Psychometric performance assessment of the Arabic version of the pregnancy experience scale-brief version (PES-brief) in an Arabic-speaking population.

OBJECTIVE: Although tools exist to assess psychological distress during pregnancy, a scarcity of instruments are designed to measure maternal perceptions of the more positive, uplifting features of pregnancy in addition to the more negative, hassling aspects. To address this shortcoming, DiPietro et al. developed the Pregnancy Experience Scale-Brief (PES-Brief). We aimed to assess the reliability and psychometric performance of an Arabic translation of the PES-Brief among Lebanese pregnant women. METHODS: The PES-Brief, the Patient Health Questionnaire, the Lebanese Anxiety Scale, and the Multidimensional Scale of Perceived Social Support were administered to 433 participants. PES-Brief scores were computed as frequency and intensity, with Hassles to Uplifts frequency and intensity ratios. RESULTS: The PES-Brief was internally consistent, with McDonald's ω = 0.87 for Uplifts and 0.81 for Hassles. Higher PES-Uplifts scores were significantly associated with lower depression and anxiety scores, and higher perceived social support; whereas higher PES-Hassles scores showed inverse correlations. The Hassles to Uplifts frequency and intensity ratios were 0.864 and 0.836, respectively, indicating that pregnant women were more uplifted than hassled. The CFA results confirmed the two-factor structure of the scale. CONCLUSION: Our findings suggest that the Arabic PES-Brief is a psychometrically valid and reliable scale that may be employed as a legitimate indicator of pregnancy-specific uplifts and hassles among Arabic-speaking populations. Our study prompts clinicians and researchers to benefit from this tool for capturing the integral psychological/emotional experience of women during pregnancy, which may facilitate pregnant women's support when needed.

Fetal heart rate responses to maternal sleep-disordered breathing.

BACKGROUND: Maternal sleep-disordered breathing is associated with adverse pregnancy outcomes and is considered to be deleterious to the developing fetus. Maternal obesity potentiates sleep-disordered breathing, which, in turn, may contribute to the effect of maternal obesity on adverse fetal outcomes. However, only a few empirical studies have evaluated the contemporaneous effects of maternal sleep-disordered breathing events on fetal well-being. These events include apnea and hypopnea with accompanying desaturations in oxyhemoglobin. OBJECTIVE: This study aimed to reconcile contradictory findings on the associations between maternal apnea or hypopnea events and clinical indicators of fetal compromise. It also sought to broaden the knowledge base by examining the fetal heart rate and heart rate variability before, during, and after episodes of maternal apnea or hypopnea. To accomplish this, we employed overnight polysomnography, the gold standard for ascertaining maternal sleep-disordered breathing, and synchronized it with continuous fetal electrocardiography. STUDY DESIGN: A total of 84 pregnant women with obesity (body mass index >30 kg/m2) participated in laboratory-based polysomnography with digitized fetal electrocardiography recordings during or near 36 weeks of gestation. Sleep was recorded, on average, for 7 hours. Decelerations in fetal heart rate were identified. Fetal heart rate and heart rate variability were quantified before, during, and after each apnea or hypopnea event. Event-level intensity (desaturation magnitude, duration, and nadir O2 saturation level) and person-level characteristics based on the full overnight recording (apnea-hypopnea index, mean O2 saturation, and O2 saturation variability) were analyzed as potential moderators using linear mixed effects models. RESULTS: A total of 2936 sleep-disordered breathing events were identified, distributed among all but 2 participants. On average, participants exhibited 8.7 episodes of apnea or hypopnea per hour (mean desaturation duration, 19.1 seconds; mean O2 saturation nadir, 86.6% per episode); nearly half (n=39) of the participants met the criteria for obstructive sleep apnea. Only 45 of 2936 apnea or hypopnea events were followed by decelerations (1.5%). Conversely, most (n=333, 88%) of the 378 observed decelerations, including the prolonged ones, did not follow an apnea or a hypopnea event. Maternal sleep-disordered breathing burden, body mass index, and fetal sex were unrelated to the number of decelerations. Fetal heart rate variability increased during events of maternal apnea or hypopnea but returned to initial levels soon thereafter. There was a dose-response association between the size of the increase in fetal heart rate variability and the maternal apnea-hypopnea index, event duration, and desaturation depth. Longer desaturations were associated with a decreased likelihood of the variability returning to baseline levels after the event. The mean fetal heart rate did not change during episodes of maternal apnea or hypopnea. CONCLUSION: Episodes of maternal sleep apnea and hypopnea did not evoke decelerations in the fetal heart rate despite the predisposing risk factors that accompany maternal obesity. The significance of the modest transitory increase in fetal heart rate variability in response to apnea and hypopnea episodes is not clear but may reflect compensatory, delimited autonomic responses to momentarily adverse conditions. This study found no evidence that episodes of maternal sleep-disordered breathing pose an immediate threat, as reflected in fetal heart rate responses, to the near-term fetus.

More than meets the eye: Examining physiological and behavioral regulation during delay of gratification task.

Children continually encounter situations where they must regulate impulsive responses to achieve a goal, requiring both self-control (SC) and delay of gratification. We examined concurrent behavioral SC strategies (fidgeting, vocalizations, anticipation) and physiological regulation (heart rate [HR], respiratory sinus arrhythmia [RSA]) in 126 children (M (SD) = 5.4 (0.29) years) during a standard delay of gratification task. Latent variable models derived latent SC classes and examined the moderating role of HR/RSA on SC and delay ability. Three classes of SC were identified: passive: low fidgeting and vocalizations, moderate anticipation; active: moderate fidgeting, low vocalizations, and high anticipation; and disruptive: moderate fidgeting, high vocalizations, and high anticipation. Children in the active class had the lowest odds of delaying full task time, compared to children in the passive (OR = 0.67, z = -5.25, p < .001) and disruptive classes (OR = 0.76, z = -2.03, p = .04). RSA changes during the task moderated the relationship between SC class and delay ability for children in the active class (aOR = 0.92, z = -3.1, p < .01). Within the group who struggled to delay gratification (active class), a subset exhibiting appropriate autonomic regulation was able to delay. The findings suggest probing congruency of observed behavioral and unobserved physiological regulation.

Measuring fetal heart rate and variability: Fetal cardiotocography versus electrocardiography.

Fetal heart rate variability is a key indicator of fetal neurodevelopment and well-being. Most studies have relied on Doppler-based fetal cardiotocography (fCTG) but recent technologies have made fetal electrocardiography (fECG) more widely available. We compared simultaneous recordings of fCTG and fECG in 131 fetuses twice during gestation (28 and 36 weeks) using a commercially available device (Monica AN24). Within-individual correlations for fetal heart rate values, based on averaged data during 50-min recordings, neared 1.0. Continuous and episodic measures of variability were also correlated, particularly at 36 weeks. Data collected during maternal polysomnography at 36 weeks were used to evaluate reliability of variability measures collected during the 50-min recording. Both fCTG- and fECG-derived measures of variability exhibited correspondence with variability during maternal presleep wakefulness and most sleep states. Results did not appreciably differ by data source or method used to calculate variability. fECG monitoring presented challenges, particularly at 28 weeks, when recordings with signal loss of ≤30% were available from only 27% of participants. Success rates improved to 84% at 36 weeks. fCTG was successful in over 90% of participants at each gestational age. Considerations in the selection of fECG versus fCTG in developmental research are discussed.

Fetal neuromaturation in late gestation is affected by maternal sleep disordered breathing and sleep disruption in pregnant women with obesity.

OBJECTIVE: Maternal sleep disordered breathing and sleep disruption have adverse effects on pregnancy outcomes through multiple potential pathophysiologic pathways. We hypothesize that disordered maternal sleep also adversely impacts the neuromaturation of the fetus. METHODS: Participants in this prospective observational study included 102 obese pregnant women (pre-pregnancy body mass index [BMI] of 30 or higher) at 36 weeks of pregnancy. Fetal neuromaturation, defined through measures of fetal heart rate variability, motor activity, and motor-cardiac coupling, was quantified through digitized fetal actocardiography during an afternoon recording. Maternal sleep measures were collected overnight through polysomnography. Data analysis focused on multiple regression, controlling for maternal BMI, blood pressure, and diabetes. RESULTS: Indicators of higher sleep disordered breathing were associated with delayed fetal neuromaturation and greater fetal motor activity. Less maternal sleep disruption (shorter rapid eye movement [REM] latency, more REM sleep, and/or fewer transitions) was associated with higher fetal heart rate variability and coupling-based neuromaturation. CONCLUSION: Characteristics of disordered maternal sleep affect the developing fetal nervous system. It is unknown whether these results extend to populations that are not characterized by obesity. The influence of maternal sleep on the developing fetal nervous system has been understudied and may yield effects that persist beyond pregnancy.

Fetal heart rate during maternal sleep.

Despite prolonged and cumulative exposure during gestation, little is known about the fetal response to maternal sleep. Eighty-four pregnant women with obesity (based on pre-pregnancy BMI) participated in laboratory-based polysomnography (PSG) with continuous fetal electrocardiogram monitoring at 36 weeks gestation. Multilevel modeling revealed both correspondence and lack of it in maternal and fetal heart rate patterns. Fetal heart rate (fHR) and variability (fHRV), and maternal heart rate (mHR) and variability (mHRV), all declined during the night, with steeper rates of decline prior to 01:00. fHR declined upon maternal sleep onset but was not otherwise associated with maternal sleep stage; fHRV differed during maternal REM and NREM. There was frequent maternal waking after sleep onset (WASO) and fHRV and mHRV were elevated during these episodes. Cross-correlation analyses revealed little temporal coupling between maternal and fetal heart rate, except during WASO, suggesting that any observed associations in maternal and fetal heart rates during sleep are the result of other physiological processes. Implications of the maternal sleep context for the developing fetus are discussed, including the potential consequences of the typical sleep fragmentation that accompanies pregnancy.

It Takes Two: An antenatal to postnatal RDoC framework for investigating the origins of maternal attachment and mother-infant social communication.

Transformation of the maternal-fetal relationship into the mother-infant relationship remains an enigmatic process. This progression is considered using an RDoC-informed approach centered on domains of Arousal/Regulation, Positive/Negative Valence, and Social Processes. 158 maternal-fetal dyads began participation during pregnancy, maternal-infant dyads were followed at 6-months postpartum. Women exhibited stability in feelings of attachment to the fetus and infant, and in positive/negative appraisal of pregnancy and motherhood. Elicited maternal physiological arousal to emotionally evocative videos generated fetal heart rate variability and motor activity responses. Parasympathetic (i.e., heart rate variability) suppression in the fetus was associated with more positive and regulated infant social communication in the Face-to-face Still Face protocol; suppression of maternal respiratory sinus arrhythmia was related to infant affect but in the opposite direction. Maternal ratings of infant temperament aligned with maternal antenatal affective valence. Attachment trajectories characterized by stability from antenatal to postnatal periods were most associated with maternal affective appraisal of pregnancy; shifts were influenced by infant characteristics and maternal sympathetic responsivity. Results illustrate how variation in arousal and regulatory systems of the pregnant woman and fetus operate within the context of maternal positive and negative valence systems to separately and jointly shape affiliation and temperament in early infancy.

Long-Term Associations Between Prenatal Maternal Cortisol and Child Neuroendocrine-Immune Regulation.

BACKGROUND: Advancing understanding of the developmental origins of neuroendocrine-immune (NEI) functioning is key to elucidating the biological mechanisms involved in health and disease risk across the lifespan. This study examined whether prenatal maternal hypothalamic-pituitary-adrenal (HPA) activity moderates child NEI relations and explored the consistency of this moderating effect across gestation. METHODS: Pregnant women participated in five prenatal study visits from 24 to 38 weeks gestation. At each visit, women provided a saliva sample. In a 5-year follow-up study, children (nfemale = 25, nmale=20) provided four saliva samples and participated in behavioral assessments and challenge tasks. Prenatal maternal saliva samples were assayed for cortisol. Child saliva samples were assayed for cortisol and cytokines (IL-1ß, IL-6, IL-8, TNFα) as indices of HPA and inflammatory activity. Multilevel mixed-effects models examined the moderation of child NEI relations by prenatal maternal cortisol. RESULTS: Among males, average prenatal maternal cortisol did not moderate child NEI relations. Among females, average prenatal maternal cortisol moderated some child NEI relations with higher prenatal cortisol associated with more positive cortisol-cytokine relations at age five. When examined by gestational time point, there were more significant NEI moderation effects by maternal cortisol from later gestation (≥ 30 weeks) than earlier. CONCLUSIONS: The findings suggest prenatal maternal HPA activity may moderate child NEI functioning. Additional research conducted with more heterogeneous and larger samples is needed to fully understand these relations. Furthering our knowledge of NEI development has important research and clinical implications, particularly for understanding and addressing conditions with inflammatory pathophysiologies, such as depression and cardiovascular disease.

The bloom is (slightly) off the rose: the motherhood effect on psychological functioning in successive pregnancies.

Objective: To examine the maternal psychological state during the course of two successive pregnancies.Methods: The sample consisted of 73 women drawn from a larger maternal-fetal cohort that participated during two pregnancies. Women completed self-report psychological questionnaires at 24, 30, and 36 weeks gestation to index maternal depressive symptoms, trait anxiety, and pregnancy hassles and uplifts. Analyses examined stability of maternal symptoms across successive pregnancies in the same women.Results: Antenatal symptoms of depression and anxiety exhibited strong intra-individual stability between successive pregnancies. Mean differences in maternal symptoms were not detected for either at 24, 30, or 36 weeks gestation, excepting elevated anxiety symptoms at the mid-point due to greater fluctuation in maternal anxiety during the prior pregnancy. Subsequent pregnancies were associated with less intense uplifting feelings about the pregnancy on each measurement occasion.Conclusions: Findings suggest marked consistency in maternal psychological orientation across subsequent pregnancies, though parity also plays a role in the maternal experience.

Maternal buprenorphine treatment during pregnancy and maternal physiology.

BACKGROUND: Buprenorphine, used for opioid use disorder (OUD) treatment during pregnancy, provides unknown effects on maternal physiological activity. The primary aim of this report is to document acute effects of buprenorphine administration on indicators of maternal autonomic functioning. Effects of maternal buprenorphine dose and other substance exposures on maternal measures were examined, as were neonatal abstinence syndrome (NAS) outcomes. METHODS: Forty-nine pregnant, buprenorphine-maintained women yielded maternal physiologic information (heart rate and variability, electrodermal activity, and respiratory rate) at 24, 28, 32 and 36 weeks gestation. Monitoring at trough and peak maternal medication levels was implemented to ascertain acute physiologic effects of buprenorphine administration. RESULTS: Buprenorphine administration accelerated maternal heart rate and reduced variability at two gestational ages (24 and 36 weeks) and suppressed sympathetic (electrodermal) activation at 24, 28 and 32 weeks at times of peak maternal medication levels. Maternal autonomic parameters were unrelated to polysubstance exposure with the exception of cigarette smoking. Heavier smoking dampened maternal heart rate variability across gestation and potentiated reactivity to buprenorphine at 24 and 36 weeks. Heavier smoking was also associated with reduced electrodermal activity at 36 weeks. Buprenorphine dose was unrelated to observed effects. Larger degree of maternal heart rate reactivity to buprenorphine administration was related to more severe NAS expression. CONCLUSIONS: These findings detail the maternal autonomic response to buprenorphine administration but also illustrate the significant effect of concurrent cigarette use on maternal autonomic regulation. This suggests the importance of smoking-reduction strategies in the comprehensive, medication-assisted treatment of women with OUD.

In sync: Physiological correlates of behavioral synchrony in infants and mothers.

Infant-mother behavioral synchrony is thought to scaffold the development of self-regulation in the first years of life. During this time, infants' and mothers' physiological regulation may contribute to dyadic synchrony and, in infants, dyadic synchrony may support infants' physiological regulation. Because the sympathetic nervous system (SNS) and parasympathetic nervous system (PNS) serve different regulatory functions, the current study aimed to elucidate relations between infants' and mothers' SNS and PNS functioning and dyadic behavioral synchrony. Skin conductance (SC; SNS index), respiratory sinus arrhythmia (RSA; PNS index), heart period (HP; index of joint SNS and PNS arousal), and behavioral synchrony were assessed in 6-month-old infants (N = 140) and their mothers during a mild social stressor, the Face-to-Face Still-Face paradigm (Tronick, Als, Adamson, Wise, & Brazelton, 1978). Synchrony was related to infants' and mothers' PNS and to mothers' broad autonomic arousal but not to SNS-specific arousal. Higher levels of behavioral synchrony were associated with lower infant RSA but with higher mother HP and RSA at baseline and in each Face-to-Face Still-Face paradigm episode. Therefore, lower RSA infants may have required more synchronous engagement with mothers to support regulation, while higher RSA, less aroused mothers may have been particularly well-attuned to infants' emotions. Findings suggest that each individual's physiological state may contribute to the behavioral functioning of the dyad. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Predicting child temperament and behavior from the fetus.

There remains little debate that the period before birth sets the stage for subsequent development, yet scant evidence exists showing continuity from characteristics of the individual fetus to characteristics of the child. This report examines, in two studies, whether baseline and evoked fetal neurobehavioral functioning are predictive of features of child temperament and behavior as reported by mothers when offspring were between 7 and 14 years old (M = 10.1 years). Study 1 utilizes data generated from 333 maternal-fetal pairs collected during an undisturbed condition during the second half of gestation in relation to the child temperament dimensions of behavioral inhibition and exuberance. Associations at 32 weeks gestation were detected between all features of fetal neurobehavior and behavioral inhibition. In adjusted models, slower fetal heart rate and less fetal movement were associated with significant unique variance in predicting higher levels of childhood behavioral inhibition. No associations were detected for exuberance. Study 2 focuses on the association of evoked fetal reactivity and recovery to induced maternal arousal with subsequent child behavioral difficulties in a subset of the full sample (n = 130). Greater recovery in fetal heart rate following maternal stimulation was predictive of fewer behavioral difficulties and more prosocial behavior in childhood. Results from both studies provide support for gestational origins of core individual differences that portend childhood outcomes with foundational reactivity and regulatory components.

Maternal buprenorphine treatment and infant outcome.

BACKGROUND AND OBJECTIVES: Maternal buprenorphine maintenance predisposes the infant to exhibit neonatal abstinence syndrome (NAS), but there is insufficient published information regarding the nature of NAS and factors that contribute to its severity in buprenorphine-exposed infants. METHODS: The present study evaluated forty-one infants of buprenorphine-maintained women in comprehensive substance use disorder treatment who participated in an open-label study examining the effects of maternal buprenorphine maintenance on infant outcomes. Modifiers of the infant outcomes, including maternal treatment and substance use disorder parameters, were also evaluated. RESULTS: Fifty-nine percent of offspring exhibited NAS that required pharmacologic management. Both maternal buprenorphine dose as well as prenatal polysubstance exposure to illicit substance use/licit substance misuse were independently associated with NAS expression. Polysubstance exposure was associated with more severe NAS expression after controlling for the effects of buprenorphine dose. Other exposures, including cigarette smoking and SRI use, were not related to outcomes. Maternal buprenorphine dose was positively associated with lower birth weight and length. CONCLUSIONS: Polysubstance exposure was the most potent predictor of NAS severity in this sample of buprenorphine-exposed neonates. This finding suggests the need for interventions that reduce maternal polysubstance use during medication assisted treatment for opioid use disorder, and highlights the necessity of a comprehensive approach, beyond buprenorphine treatment alone, for the optimal care for pregnant women with opioid use disorders.

Maternal salivary testosterone in pregnancy and fetal neuromaturation.

Testosterone exposure during pregnancy has been hypothesized as a mechanism for sex differences in brain and behavioral development observed in the postnatal period. The current study documents the natural history of maternal salivary testosterone from 18 weeks gestation of pregnancy to 6 months postpartum, and investigates associations with fetal heart rate, motor activity, and their integration. Findings indicate maternal salivary testosterone increases with advancing gestation though no differences by fetal sex were detected. High intra-individual stability in prenatal testosterone levels extend into the postnatal period, particularly for pregnancies with male fetuses. With respect to fetal development, by 36 weeks gestation higher maternal prenatal salivary testosterone was significantly associated with faster fetal heart rate and less optimal somatic-cardiac integration. Measurement of testosterone in saliva is a useful tool for repeated-measures studies of hormonal concomitants of pregnancy. Moreover, higher maternal testosterone levels are associated with modest interference to fetal neurobehavioral development.

Maternal buprenorphine treatment and fetal neurobehavioral development.

BACKGROUND: Gestational opioid use/misuse is escalating in the United States; however, little is understood about the fetal effects of medications used to treat maternal opioid use disorders. OBJECTIVE: The purpose of this study was to determine the effect of maternal buprenorphine administration on longitudinal fetal neurobehavioral development. STUDY DESIGN: Forty-nine buprenorphine-maintained women who attended a substance use disorder treatment facility with generally uncomplicated pregnancies underwent fetal monitoring for 60 minutes at times of trough and peak maternal buprenorphine levels. Data were collected at 24, 28, 32, and 36 weeks gestation. Fetal neurobehavioral indicators (ie, heart rate, motor activity, and their integration [fetal movement-fetal heart rate coupling]) were collected via an actocardiograph, digitized and quantified. Longitudinal data analysis relied on hierarchic linear modeling. RESULTS: Fetal heart rate, heart rate variability, and heart rate accelerations were significantly reduced at peak vs trough maternal buprenorphine levels. Effects were significant either by or after 28 weeks gestation and tended to intensify with advancing gestation. Fetal motor activity and fetal movement-fetal heart rate coupling were depressed from peak to trough at 36 weeks gestation. Polysubstance exposure did not significantly affect fetal neurobehavioral parameters, with the exception that fetuses of heavier smokers moved significantly less than those of lighter smokers at 36 weeks gestation. By the end of gestation, higher maternal buprenorphine dose was related to depression of baseline fetal cardiac measures at trough. CONCLUSION: Maternal buprenorphine administration has acute suppressive effects on fetal heart rate and movement, and the magnitude of these effects increases as gestation progresses. Higher dose (≥13 mg) appears to exert greater depressive effects on measures of fetal heart rate and variability. These findings should be balanced against comparisons to gestational methadone effects, relatively good outcomes of buprenorphine-exposed infants, and recognition of the benefits of medication-assisted treatment for pregnant women with opioid use disorders in optimizing pregnancy outcomes.

Maternal distress and child neuroendocrine and immune regulation.

RATIONALE: Neuroendocrine-immune regulation is essential for maintaining health. Early-life adversity may cause dysregulation in the neuroendocrine-immune network through repeated activation of the stress response, thereby increasing disease risk. OBJECTIVE: This paper examined the extent to which maternal psychological well-being moderates neuroendocrine-immune relations in children. METHODS: We used data from a laboratory-based study of mothers and their five-year old children (n = 125 mother-child pairs) conducted from 2011 to 2013 in Baltimore, Maryland. Child saliva was assayed for markers of immune function (i.e., cytokines: interleukin [IL]-1ß, IL-6, IL-8, tumor necrosis factor alpha [TNF-α]) and hypothalamic-pituitary-adrenal activity (i.e., cortisol). A composite score for depressive symptoms, anxiety, and parenting stress characterized maternal psychological distress. Multilevel mixed models examined the relationship between maternal psychological well-being and child neuroendocrine-immune relations. RESULTS: Significant cytokine × maternal distress interactions indicated that as maternal distress increased, expected inverse cytokine-cortisol relations within children became weaker for IL-1ß, IL-6, and TNF-α. Sex-stratified models revealed that these interactions were only significant among girls. Among boys, there were inverse cytokine-cortisol relations for all cytokines, and, while in the same direction as observed among girls, the cytokine × maternal distress interactions were non-significant. CONCLUSION: The findings suggest that maternal distress is associated with child neuroendocrine-immune relations in saliva and may alter the sensitivity of inflammatory immune processes to cortisol's inhibitory effects. This desensitization may place the child at risk for inflammatory diseases. The findings support efforts for the early detection and treatment of at-risk mothers to protect maternal and child health and well-being.

Fetal heart rate and motor development in overweight and obese pregnant women.

OBJECTIVE: To determine the relationship between maternal prepregnancy body mass index (BMI) and fetal cardiac and motor activity and integration during the second half of pregnancy. METHODS: Longitudinal data were collected from 610 nonsmoking women with normally progressing pregnancies at three gestational periods (24, 30-32, and 36 weeks) across eight cohorts studied between 1997 and 2013. Fifty minutes of fetal heart rate and motor activity data were collected at each period via actocardiography in a laboratory setting. Data were digitized and analyzed using customized software. Standard BMI categories were computed from maternal prepregnancy weight and height. Participants were stratified into normal weight (n=401, 65.7%), overweight (n=137, 22.5%), or obese (n=72, 11.8%). RESULTS: Fetuses of obese women showed lower heart rate variability and fewer accelerations relative to fetuses of normal weight women. Fetuses of both obese and overweight women exhibited more vigorous motor activity than fetuses of normal weight women. Cardiac-somatic integration was reduced in both obese and overweight groups. Findings differed by gestational age at assessment. CONCLUSIONS: Excess maternal prepregnancy weight in overweight and obese women alters the normal trajectory of fetal cardiac and motor development and their integration, with effects amplified as pregnancy progresses.

Don't worry, be (moderately) happy: Mothers' anxiety and positivity during pregnancy independently predict lower mother-infant synchrony.

Maternal positivity and mother-infant synchrony have been linked, independently, to beneficial infant outcomes; however, research that has examined relations between the two has found that higher positivity is associated with lower synchrony. Methodological issues may inform this counter-intuitive association and clinical theory supports its validity. This study examined the theory that heightened positivity associated with anxiety is a way of avoiding negative emotion and contributes to lower synchrony because it interferes with appropriate responding to infant cues. We examined mothers' (N=75) self-reported anxiety and verbal expression of positivity during pregnancy in relation to mother-infant synchrony at 6 months post-partum. Verbal positivity was assessed using linguistic analysis of interviews about pregnancy experiences. Mother and infant affect and gaze were coded during interaction and synchrony was computed as the correlation between mother and infant behaviors. Higher verbal positivity and anxiety during pregnancy independently predicted lower mother-infant synchrony, suggesting distinct pathways to the same degree of synchrony with potentially different consequences for infant development.

STUDIES IN FETAL BEHAVIOR: REVISITED, RENEWED, AND REIMAGINED.

Among the earliest volumes of this monograph series was a report by Lester Sontag and colleagues, of the esteemed Fels Institute, on the heart rate of the human fetus as an expression of the developing nervous system. Here, some 75 years later, we commemorate this work and provide historical and contemporary context on knowledge regarding fetal development, as well as results from our own research. These are based on synchronized monitoring of maternal and fetal parameters assessed between 24 and 36 weeks gestation on 740 maternal-fetal pairs compiled from eight separate longitudinal studies, which commenced in the early 1990s. Data include maternal heart rate, respiratory sinus arrhythmia, and electrodrmal activity and fetal heartrate, motor activity, and their integration. Hierarchical linear modeling of developmental trajectories reveals that the fetus develops in predictable ways consistent with advancing parasympathetic regulation. Findings also include:within-fetus stability (i.e., preservation of rank ordering over time) for heart rate, motor, and coupling measures; a transitional period of decelerating development near 30 weeks gestation; sex differences in fetal heart rate measures but not in most fetal motor activity measures; modest correspondence in fetal neurodevelopment among siblings as compared to unrelated fetuses; and deviations from normative fetal development in fetuses affected by intrauterine growth restriction and other conditions. Maternal parameters also change during this period of gestation and there is evidence that fetal sex and individual variation in fetal neurobehavior influence maternal physio-logical processes and the local intrauterine context. Results are discussed within the framework of neuromaturation, the emergence of individual differences, and the bidirectional nature of the maternal-fetal relationship.We pose a number of open questions for future research. Although the human fetus remains just out of reach, new technologies portend an era of accelerated discovery of the earliest period of development

The ups and downs of early mothering.

INTRODUCTION: The maternal experience of having a young infant is often viewed through a negative lens focused on psychological distress due, in part, to a historical focus on identifying threats to prenatal, perinatal and postpartum well-being of women and infants. This report examines maternal appraisal of both positive and negative experiences during and after pregnancy and introduces a new scale that assesses both uplifts and hassles that are specific to early motherhood. METHODS: The sample included 136 women who began study participation during pregnancy and completed an existing scale designed to evaluate pregnancy-specific hassles and uplifts. When infants were 6 months old, participants completed the newly developed Maternal Experience Scale (MES) along with questionnaires related to anxiety, depression, attachment, parenting stress and infant temperament characteristics. RESULTS: In general, women with 6-month-old infants rated their maternal experiences far more positively than negatively. MES hassles and uplift scores reflected both convergent and discriminant validity with general measures of psychological well-being and parent-specific measures. Appraisal of the pregnancy experience significantly predicted appraisal of early motherhood for hassles, uplifts and a composite score reflecting emotional valence. Women became relatively more uplifted and less hassled from pregnancy to 6-month postpartum; this was particularly true for multiparous women. DISCUSSION: The maternal perception of motherhood corresponds to her perception of pregnancy. The MES provides a balanced view of motherhood by including maternal appraisal of the uplifting aspects of caring for an infant.