Implications of Maternal Psychiatric Symptomatology for Preterm Infant Development

1. Implications of Maternal Psychiatric Symptomatology for Preterm Infant Development Simran K. Sabherwal, MHS 13th Annual MCH Epidemiology Conference Atlanta, Georgia December 14, 2007 Acknowledgements: Pamela K. Donohue, ScD Marilee C. Allen, MD Aynur Unalp-Arida, MD PhD

2. Presentation Overview • Background • Research Question • Data Source • Methods • Results • Discussion

3. Background • Recent recognition of the importance of addressing maternal mental health • Most studies on postpartum mental health among mothers of preterm babies have focused solely on depression • Maternal mental health impacts maternal well-being and child development • Little has been studied about this association in preterm children

4. Findings of Other Studies • Prevalence of perinatal depression: • 10-15% of women (range: 5-25%) • nearly 30% of women living in poverty • Postpartum women have 3 times the risk of experiencing depressive symptoms compared to women in the general population • Prematurely born infants are at greater risk for developing serious health problems, including mental retardation and developmental disability • Effective treatment for postpartum depression is not enough to improve the mother-child relationship and child outcomes

5. Research Question • What are the mean maternal total and subscale psychiatric index scores at 4 and 12 months from term and how do these scores compare to normative scores? • What are the average child language and motor development scores at 4 and 12 months from term and how do these scores compare to normative scores? • What is the impact of maternal psychiatric symptomatology on preterm infant language and motor development?

6. Data Source:Preterm Assessment of Neurodevelopment and Achievement (PANDA) Study • Sponsored by the USDHHS HRSA Maternal and Child Health Bureau • Data collected from Feb 2003- Oct 2006 • Study criteria: • Preterm infants with birth weight < 1500 g or gestational age < 33 weeks • Infants born at or transferred to Johns Hopkins Hospital or Johns Hopkins Bayview Medical Center within 1 month of birth • Maternal psychiatric status and child development were evaluated by maternal self-reporting at 4 and 12 months via phone administered surveys

7. Evaluation Tools • Psychiatric Symptom Index (PSI)- 29 items • Anxiety (11) • Depression (10) • Anger (4) • Cognitive Disturbance (4) • Clinical Linguistic and Auditory Milestone Scale (CLAMS)- 32 items • Motor Milestone Attainment- 20 items

8. Methods • PANDA dataset: 176 parent-child pairs • Exclusion criteria: • missing interview dates at 4 and 12 months; • different respondents for both interviews; • infants with gestational ages over 33 weeks • N=103 mother-child pairs

9. Sample Characteristics

10. Analyses • Data were analyzed using Stata Statistical Software: Release 9.0 • Logistic regression model: adjusted for maternal education, race, age, employment status, history of depression, and infant sex and birth weight • Categorizations of Main Variables: • Maternal PSI Scores: low-moderate (<20) vs high symptomatology (≥ 20) • CLAMS: normal (>85) vs suspect/mental retardation (≤ 85) • Motor Milestones: normal (≥ 50) vs delay (<50)

11. Results: What are the mean maternal total and subscale psychiatric index scores at 4 and 12 months from term and how do these scores compare to normative scores?

12. PSI Score Ranges: 0-9: Low 10-19: Moderate 20-100: High

13. PSI Score Ranges: 0-9: Low 10-19: Moderate 20-100: High

14. Results (cont.): What are the average child language and motor development scores at 4 and 12 months from term and how do these scores compare to normative scores?

16. Results (cont.):What is the impact of maternal psychiatric symptomatology on preterm infant language and motor development? • Association between maternal mental health and child development did not reach statistical significance • Most factors were not predictive of child developmental delay at 4 or 12 months after correcting for degree of prematurity

17. Strengths • Longitudinal, prospective data • Investigates impact of maternal mental health on preterm child development • More broad consideration of maternal mental health than other studies

18. Limitations • Sociodemographic sample restricts generalizability to more diverse regions • Focus on mothers • Child language and motor development assessed via maternal self-reporting • Social support variable • Small sample

19. Public Health Implications • Double jeopardy • Influence of findings in this area on family-centered health policy and health care

20. Recommendations • Further research • Universal screening for postpartum episodes as early as 2 weeks following delivery and no later than 12 weeks postpartum • Educating health care providers in how to incorporate maternal mental health screening during women’s health and/or child exams

21. Thank you! Contact Information: Simran K. Sabherwal Philip R. Lee Institute for Health Policy Studies University of California, San Francisco (UCSF) Simran.Sabherwal@ucsf.edu