Janet A. DiPietro

Psychophysiological characteristics of the regulatory disordered infant

Abstract This study examined the psychophysiological responses to sensory and cognitive challenges of 24 normal and 11 regulatory disordered infants (8–11 months). Regulatory disordered infants were defined as being behaviorally difficult and exhibiting disturbances in sleep, feeding, state control, self-calming, and mood regulation. Heart period and cardiac vagal tone were measured during baseline and during sensory and cognitive challenges. The regulatory disordered infants tended to have higher baseline vagal tone. Across groups there was a significant suppression of vagal tone during cognitive processing. Baseline vagal tone was correlated with the suppression of vagal tone during the cognitive task only for the normal infants. In contrast, the responses of the infants with regulatory disorders were heterogeneous. The results provide preliminary support for the hypothesized relationship between vagal tone and the regulatory disorder.

Maternal Stress and Affect Influence Fetal Neurobehavioral Development.

The authors investigated the association between maternal psychological and fetal neurobehavioral functioning. Data were provided by 52 maternal-fetal pairs at 24, 30, and 36 weeks gestation. The relations between maternal measures and fetal heart rate, variability, and motor activity were statistically modeled. Fetuses of women who were more affectively intense, appraised their lives as more stressful, and reported more frequent pregnancy-specific hassles were more active across gestation. Fetuses of women who perceived their pregnancy to be more intensely and frequently uplifting and had positive emotional valence toward pregnancy were less active. Associations with fetal heart-rate measures were detected at 36 weeks gestation. These data provide evidence for proximal effects of maternal psychological functioning on fetal neurobehavior.

Maternal stress in pregnancy: considerations for fetal development

There is significant current interest in the degree to which prenatal exposures, including maternal psychological factors, influence child outcomes. Studies that detect an association between prenatal maternal psychological distress and child developmental outcomes are subject to a number of interpretative challenges in the inference of causality. Some of these are common to many types of prenatal exposures that must necessarily rely on observational designs. Such challenges include the correlation between prenatal and postnatal exposures and the potential role of other sources of shared influence, such as genetic factors. Others are more specific to this area of research. These include confounding between maternal report of child outcomes and the maternal psychological attributes under study, difficulties in distinguishing maternal stress from more ubiquitous aspects of maternal personality, and the lack of association between cortisol and measures of maternal psychological stress. This article considers these methodological issues and offers an additional methodology focused on fetal neurobehavior for discerning potential mechanisms that may mediate associations between maternal psychological functioning and the developing fetal nervous system.

Diurnal rhythm of cortisol during late pregnancy: Associations with maternal psychological well-being and fetal growth

Maternal psychological functioning during pregnancy affects both maternal and fetal well-being. The hypothalamic-pituitary-adrenal (HPA) axis provides one mechanism through which maternal psychosocial factors may be transduced to the fetus. However, few studies have examined maternal psychological factors or birth outcomes in relation to the diurnal pattern of cortisol across the day. The current study examined maternal psychological well-being, parity status, and birth weight in relation to the maternal cortisol diurnal rhythm in a group of 98 low-risk pregnant women (51 primiparae). At 36 weeks gestation, participants completed both pregnancy-specific and general self-report measures of psychological functioning and provided saliva samples at 8:00, 12:00, and 16:00 h on 2 consecutive working days for the assay of cortisol. The expected diurnal decline in salivary cortisol was observed. Higher trait anxiety was associated with a flatter afternoon decline for all mothers. For primiparae, steeper morning cortisol declines were associated with lower infant birth weight. The findings suggest that regulation of the HPA axis may differ by parity status with downstream implications for fetal growth and development.

Behavioral and Physiologic Effects of Nonnutritive Sucking during Gavage Feeding in Preterm Infants

ABSTRACT: Behavioral and physiologic responsivity to nasogastric gavage feeding was assessed in 36 preterm infants on 2 consecutive d. On one of these days, a pacifier was provided during and after the gavage segment of the standardized protocol. The protocol was divided into segments that included baseline, preparatory handling, pregavagc, gavage, and postgavage periods. Patterns of cardiac (heart period and vagal tone), oxygen saturation, behavioral state, and defensive behavioral responses to gavage were quantified. These stable preterm infants responded to handling and gavage feeding with reductions in heart period, vagal tone, and oxygen saturation. These responses were not altered by provision of a pacifier, although there was a tendency for fewer episodes of bradycardia and oxygen desaturation. Conversely, behavioral state was affected significantly by nonnutritive sucking: when provided with a pacifier, infants exhibited less behavioral distress, spent less time in fussy and active awake states during and after feeding, and returned to a sleep state significantly faster. There is converging evidence to suggest that nonnutritive sucking lessens behavioral distress to iatrogenic stressors but does not alter physiologic responsiveness.

Continuity in self-report measures of maternal anxiety, stress, and depressive symptoms from pregnancy through two years postpartum

This study examined stability and change in maternal anxiety, stress and depression both during the second half of pregnancy and from pregnancy to six weeks and two years postpartum. Self-report measures included those designed to measure mood and state as well as more persistent attributes. Longitudinal data were collected from 137 women during pregnancy, 120 at six weeks, and 97 at two years. There was significant individual stability in scores on specific measures during pregnancy (range in Pearson rs = 0.30–0.86) and from pregnancy through two years postpartum (rs = 0.30–0.74). Comparable levels of convergence among measures of different constructs both within pregnancy and over time were also demonstrated, suggesting lack of precision in measurement instruments designed for specific constructs. Despite intra-individual stability, changes in mean levels were also observed over time with somewhat different patterns for each variable. However, maternal parity was an important contributor to both level and trajectory. A summary composite score showed an elevated level of psychological distress during pregnancy in multiparous women, followed by a decline through two years postpartum; primiparous women displayed a gradual increase in distress [main effect F (1,87) = 3.97, p < 0.05; time interaction F (2,174) = 7.15, p < 0.001] to multiparous levels by two years. Results are discussed in terms of a “motherhood” effect on psychological distress.

Prenatal antecedents of newborn neurological maturation

Fetal neurobehavioral development was modeled longitudinally using data collected at weekly intervals from 24 to 38 weeks gestation in a sample of 112 healthy pregnancies. Predictive associations between 3 measures of fetal neurobehavioral functioning and their developmental trajectories to neurological maturation in the first weeks after birth were examined. Prenatal measures included fetal heart rate (FHR) variability, fetal movement, and coupling between fetal motor activity and heart rate patterning; neonatal outcomes include a standard neurologic examination (n = 97) and brainstem auditory evoked potential (BAEP; n = 47). Optimality in newborn motor activity and reflexes was predicted by fetal motor activity, FHR variability, and somatic-cardiac coupling predicted BAEP parameters. Maternal pregnancy-specific psychological stress was associated with accelerated neurologic maturation.

Fetal neurobehavioral development: Associations with socioeconomic class and fetal sex

This longitudinal study investigated neurobehavioral development in the human fetus from 24 to 36 weeks gestation. Subject (N=103) were stratified by socioeconomic class. Fetal data were collected for 50 min at three intervals, and included measures of heart rate, movement, and biobehavioral patterns. Repeated measures analysis of variance by fetal sex and maternal socioeconomic status was used to detect maturation effects and group differences. With advancing gestation, fetuses exhibited reduced heart rate, increased heart rate variability and coupling between movement and heart rate, increased movement vigor, and more biobehavioral concordance. Male fetuses displayed higher heart rate variability throughout gestation and somewhat earlier emergence of biobehavioral organization than females. Fetuses of women of lower socioeconomic status had reduced heart rate variability, moved less often and with less vigor, showed less coupling between movement and heart rate, and had fewer episodes of synchronous quiescence/activity. Results are discussed in terms of development of the central nervous system.

In vitro fertilization and the family: quality of parenting, family functioning, and child psychosocial adjustment.

This study examined associations between homologous in vitro fertilization (IVF) and quality of parenting, family functioning, and emotional and behavioral adjustment of 3-7-year-old children. A cross-sectional survey was conducted in Taiwan with 54 IVF mother-child pairs and 59 mother-child pairs with children conceived naturally. IVF mothers reported a greater level of protectiveness toward their children than control mothers. Teachers, blind to condition, rated IVF mothers as displaying greater warmth but not overprotective or intrusive parenting behaviors toward their children. Teachers scored children of IVF as having fewer behavioral problems than control children. In contrast, IVF mothers reported less satisfaction with aspects of family functioning. Family composition moderated parenting stress: IVF mothers with only 1 child perceived less parenting stress than did those in the control group.

Fetal responses to induced maternal relaxation during pregnancy

Fetal responses to induced maternal relaxation during the 32nd week of pregnancy were recorded in 100 maternal-fetal pairs using a digitized data collection system. The 18-min guided imagery relaxation manipulation generated significant changes in maternal heart rate, skin conductance, respiration period, and respiratory sinus arrhythmia. Significant alterations in fetal neurobehavior were observed, including decreased fetal heart rate (FHR), increased FHR variability, suppression of fetal motor activity (FM), and increased FM-FHR coupling. Attribution of the two fetal cardiac responses to the guided imagery procedure itself, as opposed to simple rest or recumbency, is tempered by the observed pattern of response. Evaluation of correspondence between changes within individual maternal-fetal pairs revealed significant associations between maternal autonomic measures and fetal cardiac patterns, lower umbilical and uterine artery resistance and increased FHR variability, and declining salivary cortisol and FM activity. Potential mechanisms that may mediate the observed results are discussed.