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Karina M Shreffler,1 Stacy Tiemeyer,1 Lucia Ciciolla,2 Julie M Croff31Department of Human Development and Family Science, Oklahoma State University, Stillwater, OK, USA; 2Department of Psychology, Oklahoma State University, Stillwater, OK, USA; 3Department of Rural Health, Center for Health Sciences, Oklahoma State University, Tulsa, OK, USAAbstract: This pilot study explored the effects of a two-week mindfulness-based intervention designed to enhance maternal-fetal bonding among pregnant women. Participants who listened to their baby’s heartbeat every day for two weeks and received four texts per week with mindfulness-based activities to do from home reported a significant increase in reported maternal-fetal attachment scores across the study period. Enhancing maternal-fetal bonding through this low-cost intervention has the potential for reducing adverse birth outcomes.Keywords: pregnancy, mindfulness, intervention, attachment, bonding, MFAS

Background: Satisfaction with birth and healthcare provider experiences have long-term effects for maternal health. Research has shown that mothers who report more trust, respect, and self-efficacy in their relationship with their healthcare providers are more likely to report positive birthing experiences. Further, individuals with obesity, including pregnant mothers, are more likely to experience weight-related stigma from healthcare providers which may negatively impact satisfaction with this relationship. Thus, the current study examines maternal pre-pregnancy body mass index (BMI) as a moderator between birth and provider satisfaction., Methods: A sample of 94 women (ages 16-38) were recruited during pregnancy. Participants completed surveys about their satisfaction with their birth experience, provider satisfaction, height, weight, and demographics including age and education. A moderation analysis was used to examine pre-pregnancy BMI as a moderator between birth and provider satisfaction., Results: Results show that provider satisfaction is positively associated with birth satisfaction among mothers with moderate (overweight) to high (obese) pre-pregnancy BMI scores in our sample., Conclusions: Findings suggest that strengthening the patient-provider relationship may promote satisfaction with birth experiences., (© 2024. The Author(s).)

Competing Interests: Competing interests: None declared.

Introduction: Prior research has identified associations between pregnancy intendedness and maternal-foetal bonding, but no studies have examined the potential mediation of pregnancy happiness on the development of the maternal-infant relationship., Methods: In 2017-2018, a clinic-based pregnancy cohort of 177 low-income and racially diverse women in a South-Central U.S. state participated in a study examining their pregnancy intentions, attitudes and behaviours. Pregnancy intentions and happiness and demographic characteristics were measured during the first trimester assessment, and maternal-foetal bonding was measured with the Prenatal Attachment Inventory (PAI) during the second trimester. Structural equation modelling was used to examine the associations between intendedness, happiness and bonding., Results: Findings indicate positive associations between intended pregnancies and pregnancy happiness and pregnancy happiness to bonding. The direct effect from intended pregnancy to maternal-foetal bonding was not significant, providing evidence for full mediation. We did not find any associations between pregnancies that were unintended or ambivalent with pregnancy happiness or maternal-foetal bonding., Conclusions: Pregnancy happiness provides one potential explanation for the association between intended pregnancies and maternal-foetal bonding. These findings have implications for research and practice, as inquiring about mothers' pregnancy attitudes (e.g. how happy they are about their pregnancy) may be more important for maternal psychological health outcomes, such as the maternal-child relationship, than whether or not their pregnancies were intended.

Substance use rates, particularly among women, increased substantially during the COVID-19 pandemic. Psychological and economic risks disproportionately experienced by women were associated with increase in substance use patterns during the pandemic. Using substances (i.e., tobacco, alcohol, cannabis) to cope with stress is well-documented; what is less known are protective factors that were associated with less substance use during the pandemic. We examined whether mothers of young children ( N  = 96) who reported postpartum bonding impairment before the start of the pandemic reported greater substance use during the pandemic as a means to cope. Results from linear regression analyses found that mothers who reported higher levels of pre-pandemic mother-infant bonding impairments reported greater use of alcohol and other substances as a means to cope with pandemic stressors. These findings suggest that social connections might be a strategy to reduce substance use as a maladaptive coping behavior, especially during widespread crises such as the recent pandemic or for mothers of young children. In particular, promoting postpartum bonding through interventions might help to reduce substance use among new mothers., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Roland, Dressler and Shreffler.)

Objectives: Nearly half of all pregnancies in the U.S. are classified as unintended (e.g. unplanned, mistimed, or unwanted), which have been linked to numerous adverse consequences for maternal and child outcomes. Recent evidence suggests that happiness about a pregnancy is often a better predictor of maternal and infant health outcomes than pregnancy intentions, but few studies have examined maternal predictors of pregnancy happiness., Methods: Using a clinic-based sample of pregnant women ( n = 177), we apply multiple regression analysis to examine the association between maternal adverse childhood experiences and pregnancy happiness, as well as the moderating role of pregnancy intentions., Results: Women with more childhood adversity and pregnancies that were unplanned and mistimed or unwanted reported lower levels of pregnancy happiness, compared with women with less childhood adversity and intended pregnancies. However, pregnancy intentions did not moderate the relationship between maternal adverse childhood experiences and pregnancy happiness., Conclusion: Our results suggest that pregnancy happiness is lower among mothers with a history of childhood adversity and pregnancies classified as unplanned and mistimed or unwanted. Understanding the factors that impact pregnancy happiness is critical to inform prenatal clinical practice and health policy, particularly when caring for those with a history of adversity.

Food insecurity during pregnancy is associated with various adverse pregnancy outcomes for the mother and infant, but less is known about the role of periconception food insecurity and its links to maternal and child wellbeing in the postpartum period. In a sample of 115 diverse (41% white) and predominately low-income mothers, results of hierarchical regression analyses showed that periconception food insecurity was positively associated with parenting stress at 2 months postpartum. A negative association between food insecurity and maternal-infant bonding at 6 months postpartum was mediated after controlling for prenatal depression, social support, and demographic factors. Findings highlight the need for maternal linkage to effective food security programs, such as United States-based Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), for women during their childbearing years due to the critical importance of food security for maternal and infant well-being., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Shreffler, Dressler, Ciciolla, Wetherill and Croff.)

Introduction: Admission of a newborn to a neonatal intensive care unit (NICU) can be a highly stressful event that affects maternal psychological well-being and disrupts the early maternal-infant bonding relationship. Determining factors that promote maternal-infant bonding among those with a NICU admission is essential for the development of effective interventions., Methods: Using a longitudinal clinic-based sample of diverse and low-income pregnant women, we examined whether maternal-fetal bonding measured during the second trimester moderated the association between NICU admission and postpartum bonding measured at six months post birth, controlling for demographic characteristics., Results: Approximately 18% of the sample experienced a NICU admission at birth. NICU admission was associated with lower postpartum bonding (b = -8.74; p < .001, Model 1), whereas maternal-fetal bonding was associated with higher bonding reported at six months postpartum (b = 3.74, p < .001, Model 2). Results of the interaction revealed that women who reported higher maternal-fetal bonding reported higher postnatal bonding regardless of NICU admission status., Discussion: Because maternal-fetal bonding can be enhanced through intervention, it is a promising target for reducing the risks of NICU admission for the early maternal-infant relationship., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Hispanic adolescents report earlier onset and higher substance use rates than their non-Hispanic White and Black peers. This study examines the associations between the immigration-related arrest of a family member and substance use among Hispanic early adolescents and explores the mediating role of depressive symptoms as the mechanism explaining the association. We apply a mediated multiple linear regression analysis on 661 Hispanic youth attending 7th grade in an urban school district in a south-central, new arrival state. We found that Hispanic early adolescents who experienced the immigration-related arrest of a family member reported significantly higher substance use than Hispanic youth who did not experience the arrest of a family member due to immigration enforcement. Moreover, we found this relationship to be fully mediated by depressive symptoms. Findings suggest that even though the majority of Hispanic youth in the U.S. are citizens, experiencing the immigration-related arrest of a family member is not uncommon and has critical implications for poor mental health and maladaptive coping behaviors., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

This study explores the role of personality traits in the relationship between maternal adverse childhood experiences (ACEs) and perceived stress during pregnancy. Pregnancy can be a stressful time for new mothers. ACEs have been associated with elevated levels of pregnancy stress, and have also been linked to the Big Five dimensions of personality, including a positive association with neuroticism. The Big Five have also been associated with perceptions of stress, and there is evidence to suggest that personality may be one mechanism through which ACEs disrupt psychosocial functioning during pregnancy. The sample included 177 pregnant girls and women (ages 15-40) from two prenatal clinics serving diverse and low-income patients. Participants completed online questionnaires on perceived stress, ACEs, and the Ten Item Personality Inventory. Results of a path analysis and test of mediation showed significant indirect effects from ACEs to perceived stress mediated independently by neuroticism and conscientiousness. Mothers with high ACEs reported higher neuroticism and lower conscientiousness, and in turn, experienced high levels of perceived stress during pregnancy. High neuroticism and low conscientiousness associated with early adverse experiences increase the risk for perceived stress during pregnancy. Screening for ACEs may help identify mothers at risk for perinatal stress and provide the opportunity for additional support for maternal emotion regulation and mental health., Competing Interests: Conflicts of interestAll authors declare that they have no conflict of interest., (© The Author(s), under exclusive licence to Springer Nature Switzerland AG 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Background: Mindfulness-based interventions have been shown to be efficacious for reducing psychological distress and mental health symptoms and promoting well-being, including during pregnancy and postpartum. There is promising, though limited, evidence showing that interventions that focus on improving the mother-infant relationship are associated with improvements in both the mother-infant relationship and maternal mental health symptoms. The current study examines the effects of a prenatal mindfulness-based, reflective intervention designed to enhance maternal-fetal bonding on pregnancy-related distress and prenatal depressive symptoms., Methods: Out of a larger sample of 130 pregnant women in their second trimester, 15 women were recruited to participate in a 2-week long mindfulness-based, reflective intervention with daily short (<5-minute) activities. Multiple linear regression analyses were conducted to examine associations between the intervention and pregnancy-related distress and depression during the third trimester of pregnancy, controlling for race, age, education, union status, and first trimester depressive symptoms., Results: Results indicate that women who participated in the intervention during their second trimester reported lower pregnancy-related distress in their third trimester but no differences in depressive symptoms., Conclusions: A brief, mindfulness-based intervention delivered during pregnancy via cellphone texts can be a useful tool to reduce maternal distress related to pregnancy. Additional reflective exercises that address mood and global stress, as well as increasing the amount and/or frequency of the intervention, may be important for promoting maternal mental health more globally., Competing Interests: No competing financial interests exist., (© Lucia Ciciolla et al., 2023; Published by Mary Ann Liebert, Inc.)

Depression during pregnancy is common, and previous research suggests childhood adversity may increase the risk for prenatal depression. Support during pregnancy can buffer these risks, and paternal support is associated with improved maternal well-being during pregnancy. There is evidence to suggest that increased support from fathers may be particularly helpful in combatting depressive symptoms for mothers with adverse childhood experiences. The study aims to explore the role of biological father support as a protective factor against the risks associated with childhood adversity for maternal prenatal depression. Sample included 133 pregnant women recruited from two university-affiliated OB-GYN clinics serving diverse and low-income patients. Participants completed measures on childhood adversity, prenatal depressive symptoms, and father support. Results showed a significant moderating effect of father support on the relation between maternal ACEs and prenatal depressive symptoms, suggesting that higher levels of father support are protective against prenatal depressive symptoms, specifically in mothers with low-to-moderate ACEs. These results highlight the positive impact of paternal support for maternal well-being during pregnancy. Although mothers with low-to-moderate ACEs experience a buffering effect of father support, mothers with high levels of childhood adversity remain at elevated risk for prenatal depressive symptoms even with high father support. As such, screening mothers for ACEs in addition to father support may help identify those at higher risk of prenatal depression., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.)

Objective: To examine maternal childhood adversity in relation to increased risk for maternal and infant perinatal complications and newborn Neonatal Intensive Care Unit (NICU) admittance., Methods: A sample of 164 women recruited at their first prenatal appointment participated in a longitudinal study through 6 weeks postdelivery. Participants self-reported on their adverse childhood experiences (ACEs), negative health risks (overweight/obesity, smoking, and alcohol use), adverse infant outcomes, NICU admittance, and maternal perinatal complications across three pregnancy assessments and one post-birth assessment. Logistic binomial regression analyses were used to examine associations between maternal ACEs and adverse infant outcomes, NICU admittance, and maternal perinatal complications, controlling for pregnancy-related health risks., Results: Findings showed that women with severe ACEs exposure (6+ ACEs) had 4 times the odds of reporting at least one adverse infant outcome (odds ratio [OR] = 4.33, 95% CI: 1.02-18.39), almost 9 times the odds of reporting a NICU admission (OR = 8.70, 95% CI: 1.34-56.65), and 4 times the odds of reporting at least one maternal perinatal outcome (OR = 4.37, 95% CI: 1.43-13.39)., Conclusions: The findings demonstrate the extraordinary risk that mothers' ACEs pose for infant and maternal health outcomes over and above the associations with known maternal health risks during pregnancy, including overweight/obesity, smoking, and alcohol use. These results support a biological intergenerational transmission framework, which suggests that risk from maternal adversity is perpetuated in the next generation through biophysical and behavioral mechanisms during pregnancy that negatively affect infant health outcomes., (© The Author(s) 2021. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Little is known about how "reproductive orientation" (i.e., trying to get pregnant, ambivalent about pregnancy, trying to avoid pregnancy, or having had a sterilization surgery) is associated with sexual satisfaction among women of childbearing age. Using data from the National Survey of Fertility Barriers (N = 2811), we examined the association of reproductive orientation with sexual satisfaction, adjusting for relationship characteristics including union type (cohabitation versus marriage), quality, and length; infertility history; and demographic characteristics including age, parity, and race/ethnicity. Results indicated that women who were ambivalent or trying to get pregnant reported significantly higher levels of sexual satisfaction than women who were sterile in the unadjusted model, but not in the models that included relationship quality. The association of reproductive orientation and sexual satisfaction depended upon relationship quality; among women with lower relationship quality, "trying" was associated with higher, and among those with higher relationship quality, with lower sexual satisfaction., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

This study models associations between pregnancy intendedness and prenatal maternal-fetal bonding with postnatal maternal-infant bonding. Unintended pregnancies are associated with disruptions in maternal-infant bonding, which has long-term adverse implications for maternal and child well-being. Given the high proportion of births that are unintended in the United States, identifying protective factors is critical. Pregnant women (ages 16-38) were recruited from two prenatal clinics in a metropolitan city in the South Central United States at their first prenatal visit and followed throughout pregnancy and postbirth. Multiple regression analyses examined associations, mediation, and moderation. Results indicate that the more unintended/unwanted women reported their pregnancies to be, the lower they reported their maternal-infant bonding postbirth, and higher maternal-fetal bonding scores are associated with higher postnatal maternal-infant bonding. An interaction revealed that a higher level of prenatal bonding is protective for postnatal bonding among those with unintended/unwanted pregnancies. Because prenatal bonding can be enhanced through intervention, it is a promising target to reduce the risks associated with unintended pregnancy., (© 2021 Michigan Association for Infant Mental Health.)

Objectives: To examine the association between childhood trauma exposure (i.e., extent of interpersonal trauma experienced in childhood) and attitudes toward teen parenthood., Study Design: We used a cross-sectional sample of 416 urban middle and high school male and female students from Tulsa, OK recruited through a local public school district mailing list. Multinomial logistic regression analyses were used to examine odds of reporting having a baby would make life worse, better, or cause no change according to childhood trauma score., Results: Approximately 8% of students and their guardians responded to the mailed survey invitation. Among the students, 67% reported having a baby would make their lives worse; 17% reported it would not change their lives much, and 16% reported having a baby would make their lives better. Each increase in trauma score was associated with a 9% increase in reporting an indifferent attitude ( p < 0.001) and a 15% increase in reporting a positive attitude toward having a baby ( p < 0.01). After controlling for a wide range of sociodemographic, attitudinal, and sexual history variables, childhood trauma remained associated with a positive attitude toward having a baby ( p <.01), but not an indifferent attitude toward having a baby., Conclusions: Greater childhood trauma exposure is associated with indifferent and positive attitudes toward having a baby during adolescence., Implications: Screening for childhood trauma and utilizing interventions designed to reduce the harmful effects of trauma exposure in childhood may offer a more targeted approach to adolescent pregnancy prevention strategies., (© 2021 The Authors.)

Using data from a population survey, this article explores whether perceptions of having a fertility problem among 926 U.S. couples in heterosexual relationships (women aged 25-45 and male partners) are associated with distress. Most couples did not perceive a fertility problem (58%). In almost a third (30%) of the couples, only women perceived a fertility problem; in 4%, only the men; and in nearly a fifth (19%), both perceived a problem. Adjusted for characteristics associated with fertility problems and depressive symptoms, those who perceived a problem exhibited significantly more depressive symptoms than those who did not. Fertility problems are sometimes experienced as individual because in some couples only one partner perceives a problem or has higher distress in response to their own rather than to their partners' perceived problems. For women, fertility problems are experienced as a couple phenomenon because women were more distressed when both partners perceive a problem. The perception of fertility problems is gendered in that women were more likely to perceive a problem than men. Furthermore, men are most distressed when they perceive a problem and their partner does not.

Childhood exposure to adversity may increase an individual's reactivity to subsequent stressors. In this paper, we examine how adverse childhood experiences (ACEs) are associated with experiencing greater perceived distress during the pandemic. In this volunteer clinical cohort study, 177 pregnant women (ages 16-38) were recruited from two university-affiliated perinatal clinics located in a small metropolitan city between October 2017 and May 2018. Longitudinal data collection is ongoing. The current study includes the 101 women who participated through the eighth and most recent survey conducted in mid-April 2020. OLS regression analyses were used to examine the association between childhood adversity and pandemic-related distress. We found that ACE scores were associated with higher levels of distress ( b  = .08; se = .03; p  < .01) when controlling for demographic characteristics. The addition of loneliness to the model fully mediates the association between ACEs score and distress. Findings suggest that adverse childhood experiences influence COVID-19-related distress due to greater social isolation. Those who had greater adversity during childhood may be less likely to have the social connectedness needed to reduce distress due to the pandemic., Competing Interests: Competing InterestsThe authors declare no competing interests., (© Springer Nature Switzerland AG 2021.)

Latino parents have lower levels of school involvement compared to other ethnic groups, which is often attributed-though not tested-to low English language proficiency. Using a population-based sample of 637 7th grade Latino youth attending an urban school district, we find no significant difference in maternal school involvement when mothers and students are either both fluent in English or both non-fluent. When students are more fluent than their mothers, however, maternal school involvement is significantly lower, suggesting that schools may need to take additional steps to encourage parental involvement when there is language dissonance between parents and their children., Competing Interests: Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The study was conducted to prospectively examine how pregnancy intendedness and prenatal provider counseling about postpartum contraceptive options are associated with lack of contraception use at 6 months post-birth (e.g., increased risk for a short interpregnancy interval)., Methods: Logistic regression models were used to examine risk for no postpartum contraception use among a sample of low-income and racially/ethnically diverse women recruited from two metropolitan perinatal clinics in Tulsa, OK., Results: Women who reported that they were trying to get pregnant or "okay either way" about getting pregnant had significantly lower odds of using contraception at 6 months post childbirth than those who had unintended pregnancies. Having providers who discussed postpartum contraceptive options during pregnancy significantly increased the odds of contraceptive uptake among those who were planning or ambivalent about their pregnancies., Conclusions: Intentions of a current pregnancy and provider contraceptive counseling matter for postpartum contraceptive use and the associated risk for a short interval subsequent pregnancy. Provider contraceptive counseling that accounts for the intendedness of a current pregnancy may offer a more targeted approach to prevent a short interval subsequent pregnancy., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s) 2020.)

Objective: To examine how measures of infertility based on medical criteria and based on self-perception relate to depressive symptoms among women with infertility. Background: Survey-based studies of depressive symptoms have used either measures of self-reported infertility based on meeting medical criteria or measures of self-perceived fertility problems, but seldom both. It is, therefore, not known which type of measure is more closely associated with depressive symptoms. Materials and Methods: Using ordinary least-squares multiple regression, this study compares associations between a measure of meeting medical criteria for infertility and a measure of self-perceived fertility problems with a common measure of depressive symptoms. Data come from the National Survey of Fertility Barriers, a population-based survey of 4,711 U.S. women. Results: Both meeting medical criteria for infertility and self-perception were associated with depressive symptoms after controlling for a number of relevant variables, but the coefficient for the self-perception measure was slightly higher than the coefficient for medical criteria. Conclusion: If possible, both medical criteria and self-perception measures should be used in studies of the consequences of infertility for psychosocial outcomes. If only one measure can be used, self-perception of a fertility problem is an acceptable measure., Competing Interests: No competing financial interests exist., (© Michele H. Lowry et al. 2020; Published by Mary Ann Liebert, Inc.)

Objectives: Experiencing an immigration-related arrest of a family member adversely impacts youth well-being, yet the role of parental documentation status for exacerbating adverse mental health outcomes following these arrests has not been investigated., Method: Using a general population sample of Latino 7th-grade students in an urban public school district in the south-central United States (N = 611), we examined the relationship between an immigration-related arrest of a family member and depressive symptoms as well as the moderating associations of perceived parental documentation status., Results: Using ordinary least squares regression, findings indicate that experiencing or witnessing an immigration-related arrest of a family member is significantly associated with higher rates of depressive symptoms. Moreover, parental citizenship status has a moderating effect; depressive symptoms are magnified among youth who report that both of their parents have undocumented legal status., Conclusions: The study findings suggest that there are significant consequences for youth well-being when a family member is arrested for immigration-related violations. Further, among youth whose parents are both undocumented, there appears to be a compounding effect on mental health. Immigration policies, programs, and schools need to consider the emotional needs of youth who have undocumented parents, particularly in the context of elevated immigration enforcement. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Study Question: Is giving birth associated with improved subjective well-being among involuntarily childless women?, Summary Answer: Resolution of infertility is associated with increased life satisfaction and self-esteem, but not with a decrease in depressive symptoms., What Is Known Already: Cross-sectional data and studies of treatment-seekers show that infertility is associated with lower subjective well-being. Childless women with infertility tend to report lower subjective well-being than women who experience secondary infertility, but a prospective study using a random sample of involuntarily childless women over time has not previously been conducted., Study Design, Size, Duration: The sample for the current study includes all women without children who met medical criteria for infertility or perceived a fertility problem (N = 283) at baseline and who were interviewed in both waves (3 years apart) of the National Survey of Fertility Barriers (NSFB), in a random-digit dialing telephone survey. It is therefore possible to explore here whether there are differences in the association of infertility resolution and subjective well-being among women who do and do not perceive themselves as having a fertility problem., Participants/materials, Setting, Methods: Depressive symptoms (as measured by the Center for Epidemiologic Studies-Depression Scale), self-esteem (as measured by a modified version of the Rosenberg Self-esteem Scale) and life satisfaction (as measured by a modified version of the Satisfaction with Life Scale) were assessed for all 283 participants at both waves. For all three variables, change scores of 47 involuntarily childless women who resolved their infertility through a live birth were compared to the scores for the 236 women who remained childless. A number of variables shown to be associated with subjective well-being among infertile women were included as controls., Main Results and the Role of Chance: No relationship between infertility resolution and change in depressive symptoms was observed (b = -0.04; P > 0.05). Involuntarily childless women who resolved their infertility improved in self-esteem (b = 0.74; P < 0.01) and life satisfaction (b = 1.06; P < 0.01)., Limitations, Reasons for Caution: Women were measured at only two time points. Only 47 women had a live birth between waves. While it is common practice to make causal interpretations based on panel data, such interpretations should be made with caution. In addition, the NSFB was conducted in the USA where medical expenditures are high and most fertility treatment expenses are not covered by insurance. Thus it may not be possible to generalize the findings to other modern industrialized societies., Wider Implications of the Findings: Knowing that resolution of infertility is associated with improved subjective well-being is important for infertile couples and infertility professionals alike., Study Funding/competing Interest(s): This research was supported in part by NICHD grant R01-HD044144 and NIGMS grant P20-GM109097 from the National Institutes of Health. The authors have no competing interests., (© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For permissions, please e-mail: journals.permission@oup.com.)

Studies of medical help-seeking presume that self-identifying as having a health problem precedes medical contact, but this ordering of the identity-behavior relationship has not been systematically examined. We used longitudinal data from the National Survey of Fertility Barriers (2004 to 2010) on 412 women with infertility to document the temporal relationship between self-identifying as having a fertility problem and making medical contact. The symbolic interactionist perspective suggests that infertility will be perceived as identity disruption and that in response women will align self-identity and medical behavior over time. Cross-tabulation analysis indicated that more women do self-identify as having a fertility problem first (24 percent) as opposed to making medical contact first (5.5 percent). There was also a tendency toward aligning self-identification and behavior over time. Latent class analyses revealed six patterns: 1) consistently involved, 2) early consulters, 3) consistently uninvolved, 4) consistent perceivers, 5) medical dropouts, and 6) early perceivers. Strong fertility intent and primary infertility, two identity-relevant characteristics, had the strongest associations with latent class membership. The relationship between self-identification and medical help-seeking is thus dynamic and complex.

There are significant barriers in engaging pregnant and postpartum women that are considered high-risk (e.g., those experiencing substance use and/or substance use disorders (SUD)) into longitudinal research studies. To improve recruitment and retention of this population in studies spanning from the prenatal period to middle childhood, it is imperative to determine ways to improve key research engagement factors. The current manuscript uses a qualitative approach to determine important factors related to recruiting, enrolling, and retaining high-risk pregnant and postpartum women. The current sample included 41 high-risk women who participated in focus groups or individual interviews. All interviews were analyzed to identify broad themes related to engaging high-risk pregnant and parenting women in a 10-year longitudinal research project. Themes were organized into key engagement factors related to the following: (1) recruitment strategies, (2) enrollment, and (3) retention of high-risk pregnant and parenting women in longitudinal research studies. Results indicated recruitment strategies related to ideal recruitment locations, material, and who should share research study information with high-risk participants. Related to enrollment, key areas disclosed focused on enrollment decision-making, factors that create interest in joining a research project, and barriers to joining a longitudinal research study. With regard to retention, themes focused on supports needed to stay in research, barriers to staying in research, and best ways to stay in contact with high-risk participants. Overall, the current qualitative data provide preliminary data that enhance the understanding of a continuum of factors that impact engagement of high-risk pregnant and postpartum women in longitudinal research with current results indicating the need to prioritize recruitment, enrollment, and retention strategies in order to effectively engage vulnerable populations in research., Competing Interests: Conflict of InterestThe authors declare that they have no conflict of interest., (© Springer Nature Switzerland AG 2020.)

Although nulliparous women who are sterilized appear voluntarily "childfree," the majority report non-contraceptive reasons for their surgical procedure. Using an analytical subsample of the National Survey of Fertility Barriers, we examined 105 women's closed- and open-ended responses about the reasons for their sterilization surgeries and whether their sterilization occurred before their childbearing desires were met. We found considerable heterogeneity in the experiences and attitudes of participants. We highlight important implications of women's experiences for fertility and reproductive health research and practice, particularly by drawing a distinction between voluntarily childfree and involuntarily childless women., Competing Interests: COI: The authors have no conflicts of interest to declare.

Objective : This study aimed to examine the impact of newborns' Neonatal Intensive Care Unit (NICU) admittance on maternal postpartum depression. Background : Prior research on the parental psychological impacts of a NICU admittance typically includes a hospital sample of parents following birth, so the causality of NICU admittance and maternal depressive symptomatology is unclear. Methods : 127 women across 38 counties in a South Central US state participated in online surveys in their third trimester and approximately six weeks post-birth in 2016. Pre- and post-birth assessments of depression were measured with the Center for Epidemiologic Studies Depression Scale (CES-D). NICU admittance was asked in the post-birth survey. t -Tests and multivariable regression analyses were used to determine predictors of NICU admittance and postnatal depressive symptomatology. Results : Findings indicate that prenatal depression does not differ significantly between mothers by NICU admission status, but NICU admission is a significant predictor of postpartum depressive symptomatology. Conclusions : Having a newborn admitted to the NICU is a risk factor for maternal postpartum depression. These findings have implications for practice; screening mothers in the NICU for depression as a target for intervention has the potential to improve maternal well-being, which in turn should enhance subsequent infant developmental outcomes.

Many Latino youth are U.S. citizens but live with parents whose immigration status is unauthorized. The association between parental documentation status and early adolescent academic attitudes and expectations is unclear. Using a general population sample of urban 7th grade students who self-identified as Latino in the South Central U.S. (n = 514), we examine the associations between parental documentation status and youth attitudes about the importance of graduating high school and college and expectations of the likelihood of completing high school and attending college. Findings suggest that parent documentation status is not associated with attitudes toward the importance of high school and college among Latino early adolescents, but it is significantly associated with perceptions of the likelihood of achievement. Thus, parent immigration status may be an educational barrier that needs to be addressed early for Latino youth, as efforts in high school may be too late for some students., (Copyright © 2018 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.)

Public awareness and utilization of assisted reproductive technology has been increasing, but little is known about changes in ethical concerns over time. The National Survey of Fertility Barriers, a national, probability-based sample of US women, asked 2031 women the same set of questions about ethical concerns regarding six reproductive technologies on two separate occasions approximately 3 years apart. At Wave 1 (2004-2007), women had more concerns about treatments entailing the involvement of a third party than about treatments that did not. Ethical concerns declined between Wave 1 and Wave 2, but they declined faster for treatments entailing the involvement of a third party. Ethical concerns declined faster for women with greater levels of concern at Wave 1. Initial ethical concerns were higher, and there was less of a decline in ethical concerns for women with higher initial levels of religiosity.

Infertility is a common, yet often misunderstood, experience. Infertility is an important topic for family scientists because of its effects on families; its relevance to research in related areas, such as fertility trends and reproductive health; and its implications for practitioners who work with individuals and couples experiencing infertility. In this review, we focus on common misperceptions in knowledge and treatment of infertility and highlight insights from recent research that includes men, couples, and people with infertility who are not in treatment. The meaning of parenthood, childlessness, awareness of a fertility problem, and access to resources are particularly relevant for treatment seeking and psychosocial outcomes. On the basis of insights from family science research, we provide specific guidelines for infertility practice within broader social contexts such as trends in health care, education, employment, and relationships. Guidelines are presented across three areas of application: infertility education for individuals, families, and practitioners; steps to support the emotional well-being of those affected by infertility; and understanding of treatment approaches and their implications for individuals and couples.

A child's death augments how grieving parents view the world, the family, and the self. Using a representative sample of women ages 25-45 who have ever given birth, we assessed whether miscarriage, stillbirth, and child death impact self-esteem and whether this loss is moderated by maternal identity. We found that stillbirth and child death, but not miscarriage, negatively impacted self-esteem. For those who experienced a loss, the impact on self-esteem was moderated by maternal identity. Women who experienced a stillbirth were the only group who had significantly lower self-esteem after controlling for background characteristics and maternal identity variables.

Background: Fewer than 50% of women who meet the medical/behavioral criteria for infertility receive medical services. Estimating the number of women who both meet the medical/behavioral criteria for infertility and who have pro-conception attitudes will allow for better estimates of the potential need and unmet need for infertility services in the United States., Methods: The National Survey of Fertility Barriers was administered by telephone to a probability sample of 4,712 women in the United States. The sample for this analysis was 292 women who reported an experience of infertility within 3 years of the time of the interview. Infertile women were asked if they were trying to conceive at the time of their infertility experience and if they wanted to have a child to determine who could be considered in need of services., Results: Among U.S. women who have met medical criteria for infertility within the past three years, 15.9% report that they were neither trying to have a child nor wanted to have a child and can be classified as not in need of treatment. Of the 84.9% of infertile women in need of treatment, 58.1% did not even talk to a doctor about ways to become pregnant., Discussion: Even after taking into account that not all infertile women are in need of treatment, there is still a large unmet need for infertility treatment in the United States., Conclusion: Studies of the incidence of infertility should include measures of both trying to have a child and wanting to have a child.

Objective: To examine the associations between sterilisation reasons, regret, and depressive symptoms., Study Design: Black, Hispanic, and non-Hispanic White US women ages 25-45 who participated in the National Survey of Fertility Barriers (NSFB) and reported a tubal sterilisation surgery were included in the sample for this study (n=837). Logistic regression was used to examine how characteristics of the sterilisation surgery (reasons for sterilisation, time since sterilisation, and new relationship since sterilisation) are associated with the odds of sterilisation regret, and linear regression was used to examine associations between sterilisation regret, sociodemographic factors, and depressive symptoms., Results: Findings revealed that 28 percent of U.S. women who have undergone tubal sterilisation report regret. Time since sterilisation and having a reason for sterilisation other than simply not wanting (more) children (e.g., situational factors, health problems, encouragement by others, and other reasons) are associated with significantly higher odds of sterilisation regret. Finally, sterilisation regret is significantly associated with depressive symptoms after controlling for sociodemographic characteristics., Conclusion: Sterilisation regret is relatively common among women who have undergone tubal sterilisation, and regret is linked to elevated, but not necessarily clinical depressive symptoms. The reasons for sterilisation can have important implications for women's sterilisation regret and associated depressive symptoms., Competing Interests: The authors have no conflicts of interest.

How stable are women's pregnancy intentions across their reproductive lifespans? Are there demographic, social, or attitudinal characteristics that are associated with differing pregnancy intentions patterns? Patterns of intendedness across pregnancies were examined using a sample of 3,110 women ages 25-45 who have been pregnant at least twice from the National Survey of Fertility Barriers. Multinomial logistic regression analyses assessed associations between patterns of intentions and respondents' economic/social status, values and ideologies to determine if intentions are a stable characteristic or pregnancy-specific. The majority of women (60 %) reported varying intendedness across individual pregnancies, indicating that intendedness tends to be pregnancy-specific. Sociodemographic status as well as values and ideologies were significantly associated with pregnancy intendedness patterns. Compared to women who intended each pregnancy, women who were ambivalent, did not intend each pregnancy, or had intermittent intendedness were more likely to be single, younger, Black, report lower importance of motherhood and religiosity and were less likely to be Hispanic. A substantial proportion of women report the intendedness of their pregnancies varied between pregnancies. Research and policy addressing unintended pregnancies should consider that pregnancy intentions are not a static characteristic of most women.

The purpose of the current investigation was to explore whether monitoring behavior (i.e., parental solicitation, child disclosure, and parental involvement) was directly and indirectly (via parental knowledge and parent-youth openness) related to adolescent adjustment (i.e., antisocial behavior, substance use, and school grades). The sample consisted of 206 families with adolescents (ages 10-18 years) from predominantly low-income, high-risk neighborhoods. Monitoring behavior (parent reports), parental knowledge and parent-youth openness (youth reports), and adolescent adjustment (parent and youth reports) were all based on questionnaire data collected during a laboratory assessment. Results showed that when the monitoring behavior factors were examined simultaneously, only child disclosure was significantly and inversely related to youth antisocial behavior. In contrast, only parental involvement was significantly associated with less substance use. Moreover, school grades were significantly and incrementally predicted by both child disclosure and parental involvement. Parental solicitation was not significantly related to any of the adolescent outcomes. The findings also demonstrated evidence of indirect effects (via parental knowledge) in the link between monitoring behavior and adolescent adjustment. Implications regarding the socialization process during adolescence are discussed.

Surgical sterilization is a relatively permanent form of contraception that has been disproportionately used by Black, Hispanic, and Native American women in the United States in the past. We use a nationally representative sample of 4592 women ages 25-45 to determine whether sterilization continues to be more common and consequential by race for reproductive-age women. Results indicate that Native American and Black women are more likely to be sterilized than non-Hispanic White women, and Hispanic and Native American women are more likely than non-Hispanic White women to report that their sterilization surgeries prevent them from conceiving children they want. Reasons for sterilization differ significantly by race. These findings suggest that stratified reproduction has not ended in the United States and that the patterns and consequences of sterilization continue to vary by race., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Prior research indicates a negative relationship between women's labor force participation and fertility at the individual level in the United States, but little is known about the reasons for this relationship beyond work hours. We employed discrete event history models using panel data from the National Survey of Families and Households ( N = 2,411) and found that the importance of career considerations mediates the work hours/fertility relationship. Further, fertility intentions and the importance of career considerations were more predictive of birth outcomes as women's work hours increase. Ultimately, our findings challenge the assumption that working more hours is the direct cause for employed women having fewer children and highlight the importance of career and fertility preferences in fertility outcomes.

The literature has been mixed regarding how parent-child relationships are affected by the acculturation process and how this process relates to alcohol use among Latino youth. The mixed results may be due to, at least, two factors: First, staggered migration in which one or both parents arrive to the new country and then send for the children may lead to faster acculturation in parents than in children for some families. Second, acculturation may have different effects depending on which aspects of alcohol use are being examined. This study addresses the first factor by testing for a curvilinear trend in the acculturation-alcohol use relationship and the second by modeling past year alcohol use as a zero inflated negative binomial distribution. Additionally, this study examined the unique and mediation effects of parent-child acculturation discrepancies (gap), mother involvement in children's schooling, father involvement in children's schooling, and effective parenting on youth alcohol use during the last 12 months, measured as the probability of using and the extent of use. Direct paths from parent-child acculturation discrepancy to alcohol use, and mediated paths through mother involvement, father involvement, and effective parenting were also tested. Only father involvement fully mediated the path from parent-child acculturation discrepancies to the probability of alcohol use. None of the variables examined mediated the path from parent-child acculturation discrepancies to the extent of alcohol use. Effective parenting was unrelated to acculturation discrepancies; however, it maintained a significant direct effect on the probability of youth alcohol use and the extent of use after controlling for mother and father involvement. Implications for prevention strategies are discussed.

Evidence of group differences in reproductive control and access to reproductive health care suggests the continued existence of "stratified reproduction" in the United States. Women of color are overrepresented among people with infertility but are underrepresented among those who receive medical services. The authors employ path analysis to uncover mechanisms accounting for these differences among black, Hispanic, Asian, and non-Hispanic white women using a probability-based sample of 2,162 U.S. women. Black and Hispanic women are less likely to receive services than other women. The enabling conditions of income, education, and private insurance partially mediate the relationship between race-ethnicity and receipt of services but do not fully account for the association at all levels of service. For black and Hispanic women, social cues, enabling conditions, and predisposing conditions contribute to disparities in receipt of services. Most of the association between race-ethnicity and service receipt is indirect rather than direct.

Background: We examine variation in fertility-specific distress (FSD) and general distress according to different experiences of infertility among 1027 US women who have experienced infertility within the previous 10 years., Methods: General distress was measured by a short form of the Center for Epidemiological Studies-Depression. Multiple regression analysis was conducted on self-report data (based on a telephone interview) from a probability-based sample of US women aged 25-45 years. We compare women with infertility who have had a prior pregnancy (secondary infertility, n = 628) to women with infertility with no prior pregnancies (primary infertility, n = 399). We further distinguish between women with infertility who were actually 'trying' to become pregnant (the infertile with intent) with those who met the medical definition of infertile but did not describe themselves as trying to become pregnant (infertile without intent)., Results: Both types of infertility (primary versus secondary) (β = 0.31*) and intentionality (infertile with and without intent) (β = 0.08*) are associated with FSD. These associations persist when we control for resource and demographic variables, life course variables, social support and social pressure variables. General distress does not vary by infertility type or intentionality., Conclusions: Results reveal variation in women's recalled experiences of infertility and that FSD is more sensitive to effects of different experiences than general distress. Women with primary infertility who were explicitly trying to become pregnant at the time of the infertility episode stand out as a particularly distressed group. Caregivers should be aware that the emotional needs of women with primary infertility may differ from those with secondary infertility.

Because research on infertile women usually uses clinic-based samples of treatment seekers, it is difficult to sort out to what extent distress is the result of the condition of infertility itself and to what extent it is a consequence of the experience of infertility treatment. We use the National Survey of Fertility Barriers, a two-wave national probability sample of U.S. women, to disentangle the effects of infertility and infertility treatment on fertility-specific distress. Using a series of ANOVAs, we examine 266 infertile women who experienced infertility both at Wave 1 and at Wave 2, three years later. We compare eight groups of infertile women based on whether or not they have received treatment and on whether or not they have had a live birth. At Wave 1, infertile women who did not receive treatment and who had no live birth reported lower distress levels than women who received treatment at Wave 1 only, regardless of whether their infertility episode was followed by a live birth. At Wave 2, women who received no treatment have significantly lower fertility-specific distress than women who were treated at Wave 1 or at Waves 1 and 2, regardless of whether there was a subsequent live birth. Furthermore, fertility-specific distress did not increase over time among infertile women who did not receive treatment. The increase infertility-specific distress was significantly higher for women who received treatment at Wave 2 that was not followed by a live birth than for women who received no treatment or for women who received treatment at Wave 1 only. These patterns suggest that infertility treatment is associated with levels of distress over and above those associated with the state of being infertile in and of itself., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Are women who are intentional about pregnancy (trying to or trying not to get pregnant) systematically different from women who are "okay either way" about getting pregnant? We use a currently sexually active subsample (n = 3,771) of the National Survey of Fertility Barriers, a random digit dialing telephone survey of reproductive-aged women (ages 25-45) in the United States. We compare women who are trying to, trying not to, or okay either way about getting pregnant on attitudes, social pressures, life course and status characteristics using bivariate analyses (chi-square tests for categorical and ANOVA tests for continuous variables). Multivariate multinomial logistic regression provides adjusted associations. Most women say that they are trying not to get pregnant (71%) or are okay either way (23%); few are trying to get pregnant. Among women with no prior pregnancies (n = 831), more say that they are trying to get pregnant (14%) but a similar percentage are okay either way (26%). Several characteristics distinguish those trying to from those okay: fertility intentions, importance of motherhood, age, parity, race/ethnicity and self identifying a fertility problem. Additional characteristics are associated with trying not to get pregnant compared to being okay: ideal number of children, wanting a baby, trusting conception, relationship satisfaction, race ethnicity, economic hardship, and attitudes about career success. Women who are "okay either way" about pregnancy should be assessed separately from women who are intentional (trying to, trying not to) about pregnancy.

Although media coverage of infertility treatments has increased markedly over the past decade, there is a dearth of empirical information about public perceptions of the ethics of infertility procedures (e.g. artificial insemination, in-vitro fertilization, donor eggs, surrogate mothering, gestational carriers) and about the factors that shape them. Two representative telephone survey samples (930 adults in a Midwestern state, and 580 adult women aged 25 to 50 in the North Central region) are analyzed to gauge public views on the ethics of infertility treatments and estimate the effects of social structure and exposure on these views. Ethical concerns were viewed as more serious for techniques that could result in a child who may not be biologically related to the woman or her partner than for those yielding a child biologically related to both parents. Social structural factors such as age and education were the strongest predictors of attitudes towards the ethics of infertility treatments. Neither parenthood nor experiencing infertility was related to ethical concerns, although women reporting the use of infertility services had fewer ethical concerns than their counterparts.

A national probability sample reveals two relatively distinct groups of infertile women: those with intent, who have experienced a period of 12 or more months during which they tried to conceive but did not, and those without intent, who had a period of at least 12 months during which they could have conceived and did not but who do not describe themselves as having tried to become pregnant at that time. Those with intent are more likely to identify as having a fertility problem, to be distressed, and to pursue infertility treatment than those without intent, suggesting that many women do not realize that they meet the medical criteria for infertility and may wait longer to get help, therefore lowering their chances of conception., (Copyright 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Background and Objectives: This study's purpose was to simultaneously investigate demographic, socioeconomic status, health status, and access-to-care factors to see if they could explain racial/ethnic differences in the odds of reproductive-aged women having a regular physician and perceptions of those women about their care., Methods: Data come from a nationally representative sample of 4,520 women ages 25--45. We used logistic regression models to ascertain the odds of having a regular doctor and feeling cared for among black, Hispanic, and Asian women as compared to non-Hispanic white women. Models contained controls for factors found significant in prior research and interaction terms., Results: Hispanic women have significantly lower odds of having a regular doctor than white non-Hispanic women, a gap primarily explained by differences in language and insurance status. Asian and Hispanic women have significantly lower odds of reporting feeling cared for by their doctor, and black women have higher odds of reporting feeling cared for by their doctor than white women. Significant interaction terms of race/ethnicity by economic level, residence, and health status show that the associations between race/ethnicity and having a regular doctor, and feeling cared for by that doctor, depend on other characteristics., Conclusions: The odds that women of reproductive age will have a regular doctor and report feeling cared for by that doctor differ by race/ethnicity and socioeconomic characteristics. Black women have higher odds, and Spanish-speaking women have lower odds of having a regular doctor than white women, and Hispanic and Asian women have lower odds of feeling cared for.

Recent studies have repeatedly associated posttraumatic symptoms with women's experience of pregnancy loss. Using a nationally representative sample of American women (N = 2,894) from the National Survey of Fertility Barriers, the current study examines long-term psychological outcomes and reactions to pregnancy loss and infertility among mothers and involuntary childless women. In general, childless women who have experienced pregnancy loss or failure to conceive report the lowest life satisfaction and highest levels of depression despite a considerable period of time (seven years) since the loss or first year without a conception. However, women with the dual experience of pregnancy loss and involuntary childlessness report the most fertility-related distress. Results of the current study suggest that the "non-event" of involuntary childlessness may serve as an additional stressor in the traumatic experience of pregnancy loss.