High Maternal Anxiety Research Articles

Associations between maternal smartphone use and mother-infant responsiveness: A cluster analysis of potential risk and protective factors.

Contradictory results in the extant literature suggests that additional risk factors should be considered when exploring the impacts of maternal smartphone use on mother-infant relationships. This study used cluster analysis to explore whether certain risk factors were implicated in mother-infant dyads with high smartphone use and low mother-infant responsiveness. A cross-sectional survey of 450 participants in the UK measured infant social-emotional development, maternal depressive, anxiety and stress symptoms, wellbeing, social support, smartphone use, and mother-infant responsiveness. Participants were predominantly White (95.3%) and living with a partner (95.2%), with infants who were born full-term (88.9%). Cluster analysis identified three clusters characterized as; cluster (1) "infant at risk" showing high infant development concerns, high maternal smartphone use, and low mother-infant responsiveness; cluster (2) "mother at risk" showing high maternal depressive, anxiety, and stress scores, low social support, high maternal smartphone use, and low mother-infant responsiveness, and cluster (3) "low risk" showing low maternal smartphone use and high mother-infant responsiveness. Significant differences were found between all risk factors, except for maternal smartphone use and mother-infant responsiveness between clusters 1 and 2 suggesting that both clusters require early intervention, although interventions should be tailored towards the different risk factors they are presenting with.

Change in maternal relationship quality and maternal and child distress

BackgroundMaternal relationship quality is associated with mental health; maternal mental health could affect child mental health. The COVID-19 pandemic adversely affected both relationship quality and mental health. PurposeTo examine if maternal distress mediates the association between pandemic-related changes in maternal relationship quality and child distress. MethodsA sample of 194 mother-child dyads were from the Alberta Pregnancy Outcomes and Nutrition (APrON) cohort participated. Mothers reported pandemic-related changes in relationship quality (partner, child, friends/family) and mental health (anxiety, depressive symptoms). Children (7-10 yrs) self-reported mental health (anxiety, depressive symptoms). Covariates were maternal sociodemograhics, child age and gender, number of children in the home, time between pandemic start and assessments, and pandemic change in household income. Mediation was tested using the SPSS PROCESS macro. ResultsAn indirect effect of maternal relationship quality on child anxiety via maternal depressive symptoms was detected, .95CI upper boundary <-.025. Decreases in partner relationship quality, b = -.45, SE = .23, p = .001, and relationship quality with friends or family outside the household, b = -.46, SE = .27, p = .001, were associated with higher maternal anxiety, which in turn, predicted higher child depressive symptoms, p’s<.014. ConclusionsPandemic-related decreases in maternal relationship quality were associated with maternal distress, which in turn was associated with child distress. LimitationsWe focused on mothers only and obtained retrospective recall reports on changes in relationship quality during the pandemic.

Maternal anxiety during pregnancy is associated with weaker prefrontal functional connectivity in adult offspring

BackgroundThe connectome, constituting a unique fingerprint of a person’s brain, may be influenced by its prenatal environment, potentially affecting later-life resilience and mental health.MethodsWe conducted a prospective resting-state functional Magnetic Resonance Imaging study in 28-year-old offspring (N = 49) of mothers whose anxiety was monitored during pregnancy. Two offspring anxiety subgroups were defined: “High anxiety” (n = 13) group versus “low-to-medium anxiety” (n = 36) group, based on maternal self-reported state anxiety at 12–22 weeks of gestation. To predict resting-state functional connectivity of 32 by 32 ROIs, maternal state anxiety during pregnancy was included as a predictor in general linear models for both ROI-to-ROI and graph theoretical metrics. Sex, birth weight and postnatal anxiety were included as covariates.ResultsHigher maternal anxiety was associated with weaker functional connectivity of medial prefrontal cortex with left inferior frontal gyrus (t = 3.45, pFDR < 0.05). Moreover, network-based statistics (NBS) confirmed our finding and revealed an additional association of weaker connectivity between left lateral prefontal cortex with left somatosensory motor gyrus in the offspring. While our results showed a general pattern of lower functional connectivity in adults prenatally exposed to maternal anxiety, we did not observe significant differences in global brain networks between groups.ConclusionsWeaker (medial) prefrontal cortex functional connectivity in the high anxiety adult offspring group suggests a long-term negative impact of prenatal exposure to high maternal anxiety, extending into adulthood. To prevent mental health problems at population level, universal primary prevention strategies should aim at lowering maternal anxiety during pregnancy.

Maternal anxiety forecasts shorter prolongation of pregnancies complicated by early-onset preeclampsia

PurposeIn early-onset preeclampsia, each additional day of pregnancy prolongation reduces offspring infant mortality about 9%. We evaluated if maternal stress at admission to hospital for early-onset preeclampsia predicted admission-to-delivery intervals in days.MethodsThis prospective, longitudinal cohort-study involved 15 singleton pregnancies with a diagnosis of preeclampsia before 34 weeks gestation with intended expectant management. Upon hospital admission, maternal psychological stress was assessed with questionnaires and physiological stress with hair cortisol. Hair samples were analyzed in three hair segments representing the preconception period, and the first and second trimester of pregnancy.ResultsMean pregnancy prolongation was 16.2 days. Higher maternal anxiety at hospital admission significantly correlated with shorter admission-to-delivery intervals (r = − 0.54, p = 0.04). Chronically increased hair cortisol concentrations (i.e. from preconception through the second trimester) of pregnancy tended to be related to shorter admission-to-delivery intervals (p <. 10).ConclusionHigher reported anxiety is, and chronically high hair cortisol tended to be, related with fewer days of prolongation from admission to delivery in women with early-onset preeclampsia. These findings suggest that maternal stress might be a potential determinant of disease progression. Future research into early innovative stress-reducing interventions for early-onset preeclampsia may shed more light on the etiology and treatment of this disease.

I Want More! The Role of Child, Family and Maternal Characteristics on Child Dispositional Greed and Sharing Behavior

Greed is often regarded as a negative trait that impedes prosocial behavior in adults. Yet, relatively little is known about the development of greed and its effects on children. We examine the effect of dispositional greed on sharing behavior in 4-to-6-year-olds. In addition, we identified potential factors associated with child greed, including child, family, and maternal characteristics. This study with 63 mother–child dyads (Agechild = 5.11, SD = 0.88, 50.8% female) revealed that child greed was associated with less prosocial behavior in an observational sharing task. More specifically, children who were reported as greedier by their mothers shared less than less greedy children. Having fewer siblings, less mindful maternal parenting style, and high maternal trait anxiety was associated with higher dispositional greed in children. Additionally, their mother rated greedier children as having higher negative affectivity. These findings suggest that child greed is an important developmental trait that warrants further investigation.Highlights• 63 mother–child dyads revealed that child greed was associated with less pro-social behavior in an observational sharing task• Child greed was associated with higher rates of child negative affectivity.• Having fewer siblings, less mindful parenting style, high maternal trait anxiety predicted dispositional greed in 4-to-6-year-old children

Associations among maternal lifetime trauma, psychological symptoms in pregnancy, and infant stress reactivity and regulation.

Maternal trauma has intergenerational implications, including worse birth outcomes, altered brain morphology, and poorer mental health. Research investigating intergenerational effects of maternal trauma on infant stress reactivity and regulation is limited. Maternal mental health during pregnancy may be a contributor: psychopathology is a sequela of trauma exposure and predictor of altered self-regulatory capacity in offspring of affected mothers. We assessed associations among maternal lifetime trauma and infant stress responsivity, mediated by psychological symptoms in pregnancy. Mothers reported lifetime trauma history and anxiety, depressive, and posttraumatic stress symptoms during pregnancy. At infant age 6 months, stress reactivity and regulation were assessed via maternal behavior ratings (Infant Behavior Questionnaire-Revised, IBQ-R) and behavioral (negative mood) and physiological (respiratory sinus arrhythmia, RSA) markers during a laboratory stressor (Still-Face Paradigm). Maternal trauma was directly associated with lower infant physiological regulation and indirectly associated with lower levels of both infant behavioral and physiological regulation via higher maternal anxiety during pregnancy. Maternal trauma was also indirectly associated with higher infant reactivity via higher maternal anxiety during pregnancy. Post hoc analyses indicated differential contributions of maternal prenatal versus postnatal anxiety to infant outcomes. Findings highlight potential contributory mechanisms toward maladaptive child stress response, which has been associated with poor behavioral, cognitive, and academic outcomes.

Prenatal PM2.5 affects atopic dermatitis depending on maternal anxiety and gender: COCOA study.

BackgroundThe prevalence of atopic dermatitis (AD) is increasing worldwide. Prenatal particulate matter with an aerodynamic diameter <2.5 μm (PM2.5) and maternal anxiety during pregnancy has been suggested as a potential causes of AD. This study investigated the effects of prenatal PM2.5 and maternal anxiety on AD and identified the critical period of PM2.5 exposure for AD in infants.MethodsThis study included 802 children from the COCOA birth cohort study with follow‐up data at 1 year of age. PM2.5 was estimated by land‐use regression models and prenatal anxiety was measured with a questionnaire. AD was diagnosed by doctor at 1 year of age. Logistic regression analysis and Bayesian distributed lag interaction models were applied.ResultsHigher PM2.5 during the first trimester of pregnancy, higher prenatal maternal anxiety, and male gender were associated with AD at 1 year of age (adjusted odds ratio [aOR] and 95% confidence interval [CI]: 1.86 [1.08–3.19], 1.58 [1.01–2.47], and 1.54 [1.01–2.36], respectively). Higher PM2.5 during the first trimester and higher maternal anxiety during pregnancy showed an additive effect on the risk of AD (aOR: 3.13; 95% CI: 1.56–6.28). Among boys exposed to higher maternal anxiety during pregnancy, gestational weeks 5–8 were the critical period of PM2.5 exposure for the development of AD.ConclusionsHigher PM2.5 exposure during gestational weeks 5–8 increased the probability of AD in infancy, especially in boys with higher maternal anxiety. Avoiding PM2.5 exposure and maternal anxiety from the first trimester may prevent infant AD.

Epigenetic Modifications Associated with Maternal Anxiety during Pregnancy and Children's Behavioral Measures.

Epigenetic changes are associated with altered behavior and neuropsychiatric disorders and they modify the trajectory of aging. Maternal anxiety during pregnancy is a common environmental challenge for the fetus, causing changes in DNA methylation. Here, we determined the mediating role of DNA methylation and the moderating role of offspring sex on the association between maternal anxiety and children’s behavioral measures. In 83 mother–child dyads, maternal anxiety was assessed in each trimester of pregnancy when the child was four years of age. Children’s behavioral measures and children’s buccal DNA methylation levels (NR3C1, IGF2/H19 ICR, and LINE1) were examined. Higher maternal anxiety during the third trimester was associated with more methylation levels of the NR3C1. Moderating effects of sex on the association between maternal anxiety and methylation were found for IGF2/H19 and LINE1 CpGs. Mediation analysis showed that methylation of NR3C1 could buffer the effects of maternal anxiety on children’s behavioral measures, but this effect did not remain significant after controlling for covariates. In conclusion, our data support an association between maternal anxiety during pregnancy and DNA methylation. The results also underscore the importance of sex differences and timing effects. However, DNA methylation as underlying mechanism of the effect of maternal anxiety during pregnancy on offspring’s behavioral measures was not supported.

Prenatal and postnatal maternal anxiety and amygdala structure and function in young children

Anxiety symptoms are relatively common during pregnancy and are associated with behavioural problems in children. The amygdala is involved in emotion regulation, and its volume and function are associated with exposure to prenatal maternal depression. The associations between perinatal maternal anxiety and children’s amygdala structure and function remain unclear. The objective of this study was to determine associations between prenatal and postnatal maternal anxiety and amygdala structure and function in children. Maternal anxiety was measured during the second trimester of pregnancy and 12 weeks postpartum. T1-weighted anatomical data and functional magnetic resonance imaging data were collected from 54 children (25 females), between the ages of 3–7 years. Amygdala volume was calculated and functional connectivity maps were created between the amygdalae and the rest of the brain. Spearman correlations were used to test associations between amygdala volume/functional connectivity and maternal anxiety symptoms, controlling for maternal depression symptoms. Second trimester maternal anxiety symptoms were negatively associated with functional connectivity between the left amygdala and clusters in bilateral parietal regions; higher maternal anxiety was associated with increased negative connectivity. Postnatal maternal anxiety symptoms were positively associated with child amygdala volume, but this finding did not remain significant while controlling for total brain volume. These functional connectivity differences may underlie behavioral outcomes in children exposed to maternal anxiety during pregnancy.

Pregnant women misusing opioids: Depression, anxiety, stress, and neonatal opioid withdrawal syndrome

• Pregnant women misusing opioids report significant depression, anxiety, and stress. • Symptoms are higher compared to women with other medically high-risk pregnancies. • High maternal anxiety and low stress predict neonatal opioid withdrawal syndrome. Diagnoses of anxiety and depressive disorders are prevalent among women who misuse opioids during pregnancy and have been linked to the development of neonatal opioid withdrawal syndrome (NOWS) in infants. The role of stress in NOWS, however, has not been studied, despite its relationship to anxiety and depression. Moreover, anxiety and depression have only been assessed at the level of diagnoses, limiting our understanding of the effects of symptoms along a continuum of severity on opioid misuse in pregnancy and NOWS. We first compared symptoms of anxiety, depression, and stress assessed along a continuum in women who misused opioids during pregnancy ( n = 53) who chose to receive medication assisted treatment (MAT) or to detoxify from opioids, and women with high-risk pregnancies for medical reasons unrelated to drug use ( n = 37). We then examined whether depression, anxiety, and stress symptoms during pregnancy predicted NOWS. Findings revealed significantly higher depression, anxiety, and stress among pregnant women who misused opioids than among the comparison group. Furthermore, results indicated that higher anxious symptoms as hypothesized (but not depressive symptoms), and lower stress symptoms contributed to a greater likelihood of infants developing NOWS after delivery beyond the type of treatment (i.e., MAT or tapering/detoxification) they received for opioid use. The present study used a small sample size and had some measurement limitations. Findings suggest important opportunities for effective integrated psychological and medical interventions for pregnant women misusing opioids to improve their own health and that of their infants.

A variation in the infant oxytocin receptor gene modulates infant hippocampal volumes in association with sex and prenatal maternal anxiety

Genetic variants in the oxytocin receptor (OTR) have been linked to distinct social phenotypes, psychiatric disorders and brain volume alterations in adults. However, to date, it is unknown how OTR genotype shapes prenatal brain development and whether it interacts with maternal prenatal environmental risk factors on infant brain volumes.In 105 Finnish mother-infant dyads (44 female, 11–54 days old), the association of offspring OTR genotype rs53576 and its interaction with prenatal maternal anxiety (revised Symptom Checklist 90, gestational weeks 14, 24, 34) on infant bilateral amygdalar, hippocampal and caudate volumes were probed.A sex-specific main effect of rs53576 on infant left hippocampal volumes was observed. In boys compared to girls, left hippocampal volumes were significantly larger in GG-homozygotes compared to A-allele carriers. Furthermore, genotype rs53576 and prenatal maternal anxiety significantly interacted on right hippocampal volumes irrespective of sex. Higher maternal anxiety was associated both with larger hippocampal volumes in A-allele carriers than GG-homozygotes, and, though statistically weak, also with smaller right caudate volumes in GG-homozygotes than A-allele carriers.Our study results suggest that OTR genotype enhances hippocampal neurogenesis in male GG-homozygotes. Further, prenatal maternal anxiety might induce brain alterations that render GG-homozygotes compared to A-allele carriers more vulnerable to depression.

Maternal anxiety in relation to growth failure and growth hormone treatment in children.

Health disorders in mothers and their children are subject to mutual influences arising from the nature of mother–child relationship. The aim of the study was to analyze the issue of anxiety amongst mothers of short children in aspect of growth hormone (GH) therapy in Poland.The study was based on a group of 101 mothers of originally short-stature children: 70 with GH deficiency treated with recombinant human GH and 31 undergoing the diagnostic process, without any treatment. Collected medical data included the child's gender, height and weight, chronological age, bone age delay, and GH therapy duration. For all children the height SDS (standard deviation score of height) and BMI SDS (standard deviation score of body mass index) were calculated. The Spielberger State-Trait Anxiety Inventory (STAI) was used to evaluate anxiety levels among the recruited mothers. Obtained results revealed low trait anxiety levels in all mothers, with no statistically significant differences between the groups. State anxiety levels were significantly higher in mothers of children without diagnosis and treatment than in mothers of children receiving appropriate therapy. Significantly lower levels of maternal state anxiety were observed during the first stage of the GH therapy, and they were further reduced in mothers of children treated for more than 4 years.Growth failure in Polish children is not associated with high maternal anxiety as a personality trait, but lack of diagnosis and lack of appropriate treatment seem to generate high levels of anxiety as a transient state in mothers. The initiation of GH therapy induces a substantial reduction of maternal state anxiety, and the duration of this treatment causes its further decrease. Mothers of short children undergoing diagnostic process could benefit from psychological support, but it seems to be unnecessary when their children are treated with GH.

Maternal Anxiety and Depression during Late Pregnancy and Newborn Brain White Matter Development.

Anxiety and depression during pregnancy have been associated with an increased risk of adverse neurodevelopmental outcomes in offspring. We aimed to study the in utero effects of maternal anxiety and depression on early brain development. Pregnant women were recruited at ∼36 weeks of gestation for this prospective study. They were assessed for anxiety symptoms by the State-Trait Anxiety Inventory and for depression symptoms by the Beck Depression Inventory, 2nd Edition. After delivery, infant underwent an MR imaging examination of the brain without sedation, including DTI, for evaluation of white matter (WM) development. Infant fractional anisotropy values, a putative marker of WM integrity, were correlated with the mothers' State-Trait Anxiety Inventory and Beck Depression Inventory scores by using both tract-based spatial statistics and ROI methods. Thirty-four infants were included in this study. Both maternal State-Anxiety and Trait-Anxiety scores negatively correlated (P < .05, corrected) with fractional anisotropy values in widespread brain WM regions; Beck Depression Inventory scores also negatively correlated (P < .05) with fractional anisotropy values in one cluster in the brain. Further ROI analyses confirmed significant negative correlations between average fractional anisotropy values in ROIs including left and right prefrontal WM, left and right middle frontal gyrus WM, and the fornix, and State-Anxiety (R values, -0.47 to -0.67; P values, .008 to <.001), Trait-Anxiety (R, -0.37 to -0.59; P, .04 to <.001), and Beck Depression Inventory (R values, -0.36 to -0.55; P, .05 to .002) scores. Higher maternal anxiety and depression symptom scores during late pregnancy were associated with lower estimated infant brain WM development, which indicated in utero influences of maternal mental health during pregnancy on the developing brain.

Inkskinned: Gender and Personality Aspects Affecting Heavy Tattooing—A Moderation Model

While literature findings regarding the psychosocial and behavioral aspects of tattooing are evident, findings regarding its personality aspects are mixed. The present study aimed to examine the effect of maternal separation conflict that might affect the association between physical appearance anxiety, gender, and heavy tattooing. This cross-sectional study included 606 adults (395 having at least four tattoos and 211 not tattooed). Physical appearance anxiety, maternal separation conflict, and demographics were assessed. Findings revealed significant main effects for all variables. Furthermore, gender by maternal separation conflict and physical appearance anxiety by maternal separation conflict interactions were revealed. Specifically, the gender by maternal separation conflict interaction and the physical appearance anxiety by maternal separation conflict interaction indicated high maternal separation conflict and high physical appearance anxiety among women. Among men, however, low maternal separation conflict and low physical appearance anxiety predicted heavy tattooing. Maternal separation conflict, as a moderator, plays a key role in conceptualizing both gender differences and the effect of physical appearance anxiety on becoming tattooed. Thus, different constellations of personality variables are associated with heavy tattooing for men and women.

Prenatal Developmental Origins of Future Psychopathology: Mechanisms and Pathways.

The developmental origins of health and disease hypothesis applied to neurodevelopmental outcomes asserts that the fetal origins of future development are relevant to mental health. There is a third pathway for the familial inheritance of risk for psychiatric illness beyond shared genes and the quality of parental care: the impact of pregnant women's distress-defined broadly to include perceived stress, life events, depression, and anxiety-on fetal and infant brain-behavior development. We discuss epidemiological and observational clinical data demonstrating that maternal distress is associated with children's increased risk for psychopathology: For example, high maternal anxiety is associated with a twofold increase in the risk of probable mental disorder in children. We review several biological systems hypothesized to be mechanisms by which maternal distress affects fetal and child brain and behavior development, as well as the clinical implications of studies of the developmental origins of health and disease that focus on maternal distress. Development and parenting begin before birth.

Maternal self-confidence during the first four months postpartum and its association with anxiety and early infant regulatory problems

Maternal self-confidence has become an essential concept in understanding early disturbances in the mother-child relationship. Recent research suggests that maternal self-confidence may be associated with maternal mental health and infant development. The current study investigated the dynamics of maternal self-confidence during the first four months postpartum and the predictive ability of maternal symptoms of depression, anxiety, and early regulatory problems in infants. Questionnaires assessing symptoms of depression (Edinburgh Postnatal Depression Scale), anxiety (State-Trait Anxiety Inventory), and early regulatory problems (Questionnaire for crying, sleeping and feeding) were completed in a sample of 130 women at three different time points (third trimester (T1), first week postpartum (T2), and 4 months postpartum (T3). Maternal self-confidence increased significantly over time. High maternal trait anxiety and early infant regulatory problems negatively contributed to the prediction of maternal self-confidence, explaining 31.8% of the variance (R=.583, F3,96=15.950, p<.001).Our results emphasize the transactional association between maternal self-confidence, regulatory problems in infants, and maternal mental distress. There is an urgent need for appropriate programs to reduce maternal anxiety and to promote maternal self-confidence in order to prevent early regulatory problems in infants.

Mothers' and fathers' internalizing symptoms influence parental ratings of adolescent anxiety symptoms.

Clinical assessment of anxiety in adolescents often involves multiple informants, and parental internalizing symptoms have been found to influence parent ratings of adolescents' anxiety symptoms. We investigated how parental internalizing symptoms (anxiety and depression) were related to adolescent and parent reports of adolescents' anxiety symptoms in a population-based cross-sectional survey. The sample comprised 337 adolescent-mother-father triads (N = 1,011) drawn from the Tracking Opportunities and Problems in Childhood and Adolescence (TOPP) study. Adolescents (43.9% boys) were 14- and 15-years old. Adolescent and parent ratings of adolescent anxiety symptoms (The Coolidge Personality and Neuropsychological Inventory for Children) were moderately and significantly correlated (mother-adolescent r = .30; father-adolescent r = .25). Parents also self-rated internalizing symptoms (Hopkins Symptom Checklist-25). Regression models showed higher maternal and paternal depression symptoms, but not anxiety symptoms, were associated with higher parent-rated adolescent anxiety symptoms. Higher maternal anxiety and depression symptoms, as well as paternal depression symptoms, but not paternal anxiety symptoms, were associated with lower parent-adolescent agreement on adolescent anxiety symptoms (i.e., parent-rating higher relative to adolescent-rating). When adolescents rate considerably lower anxiety compared with how their parents rate them, considering parental depression as a possible reason may be key to understanding adolescents' treatment needs. (PsycINFO Database Record

Patterns of adaptation to children's food allergies.

Families with food allergy (FA) are at risk of reduced quality of life and elevated anxiety. A moderate level of anxiety may be beneficial to sustain vigilance for food avoidance; however, excessive anxiety may increase risk for burden and maladjustment. The current study presents a framework for understanding the patterns of adaptation to FA across families and to identify typologies of families that would benefit from intervention. Participants included 57 children, 6-12 years old with documented FA, and their mothers. Families were assessed using the Food Allergy Management and Adaptation Scale. Families also completed measures of quality of life, anxiety, FA management, and psychosocial impairment. A hierarchical cluster analysis revealed that 56 of the 57 families of food-allergic children were categorized into four groups that differed on their adequacy of family FA management, levels of anxiety, and balanced psychosocial functioning: balanced responders (n = 23; 41%), high responders (n = 25; 45%), and low responders (n = 3; 5%). The fourth group, anxious high responders (n = 5; 9%), was characterized by extremely high maternal FA anxiety scores and low scores for balanced integration of FA management and psychosocial functioning. Families in clusters differed across illness and psychosocial outcome variables. Families with FA were characterized by patterns of FA management, anxiety, and ability to integrate FA demands into daily life. Identified adaptation patterns correspond with clinical impressions and provide a framework for identifying families in need of intervention.

Predictors of impaired breastfeeding initiation and maintenance in a diverse sample: what is important?

This study aimed to investigate socio-demographic, medical and psychological factors that have an impact on breastfeeding. Questionnaires were administered to 330 women prenatally (TI third trimester) and postpartum (TII 3-4days, TIII 4months). Medical data were collected from the hospital records. Self-reported data on initiation and maintenance of breastfeeding was collected simultaneously. Primary endpoint was breastfeeding initiation and maintenance. Data analyses were performed using Spearman's ρ correlations between breastfeeding and other study variables and generalized multiple ordinal logistic regression analysis. Neonatal admission to the NICU, high BMI, cesarean section, difficulties with breastfeeding initiation and high maternal state anxiety were the strongest predictors of impaired breastfeeding initiation, explaining together 50% of variance. After 4months, the strongest predictors of impaired maintenance of breastfeeding were maternal smoking, a high BMI and a history of postpartum anxiety disorder, explaining 30% of variance. Successful initiation and maintenance of breast feeding is a multifactorial process. Our results underline the need of interdisciplinary approaches to optimise breastfeeding outcomes by demonstrating the equality of medical and psychological variables. Whereas practices on maternity wards are crucial for optimal initiation, continuous lifestyle modifying and supporting approaches are essential for breastfeeding maintenance. Healthcare providers can also significantly influence breastfeeding initiation and maintenance by counselling on the importance of maternal BMI.

Psychosocial Adjustment in School-age Girls With a Family History of Breast Cancer.

Understanding how young girls respond to growing up with breast cancer family histories is critical given expansion of genetic testing and breast cancer messaging. We examined the impact of breast cancer family history on psychosocial adjustment and health behaviors among >800 girls in the multicenter LEGACY Girls Study. Girls aged 6 to 13 years with a family history of breast cancer or familial BRCA1/2 mutation (BCFH+), peers without a family history (BCFH-), and their biological mothers completed assessments of psychosocial adjustment (maternal report for 6- to 13-year-olds, self-report for 10- to 13-year-olds), breast cancer-specific distress, perceived risk of breast cancer, and health behaviors (10- to 13-year-olds). BCFH+ girls had better general psychosocial adjustment than BCFH- peers by maternal report. Psychosocial adjustment and health behaviors did not differ significantly by self-report among 10- to 13-year-old girls. BCFH+ girls reported higher breast cancer-specific distress (P = .001) and were more likely to report themselves at increased breast cancer risk than BCFH- peers (38.4% vs 13.7%, P < .001), although many girls were unsure of their risk. In multivariable analyses, higher daughter anxiety was associated with higher maternal anxiety and poorer family communication. Higher daughter breast cancer-specific distress was associated with higher maternal breast cancer-specific distress. Although growing up in a family at risk for breast cancer does not negatively affect general psychosocial adjustment among preadolescent girls, those from breast cancer risk families experience greater breast cancer-specific distress. Interventions to address daughter and mother breast cancer concerns and responses to genetic or familial risk might improve psychosocial outcomes of teen daughters.