published_or_final_version / Obstetrics and Gynaecology / Doctoral / Doctor of Philosophy

published_or_final_version / Obstetrics and Gynaecology / Master / Master of Philosophy

This study examined the effects of prenatal exposure to methadone on clinical and neurobehavioural outcomes of infants between 40 and 42 weeks gestation. The aims of this study were: (a) to describe clinical and neurobehavioural outcomes of infants exposed to methadone during pregnancy, (b) to examine the effects of maternal methadone dose during pregnancy on infant clinical and neurobehavioural measures, and (c) to examine the extent to which associations between exposure to methadone during pregnancy and infant outcomes persisted after statistical control for a range of confounding variables. Two groups of study infants were recruited. These consisted of 51 consecutively recruited infants born to mothers maintained on methadone during their pregnancy and 42 randomly identified non-methadone exposed comparison infants. Prior to her child's birth, each pregnant woman completed a comprehensive maternal interview. At birth and during the infant's hospital stay a broad perinatal data-base was collected. At 42 weeks gestation infants underwent a neurobehavioural assessment including the NICU Network Neurobehavioural Scale (NNNS; Lester & Tronick, 2004) and infant cry analysis. Study results showed significant differences across several clinical and neurobehavioural measures. Infants exposed to methadone in utero were found to be significantly lighter, have smaller head circumferences, and spend longer in hospital. Neurobehaviourally, they were significantly less well regulated, less attentive, more easily aroused, more excitable, and more hypertonic. In addition, they exhibited less motor maturity, displayed more stress abstinence symptomatology, and required more support from the assessor in order to remain in an appropriate state. Concurrent analysis of infant cry characteristics revealed no significant differences between the fundamental frequencies or the melody contours of the two groups. However, infants prenatally exposed to methadone did display higher levels of frequency perturbation in their cries, as evidenced by analysis of their jitter factor and percentage of directional jitter. Analysis of the effects of maternal dose during pregnancy suggested that maternal dose levels above 60mg/day were general indicative of poorer infant outcomes than those below 60mg/day, with significant linear trends occurring across a number of measures. The extent to which associations between methadone exposure during pregnancy and infant outcomes reflected either a) the direct effects of methadone exposure and/or b) the effects of confounding factors correlated with maternal methadone use was examined using regression analysis. The results of this analysis for infant clinical outcomes showed confounding variables attenuated the effects of methadone exposure on infant birth length and, to some degree, infant head circumference. In contrast, associations between methadone exposure during pregnancy and most neurobehavioural outcomes remained significant, suggesting that maternal methadone use during pregnancy is an important, independent predictor of infant neurobehavioural functioning. These findings support the view that prenatal exposure to methadone has at least short term impacts on the infant's central nervous system (CNS) development. Important implications of possible vulnerabilities faced by these infants and their families are discussed.

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This research was undertaken to measure the level of comfort pregnant women felt regarding the changing communication they experienced and how that response related to facets of self-concept over the last six months of pregnancy. Major focus was placed on the relationships between variables used to measure social interaction and self-concept. A descriptive, correlational research design with longitudinal data collection was chosen to measure the concepts. Social interaction was measured with the Prenatal Communication Comfort, Close Scale, the Prenatal Communication Comfort, Far Scale and the Interpersonal Support Subscale. Aspects of self-concept were measured with the Present Body Image Scale, the Self-esteem Scale, the Modified Self-reliance Scale and the Mastery Scale. All scales demonstrated acceptable levels of reliability and validity. Purposive sampling was used to obtain the initial sample of 87 pregnant women (averaging 14.7 weeks gestation at time one) from across South Dakota. Over the next six months 67 of the women completed all three data collection periods. The women averaged 26 weeks gestation at time two and 37 weeks gestation at time three. Relationships among the major variables and the demographic variables were analyzed using descriptive statistics, Pearson Correlation, analysis of variance and covariance, and t-tests. Analyses of variance suggested no significant change over time in self-esteem, self-reliance, mastery, body image or interpersonal support. Using exploratory data analysis, four subgroups demonstrated significant variance in comfort with prenatal communication with those inside and outside their immediate social circles. The four subgroups evidenced significant differences in their level of self-esteem, self-reliance and body image. This research clarifies the actuality that women who value themselves experience discomfort with the alterations they perceive in social exchanges during their pregnancies. Women with a lower sense of self-worth become more comfortable with prenatal communication changes, but the increasing comfort does not necessarily result in a better sense of self-worth. The results of this research further underline the importance of identifying women with a diminished self-concept. Nurses may be catalysts in helping pregnant women recognize that negative attention is not necessarily better than no attention.

The purpose of this study was the assessment during pregnancy of women's ratings of the desirability of selected behaviors affecting the marital relationship. One sample of women was studied longitudinally to determine values in each trimester and changes across time. Data were obtained on 70 women in the first trimester, 57 of these in the second and 51 in the third trimester. A second sample of 30 women in the third trimester was used to ascertain any effect on the primary sample of the multiple ratings. In addition to rating the desirability of the behaviors, each woman also indicated her satisfaction with her husband's performance of the behavior. The desirability of and satisfaction with the performance were the two multiplicative components of the Gestational Behavior Index (Ge.B.I.). Also completed were a demographic data form; the Interpersonal Conflict Scale (IPC) to ascertain construct validity; and the Marlowe-Crowne Social Desirability Scale (MC-SDS) to determine social desirability response bias. The women rated the behaviors in a range from less than 1 to over 300. These ratings did not change across trimesters for the acceptant subscale but did change for the attentive, approbative, attendant, affection and total. There were no differences between ratings of first time mothers and women already mothers. Internal consistency was assessed using Pearsonian correlations and coefficients alpha and theta. Theta coefficients for subscales were .53 to .70; alpha coefficients were even lower, indicating that the behaviors were not parallel. The reliability and stability coefficients advocated by Heise (1969) were calculated to estimate stability. Desirability was less stable between the first and second than between the second and third trimester. In terms of validity, the hypothesized inverse relationship between the IPC and the Ge.B.I. was obtained, with correlations ranging from -.37 to -.76 (p < .05). Social desirability response bias was not a factor in subjects' responses. Most correlations between the Ge.B.I. subscale and total, the IPC subscale and total and the MC-SDS were nonsignificant. When significant correlations did occur, the magnitude was quite small, from .27 to .47 for the Ge.B.I. and -.35 for the IPC (p < .05).

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