, ≥ 35 25

Low social support

<88 (lowest quartile)Personal Resources Questionnaire (PRQ) 2000

24

Other Sample Characteristics

Characteristics n = 188

Maternal

Age at delivery (m, sd) 26 (6.6)

Race/ethnicity: African-American Latina

5050

Parity (% Primiparous) 39

Infant

Sex (% Male) 50

GA at birth in weeks (m, sd) 32.5 (1.5)

Birthweight in grams (m, sd) 1822 (375)

Data Analysis – 3 Methods

1) T-tests to identify the impact of individual SE risk factors on mean NCAST scores

2) Linear regressions for the cumulative number of risk factors as predictors of NCAST scores

3) Hierarchical cluster analysis to identify patterns of risk factors, followed by linear regression to assess relationship between patterns and NCAST scores– Linkage Method= Ward’s Minimum Variance – Assessed Criteria for Number of Clusters (CCC,

Pseudo F, Pseudo T2

– Stratification by age group prior to clustering (≥ 20, <20)

Mean NCAST scores by Individual SE risks

Individual Risk Factors n NCAST scoreMean (SD)

Overall Mean 108 60 (6.7)

Baby’s father not living in HH* 48 61.9 (5.5)

Baby’s father living in HH 60 58.7 (7.1)

High Trait Anxiety* 25 56.9 (8.4)

Low Trait Anxiety 83 61.1 (5.7)

*p < 0.05

Mean NCAST scores by Cumulative Number of SE Risks

2 (n = 15)

3 (n =

25)

4 (n

= 20)

5 (n =

19)

6 (n = 16)

7-9 (n = 13)

40

45

50

55

60

65

70

75

60.8

57.3

# SE Risk Factors

Mean NCAST Scores by Patterns of SE RisksCluster Cluster Label n NCAST

Mean (SD)

Adult-1 Impoverished only 27 60.8 (5.8)

Adult-2 Depressed only 22 61.0 (6.3)

Adult-3 Impoverished, disadvantaged neighborhood, high child care burden, father absence

21 60.7 (5.5)

Adult-4 Impoverished, less than high school education

8 54.0 (9.4)*

Adult-5 Low education, depressed, anxious, low support, disadvantaged neighborhood

13 60.5 (6.6)

Teen-1 Low risk teens 8 60.5 (5.6)

Teen-2 Depressed, anxious, low support, higher childcare burden teens

9 58.9 (9.1)

*p < 0.01 compared to Adult-1

Strengths/Limitations

Strengths

Wide variety of SE risk factors measured at baseline

Underserved and understudied population of women and infants

Limitations

Small sample size

Dichotomous risk factors

Generalizability

Conclusions

Women with high trait anxiety and those with baby’s father in the household appear to have lower quality interactions

The cumulative number of risk factors is not correlated with mother-infant interaction in a dose-response fashion

Conclusions

Women were identified as belonging to clusters according to patterns of SE risks

Patterns of SE risks may be more relevant than the total number of risk factors with regard to outcomes

A subgroup of impoverished women with less than a high school education had the lowest quality interaction of all groups in the sample

Implications

Education and economic opportunity are crucial

Women with SE risks who just had a preterm infant should receive anticipatory guidance to help improve mother-infant interaction

Women with both low education levels and economic disadvantage may especially be in need of guidance

Future directions include examining other study outcomes by clusters

Acknowledgements

Funded by the National Institute of Child Health and Development, the National Institute of Nursing Research (1 R01 HD050738-01A2) and the Harris Foundation

The authors wish to acknowledge the infants and their parents who participated in this research