Research in Progress:

Impact of a relationship-based newborn intervention on postpartum maternal depression and anxiety

Johnson, L., Dym-Bartlett, J.

Preterm birth is a serious public health issue, with 1 in 10 infants born preterm in the U.S. alone. Three quarters of these infants are born late-preterm (LP), or between 34 0/7 and 36 6⁄7 weeks’ gestation. Mothers of LP infants are at increased risk for postpartum stress and depression, which may lead to serious difficulties in the mother-infant relationship, including lower levels of emotional connection, maternal insensitivity, and less optimal infant health care practices. Currently, research is lacking to address the specific needs of LP infants and their families. The proposed project will use a randomized controlled trial (RCT) design to test the impact of the Newborn Behavioral Observations-Family Wellness (NBO-FW) Intervention. The NBO-FW is a relatively low-cost, short-term, preventive intervention to promote the well-being of LP newborns and their mothers that can be integrated into multiple settings. Participants will be 200 first-time mothers and their LP newborns (100 intervention dyads and 100 control dyads) at Brigham and Women’s Hospital, an urban teaching hospital of Harvard Medical School and largest maternity care provider in the Boston area. The NBO-FW intervention will take place over a 12-week period with data collected at three time points: Time 1, at the hospital in the newborn unit or NICU unit within a week of birth; Time 2, at the Center for Child Development (CCD; a clinic at the hospital) during the 4-6 follow-up medical visit; and Time 3 at CCD during a research visit 10-12 weeks after birth. The study will use standardized measures of maternal stress (Parenting Stress Index-Short Form; PSI-SF), maternal depression (Center for Epidemiological Studies Revised; CESD-R), and maternal parenting confidence (Karitane Parenting Confidence Scale; KPCS); medical records on maternal infant health care practices (safe sleep; breastfeeding; injury prevention; participation in well-child visits); and, videotaped and coded observations of mother-infant interactions (Parent-Child Early Relational Assessment; PCERA). We hypothesize that, compared to mothers in the control group, first-time mothers of LP infants who receive the NBO-FW will (a) have lower levels of stress and depression; (b) have more confidence in their parenting skills; (c) demonstrate more positive interactions with their infants (e.g., breastfeeding, use of safe sleep practices, participation in well-child visits, injury prevention); and (d) engage in better infant health care practices (i.e., breastfeeding, safe sleep practices, well-child visit participation, injury prevention). The focal outcomes of the project align with Health Resource and Services Administration/Maternal and Child Health Bureau goals, Healthy People 2020 objectives, Title V Maternal and Child Health Block Grant National Performance Domains, and U.S. Department of Health and Human Services clinical priorities.