Maternal Intolerance Research Articles

Intolerance of uncertainty and protective parenting: the mediating role of maternal appraisals and the moderating role of child health status

ABSTRACT This study examined how intolerance of uncertainty and having a child with food allergy relate to protective parenting. Eighty mothers of children with food allergy and 78 mothers of healthy children completed questionnaires assessing intolerance of uncertainty and parenting style. Mothers then rated vignettes of hypothetical parenting situations in terms of perceived uncertainty, threat, and negative affect and reported their likely parenting response. Results indicated that mothers’ affective and cognitive appraisals mediated the association between intolerance of uncertainty and protective parenting. Findings suggest that maternal intolerance of uncertainty and child health status may increase the risk of protective parenting.

Effect of maternal tolerance on behavioural problems in children with enuresis.

To determine the effect of maternal tolerance on behavioural problems in children with enuresis. The cross-sectional descriptive study was conducted from January to November 2018 at the outpatient departments of three hospitals in Lahore and Sialkot district of the Punjab province in Pakistan. The sample comprised of mothers aged 23-50 years having children with enuresis visiting one public-sector tertiary-care hospital and two private-sector secondary-care hospitals. Data was collected using the Tolerance Scale and the Children Behavioural Questionnaire and was analysed using SPSS 21. There were 80 mothers with a mean age of 34.53±4.89 years and as many children with a mean age of 8.16±2.36 years. Maternal intolerance was positively and significantly correlated with rule-breaking (p=0.02) and aggressive behaviour (p=0.01) in children with enuresis. Maternal intolerance was a significant and positive predictor of rule-breaking behaviour (p=0.02), aggressive behaviour (p=0.001) and attention problems (p=0.01) in the affected children. Maternal intolerance and hostile attitudes towards children with enuresis was seen to be leading to secondary behavioural and emotional difficulties.

Caregiver perceptions of when to offer an oral food challenge for children with food allergy

Food allergy (FA) is a rising public health concern, affecting up to 5% of the pediatric population. 1 Sicherer S.H. Sampson H.A. Food allergy: epidemiology, pathogenesis, diagnosis, and treatment. J Allergy Clin Immunol. 2014; 133: 291-307 Abstract Full Text Full Text PDF PubMed Scopus (967) Google Scholar Oral food challenges (OFCs) are the gold standard for diagnosing FA. 2 Bindslev-Jensen C. Ballmer-Weber B.K. Bengtsson U. et al. Standardization of food challenges in patients with immediate reactions to foods—position paper from the European Academy of Allergology and Clinical Immunology. Allergy. 2004; 59: 690-697 Crossref PubMed Scopus (585) Google Scholar Although the decision to undergo an OFC is multifactorial, current guidelines suggest considering an OFC when the likelihood of passing the challenge is approximately 50%. 3 Nowak-Węgrzyn Assa'ad A.H. Bahna S.L. et al. Work Group report: oral food challenge testing. Adverse Reactions to Food Committee of the American Academy of Allergy. Asthma & Immunology. 2009; 123: S365-S383 Scopus (446) Google Scholar Prior studies have shown that performing an OFC is associated with better quality of life (QOL) among caregivers of individuals with FA and reduced parental burden of FA, regardless of challenge outcome. 4 Franxman T.J. Howe L. Teich E. Greenhawt M.J. Oral food challenge and food allergy quality of life in caregivers of children with food allergy. J Allergy Clin Immunol. 2015; 3: 50-56 Scopus (42) Google Scholar , 5 Kansen H.M. Le T.M. Meijer Y. et al. The impact of oral food challenges for food allergy on quality of life: a systematic review. Pediatr Allergy Immunol. 2018; 29: 527-537 Crossref PubMed Scopus (32) Google Scholar Others have reported that maternal anxiety regarding allergic reactions decreases after children pass an OFC. 6 Herbert L.J. Dahlquist L.M. Bollinger M.E. Maternal intolerance of uncertainty, anxiety, and adherence with food challenge referrals. J Health Psychol. 2013; 18: 1209-1219 Google Scholar When caregivers believe it is appropriate to undergo an OFC and whether they are conflicted about that decision is unclear. The aim of our study was to gain further understanding of caregiver knowledge, perceptions, and comfort level participating in OFCs.

Does Changing Antiretroviral Therapy in the First Trimester of Pregnancy for Safety Concerns Have an Impact on Viral Suppression?

To determine whether changing antiretroviral therapy (ART) during pregnancy because of concern about fetal risks led to poorer virological outcomes. All pregnancies in women with HIV-1 infection enrolled in the national multicenter prospective French Perinatal cohort at 14 week gestation or more were included between January 2005 and December 2015, if the mother was on ART at conception with a plasma viral load <50 copies/mL. The reasons for a change in the ART were analyzed according to treatment guidelines at the time of the pregnancy and defined as for safety concerns in the absence of reported maternal intolerance. Virological and pregnancy outcomes were studied by survival analysis and logistic regression adjusted for a propensity score established for each patient according to baseline characteristics. Of 7079 pregnancies in the overall cohort, 1797 had ART at conception with a viral load <50 copies/mL before 14 week gestation. Of these, 22 changed regimens in the first trimester for intolerance, and 411 of the remaining 1775 (23%) solely for safety concerns. The proportion of change was higher when the initial treatment was not recommended in the national guidelines (OR adjusted: 23.1 [14.0-38.2]), than when it was an alternative option (ORa: 2.2 [1.3-3.7]), as compared to recommended first-line regimens. Treatment changes for safety concerns did not lead to poorer virological control, compared with pregnancies without such changes (19.3% vs. 15.6%, HRa: 1.0 [0.7-1.4]). Changing ART early in pregnancy to regimens considered safer for pregnancy, and neonatal health did not have a destabilizing effect on viral suppression.

Gene-environment correlations in parental emotional warmth and intolerance: genome-wide analysis over two generations of the Young Finns Study.

Genomic analysis of the child might offer new potential to illuminate human parenting. We examined whether offspring (G2) genome-wide genotype variation (SNPs) is associated with their mother's (G1) emotional warmth and intolerance, indicating a gene-environment correlation. If this association is stronger than between G2's genes and their emotional warmth and intolerance toward their own children, then this would indicate the presence of an evocative gene-environment correlation. To further understand how G1 mother's parenting has been evoked by genetically influenced characteristics of the child (G2), we examined whether child (G2) temperament partially accounted for the association between offspring genes and parental responses. Participants were from the Young Finns Study. G1 mothers (N=2,349; mean age 39years) self-reported the emotional warmth and intolerance toward G2 in 1980 when the participants were from 3 to 18years old. G2 participants answered the same parenting scales in 2007/2012 (N=1,378; mean age=38years in 2007; 59% female) when their children were on average 11years old. Offspring temperament traits were self-reported in 1992 (G2 age range 15-30years). Estimation of the phenotypic variance explained by the SNPs of G2 was done by genome-wide complex trait analysis with restricted maximum likelihood (GCTA-GREML). Results showed that the SNPs of a child (G2) explained 22.6% of the phenotypic variance of maternal intolerance (G1; p-value=.039). G2 temperament trait negative emotionality explained only 2.4% points of this association. G2 genes did not explain G1 emotional warmth or G2's own emotional warmth and intolerance. However, further analyses of a combined measure of both G1 parenting scales found genetic effects. Parent or child gender did not moderate the observed associations. Presented genome-wide evidence is pointing to the important role a child plays in affecting and shaping his/her family environment, though the underlying mechanisms remain unclear.

Does Changing Antiretroviral Therapy in the First Trimester for Pregnancy-Related Concerns Have an Impact on Viral Suppression?

Objective: To determine whether changing antiretroviral therapy (ART) during pregnancy in order to follow guidelines because of concern about fetal risks led to poorer virological outcomes. Methods: All pregnancies in women with HIV1 infection enrolled in the national multicenter prospective French Perinatal cohort were included between 01/2005 and 12/2015, at 14 gestational weeks or more and if the mother was on ART at conception with a plasma viral load < 50 copies/ml. The reasons for a change in the ART were analyzed according to treatment guidelines at the time of the pregnancy, and defined as for pregnancy-related concerns in the absence of reported maternal intolerance. Virological and pregnancy outcomes were studied by survival analysis and logistic regression adjusted for a propensity score established for each patient according to baseline characteristics. Results: Of 10553 pregnancies in the cohort, 1797 were taking ART at conception and had a viral load <50 copies/mL before 14 weeks' gestation. Of these, 411 changed regimens in the first trimester for pregnancy-related concerns. The proportion of change was statistically higher when initial treatment was clearly contraindicated (OR adjusted: 23.1 [14.0- 38.2]) or was regarded as an alternative option (ORa: 2.2 [1.3-3.7]), as compared to recommended first-line regimens. Treatment changes for pregnancy-related concerns did not lead to poorer virological control, compared to pregnancies without such changes (19.3% vs. 15.6%, HRa: 1.0 [0.7-1.4]). Conclusions: Changing ART early in pregnancy with the goal of improving fetal and pregnancy outcomes did not appear to have a destabilizing effect on viral suppression. Financial Support: This work was supported by the French Agence Nationale de Recherche sur le SIDA (ANRS). Potential Conflicts of Interest: The authors declare no conflicts of interest in relation with this work. Ethics Approval Statement: The French Perinatal Cohort (ANRS EPF CO1/CO11) is a prospective, obervational study ongoing since 1985 in 90 perinatal centers throughout France (8) which includes all pregnancies in women with HIV-1 and/or HIV-2 with their informed consent and ethics committee (Comite de Protection des Personnes) approval.

Prevention of preterm birth with pessary in singletons (PoPPS): randomized controlled trial.

To determine if pessary use prevents preterm birth (PTB) in women with singleton pregnancy, with short cervical length (CL) measured on transvaginal sonography (TVS) and without prior spontaneous PTB (sPTB). This was an open-label multicenter randomized trial of asymptomatic women presenting at 18 + 0 to 23 + 6 weeks' gestation with a singleton pregnancy, CL ≤ 25 mm on TVS and no prior sPTB. sPTB included those with spontaneous onset of labor and those with rupture of membranes prior to labor. Subjects were randomized to receive either a Bioteque cup pessary or no pessary. Pessaries were inserted by trained maternal-fetal medicine staff. Vaginal progesterone was recommended to women with CL ≤ 20 mm. The primary outcome was PTB < 37 weeks. A sample size of 121 women in each group (n = 242) was needed to detect a reduction in the primary outcome from 30% in the no-pessary group to 15% in the pessary group. The trial was stopped early before complete enrollment. Between 17 March 2014 and 29 July 2016, 17 383 women underwent CL measurement on TVS. Of these, 422 (2.4%) had CL ≤ 25 mm and 391 (92.7%) met the full eligibility criteria, of which 122 (31.2%) agreed to randomization. Sixty-one (50%) women were randomized to the pessary group and 61 (50%) to the no-pessary group. Baseline characteristics were similar between the groups. There were no significant differences between the pessary and no-pessary groups in the rate of PTB < 37 weeks (43% vs 40%; relative risk 1.09; 95% CI, 0.71-1.68) or in secondary outcomes, such as rate of PTB < 34 weeks, rate of PTB < 28 weeks, gestational age at delivery, birth weight and rate of composite adverse neonatal outcome. Cervical pessary use was not associated with prevention of PTB in women with a singleton pregnancy, short CL on TVS and no prior sPTB in this small, underpowered randomized controlled trial. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Antiretroviral Therapy Containing Raltegravir to Prevent Mother-to-Child Transmission of HIV in Infected Pregnant Women.

We conducted a retrospective study in a general hospital in Buenos Aires, Argentina (2009-2015) aimed at evaluating outcomes in HIV-infected pregnant women (HIPW), who were prescribed raltegravir (RAL)-containing antiretroviral therapy (ART). A total of 239 HIPW were enrolled in our study; among them 31 received RAL (12.9%) at different clinical stages: i) intensification (INS): addition of RAL to current ART because of detectable antepartum viral load, 13 (41.9%); ii) late presenter (LP): standard ART + RAL as fourth drug, 15 (48.4%); iii) treatment of resistant-HIV: 3 (9.7%). Median gestational age at RAL initiation was 34 weeks and median exposure was 30 days. In INS-group, median viral load (VL) decrease was 1.48 log10. In LP-group, median VL decline was 2.15 log10. No clinical adverse events or maternal intolerance attributable to RAL were observed. Elective cesarean section was done in 51.7%; mild elevation of transaminases was observed in 35% of neonates. No vertical transmission was documented.

Effects of maternal intolerance to glucose on maternal behavior and lactation

Univ Estadual Paulista, UNESP, Botucatu Med Sch, Lab Expt Res Gynecol & Obstet, Botucau, SP, Brazil

Maternal intolerance of uncertainty, anxiety, and adherence with food challenge referrals

Anxiety regarding food challenges may serve an important role in parents' decisions to adhere to their child's food challenge referrals. This study examined the role of intolerance of uncertainty in food challenge referral adherence by assessing state/trait anxiety among mothers whose children were referred for a food challenge. Mothers whose children passed a food challenge reported significant decreases in anxiety regarding allergic reactions, but intolerance of uncertainty did not predict adherence. Trust in the physician was a primary reason mothers attended the food challenge, suggesting that physicians should consider the impact of the physician-patient relationship when treating these families.

Wild-Derived Inbred Mice No Longer ART-Resistant1

Wild-Derived Inbred Mice No Longer ART-Resistant1

Assessment of danger to themselves and their infants by rhesus macaque (Macaca mulatta) mothers.

This study investigated whether rhesus macaque (Macaca mulatta) mothers distinguish between what is dangerous to themselves and what is dangerous to their infants. The behavioral interactions between 11 mother-infant pairs and other females living in their group were analyzed in the 1st 2 months of infant life. Mothers behaved as if they perceived higher ranking females as dangerous to both themselves and their infants, lower ranking females as dangerous to their infants but not to themselves, and their young daughters as relatively harmless to both themselves and their infants. Changes in maternal intolerance of infant handling between the 1st and 2nd months covaried with changes in the probability of infant harassment rather than with the temporal pattern of aggression received by mothers. The possible cognitive mechanisms underlying parental recognition of infant's special needs are discussed in the light of comparative evidence from other mammalian species.

Role of the Mother's Touch in Failure to Thrive: A Preliminary Investigation

This study investigated the hypothesis that specific types of maternal touch that might promote infant growth are reduced in cases of failure to thrive (FTT) and tested reports that maternal physical interaction and physical affection are diminished in FTT. Frequencies of operationally defined maternal touch categories were scored by blinded raters from videotaped mother-child feeding and play interactions of 21 children, aged 9 to 19 months, with FTT and 18 normally growing comparison children. After scoring and statistical analyses were completed, investigators unblinded to group status and clinical data reviewed the videotapes of the dyads with the lowest touch scores. Mothers of children with FTT provided less matter-of-fact touch in feeding (p = .017) and unintentional touch in play (p = .048) than the comparison group, and there was a trend (p = .082) for them to provide less proprioceptive stimulation in play. Unblinded case reviews indicate that, among children with FTT, extremely infrequent touch signals a marked touch aversion by either the mother or child. Types of maternal touch that may promote growth or facilitate feeding are reduced in FTT, due, in extreme cases, to maternal or child touch aversion. Clinicians evaluating FTT should be alert to very infrequent touch in the mother-child interaction and consider whether it may represent a maternal intolerance of physical contact with her infant or a problem with the infant's feeding competence.