PRISM :: Browsing by Author "Letourneau, Nicole"

Browsing by Author "Letourneau, Nicole"

Now showing 1 - 20 of 36

Open Access
A harmonized analysis of five Canadian pregnancy cohort studies: exploring the characteristics and pregnancy outcomes associated with prenatal alcohol exposure
(2023-02-28) Schmidt, Rose A.; Wey, Tina W.; Harding, Kelly D.; Fortier, Isabel; Atkinson, Stephanie; Tough, Suzanne; Letourneau, Nicole; Knight, Julia A.; Fraser, William D.; Bocking, Alan
Abstract Background As a teratogen, alcohol exposure during pregnancy can impact fetal development and result in adverse birth outcomes. Despite the clinical and social importance of prenatal alcohol use, limited routinely collected information or epidemiological data exists in Canada. The aim of this study was to pool data from multiple Canadian cohort studies to identify sociodemographic characteristics before and during pregnancy that were associated with alcohol consumption during pregnancy and to assess the impact of different patterns of alcohol use on birth outcomes. Methods We harmonized information collected (e.g., pregnant women’s alcohol intake, infants' gestational age and birth weight) from five Canadian pregnancy cohort studies to consolidate a large sample (n = 11,448). Risk factors for any alcohol use during pregnancy, including any alcohol use prior to pregnancy recognition, and binge drinking, were estimated using binomial regressions including fixed effects of pregnancy cohort membership and multiple maternal risk factors. Impacts of alcohol use during pregnancy on birth outcomes (preterm birth and low birth weight for gestational) were also estimated using binomial regression models. Results In analyses adjusting for multiple risk factors, women’s alcohol use during pregnancy, both any use and any binge drinking, was associated with drinking prior to pregnancy, smoking during pregnancy, and white ethnicity. Higher income level was associated with any drinking during pregnancy. Neither drinking during pregnancy nor binge drinking during pregnancy was significantly associated with preterm delivery or low birth weight for gestational age in our sample. Conclusions Pooling data across pregnancy cohort studies allowed us to create a large sample of Canadian women and investigate the risk factors for alcohol consumption during pregnancy. We suggest that future pregnancy and birth cohorts should always include questions related to the frequency and amount of alcohol consumed before and during pregnancy that are prospectively harmonized to support data reusability and collaborative research.
Open Access
Advancing Gestation Does Not Attenuate Biobehavioural Coherence Between Psychological Distress and Cortisol
(Biological Psychology, 2013-04) Giesbrecht, Gerald; Campbell, Tavis; Letourneau, Nicole; Kaplan, Bonnie; APrON Study Team
Background: Despite little evidence to suggest that HPA axis responses to psychological provocation are attenuated during pregnancy, it is widely held that dampening of the HPA axis response to psychological distress serves a protective function for the mother and fetus. The current study was designed to assess changes in biobehavioral coherence between psychological distress and cortisol over the course of pregnancy. Methods: Ambulatory assessment of ecologically relevant psychological distress and salivary cortisol were repeated in all three trimesters for 82 pregnant women. Samples were collected 5 times per day over the course of 2 days in each trimester. Results: Psychological distress and cortisol were positively associated, β = .024, p < .01, indicating that increases in psychological distress were associated with increases in cortisol. Gestational age did not moderate this association, β = .0009, p = .13, suggesting that negative psychological experiences remain potent stimuli for the HPA axis during pregnancy. Conclusion: Biobehavioral coherence between ecologically relevant experiences of psychological distress and cortisol is not attenuated with advancing gestation.
Open Access
Adverse Childhood Experiences and Adult Depression: Resilience as a Moderator
(2016) Poole, Julia; Dobson, Keith; Yeates, Keith; Tough, Suzanne; Letourneau, Nicole
Adverse childhood experiences (ACEs), such as childhood abuse and neglect, have been identified as salient risk factors for adult depression. However, not all individuals who experience ACEs go on to develop depression. To assess the extent to which resilience- or the ability to demonstrate stable levels of functioning despite adversity- moderates the association between ACEs and depression, 4,006 adult primary care patients completed self-report questionnaires on their childhood experiences and current depressive symptoms and resilience. Results indicated that resilience moderated the association between ACEs and depression, F(10, 3039) = 174.36, p < .001, R2 = .365. Specifically, the association between ACEs and depression was stronger among individuals with low resilience relative to those with high resilience. Findings have the potential to inform the development of a treatment program aimed to reduce symptoms of depression among primary care patients with a history of childhood adversity.
Open Access
Affective Experience in Ecologically Relevant Contexts is Dynamic, and Not Progressively Attenuated During Pregnancy
(Archives of Women's Mental Health, 2012-08) Giesbrecht, Gerald; Letourneau, Nicole; Campbell, Tavis; Kaplan, Bonnie; APrON Study Team
Pregnancy is thought to diminish a woman’s appraisals of and affective responses to stressors. To examine this assumption, we used an electronic diary and an ecological momentary assessment strategy to record women’s (n=85) experiences of positive and negative affect five times each day over two days within each trimester of pregnancy. Women also completed the Edinburgh Postnatal Depression Scale each trimester. Multi-level modeling indicated non-linear patterns for both positive and negative affect that differed by level of depressive symptoms. The findings suggest that changes in psychological experience over the course of pregnancy are dynamic and not progressively attenuated.
Open Access
The Alberta Pregnancy Outcomes and Nutrition (APrON) cohort study: rationale and methods
(Maternal & Child Nutrition, 2014-01) Kaplan, Bonnie; Giesbrecht, Gerald; Leung, Brenda; Field, Catherine; Dewey, Deborah; Bell, Rhonda; Manca, Donna; O'Beirne, Maeve; Johnston, David; Pop, Victor; Singhal, Nalini; Gagnon, Lisa; Bernier, Francois; Eliasziw, Misha; McCargar, Linda; Kooistra, Libbe; Farmer, Anna; Cantell, Marja; Goonewardene, Laki; Casey, Linda; Letourneau, Nicole; Martin, Jonathan; APrON Study Team
The Alberta Pregnancy Outcomes and Nutrition (APrON) study is an ongoing prospective cohort study that recruits pregnant women early in pregnancy and, as of 2012, is following up their infants to 3 years of age. It has currently enrolled approximately 5000 Canadians (2000 pregnant women, their offspring and many of their partners).The primary aims of the APrON study were to determine the relationships between maternal nutrient intake and status, before, during and after gestation, and (1) maternal mood; (2) birth and obstetric outcomes; and (3) infant neurodevelopment. We have collected comprehensive maternal nutrition, anthropometric, biological and mental health data at multiple points in the pregnancy and the post-partum period, as well as obstetrical, birth, health and neurodevelopmental outcomes of these pregnancies. The study continues to follow the infants through to 36 months of age.The current report describes the study design and methods, and findings of some pilot work. The APrON study is a significant resource with opportunities for collaboration.
Open Access
An Examination of Mode of Birth, Maternal Postpartum Mental Health, and Childhood Behavioural Problems
(2024-01-26) Grisbrook, Marie-Andrée; Letourneau, Nicole; Dewey, Deborah; Cuthbert, Colleen; McDonald, Sheila
Cesarean section (C-section) deliveries account for 21% of all deliveries worldwide (Betran, Ye, Moller, Souza, & Zhang, 2021). They are frequently considered a medical necessity in labour dystocia, placenta previa, and malpresentation (Caughey, Cahill, Guise, & Rouse, 2014). However, delivery via C-section has been associated with an increased risk of internalizing (anxiousness, depressiveness, withdrawal) and externalizing (aggression, hyperactivity) behavioural problems among children (Rutayisire et al., 2018; Sirvinskiene, Zemaitiene, Jusiene, & Markuniene, 2016). Research evaluating the link between C-section and child behaviour is inconclusive and limited. Delivery via an emergency C-section is the strongest factor linked to a negative perception of the birth experience (Waldenstrom & Schytt, 2009). A negative perception of the birth experience is strongly associated with postpartum post-traumatic stress disorder (PTSD) (Dekel, Ein-Dor, et al., 2019; Soderquist, Wijma, & Wijma, 2002; Verreault et al., 2012), which may be comorbid with postpartum depression (PPD) (Soderquist, Wijma, & Wijma, 2006). Therefore, it is hypothesized that the relationship between C-section and child behaviour depends on the type of C-section, and postpartum PTSD and PPD mediate this association. This manuscript-based dissertation is comprised of five papers. The first and second manuscripts include a review protocol and systematic review outlining the procedures and current evidence regarding the association between C-section delivery and child externalizing and internalizing behavioural problems. The third manuscript presents results regarding the association between C-section delivery and maternal PPD and the role of maternal PTSD in mediating this association. The fourth manuscript presents the study findings on the association between C-section delivery and child behavioural problems and the role of maternal postpartum PTSD and PPD as mediating factors. The final manuscript reviews the current landscape of maternal postpartum mental health screening in Canada and suggests improvements for screening. The dissertation concludes with implications for nursing practice, policy, education, and research.
Open Access
Analysis of reported cases of sexual violence in Espírito Santo, southeastern Brazil, 2011–2018
(2023-05-19) Leite, Franciéle M.; Ferrari, Beatriz; Fiorotti, Karina F.; de Oliveira Pedroso, Márcia R.; Venturin, Bruna; Letourneau, Nicole; Tavares, Fábio L.
Abstract Background sexual violence includes all sexual acts consummated or attempt to obtain them, unwanted sexual comments and actions that go against the other’s sexuality through coercion, which can be done through the use of physical force, psychological pressure, extortion or threat, this phenomenon appears in all life cycles. Identified the frequency and characteristics of sexual violence against women in a state in the southeastern region of Brazil. from 2011 to 2018. Method this is a cross-sectional epidemiological study that evaluated all cases of sexual violence reported in Espírito Santo, present in the Information System of Diseases and Notifications of the Ministry of Health from 2011 to 2018. The analysis was based on performed in Stata 14.1. Results the prevalence of notification of sexual violence was 13.2% (CI95%: 12.8–13.5). Most victims were women (PR: 3.38), aged between 0 and 9 years (PR: 19), with a higher prevalence in people without disabilities or disorders (PR: 1.18) and residents of urban/periurban area (PR: 1.15). Men were the most frequent aggressors (PR: 13.79), with the most prevalent cases being reported by people unknown to the victim (PR: 6.01). The occurrence was 78% more reported at home and committed by an aggressor (PR:1.19). Most cases were repeated (PR:1.13). Conclusions the notification of sexual violence in Espírito Santo was high and evidenced the vulnerability of some groups, as well as the profile of the perpetrators. It is necessary to work on training professionals in the areas of health and education in relation to the identification of cases of sexual violence, mainly due to the significant involvement of children and adolescents.
Open Access
The Buffering Effect of Social Support on Hypothalamic-Pituitary-Adrenal Axis Function During Pregnancy
(Psychosomatic Medicine, 2013) Giesbrecht, Gerald; Poole, Julia; Letourneau, Nicole; Campbell, Tavis; Kaplan, Bonnie; APrON Study Team
Objective: Recent studies suggest that effective social support during pregnancy may buffer adverse effects of maternal psychological distress on fetal development. The mechanisms whereby social support confers this protective advantage, however, remain to be clarified. The aim of this study was to assess whether individual differences in social support alter the co-variation of psychological distress and cortisol during pregnancy. Methods: Eighty two pregnant women’s psychological distress and cortisol were prospectively assessed in all three trimesters using an ecological momentary assessment strategy. Appraisal of partner social support was assessed in each trimester via the Social Support Effectiveness questionnaire. Results: In multilevel analysis, ambulatory assessments of psychological distress during pregnancy were associated with elevated cortisol levels, unstandardized β = .023, p < .001. Consistent with the stress buffering hypothesis, social support moderated the association between psychological distress and cortisol, unstandardized β = -.001, p = .039, such that the co-variation of psychological distress and cortisol increased with decreases in effective social support. The effect of social support for women with the most effective social support was a 50.4% reduction in the mean effect of distress on cortisol and a 2.3 fold increase in this effect for women with the least effective social support scores. Conclusions: Pregnant women receiving inadequate social support secrete higher levels of cortisol in response to psychological distress as compared to women receiving effective social support. Social support during pregnancy may be beneficial because it decreases biological sensitivity to psychological distress, potentially shielding the fetus from the harmful effects of stress-related increases in cortisol.
Open Access
Developmental origins of infant stress reactivity profiles: A multi-system approach
(Wiley, 2016-03-08) Giesbrecht, Gerald; Rash, Joshua, A.; Thomas, Jenna, C.; Campbell, Tavis, S.; Letourneau, Nicole; Granger, Douglas, A.
Background: This study tested the hypothesis that maternal physiological and psychological variables during pregnancy discriminate between theoretically informed infant stress reactivity profiles. Methods: The sample comprised 254 women and their infants. Maternal mood, salivary cortisol, respiratory sinus arrhythmia (RSA), and salivary α-amylase (sAA) were assessed at 15 and 32 weeks gestational age. Infant salivary cortisol, RSA, and sAA reactivity were assessed in response to a structured laboratory frustration task at 6-months of age. Infant responses were used to classify them into stress reactivity profiles using three different classification schemes: HPA-axis, autonomic, and multi-system. Discriminant function analyses evaluated the prenatal variables that best discriminated infant reactivity profiles within each classification scheme. Results: Maternal stress biomarkers, along with self-reported psychological distress during pregnancy discriminated between infant stress reactivity profiles. Conclusions: These results suggest that maternal psychological and physiological states during pregnancy have broad effects on the development of the infant stress response systems.
Open Access
Experiences of Albertan Families with Young Children during the COVID-19 Pandemic: Descriptive Report
(2020-11-30) McDonald, Sheila; Edwards, Sarah; Hetherington, Erin; Racine, Nicole; Mueller, Melissa; McArthur, Brae Anne; Madigan, Sheri; Dewey, Deborah; Letourneau, Nicole; Tough, Suzanne; Geisbrecht, Gerald
This report describes data collected from Albertan families on the COVID-19 Impact Survey implemented in May 2020, which built on a unique collaboration across two longitudinal cohorts in Alberta: The All Our Families study (AOF) and the Alberta Pregnancy Outcomes and Nutrition study (APrON). Our objectives were as follows: (1) Describe household infections of COVID-19 in Alberta among families with school-aged children; (2) Describe urban Albertan family experiences of the pandemic within the first 3-4 months of the outbreak across the areas of financial impact, maternal mental health and well-being, school and daily life, and relationships in the home; and (3) Describe associations among key predictor variables (e.g., financial impact) and outcomes (e.g., maternal anxiety, concern for child’s well-being). Study Sample: AOF and APrON Cohort participants reflect families parenting at least one child in between the ages of 8 and 12. While the respondents represent a broad range of income, education and ethnicity, they are typified by adequate income, food and housing security and partnered marital status. Highlighted Results: Physical Impact: At the time of data collection in May, 2020, over 90% of families did not have personal experience with COVID-19, either through personal infection, infection of a child, extended family member or close friend. Vaccine Intentions: Although over 60% of mothers and their children would obtain a COVID-19 vaccine when available, almost 30% are undecided and 8% would not obtain a vaccine. Financial Impact: In 58% of all families, at least one parent experienced job loss, loss of main income source, or reduced employment hours. One in five mothers reported difficulty meeting financial needs for the household, and 5% of families were experiencing food insecurity. Over 40% of respondents reported at least some impact on their ability to meet financial obligations. Mental Health and Wellness Impact: Mothers reported elevated levels of stress (21%), anxiety (25%) and depression (35%). Approximately 26% of mothers reported having limited coping skills. Almost 90% of mothers have undertaken more domestic tasks in the home. Mothers also reported that their children showed increased sadness and behavioural challenges. The COVID-19 pandemic has had profound financial and mental health impact on some families. Investment in strategies to alleviate financial stress, provide parenting supports, and alleviate mental health concerns is critical. Suggested Citation: McDonald S, Edwards S, Hetherington E, Racine N, Mueller M, McArthur BA, Madigan S, Dewey D, Geisbrecht G, Letourneau N, Tough S. Experiences of Albertan Families with Young Children during the COVID-19 Pandemic: A Descriptive Report. Calgary, Alberta: University of Calgary; 2020.
Open Access
Explanatory Variables of Infant Care Competence among Mothers with Postpartum Depression
(2018-03) Jones, Debbie Annette; Letourneau, Nicole; Secco, M. Loretta; Duffett-Leger, Linda A.
Abstract Introduction. Postpartum Depression (PPD), characterized by feelings of sadness, guilt, decreased energy, decreased mood and appetite, occurs in 10-15% of new mothers with onset in the three months postpartum. Although it can last into the second postpartum year, symptoms have been shown to decrease with treatment. The impact of the mother’s depressive symptoms has negative consequences that can affect her infant care competence (ICC), i.e. how a mother perceives and performs her ability to care for her infant, potentially explaining the observed negative health and developmental outcomes of children whose mothers were affected by PPD. Aim. The aim of this master’s thesis is to complete two papers; both examining explanatory variables that impact/influence ICC in mothers with PPD. The first paper addresses the question: What are explanatory variables of perceived infant care competence in mothers affected by PPD? The second paper addresses the question: “How do depression and other variables influence and/or explain perceived ICC?” Methods. For paper one, a secondary correlational study of women aged 16 to 45 years (n = 55), who were initially recruited for a peer support intervention on women with PPD from May 2011-October 2013 was conducted. Perceived ICC was measured using the Infant Care Questionnaire (ICQ), which is comprised of three domains called responsiveness, emotionality, and mom & baby. The predictor variables that were examined include: severity of depressive symptoms measured using Edinburgh Postnatal Depression Scale (EPDS), social support using the Social Provisions scale (SPS), child development measured using the Ages and Stages Questionnaire (ASQ), family functioning measured using the Family Functioning Scale (FFS) and sociodemographic covariates. Regression analysis was used to determine associations between outcomes (responsiveness, emotionality, mom & baby) on the ICQ and explanatory variables. For paper two, a narrative systematic review was undertaken employing the following six databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, PsycINFO, PubMed, SocINDEX, and the Cochrane Library. The search was conducted examining articles about depressed mothers’ feelings and perceptions of their abilities to care for and interact with their infants as well as performed infant care abilities. After reviewing the selected articles, data were grouped identifying ICC (performed and perceived), how depression was measured, study designs, samples, and explanatory variables. Knowledge Transfer. Two papers were derived for this thesis, one entitled: “Explanatory variables of perceived infant care competence among mothers with postpartum depression” and the other entitled “A narrative systematic review of explanatory variables of infant care competence for mothers with PPD.” These will be prepared for publication in peer-reviewed journals. Papers will also be presented at peer-reviewed national conferences. Results. In the secondary analysis paper, child development across all domains, but perhaps most robustly fine motor skills, predicted responsiveness as an aspect of ICC. The best model fit was for responsiveness with 37% of the variance explained by infant fine motor skills, family functioning and nurturance. The second best model fit was for emotionality, with gross motor, problem solving, social interaction and reliable alliance explaining 16% of the variance. In the systematic review paper, 21 papers yielded variables that explained ICC in mothers including: depression, depression severity, timing of symptoms, social support, maternal adversities, infant characteristics, as well as demographic variables such as education and income. Conclusion. Identifying variables that explain ICC can ultimately give guidance to early preventative measures for mothers, and ultimately decrease possible negative influences on children’s health and development. Depressed mothers with children who have developmental deficits may influence a mother’s perceptions, perhaps further decreasing her confidence in performed infant care tasks. Interventions are needed to enhance a mother’s perceptions by educating mothers on detection of early infant milestones and to respond to infant cues and signals of responsiveness. Perinatal healthcare professionals can advocate for, increase awareness and educate mothers and families about predictors of and interventions to improve ICC. Keywords: postpartum depression, infant care competence, maternal competence, maternal-infant interaction, predictors
Open Access
Exploring protective factors for pregnancy-related anxiety in Tanzanian women
(2017) Wall, Vanessa; Premji, Shahirose; Letourneau, Nicole; McCaffrey, Graham; Dimitropoulos, Gina
Pregnancy-related anxiety is highly correlated with pre-term birth which can be fatal in low-and-middle-income countries. Modifiable protective factors for pregnancy-related anxiety need to be identified to prevent this condition. This study aimed to identify factors associated with low or no pregnancy-related anxiety among women attending two antenatal clinics in districts of Mwanza, Tanzania. A cross-sectional secondary data analysis was completed using data from a longitudinal study that examined biomarkers of stress, anxiety, depression, and birth outcomes. Data were analyzed using bivariate analysis and multiple linear regression. Findings did not reveal any modifiable protective factors. Perceived stress, active depression, and number of people living in the home were the only statistically significant predictors of pregnancy-related anxiety in our sample. Findings indicated that pregnancy-related anxiety may be associated with cultural factors such as family dynamics, and stigmatization of fear or anxiety. Before protective factors can be identified, more qualitative research may be needed in these countries to better understand the cultural nuances of pregnancy-related anxiety in low-and-middle income countries.
Open Access
How Do Interactions Between Early Caregiving Environment and Genes Influence Health and Behavior?
(Biological Research for Nursing, 2014) Letourneau, Nicole; Giesbrecht, Gerald; Bernier, Francois; Joschko, Justin
To promote optimal health and behavioral outcomes in children, nurses have long supported parents in providing the best possible care and nurturance to their offspring. A growing body of neuroscience research argues convincingly for the combined influences of genes and early caregiving on producing an individual’s unique health and behavioral phenotype. In this article, we systematically review studies that demonstrate the relationship between qualities of early caregiving and genetic propensity to health and behavioral outcomes. From an initial set of 255 articles, 24 articles met our inclusion criteria. The outcomes fall into four distinct groups: hypothalamic-pituitary-adrenal (HPA) response to stress, externalizing behavior, internalizing behavior, and disorganized attachment. In the articles, authors examined genes that code for the 5-hydroxy tryptamine (serotonin) transporter genes linked polymorphic region [5-HTTLPR] serotonin transporter promoter, D4 dopamine receptor, brain-derived neurotrophic factor, and monoamine oxidase A promoter. The reviewed studies suggest that the effect of the early rearing environment on gene expression relates mainly to HPA response to stress, whereas interactions between genes and caregiving mainly relate to behavior and attachment. Findings have implications for nurses focused on advocacy, prevention, and intervention to support the healthy development of children in families faced with adversity.
Open Access
Impacts of parental technoference on parent-child relationships and child health and developmental outcomes: a scoping review protocol
(2022-03-17) Mackay, Lyndsay J.; Komanchuk, Jelena; Hayden, K. A.; Letourneau, Nicole
Abstract Background With increases in the use of technological devices worldwide, parental technoference is a potential threat to the quality of parent-child relationships and children’s health and development. Parental technoference refers to disrupted interactions between a parent and child due to a parent’s use of a technological device. The aims of this scoping review are to map, describe, and summarize the existing evidence from published research studies on the impacts of parental technoference on parent-child relationships and children’s health and development and to identify the limitations in the studies and gaps in the literature. Methods This scoping review will be conducted in accordance with the Joanna Briggs Institute (JBI) methodology. A search for relevant research studies will be undertaken in APA PsycInfo, MEDLINE, Central, Cochrane Database for Systematic Reviews, JBI EBP, and Embase (OVID). CINAHL (Ebsco) and Scopus will also be searched. Grey and popular literature will be excluded. This review will include primary research studies and review papers published in English with no time limit that identify the impacts of technoference on parent-child relationships and child health and developmental outcomes. Parent participants include primary caregivers, either biological, adopted, or foster parents, of children under the age of 18 who engage in technoference. Two reviewers will independently screen the titles, abstracts, and full texts of studies according to the inclusion and exclusion criteria. Disagreements will be resolved through discussion with a third researcher. Data will be extracted into a data charting table including author(s), year of publication, country, research aim, methodology/design, population and sample size, variables/concepts, and corresponding measures and main results. Data will be presented in tables and figures accompanied by a narrative summary. Discussion The goal of this scoping review is to present an overview of the evidence on the impacts of parental technoference on parent-child relationships and child and health developmental outcomes, highlighting the current risk of children of today. It will identify gaps in the literature, inform future research, advise recommendations for parents on technological device use, and possibly guide the development of interventions aimed at addressing parental technoference. Trial registration Open Science Framework https://doi.org/10.17605/OSF.IO/QNTS5
Open Access
Latent trait cortisol (LTC) during pregnancy: Composition, continuity, change, and concomitants
(Psychoneuroendocrinology, 2015-08) Giesbrecht, Gerald; Bryce, Crystal; Letourneau, Nicole; Granger, Douglas; APrON Study Team
Individual differences in the activity of the hypothalamic pituitary adrenal (HPA) axis are often operationalized using summary measures of cortisol that are taken to represent stable individual differences. Here we extend our understanding of a novel latent variable approach to latent trait cortisol (LTC) as a measure of trait-like HPA axis function during pregnancy. Pregnant women (n=380) prospectively collected 8 diurnal saliva samples (4 samples/day, 2 days) within each trimester. Saliva was assayed for cortisol. Confirmatory factor analyses were used to fit LTC models to early morning and daytime cortisol. For individual trimester data, only the daytime LTC models had adequate fit. These daytime LTC models were strongly correlated between trimesters and stable over pregnancy. Daytime LTC was unrelated to the cortisol awakening response and the daytime slope but strongly correlated with the area under the curve from ground. The findings support the validity of LTC as a measure of cortisol during pregnancy and suggest that it is not affected by pregnancy-related changes in HPA axis function.
Open Access
Maternal and paternal perinatal depressive symptoms associate with 2- and 3-year-old children’s behaviour: findings from the APrON longitudinal study
(2019-11-13) Letourneau, Nicole; Leung, Brenda; Ntanda, Henry; Dewey, Deborah; Deane, Andrea J; Giesbrecht, Gerald F
Abstract Background Prenatal and postnatal depressive symptoms are common in expectant and new mothers and fathers. This study examined the association between four patterns of probable perinatal depression (mother depressed, father depressed, both depressed, neither depressed) in co-parenting mothers and fathers and their children’s internalizing and externalizing behaviours at 24 and 36 months of age. The influence of sociodemographic, risk and protective factors was also examined. Methods Depressive symptoms were measured during pregnancy and at 3 months postpartum and children’s behaviour was assessed at 24 and 36 months of age. Families (n = 634) provided data on their children’s internalizing (i.e. emotionally reactive, anxious/depressed, somatic complaints, withdrawn and total) and externalizing (i.e. attention problems, aggression and total) behaviour. Marginal models were employed to determine the relationship between children’s behaviour over the two time points and the four patterns of probable parental depression. Sociodemographic variables as well as risk (stress) and protective (social support) factors were included in these models. Results In the perinatal period 19.40% (n = 123) of mothers scored as probably depressed and 10.57% (n = 67) of fathers. In 6.31% (n = 40) of the participating families, both parents scored as probably depressed and in 63.72% (n = 404) neither parent scored as depressed. For children’s emotionally reactive, withdrawn and total internalizing behaviours, both mothers’ probable depression and mothers and fathers’ co-occurring probable depression predicted higher scores, while for children’s aggressive behaviour, attention problems, and total externalizing behaviours, only mothers’ probable depression predicted higher scores, controlling for sociodemographic, risk and protective factors. Conclusions While probable perinatal depression in mothers predicted 2 and 3 year-old children’s behavioural problems, co-occurrence of depression in mothers and fathers had an increased association with internalizing behavioural problems, after considering sociodemographic, risk and protective factors. Health care providers are encouraged to consider the whole family in preventing and treating perinatal depression.
Open Access
Maternal cortisol during pregnancy is related to infant cardiac vagal control
(Psychoneuroendocrinology, 2015-04) Rash, Joshua; Campbell, Tavis; Letourneau, Nicole; Giesbrecht, Gerald
Background: Prenatal exposure to maternal psychological distress and glucocorticoids result in neurobiological adaptations within the fetus that increase risk for developing exaggerated emotional, behavioral, and stress responses to novelty and challenges in childhood. The current study investigated the influence of maternal depressed mood and cortisol during pregnancy on infant cardiac vagal control (CVC) to standardized laboratory challenge tasks. Methods: The sample comprised 194 women and their infants. Maternal reports of depressed mood and salivary cortisol were assessed at 14 and 32 weeks gestational age. Linear regression was used to examine associations between maternal measures during early and late pregnancy, and infant CVC indexed via respiratory sinus arrhythmia (RSA) at rest and in response to laboratory tasks designed to elicit frustration when infants were 6 months of age. It was hypothesized that maternal depressed mood and cortisol would be associated with lower basal RSA and smaller decreases in RSA from baseline to challenge. Results: A significant decrease in infant RSA from baseline to frustration tasks indicated that laboratory tasks elicited a reliable decrease in RSA from baseline to frustration among infants which is characterized by reduction in vagal efferent activity on the heart in response to challenge. Higher maternal cortisol, but not depressed mood, was associated with lower basal RSA and greater decrease in RSA from baseline to frustration. Associations between maternal cortisol and infant basal RSA were observed for both early and late pregnancy whereas the associations between prenatal cortisol and decrease in RSA from baseline to frustration were observed for early, but not late, pregnancy. Conclusions: Maternal cortisol during pregnancy was associated with infant CVC at 6-months of age. Such influences may have enduring impacts on the child and important implications for the development of physical and mental health outcomes.
Open Access
Parental Technology Use and its Implications for Parent-Child Interactions and Children’s Health and Development
(2023-06) Komanchuk, Jelena; Letourneau, Nicole; Cameron, Judy L.; Duffett-Leger, Linda; King-Shier, Kathryn
Adverse experiences (e.g., poverty, family violence, neglect in childhood) can lead to negative health and developmental consequences, yet impacts may be buffered by positive parent-child interactions. While families experiencing adversity (e.g., poverty) report barriers to attending in-person parenting programs, online parenting programs have potential to improve children’s health and development by increasing accessibility. In contrast, parental technoference (i.e., parental technology use that interrupts interactions with one’s child) can negatively affect parent-child relationships and children’s outcomes (e.g., behavior, mental health). Research is needed on digitally delivered parenting programs for families experiencing adversity and on the implications of parental technoference on parent-child relationships and children’s outcomes. The first manuscript in this dissertation is a realist review of research and theory on serve and return interactions (a metaphor utilized to convey the importance of sensitive and responsive caregiving) and a synthesis of research examining its impacts on children’s health (e.g., mental, physical) and development. The second manuscript presents findings from a randomized controlled trial evaluation of the First Pathways program with families experiencing adversity in Alberta. The First Pathways program is an online tool designed to improve parent-child interactions and children’s development by sharing brain development knowledge and activities for parents and children. Compared to the quartile of parent-child dyads who seldom accessed the website (n = 12), the quartile of parent-child dyads who accessed the website the most (n = 13) demonstrated significantly greater improvements in parent-child interaction quality. Further, daily reminders significantly increased website access. High retention (99%) was observed in the First Pathways study; thus, the third manuscript describes the effective recruitment and retention strategies employed. In the fourth manuscript, a realist review of literature on the psychometrics of digitally delivered child development tools is presented. The last manuscript is a scoping review on parental technoference and its effects on parent-child relationships, children’s health, and development. This dissertation concludes with a discussion of the positive and negative implications of parental technology use on children’s health and development and recommendations for nursing research, education, and practice.
Open Access
Perinatal nutrition in maternal mental health and child development: Birth of a pregnancy cohort.
(Elsevier, 2016-02) Giesbrecht, Gerald; Leung, Brenda, M.Y.; Letourneau, Nicole; Field, Catherine, J.; Bell, Rhonda, C.; Dewey, Deborah
Background: Mental disorders are one of the leading contributors to the global burden of disease. The Alberta Pregnancy Outcomes and Nutrition (APrON) study was initiated in 2008 to better understand perinatal environmental impacts on maternal mental health and child development. Aims: This pregnancy cohort was established to investigate the relationship between the maternal environment (e.g. nutritional status), maternal mental health status, birth outcomes, and child development. The purpose of this paper is to describe the creation of this longitudinal cohort, the data collection tools and procedures, and the background characteristics of the participants. Subjects: Participants were pregnant women age 16 or older, their infants and the biological fathers. Outcome measures: For the women, data were collected during each trimester of pregnancy and at 3, 6, 12, 24, and 36 months after the birth of their infant. Maternal measures included diet, stress, current mental and physical health, health history, and lifestyle. In addition, maternal biological samples (DNA, blood, urine, and spot breast milk samples) were banked. Paternal data included current mental and physical health, health history, lifestyle, and banked DNA samples. For infants, DNA and blood were collected as well as information on health, development and feeding behavior. Results: At the end of recruitment in 2012, the APrON cohort included 2140 women, 2172 infants, and 1417 biological fathers. Descriptive statistics of the cohort, and comparison of women who stayed in the study and those who dropped out are discussed. Conclusion: Findings from the longitudinal cohort may have important implications for health policy and clinical practice.
Open Access
Prenatal bisphenol a exposure and dysregulation of infant hypothalamic-pituitary-adrenal axis function: findings from the APrON cohort study
(2017-05-19) Giesbrecht, Gerald F; Ejaredar, Maede; Liu, Jiaying; Thomas, Jenna; Letourneau, Nicole; Campbell, Tavis; Martin, Jonathan W; Dewey, Deborah
Abstract Background Animal models show that prenatal bisphenol A (BPA) exposure leads to sexually dimorphic disruption of the neuroendocrine system in offspring, including the hypothalamic-pituitary-adrenal (HPA) neuroendocrine system, but human data are lacking. In humans, prenatal BPA exposure is associated with sex-specific behavioural problems in children, and HPA axis dysregulation may be a biological mechanism. The objective of the current study was to examine sex differences in associations between prenatal maternal urinary BPA concentration and HPA axis function in 3 month old infants. Methods Mother-infant pairs (n = 132) were part of the Alberta Pregnancy Outcomes and Nutrition study, a longitudinal birth cohort recruited (2010–2012) during pregnancy. Maternal spot urine samples collected during the 2nd trimester were analyzed for total BPA and creatinine. Infant saliva samples collected prior to and after a blood draw were analyzed for cortisol. Linear growth curve models were used to characterize changes in infant cortisol as a function of prenatal BPA exposure. Results Higher maternal BPA was associated with increases in baseline cortisol among females (β = 0.13 log μg/dL; 95% CI: 0.01, 0.26), but decreases among males (β = −0.22 log μg/dL; 95% CI: -0.39, −0.05). In contrast, higher BPA was associated with increased reactivity in males (β = .30 log μg/dL; 95% CI: 0.04, 0.56) but decreased reactivity in females (β = −0.15 log μg/dL; 95% CI: -0.35, 0.05). Models adjusting for creatinine yielded similar results. Conclusions Prenatal BPA exposure is associated with sex-specific changes in infant HPA axis function. The biological plausibility of these findings is supported by their consistency with evidence in rodent models. Furthermore, these data support the hypotheses that sexually dimorphic changes in children’s behaviour following prenatal BPA exposure are mediated by sexually dimorphic changes in HPA axis function.