Sue Jacobs

Predictors of postnatal mother-infant bonding: the role of antenatal bonding, maternal substance use and mental health

The emotional bond that a mother feels towards her baby is critical to social, emotional and cognitive development. Maternal health and wellbeing through pregnancy and antenatal bonding also play a key role in determining bonding postnatally, but the extent to which these relationships may be disrupted by poor mental health or substance use is unclear. This study aimed to examine the extent to which mother-fetal bonding, substance use and mental health through pregnancy predicted postnatal mother-infant bonding at 8xa0weeks. Participants were 372 women recruited from three metropolitan hospitals in Australia. Data was collected during trimesters one, two and three of pregnancy and 8xa0weeks postnatal using the Maternal Antenatal Attachment Scale (MAAS), Maternal Postnatal Attachment Scale (MPAS), the Edinburgh Antenatal and Postnatal Depression Scale (EPDS), the Depression and Anxiety Scales (DASS-21), frequency and quantity of substance use (caffeine, alcohol and tobacco) as well as a range of demographic and postnatal information. Higher antenatal bonding predicted higher postnatal bonding at all pregnancy time-points in a fully adjusted regression model. Maternal depressive symptoms in trimesters two and three and stress in trimester two were inversely related to poorer mother-infant bonding 8xa0weeks postnatally. This study extends previous work on the mother’s felt bond to her developing child by drawing on a large sample of women and documenting the pattern of this bond at three time points in pregnancy and at 8xa0weeks postnatally. Utilising multiple antenatal waves allowed precision in isolating the relationships in pregnancy and at key intervention points. Investigating methods to enhance bonding and intervene in pregnancy is needed. It is also important to assess maternal mental health through pregnancy.

Prenatal alcohol consumption between conception and recognition of pregnancy

BACKGROUNDnCurrent estimates of the rates of alcohol-exposed pregnancies may underestimate prenatal alcohol exposure if alcohol consumption in early trimester 1, prior to awareness of pregnancy, is not considered. Extant literature describes predictors of alcohol consumption during pregnancy; however, alcohol consumption prior to awareness of pregnancy is a distinct behavior from consumption after becoming aware of pregnancy and thus may be associated with different predictors. The purpose of this study was therefore to examine prevalence and predictors of alcohol consumption by women prior to awareness of their pregnancy, and trajectories of change to alcohol use following pregnancy recognition.nnnMETHODSnPregnant women (nxa0=xa01,403) were prospectively recruited from general antenatal clinics of 4 public hospitals in Australian metropolitan areas between 2008 and 2013. Women completed detailed interviews about alcohol use before and after recognition of pregnancy.nnnRESULTSnMost women (nxa0=xa0850, 60.6%) drank alcohol between conception and pregnancy recognition. Binge and heavy drinking were more prevalent than low-level drinking. The proportion of women who drank alcohol reduced to 18.3% (nxa0=xa0257) after recognition of pregnancy. Of women who drank alcohol, 70.5% ceased drinking, 18.3% reduced consumption, and 11.1% made no reduction following awareness of pregnancy. Socioeconomic status (SES) was the strongest predictor of alcohol use, with drinkers more likely to be of high rather than low SES compared with abstainers (ORxa0=xa03.30, pxa0<xa00.001). Factors associated with different trajectories (either cessation, reduction, or continuation of drinking) included level of alcohol use prior to pregnancy recognition, age, pregnancy planning, and illicit substance use.nnnCONCLUSIONSnIn this sample of relatively high SES women, most women ceased or reduced drinking once aware of their pregnancy. However, the rate of alcohol-exposed pregnancies was higher than previous estimates when the period prior to pregnancy recognition was taken into account.

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.

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

INTRODUCTION AND AIMSnThere 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.nnnDESIGN AND METHODSnData were from an Australian cohort study. Maternal demographics and substance use were assessed during pregnancy and at 8u2009weeks and 12u2009months 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.nnnRESULTSnAlcohol use was reported by 60.7% and 69.6% of breastfeeding women at 8u2009weeks and 12u2009months 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 8u2009weeks, and most infant developmental outcomes at 8u2009weeks or 12u2009months, after adjusting for confounders. The only significant association showed that infants whose mothers drank at 8u2009weeks postpartum had more favourable results for personal-social development at 12u2009months compared with those whose mothers abstained.nnnDISCUSSION AND CONCLUSIONSnLow level drinking during breastfeeding is not linked with shorter breastfeeding duration or adverse outcomes in infants up to 12u2009months 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].

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 (nu2009=u20091534 women; 842 of their partners); and (ii) a smaller sample of pregnant women with diagnosed substance use disorders (SUD; nu2009=u200989 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

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 nfor young Australians. Little is known about the context of adolescent nalcohol initiation and the development of harmful patterns of nconsumption. This research reports descriptive baseline data from a nnational Australian longitudinal cohort. nApproach: Parent-child dyads were recruited nationally via NSW, nTasmanian and WA secondary schools. During 2010/11, 1929 nparent–child dyads completed baseline surveys. Measures include: nalcohol use and harms; rules; parental style and monitoring; family nrelationships, confl ict and relations; peer substance use and approval; nand delinquency. nKey Findings: Sixty-eight percent of adolescents (M = 12.5 yrs) nhad tried alcohol. Parent factors including frequency and quantity of nalcohol consumption (÷2 n(3, N=1880) = 79.27, P < 0.00005; ÷2 n(3, N=1879) = n63.75, P < 0.00005), drinking alcohol in the presence of their child n(÷2 n(3, N=1879) = 81.63, P < 0.00005) and younger age of alcohol initiation n(÷2 n(1, N=1785) = 20.13, P < 0.00005) were associated with adolescent nalcohol initiation. Children with higher levels of rule breaking and naggressive behaviour (÷2 n(1, N=1903) = 44.43, P < 0.0005; ÷2 n(1, N=1893) = n13.40, P = 0.0003), who were male (÷2 n(1, N=1904) = 6.72, P = 0.0095) and nwho had at least some friends who had tried alcohol (÷2 n(3, N=1896) = n506.94, P < 0.00005) and who approved of drinking alcohol n(÷2 n(2, N=1903) = 91.21, P < 0.00005) were more likely to have tried nalcohol themselves. nImplications: To address current levels of binge drinking and long nterm harms from alcohol, it is essential to understand the context of nearly-adolescent alcohol use and how harmful trajectories may ndevelop. nConclusion: Future analyses of this cohort will provide insight into nthe impact of contextual factors on adolescent alcohol use and inform npublic health policy and prevention.Background / Aims: Cannabis Withdrawal Syndrome is proposed in the DSM-5 due for release 2013. Problematic cannabis use among remote Indigenous communities has been reported and stressing out has been reported when cannabis is not available. Sudden cessation of cannabis use by remanded/sentenced inmates could further increase risk of stressing out however, the experience of withdrawal has not been considered. n nMethods: Indigenous inmates aged 18-40 years were recruited from a far north Queensland Correctional Centre. Retrospective cannabis use, dependence and withdrawal measures prior to incarceration were self-reported. Assessments included other drug use, Time Line Follow Back, Severity of Dependence Scale, Indigenous Risk Impact Screen and Cannabis Withdrawal Checklist. n nResults: From 101 males inmates, 89% (n=90) reported lifetime use and 70% (n=70) used cannabis <3 months before prison. Of the 70 current cannabis users, 57% (n=41) believed use was excessive, 63% (n=44) met dependence criteria and reported an average of 2.9 withdrawal symptoms (most likely: irritability/anger/aggression, nervousness/anxiety, sleep difficulties, depression and physical symptoms). n nConclusion: Results reveal heavy and problematic cannabis use and dependence symptoms however, withdrawal is not well defined. To improve assessment and timely treatment of cannabis withdrawal within custodial settings, studies nare needed to document onset, time course and severity of symptoms and to assist in management of withdrawal. Findings from this study contributed to NHMRC#1020514 (commencing October 2012) to interview new entrants to prison on eight occasions over 28 days. Assessments validated with biological markers, will examine onset and severity of cannabis withdrawal and psychological distress.

Maternal and partner prenatal alcohol use and infant cognitive development

BACKGROUNDnTeratogenicity 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.nnnMETHODSnPregnant women (nu202f=u202f1331) and their partners (nu202f=u202f699) 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.nnnRESULTSnAlcohol 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.nnnCONCLUSIONnThis 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 Triple B Pregnancy Cohort Study: Alcohol use during pregnancy and developmental outcomes in infants at 12 months of age

Introduction and Aims: Substance misuse results in a range of social harms. Estimating alcohol, nicotine and illicit drug use in the community is important, with current estimates reliant upon self-report data and subject to biases. Chemists can now quantify substances in wastewater using an internationally validated method. This research estimated consumption levels based upon contaminants discharged in municipal wastewater treatment plants in metropolitan and regional Victoria sites during a week in March and June/July 2015.National Drug and Alcohol Research Centre, University of New South Wale; Deakin University, School of Psychology, Faculty of Health,Centre for Social and Early Emotional Development; Murdoch Childrens Research Institute, The Royal Children’s Hospital Melbourne, The University of Melbourne (Paediatrics and Psychological Sciences); National Drug Research Institute, Curtin University; Queensland Alcohol and Drug Research and Education Centre and Schools of Population Health and Social Science, University of Queensland; Discipline of Paediatrics and Child Health, The University of Sydney, The Children’s Hospital at Westmead; Department of Obstetrics, Royal Prince Alfred Hospital; School of Nursing and Midwifery, Curtin University

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 nfor young Australians. Little is known about the context of adolescent nalcohol initiation and the development of harmful patterns of nconsumption. This research reports descriptive baseline data from a nnational Australian longitudinal cohort. nApproach: Parent-child dyads were recruited nationally via NSW, nTasmanian and WA secondary schools. During 2010/11, 1929 nparent–child dyads completed baseline surveys. Measures include: nalcohol use and harms; rules; parental style and monitoring; family nrelationships, confl ict and relations; peer substance use and approval; nand delinquency. nKey Findings: Sixty-eight percent of adolescents (M = 12.5 yrs) nhad tried alcohol. Parent factors including frequency and quantity of nalcohol consumption (÷2 n(3, N=1880) = 79.27, P < 0.00005; ÷2 n(3, N=1879) = n63.75, P < 0.00005), drinking alcohol in the presence of their child n(÷2 n(3, N=1879) = 81.63, P < 0.00005) and younger age of alcohol initiation n(÷2 n(1, N=1785) = 20.13, P < 0.00005) were associated with adolescent nalcohol initiation. Children with higher levels of rule breaking and naggressive behaviour (÷2 n(1, N=1903) = 44.43, P < 0.0005; ÷2 n(1, N=1893) = n13.40, P = 0.0003), who were male (÷2 n(1, N=1904) = 6.72, P = 0.0095) and nwho had at least some friends who had tried alcohol (÷2 n(3, N=1896) = n506.94, P < 0.00005) and who approved of drinking alcohol n(÷2 n(2, N=1903) = 91.21, P < 0.00005) were more likely to have tried nalcohol themselves. nImplications: To address current levels of binge drinking and long nterm harms from alcohol, it is essential to understand the context of nearly-adolescent alcohol use and how harmful trajectories may ndevelop. nConclusion: Future analyses of this cohort will provide insight into nthe impact of contextual factors on adolescent alcohol use and inform npublic health policy and prevention.Background / Aims: Cannabis Withdrawal Syndrome is proposed in the DSM-5 due for release 2013. Problematic cannabis use among remote Indigenous communities has been reported and stressing out has been reported when cannabis is not available. Sudden cessation of cannabis use by remanded/sentenced inmates could further increase risk of stressing out however, the experience of withdrawal has not been considered. n nMethods: Indigenous inmates aged 18-40 years were recruited from a far north Queensland Correctional Centre. Retrospective cannabis use, dependence and withdrawal measures prior to incarceration were self-reported. Assessments included other drug use, Time Line Follow Back, Severity of Dependence Scale, Indigenous Risk Impact Screen and Cannabis Withdrawal Checklist. n nResults: From 101 males inmates, 89% (n=90) reported lifetime use and 70% (n=70) used cannabis <3 months before prison. Of the 70 current cannabis users, 57% (n=41) believed use was excessive, 63% (n=44) met dependence criteria and reported an average of 2.9 withdrawal symptoms (most likely: irritability/anger/aggression, nervousness/anxiety, sleep difficulties, depression and physical symptoms). n nConclusion: Results reveal heavy and problematic cannabis use and dependence symptoms however, withdrawal is not well defined. To improve assessment and timely treatment of cannabis withdrawal within custodial settings, studies nare needed to document onset, time course and severity of symptoms and to assist in management of withdrawal. Findings from this study contributed to NHMRC#1020514 (commencing October 2012) to interview new entrants to prison on eight occasions over 28 days. Assessments validated with biological markers, will examine onset and severity of cannabis withdrawal and psychological distress.

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 nfor young Australians. Little is known about the context of adolescent nalcohol initiation and the development of harmful patterns of nconsumption. This research reports descriptive baseline data from a nnational Australian longitudinal cohort. nApproach: Parent-child dyads were recruited nationally via NSW, nTasmanian and WA secondary schools. During 2010/11, 1929 nparent–child dyads completed baseline surveys. Measures include: nalcohol use and harms; rules; parental style and monitoring; family nrelationships, confl ict and relations; peer substance use and approval; nand delinquency. nKey Findings: Sixty-eight percent of adolescents (M = 12.5 yrs) nhad tried alcohol. Parent factors including frequency and quantity of nalcohol consumption (÷2 n(3, N=1880) = 79.27, P < 0.00005; ÷2 n(3, N=1879) = n63.75, P < 0.00005), drinking alcohol in the presence of their child n(÷2 n(3, N=1879) = 81.63, P < 0.00005) and younger age of alcohol initiation n(÷2 n(1, N=1785) = 20.13, P < 0.00005) were associated with adolescent nalcohol initiation. Children with higher levels of rule breaking and naggressive behaviour (÷2 n(1, N=1903) = 44.43, P < 0.0005; ÷2 n(1, N=1893) = n13.40, P = 0.0003), who were male (÷2 n(1, N=1904) = 6.72, P = 0.0095) and nwho had at least some friends who had tried alcohol (÷2 n(3, N=1896) = n506.94, P < 0.00005) and who approved of drinking alcohol n(÷2 n(2, N=1903) = 91.21, P < 0.00005) were more likely to have tried nalcohol themselves. nImplications: To address current levels of binge drinking and long nterm harms from alcohol, it is essential to understand the context of nearly-adolescent alcohol use and how harmful trajectories may ndevelop. nConclusion: Future analyses of this cohort will provide insight into nthe impact of contextual factors on adolescent alcohol use and inform npublic health policy and prevention.Background / Aims: Cannabis Withdrawal Syndrome is proposed in the DSM-5 due for release 2013. Problematic cannabis use among remote Indigenous communities has been reported and stressing out has been reported when cannabis is not available. Sudden cessation of cannabis use by remanded/sentenced inmates could further increase risk of stressing out however, the experience of withdrawal has not been considered. n nMethods: Indigenous inmates aged 18-40 years were recruited from a far north Queensland Correctional Centre. Retrospective cannabis use, dependence and withdrawal measures prior to incarceration were self-reported. Assessments included other drug use, Time Line Follow Back, Severity of Dependence Scale, Indigenous Risk Impact Screen and Cannabis Withdrawal Checklist. n nResults: From 101 males inmates, 89% (n=90) reported lifetime use and 70% (n=70) used cannabis <3 months before prison. Of the 70 current cannabis users, 57% (n=41) believed use was excessive, 63% (n=44) met dependence criteria and reported an average of 2.9 withdrawal symptoms (most likely: irritability/anger/aggression, nervousness/anxiety, sleep difficulties, depression and physical symptoms). n nConclusion: Results reveal heavy and problematic cannabis use and dependence symptoms however, withdrawal is not well defined. To improve assessment and timely treatment of cannabis withdrawal within custodial settings, studies nare needed to document onset, time course and severity of symptoms and to assist in management of withdrawal. Findings from this study contributed to NHMRC#1020514 (commencing October 2012) to interview new entrants to prison on eight occasions over 28 days. Assessments validated with biological markers, will examine onset and severity of cannabis withdrawal and psychological distress.