The long-term goal of the proposed research is to improve understanding of the effect of a history of perinatal loss on women and their infants born subsequent to perinatal loss in order to provide critical knowledge that can inform the future development of appropriate nursing interventions. Perinatal loss (miscarriage, stillbirth, o neonatal death) occurs in over 1 million pregnancies each year in the U.S., with 80% of women becoming pregnant again within 18 months. It is well known that women pregnant after loss experience increased prevalence of depression compared to women who are pregnant for the first time, however, little is known about how depression may continue after the birth of a healthy newborn. Of particular concern is the way in which alterations in maternal mental health will affect maternal-infant bonding. Researchers have discovered that postpartum depression is associated with the presence of maternal-infant bonding disorders. However, most previous studies on the effect of perinatal loss utilize cross-sectional analysis, which has left a gap in te knowledge of how maternal depression and maternal-infant bonding may change over time in these women. The proposed study will compare first-time mothers with a history of perinatal loss to those without a history of loss.
The specific aims of the study are 1.) To determine the longitudinal relationship between a history of perinatal loss and maternal depression during pregnancy and throughout the first year postpartum in a sample of women giving birth for the first time, and 2.) To evaluate the effect of a history of perinatal loss on maternal-infant bondin throughout the first year postpartum in a sample of first-time mothers. A sub aim will also evaluate the relationship between maternal depression and maternal-infant bonding throughout the first year postpartum to determine whether depression mediates the relationship between a history of perinatal loss and maternal-infant bonding. Secondary analysis of a recent large, multisite, longitudinal cohort study will examine these specific aims. Analysis will include data from telephone interviews during the 3rd trimester of pregnancy and at 1, 6, and 12 months postpartum. Findings from this study will be used to provide insight into the progression or amelioration of depression and the progress of maternal-infant bonding in women with a history of perinatal loss, as compared to first-time mothers without a history of loss. The study will also evaluate whether the relationship between a history of perinatal loss and maternal-infant bonding is mediated by maternal depression. Results from this study will provide insight into the design and development of interventions and the appropriate timing of these interventions in order to improve the health of women who experience this type of loss and their children.
The outcomes of the proposed research will contribute to building the scientific foundation for clinical nursing practice by increasing knowledge of perinatal loss and its effect on women and their infants born subsequent to loss. This study will help to decrease the negative effects of perinatal loss for women experiencing pregnancy after loss and their infants by potentially informing the development of targeted nursing interventions for this population of women and their families.
