Prematurity, maternal posttraumatic stress and consequences on the mother-infant relationship

Objective: Premature birth is a stressful experience for parents. This study explores the links between maternal posttraumatic stress, maternal attachment representations of the infant and mother-infant dyadic interactions.

Methods: The study enrols 47 preterm (GA<34 weeks) and 25 full-term infants. The Perinatal Posttraumatic Stress Disorder Questionnaire was administered to evaluate maternal posttraumatic stress symptoms. At 6 months of corrected age, maternal attachment representations of the infant were explored and coded with the Working Model of the Child Interview. Interactive characteristics were explored in a videotaped play session and coded with the Care Index.

Results: Full-term mothers were more likely to follow a "Cooperative" dyadic pattern of interaction with the infant and demonstrate Balanced representations of the infant. Preterm mothers with high posttraumatic stress symptoms were more likely to follow a "Controlling" dyadic pattern of interaction, with more Distorted representations. In contrast, preterm mothers with low posttraumatic stress symptoms were more likely to fall into a "Heterogeneous" group of patterns of dyadic interaction, with Disengaged representations. Interestingly, in Cooperative preterm dyads, only 23% of the mothers demonstrated Balanced representations, despite rates of 69% in full-term Cooperative dyads.

Conclusion: Premature birth affects both mother-infant interaction characteristics and maternal representations of attachment with the infant. In particular, a "Controlling" dyadic pattern was associated with high maternal posttraumatic stress symptoms and Distorted maternal representations. It is important to examine the impact of maternal posttraumatic stress on the parent-infant relationship in order to plan supportive, preventive interventions in the neonatal period.