Parenting Stress Index Scores Research Articles

Evaluating Family Coping Mechanisms in Pediatric Seizure Disorders: From Emergency Room to Long-Term Follow-Up.

Pediatric seizure disorders profoundly impact family dynamics, often escalating stress and impairing coping mechanisms. This study aimed to longitudinally assess the impact of pediatric seizures on family stress and coping, evaluating the efficacy of multidisciplinary follow-up care in enhancing psychological resilience and adaptation. A longitudinal study design was implemented, enrolling children aged 1-18 who presented with a first seizure and received a neurologist's diagnosis at the Emergency Clinical Hospital for Children "Louis Turcanu," Timisoara, Romania. Validated questionnaires, including the Parenting Stress Index (PSI), Hospital Anxiety and Depression Scale (HADS), Perceived Stress Scale (PSS-10), and Parental Concerns Questionnaire (PCQ), were employed at baseline, 6, and 12 months. Statistical analysis utilized ANOVA and t-tests to evaluate changes in stress and coping outcomes. The study involved 68 families, with significant reductions in stress and anxiety reported over the follow-up period. Initial PSI scores showed high stress levels across various domains: Emotional Stress (59.47) decreased to 50.63 at one year; Parent-Child Communication Difficulties started at 66.03 ± 20.15 and reduced to 56.92 ± 18.74; and Total Family Stress decreased from 65.55 to 55.97. The HADS scores indicated initial anxiety and depression at 8.2 ± 3.1 and 7.1 ± 2.8, respectively, with reductions to 6.8 and 5.9 by the end of the year. The overall HADS score showed a decrease from 15.4 to 12.8. PCQ results mirrored these findings, with Total Score dropping from 9.7 to 7.7. PSS-10 scores declined from 13.5 to 11.3, with a significant reduction in the positive sub-score. The proactive, multidisciplinary care approach significantly reduced stress and enhanced coping mechanisms in families dealing with pediatric seizures. The decreases in stress, anxiety, and depression scores highlight the potential for integrated care models to improve long-term outcomes in these families. These findings support the continued development of targeted interventions to aid in the management of chronic pediatric conditions.

The psychobiology of child and parental stress and the subjective perception of parental stress in a clinical sample of children

Parental stress may influence the assimilation of treatment strategies and affect a child's recovery trajectory. Thus, assessing parental stress is crucial for children requiring psychiatric care. The Parenting Stress Index (PSI) is widely utilized to gauge perceived parental stress. However, since the PSI does not quantify cortisol concentration (i.e., a biological marker for stress), it is vital to ascertain the alignment between these indicators. Moreover, understanding the correlation in cortisol concentrations between parents and children in clinical contexts can refine assessment and diagnostic methodologies. In an outpatient sample [mean age (Mage) = 9.68 years], we examined the correlation between hair cortisol concentration (HCC) in 60 pairs of parents and children, analyzed the relationship between PSI scores and parent HCC (n = 65), and used a regression model to probe the influence of child HCC and PSI scores on parent HCC (n = 63). The results showed a significant relationship between parent and child HCC (p < 0.001). The “Distraction and Hyperactivity” PSI subscale correlated significantly with parent HCC (p = 0.02). None of the PSI scores correlated with child HCC (p ≥ 0.07). The regression model, accounting for 44% of the variance, demonstrated that only child HCC significantly predicted parent HCC (p < 0.001), while the “Distraction and Hyperactivity” subscale did not.

Stress of the mothers in caring for children with developmental disabilities and some related factors

Objective: to determine the stress status of mothers in caring for children with intellectual disabilities from 4-9 years old and survey some related factors in order to design an intervention program to improve maternal stress. Methods: A cross-sectional study design was implemented in May 2022 in Phuoc Long district, Binh Phuoc province on a sample of all 55 mothers of children with developmental disabilities (4-9 years old) who were screened and diagnosed by interdisciplinary approach in locality. The Parenting Stress Index (PSI) was used to collect information from mothers in a self-completed form. The t-test and linear regression was used to compare and find the association of the stress levels with the independent variables. Results: The mean total PSI score of mothers was 97.2. Maternal stress was associated with level of disability and time of continuous care in univariate analysis and linear regression. Conclusion: The focus of the intervention program can be considered to target groups of mothers with children with more severe disabilities and older age groups in order to improve the effectiveness of the intervention program towards improving the stress status of mothers. Keywords: Stress, children with intellectual disabilities, PSI, maternal health.

Severity of Child Autistic Symptoms and Parenting Stress in Mothers of Children with Autism Spectrum Disorder in Japan and USA: Cross-Cultural Differences.

The purpose of this study was to compare the relationship between parenting stress and autistic symptom severity in the U.S. and Japan. Fifty-two U.S. and 51 Japanese mothers of children aged 2–12 with autism completed measures of parenting stress and child characteristics, including the parenting stress index (PSI), the social communication questionnaire (SCQ), and social responsiveness scale-2 (SRS-2). There was a nonlinear relationship between the child's autistic symptom severity and parenting stress in both countries. We also found some cultural differences: in the parent domain, the relationships between children's SCQ scores and PSI scores differed significantly between the U.S. and Japan. Our findings suggest that autistic severity symptom scores may reflect cross-cultural differences in parenting beliefs, views toward autism, and response styles for evaluating children's behavior. The findings also suggest that parents need support regardless of the child's autism severity, including those with mild to moderate symptoms. Expanding on this line of research and understanding cultural influences on parenting stress may help service providers and agencies offer more culturally sensitive services, parent-education courses, and intervention programs.

Effects of the healthy start randomized intervention on psychological stress and sleep habits among obesity-susceptible healthy weight children and their parents.

Poor sleep and psychological stress are obesity determinants that are rarely included in obesity prevention programs. The aim was to report the effects of the Healthy Start randomized intervention on the secondary outcomes psychological stress and sleep duration and onset latency. Data was obtained from the Healthy Start randomized intervention conducted in 2009-2012 among Danish healthy weight children aged 2-6 years, who had either a high birth weight (>4,000 g), high maternal pre-pregnancy body mass index (>28 kg/m2), or low maternal educational level (≤10 years of schooling) and their parents. The intervention was designed to deliver improvements in diet and physical activity habits, optimization of sleep habits, and reduction of psychological family stress. The average intervention period was 15 months. Children with information on a 7-day sleep record, sleep onset latency, Strengths and Difficulties Questionnaire (SDQ), and a modified version of Parenting Stress Index (PSI) were included. The effects of the intervention on sleep habits, PSI scores, SDQ Total Difficulties (SDQ-TD) and Pro-social Behavior scores, and 95% Confidence Intervals (95% CI) were analyzed using linear regression intention-to-treat (n = 543 (intervention group n = 271, control group n = 272)) analyses. No statistically significant effects on sleep duration, sleep onset latency, PSI score, or SDQ Pro-social Behavior score were observed. Values both before and after the intervention were within the normal range both for children in the intervention and children in the control group. Mean change in SDQ-TD was 0.09 points (95% CI -0.57;0.59) in the intervention group, and -0.69 points (95% CI -1.16; -0.23) in the control group (p = 0.06). In conclusion, there were no intervention effects in relation to sleep duration, sleep onset latency, PSI score, or SDQ Pro-social behavior. There was an indication that children in the intervention group had slightly more behavioral problems than the control group after the intervention, but values were within normal range both before and after the intervention, and the difference is not considered to be clinically meaningful.

Corrigendum

Corrigendum

Quality of life in adolescents with epilepsy, cerebral palsy, and population norms.

To compare: (1) self- and proxy-reported quality of life (QoL) in adolescents with epilepsy, cerebral palsy (CP), both epilepsy and CP, and a representative general population sample; and (2) parental stress between parents of adolescents with epilepsy, CP, or both epilepsy and CP. This was a cross-sectional observational study with 496 adolescents with epilepsy, 699 with CP, 192 with both CP and epilepsy, and 15396 from the general population, assessed with the KIDSCREEN-52 and Parenting Stress Index (PSI). All KIDSCREEN-52 domains showed statistically significant differences across groups. The epilepsy population showed clinically better scores for 'school environment' than the general population (Cohen'sd=0.62). Parents scored adolescents with CP lower than adolescents with epilepsy or general populations on 'physical health' (d=0.57, d=0.55) and 'social-support and peers' (d=0.82, d=0.91). Parents of adolescents with CP scored them lower than parents of the epilepsy group on 'autonomy' (d=0.62).Parents of adolescents with epilepsy scored them lower on 'mood and emotions' (d=0.52) and 'social acceptance' (d=0.66) than the general population. PSI scores were better for parents of adolescents with CP than for parents of adolescents with epilepsy (d=2.12, d=2.70, d=3.35, d=1.67). Adolescents with epilepsy or CP self-report equal or better QoL than the general adolescent population, which should comfort families and allow clinicians to address parental concerns. Adolescents with epilepsy, with or without cerebral palsy (CP), self-reported better school environment than adolescents in the general population. Proxy quality of life(QoL) results showed clinically important differences across groups in 6 out of 10 domains of the KIDSCREEN-52. Proxy-reported results showed poorer QoL scores for adolescents with epilepsy or CP than the general population. Parental stress level was lower in parents of children with CP or both CP and epilepsy, than in those with only epilepsy.

Atypical maternal cradling laterality in an impoverished South African population

ABSTRACTHuman studies consistently report a 60%–80% maternal left cradling preference. The dominant explanation points to an engagement of the emotionally more-attuned right brain. In contrast, we found equal incidences of left (31.3%), right (34.3%) and no-preference (34.3%) cradling in an impoverished South African population living under adverse conditions characterized by extreme dangers. We found striking differences on the Parenting Stress Index (PSI) between mothers with no cradling laterality preference and mothers with either a left or right preference. In several mammals a homologous left preference becomes stronger when acute threats prevail, rendering the rightwards shift we observed under dangerous conditions seemingly paradoxical. We propose this paradox can be resolved in terms of life-history strategy theory which predicts reduced parental investment in chronically dangerous environments. We interpret our high PSI score findings in no-preference cradlers as indicative of poorer, or at least ambivalent, maternal coping which many studies show is typically associated with reduced emotional sensitivity and responsiveness. We suggest that the latter may be a psychological mechanism mediating a partial withdrawal of parental investment in response to an enduringly adverse environment. To the best of our knowledge, this is the first study investigating cradling laterality preferences in an adverse socioeconomic environment.

Vagus nerve stimulation for 6- to 12-year-old children with refractory epilepsy: Impact on seizure frequency and parenting stress index

ObjectivesRefractory epilepsy (RE) is frequently associated with neuropsychological impairment in children and may disrupt their social development. Vagus nerve stimulation (VNS) had been reported to have beneficial effects on behavioral outcomes. The aim of this study was to compare Parenting Stress Index (PSI) scores before and after VNS device implantation in children with RE, especially those who experienced seizure frequency reduction. MethodsWe conducted a one-group pretest–posttest study in school age children with RE. Seizure frequency and PSI were recorded at 12months after VNS device implantation. ResultsTreatment with VNS was significantly associated with reduced seizure frequency and parental stress as measured by PSI. Factors contributing to seizure frequency included idiopathic/cryptogenic etiology and neurobehavioral comorbidities. In children with reduced seizure frequency, statistically significant improvements in the child domain of the PSI on the subscales of mood and reinforces parent were found. In the parent domain, the scores for social isolation were reduced. ConclusionsTreatment with VNS was significantly associated with reduced seizure frequency and improved PSI scores, especially within the child domain on the mood and reinforces parent subscales. These findings suggest that VNS reduced not only seizure frequency but also the psychological burden on children with RE.

Sugarsquare, a Web-Based Patient Portal for Parents of a Child With Type 1 Diabetes: Multicenter Randomized Controlled Feasibility Trial.

BackgroundRaising a child with type 1 diabetes (T1D) means combining the demands of the disease management with everyday parenting, which is associated with increased levels of distress. A Web-based patient portal, Sugarsquare, was developed to support parents, by providing online parent-professional communication, online peer support and online disease information.ObjectiveThe first aim of this study was to assess the feasibility of conducting a multicenter, randomized controlled trial in Dutch parents of a child with T1D. The second aim was to assess the feasibility of implementing Sugarsquare in clinical practice.MethodsThe parents of 105 children (N=105) with T1D below the age of 13 participated in a 6-month multicenter randomized controlled feasibility trial. They were randomly assigned to an experimental (n=54, usual care and Sugarsquare) or a control group (n=51, usual care). Attrition rates and user statistics were gathered to evaluate feasibility of the trial and implementation. To determine potential efficacy, the parenting stress index (PSI-SF) was assessed at baseline (T0) and after 6 months (T1).ResultsOf a potential population of parents of 445 children, 189 were willing to participate (enrollment refusal=57.5%, n=256), 142 filled in the baseline questionnaire (baseline attrition rate=25%, n=47), and 105 also filled in the questionnaire at T1 (post randomization attrition rate during follow-up=26%, n=32). As such, 24% of the potential population participated. Analysis in the experimental group (n=54) revealed a total of 32 (59%) unique users, divided into 12 (38%) frequent users, 9 (28%) incidental users, and 11 (34%) low-frequent users. Of the total of 44 professionals, 34 (77%) logged in, and 32 (73%) logged in repeatedly. Analysis of the user statistics in the experimental group further showed high practicability and integration in all users, moderate acceptability and demand in parents, and high acceptability and demand in health care professionals. Baseline parenting stress index scores were related to the parents’ frequency of logging on (ρ=.282, P=.03) and page-views (ρ=.304, P=.01). No significant differences in change in parenting stress between experimental and control group were found (F3,101=.49, P=.49).ConclusionsThe trial can be considered feasible, considering the average enrollment refusal rate, baseline attrition rate and postrandomization attrition rate, compared to other eHealth studies, although lower than hypothesized. Implementing Sugarsquare in clinical practice was partly feasible, given moderate demand and acceptability in parent users and lack of potential efficacy. Parents who reported higher levels of parenting stress used Sugarsquare more often than other parents, although Sugarsquare did not reduce parenting stress. These results indicate that Web-based interventions are a suitable way of providing parents of children with T1D with additional support. Future studies should determine how Sugarsquare could reduce parenting stress, for instance by adding targeted interventions. Factors potentially contributing to successful implementation are suggested.Trial RegistrationNederlands Trial Register Number: NTR3643; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3643 (Archived by WebCite at http://www.webcitation.org/6qihOVCi6)

Psychosocial stress and obesity among children residing in Kaunas City

IntroductionAn unfavorable psychosocial environment has been associated with an increased prevalence of obesity among children. However, the available evidence on the association of low socioeconomic status and parent-child relationships with childhood obesity is scarce. The aim of our study was to conduct a simultaneous evaluation of the risks associated with pathological mother-child relationships, education level, and overweight/obesity among 4−6 year-old children. MethodsThis cross-sectional study included 1489 mother-child pairs living in Kaunas city, Lithuania. The Parenting Stress Index was measured using the Parent-Child Dysfunctional Interaction subscale. Children's overweight/obesity was defined as the body mass index ≥18kg/m2. Logistic regression models as well as crude and adjusted odds ratios (OR) and their 95% confidence intervals (CI) were used to indicate the strength of the associations between childhood overweight/obesity, maternal education level, and psychosocial stress. ResultsThe percentage of children with overweight/obesity rose with an increasing Parenting Stress Index score. The percentage of children with overweight/obesity in the group of parents with better education and normal mother-child relations was 6.0%, while in the group of less educated parents and pathological mother-child relations, this percentage reached 13.9%. The stratified multivariable model showed that, with reference to the group of better educated parents and normal mother-child relations, lower education level and pathological mother-child relations were statistically significant risk factors for overweight/obesity in 4–6 year-old children, increasing the OR of overweight/obesity (aOR: 2.43; 95% CI: 1.31–4.51). Pathological mother-child relations and maternal smoking mediated the effect of low maternal education level on children's BMI z-scores. ConclusionPathological mother-child relations, lower parental education levels, and smoking may be predictors of children's overweight/obesity. Measures oriented towards health behavior and psychosocial stress management should be encouraged among parents in order to decrease the risk of overweight/obesity in their children.

Living with children with autistic spectrum condition: parental stress and the impact upon family functioning.

Introduction. Parenting a child with Autistic Spectrum Condition (ASC) is both practically and emotionally challenging. The condition brings difficulties in communication and social interaction, as well as abnormal behaviour patterns, all of which have an impact upon parents. Method. As part of a larger study, one hundred mothers of children with ASC were asked to complete several scales including the Family Adaptation and Cohesion Evaluation Scale (FACES IV), and The Parenting Stress Index-Short form (PSI-SF). Results. The Parenting Stress Index scores showed that the mothers of the primary aged children felt very high levels of parental stress, and distress, while the mothers of secondary age children reported lesser levels. The FACES IV scores indicated that the sense of flexibility was higher in the mothers of adolescents, and that the families of girls were less cohesive than that of boys. Discussion. The highest level of parental stress was reported by the mothers of younger children, with the parenting of teenage girls being the most stressful. Conclusion. A family pattern which tends to seek smaller changes could reduce the sense of family distress that parents of children with ASC experience. As the children move into adolescence the mothers tend to feel less stressed, but less so for the mothers of teenage girls.

Blended Infant Massage–Parenting Enhancement Program on Recovering Substance-Abusing Mothers' Parenting Stress, Self-Esteem, Depression, Maternal Attachment, and Mother-Infant Interaction

This study aimed to determine whether a blended Infant Massage-Parenting Enhancement Program (IMPEP) improved maternal psychosocial health outcomes (parenting stress, depressive symptoms, self-esteem, maternal attachment) and maternal-infant interaction among substance-addicted mothers (SAMs) actively engaged in outpatient rehabilitation. Designed as a randomized, three-group controlled trial testing two levels of psychoeducational intervention (IMPEP vs. PEP) and a control group (standard care parenting resources), the study was conducted in two substance abuse centers in southeast Florida on a convenience sample of 138 recovering SAM-infant pairs. IMPEP or PEP classes were held weekly on Weeks 2-5, with data collected at baseline (Week 1), Week 6, and Week 12 via structured interviews, observation (Observation Checklist on Maternal-Infant Interaction), and self-administered questionnaires (Abidin Parenting Stress Index, Beck Depression Inventory, Rosenberg Self-Esteem Scale, Muller's Maternal Attachment Inventory), analyzed descriptively and inferentially using Kruskall-Wallis analysis of variance and post hoc Wilcoxon rank sum and Mann-Whitney U tests. Both IMPEP and PEP groups had significantly increased Parenting Stress Index scores (decreased parenting stress) and decreased Beck Depression Inventory scores (decreased depressive symptoms) compared to controls at Week 12, whereas there were no clinically meaningful differences among study groups in Rosenberg Self-Esteem Scale, Muller's Maternal Attachment Inventory, or Observation Checklist on Maternal-Infant Interaction scores. Only the IMPEP group showed significant improvements in both psychological and physical (waist-hip ratio) measures of parenting stress over time. The findings suggest that infant massage blended into a structured parenting program has value-added effects in decreasing parenting stress and maternal depressive symptoms, but not on SAM's self-esteem, attachment, or maternal-infant interaction.

The Relationship Among Depression, Parenting Stress, and Partner Support in Low-Income Women From Montevideo, Uruguay

We investigated the prevalence and predictors of depression in low-income mothers (n = 99) of young children from Uruguay. We administered the Beck Depression Scale (BDI) and the Parenting Stress Index (PSI), and asked who is responsible for the main tasks of parenting and household care. We found a high prevalence of moderate-to-severe depression (BDI >19 points, 31.3%), with women with t scores > 90 on the PSI being seven times more likely to experience moderate-to-severe depressive symptoms than women with lower PSI scores (p <.01). This is the first investigation of the predictors of depression in urban Uruguayan mothers of low socioeconomic status.

Parenting stress in parents of children with cerebral palsy and its association with physical function

This study was carried out to determine parenting stress levels in the parents of children with cerebral palsy (CP) and to examine the factors that contribute to the parenting stress score. Parenting stress levels were assessed in 101 parents of children with CP (mean age 8.8 years, SD 2.1) using the parenting stress index (PSI). The extent of involvement, gross motor function classification system, and pediatric outcomes data collection instrument were collected for patients' information. The responding parent, parents' age, percentage of involvement in the parenting role, employment, socioeconomic status, educational level, other children, and age were obtained for parents' information. Normative percentile scores were calculated for each subscale, each domain, and the total PSI score. Multiple regression analysis was carried out to determine the significant factors contributing to the PSI score. The mean total PSI score was 97.7 (SD 4.6). The global function score of pediatric outcomes data collection instrument (P=0.004) and ambulatory states (gross motor function classification system, P=0.002) were found to be the significant factors contributing to the total PSI score, where parents of children with a more favorable function showed a higher PSI score. Parents of children with CP showed a high level of parenting stress. Clinicians should keep in mind that psychological support and intervention might be needed for parents of children with CP.

Relational development in children with cleft lip and palate: influence of the waiting period prior to the first surgical intervention and parental psychological perceptions of the abnormality

BackgroundThe birth of a child with a cleft lip, whether or not in association with a cleft palate, is a traumatic event for parents. This prospective, multidisciplinary and multi-centre study aims to explore the perceptions and feelings of parents in the year following the birth of their child, and to analyse parent–child relationships. Four inclusion centres have been selected, differing as to the date of the first surgical intervention, between birth and six months. The aim is to compare results, also distinguishing the subgroups of parents who were given the diagnosis in utero and those who were not.Methods/DesignThe main hypothesis is that the longer the time-lapse before the first surgicalintervention, the more likely are the psychological perceptions of the parents to affect the harmonious development of their child. Parents and children are seen twice, when the child is 4 months (T0) and when the child is one year old (T1). At these two times, the psychological state of the child and his/her relational abilities are assessed by a specially trained professional, and self-administered questionnaires measuring factors liable to affect child–parent relationships are issued to the parents. The Alarme Détresse BéBé score for the child and the Parenting Stress Index score for the parents, measured when the child reaches one year, will be used as the main criteria to compare children with early surgery to children with late surgery, and those where the diagnosis was obtained prior to birth with those receiving it at birth.DiscussionThe mental and psychological dimensions relating to the abnormality and its correction will be analysed for the parents (the importance of prenatal diagnosis, relational development with the child, self-image, quality of life) and also, for the first time, for the child (distress, withdrawal). In an ethical perspective, the different time lapses until surgery in the different protocols and their effects will be analysed, so as to serve as a reference for improving the quality of information during the waiting period, and the quality of support provided for parents and children by the healthcare team before the first surgical intervention.Trial RegistrationClinicalTrials.gov Identifier: NCT00993993.

Maternal parenting stress and its correlates in families with a young child with cerebral palsy

To investigate factors predicting parenting stress in mothers of pre-school children with cerebral palsy. Eighty mothers and children participated. Mothers completed the Parenting Stress Index (PSI) and the following measures of family functioning: family support, family cohesion and adaptability, coping strategies, family needs and locus of control. Children were assessed using the Griffiths Scales and the Gross Motor Function measure. The child's home environment was assessed using Home Observation for Measuring the Environment. Mothers had higher mean total PSI scores than the means for the typical sample; 43% had total PSI scores above the threshold for clinical assessment. Cluster analysis demonstrated five distinct clusters of families, more than half of whom were coping well. High stress items were role restriction, isolation and poor spouse support, and having a child who was perceived as less adaptable and more demanding. Lower stress items indicated that this sample of mothers found their children emotionally reinforcing and had close emotional bonds. Regression analysis showed that the factors most strongly related to parenting stress levels were high family needs, low family adaptability and cognitive impairment in the child. The results confirmed the individuality of families, and that individual characteristics of coping and feeling in control, together with family support and cohesion, are associated with variation in amount of stress experienced in parenting a child with cerebral palsy.

Relationship Between Parenting Stress and Concerns Identified by Developmental Screening and Their Effects on Parental Medical Care—Seeking Behavior

This cross-sectional study examines the relationship between parenting stress and concerns identified by developmental screening and their effects on parents' decisions to seek medical care for their children. A total of 182 parents completed both the Parenting Stress Index (PSI) and the Parents' Evaluation of Developmental Status (PEDS) when their children were admitted to a sick child care program that provides parents the option of requesting medical evaluations for their children with mild acute illnesses. Although 31.6% of parents (N = 62) requested medical evaluations, neither PSI nor PEDS scores were associated with these requests. However, PEDS scores indicating significant parental concerns about their child's development or behavior predicted clinically significant levels of parenting stress on the PSI (odds ratio 4.9; 95% confidence interval, 1.5-15.9; P = .007). Primary pediatric health care providers who routinely perform developmental screening need to consider this relationship when interpreting developmental screening results and offer supportive and referral services to families as needed.

Randomised trial of a parenting intervention during neonatal intensive care

Objective:To evaluate the influence of parenting intervention on maternal responsiveness and infant neurobehavioural development following a very premature birth.Design:Cluster-randomised controlled trial, with a crossover design and three-month washout period.Setting:Six neonatal...

Parenting stress in first-time mothers of twins and triplets conceived after in vitro fertilization

Objective To examine psychosocial and obstetric outcomes at 1 year postpartum in first-time mothers who conceived after IVF. Design Prospective cohort study. Setting University medical center in the United Kingdom. Patient(s) One hundred twenty-nine mothers with a single naturally conceived birth, 95 mothers with a single IVF birth, and 36 mothers with a twin or triplet IVF birth. Main outcome measure(s) General Health Questionnaire and Parenting Stress Index. Result(s) Twenty-two percent of mothers of multiples had Parenting Stress Index scores indicating severe parenting stress, compared with 5% of mothers of IVF singletons (odds ratio, 5.14 [95% confidence interval (CI), 1.55–16.99]) and 9% of mothers of naturally conceived singletons (odds ratio, 2.76 [95% CI, 1.03–7.4]). Mothers of multiple children conceived by IVF did not have poorer mental health but were less likely to be in paid employment at follow-up than were mothers of singletons conceived by IVF (odds ratio, 0.3 [95% CI, 0.13–0.67]) or naturally (odds ratio, 0.27 [95% CI, 0.12–0.59]). Multiple births were more premature, had lower birth weights, and had more medical complications. They were more likely to have been admitted to special care than were singletons conceived by IVF (odds ratio, 14.6 [95% CI, 5.1–42.0)] or those conceived naturally (odds ratio, 10.59 [95% CI, 3.67–30.57]) Conclusion(s) Clinicians should ensure that couples making decisions about embryo transfer have considered the potential psychosocial burden of a multiple birth.