Journal of Pediatric Psychology Advance Access originally published online on October 12, 2005
Journal of Pediatric Psychology 2006 31(3):331-336; doi:10.1093/jpepsy/jsj084
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Do Gestational Age and Weight for Gestational Age Predict Concordance in Parental Perceptions of Infant Temperament?
1 Department of Psychology, University of Helsinki, 2 Department of Medicine, University of Helsinki, and 3 Department of Neonatology, Hospital for Children and Adolescents, Helsinki University Central Hospital
All correspondence concerning this article should be addressed to Katri Räikkönen, PhD, Department of Psychology, University of Helsinki, PO Box 9, FI-00014 Helsinki, Finland. E-mail: katri.raikkonen{at}helsinki.fi.
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Abstract |
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Objective To study whether infant weight for gestational age, and gestational age predict mother- and father-rated infant temperament (IBQ) at 6 months. Methods The sample comprised of family units with both biological parents and infants born at term (n = 152). Data on weight and gestational age were collected form obstetric database. Results Infants born small for gestational age (SGA) (weight < 10th percentile for gestational age) were rated by both parents as significantly more fearful and negatively reactive compared to infants born appropriate for gestational age (AGA). Infants born SGA defined by using the lowest 15th or 20th percentile groups did not differ from AGA group in temperament. The weekly continuum of gestational age predicted differences in parental ratings of infant temperamental attentiveness. Conclusions The predictive significance of infant weight for gestational age and gestational age for behavioral outcomes appear true also for infants born at term. Concordance in parental perceptions of an infant born SGA emphasizes the clinical significance of the findings.
Key words: father; gestational age; infant; mother; temperament; weight for gestational age.
Infants born small for gestational age (SGA)1 are at increased risk of a wide range of adverse physical and psychological outcomes (Arends et al., 2002
; Cheung, Khoo, Karlberg, & Machin, 2002). Research directed at examining associations between perinatal measures and early temperament characteristics of the infant do not yield a consistent picture: some studies have assigned more positive temperament characteristics to the infant (Newman et al., 1997; Riese, 1992), some more negative (Halpern & Garcia Coll, 2000; Halpern, Garcia Coll, Meyer, & Bendersky, 2001; Watt, 1987). One study reported no differences in temperament between the infants born SGA and appropriate for gestational age (AGA) at 7 months of age (Robson & Cline, 1998), one study found that the infants born SGA tended to be less attentive than the infants born AGA between the ages of 4 and 8 months, but just as attentive at the age of 12 months (Halpern & Garcia Coll, 2000).
The inconsistent findings may, at least in part, reflect differences in age and methods of measuring temperament between the different studies (Newman et al., 1997; Riese, 1992; Watt, 1987), the fact that SGA and AGA criteria has varied from one study to another (Halpern & Garcia Coll, 2000; Watt, 1987), or across the time of data collection within one study (Newman et al., 1997), the heterogeneity of the groups of infants born SGA with infants born prematurely and at term being included in the same group (Newman et al., 1997; Watt, 1987), and the fact that the comparison groups are matched controls (i.e., co-twins) (Riese, 1992) or AGA/normal-birth-weight infants (Halpern & Garcia Coll, 2000; Halpern et al., 2001; Watt, 1987). Moreover, in the previous studies temperament has been measured using mother reports (Newman et al., 1997; Watt, 1987), observer reports (Riese, 1992), or both (Halpern & Garcia Coll, 2000; Halpern et al., 2001; Robson & Cline, 1998). In only one of these studies (Halpern & Garcia Coll, 2000) has temperament been measured using the mother ratings and the observer ratings at a simultaneous timepoint allowing comparisons of the different measures of temperament between the groups of infants born SGA and AGA. From empirical and theoretical perspectives, however, inclusion of infant temperament as rated by both parents, might provide a more fruitful approach than that applying mother ratings and/or observer ratings only.
This study tested whether, in a group of infants born at term, that is, at weeks 37–42, infants born SGA and AGA differed in characteristics of temperament (Rothbart, 1981) as assessed by both biological parents 6 months postpartum. Because measures of temperament were derived from both mothers and fathers we were able to test whether the infant weight for gestational age had a similar or a different effect on the mother- and father-rated infant temperament. Further, as the definition of SGA is arbitrary in nature, exploratory analyses were conducted to find the upper limit for size for gestational age which would be significant in relation to temperament.
Also, this study tested whether the full-term variation in gestational age per se and mother- and father-rated infant temperament at 6 months were related. Previous studies associate prematurity with more negative temperament (Gennaro, Tulman, & Fawcett, 1990; Langkamp, Young, & Pascoe, 1998; Sajaniemi, Salokorpi, & von Wendt, 1998; Washington, Minde, & Goldberg, 1986) or have found no associations between prematurity and temperament (Goldstein & Bracey, 1988; Halpern & McLean, 1997; Oberklaid, Prior, & Sanson, 1986; Ross, 1987). In these studies, full-term infants were not separated according to gestational age, and the groups were treated as homogenous control groups. This carries implicit premise that the 6-week variation in gestational age is not of importance within a full-term group. However, even though the full-term variation is not a risk factor for biological development, the gestational age may still function either as a biological or as an environmental factor influencing parental perceptions of infant temperament. The biological factor could be linked to the variation in physical and neurological maturity associated with full-term gestational age (Amiel-Tison, Maillard, Lebrun, Breart, & Papiernik, 1999). It could be hypothesized that variation in neurological and physical maturity could also affect the parental behavior and perceptions of the infant.
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Methods |
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The present sample comprised of 152 family units consisting of both biological parents and the infant. The families participated in a study on neonatal and early-childhood predictors of hypertension development. The initial sample of 1,049 mother–infant dyads was recruited from one of the principal maternity hospitals of Helsinki, with approximately 4,500 births per year. The dyads represented a consecutive series of mothers with singleton healthy births in 1998. Sickness of preterm babies were treated in the pediatric ward in the university hospital and they were not included in the study. After the delivery, while still on the maternity ward, the first 500 mothers, as well as the biological fathers, were invited to participate in a psychological survey on child development follow-up. Of these families, a total of 328 (65.6%) returned the psychological questionnaires approximately 6 months after the delivery. Of the 328 family units, 180 units were represented by both biological mothers and fathers. One hundred and fifty-two units of term infants (gestational age
37 weeks) had data available for the present study purposes (age M = 6.3, SD = 1.4 months). The Institutional Review Board at the University of Helsinki approved this project, and the participating parents gave their informed consent. Details of the research protocol and of the recruitment of the initial sample are to be found in Strandberg, Järvenpää, Vanhanen, & McKeigue (2001). A comparison of the mothers and fathers in this study revealed no significant differences in education (of the mothers and fathers, respectively, 31.5% and 35.6% had a university degree, 47.6% and 47.3% had vocational education, 12.8% and 10.7% only high-school education, and 4.0% and 5.4% did not have education beyond elementary school; p = .58). A comparison of the mother–child dyads participating in this study and those in the initial sample revealed no significant differences in 1-min Apgar score (p > .32; M = 8.77, SD = 0.84; M = 8.68, SD = 1.04), birth weight (p = 0.74; M = 3557, SD = 414; M = 3544, SD = 466), the gender of the infant (p > .08; 56% girls/48% girls), or in maternal age (M = 29.0, SD = 4.4; M = 29.8, SD = 5.1; p > .06). The infants of this study (M = 40.3, SD = 1.14) were born somewhat later in weeks than the initial sample (M = 40.0, SD = 1.28; p < .01) and were more likely to be among the first children born in the family (M = 1.4, SD = .70; M = 1.6, SD = .87; p < .02).
Measures
Weight for Gestational Age and Gestational Age
Estimates of gestational age obtained by fetal ultrasound measurements of biparietal diameter during the first trimester were available from hospital maternity records for 90% of the women. If ultrasound measurements were unavailable, gestational age was obtained from the mother’s self-report of the last menstrual period.
Infants were considered SGA (n = 16) if they were in the lowest 10th percentile of birth weight for each gestational week stratified by infant gender. The AGA group (n = 136) consisted of infants with birth weights above 10th percentile. Groupings were done according to the population-based fetal growth chart (Pihkala, Hakala, Voutilainen, & Raivio, 1989). The SGA infants size-for-gestational age ranged from 2nd percentile to 10th percentile (M = 6.13, SD = 2.21). Gestational age of SGA infants varied from 38 to 42 (M = 40.7, SD = 1.16) and was not significantly different from AGA infants’ gestational age (M = 40.3, SD = 1.11, p > .16). Birth weights within the SGA and AGA groups were normally distributed (SGA: M = 2934, SD = 144; AGA: M = 3629, SD = 370). The gender distribution between SGA and AGA groups was also equal (p > .34).
Analyses were conducted also with SGA infants defined as belonging to the lowest 15th percentile (N = 22) and the lowest 20th percentile (N = 27) of birth weight.
Gestational age varied in weeks from 37 to 42. Because of small sample size at week 37 (n = 3), infants born at weeks 37 and 38 were combined in the analyses testing effects of gestational age on temperament. Distribution of the sample and mean birth weights in grams according to gestational age were following: week 37–38, N = 16, M = 3402, SD = 362; week 39, N = 35, M = 3459, SD = 400; week 40, N = 56, M = 3613, SD = 386; week 41, N = 35, M = 3592, SD = 448; and week 42, N = 10, M = 3719, SD = 505.
Parent-Rated Infant Temperament
Mother- and father-rated infant temperament was assessed using the Infant Behavior Questionnaire (IBQ) (Rothbart, 1986). The IBQ includes 96 items evaluated on a 7-point scale reflecting the relative frequency of occurrence of specified infant reactions in concrete situations in previous weeks and six subscales (activity level, smiling and laughter, fear, distress to limitations, soothability, and duration of orienting). In addition, an item-weighted sum of fear and distress to limitation subscales form a negative reactivity cluster, whereas positive reactivity cluster is formed from smiling and laughter and activity subscales (Rothbart, 1986). The reliability of IBQ is good (Rothbart, 1986). In this study, the Cronbach alphas ranged from .74 to .93.
Statistical Analyses
Univariate analyses of variance (ANOVA) with repeated measures were computed to test mother- and father-rated infant temperament (within-subject factor) in relation to infant weight for gestational age, and gestational age (between-group factor). Also, the ANOVA tested whether the parental perceptions with mother ratings and father ratings combined were associated with the perinatal measures. We included interactions of infant gender with the perinatal measures into the models to test whether the perinatal measures and parent-rated temperament varied according to infant gender. Analyses of significant interactions were further examined using paired-samples t tests and one-way univariate ANOVAs where appropriate.
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Results |
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Weight for gestational age and gestational age status were not significantly correlated (Pearson p > .12). Mother- and father-rated infant temperament were significantly related as determined both by intraclass and Pearson correlations (activity, .45 and .29; smiling and laughter, .47 and .31; distress to limitations, .59 and .42; fear, .54 and .37; duration of orienting .41 and .26; soothability, .28 and .17, positive reactivity, .54 and .37; negative reactivity, .61 and .44; all p < .05). Mean level comparisons of the mother- and father-rated infant temperament revealed that fathers perceived their infants as significantly more fearful (t = –3.77, p < .001), distressed to limitations (t = –2.33, p < .05), and negatively reactive (t = –3.72, p < .001) than the mothers did. Infant gender did not interact with the parental ratings of the infant temperament in these analyses.
Weight for Gestational Age and Infant Temperament
Infant weight per se was not correlated significantly with dimensions of temperament. Infant weight for gestational age (10th percentile) did not predict any significant differences in the parental perceptions of the temperament in 2 (SGA/AGA) x 2 (mother/father) repeated measures ANOVA. Instead, the ANOVA revealed that infants born SGA were rated by both the parents, mother and father ratings combined, as significantly more fearful and more negatively reactive than were infants born AGA (Table I). Infant gender did not affect the result.
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Exploratory analyses with SGA limit in the 15th and 20th percentile showed no significant differences in the mother- and father-rated infant temperament (fear and negative reactivity) within the parents or when parents’ ratings were combined (all p > .17).
Gestational Age and Infant Temperament
Mother- and father-rated duration of orienting varied according to infant gestational age, F(4, 143) = 3.89, p < .01 (Fig. 1). Fathers perceived the infants born at week 41 as significantly more attentive than mothers did, t(34) = –2.92, p < .01. The reverse was true with infants born in week 42, with fathers rating the infants as less attentive than the mothers, t(9) = 3.59, p < .01. Maternal and paternal ratings were not significantly different for infants born at weeks 37–38 to 40. Although the effect did not show statistically significant linearity across all full-term gestational weeks, there was a significant increase in one-way ANOVA in maternal perceptions of infant’s duration of orienting when infants born at weeks 37–38 were compared with infants born at week 42, F(1, 23) = 5.50, p < .03. For fathers, the downward trend in perceptions of infant’s duration of orienting according to gestational age was not significant (p > .08). There were no other significant effects.
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Discussion |
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We tested whether perinatal status predicted parental perceptions of temperament among healthy full-term infants and found that those born SGA were perceived by the mothers and fathers as more fearful and negatively reactive than those born AGA. This effect was significant only in the group defined as belonging to the lowest 10th percentile of weight-for-gestational age. Analyses with groups using 15th or 20th percentile limits for weight for gestational age did not produce any significant effects. Our study findings thus underline the fact that infant perinatal status may matter for early behavioral development even within the healthy, full-term range.
The other major contribution of this study was to show that there is a shared parental experience of an infant born SGA. The weight for gestational age did not predict any differences in the parental perceptions of the infant temperament suggesting that infants born SGA might be characterized by a common biological factor that affects the temperamental outcomes. Nor can it be ruled out, that the mechanism underlying these associations may be primarily due to parental cognitions rather than to physiological or neurodevelopmental factors. Specifically, parents may have had a shared experience with an infant born SGA as more vulnerable and reactive from the start, and that experience, in turn, may have modulated the infant’s temperamental reactivity. From the clinical perspective, it is noteworthy that the behavioral outcomes of infants born preterm or SGA is also dependent on maternal sensitivity of interactions (Gorman, Lourie, & Choudhury, 2001; Halpern et al., 2001). This effect should not be any different and ought to apply for fathers as well.
Although the effect of infant weight for gestational age on parent reported infant temperament was linear for both parents, maternal and paternal reports of infant’s duration of orienting were differently related to the infant gestational age. Previous comparisons on premature/term infants suggest that development of attention processes might be sensitive to infant’s gestational age (Cherkes-Julkowski, 1998). The parental perceptions of this study suggest that duration of orienting might be dependent on gestational age also at a full-term range. However, the nonlinearity between maternal and paternal perceptions suggests that the gestational age may function as an environmental variable affecting parental perceptions of the child’s duration of orienting differently. Infant attentiveness and interaction with environment at 4–6 months is known to be closely related to the moments after breastfeeding (Gerrish & Mennella, 2000). As the gestational age of full terms is linearly related to both physical and neurological maturity (i.e., sucking reflex), (Amiel-Tison et al., 1999), more mature infants may have been more attentive in breastfeeding interactions with the mother from the early days on. This interpretation is also supported by the result showing an increase in maternal perceptions of the duration of orienting along the more mature gestational age. Whether the different parental roles of mothers and fathers is also related to current finding that fathers perceived the infants more negatively reactive in general, remains a question to be addressed in future.
There are limitations to our study. First, the number of infants born SGA as in week 42 was small. Secondly, we measured temperament only once. Finally, there is lack of more concise theoretical understanding on the relation between weight-for-gestational age and temperament. Specifically, studies associating temperament and perinatal measures have not been able to differentiate infants born SGA according to etiology: the relation of temperament and weight for gestational age might then be different for infants born SGA for genetic reasons and for infants born SGA because of deficits in placental environment (Thompson et al., 2001).
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This study was supported by the University of Helsinki (grant number 20550) and the Academy of Finland (grants number 104769 and 106424).
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1 [When SGA and specific clinical indicators are detected, a diagnosis of intrauterine growth retardation (IUGR) may be given. All infants with IUGR are SGA, but not all SGA infants have IUGR. Our sample was healthy and IUGR-free. Therefore, we use the term SGA throughout this article.]
Received November 30, 2002; revision received September 18, 2003; accepted December 15, 2003
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