Preventive Effects on Birth Outcomes: Buffering Impact of Maternal Stress, Depression, and Anxiety
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Although maternal stress, anxiety, and depression have been linked to negative birth outcomes, few studies have investigated preventive interventions targeting maternal mental health as a means of reducing such problems. This randomized controlled study examines whether Family Foundations (FF)—a transition to parenthood program for couples focused on promoting coparenting quality, with previously documented impact on maternal stress, depression, and anxiety—can buffer the negative effects of maternal mental health problems.
To assess the effects of FF, we used a randomized block design with a sample of 259 expectant mothers assigned to FF or a control condition and analyzed using propensity score models. We examine two-way interactions of condition (intervention vs. control) with maternal mental health problems (financial stress, depression, and anxiety) on birth outcomes (birth weight, days in hospital for mothers and infants). For birth weight, we assess whether intervention effects depend on length of gestation by including a third interaction term.
FF buffered (p < 0.05) the negative impact of maternal mental health problems on birth weight and both mother and infant length of post-partum hospital stay. For birth weight, assignment to FF was associated with higher birth weight for infants born before term.
These results demonstrate that a psycho-educational program for couples focused on enhancing mutual coparental support, with preventive effects on maternal mental health, can reduce incidence of birth problems among women at elevated risk. Such improvements in birth outcomes could translate into substantial reductions in public and personal healthcare costs. Future work should assess mediating mechanisms of intervention impact and cost-benefit ratio of the intervention.
Clinical trials registration
The Family Foundations follow-up intervention study is currently registered with www.clinicaltrials.gov. The study identifier is NCT01907412.
KeywordsPrenatal stress Depression Anxiety Birth weight Length of hospital stay Coparenting Family Foundations
Adverse birth outcomes
This study was funded by a grant from the National Institute of Child Health and Development (RO1 HD058529-02), Mark E. Feinberg, principal investigator. Dr. Feinberg created the Family Foundations program and is the owner of a private company, Family Gold, which disseminates the Family Foundations program. Dr. Feinberg’s financial interest has been reviewed by the Institutional Review Board and the Conflict of Interest Committee at The Pennsylvania State University.
Compliance with Ethical Standards
All phases of this study were supported by National Institute of Child and Human Development Grant RO1 HD058529-02
Dr. Mark Feinberg created the Family Foundations program and is the owner of a private company, Family Gold, which disseminates the Family Foundations program. Dr. Feinberg’s financial interest has been reviewed by the Institutional Review Board and the Conflict of Interest Committee at The Pennsylvania State University. The remaining authors have no financial relationships relevant to this article to disclose.
Conflict of interest
Dr. Mark Feinberg developed the Family Foundations program and is the owner of a private company, Family Gold, which disseminates the program. Dr. Feinberg’s conflict of interest has been reviewed by the Institutional Review Board and the Conflict of Interest Committee at The Pennsylvania State University. All other authors, Dr. Deborah Ehrenthal, Dr. Michelle Hostetler, Dr. Damon Jones, Dr. Kari-Lyn Sakuma, Dr. Ian Paul, and Dr. Michael Roettger, declare no potential conflicts of interest from publication of this study.
Integrity of research and reporting
All aspects of this study, including design, implementation and analysis, have been approved by the Penn State Institutional Review Board, and have followed the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
- 2.Baibazarova, E., van de Beek, C., Cohen-Kettenis, P., Buitelaa, J., Shelton, K., & van Goozen, S. (2013). Influence of prenatal maternal stress, maternal plasma cortisol and cortisol in the amniotic fluid on birth outcomes and child temperament at 3 months. Psychoneuroendocrinology, 38(6), 907–915.PubMedCrossRefGoogle Scholar
- 6.Blencowe, H., Cousens, S., Oestergaard, M., Chou, D., Moller, A., Narwal, R., & Lawn, J. (2012). National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet, 379(9832), 2162–2172.PubMedCrossRefGoogle Scholar
- 7.Buss, C., Davis, E. P., Shahbaba, B., Pruessner, J. C., Head, K., & Sandman, C. A. (2012). Maternal cortisol over the course of pregnancy and subsequent child amygdala and hippocampus volumes and affective problems. National Academy of Sciences, USA, 109(20), E1312–E1319. doi: 10.1073/pnas.1201295109.CrossRefGoogle Scholar
- 8.Buss, C., Entringer, S., Swanson, J., & Wadhwa, P. (2012). The role of stress in brain development: The gestational environment’s long-term effects on the brain. Cerebrum, 4. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3574809.
- 10.Conde, A., Figueiredo, B., Tendais, I., Teixeira, C., Costa, R., Pacheco, A., & Nogueira, R. (2010). Mother’s anxiety and depression and associated risk factors during early pregnancy: Effects on fetal growth and activity at 20–22 weeks of gestation. Journal of Psychosomatic Obstetrics & Gynecology, 31(2), 70–82.CrossRefGoogle Scholar
- 11.Conley, D., Strully, K. W., & Bennett, N. G. (2003). The starting gate: birth weight and life chances. Oakland: Univ of California Press.Google Scholar
- 17.Feinberg, M. E., Jones, D., Hostetler, M., Roettger, M., Paul, I., & Ehrenthal, D. (2015, Under Review). Couple-focused prevention at the transition to parenthood, a randomized trial: Effects on coparenting, parenting, family violence, and parent and child adjustment.Google Scholar
- 19.Feinberg, M. E., Jones, D. E., Roettger, M. E., Solmeyer, A., & Hostetler, M. L. (2014). Long-term follow-up of a randomized trial of family foundations: Effects on children’s emotional, behavioral, and school adjustment. Journal of Family Psychology, 28(6), 821–831. doi: 10.1037/fam0000037.PubMedCrossRefGoogle Scholar
- 26.Grote, N., Bridge, J., Gavin, A., Melville, J., Iyengar, S., & Katon, W. (2010). A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Archives of General Psychiatry, 67(10), 1012–1024.PubMedPubMedCentralCrossRefGoogle Scholar
- 27.Guo, S., & Fraser, M. W. (2014). Propensity score analysis: Statistical methods and applications (Vol. 11). Thousand Oaks: Sage.Google Scholar
- 31.Hobel, C., Dunkel-Schetter, C., Roesch, S., Castro, L., & Arora, C. (1999). Maternal plasma corticotropin-releasing hormone associated with stress at 20 weeks’ gestation in pregnancies ending in preterm delivery. American Journal of Obstetrics and Gynecology, 180(1 pt 3), S257–S263.PubMedCrossRefGoogle Scholar
- 33.Howe, G. W., Caplan, R. D., Foster, D., Lockshin, M., & McGrath, C. (1995). When couples cope with job loss: A strategy for developing and testing preventive interventions. In L. R. Murphy & J. J. Hurrell (Eds.), Job stress interventions (pp. 139–157). Washington, DC: American Psychological Association.CrossRefGoogle Scholar
- 35.Jones, D. E., Feinberg, M. E., & Hostetler, M. L. (2014). Costs to implement an effective transition-to-parenthood program for couples: Analysis of the Family Foundations program. Evaluation and Program Planning, 44, 59–67. doi: 10.1016/j.evalprogplan.2014.02.001.PubMedPubMedCentralCrossRefGoogle Scholar
- 37.Lawn, J., Gravett, M., Nunes, T., Rubens, C., Stanton, C., Group, G. R., & Zaentz, R. (2010). Global report on preterm birth and stillbirth (1 of 7): Definitions, description of the burden and opportunities to improve data. BMC Pregnancy Childbirth, 10(Supp 1), S1.PubMedPubMedCentralCrossRefGoogle Scholar
- 43.Osborne, J. W., & Overbay, A. (2004). The power of outliers (and why researchers should always check for them). Practical Assessment, Research & Evaluation, 9(6). http://PAREonline.net/getvn.asp?v=9&n=6.
- 48.Spielberger, C. D., Gorsuch, R. L., Lushene, R., Vagg, P. R., & Jacobs, G. A. (1983). Manual for the State-Trait anxiety inventory (form Y). Palo Alto, CA: Consulting Psychologists Press.Google Scholar
- 51.The Henry J. Kaiser Family Foundation. (2012). Hospital adjusted expenses per inpatient day. State Health Facts: The Henry J. Kaiser Family Foundation.Google Scholar