1. 2012 State of the Science Congress on Nursing Research Jeanne Alhusen 1, Deborah Gross 1, Matthew Hayat 2, and Phyllis Sharps 1 1 Johns Hopkins University School of Nursing, Baltimore, MD 2 Rutgers University College of Nursing, Newark, NJ

2. National Institute of Mental Health (T32 MH020014) National Institute of Nursing Research (F31NR010957) Morton and Jane Blaustein Fellowship in Mental Health and Psychiatric Nursing National Center for Research Resources (5KL2RR025006), a component of the NIH, and the NIH Roadmap for Medical Research

3. Study Purpose: To understand the role of maternal-fetal attachment (MFA) on neonatal outcomes in a sample of low income, African American women at increased risk for adverse neonatal outcomes Study Rationale: Persistent racial disparities in low birth weight and infant mortality rate in the U.S Disparities persist beyond neonatal period

4. Purpose To understand the role of maternal-fetal attachment (MFA) on neonatal outcomes Design/Methods (n=166) Prospective longitudinal concurrent mixed methods design Maternal data collected at 24-28 weeks gestation Neonatal data collected within 48 hrs postpartum Primary Variables (measures) MFA (MFAS) Maternal Mental Health (EPDS, PPP, DTS) Intimate Partner Violence (AAS) Health Practices (HPQ-II) Neonatal Outcomes (BW and GA)

5. Demographic n % Race African American White non-Hispanic Other 155 9 2 93 5 2 Marital Status Single Partnered/Not Married Married or Other 90 56 20 54 34 12 Education Less than High School HS grad/GED Some College/Trade School College/Trade School grad 110 45 5 6 67 27 3 Household Income Under $10,000 $10,000 - $20,000 $20,001-$30,000 >$30,001 76 66 12 46 40 7 93% African American 88% Not Married 94% High School Diploma or less 86% Total Household Income <$20,000

6. Maternal Mental Health Outcomes 59% (n=98) high depressive symptoms 48% (n=79) high PTSD symptoms 19% (n=32) reported physical abuse during this pregnancy Neonatal Outcomes 41% of neonates classified as having adverse outcome (SGA, LBW, PTB)

7. PERCENTILE

8. Women reporting higher MFA had a decreased likelihood of delivering a neonate with an adverse outcome (OR.91, CI 0.88-0.94) Women reporting more depressive symptoms had lower MFA scores than women with less depressive symptoms (b=-1.02, CI -1.32, -.73) Qualitative participants discussed the links between depression, MFA, and neonatal outcomes Alhusen, J., et al. (2012). The influence of maternal-fetal attachment on neonatal outcomes among low income, African American women. Research in Nursing and Health, 35, 112- 120. Alhusen, J., et al. (2012). The role of mental health on maternal-fetal attachment in low- income women, JOGNN, epub ahead of print.

9. Follow-Up Study Purpose (n=81): To understand the role of maternal attachment style on early childhood outcomes in a sample of low income, predominantly African American women and children at increased risk for adverse physical and mental health outcomes

10. Attachment between a mother and a child is a biologically-driven process May be adapted or modified by experience A child’s ability to develop a secure attachment is nurtured in early interactions with parents Significant differences in early care giving → early childhood health and developmental outcomes (Naber et al., 2010; Feldman et al., 2010; Bowlby, 1969)

11. Purpose To understand the role of maternal attachment style on early childhood developmental outcomes Design/Methods (n=81) Extension of longitudinal study Maternal-child data collected during home visits Children age 14-26 months Primary Variables (Measures) Attachment Style (Attachment Style Questionnaire) Maternal Depression (EPDS) Early Childhood Developmental Outcomes (Ages & Stages Questionnaires)

12. No differences between follow up and original sample on background characteristics 36% of mothers scored high for depressive symptoms Early Childhood Developmental Assessment 30% delayed in communication skills 26% delayed in problem solving skills 21% delayed in gross motor skills 17% delayed in fine motor skills 14% delayed in personal-social skills

13. VariableAvoidant Attachment Postpartum Depression Adverse Neonatal Outcomes Early Childhood Dev. MFA -.62*-.61*-.55*.58* Avoidant Attachment -.85*.35*-.83* Postpartum Depression -.39*-.82* Adverse Neonatal Outcomes --.50* *p < 0.001

14. Predictor Exp β95%CIp value Model 1 Maternal-Fetal Attachment1.02[1.01, 1.03]<0.001 Model 2 Avoidant Attachment Post-partum Depression.98.97 [.97,.99] [.96,.99] <0.001 Model 3 Maternal-Fetal Attachment Avoidant Attachment Post-partum Depression 1.00.98 [.99, 1.00] [.97,.99] [.96,.99] 0.07 <0.001 0.018 a GLM= Generalized Linear Model with Gamma Distribution and Log Link Function b Adjusted for marital status, education, income, and adverse neonatal outcome c AIC 358.4

15. Success of early intervention programs may be affected by maternal attachment style More research needed on the role of maternal attachment and child outcomes in vulnerable populations Further research on neuroendocrinological processes Alterations in oxytocin functioning