Longitudinal predictors of maternal stress and coping after very low-birth-weight birth

Abstract

Objective: To determine longitudinal outcomes and contributors to parental stress and coping in mothers of very low-birth-weight (VLBW) children.

Design: Prospective cohort follow-up of high-risk VLBW children (n = 113), low-risk VLBW children (n = 80), and term children (n = 122) and their mothers from birth to 14 years.

Setting: Recruitment from level III neonatal intensive care and term nurseries in a large Midwestern region with follow-up at an academic medical center.

Participants: A total of 315 mother-infant dyads enrolled from November 8, 1989, to February 22, 1992.

Main exposures: High-risk VLBW infants had bronchopulmonary dysplasia. Comparison groups were demographically similar low-risk VLBW children (without bronchopulmonary dysplasia) and term children.

Main outcome measures: Child IQ and self-report measures of parenting stress, family impact, maternal coping, education, and social support.

Results: After VLBW birth, mothers attained fewer additional years of education than term mothers (P = .04). Mothers of high-risk VLBW children felt more personal stress (P = .006) and family stress (P = .009) under conditions of low social support and had greater child-related stress than term mothers; however, they also expressed the highest levels of parenting satisfaction at 14 years. They became less likely to use denial (P = .02) and mental disengagement (P = .03) as coping mechanisms over time. Except for education attainment, mothers of low-risk VLBW infants did not differ from mothers of term children and at 14 years reported the lowest stress.

Conclusions: Parenting a VLBW child had both positive and negative outcomes, dependent on child medical risk, child IQ, social support, and maternal coping mechanisms, suggesting that mothers experience posttraumatic growth and resilience after significant distress post partum.

Figure 1.

Denial coping on the Coping Orientation to Problems Experienced scale by risk group at each age. P=.02 at 96 months and P=.03 at 168 months for high-risk (HR)–very low-birth-weight (VLBW) vs term children. LR indicates low risk.

Figure 2.

Means of total impact on the Impact on Family Scale by risk group and social support (SS) at each age, adjusted for child’s IQ and maternal mental disengagement. HR indicates high risk; VLBW, very low birth weight; and LR, low risk.

Figure 3.

Means of mastery by risk group at each age, adjusted for age, maternal Peabody Picture Vocabulary Test–Revised standard score, social support, mental disengagement, and child IQ. Mastery scores were reverse coded before graphing; thus, higher scores indicate higher mastery. P=.04 at 24 months, P=.03 at 36 months, and P=.03 at 96 months for low-risk (LR)–very low-birth-weight (VLBW) vs term children; P=.008 at 96 months and P<.001 at 168 months for high-risk (HR)–VLBW vs term children.

Figure 4.

Means of standardized child domain scores on the Parenting Stress Index by risk group at each age, adjusted for child age, maternal Peabody Picture Vocabulary Test–Revised standard score, social support, and mental disengagement. P=.005 at 1 month, P=.005 at 8 months, P=.005 at 12 months, P=.006 at 24 months, and P=.008 at 36 months for high-risk (HR)–very low-birth-weight (VLBW) vs term children; P=.006 at 96 months and P=.007 at 168 months for HR-VLBW vs low-risk (LR)–VLBW children; and P=.01 at 168 months for LR-VLBW vs term children.

Figure 5.

Means of parent domain scores on the Parenting Stress Index by risk group at each age, adjusted for child age, maternal Peabody Picture Vocabulary Test–Revised standard score, and mental disengagement. P=.02 at 168 months for low-risk (LR)–very low-birth-weight (VLBW) vs term children. HR indicates high risk.