Risk Factors for Parenting Stress in Parents of Children Treated with Laser Surgery for Twin-Twin Transfusion Syndrome 2 Years Postpartum

Kelly Schifsky; Alexis Deavenport-Saman; Mary Rose Mamey; Nidhi Sheth; Christine B. Mirzaian; Sheree M. Schrager; Ramen H. Chmait; Douglas L. Vanderbilt

doi:10.1055/s-0040-1701194

American Journal of Perinatology, Table of Contents

Am J Perinatol 2021; 38(09): 944-951
DOI: 10.1055/s-0040-1701194

Original Article

Risk Factors for Parenting Stress in Parents of Children Treated with Laser Surgery for Twin-Twin Transfusion Syndrome 2 Years Postpartum

Kelly Schifsky

¹Department of Pediatrics, USC University Center for Excellence in Developmental Disabilities, Children's Hospital Los Angeles, Los Angeles, California

,

Alexis Deavenport-Saman

¹Department of Pediatrics, USC University Center for Excellence in Developmental Disabilities, Children's Hospital Los Angeles, Los Angeles, California

,

Mary Rose Mamey

²USC Suzanne Dworak-Peck School of Social Work, Los Angeles, California

,

Nidhi Sheth

³College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, California

,

Christine B. Mirzaian

¹Department of Pediatrics, USC University Center for Excellence in Developmental Disabilities, Children's Hospital Los Angeles, Los Angeles, California

,

Sheree M. Schrager

⁴Division of Hospital Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California

,

Ramen H. Chmait

⁵Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, USC Keck School of Medicine, Los Angeles, California

,

Douglas L. Vanderbilt

¹Department of Pediatrics, USC University Center for Excellence in Developmental Disabilities, Children's Hospital Los Angeles, Los Angeles, California

› Author Affiliations

Abstract

Objective Twin-twin transfusion syndrome (TTTS) is a rare but serious condition that can occur in monochorionic and diamniotic twin pregnancies. Research indicates almost half of postpartum mothers with TTTS may have clinically significant levels of stress. However, no studies have measured the levels of parenting stress at 2 years postpartum, and little research has been conducted on sources of stress.

Study Design A prospective cohort study was conducted. Data were collected from parents whose children were treated with laser ablation in utero and were 2 years old at the time of screening. The Parenting Stress Index - Short Form (PSI-SF) and its three subscales were used to collect data. Descriptive, bivariate, and multivariate analyses were conducted to determine significant predictors associated with each outcome.

Results A total of 99 children from 56 families were enrolled. Unmarried status (B = –22.8; p = 0.039) and lower maternal educational level (B = –7.8; p = 0.01) were both significantly associated with higher PSI-SF total score.

Conclusion Subgroups of parents whose pregnancy required laser surgery for TTTS may continue to have clinically significant levels of stress at 2 years postpartum. It is important the health care team is aware of this and the sociodemographic risk factors to provide appropriate support for families.

Keywords

twin-twin transfusion syndrome - parenting stress - sociodemographic risk factors - 2 years postpartum - children

Full Text

References

References
1 Nicholas L, Fischbein R, Falletta L, Baughman K. Twin-twin transfusion syndrome and maternal symptomatology-an exploratory analysis of patient experiences when reporting complaints. J Patient Exp 2018; 5 (02) 134-139
2 Baud D, Windrim R, Keunen J, Ryan G. Fetoscopic laser therapy for twin-twin transfusion syndrome: beyond current gestational age limits. Am J Perinatol 2014; 31 (Suppl. 01) S19-S24
3 Bamberg C, Hecher K. Update on twin-to-twin transfusion syndrome. Best Pract Res Clin Obstet Gynaecol 2019; 58: 55-65
4 Edwards DM, Gray PH, Soong B, Chan F-Y, Cincotta R. Parenting stress and psychosocial health in mothers with twin-twin transfusion syndrome managed with laser surgery: a preliminary study. Twin Res Hum Genet 2007; 10 (02) 416-421
5 Fischbein R, Meeker J, Saling JR, Chyatte M, Nicholas L. Identifying families' shared disease experiences through a qualitative analysis of online twin-to-twin transfusion syndrome stories. BMC Pregnancy Childbirth 2016; 16 (01) 163
6 Singer LT, Salvator A, Guo S, Collin M, Lilien L, Baley J. Maternal psychological distress and parenting stress after the birth of a very low-birth-weight infant. JAMA 1999; 281 (09) 799-805
7 Wenze SJ, Battle CL, Tezanos KM. Raising multiples: mental health of mothers and fathers in early parenthood. Arch Women Ment Health 2015; 18 (02) 163-176
8 Dollberg DG, Rozenfeld T, Kupfermincz M. Early parental adaptation, prenatal distress, and high-risk pregnancy. J Pediatr Psychol 2016; 41 (08) 915-929
9 Forcada-Guex M, Pierrehumbert B, Borghini A, Moessinger A, Muller-Nix C. Early dyadic patterns of mother-infant interactions and outcomes of prematurity at 18 months. Pediatrics 2006; 118 (01) e107-e114
10 Leerkes EM, Nayena Blankson A, O'Brien M. Differential effects of maternal sensitivity to infant distress and nondistress on social-emotional functioning. Child Dev 2009; 80 (03) 762-775
11 Vanderbilt D, Gleason MM. Mental health concerns of the premature infant through the lifespan. Pediatr Clin North Am 2011; 58 (04) 815-832 , ix
12 Vanderbilt DL, Schrager SM, Llanes A, Hamilton A, Seri I, Chmait RH. Predictors of 2-year cognitive performance after laser surgery for twin-twin transfusion syndrome. Am J Obstet Gynecol 2014; 211 (04) 388.e1-388.e7
13 Abidin RR. Parenting Stress Index, Third Edition: Professional Manual. Odessa, FL: Psychological Assessment Resources Inc; 2012
14 Barroso NE, Hungerford GM, Garcia D, Graziano PA, Bagner DM. Psychometric properties of the Parenting Stress Index-Short Form (PSI-SF) in a high-risk sample of mothers and their infants. Psychol Assess 2016; 28 (10) 1331-1335
15 Díaz-Herrero A, López-Pina JA, Pérez-López J, Brito de la Nuez AG, Martínez-Fuentes MT. Validity of the Parenting Stress Index-Short Form in a sample of Spanish fathers. Span J Psychol 2011; 14 (02) 990-997
16 The National Child Traumatic Stress Network. Parenting Stress Index, Short Form. Accessed August 2, 2019 at: https://www.nctsn.org/measures/parenting-stress-index-short-form
17 Reitman D, Currier RO, Stickle TR. A critical evaluation of the Parenting Stress Index-Short Form (PSI-SF) in a head start population. J Clin Child Adolesc Psychol 2002; 31 (03) 384-392
18 Lopriore E, van Wezel-Meijler G, Middeldorp JM, Sueters M, Vandenbussche FP, Walther FJ. Neurodevelopmental outcome after laser therapy for twin-twin transfusion syndrome. Am J Obstet Gynecol 2007; 196 (01) e20
19 Copeland D, Harbaugh BL. Differences in parenting stress between married and single first time mothers at six to eight weeks after birth. Issues Compr Pediatr Nurs 2005; 28 (03) 139-152
20 Parkes A, Sweeting H, Wight D. Parenting stress and parent support among mothers with high and low education. J Fam Psychol 2015; 29 (06) 907-918
21 Assel MA, Landry SH, Swank PR, Steelman L, Miller-Loncar C, Smith KE. How do mothers' childrearing histories, stress and parenting affect children's behavioural outcomes?. Child Care Health Dev 2002; 28 (05) 359-368
22 Quinnell FA. Postpartum Posttraumatic Stress as a Risk Factor for Atypical Cognitive Development in High-Risk Infants [dissertation]. Milwaukee, WI: University of Wisconsin-Milwaukee; 2001
23 Neece CL, Green SA, Baker BL. Parenting stress and child behavior problems: a transactional relationship across time. Am J Intellect Dev Disabil 2012; 117 (01) 48-66
24 Gondwe KW, White-Traut R, Brandon D, Pan W, Holditch-Davis D. The role of sociodemographic factors in maternal psychological distress and mother-preterm infant interactions. Res Nurs Health 2017; 40 (06) 528-540