(FIRST) Impact of a Newborn Behavioral Intervention on the Mental Health and Parenting of First-Time Mothers with Late-
Preterm Infants

Preterm birth is a serious public health issue affecting 10% of all births in the US alone. Three quarters of these infants are born between 34 0/7 and 36 6/7 weeks' gestation or late-preterm (LP). Mothers of LP infants are at increased risk for postpartum stress depression and mother-infant interaction problems posing significant risks for infant development. Specific challenges include mother-infant emotional disconnection less sensitive maternal care behavior and reduced engagement in healthy infant care practices such as breastfeeding. However relatively little attention has been given to addressing the needs of LP infants and their families especially from a family centered and dyadic or two generational perspective. This stands in contrast to an extensive body of experimental and human infant research showing that early mother-infant contact is essential for both maternal wellbeing and offspring development with disruptions having lifelong negative effects. Our proposed project will advance the fields of maternal and child health by examining the impact of the Newborn Behavioral Observations-Family Wellness (NBO-FW) a dyadic two generational intervention targeting maternal wellbeing and early mother-infant relations in families of LP born infants. The NBO-FW is a 12-week preventative intervention aimed at promoting maternal mental health and positive parenting. It is based on the highly successful NBO intervention developed by our team and applied across five continents but with important new elements targeting maternal mental health and the needs of high-risk LP infants and their families. Participants will consist of 200 first-time mothers and their LP infants (100 intervention and 100 control dyads) born at Brigham and Women's Hospital (BWH) an urban teaching hospital of Harvard Medical School and the largest maternity care provider in Boston. Data will be collected at three time points: during the first week of hospitalization at each infant's 4 to 6 week medical follow-up visit and at a further visit 10-12 weeks after birth. Outcomes will include standardized measures of maternal stress depression parenting confidence and observed mother-infant interaction. Information about infant health care practices and maternal/infant health will also be recorded. We hypothesize that compared to mothers in the care as usual control group first-time mothers of LP infants who receive the NBO-FW will demonstrate a) lower levels of stress and depression b) greater parenting confidence c) higher quality interactions with their infants (e.g. positive affect sensitivity responsiveness emotional connection); and (d) engage in more optimal infant health care practices. These outcomes align with the goals of the Health Resource and Services Administration/Maternal and Child Health Bureau Healthy People 2020 objectives Title V Maternal and Child Health Block Grant National Performance Domains and U.S. Department of Health and Human Services clinical priorities.