The vocal dialogue in 9/11 pregnant widows and their infants: Specificities of co-regulation.

Mothers who were pregnant and widowed on September 11, 2001, and their 4-6-month infants (in utero on 9/11) were filmed during face-to-face interaction and their vocal dialogues were examined via microanalysis. Mothers were White, well-educated, mean age 34.3 years, and far from the World Trade Center site on 9/11; infants were 4-6 months, half female. We examined the bi-directional, moment-by-moment co-regulation of the timing of vocal dialogue, and particularly turn taking, in mother-infant and stranger-infant interactions, with time-series models. We analyzed the contingent coordination of durations of (1) vocalizations of the turn-holder, and (2) switching-pauses at the moment of the turn exchange. The switching pause is an aspect of the rhythm of the turn-holder who, after taking a turn, yields the floor to the partner through the switching pause. Turn taking is the lynchpin of dialogue, and the bi-directional contingent coordination of the switching-pause regulates the turn exchange. Both partners showed signs of risk and resilience. The 9/11 mothers did not coordinate the timing of turn taking with their infants, a highly unusual finding. In contrast, the 9/11 infants did coordinate the timing of turn taking with their mothers, and with the "stranger," forms of resilience. We propose that the 9/11 mother's difficulty coordinating with the infant's turn taking rhythm is a mode of transmission of her trauma to the infant. This work expands our knowledge of the specificities of co-regulation in the context of the 9/11 trauma.

Urgent engagement in 9/11 pregnant widows and their infants: Transmission of trauma.

The potential effects of maternal trauma on mother-infant interaction remain insufficiently studied empirically. This study examined the effects of the September 11, 2001, trauma on mother-infant interaction in mothers who were pregnant and widowed on 9/11, and their infants aged 4-6 months. Split-screen videotaped interaction was coded on a one-second basis for infant gaze, facial affect, and vocal affect; and mother gaze, facial affect, and touch. We examined the temporal dynamics of communication: self-contingency and interactive contingency of behavior by time-series methods. We documented heightened maternal and infant efforts at engagement in the 9/11 (vs. control) dyads. Both partners had difficulty tolerating moments of looking away as well as moments of negative behavior patterns. Heightened efforts to maintain a positive visual engagement may be adaptive and a potential source of resilience, but these patterns may also carry risk: working too hard to make it work. A vigilant, hyper-contingent, high-arousal engagement was the central mode of the interpersonal transmission of the trauma to these infants, with implications for intervention.

Long-acting reversible contraception: A route to reproductive justice or injustice.

This article presents information on unintended pregnancies and the ongoing efforts of policy makers to promote long-acting reversible contraception (LARC) to reduce the numbers of such pregnancies. Also discussed is the tension between the encouragement of LARC to promote the public's interests in achieving that goal versus the need to assure that all women can decide about their bodies and reproductive needs. Our discussion includes information, primarily from the United States, on (a) risks associated with unintended pregnancies, (b) LARC devices approved in the United States (copper intrauterine devices (IUDs), hormone IUDs, and implants), (c) public and social benefits of increasing the use of LARC, (d) disadvantages and barriers to using LARC, (e) dangers of promoting LARC in unjust ways, and (f) the meaning of reproductive justice and its connection to social justice. By sharing the information with the audience of this journal, we hope that it will be integrated into clinical work and research on mental health and development. We also hope that experts in those fields will become discussants in the conversation regarding women's reproductive health and social justice that is taking place in the United States and elsewhere.

Este artículo presenta información sobre embarazos no intencionales y el continuo esfuerzo de las autoridades para promover LARC (Contracepción Reversible de Larga Actuación) con el fin de reducir el número de tales embarazos. También se discute la tensión entre el aconsejar LARC para promover los intereses públicos de alcanzar esa meta vs. la necesidad de asegurar que todas las mujeres puedan ellas mismas decidir sobre sus cuerpos y necesidades reproductivas. Nuestra discusión incluye información, primariamente de los Estados Unidos (EUA), sobre: (1) riesgos asociados con embarazos no intencionales, (2) objetos de LARC aprobados en EUA (objetos intrauterinos de cobre -IUD-, IUD de hormonas, e implantes), (3) los beneficios públicos y sociales de aumentar el uso de LARC, (4) desventajas y barreras que presenta el uso de LARC, (5) peligros de promover LARC de maneras injustas, y (6) el significado de la justicia reproductiva y su conexión con la justicia social. Al compartir la información con el público de esta revista especializada, esperamos que la misma sea integrada dentro del trabajo clínico y la investigación sobre salud y desarrollo mental. También esperamos que los expertos en esos campos de estudio participarán activamente en la conversación acerca de la salud reproductiva de las mujeres y la justicia social que se lleva a cabo en EUA y otros lugares.

Cet article porte sur les grossesses involontaires et les efforts continus que font les responsables politiques pour promouvoir la contraception à long terme et réversible LARC (en anglais Long Acting Reversible Contraception) de façon à réduire le nombre de ces grossesses. Nous discutons aussi la tension entre l'encouragement de la LARC à promouvoir les intérêts publics pour arriver ce but et le besoin qui existe de s'assurer que toutes les femmes puissent décider d'elles-mêmes ce qu'elles veulent faire avec leur propre corps et leurs besoins sexuels. Notre discussion inclut des renseignements, principalement des Etats-Unis d'Amériques, sur: (1) les risques liés aux grossesses involontaires; (2) les dispositifs de contraception à long terme réversible approuvés aux Etats-Unis d'Amérique (dispositifs intra-utérins au cuivre (DIU), hormones DIU, et implants), (3) les avantages publics et sociaux qu'il y a à augmenter l'utilisation de la LARC, (4) les désavantages et les barrières à l'utilisation de la LARC, (5) les dangers de la promotion de la LARC de manières injustes, et (6) la signification de la justice reproductive et son lien à la justice sociale. En partageant ces informations avec les lecteurs de cette revue, nous espérons qu'elles seront intégrées dans le travail clinique et les recherches sur la santé mentale et le développement. Nous espérons aussi que les experts dans ces domaines pourront ainsi intervenir dans la conversation qui concerne la santé reproductive des femmes et la justice sociale qui se tient aux Etats-Unis et ailleurs.

PREDICTORS OF SELF-REPORTED GAINS IN A RELATIONSHIP-BASED HOME-VISITING PROJECT FOR MOTHERS AFTER CHILDBIRTH.

We assessed mothers' self-reported gains from a postpartum home-visiting (HV) project in which home visitors are volunteer mothers from the community. Hypotheses were that gains are positively related to (a) mothers' felt-closeness with their home visitor, (b) mothers' level of sociodemographic risk, and (c) the home visitors' preproject training in support services for families or children (Professionalism). One hundred sixty-four clients returned written evaluations of the HV project. Items assessing gains were reduced to two factors: Improved Well-Being ("Self") and Improved Infant Care ("Infant"). Repeated measures general linear models, with Gains (Self, Infant) as the repeated measure, and multiple regression analyses evaluated the hypotheses. Across the sample, gains on both factors were moderate, although gain scores were higher regarding Self than for Infant. Results show that (a) Mothers' felt-closeness with their volunteer was strongly related to mothers' gains; (b) high-risk mothers gained more from the project than did mothers of lower risk, particularly regarding Infant Care; and (c) mothers visited by volunteers who were professionals reported more substantial gains than did mothers visited by volunteers who were not professionals. Findings can help explain variance in mothers' gains from such projects and could be useful in improving their efficacy.

Gestational age within normal range and infants' health and temperament at 3-months of age.

OBJECTIVE: To examine the association between gestational age (GA) at birth across the normal GA spectrum (37-41 weeks) and the temperament and health of 3-month old infants. METHODS: The sample comprised 242 "low-risk" mothers and infants without chronic illnesses or severe pregnancy complications. Infant temperament was defined by three constructs: Negative Affectivity (NA), Extraversion, and Regulation, assessed by parents' reports on the Infant Behavior Questionnaire. Infants' health was defined as the number of nonroutine doctors' visits attended by the infants since their release from the hospital after birth. Analyses employed a continuous measure of GA to assess outcomes across GAs and a categorical measure (37, 38, 39-41 weeks GA) to examine contrasts. RESULTS: Extraversion was positively related to GA primarily due to the lower scores of infants born at 37 weeks compared to infants born at 39-41 weeks GA. NA showed a similar effect. The odds of infants born at 37 weeks attending a nonroutine medical visit were 2.8 times that of infants born full-term. DISCUSSION: Infants born at 37 weeks GA express less affect and use more nonroutine medical services than do infants born at 39-41 weeks GA. The findings underscore the importance of considering the risks of pregnancy prolongation with the developmental risk associated with early-term delivery.

Dopamine receptor polymorphism modulates the relation between antenatal maternal anxiety and fetal movement.

We determined whether the combination of fetal genotype (dopamine D4 receptor; DRD4) and mothers' anxiety during pregnancy is associated with fetal behavior. Two hundred and six pregnant women underwent an ultrasound exam. Fetal movement measures (Movement Frequency, Total Activity, Movement Duration, and Longest Quiet Time) were derived from off-line coding. A moderating role of the DRD4-III polymorphism was found: Results indicate that higher levels of antenatal maternal anxiety symptoms were associated with more frequent fetal movements among fetuses carrying a 7R allele, but not among fetuses carrying shorter alleles. Total Activity did not show full moderation by DRD4, though the measure was correlated with maternal anxiety among fetuses in the Anxious Group with a 7R allele; not among fetuses without both factors. The findings provide the first evidence of a GXE interaction in association with fetal behavior. Results also demonstrate that some individuals are inherently more susceptible to uterine environmental influences than are others.

Relation between maternal antenatal anxiety and infants' weight depends on infants' sex: A longitudinal study from late gestation to 1-month post birth.

OBJECTIVE: To test for gender-differences in the relation between mothers' antenatal anxiety and infants' body weight during gestation, at birth, and at 1-month of age. METHODS: Two hundred and twelve randomly-recruited women were divided into two groups: Controls (n=105) and Anxious Group (n=107) based on a standard cut-off of the Beck Anxiety Inventory. Outcome measures were Fetal Weight derived from biometrics obtained from an ultrasound scan in the 3rd trimester and infants' weight at birth and at 1-month of age, both obtained from medical records. RESULTS: Multivariate analyses showed main effects of Gender on infants' birth weight (P=.001) and on infants' weight at 1-month of age (P=.004), but no main effects of Anxiety Group at any time-point. Gender x Anxiety Group interactions at all three time points (Fetal weight: P=.05; Birth weight: P=.03; 1-month of age: P=.10) reflected gender differences (males>females) among infants in the anxious group, but not among controls. Distinct trends regarding same sex comparisons across groups (Control vs. Anxiety) were in line with predictions (male controlsfemales anxious). Controlling for Postpartum Anxiety and Antenatal and Postpartum Depression in the models did not affect primary results. CONCLUSION: Gender differences in fetal and birth weight were more substantial among infants of anxious mothers than among controls due to the seemingly accelerated growth of "anxious" males and the diminution of weight among "anxious" females.

Moderate antenatal anxiety symptoms and birth outcomes of boys and girls.

Women's antenatal anxiety, especially if paired with significant life stressors or comorbid physical or mental health disorders, can predict adverse birth outcomes, defined in terms of birth weight, gestational age at birth and obstetric complications. Here, we tested for an impact of moderate anxiety symptoms on these outcomes because many women experience these kinds of symptoms during pregnancy, and even subtle differences in birth outcomes can have significant effects on children's development. We also tested for moderation of anxiety effects by infant gender. The sample comprised 219 women with anxiety symptoms ranging from none to moderate levels on the Beck Anxiety Inventory. Multivariate models estimated main effects of Group (no/minimal versus moderate symptoms) and interactions between Group and infant Gender. Results indicate that moderate anxiety predicted more obstetric complications, particularly among mothers of daughters. Results also demonstrate a Group × Gender interaction on BW, indicating that sons of anxious mothers weighed more than sons of controls; whereas, daughters of anxious mothers weighed less than daughters of controls. These findings show that moderate anxiety symptoms may affect some birth outcomes, and differently for males and females.

Exposure to childhood traumas ups the odds of giving birth to daughters.

This study examined the likelihood of giving birth to a daughter as a function of women's exposure to four categories of stressors: childhood trauma, adult trauma, chronic stressors, and recent (adverse) life events. Hypothesis 1 stated that exposure to recent life events (near conception) and to childhood traumas would increase women's chances of having a girl baby. Hypothesis 2 stated that the relationship between stress and gender outcome is mediated by persistent posttraumatic stress disorder (PTSD) symptoms. The final sample was comprised of 225 women. The design was prospective observational. At first contact, women were retained if they were <27 weeks pregnant and met initial inclusion criteria. In interview 2, at 27-30 weeks, women were excluded for positive diagnoses of anxiety disorders besides PTSD with or without depression (Structured Clinical Interview for DSM-IV Disorders). In interview 3 (30-34 weeks), reports on stress categories (Social Stress Indicator Questionnaire) and PTSD symptoms (Post-Traumatic Checklist) were obtained. Infant gender was obtained from medical records. The relationship between stress categories and the distribution of girl/boy infants was examined with Chi Squares and logistic regression analyses. Mediation was tested with the macro PROCESS (Hayes 2012). Childhood trauma was the only stress category that increased the odds of having a girl, with an odds ratio of >3.0 for women who had been exposed to more than two such events. PTSD symptoms (partially) mediated the relationship between childhood trauma and infant gender. Findings suggest that women's exposure to childhood trauma contributes to the determination of the sex ratio at birth and that PTSD symptoms are part of the cause.

Epigenetic and genetic factors predict women's salivary cortisol following a threat to the social self.

Evidence suggests that the reactivity of the Hypothalamus-Pituitary-Adrenal axis (HPAA) is modulated by both genetic and environmental variables. Of special interest are the underlying molecular mechanisms driving gender differences to psychosocial stressors. Epigenetic mechanisms that sculpt the genome are ideal candidates for mediating the effects of signals on the HPAA. In the current study, we analyzed by pyrosequencing, bisulfite-treated buccal DNA from male and female university students who participated in the Trier Social Stress Test (TSST). A linear regression model was used to ascertain the effects of sex, CpG methylation and genes on stress response. Total cortisol output (area under the curve, AUC) was significantly predicted by glucocorticoid receptor (NR3C1) exon 1F methylation (averaged across 39 CpG sites) solely in female subjects. A single CpG site located in the exon 1F noncanonical nerve growth factor-inducible protein A (NGFI-A) transcription factor was a highly significant predictor of AUC in female subjects. Additionally, variations in the estrogen receptor alpha (ESR1) and the serotonin transporter promoter (5-HTTLPR) genes were independent additive predictors of AUC. The full model accounted for half of the variance (50.06%) in total cortisol output. Notably, this is the first demonstration that epigenetic changes at the GR exon 1F correlate with HPAA reactivity. These findings have important implications for understanding the molecular mechanisms underlying gender differences in stress-related disorders and underscore the unique value of modeling both epigenetic and genetic information in conferring vulnerability to stress.

Children's noncompliance during saliva collection predicts measures of salivary cortisol.

Salivary cortisol has been useful for evaluating children's physiological responses to stress and for identifying factors that predict their magnitude and duration. However, results have been somewhat equivocal across studies, and this has motivated researchers to identify sources of variance and error. Here, we examined the prevalence of preschoolers' noncompliance during saliva collection and aimed to learn about noncompliant children in terms of their hypothalamus-pituitary-adrenal function, behavior in other situations, and symptoms of behavioral problems. Results were based on measures of cortisol, children's behavior during saliva collection and a mother-child teaching interaction, and ratings of problem behavior by teachers and parents. Results show that 12% (21/174) of the sample was noncompliant on at least one of the collection trials. Children, who were noncompliant but did not outright refuse saliva collection, had higher cortisol than did compliant children. Children who were noncompliant during saliva collection were likely to be noncompliant during the teaching episode, and they were perceived as having more internalizing symptoms than compliant children. These results suggest that children's noncompliance during saliva collection can be a source of nonrandom missing data or extreme cortisol values, which should be considered in future studies.

Differential genetic susceptibility to child risk at birth in predicting observed maternal behavior.

This study examined parenting as a function of child medical risks at birth and parental genotype (dopamine D4 receptor; DRD4). Our hypothesis was that the relation between child risks and later maternal sensitivity would depend on the presence/absence of a genetic variant in the mothers, thus revealing a gene by environment interaction (GXE). Risk at birth was defined by combining risk indices of children's gestational age at birth, birth weight, and admission to the neonatal intensive care unit. The DRD4-III 7-repeat allele was chosen as a relevant genotype as it was recently shown to moderate the effect of environmental stress on parental sensitivity. Mothers of 104 twin pairs provided DNA samples and were observed with their children in a laboratory play session when the children were 3.5 years old. Results indicate that higher levels of risk at birth were associated with less sensitive parenting only among mothers carrying the 7-repeat allele, but not among mothers carrying shorter alleles. Moreover, mothers who are carriers of the 7-repeat allele and whose children scored low on the risk index were observed to have the highest levels of sensitivity. These findings provide evidence for the interactive effects of genes and environment (in this study, children born at higher risk) on parenting, and are consistent with a genetic differential susceptibility model of parenting by demonstrating that some parents are inherently more susceptible to environmental influences, both good and bad, than are others.

Vasopressin needs an audience: neuropeptide elicited stress responses are contingent upon perceived social evaluative threats.

The nonapeptide arginine vasopressin (AVP) plays an important role in hypothalamus-pituitary-adrenal axis regulation and also functions as a social hormone in a wide variety of species, from voles to humans. In the current report we use a variety of stress inducing tasks, including the Trier Social Stress Test (TSST) and intranasal administration of AVP to show that intranasal administration of this neuropeptide leads to a significant increase in salivary cortisol and pulse rate, specifically in conditions where subjects perform tasks in the presence of a social evaluative threat (task performance could be negatively judged by others). In contrast, in conditions without a social evaluative threat (no task condition, modified TSST without audience and bike ergometry), subjects receiving AVP did not differ from subjects receiving placebo. Thus exogenous AVP's influence is contingent upon a circumscribed set of initial conditions that constitute a direct threat to the maintenance of our social selves. Stress evoked by social threat is an integral part of social life and is related to self-esteem and in extreme forms, to poor mental health (e.g., social phobia). Our findings suggest that AVP is a key component in the circuit that interlaces stress and social threat and findings offer inroads to our understanding of individual differences in sociability and in stress response elicited in threatening social situations.

MATERNAL ANXIETY SYMPTOMS AND MOTHER-INFANT SELF- AND INTERACTIVE CONTINGENCY.

Associations of maternal self-report anxiety-related symptoms with mother-infant 4-month face-to-face play were investigated in 119 pairs. Attention, affect, spatial orientation, and touch were coded from split-screen videotape on a 1-s time base. Self- and interactive contingency were assessed by time-series methods. Because anxiety symptoms signal emotional dysregulation, we expected to find atypical patterns of mother-infant interactive contingencies, and of degree of stability/lability within an individual's own rhythms of behavior (self-contingencies). Consistent with our optimum midrange model, maternal anxiety-related symptoms biased the interaction toward interactive contingencies that were both heightened (vigilant) in some modalities and lowered (withdrawn) in others; both may be efforts to adapt to stress. Infant self-contingency was lowered ("destabilized") with maternal anxiety symptoms; however, maternal self-contingency was both lowered in some modalities and heightened (overly stable) in others. Interactive contingency patterns were characterized by intermodal discrepancies, confusing forms of communication. For example, mothers vigilantly monitored infants visually, but withdrew from contingently coordinating with infants emotionally, as if mothers were "looking through" them. This picture fits descriptions of mothers with anxiety symptoms as overaroused/fearful, leading to vigilance, but dealing with their fear through emotional distancing. Infants heightened facial affect coordination (vigilance), but dampened vocal affect coordination (withdrawal), with mother's face-a pattern of conflict. The maternal and infant patterns together generated a mutual ambivalence.

Maternal anxiety, mother-infant interactions, and infants' response to challenge.

Children of anxious mothers are at risk for social-emotional difficulties and disturbed, early interactions with their mother may account for some of the risk. This study evaluated the association between maternal anxiety, features of mother-infant interactions, and infants' emotion regulation during stressful situations (still-face, play with a stranger). Thirty-four anxiety-disordered mothers of 6-month-old infants and 59 typical dyads comprised the sample. Dyads were filmed during free play, teaching, care giving, and face-to-face play; and monadic (e.g., maternal sensitivity, infant affect) and dyadic measures (e.g., synchrony) were derived by global or time-event coding of the films. Results indicate that, compared to controls, more anxious mothers showed exaggerated behavior with their infant during free play and teaching, and infants of anxious mothers were less likely to show negative affect during the still-face and stranger challenges. We conclude that anxious maternal behavior reflects the hyperarousal that is characteristic of most anxiety disorders; and infants of anxious mothers and controls show differences in the manner in which they cope with social challenges.

Mothers' dopamine receptor polymorphism modulates the relation between infant fussiness and sensitive parenting.

We determined whether the combination of the 48-bp variable number tandem repeat polymorphism of the dopamine (DRD4) gene and infants' (fussy-difficult) temperament predicted parenting sensitivity. The sample was comprised of 147 mothers and their 6-month olds. Sensitive parenting was assessed by coding filmed interactions between mothers and infants. Infant temperament was assessed by parents' reports on a standard questionnaire. Moderated regressions models, with maternal education and infants' interactive behavior as controls, were used to test our hypotheses. Results showed no main effects of either temperament or DRD4, though the maternal DRD4 x infant temperament interaction was significant. Probes indicated that parents with a DRD4 7-repeat allele behaved more sensitively to fussier infants and less sensitively to less fussy infants compared to parents without the 7-repeat allele. Among those parents, sensitivity did not vary with infant temperament. This pattern of results indicates that mothers are differentially susceptible to infant fussiness, dependent on the presence of the 7-repeat DRD4 allele.

BDNF Val66Met polymorphism is associated with HPA axis reactivity to psychological stress characterized by genotype and gender interactions.

BACKGROUND: A key protein in maintaining neuronal integrity throughout the life span is brain-derived neurotrophic factor (BDNF). The BDNF gene is characterized by a functional polymorphism, which has been associated with stress-related disorders such as anxiety-related syndromes and depression, prompting us to examine individual responses by Genotype and Sex to a standardized social stress paradigm. Gender differences in BDNFxstress responses were posited because estrogen induces synthesis of BDNF in several brain regions. METHODS: 97 university students (51 females and 46 males) participated in a social stress procedure (Trier Social Stress Test, TSST). Indices of stress were derived from repeated measurement of cortisol, blood pressure, and heart rate during the TSST. All subjects were genotyped for the Val66Met polymorphism. RESULTS: Tests of within-subject effects showed a significant three-way interaction (SPSS GLM repeated measures: Time (eight levels)xBDNF (val/val, val/met)xSex: p=0.0002), which reflects gender differences in the pattern of cortisol rise and decline during the social challenge. In male subjects, val/val homozygotes showed a greater rise in salivary cortisol than val/met heterozygotes. In female subjects, there was a trend for the opposite response, which is significant when area under the curve increase (AUCi) was calculated for the val/val homozygotes to show the lowest rise. Overall, the same pattern of results was observed for blood pressure and heart rate. CONCLUSIONS: These results indicate that a common, functionally significant polymorphism in the BDNF gene modulates HPA axis reactivity and regulation during the TSST differently in men and women. Findings may be related to gender differences in reactivity and vulnerability to social stress.

The intergenerational effects of trauma from terror: A real possibility.

The goals of this article are to discuss the potential risk of children whose parents were traumatized by terror, to present literature on parenting in the context of terror, and to consider factors that may mediate the transmission of trauma-effects from parents to children. Mediators considered are parents' traumatic distress, disturbed parent-child interactions, trauma-related disturbances in parents' thinking, and effects of stress on children's neural functioning. Also discussed are genetic and environmental factors that may moderate the transmission of intergenerational effects and promote children's risk and resilience. Points raised during the discussion are illustrated with segments from interviews of women who were pregnant or gave birth some time after direct exposure to a terror attack. The authors conclude that empirical studies are needed to learn more about the intergenerational transmission of trauma-effects and processes that underlie it. The authors join others in the call to improve evaluation, treatment, and support of trauma victims and their children to stymie the transmission of problems from one generation to the next.

Anxiety symptoms of new mothers during a period of recurrent, local terror.

OBJECTIVE: From September 2000, Israelis have been exposed to frequent terror attacks. In this study, we evaluated the severity of anxiety symptoms among Jerusalem-based mothers during the period of terror (1/2002 to 2/2005). METHOD: Women (N=595) were recruited from maternity wards in public hospitals throughout the three year interval, and each participant was administered a standardized anxiety inventory (Beck Anxiety Inventory, BAI) by phone five months after giving birth. RESULTS: Results show that anxiety scores were within normal range throughout the assessment period, but were most severe early in 2002, when the casualty-toll was especially high. Psychological symptoms consistently were rated higher in severity than physiological symptoms and only physiological symptoms declined in the aftermath of attacks. Tests for risk factors revealed higher scores among young mothers (<21 years old), new immigrants (<10 years in the country), and women who delivered by c-section. CONCLUSION: Our sample did not experience high levels of anxiety despite the challenge of adapting to parenthood within a context of local terror.

Antenatal moods regarding self, baby, and spouse among women who conceived by in vitro fertilization.

OBJECTIVE: To evaluate the antenatal feelings of women who conceived by IVF, with a focus on their moods regarding self, baby, and spouse. DESIGN: Controlled, prospective study. SETTING: Outpatient clinics. PATIENT(S): Thirty women who conceived by IVF and 30 demographically matched women who conceived naturally. INTERVENTION(S): Validated interview and standardized questionnaires. MAIN OUTCOME MEASURE(S): Emotionality; positive affect; negative affect; moods regarding self, spouse, and baby; and global anxiety and depression. RESULT(S): Compared with controls, the IVF group scored lower on negative affect and higher on measures of (positive) mood regarding self, baby, and spouse. No differences between groups were found on measures of positive affect, depression, or anxiety. Women who had undergone two to three IVF cycles had lower negative affect scores than women who had conceived after the first treatment cycle, and mood regarding spouse depended on whether or not he had been the sole source of the couple's infertility. CONCLUSION(S): Women who conceived by IVF experienced more positive moods during pregnancy than did the controls, and lingering effects of the women's history of infertility were still in evidence.