Elsevier

Academic Pediatrics

Volume 19, Issue 8, November–December 2019, Pages 917-924
Academic Pediatrics

Interactive Effects of Infant Gestational Age and Infant Fussiness on the Risk of Maternal Depressive Symptoms in a Nationally Representative Sample

https://doi.org/10.1016/j.acap.2019.02.015Get rights and content

Abstract

Objective

To examine the interactive effects of gestational age and infant fussiness on the risk of maternal depressive symptoms in a nationally representative sample.

Methods

Our sample included 8200 children from the Early Childhood Longitudinal Study, Birth Cohort. Gestational age categories were very preterm (VPT, 24–31 weeks), moderate/late preterm (MLPT, 32–36 weeks) and full term (FT, 37–41 weeks). Maternal depressive symptoms (categorized as nondepressed/mild/moderate-severe), from the modified Center for Epidemiological Studies Depression Questionnaire, and infant fussiness (categorized as fussy/not fussy) were assessed at 9 months from parent-report questionnaires. We examined the interactive effects of infant fussiness and gestational age categories and estimated adjusted odds ratios (aOR) and 95% confidence intervals (CI) of maternal depressive symptoms using multinomial logistic regression.

Results

Infant fussiness interacted with gestational age categories in predicting maternal depressive symptoms (P = .04), with severity varying by gestational age and infant fussiness. Compared with mothers of VPT infants without fussiness, mothers of VPT infants with fussiness had greater odds of mild depressive symptoms (aOR, 2.32; 95% CI, 1.19–4.53). Similarly, compared with mothers of MLPT and FT infants without fussiness, mothers of fussy MLPT and FT infants had greater odds of moderate-severe symptoms (aOR, 2.30; 95% CI, 1.40–3.80, and aOR, 1.74; 95% CI, 1.40–2.16, respectively).

Conclusions

Mothers of MLPT and FT infants with fussiness had increased odds of moderate-severe depressive symptoms, and mothers of VPT infants with fussiness had increased risk of mild symptoms. Early screening for infant fussiness in preterm and FT may help identify mothers with depressive symptoms in need of support.

Section snippets

Study Design and Sample

Data were drawn from the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B), a nationally representative, population-based longitudinal study of children born in the United States in 2001. Data were collected from >10,000 children and their parents at 9 months, with subsequent assessments at 24 months, preschool, and kindergarten timepoints. Data collection consisted of home visits with parent interviews and direct child assessments and included information on children's development

Covariates

Maternal and infant characteristics associated with prematurity or maternal depression were chosen a priori as covariates after a review of the literature. The following maternal characteristics were ascertained from the restricted ECLS-B birth certificate data: maternal age, race/ethnicity, marital status (married/ unmarried), history of prenatal smoking, history of breastfeeding (any breastfeeding, no breast feeding), and plurality (singleton, twin or multiple gestation). Also included were

Statistical Analysis

Maternal and child characteristics were examined using descriptive statistics. Multivariate, multinomial logistic regression using the SURVEYLOGISTIC procedure in SAS was used to examine the association between gestational age categories and infant fussiness with the outcome of maternal depressive categories. We controlled for variables that were related to gestational age and maternal depressive categories to adjust for potential confounding. We also examined whether the association between

Sample Characteristics

Our final sample of 8200 infants born between 24 and 41 weeks included 800 VPT (<32 weeks), 1500 MPLT (32–36 weeks), and 5900 term infants (37–41 weeks). Gestational age groups differed by select maternal (Table 1) and infant characteristics (Table 2). Compared with infants born FT, infants born VPT and MLPT were more likely to have mothers who were unmarried, have less than a high school education, have income <185% below the poverty line, and were less likely to have breastfed. They were also

Discussion

This is the first study to examine the interactive effects of the degree of prematurity (VPT, MLPT, FT) and infant fussiness (fussy vs not fussy) on the severity of maternal depressive symptoms in a nationally representative sample. Our study is also unique in its focus on predictors associated with both mild (ie, subclinical) depressive symptoms, as well as more commonly studied moderate-to-severe depressive symptoms. Although there is a paucity of research regarding child outcomes associated

Conclusions

Mothers of VPT with infant fussiness experienced increased odds of mild depressive symptoms whereas mothers of “fussy” MLPT and FT infants had increased odds of moderate-severe depressive symptoms, suggesting a potential need for closer surveillance and supports for these mothers. Pediatric providers can query mothers about their experiences of infant fussiness, which can help identify which mothers would benefit from additional depression screening, and referrals for additional services (eg,

Acknowledgments

Financial disclosure: Supported by the University of Michigan, NICHD (K08HD078506), The funding sources had no involvement in the study design, collection, analysis, interpretation of data, in the writing of the report, or in the decision to submit the article for publication

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    The authors have no conflicts of interest to disclose.

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