Early cognitive and motor development among infants born to women infected with human immunodeficiency virus. Women and Infants Transmission Study Group.

OBJECTIVE: To examine the frequency, timing, and factors associated with abnormal cognitive and motor development during the first 30 months of life in infants born to women infected with human immunodeficiency virus type 1 (HIV-1). METHODS: Serial neurodevelopmental assessment was performed with 595 infants born to women infected with HIV-1 in a multicenter, prospective, natural history cohort study. Survival analysis methods were used to evaluate 6 outcome events related to abnormal cognitive and motor growth (time to confirmed drop of 1 SD, time to first score <69, and time to confirmed drop of 2 SD) in Bayley Scales of Infant Development Mental Developmental Index (MDI) and Psychomotor Developmental Index (PDI) scores among infected (n = 114) and uninfected (n = 481) infants. Proportional hazards modeling was used to evaluate the effects of HIV infection status, prematurity, prenatal exposure to illicit drugs, maternal educational attainment, and primary language. RESULTS: HIV-1 infection was significantly associated with increased risk for all outcome events related to abnormal mental and motor growth. Differences between infected and uninfected infants were apparent by 4 months of age. Prematurity was associated with increased risk for MDI <69 and PDI <69. Maternal education of <9 completed years was associated with increased risk for MDI <69. Neither prenatal exposure to illicit drugs nor primary language other than English was associated with abnormal development. CONCLUSION: A significant proportion of infants with HIV-1 infection show early and marked cognitive and motor delays or declines that may be important early indicators of HIV disease progression. These abnormalities are independent of other risk factors for developmental delay.

Does infant carrying promote attachment? An experimental study of the effects of increased physical contact on the development of attachment.

This study was designed to test the hypothesis that increased physical contact, experimentally induced, would promote greater maternal responsiveness and more secure attachment between infant and mother. Low-SES mothers of newborn infants were randomly assigned to an experimental group (n = 23) that received soft baby carriers (more physical contact) or to a control group (n = 26) that received infants seats (less contact). Using a transitional probability analysis of a play session at 31/2 months, it was demonstrated that mothers in the experimental group were more contingently responsive than control mothers to their infants' vocalizations. When the infants were 13 months old, the Ainsworth Strange Situation was administered. Significantly more experimental than control infants were securely attached to their mothers. We infer from these results that for low-income, inner-city mothers, there may be a causal relation between increased physical contact, achieved through early carrying in a soft baby carrier, and subsequent security of attachment between infant and mother.

Early contact, social support, and mother-infant bonding.

A study was designed to explore further the hypothesis that a period of close contact between mother and infant immediately after birth facilitates the establishment of a close bond. The study investigated whether the effects of extra contact interact with other variables present in the labor and delivery situation and with the extent of social support available to the mother. Two sets of procedures for the immediate postpartum period were established and mothers were randomly assigned to one of these conditions. Twenty-nine mothers experienced extracontact procedures in which the baby was placed on the mother's abdomen for 1 hour. Thirty mothers received routine care procedures in which the baby was shown to the mother and then taken to the nursery. Observations of maternal behavior during a feeding were made two days after birth by an observer blind to the randomization status of the mother. The mothers who received extra contact exhibited significantly more affectionate behavior toward their infants than did the mothers who received routine care. The extracontact treatment produced more affectionate behaviors in the mothers who had less social support than in those who had more social support. The extra contact was equally effective for multiparous and primiparous mothers. Mothers of female infants exhibited more affectionate behavior to their infants regardless of which postpartum procedures the mothers had experienced.