Judy Wilson

Maternal Bonding through Pregnancy and Postnatal: Findings from an Australian Longitudinal Study

Background Mother‐infant bonding provides the foundation for secure attachment through the lifespan and organizes many facets of infant social‐emotional development, including later parenting. Aims To describe maternal bonding to offspring across the pregnancy and postnatal periods, and to examine a broad range of sociodemographic and psychosocial predictors of the maternal‐offspring bond. Methods Data were drawn from a sample of 372 pregnant women participating in an Australian population‐based longitudinal study of postnatal health and development. Participants completed maternal bonding questionnaires at each trimester and 8 weeks postnatal. Data were collected on a range of sociodemographic and psychosocial factors. Results Bonding increased significantly through pregnancy, in quality and intensity. Regression analyses indicated that stronger antenatal bonding at all time points (trimesters 1 through 3) predicted stronger postnatal bonding. Older maternal age, birth mother being born in a non‐English speaking country, mother not working full time, being a first‐time mother, breast‐feeding problems, and babys crying behavior all predicted poorer bonding at 8 weeks postpartum. Conclusion These novel findings have important implications for pregnant women and their infant offspring, and for health care professionals working in perinatal services. Importantly, interventions to strengthen maternal‐fetal bonding would be beneficial during pregnancy to enhance postnatal bonding and infant health outcomes.

Perinatal maternal alcohol consumption and methylation of the dopamine receptor DRD4 in the offspring: the Triple B study

Maternal alcohol use during the perinatal period is a major public health issue, the higher ends of which are associated with foetal alcohol spectrum disorder and a range of adverse health outcomes in the progeny. The underlying molecular mechanisms remain largely unknown but may include the epigenetic disruption of gene activity during development. Alcohol directly activates the neurotransmitter dopamine, which plays an essential role in neurodevelopment. To investigate whether antenatal and early postnatal alcohol consumption were associated with differential dopamine receptor DRD4 promoter methylation in infants (n = 844). Data were drawn from the large population based Triple B pregnancy cohort study, with detailed information on maternal alcohol consumption in each trimester of pregnancy and early postpartum. DNA was extracted from infant buccal swabs collected at 8-weeks. DRD4 promoter DNA methylation was analysed by Sequenom MassARRAY. No strong evidence was found for an association between alcohol consumption during pregnancy and infant DRD4 methylation at 8-weeks postpartum. However, maternal alcohol consumption assessed contemporaneously at 8-weeks postpartum was associated with increased methylation at 13 of 19 CpG units examined (largest Δ + 3.20%, 95%Confidence Interval:1.66,4.75%, P = 0.0001 at CpG.6). This association was strongest in women who breastfeed, suggesting the possibility of a direct effect of alcohol exposure via breast milk. The findings of this study could influence public health guidelines around alcohol consumption for breastfeeding mothers; however, further research is required to confirm these novel findings.

Alcohol consumption by breastfeeding mothers: Frequency, correlates and infant outcomes

INTRODUCTION AND AIMS There is limited research regarding the effects of alcohol consumption by breastfeeding mothers on infant development. This study examined the frequency, correlates and outcomes of alcohol use during lactation. DESIGN AND METHODS Data were from an Australian cohort study. Maternal demographics and substance use were assessed during pregnancy and at 8 weeks and 12 months postpartum. Breastfeeding duration, infant feeding, sleeping and development (Ages and Stages Questionnaire) were also assessed postpartum. Logistic regression and general linear model analyses examined characteristics of women who drank during breastfeeding, and the association between alcohol use during breastfeeding and infant outcomes. RESULTS Alcohol use was reported by 60.7% and 69.6% of breastfeeding women at 8 weeks and 12 months postpartum, respectively. Breastfeeding women who consumed alcohol were more likely to be born in Australia or another English-speaking country, be tertiary educated and have higher household incomes. Most drank at low levels (≤14 standard drinks per week, <3 per occasion) and employed strategies (e.g. timing of alcohol use) to minimise alcohol passed onto infants via breastmilk. Alcohol consumption was unrelated to breastfeeding duration, infant feeding and sleeping behaviour at 8 weeks, and most infant developmental outcomes at 8 weeks or 12 months, after adjusting for confounders. The only significant association showed that infants whose mothers drank at 8 weeks postpartum had more favourable results for personal-social development at 12 months compared with those whose mothers abstained. DISCUSSION AND CONCLUSIONS Low level drinking during breastfeeding is not linked with shorter breastfeeding duration or adverse outcomes in infants up to 12 months of age. [Wilson J, Tay RY, McCormack C, Allsop S, Najman J, Burns L, Olsson CA, Elliott E, Jacobs S, Mattick RP, Hutchinson D. Alcohol consumption by breastfeeding mothers: Frequency, correlates and infant outcomes. Drug Alcohol Rev 2017;00:000-000].

Adherence to the Caffeine Intake Guideline during Pregnancy and Birth Outcomes: A Prospective Cohort Study

The aims of this study were to identify: (i) the proportion of women exceeding the caffeine intake guideline (>200 mg/day) during each trimester, accounting for point of pregnancy awareness; (ii) guideline adherence trajectories across pregnancy; (iii) maternal characteristics associated with trajectories; and (iv) association between adherence and growth restriction birth outcomes. Typical and maximal intake per consumption day for the first trimester (T1; pre- and post-pregnancy awareness), second (T2), and third trimester (T3) were recorded for a prospective cohort of pregnant Australian women with singleton births (n = 1232). Birth outcomes were birth weight, small for gestational age, and head circumference. For each period, participants were classified as abstinent, within (≤200 mg), or in excess (>200 mg). Latent class growth analyses identified guideline adherence trajectories; regression analyses identified associations between adherence in each trimester and birth outcomes. The percentage of participants who reported caffeine use declined between T1 pre- and post-pregnancy awareness (89% to 68%), and increased in T2 and T3 (79% and 80%). Trajectories were: ‘low consumption’ (22%): low probability of any use; ‘within-guideline’ (70%): high probability of guideline adherence; and ‘decreasing heavy use’ (8%): decreasing probability of excess use. The latter two groups were more likely to report alcohol and tobacco use, and less likely to report planning pregnancy and fertility problems. Exceeding the guideline T1 pre-pregnancy awareness was associated with lower birth weight after covariate control (b = −143.16, p = 0.011). Overall, high caffeine intake pre-pregnancy awareness occurs amongst a significant minority of women, and continued excess use post-pregnancy awareness is more common where pregnancy is unplanned. Excess caffeine consumption pre-pregnancy awareness may increase the risk for lower birth weight. Increasing awareness of the guideline in pregnancy and preconception health care may be warranted.

Cohort profile: The Triple B Pregnancy Cohort Study: A longitudinal study of the relationship between alcohol, tobacco and other substance use during pregnancy and the health and well-being of Australian children and families

The Triple B Pregnancy Cohort Study investigates the effects of parental alcohol, tobacco and other substance use on infant development and family functioning. The study (also known as: Bumps, Babies and Beyond), recruited two sub-samples: (i) a general antenatal clinic sample of pregnant women and their partners (n = 1534 women; 842 of their partners); and (ii) a smaller sample of pregnant women with diagnosed substance use disorders (SUD; n = 89 women only). Participants were recruited through public antenatal clinics attached to major hospitals and area health services in New South Wales (NSW) and Western Australia (WA). Of 4068 eligible women from the general antenatal clinics, 37.7% participated, with equivalent numbers for the SUD clinics being 198, 44.9%. There were 1453 and 65 live births from the two groups, respectively, with a total of 1414 and 65 mothers in the two groups, respectively. Data were also collected on 1264 (86.9%) of 1455 eligible partners of women recruited through the general antenatal clinics. The study collected repeated measures across pregnancy (trimesters 1, 2 and 3), and at 8 weeks and 12 months postnatally; retention at 12 months was 84.0% and 73.8% for mothers in the general antenatal and specialist SUD clinics, respectively. The data collected include demographic, parental, familial and infant factors, with a focus on parental substance use and mental health, parenting practices, familial functioning and infant development. Following pregnancy awareness, 42% of women consumed alcohol, 12% smoked tobacco and 4% used illicit drugs at some stage in pregnancy. Comprehensive assessments have been conducted with infants at 12 months to test numerous developmental domains, including cognitive, motor and language skills, along with measures of social and emotional functioning. Data access enquiries can be made to the principal investigator

Weight in the First Year of Life: Associations with Maternal Prepregnancy Body Mass Index and Gestational Weight Gain—Findings from a Longitudinal Pregnancy Cohort

Objective To investigate the obesogenic influence of maternal prepregnancy body mass index (BMI) and gestational weight gain (GWG) on infant weight at birth and 12 months postpartum in an Australian general population sample. Methods Data on 1,305 pregnant women were collected on prepregnancy BMI and GWG through maternal interview, on infant weight at birth through hospital records, and on infant weight 12 months postbirth through direct measurement. Relationships between prepregnancy, gestational weight exposures, and infant weight outcomes were assessed with and without adjustment for potential confounding. Results We observed a 14 to 24 g increase in infant birth weight for every 1 kg increase in maternal weight (infant birth weight: &bgr;(BMI) = 0.014, p < 0.000; &bgr;(GWG) = 0.012, p < 0.000; and 12 months: &bgr;(BMI) = 0.018, p < 0.000; &bgr;(GWG) = 0.024, p < 0.000). Effects remained after adjustment for potential confounders (infant birth weight: &bgr;(BMI) = 0.014, p < 0.000; &bgr;(GWG) = 0.012, p < 0.001; and 12 months: &bgr;(BMI)= 0.017, p ≤ 0.033; &bgr;(GWG) = 0.023, p = 0.001). However, the effects observed were small, and there was no evidence that GWG mediated relationships between preconception BMI and infant weight. Conclusion In a general population sample, there is a significant but not substantial observed relationship between maternal prepregnancy BMI and GWG and infant weight outcomes, suggesting a minor role for these factors at a population level.

The Triple B Study: pilot data on the association between drug and alcohol use in pregnancy and child development at one and three years of age

Issue: Harmful use of alcohol is a leading cause of disease burden for young Australians. Little is known about the context of adolescent alcohol initiation and the development of harmful patterns of consumption. This research reports descriptive baseline data from a national Australian longitudinal cohort. Approach: Parent-child dyads were recruited nationally via NSW, Tasmanian and WA secondary schools. During 2010/11, 1929 parent–child dyads completed baseline surveys. Measures include: alcohol use and harms; rules; parental style and monitoring; family relationships, confl ict and relations; peer substance use and approval; and delinquency. Key Findings: Sixty-eight percent of adolescents (M = 12.5 yrs) had tried alcohol. Parent factors including frequency and quantity of alcohol consumption (÷2 (3, N=1880) = 79.27, P < 0.00005; ÷2 (3, N=1879) = 63.75, P < 0.00005), drinking alcohol in the presence of their child (÷2 (3, N=1879) = 81.63, P < 0.00005) and younger age of alcohol initiation (÷2 (1, N=1785) = 20.13, P < 0.00005) were associated with adolescent alcohol initiation. Children with higher levels of rule breaking and aggressive behaviour (÷2 (1, N=1903) = 44.43, P < 0.0005; ÷2 (1, N=1893) = 13.40, P = 0.0003), who were male (÷2 (1, N=1904) = 6.72, P = 0.0095) and who had at least some friends who had tried alcohol (÷2 (3, N=1896) = 506.94, P < 0.00005) and who approved of drinking alcohol (÷2 (2, N=1903) = 91.21, P < 0.00005) were more likely to have tried alcohol themselves. Implications: To address current levels of binge drinking and long term harms from alcohol, it is essential to understand the context of early-adolescent alcohol use and how harmful trajectories may develop. Conclusion: Future analyses of this cohort will provide insight into the impact of contextual factors on adolescent alcohol use and inform public health policy and prevention.

Maternal and partner prenatal alcohol use and infant cognitive development

BACKGROUND Teratogenicity of heavy prenatal alcohol exposure is established, but uncertainty remains regarding the impact of moderate alcohol exposure on cognitive deficits in infants. Separating in utero effects from environmental confounding is a challenge for observational studies; consideration of alcohol use by partners as well as mothers may help clarify this. This study examined associations between prenatal alcohol use by both mothers and their partners and infant cognitive developmental outcomes at 12-months. METHODS Pregnant women (n = 1331) and their partners (n = 699) were recruited from antenatal clinics of three metropolitan public hospitals in Australia, and completed detailed interviews about alcohol consumptions throughout pregnancy. Infants were assessed with the Bayley Scales of Infant Development - Third edition (Bayley) at 12-months of age. RESULTS Alcohol use during pregnancy was reported by 65.7% of mothers and 84.1% of partners. Using multiple methods to adjust for confounding factors, no evidence for impaired cognitive ability associated with alcohol use by mothers or their partners was observed. Children born to women who drank low-levels of alcohol had slightly higher Bayley cognitive scores than those born to abstaining women. There was some evidence for an interaction between sociodemographic factors and prenatal alcohol exposure on infant cognitive outcomes. CONCLUSION This finding corroborates existing evidence to suggest there are no detrimental effects to infant cognitive development at 12-months of age following low-level prenatal alcohol exposure. Future prospective studies involving families of a broad range of backgrounds would be informative to clarify interaction between alcohol exposure and environmental factors on developmental outcomes.

The relationship of maternal gestational drug and alcohol intake, psychosocial functioning and lifetime mental disorder with anxiety and stress during pregnancy

Issue: Harmful use of alcohol is a leading cause of disease burden for young Australians. Little is known about the context of adolescent alcohol initiation and the development of harmful patterns of consumption. This research reports descriptive baseline data from a national Australian longitudinal cohort. Approach: Parent-child dyads were recruited nationally via NSW, Tasmanian and WA secondary schools. During 2010/11, 1929 parent–child dyads completed baseline surveys. Measures include: alcohol use and harms; rules; parental style and monitoring; family relationships, confl ict and relations; peer substance use and approval; and delinquency. Key Findings: Sixty-eight percent of adolescents (M = 12.5 yrs) had tried alcohol. Parent factors including frequency and quantity of alcohol consumption (÷2 (3, N=1880) = 79.27, P < 0.00005; ÷2 (3, N=1879) = 63.75, P < 0.00005), drinking alcohol in the presence of their child (÷2 (3, N=1879) = 81.63, P < 0.00005) and younger age of alcohol initiation (÷2 (1, N=1785) = 20.13, P < 0.00005) were associated with adolescent alcohol initiation. Children with higher levels of rule breaking and aggressive behaviour (÷2 (1, N=1903) = 44.43, P < 0.0005; ÷2 (1, N=1893) = 13.40, P = 0.0003), who were male (÷2 (1, N=1904) = 6.72, P = 0.0095) and who had at least some friends who had tried alcohol (÷2 (3, N=1896) = 506.94, P < 0.00005) and who approved of drinking alcohol (÷2 (2, N=1903) = 91.21, P < 0.00005) were more likely to have tried alcohol themselves. Implications: To address current levels of binge drinking and long term harms from alcohol, it is essential to understand the context of early-adolescent alcohol use and how harmful trajectories may develop. Conclusion: Future analyses of this cohort will provide insight into the impact of contextual factors on adolescent alcohol use and inform public health policy and prevention.

The Triple B Study: The relationship between pregnancy planning, parental substance use and maternal foetal attachment

Issue: Harmful use of alcohol is a leading cause of disease burden for young Australians. Little is known about the context of adolescent alcohol initiation and the development of harmful patterns of consumption. This research reports descriptive baseline data from a national Australian longitudinal cohort. Approach: Parent-child dyads were recruited nationally via NSW, Tasmanian and WA secondary schools. During 2010/11, 1929 parent–child dyads completed baseline surveys. Measures include: alcohol use and harms; rules; parental style and monitoring; family relationships, confl ict and relations; peer substance use and approval; and delinquency. Key Findings: Sixty-eight percent of adolescents (M = 12.5 yrs) had tried alcohol. Parent factors including frequency and quantity of alcohol consumption (÷2 (3, N=1880) = 79.27, P < 0.00005; ÷2 (3, N=1879) = 63.75, P < 0.00005), drinking alcohol in the presence of their child (÷2 (3, N=1879) = 81.63, P < 0.00005) and younger age of alcohol initiation (÷2 (1, N=1785) = 20.13, P < 0.00005) were associated with adolescent alcohol initiation. Children with higher levels of rule breaking and aggressive behaviour (÷2 (1, N=1903) = 44.43, P < 0.0005; ÷2 (1, N=1893) = 13.40, P = 0.0003), who were male (÷2 (1, N=1904) = 6.72, P = 0.0095) and who had at least some friends who had tried alcohol (÷2 (3, N=1896) = 506.94, P < 0.00005) and who approved of drinking alcohol (÷2 (2, N=1903) = 91.21, P < 0.00005) were more likely to have tried alcohol themselves. Implications: To address current levels of binge drinking and long term harms from alcohol, it is essential to understand the context of early-adolescent alcohol use and how harmful trajectories may develop. Conclusion: Future analyses of this cohort will provide insight into the impact of contextual factors on adolescent alcohol use and inform public health policy and prevention.