Posttraumatic Stress Symptoms and the Quality of Maternal-Child Interactions in Mothers of Preterm Infants.

To examine associations between maternal trauma exposure, posttraumatic stress symptoms, and directly observed maternal-child interactions among a diverse cohort of mother-preterm infant dyads at 12-months corrected age. We conducted a retrospective cohort study. Maternal trauma exposure and posttraumatic stress symptoms were measured using the Modified Posttraumatic Stress Disorder Symptom Scale at baseline, 6, and 12 months. The primary outcome was directly observed maternal-child interactions at 12 months corrected age, using the Coding Interactive Behavior Manual. We used linear regression models to estimate the associations between trauma exposure, posttraumatic stress symptoms (and symptom clusters), and observer-rated maternal-child interactions. Among the 236 participants, 89 (37.7%) self-reported as Black and 98 (41.5%) as Latina; mean gestational age of the infants was 31.6 weeks (SD 2.6). Mothers with posttraumatic stress symptoms demonstrated greater maternal sensitivity (β = 0.32; 95% CI, 0.06 to 0.58; standardized effect size = 0.39) and greater dyadic reciprocity (β = 0.39; 95% CI, 0.04 to 0.73; standardized effect size = 0.36) compared to those not exposed to trauma; however, we did not observe significant differences between trauma-exposed but asymptomatic women and those not exposed to trauma. Across symptoms clusters, differences in maternal sensitivity and dyadic reciprocity were most pronounced for mothers with avoidance and re-experiencing symptoms, but not hyperarousal symptoms. Maternal posttraumatic stress symptoms appear to be associated with the quality of maternal-child interactions at one year of age among a cohort of urban, mother-preterm infant dyads. These findings have implications for strengths-based intervention development. The study is registered at clinicaltrials.gov (NCT01892982).

在矫正年龄为12个月的不同母亲 - 早产儿组合队列中，研究母亲创伤暴露、创伤后应激症状以及直接观察到的母婴互动之间的关联。 我们进行了一项回顾性队列研究。在基线、6个月和12个月时，使用改良版创伤后应激障碍症状量表测量母亲的创伤暴露和创伤后应激症状。主要结果是在矫正年龄为12个月时直接观察到的母婴互动，采用《互动行为编码手册》进行评估。我们使用线性回归模型来估计创伤暴露、创伤后应激症状（以及症状群）与观察者评定的母婴互动之间的关联。 在236名参与者中，89人（37.7%）自称是黑人，98人（41.5%）为拉丁裔；婴儿的平均胎龄为31.6周（标准差2.6）。与未暴露于创伤的母亲相比，有创伤后应激症状的母亲表现出更高的母亲敏感性（β = 0.32；95%置信区间，0.06 - 0.58；标准化效应量 = 0.39）和更高的二元互惠性（β = 0.39；95%置信区间，0.04 - 0.73；标准化效应量 = 0.36）；然而，我们未观察到有创伤暴露但无症状的女性与未暴露于创伤的女性之间存在显著差异。在各个症状群中，母亲敏感性和二元互惠性的差异在有回避和再体验症状的母亲中最为显著，但在有过度警觉症状的母亲中不显著。 在一组城市母亲 - 早产儿组合中，母亲的创伤后应激症状似乎与1岁时母婴互动的质量有关。这些发现对基于优势的干预措施的制定具有启示意义。 该研究在clinicaltrials.gov（NCT01892982）注册。