213 - Maternal Wellbeing and Early Parenting in the Context of ACEs and NOWs: A Secondary Analysis of the ESC-NOWs Trial

Publication Number: 4210.213

Leigh-Anne Cioffredi, The University of Vermont Children's Hospital, Burlington, VT, United States; Zhuopei Hu, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR, United States; Stephanie L. Merhar, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; song Ounpraseuth, UAMS, Little Rock, AR, United States; Lori Devlin, University of Louisville School of Medicine, Louisville, KY, United States; Leslie Young, The University of Vermont Children's Hospital, Burlington, VT, United States; for the Eunice Kennedy Shriver NICHD Neonatal Research Network and the, RTI International, Durham, NC, United States

Background: Maternal adverse childhood experiences (ACEs) are associated with long-term disruptions in emotional regulation, interpersonal functioning, and wellbeing. These disruptions may be particularly important in the perinatal period, having potential influence on caregiving behaviors and the early parent-infant relationship. ACE scores are often elevated in women with mental health symptoms, and in those with opioid use disorder (OUD) underscoring the need to assess how maternal childhood adversity and wellbeing may impact parenting in this population.

Objective: Examine impact of maternal ACEs and wellbeing on two key indicators of early parenting among participants enrolled in the Eating, Sleeping, Consoling for Neonatal Opioid Withdrawal (ESC-NOW) trial.

Design/Methods: Participants in the ESC-NOW follow up study who had complete data were included in this secondary analysis. ACEs were measured with the 10-item ACE questionnaire. Caregiver-reported parenting outcomes and maternal wellbeing metrics were collected at 6 months postpartum and included the Patient-Reported Outcomes Measurement Information System (PROMIS) short forms assessing anxiety, anger, depression, emotional support, and life meaning and purpose. Parenting measures include the Maternal Postnatal Attachment Questionnaire (MPAQ) and the Parenting Sense of Competence Scale (PSOC). Linear mixed effects models were used to test associations between maternal ACEs and wellbeing scores and parenting outcomes with site as a random effect. Covariates included treatment arm, infant length of stay (LOS), and infant receipt of pharmacological treatment.

Results: Descriptive statistics for the 474 participants are found in Table 1. Compared to a general postnatal population, mean number of ACES was high (mean=2.5; SD=2.7). Mean scores on the parenting outcomes are consistent with general postpartum populations representing secure attachment and parenting confidence. While ACEs were not associated with parenting, greater life satisfaction and meaning was associated with better attachment and higher parenting confidence, while higher anger scores were associated with less strong attachment and lower parenting confidence.

Conclusion(s): Maternal ACEs were not associated with 6-month parenting outcomes in this sample of mothers with OUD. However, psychological wellbeing emerged as important correlates of maternal attachment and parenting confidence. These findings suggest that enhanced maternal wellbeing may promote more resilient parenting for the mothers of opioid-exposed infants during early childhood.

Table 1: Characteristics of ESC-NOW follow up participants N=474
ACEs are adverse childhood experiences (events before age 18) ranges 0-10
The MPAQ consists of 19 items each scored 1-5, total scores range from 19-95 with higher scores indicating more secure attachment
The PSOC consists of 17 items rated on a 6-point Likert scale, total scores range from 17-102


Table 2: Adjusted associations with MPAQ total score
Linear mixed model to assess association between ACE Scores and the outcome MPAQ total score, adjusting for the other covariates in the table, and including site as random intercept.
For each point increase in maternal sense of meaning, MPAQ increased by 0.38. For each point increase in maternal anger, MPAQ decreased by 0.5.

Table 3: Adjusted associations with PSOC total score
Linear mixed model to assess association between ACE Scores and the outcome PSOC total score, adjusting for the other covariates in the table, and including site as random intercept.
Greater maternal anger scores were associated with lower PSOC scores. Additionally , longer infant LOS and lack of pharmacologic treatment were significantly associated with higher PSOC scores.