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Maternal perceived stress and infant behavior during the COVID-19 pandemic

Bradley, Holly; Fine, Dana; Minai, Yasmin; Gilabert, Laurel; Gregory, Kimberly; Smith, Lynne; Gao, Wei; Giase, Gina; Krogh-Jespersen, Sheila; Zhang, Yudong; Wakschlag, Lauren; Brito, Natalie H; Feliciano, Integra; Thomason, Moriah; Cabral, Laura; Panigrahy, Ashok; Potter, Alexandra; Cioffredi, Leigh-Anne; Smith, Beth A
BACKGROUND:Maternal stress has negative consequences on infant behavioral development, and COVID-19 presented uniquely stressful situations to mothers of infants born during the pandemic. We hypothesized that mothers with higher levels of perceived stress during the pandemic would report higher levels of infant regulatory problems including crying and interrupted sleep patterns. METHODS:As part 6 sites of a longitudinal study, mothers of infants born during the pandemic completed the Perceived Stress Scale, the Brief Infant Sleep Questionnaire, and an Infant Crying survey at 6 (n = 433) and 12 (n = 344) months of infant age. RESULTS:Maternal perceived stress, which remained consistent at 6 and 12 months of infant age, was significantly positively correlated with time taken to settle infants. Although maternal perceived stress was not correlated with uninterrupted sleep length, time taken to put the infant to sleep was correlated. Perceived stress was also correlated with the amount of infant crying and fussiness reported at 6 months. CONCLUSIONS:Mothers who reported higher levels of perceived stress during the pandemic reported higher levels of regulatory problems, specifically at 6 months. Examining how varying levels of maternal stress and infant behaviors relate to overall infant developmental status over time is an important next step. IMPACT/CONCLUSIONS:Women giving birth during the COVID-19 pandemic who reported higher levels of stress on the Perceived Stress Scale also reported higher levels of infant fussiness and crying at 6 months old, and more disruptive sleep patterns in their infants at 6 months and 12 months old. Sleeping problems and excessive crying in infancy are two regulatory problems that are known risk factors for emotional and behavioral issues in later childhood. This paper is one of the first studies highlighting the associations between maternal stress and infant behaviors during the COVID-19 pandemic.
PMID: 37500757
ISSN: 1530-0447
CID: 5613752

A comparison of the infant gut microbiome before versus after the start of the covid-19 pandemic

Querdasi, Francesca R; Vogel, Sarah C; Thomason, Moriah E; Callaghan, Bridget L; Brito, Natalie H
The COVID-19 pandemic and resulting public health directives led to many changes in families' social and material environments. Prior research suggests that these changes are likely to impact composition of the gut microbiome, particularly during early childhood when the gut microbiome is developing most rapidly. Importantly, disruption to the gut microbiome during this sensitive period can have potentially long-lasting impacts on health and development. In the current study, we compare gut microbiome composition among a socioeconomically and racially diverse group of 12-month old infants living in New York City who provided stool samples before the pandemic (N = 34) to a group who provided samples during the first 9-months of the pandemic (March-December 2020; N = 20). We found that infants sampled during the pandemic had lower alpha diversity of the microbiome, lower abundance of Pasteurellaceae and Haemophilus, and significantly different beta diversity based on unweighted Unifrac distance than infants sampled before the pandemic. Exploratory analyses suggest that gut microbiome changes due to the pandemic occurred relatively quickly after the start of the pandemic and were sustained. Our results provide evidence that pandemic-related environmental disruptions had an impact on community-level taxonomic diversity of the developing gut microbiome, as well as abundance of specific members of the gut bacterial community.
PMID: 37587195
ISSN: 2045-2322
CID: 5595802

Signal in the noise: Dimensions of predictability in the home auditory environment are associated with neurobehavioral measures of early infant sustained attention

Werchan, Denise M; Brandes-Aitken, Annie; Brito, Natalie H
The home auditory environment influences the development of early language abilities, and excessive noise exposure is increasingly linked with deficits in language and reading scores in children. However, fewer studies have considered the role of noise exposure in shaping the development of attentional processing in early infancy, a foundational neurocognitive skill relevant for learning. Here, we used passive at-home auditory recording to investigate how multiple dimensions of infants' home auditory environments, including both the quantity and the predictability of auditory input, impacts neural and behavioral measures of sustained attention in a sociodemographically diverse sample of 3-month-old infants (N = 98 infants, 62 males; age M = 3.48 months, SD = 0.39; 52% Hispanic/Latino). Results indicated that infants who were exposed to more predictable patterns of auditory input in the home demonstrated longer overall time in sustained attention during laboratory assessments. In addition, infants' who experienced more predictable auditory input also demonstrated greater relative increases in electroencephalography frontal theta power during periods of sustained attention, a neural marker relevant to information processing and attentional control. These findings provide novel evidence into the importance of the predictability of early environmental inputs in shaping developing cortical circuitry and attentional systems from the first months of postnatal life.
PMID: 36282744
ISSN: 1098-2302
CID: 5359112

Geotemporal analysis of perinatal care changes and maternal mental health: an example from the COVID-19 pandemic

Hendrix, Cassandra L; Werchan, Denise; Lenniger, Carly; Ablow, Jennifer C; Amstadter, Ananda B; Austin, Autumn; Babineau, Vanessa; Bogat, G Anne; Cioffredi, Leigh-Anne; Conradt, Elisabeth; Crowell, Sheila E; Dumitriu, Dani; Elliott, Amy J; Fifer, William; Firestein, Morgan; Gao, Wei; Gotlib, Ian; Graham, Alice; Gregory, Kimberly D; Gustafsson, Hanna; Havens, Kathryn L; Hockett, Christine; Howell, Brittany R; Humphreys, Kathryn L; Jallo, Nancy; King, Lucy S; Kinser, Patricia A; Levendosky, Alytia A; Lonstein, Joseph S; Lucchini, Maristella; Marcus, Rachel; Monk, Catherine; Moyer, Sara; Muzik, Maria; Nuttall, Amy K; Potter, Alexandra S; Rogers, Cynthia; Salisbury, Amy; Shuffrey, Lauren C; Smith, Beth A; Smyser, Christopher D; Smith, Lynne; Sullivan, Elinor; Zhou, Judy; Brito, Natalie H; Thomason, Moriah E
Our primary objective was to document COVID-19 induced changes to perinatal care across the USA and examine the implication of these changes for maternal mental health. We performed an observational cross-sectional study with convenience sampling using direct patient reports from 1918 postpartum and 3868 pregnant individuals collected between April 2020 and December 2020 from 10 states across the USA. We leverage a subgroup of these participants who gave birth prior to March 2020 to estimate the pre-pandemic prevalence of specific birthing practices as a comparison. Our primary analyses describe the prevalence and timing of perinatal care changes, compare perinatal care changes depending on when and where individuals gave birth, and assess the linkage between perinatal care alterations and maternal anxiety and depressive symptoms. Seventy-eight percent of pregnant participants and 63% of postpartum participants reported at least one change to their perinatal care between March and August 2020. However, the prevalence and nature of specific perinatal care changes occurred unevenly over time and across geographic locations. The separation of infants and mothers immediately after birth and the cancelation of prenatal visits were associated with worsened depression and anxiety symptoms in mothers after controlling for sociodemographic factors, mental health history, number of pregnancy complications, and general stress about the COVID-19 pandemic. Our analyses reveal widespread changes to perinatal care across the US that fluctuated depending on where and when individuals gave birth. Disruptions to perinatal care may also exacerbate mental health concerns, so focused treatments that can mitigate the negative psychiatric sequelae of interrupted care are warranted.
PMID: 35962855
ISSN: 1435-1102
CID: 5287432

OWLET: An automated, open-source method for infant gaze tracking using smartphone and webcam recordings

Werchan, Denise M; Thomason, Moriah E; Brito, Natalie H
Groundbreaking insights into the origins of the human mind have been garnered through the study of eye movements in preverbal subjects who are unable to explain their thought processes. Developmental research has largely relied on in-lab testing with trained experimenters. This constraint provides a narrow window into infant cognition and impedes large-scale data collection in families from diverse socioeconomic, geographic, and cultural backgrounds. Here we introduce a new open-source methodology for automatically analyzing infant eye-tracking data collected on personal devices in the home. Using algorithms from computer vision, machine learning, and ecological psychology, we develop an online webcam-linked eye tracker (OWLET) that provides robust estimation of infants' point of gaze from smartphone and webcam recordings of infant assessments in the home. We validate OWLET in a large sample of 7-month-old infants (N = 127) tested remotely, using an established visual attention task. We show that this new method reliably estimates infants' point-of-gaze across a variety of contexts, including testing on both computers and mobile devices, and exhibits excellent external validity with parental-report measures of attention. Our platform fills a significant gap in current tools available for rapid online data collection and large-scale assessments of cognitive processes in infants. Remote assessment addresses the need for greater diversity and accessibility in human studies and may support the ecological validity of behavioral experiments. This constitutes a critical and timely advance in a core domain of developmental research and in psychological science more broadly.
PMID: 36070130
ISSN: 1554-3528
CID: 5337022

Perceived discrimination as a modifier of health, disease, and medicine: empirical data from the COVID-19 pandemic

Thomason, Moriah E; Hendrix, Cassandra L; Werchan, Denise; Brito, Natalie H
Increasing reports of long-term symptoms following COVID-19 infection, even among mild cases, necessitate systematic investigation into the prevalence and type of lasting illness. Notably, there is limited data regarding the influence of social determinants of health, like perceived discrimination and economic stress, that may exacerbate COVID-19 health risks. Here, 1,584 recovered COVID-19 patients that experienced mild to severe forms of disease provided detailed medical and psychosocial information. Path analyses examined hypothesized associations between discrimination, illness severity, and lasting symptoms. Secondary analyses evaluated sex differences, timing of infection, and impact of prior mental health problems. Post hoc logistic regressions tested social determinants hypothesized to predict neurological, cognitive, or mood symptoms. 70.6% of patients reported presence of one or more lasting symptom after recovery. 19.4% and 25.1% of patients reported lasting mood or cognitive/memory problems. Perceived discrimination predicted increased illness severity and increased lasting symptom count, even when adjusting for sociodemographic factors and mental/physical health comorbidities. This effect was specific to stress related to discrimination, not to general stress levels. Further, patient perceptions regarding quality of medical care influenced these relationships. Finally, illness early in the pandemic is associated with more severe illness and more frequent lasting complaints. Lasting symptoms after recovery from COVID-19 are highly prevalent and neural systems are significantly impacted. Importantly, psychosocial factors (perceived discrimination and perceived SES) can exacerbate individual health risk. This study provides actionable directions for improved health outcomes by establishing that sociodemographic risk and medical care influence near and long-ranging health outcomes. All data from this study have been made publicly available.
PMID: 35840584
ISSN: 2158-3188
CID: 5269582

Paid maternal leave is associated with infant brain function at 3 months of age

Brito, Natalie H; Werchan, Denise; Brandes-Aitken, Annie; Yoshikawa, Hirokazu; Greaves, Ashley; Zhang, Maggie
The first months of life are critical for establishing neural connections relevant for social and cognitive development. Yet, the United States lacks a national policy of paid family leave during this important period of brain development. This study examined associations between paid leave and infant electroencephalography (EEG) at 3 months in a sociodemographically diverse sample of families from New York City (N = 80; 53 males; 48% Latine; data collection occurred 05/2018-12/2019). Variable-centered regression results indicate that paid leave status was related to differences in EEG power (ps < .02, R2 s > .12). Convergent results from person-centered latent profile analyses demonstrate that mothers with paid leave were 7.39 times as likely to have infants with EEG profiles characterized by increased higher-Hz power (95% CI, 1.9-36.9), potentially reflecting more mature patterns of brain activity.
PMID: 35373346
ISSN: 1467-8624
CID: 5191522

Maternal anxiety symptoms associated with increased behavioral synchrony in the early postnatal period

Lemus, Alejandra; Vogel, Sarah C; Greaves, Ashley N; Brito, Natalie H
The presence of perinatal mood and anxiety disorders has typically been associated with decreases in the quality of mother-infant interactions. However, maternal anxiety symptoms during the postpartum period have been less studied than other mental health disorders like depression. In the current study, we examined associations among symptoms of maternal anxiety, maternal perceived stress, and mother-infant behavioral synchrony in the early postnatal period. Eighty-one mother-infant dyads participated in this study when the infants were 3 months old. Surveys were given to obtain demographic information and current maternal mental health symptoms, and dyads completed a 5-min free-play task to measure behavioral synchrony. Results indicated that maternal anxiety symptoms were positively associated with behavioral synchrony, but only for mothers reporting moderate levels of perceived stress. These findings highlight the differential impact of maternal postpartum mental health on behavioral synchrony and suggest that higher maternal anxiety symptoms during the postnatal period may play an adaptive role in fostering more dynamic mother-infant interactions.
PMID: 35524642
ISSN: 1532-7078
CID: 5249432

Improving Perinatal Maternal Mental Health Starts With Addressing Structural Inequities

Shuffrey, Lauren C; Thomason, Moriah E; Brito, Natalie H
PMID: 35262622
ISSN: 2168-6238
CID: 5183552

Association of maternal depression and anxiety with toddler social-emotional and cognitive development in South Africa: a prospective cohort study

Shuffrey, Lauren C; Sania, Ayesha; Brito, Natalie H; Potter, Mandy; Springer, Priscilla; Lucchini, Maristella; Rayport, Yael K; Du Plessis, Carlie; Odendaal, Hein J; Fifer, William P
OBJECTIVE:A robust literature has identified associations between prenatal maternal depression and adverse child social-emotional and cognitive outcomes. The majority of prior research is from high-income countries despite increased reporting of perinatal depression in low/middle-income countries (LMICs). Additionally, despite the comorbidity between depression and anxiety, few prior studies have examined their joint impact on child neurodevelopment. The objective of the current analysis was to examine associations between prenatal maternal depression and anxiety with child social-emotional and cognitive development in a cohort from the Western Cape Province of South Africa. DESIGN/METHODS:Prenatal maternal depression and anxiety were measured using the Edinburgh Postnatal Depression Scale and the State-Trait Anxiety Inventory Scale at 20-24 weeks' gestation. Child neurobehaviour was assessed at age 3 using the Brief Infant-Toddler Social Emotional Assessment and the Bayley Scales of Infant Development III Screening Test (BSID-III ST). We used linear regression models to examine the independent and joint association between prenatal maternal depression, anxiety and child developmental outcomes. RESULTS:Participants consisted of 600 maternal-infant dyads (274 females; gestational age at birth: 38.89 weeks±2.03). Children born to mothers with both prenatal depression and trait anxiety had higher social-emotional problems (mean difference: 4.66; 95% CI 3.43 to 5.90) compared with children born to mothers with no prenatal depression or trait anxiety, each condition alone, or compared with mothers with depression and state anxiety. Additionally, children born to mothers with prenatal maternal depression and trait anxiety had the greatest reduction in mean cognitive scores on the BSID-III ST (mean difference: -1.04; 95% CI -1.99 to -0.08). CONCLUSIONS:The observed association between comorbid prenatal maternal depression and chronic anxiety with subsequent child social-emotional and cognitive development underscores the need for targeting mental health support among perinatal women in LMICs to improve long-term child neurobehavioural outcomes.
PMID: 35418432
ISSN: 2044-6055
CID: 5201982