Newborn infants with differential patterns of fetal growth, as determined by their weight-for-length, typically display behaviors which have been conceptualized as reflecting the integrity of the infant's behavioral organization. The newborn infant's sucking is one behavior that has been hypothesized to both reflect the effects of previous experiences on behavioral organization and affect the infant's future behavioral development. In particular, the infant's pattern of sucking activity may not only reflect the integrity of the infant's nervous system, it may also alter the temporal organization of the infant's behavioral state and motor activity by increasing behavioral quiescence. The purpose of this study was to compare the sucking activity of underweight-for-length (N = 30) and average-weight-for-length (N = 30) infants and its effects on behavioral state and motor activity. Fifteen low-PI and 15 average-PI infants were randomly assigned to each of two experimental conditions. / Master of Science

With increases in medical technology, infant mortality has decreased, while infant morbidity has increased over the past half century. Moreover, the definition of high-risk pregnancy continues to lack true universal acceptance. Thus, continued research in the area of perinatal complications is warranted. There have been studies that have suggested short-term and long-term deficits considered to be secondary to perinatal complications. Psychologists often gather information about a given child’s perinatal history, but do not always have means to interpret how those complications may impact the child later in life. The Maternal Perinatal Scale (MPS) has been shown to have good reliability and validity in past studies, but a scoring system has yet to be established. This project consisted of two studies. The first study created a preliminary scoring system for the developmental questionnaire, the Maternal Perinatal Scale. This questionnaire has proven to have potential for good clinical utility, but prior to this study, had nothing beyond item-by-item analysis for interpreting the results. To test the validity of the proposed scoring system, a second study was conducted to determine cutoff scores and classification rates for the scoring system on data previously collected with children in elementary school. Results revealed proposed scores for each item on the MPS and classification rates associated with certain developmental disorders later in life. / Department of Educational Psychology

The early postnatal period is marked by the rapid acquisition of sensorimotor processing capabilities. Initially responding to a limited set of environmental stimuli with a restricted repertoire of behaviors, mammals exhibit a remarkable proliferation of sensorimotor abilities in the early postnatal period. Central to action selection, reinforcement, and contingency learning are a subcortical set of evolutionarily conserved nuclei called the basal ganglia. The striatum, which is the primary input nucleus of the basal ganglia, receives afferent innervation from throughout the CNS. Its projection neurons (SPNs) integrate these diverse inputs, regulating movement and encoding salient cue-outcome contingencies. Here, using electrophysiological, electrochemical, imaging, and behavioral approaches in mice, I will explore the postnatal maturation of the striatal cholinergic interneuron (ChI), a critical modulator of dopamine signaling, afferent excitation, and SPN excitability. In Chapter 1, I will set the stage for this exploration by reviewing the current literature on striatal postnatal development, including cellular physiology, axonal elaboration and synapse formation, and plasticity expression. I will survey striatal deficits observed in clinical neurodevelopmental conditions such as autism, ADHD, tic disorders, and substance use disorders. I will additionally summarize evidence that the striatum is uniquely vulnerable to physiological and immunological insult, as well as early life adversity. In Chapter 2, I turn my focus specifically to the striatal ChI, uncovering fundamental cell-intrinsic changes that occur postnatally in this population. I will also elaborate on the postnatal maturation of dopamine release properties and regulation thereof by cholinergic signaling from the ChI. In Chapter 3, I investigate the circuit connectivity and circuit-driven firing dynamics of ChIs as they mature postnatally. I utilize a brain slice preparation retaining thalmostriatal afferents in order to assay the ChI pause, a synchronized transient quiescence in ChIs thought to facilitate cue learning and behavioral flexibility. I find that the ChI pause is refined postnatally, dependent on developmental changes in thalamic input strength and the cell- intrinsic expression of specific ionic conductances. Finally, in Chapter 4, I present preliminary evidence that ChI circuit maturation as defined in preceding chapters is delayed by chronic stress exposure postnatally. Following the maternal separation model of early life stress, ChI intrinsic characteristics mature normally, but they retain heightened thalamic innervation and thalamus-driven pause expression.

This study proposed a multifactorial model of development to understand the development of infants during their first 12 months of life who had been born to chemically dependent women. The impact of maternal chemical dependency on pregnancy outcome, factors associated with severity of neonatal abstinence syndrome and effectiveness of three treatments used in the management of neonatal abstinence syndrome was studied in 271 mother-infant pairs, who were managed by the Chemical Dependency Unit, Royal Women’s Hospital, Melbourne between April 1991 and May 1994. / The chemically dependent mothers and their infants were grouped on the basis of their primary drug of abuse: viz methadone, heroin, non-opioid and codeine groups. Fifty two infants born to drug-free mothers were recruited from a routine antenatal clinic of the same hospital to serve as a control group. The controls were matched for maternal age, marital status, race socioeconomic status, educational level, alcohol and tobacco consumption. / Patterns of maternal drug use were determined by reports from methadone treatment programs, drug rehabilitation centres, medical records, personal interviews and urine toxicologic assays performed on mothers during pregnancy and on their infants during the first 48 hours of life. Urine was assayed for metabolites of methadone, amphetamines, barbiturates, cocaine, opiates, cannabis and benzodiazepines. / There were 180 heroin-dependent, one morphine-dependent and one pethidine-dependent pregnant women enrolled in methadone maintenance programs. The methadone group consisted of these 182 methadone-maintained women and their offspring. Thirty five heroin-dependent women and their offspring formed the heroin group. The non-opioid group consisted of 46 chemically dependent women who used multiple drugs but not opioid drugs during their pregnancy and their offspring. There were eight mother-infant pairs in the codeine group. The mothers in this group primarily abused medication containing codeine in pregnancy. (For complete abstract open document)

This project encompasses program evaluations of infant massage intervention and its impact in the overall development of infants and children born with disabilities or babies born at risk for developmental delays.

Impaired intrauterine growth, inability of the fetus to achieve the required growth potential, contributes to a higher burden of neonatal morbidity and mortality. Intrauterine growth is an inferred process and small for gestational age is considered a rough estimate of impaired intrauterine growth that requires reliable gestational age data. Due to sparse data and measurement errors in gestational age, researchers rely on markers such as birth weight, birth length, and birth head circumference to infer fetal growth. While the etiology of impaired fetal growth is multifactorial, maternal anemia and undernutrition contribute substantially to impaired fetal growth and are prioritized in 2030 global nutrition goals by the World Health Assembly. Nutrition supplements such as lipid-based nutrient supplements, multiple micronutrients, and iron or folic acid during pregnancy are presumed to improve maternal anemia. But the effect of the supplements during pregnancy on fetal growth appears to be small to negligible, which has shifted the researcher’s focus to the pre-conception period. However, prior reviews on the preconception period have either synthesized the evidence from observational studies, or have explored outcomes such as congenital anomalies (e.g., neural tube defects), neurodevelopment disorders, or only birth weight. Hence the evidence from existing randomized controlled trials (RCTs) evaluating the effect of preconception nutrition supplements on maternal anemia and all markers of fetal growth including birth weight, birth length, and birth head circumference has not been systematically summarized and synthesized. We bridged this knowledge gap in the current dissertation (Aim 1). The Women First (WF) Preconception Nutrition Trial found that lipid-based nutrient supplementation started preconception or during pregnancy conferred greater benefits for birth weight and birth length among mothers who were anemic (Hemoglobin (Hb) < 12 g/dL) than among mothers who were non-anemic (Hb ≥ 12 g/dL) pre-pregnancy. However, by dichotomizing women into anemic and non-anemic women, we may miss high-risk women with specific Hb levels who may obtain greater benefits for intrauterine growth associated with the supplements. Assessing the effect of preconception nutrient supplements across a range of pre-pregnancy Hb levels will help us identify women with specific Hb cut-offs who may have the greatest potential to respond to the supplements (Aim 2). Additionally, there are major gaps in understanding the mechanisms of how nutrient supplements, consumed either before or during pregnancy, improve intrauterine growth. A better understanding of the underlying mechanisms would allow for fine-tuning of nutrition interventions for greater efficacy. Here, we examined whether Hb during pregnancy could be a potential mechanism through which nutrition supplements improve intrauterine growth (Aim 3). For Aim 1, we undertook a systematic review and meta-analysis of the RCTs evaluating the effect of preconception nutrition supplements on maternal hemoglobin and markers of intrauterine growth including birth weight, birth length, birth head circumference, and small for gestational age. Additionally, we examined preterm birth as an important perinatal outcome. We searched electronic databases including PubMed, Web of Science, Embase, CINAHL, and Cochrane Central. We computed pooled mean differences and risk ratios (RR) with 95% confidence intervals (CIs) using random-effect models. We employed I2 and Cochran’s Q test statistics to assess heterogeneity. We used the GRADE (grading of recommendations, assessment, development, and evaluations) tool to assess the quality of evidence. For Aim 2 and Aim 3, we leveraged the existing data from a large multi-country Women First (WF) Preconception Nutrition Trial conducted in Pakistan, India, Guatemala, and the Democratic Republic of Congo. Women in the WF trial were randomized to consume a lipid-based nutrient supplement (LNS) at least three months before and during pregnancy (Arm 1- preconception), only during pregnancy (Arm 2- during), or not at all (Arm 3 - control). The outcome was weight, length, and head circumference within 48 hours of birth expressed as Z-scores. For Aim 2, we analyzed the WF trial data on 2443 women-newborn dyads. For each site, we computed adjusted mean differences in these Z-scores between the randomized arms across six pre-pregnancy Hb categories (8-8.9, 9-9.9, 10-10.9, 11-11.9, 12-12.9, and ≥13g/dL) based on Hb distributions. We pooled site-specific effect measures using meta-analysis. For Aim 3, hemoglobin measured at 12 (n=2075) and 32 weeks of gestation (n=2157) was a mediator. We employed causal mediation analysis under a counterfactual approach to estimate direct and indirect effects. For Aim 1, we identified 20 eligible RCTs (n=27,659 women). Preconception nutrition supplements (iron and folic acid, multiple micronutrients, and a lipid-based nutrient supplement) increased maternal hemoglobin by 0.30g/dL ((0.03, 0.57); I2=79%). However, we did not find a significant effect of the supplements on birth weight (12.47gm ((-33.14, 58.08); I2=58%)), birth length (0.15cm (-0.26, 0.56); I2=68%; n=5), birth head circumference (-0.23cm (-0.88, 0.43); I2=84%), small for gestational age (RR: 0.91 (0.80,1.04); I2=31%), or preterm birth (RR: 0.93 (0.69,1.25); I2=57%). Overall, the quality of evidence was assessed as moderate and very low for maternal hemoglobin and three markers of intrauterine growth including birth weight, birth length, and birth head circumference, respectively. In Aim 2, we found that the effect of LNS on birth weight, length, and head circumference varied by pre-pregnancy Hb categories. Pooled mean differences in the Z-scores for birth length (0.60 (0.03, 1.23)), birth weight (0.50, (0.11, 0.89)), and birth head circumference ((0.26, (0.02, 0.51)) were greatest for Arm 1-preconception vs. Arm 3-control women with Hb 9-9.9g/dL. Women with Hb 10-10.9g/dL also benefited from preconception LNS. However, compared to controls, the effects of preconception LNS on birth weight, birth length, and birth head circumference attenuated for women with Hb 10-10.9g/dL. Compared to Arm 3-control, LNS during pregnancy (Arm 2) improved birth length, birth weight, and birth head circumference for women with Hb 8-10.9g/dL. Preconception LNS (Arm1) vs. LNS during pregnancy (Arm 2) improved the three markers of intrauterine growth only for women with Hb 9-9.9g/dL. Women with nearly normal (11-11.9 g/dL) and normal Hb (≥12g/dL) did not appreciably benefit from LNS, offered before and or during pregnancy. For Aim 3, Hb at 12 or 32 weeks of gestation did not mediate the relationship between the LNS and intrauterine growth. Indirect effects of preconception LNS (Arm 1) vs. Arm 3, mediated by Hb at 12 weeks, were 0.02 (-0.02, 0.01), 0.01 (-0.01, 0.02), and 0.01 (-0.01, 0.02) for length, weight, and head circumference Z-scores, respectively. The corresponding direct effects, not mediated by Hb, were 0.18 (0.09, 0.33), 0.12 (0.03, 0.23), and 0.06 (-0.03, 0.20), respectively. Site-specific and gestational age-adjusted data analyses both at 12 and 32 weeks of gestation confirmed the findings of negligible mediation by Hb during pregnancy. All types of preconception nutrition supplements studied to date appear to reduce maternal anemia. However, it is uncertain whether there are beneficial effects of preconception nutrition supplements on markers of intrauterine growth. Low quality of evidence from the RCTs examining the markers of intrauterine growth warrants future well-designed RCTs to produce solid scientific data, particularly on the benefits of a more comprehensive package of preconception nutrition supplements that include both macro- and micronutrients. The findings from the WF trial suggest that the benefits of preconception LNS on fetal growth are mainly confined to women with pre-pregnancy Hb 9-9.9g/dL. Compared to controls, women with Hb 10-10.9g/dL also benefited from preconception LNS, albeit the magnitude of effect on three markers of intrauterine growth was modest for women with Hb 10-10.9g/dL. However, LNS, started during pregnancy, appeared to improve markers of intrauterine growth for women with a wider range of Hb 8-10.9g/dL. Women with Hb ≥ 11g/dL did not benefit from LNS started either pre-conception or during pregnancy. These findings suggest that prioritizing women with specific pre-pregnancy Hb categories for targeted nutrition interventions may be advisable. This would target limited resources most efficiently in LMICs. Lastly, negligible mediation by Hb during pregnancy suggests that alternative pathways that potentially mediate the relationship between LNS and intrauterine growth need to be investigated.

The aim of this research was to support new mothers in groups, so that they can function optimally as educators. During the research mothers with babies up to three months of age were used by means of a support group. This research project was done after it became evident from a literature study that new mothers suffered with unique problems during this adaption phase. In the empirical survey the researcher gave attention to the new mothers' specific needs and problems during this trimester. The researcher aimed to explore the experiences of the new mother as educator through weekly group sessions. From the results it was clear that there was a need of support from other mothers that is going through the same experiences. In this way new mothers could receive emotional support and obtain knowledge regarding relevant issues experienced during this unique life phase. / Educational Studies / M. Ed. (Guidance and Counselling)

The aim of this research was to support new mothers in groups, so that they can function optimally as educators. During the research mothers with babies up to three months of age were used by means of a support group. This research project was done after it became evident from a literature study that new mothers suffered with unique problems during this adaption phase. In the empirical survey the researcher gave attention to the new mothers' specific needs and problems during this trimester. The researcher aimed to explore the experiences of the new mother as educator through weekly group sessions. From the results it was clear that there was a need of support from other mothers that is going through the same experiences. In this way new mothers could receive emotional support and obtain knowledge regarding relevant issues experienced during this unique life phase. / Educational Studies / M. Ed. (Guidance and Counselling)