Maternal Psychological Distress and Parenting Stress After the Birth of a Very Low-Birth-Weight Infant

VE R Y L O W-B I R T H-W E I G H T (VLBW; ,1500 g) birth has become an increasingly common occurrence because of medical advances in neonatal intensive care and management of high-risk pregnancy. Approximately 50 000 VLBW births occur annually in the United States. Significant improvements have occurred in survival rates of small preterm infants, especially those of extremely low birth weight (ie, ,1000 g). However, follow-up studies of survivors have documented higher rates of neurodevelopmental impairment, including motor, visual, and hearing disabilities; mental retardation; attention disorders; and learning disabilities at school age in comparison with term infants. Increased rates of disability among survivors have engendered debate about the ethics and justification of intensive care for the most immature infants. Although the birth of an infant with VLBW poses a considerable challenge to parents, there is little information detailing how they adapt to this experience and subsequent caregiving demands. Mothers of preterm infants experience more severe levels of psychological distress in the neonatal period than mothers of full-term infants, with depression and anxiety notable at the time of hospital discharge, but there have been few controlled studies beyond this period. In studies of healthy term infants, maternal depression has been Author Affiliations: Department of Pediatrics, School of Medicine (Drs Singer, Collin, and Baley and Ms Salvator), and the Mandel School of Applied Social Sciences (Dr Guo), Case Western Reserve University, MetroHealth Medical Center (Drs Singer and Collin), University Hospitals (Drs Singer and Baley), and Fairview Hospital (Dr Lilien), Cleveland, Ohio. Corresponding Author and Reprints: Lynn T. Singer, PhD, Department of Pediatrics, Triangle Bldg, Suite 250A, 11400 Euclid Ave, Cleveland, OH 44106 (e-mail: [email protected]). Context Few studies document how parents adapt to the experience of a very lowbirth-weight (VLBW; ,1500 g) birth despite societal concerns about the ethics and justification of intensive care for these infants.