PARENTING AN INFANT AFTER

PROLONGED INFERTILITY:
MATERNAL DEPRESSION AND ANXIETY,
CONFIDENCE, ENJOYMENT, AND
BONDING AS WELL AS INFANT SLEEP
QUALITY AND ROUTINE, AND INFANT
CRYING.

Catherine Pearlman, PhD, LCSW

College of New Rochelle
Department of Social Work
October 14, 2013
 Study Rationale
• Unwanted delay in family formation

• High rate of miscarriages

• Perceived stress and depression during

infertility

• Curious about effects on early parenting

 Previous Research on
Infertility and Parenting
• Depression, stress and anxiety can result
from pregnancy loss and repeated and
lengthy treatment for infertility
• More overprotective, involved, and
enmeshed with their children
• Most research on effects of previous
infertility on child behaviors is inconclusive
• Two studies show that women with a
previous history of infertility may have
children with more sleep difficulties
 Previous Research on
Length of infertility
• Only 5 of 29 studies analyzed participants with
respect to the length of time it took to conceive
• Increase in depression for women who had
prolonged fertility issues
• Length of infertility is positively correlated to
depression and anxiety in women still trying to
conceive.
• More anxiety about the health of fetus with 2 or
more IVF cycles
• A five-fold overrepresentation in a residential facility
for infant feeding or sleeping disorders, or maternal
mood disorder for those conceiving through ART.
 Data Source
• Avon Longitudinal Study of Parents
and Children (ALSPAC)

• A population-based survey located

in England (85% of eligible enrolled)
o 14,541 pregnant women recruited
o 14,062 live births
o 13,988 children who were alive at 1
year of age.
 Ethics Approval
• ALSPAC Ethics and Law
Committee and the Local
Research Ethics Committees

• Committee on Clinical
Investigations at the Albert
Einstein College of Medicine at
Yeshiva University.
 Questionnaires
Time Given Information Obtained

14 weeks – 4 months Gestation Infertility History

18 weeks Gestation Previous pregnancy History and

reactions to pregnancy
32 Weeks Gestation Maternal Demographics, prenatal
anxiety and depression
6 months of Age Infant sleep and crying

8 Months of Age Anxiety and depression, maternal

enjoyment, confidence and
bonding, and social support
 Exclusions from
ALSPAC Sample
• Low birth weight (<5lb 8oz)
• Premature (<37 weeks)
• Died before 1 year
• Multiple births
• Confidentiality conflicts
• Missing data
 Length of Time to
Conceive
Length of time Sample after Percent of Final
to conceive Exclusions Sample

Timely Less than 12 5830 88.4%

Conceivers months

Short-term 1-2 years 561 8.5%

Infertile

Prolonged 3 or more years 202 3.1%

Infertile

Tried to 40 .5
conceive but not
time given
 Study Variables
• Sleep Quality – 6 months
• Sleep Routine -6 months
• Problem Crying – 6 months
• Maternal Bonding (Confidence and
Enjoyment) – 8 months
• Maternal Mental Health:
Depression and Anxiety – 8 months
Control and Demographic
Variables
• Maternal Education
• Maternal Social Class
• Financial Difficulties
• Maternal Age at delivery
• Marital Status
• Parity
• Child’s Ethnicity
• Child’s Gender
• Maternal Medical History
General Demographics –
Sex - child
100.00%
90.00%
80.00%
70.00%
60.00% 52%
51% 51% 49% 48% 49%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
Male Female
Timely Conceivers Short-term Infertility
Prolonged Infertility
General Demographics –
Marital Status
90.00% 80% 79% 78%
80.00%
70.00%
60.00%
50.00%
40.00%
30.00%
20.00% 9% 9% 10% 7% 9% 10% 4% 3% 3%
10.00%
0.00%

Timely Conceivers Short-Term Infertility

Prolonged Infertilty
General Demographics –
Child Ethnicity
100% 97% 98% 96%
90%
80%
70%
60%
50%
40%
30%
20%
10% 3% 2% 4%
0%
White Non-White

Timely Conceivers Short-term Infertility

Prolonged Infertility
 General Demographics with
Statistical Significance
Variable Timely Short-term Prolonged
Conceiver infertility infertility
Maternal age*** 28.91 29.69 31.54
Mean (SD)
Number of .27 (.65) .41 (.70) .51(.90)
Miscarriages ***
Mean (SD)
Parity Mean .79 (.84) .64 (.85) .37 (70)
(SD)***

Significant at ***p<.001
 Findings with No
Significance
No Significant Differences
between groups in:
• Sleep Quality: night waking
• Crying as a problem
• Depression (CCEI and EPDS)
• Maternal Enjoyment and Bonding
 Significant Findings –
Sleep routine
Sleep Routine: Is your baby ever difficult
when put to bed
70 64 64 62
60
50
40
30 27 26
21
20 17
10 11
10
0
Mostly/ Often Sometimes Rarely/ Never
Timely Conceivers Short-term Inferility
Prolonged Infertility
 Significant Findings -
Anxiety
Anxiety using CCEI, Significant at p<.05
* CCEI (0 -16 very anxious)
5

4 3.85
3.39
3.14
3

0
Anxiety on CCEI Mean
Timely Conceivers Short-term Infertility Prolonged Infertility
 Significant Findings –
Maternal Confidence
Maternal Confidence: The range of valid scores is
0-18. 17
16.5
16
15.5 15.11 15.31
15.01
15
14.5
14
13.5
13
12.5
12
Maternal Confidence
Timely Conceivers Short-term Infertility
Prolonged Infertility
 Maternal Confidence
Items
• Dislikes mess around child - NS
• Mom can’t bear child crying –NS

• Child Untimely (p<.01), NS on post-hoc

• Confidence with child (p<.05)
• Unsure if doing right thing for child (p<.01)
• Mom feels lack of time for self (p<.001)
Bonferroni Test Results for Individual
Items on Confidence Scale
 Overall Findings
• Considering the size of the
sample, very few significant
differences observed

• Some increased difficulties, but

very small impact
 Additions to the field
• Large sample where infertile grouped by
length of time trying to conceive and not by
treatment group

• Mothers with Hx of infertility have a similar

experience in early parenting as those
without with respect to sleep, crying,
bonding, maternal depression and anxiety
 Limitations
• Data was obtained in 1991-92

• Sample from UK, narrow geographic area

• Sample almost entirely Caucasian