Maternal psychological distress and parenting stress after the birth of a very low-birth-weight infant

Context Few studies document how parents adapt to the experience of a very low-birth-weight (VLBW; <1500 g) birth despite societal concerns about the ethics and justification of intensive care for these infants. Objective To determine the degree and type of stress experienced over time by mothers whose infants vary in degree of prematurity and medical and deve lopmental risk. Design Longitudinal prospective follow-up study of-a cohort of mothers of h igh- and low-risk VLBW and term infants from birth to 3 years. Setting All level III neonatal intensive care units from a large midwestern metropolitan region, Participants Mothers and infants prospectively and consecutively enrolled i n a longitudinal study between 1989 and 1991. High-risk VLBW infants were d iagnosed as having bronchopulmonary dysplasia, and comparison groups were l ow-risk VLBW infants without bronchopulmonary dysplasia and term infants (> 36 weeks, >2500 g). Main Outcome Measures Standardized, normative self-report measures of mater nal psychological distress, parenting stress, family impact, and life stres sors. Results Mothers of VLBW infants (high risk, n = 122; low risk, n = 84) had more psychological distress than mothers of term infants (n = 123) at 1 mon th (13% vs 1%; P = .003). At 2 years, mothers of low-risk VLBW infants did not differ from term mothers, while mothers of high-risk infants continued to report psychological distress. By 3 years, mothers of high-risk VLBW chi ldren did not differ from mothers of term children in distress symptoms, wh ile parenting stress remained greater. Severity of maternal depression was related to lower child developmental outcomes in both VLBW groups. Conclusions The impact of VLBW birth varies with child medical risk status, age, and developmental outcome. Follow-up programs should incorporate psyc hological screening and support services for mothers of VLBW infants in the immediate postnatal period, with monitoring of mothers of high-risk VLBW i nfants.