Maternal and Child Health Commons^™

Loss Of Pleasure (Anhedonia): A Sex-Dependent, Cross-Species Consequence Of Unpredictable Signals To The Perinatal Brain, Anna M. Zhou, Madison R. Tetzlaff, Laura M. Glynn, Curt A. Sandman, Hal S. Stern, Tallie Z. Baram, Elysia Poggi Davis

Psychology Faculty Articles and Research

Reward seeking is an essential component of human behavior. Anhedonia (reduced motivation for and pleasure in reward) is a core feature of several mental illnesses. Early life adversity associates with later impairments in reward behaviors and related psychopathology; however, specific aspects of early adversity that lead to disrupted reward behaviors are unknown. Capitalizing on evidence that unpredictable signals to the developing brain constitute adversity and influence neurodevelopment, we examined whether exposure to perinatal unpredictable maternal signals associated with diminished reward responsivity, and probed causality using experiments in mice. We analyzed a longitudinal human study (N=158 mother/child dyads) and a …

Using In-Home Air Quality Monitoring To Reduce Cannabis Secondhand Smoke Exposure In Children: Quantitative Pilot Feasibility Study, Vincent Berardi, Bradley N. Collins, Laura M. Glynn, Eusabeia Silfanus, Darby G. Lyons, Stephen J. Lepore

Psychology Faculty Articles and Research

Background: An estimated 5 to 8 million US children live with a parent who uses cannabis, and most cannabis users report smoking cannabis inside their homes, placing children at risk for cannabis secondhand smoke (cSHS) exposure. Indoor air quality (IAQ) monitoring provides real-time feedback on airborne pollutants and has shown promise in reducing in-home tobacco secondhand smoke exposure, suggesting its potential as an effective harm reduction strategy for cSHS.

Objective: This pilot study evaluated the feasibility, acceptability, and preliminary effectiveness of using low-cost, off-the-shelf IAQ monitors to increase caregivers’ awareness of children’s cSHS exposure risk and to change …

Anhedonia Underlies The Association Between Childhood Unpredictability And Adult Ptsd Symptoms: Evidence From Three Independent Longitudinal Cohorts, Christopher Hunt, Laura M. Glynn, Elysia Poggi Davis, Tallie Z. Baram, Caroline M. Nievergelt, Giovanni Castillo, Christian Cortes, Christine Y. Chang, Dewleen Baker, Victoria B. Risbrough

Psychology Faculty Articles and Research

Background

Unpredictability in the child’s environment has recently emerged as a significant and unique form of early life adversity (ELA). Cross-sectional studies have linked childhood unpredictability with increased post-traumatic stress disorder (PTSD) symptoms in adults; however, no prospective studies have tested the link between childhood unpredictability and PTSD risk in later life, nor what processes, such as increased anhedonia symptoms, might mediate such risk. Here, we leveraged three distinct prospective, longitudinal cohorts to test the hypothesis that unpredictability during childhood contributes to adult PTSD via worsening anhedonia symptoms.

Methods

Participants were male service members (n=314), adult females (n=170), and adolescents …

Association Between Children’S Secondhand Co-Exposure To Tobacco And Cannabis Smoke And Elevated Urinary Cotinine Levels: A Cross-Sectional Analysis, Bradley N. Collins, Stephen J. Lepore, Vincent Berardi, Renee D. Goodwin, Karen Wilson, Mona Baishya

Psychology Faculty Articles and Research

Background Cannabis use is far more common among adults who smoke tobacco than adults who do not, and its use is increasing among people who smoke tobacco with children living in the home. Given the well-established evidence that caregiver smoking is the primary source of children’s secondhand exposures to these products, the increasing trend in caregiver co-use is raising public health concerns about children’s co-exposure. Emerging data indicates that adult co-use is linked to additive health consequences, such as elevated nicotine and other tobacco-related toxicant blood levels, relative to use of only tobacco. It is unknown whether children’s co-exposure leads …

Mom Is Developing Too: Preliminary Evidence For The Reciprocal Effects Of Infant Sensory Reactivity And Maternal Behavior, Emily C. Sweiss, Vincent Berardi, Elysia Poggi Davis, Curt A. Sandman, Laura M. Glynn

Psychology Faculty Articles and Research

Caregiver sensitivity to infant cues is well-established as a predictor of child development. Infants also actively influence their social environment, especially their caregivers, even from their earliest days. Sensory reactivity, characterized as hypo- (under) and hyper- (over) responding to environmental stimuli, is one domain of development that is likely to influence caregiver-infant interaction, due to its role in regulating emotions and responses to both physical and social stimuli. Although sensory reactivity could be an important target for improving caregiver-child interaction, the longitudinal, reciprocal relations between infant sensory reactivity and caregiver behaviors are currently unknown. In the present proof-of-concept study, we …

Associations Between Individual And Structural Level Discrimination And Psychological And Physiological Stress Indicators During Pregnancy, Özlü Aran, Melissa Nevarez-Brewster, Kimberly D'Anna-Hernandez, Julia Dmitrieva, Curt A. Sandman, Laura M. Glynn, Elysia Poggi Davis

Psychology Faculty Articles and Research

In the United States (U.S.) pervasive health disparities in prenatal care disproportionately impact marginalized individuals. The present study investigates whether discrimination at the individual and structural levels are associated with indicators of psychological and physiological stress among pregnant Latinx people living in the U.S., including both U.S. and foreign-born individuals. Pregnant participants (n = 109) reported on birthplace, lifetime experiences of racial and ethnic discrimination, perceived levels of stress, acculturation, social support, and provided residential address data and hair samples for cortisol analysis. Regression analysis revealed that individual level discrimination was linked to higher psychological stress during pregnancy ( …

Neonatal Striatal Volume Is Associated With Infant Anhedonia, Melissa Nevarez-Brewster, Catherine H. Demers, Jessica L. Irwin, Laura M. Glynn, Martin A. Styner, Mercedes Hoeflich Haase, M. Camille Hoffman, Diego A. Pizzagalli, Benjamin L. Hankin, Elysia Poggi Davis

Psychology Faculty Articles and Research

Anhedonia is increasingly recognized as a transdiagnostic risk factor for psychopathology. New evidence demonstrates that anhedonia is present in infancy and early childhood. Structural variability in striatal regions involved in reward processing and pleasure seeking is concurrently linked to anhedonia, yet few studies have examined whether striatal differences presage anhedonia, and none have examined prospective associations before middle childhood. The present study examined whether neuroanatomical markers that confer risk for anhedonia can be detected as early as the neonatal period. Specifically, we tested whether the volume of striatal regions in neonates predicted the emergence of infant anhedonic behaviors at six …

Kind Kids, Healthy Teens: Child Prosociality And Fruit And Vegetable Intake, Farah Qureshi, Krista P. Woodward, Laura D. Kubzansky, Julia K. Boehm

Psychology Faculty Articles and Research

Introduction

Methods

Prenatal Maternal Mood Instability And Child Externalizing Problems: An Ecological Momentary Assessment Study, Sophie G. Srivastava, Curt A. Sandman, Elysia Poggi Davis, Laura M. Glynn

Psychology Faculty Articles and Research

This study examines whether exposure to affect fluctuations during fetal development have implications for child psychopathology. To evaluate maternal mood instability, participants (N = 154) completed Ecological Momentary Assessment (EMA) eight times per day across three days at 15-, 25-, and 35-weeks' gestation, and then at two months postpartum. The EMA measured depressive symptoms (Center for Epidemiologic Studies Depression Scale), anxiety (Profile of Mood States), and stress (Perceived Stress Scale). Mood instability was quantified by calculating root mean square of successive differences (RMSSD), which captures both variability and temporal dependency of mood states. When the children were 3 years …

Sex-Specific Effects Of Early-Life Unpredictability On Hippocampal And Amygdala Responses To Novelty In Adolescents, Elysia Poggi Davis, Bianca T. Leonard, Robert J. Jirsaraie, David B. Keator, Steven L. Small, Curt A. Sandman, Victoria B. Risbrough, Hal S. Stern, Laura M. Glynn, Michael A. Yassa, Tallie Z. Baram, Jerod M. Rasmussen

Psychology Faculty Articles and Research

Background

Unpredictable childhood experiences are an understudied form of early-life adversity that impact neurodevelopment. The neurobiological processes by which exposure to early-life unpredictability impact development and vulnerability to psychopathology remain poorly understood. In the current study, we investigated the sex-specific consequences of early-life unpredictability on the limbic network, focusing on the hippocampus and the amygdala.

Methods

Participants included 150 youths (54% female). Early-life unpredictability was assessed using the Questionnaire of Unpredictability in Childhood (QUIC). Participants engaged in 1 or more task–functional magnetic resonance imaging scans between the ages of 8 and 17 (223 total observations) measuring blood oxygen level–dependent (BOLD) …

The Quic-Sp: A Spanish Language Tool Assessing Unpredictability In Early Life Is Linked To Physical And Mental Health, Sabrina R. Liu, Natasha A. Bailey, Sara Romero-González, Amy Moors, Belinda Campos, Elysia P. Davis, Laura M. Glynn

Psychology Faculty Articles and Research

Accumulating evidence indicates that unpredictable signals in early life represent a unique form of adverse childhood experiences (ACEs) associated with disrupted neurodevelopmental trajectories in children and adolescents. The Questionnaire of Unpredictability in Childhood (QUIC) was developed to assess early life unpredictability, encompassing social, emotional, and physical unpredictability in a child’s environment, and has been validated in three independent cohorts. However, the importance of identifying ACEs in diverse populations, including non-English speaking groups, necessitates translation of the QUIC. The current study aims to translate and validate a Spanish language version of the QUIC (QUIC-SP) and assess its associations with mental and …

Interoception In Pregnancy: Implications For Peripartum Depression, Paul W. Savoca, Laura M. Glynn, Molly M. Fox, Misty C. Richards, Bridget L. Callaghan

Psychology Faculty Articles and Research

"In this perspective piece, we propose a novel mechanistic framework for peripartum depression in which improved interoceptive functioning in pregnancy and postpartum typically protects against depressive symptoms, but when there is a failure to improve interoception, the result is an inability to maintain metabolic efficiency, which ultimately poses risk for depression. First, we will review an emerging theory that links the modeling and predictive regulation of metabolic resources as central to the expression of many depressive symptoms. Then, focusing on the period of pregnancy to articulate the framework, we will discuss the physiological changes induced by pregnancy that place an …

Leveraging The Science Of Early Life Predictability To Inform Policies Promoting Child Health, Laura M. Glynn, Sabrina R. Liu, Candice Taylor Lucas, Elysia Poggi Davis

Psychology Faculty Articles and Research

Addressing the tremendous burden of early-life adversity requires constructive dialogues between scientists and policy makers to improve population health. Whereas dialogues focused on several aspects of early-life adversity have been initiated, discussion of an underrecognized form of adversity that has been observed across multiple contexts and cultures is only now emerging. Here we provide evidence for “why unpredictability?”, including: 1. Evidence that exposures to unpredictability affect child neurodevelopment, with influences that persist into adulthood. 2. The existence of a translational non-human animal model of exposure to early life unpredictability that can be capitalized upon to causally probe neurobiological mechanisms. 3. …

Exploring The Impact Of Maternal Early Life Adversity On Interoceptive Sensibility In Pregnancy: Implications For Prenatal Depression, Paul W. Savoca, Laura M. Glynn, Molly M. Fox, Misty C. Richards, Bridget L. Callaghan

Psychology Faculty Articles and Research

Purpose

Pregnancy is a sensitive period of development in adult life characterized by massive changes in physical, emotional, and cognitive function. Such changes may be adaptive, e.g., facilitating adjustment to physical demands, but they may also reflect or contribute to risks inherent to this stage of life, e.g., prenatal depression. One cognitive ability that may undergo change during pregnancy and contribute to mental wellness is interoception - the ability to perceive, integrate, and model sensory information originating from the body. Strong interoceptive abilities are associated with lower rates of depression in non-pregnant adult populations, and interoception is generally weaker in …

Individual Longitudinal Changes In Dna-Methylome Identify Signatures Of Early-Life Adversity And Correlate With Later Outcome, Annabel K. Short, Ryan Weber, Noriko Kamei, Christina Wilcox Thai, Hina Arora, Ali Mortazavi, Hal S. Stern, Laura M. Glynn, Tallie Z. Baram

Psychology Faculty Articles and Research

Adverse early-life experiences (ELA) affect a majority of the world's children. Whereas the enduring impact of ELA on cognitive and emotional health is established, there are no tools to predict vulnerability to ELA consequences in an individual child. Epigenetic markers including peripheral-cell DNA-methylation profiles may encode ELA and provide predictive outcome markers, yet the interindividual variance of the human genome and rapid changes in DNA methylation in childhood pose significant challenges. Hoping to mitigate these challenges we examined the relation of several ELA dimensions to DNA methylation changes and outcome using a within-subject longitudinal design and a high methylation-change threshold. …

Dhea: A Neglected Biological Signal That May Affect Fetal And Child Development, Natasha A. Bailey, Elysia Poggi Davis, Curt A. Sandman, Laura M. Glynn

Psychology Faculty Articles and Research

The stress-sensitive maternal hypothalamic–pituitary–adrenal (HPA) axis through the end-product cortisol, represents a primary pathway through which maternal experience shapes fetal development with long-term consequences for child neurodevelopment. However, there is another HPA axis end-product that has been widely ignored in the study of human pregnancy. The synthesis and release of dehydroepiandosterone (DHEA) is similar to cortisol, so it is a plausible, but neglected, biological signal that may influence fetal neurodevelopment. DHEA also may interact with cortisol to determine developmental outcomes. Surprisingly, there is virtually nothing known about human fetal exposure to prenatal maternal DHEA and offspring neurodevelopment. The current study …

Mothers’ Prenatal Distress Accelerates Adrenal Pubertal Development In Daughters, Molly M. Fox, Jennifer Hahn-Holbrook, Curt A. Sandman, Jessica A. Marino, Laura M. Glynn, Elysia Poggi Davis

Psychology Faculty Articles and Research

Human life history schedules vary, partly, because of adaptive, plastic responses to early-life conditions. Little is known about how prenatal conditions relate to puberty timing. We hypothesized that fetal exposure to adversity may induce an adaptive response in offspring maturational tempo. In a longitudinal study of 253 mother-child dyads followed for 15 years, we investigated if fetal exposure to maternal psychological distress related to children’s adrenarche and gonadarche schedules, assessed by maternal and child report and by dehydroepiandrosterone sulfate (DHEA-S), testosterone, and estradiol levels. We found fetal exposure to elevated maternal prenatal psychological distress predicted earlier adrenarche and higher DHEA-S …

Contact With Caregivers Is Associated With Composition Of The Infant Gastrointestinal Microbiome In The First 6 Months Of Life, Kyle S. Wiley, Andrew M. Gregg, Molly M. Fox, Venu Lagishetty, Curt A. Sandman, Jonathan P. Jacobs, Laura M. Glynn

Psychology Faculty Articles and Research

Objectives

Little is known about how physical contact at birth and early caregiving environments influence the colonization of the infant gastrointestinal microbiome. We investigated how infant contact with caregivers at birth and within the first 2 weeks of life relates to the composition of the gastrointestinal microbiome in a sample of U.S. infants (n = 60).

Methods

Skin-to-skin and physical contact with caregivers at birth and early caregiving environments were surveyed at 2 weeks postpartum. Stool samples were collected from infants at 2 weeks, 2, 6, and 12 months of age and underwent 16S rRNA sequencing as a proxy …

One Size Doesn’T Fit All: Attitudes Towards Work Modify The Relation Between Parental Leave Length And Postpartum Depression, Christine Y. Chang, Sabrina R. Liu, Laura M. Glynn

Psychology Faculty Articles and Research

The present study aimed to investigate the relationship between parental leave length and maternal depressive symptoms at six- and twelve-months postpartum and whether this relation was influenced by women’s attitudes towards leave, whether leave was paid or unpaid, and the reason they returned to work. The sample included 115 working women recruited during pregnancy as part of a larger longitudinal study. Analyses revealed that maternal attitudes toward leave influenced the association between leave length and depressive symptoms. Specifically, longer leaves were associated with increased depressive symptoms for women who missed their previous activities at work. Furthermore, women who missed work …

Prenatal Exposure To Maternal Mood Entropy Is Associated With A Weakened And Inflexible Salience Network In Adolescence, Robert J. Jirsaraie, Anton M. Palma, Steven L. Small, Curt A. Sandman, Elysia Poggi Davis, Tallie Z. Baram, Hal S. Stern, Laura M. Glynn, Michael A. Yassa

Psychology Faculty Articles and Research

Background

Methods

Exposure To Unpredictability And Mental Health: Validation Of The Brief Version Of The Questionnaire Of Unpredictability In Childhood (Quic-5) In English And Spanish, Natasha G. Lindert, Megan Y. Maxwell, Sabrina R. Liu, Hal S. Stern, Tallie Z. Baram, Elysia Poggi Davis, Victoria B. Risbrough, Dewleen G. Baker, Caroline M. Nievergelt, Laura M. Glynn

Psychology Faculty Articles and Research

Unpredictability is increasingly recognized as a primary dimension of early life adversity affecting lifespan mental health trajectories; screening for these experiences is therefore vital. The Questionnaire of Unpredictability in Childhood (QUIC) is a 38-item tool that measures unpredictability in childhood in social, emotional and physical domains. The available evidence indicates that exposure to unpredictable experiences measured with the QUIC predicts internalizing symptoms including depression and anxiety. The purpose of the present study was to validate English and Spanish brief versions (QUIC-5) suitable for administration in time-limited settings (e.g., clinical care settings, large-scale epidemiological studies). Five representative items were identified from …

Maternal Prenatal Cortisol Trajectories Predict Accelerated Growth In Infancy, Jennifer Hahn-Holbrook, Elysia Poggi Davis, Curt A. Sandman, Laura M. Glynn

Psychology Faculty Articles and Research

Higher maternal cortisol in pregnancy has been linked to childhood obesity. Much of the previous research has been limited in that cortisol in pregnancy is only measured at one time-point, precluding the ability to examine critical timing effects of prenatal maternal cortisol. To fill this gap, this longitudinal study measured maternal plasma cortisol at 15, 19, 25, and 31 weeks of pregnancy, and assessed infant body mass index percentile (BMIP)1 at birth, 3, 6, 12, and 24 months in 189 mother-infant pairs. Three distinct patterns of maternal cortisol in pregnancy (typical, steep, and flat trajectories) were identified using general growth …

Early Life Exposure To Unpredictable Parental Sensory Signals Shapes Cognitive Development Across Three Species, Elyssia Poggi Davis, Kari Mccormack, Hina Arora, Desiree Sharpe, Annabel K. Short, Jocelyne Bachevalier, Laura M. Glynn, Curt A. Sandman, Hal S. Stern, Mar Sanchez, Tallie Z. Baram

Psychology Faculty Articles and Research

Exposure to early life adversity has long term consequences on cognitive function. Most research has focused on understanding components of early life adversities that contribute to later risk, including poverty, trauma, maltreatment, and neglect. Whereas these factors, in the aggregate, explain a significant proportion of emotional and cognitive problems, there are serious gaps in our ability to identify potential mechanisms by which early life adversities might promote vulnerability or resilience. Here we discuss early life exposure to unpredictable signals from the caretaker as an understudied type of adversity that is amenable to prevention and intervention. We employ a translational approach …

Intergenerational Risk And Resilience Pathways From Discrimination And Acculturative Stress To Infant Mental Health, Sabrina R. Liu, Curt A. Sandman, Elyssia Poggi Davis, Laura M. Glynn

Psychology Faculty Articles and Research

Preconception and prenatal stress impact fetal and infant development, and women of color are disproportionately exposed to sociocultural stressors like discrimination and acculturative stress. However, few studies examine links between mothers’ exposure to these stressors and offspring mental health, or possible mitigating factors. Using linear regression, we tested associations between prenatally assessed maternal acculturative stress and discrimination on infant negative emotionality among 113 Latinx/Hispanic, Asian American, Black, and Multiethnic mothers and their children. Additionally, we tested interactions between stressors and potential pre- and postnatal resilience-promoting factors: community cohesion, social support, communalism, and parenting self-efficacy. Discrimination and acculturative stress were related …

Prenatal Exposure To Maternal Psychological Distress And Telomere Length In Childhood, Stephanie A. Stout-Oswald, Laura M. Glynn, Marco Bisoffi, Catherine H. Demers, Elysia Poggi Davis

Psychology Faculty Articles and Research

Telomere length (TL) is a biological marker of cellular aging, and shorter TL in adulthood is associated with increased morbidity and mortality risk. It is likely that these differences in TL are established long before adulthood, and there is growing evidence that TL can reflect prenatal experiences. Although maternal prenatal distress predicts newborn TL, it is unknown whether the relation between prenatal exposure to maternal distress and child TL persists through childhood. The purpose of the current longitudinal, prospective study is to examine the relation between prenatal exposure to maternal distress (perceived stress, depressive symptoms, pregnancy-related anxiety) and TL in …

The Contribution Of Racism-Related Stress And Adversity To Disparities In Birth Outcomes: Evidence And Research Recommendations, Sabrina R. Liu, Laura M. Glynn

Psychology Faculty Articles and Research

Currently, racial and ethnic differences in adverse birth outcomes and infant mortality are some of the largest and most persistent health disparities in the United States. This narrative review article synthesizes existing literature to present a conceptual model of how racism-related stress and adversity are critical determinants of such disparities. We describe how historical and ongoing racism has created conditions wherein women of color are disproportionately exposed to chronic, multilayered stress and adversity and how the biological consequences of exposure to these stressors confers risk for adverse birth outcomes. Next, we identify important priorities and considerations for future research, including …

Development Of The Infant Gut Microbiome Predicts Temperament Across The First Year Of Life, Molly Fox, S. Melanie Lee, Kyle S. Wiley, Venu Lagishetty, Curt A. Sandman, Jonathan P. Jacobs, Laura M. Glynn

Psychology Faculty Articles and Research

Perturbations to the gut microbiome are implicated in altered neurodevelopmental trajectories that may shape life span risk for emotion dysregulation and affective disorders. However, the sensitive periods during which the microbiome may influence neurodevelopment remain understudied. We investigated relationships between gut microbiome composition across infancy and temperament at 12 months of age. In 67 infants, we examined if gut microbiome composition assessed at 1–3 weeks, 2, 6, and 12 months of age was associated with temperament at age 12 months. Stool samples were sequenced using the 16S Illumina MiSeq platform. Temperament was assessed using the Infant Behavior Questionnaire-Revised (IBQ-R). Beta …

Prenatal Maternal Mood Entropy Is Associated With Child Neurodevelopment, Mariann A. Howland, Curt A. Sandman, Elysia Poggi Davis, Hal S. Stern, Michael Phelan, Tallie Z. Baram, Laura M. Glynn

Psychology Faculty Articles and Research

Emerging evidence indicates that the predictability of signals early in life may influence the developing brain. This study examines links between a novel indicator of maternal mood dysregulation, mood entropy, and child neurodevelopmental outcomes. Associations between prenatal maternal mood entropy and child neurodevelopment were assessed in 2 longitudinal cohorts. Maternal mood was measured several times over pregnancy beginning as early as 15 weeks’ gestation. Shannon’s mood entropy was applied to distributions of mothers’ responses on mood questionnaires. Child cognitive and language development were evaluated at 2 and 6–9 years of age. Higher prenatal maternal mood entropy was associated with lower …

Aberrant Maturation Of The Uncinate Fasciculus Follows Exposure To Unpredictable Patterns Of Maternal Signals, Steven J. Granger, Laura M. Glynn, Curt A. Sandman, Steven L. Small, Andre Obenaus, David B. Keator, Tallie Z. Baram, Hal S. Stern, Michael A. Yassa, Elyssia Poggi Davis

Psychology Faculty Articles and Research

Across species, unpredictable patterns of maternal behavior are emerging as novel predictors of aberrant cognitive and emotional outcomes later in life. In animal models, exposure to unpredictable patterns of maternal behavior alters brain circuit maturation and cognitive and emotional outcomes. However, whether exposure to such signals in humans alters the development of brain pathways is unknown. In mother–child dyads, we tested the hypothesis that exposure to more unpredictable maternal signals in infancy is associated with aberrant maturation of corticolimbic pathways. We focused on the uncinate fasciculus, the primary fiber bundle connecting the amygdala to the orbitofrontal cortex and a key …

Prenatal Maternal Psychological Distress And Fetal Developmental Trajectories: Associations With Infant Temperament, Mariann A. Howland, Curt A. Sandman, Elyssia Poggi Davis, Laura M. Glynn

Psychology Faculty Articles and Research

Associations between prenatal maternal psychological distress and offspring developmental outcomes are well documented, yet relatively little research has examined links between maternal distress and development in utero, prior to postpartum influences. Fetal heart rate (FHR) parameters are established indices of central and autonomic nervous system maturation and function which demonstrate continuity with postnatal outcomes. This prospective, longitudinal study of 149 maternal–fetal pairs evaluated associations between prenatal maternal distress, FHR parameters, and dimensions of infant temperament. Women reported their symptoms of psychological distress at five prenatal visits, and FHR monitoring was conducted at the last three visits. Maternal report of infant …