2. (Anand & Scalzo, 2000; Stewart et al., 1999). This may also be in part
because birth of a medically vulnerable infant is a significant maternal
stressor (Blumberg, 1980; Muller-Nix et al., 2004; Singer et al.,
1999). Maternal stress is associated with less sensitive behavior and
disturbances in mother–infant interactions (Crnic, Greenberg,
Ragozin, Robinson, & Basham, 1983; Muller-Nix et al., 2004). The
stressor of having a newborn with a medical problem may thereby
interfere with parents’ ability to provide infants with an environment
that promotes resilience and optimal development (Blumberg, 1980;
Darke & Goldberg, 1994; Miceli et al., 2000; Muller-Nix et al., 2004;
Singer et al., 1999), resulting in poorer developmental outcomes for
the child (Bell & Ainsworth, 1972; Browne & Talmi, 2005; Hane &
Fox, 2006).
However, psychosocial resources moderate the adverse effects
of stressors on well-being (Cohen & Wills, 1985; DeLongis,
Folkman, & Lazarus, 1988). Specifically, research suggests that
maternal psychosocial resources moderate the relationship of in-
fant medical problems or maternal stress with maternal distress
and behavior. For example, social support moderates the relation
between maternal stress and quality of mother–infant interactions
among mothers of premature and healthy infants (Crnic et al.,
1983). Perceived social support moderates the relation between
infant medical vulnerability and maternal distress (Singer, Davil-
lier, Bruening, Hawkins, & Yamashita, 1996). Secure attachment
predicts decreased maternal distress in the context of infant med-
ical problems, with the effects mediated by perceived coping
abilities (Berant, Mikulincer, & Florian, 2001). Thus, when an
infant is born with a medical problem, maternal psychosocial
resources such as social support, attachment security, and per-
ceived coping may promote better infant outcomes by dampening
the maternal distress that undermines maternal sensitive respon-
siveness associated with the development of infant affect regula-
tion (Feldman, Greenbaum, & Yirmiya, 1999; Olafsen et al., 2008;
van den Boom, 1994). This is consistent with the finding that
prenatal social support dampens maternal distress, which, in turn,
predicts lower distress among healthy infants (Stapleton et al.,
2012).
Studies examining the effects of maternal psychosocial re-
sources in the context of infant medical problems have often
measured resources at or after diagnosis of the medical problem
(e.g., Berant et al., 2001; Crnic et al., 1983; Hopkins, Campbell, &
Marcus, 1987; Miceli et al., 2000; Singer et al., 1996). However,
having an infant with a medical problem may influence psychos-
ocial resources such as social support and self-esteem (e.g., M.
McGrath, Boukydis, & Lester, 1993). Postdiagnosis assessment of
psychosocial resources may therefore be biased. Many studies
have examined the effects of prenatal psychosocial resources and
maternal stress on birth and maternal outcomes. However, evi-
dence of a buffering effect of maternal prenatal social support has
been mixed (e.g., Adamakos et al., 1986; Bee, Hammond, Eyres,
Barnard, & Snyder, 1986; Collins, Dunkel-Schetter, Lobel, &
Scrimshaw, 1993; Goldstein, Diener, & Mangelsdorf, 1996), and
scant attention has been given to downstream effects on infants (cf.
Crnic, Greenberg, & Slough, 1986). It is therefore unclear whether
relationships among maternal psychosocial resources, infant med-
ical problems, and maternal or infant outcomes can be explained
by preexisting differences in mothers’ psychosocial resources.
Gallo and Matthews (2003) theorize that individuals’ reserve
capacity or “bank” of psychological, social, and tangible resources
buffer the effects of later-encountered stressors. This suggests that
preexisting maternal resources may moderate the effects of later-
encountered infant medical problems to promote more favorable
outcomes for infants.
The purpose of this study was to examine whether maternal
prenatal psychosocial resources moderate the effects of neonatal
medical problems, a maternal stressor, on important infant devel-
opmental outcomes: fussing and crying. Infant fussing and crying
may reflect elevated distress and negative affectivity, and may thus
predict internalizing and externalizing problems later in childhood
(Caspi, Henry, McGee, Moffitt, & Silva, 1995; Natsuaki et al.,
2010; Rende, 1993).
Existing research on the buffering effects of maternal psychos-
ocial resources has investigated how constructs such as social
support or attachment security singly moderate outcomes associ-
ated with maternal stressors. However, researchers have noted that
stress-buffering resources tend to occur in aggregate (Gallo &
Matthews, 2003). Further, a range of these resources may be
conceptually integrated as indicators of felt security. This concept
is derived from the attachment literature and is defined as a sense
of confidence and safety in the continued affection and availability
of close others that regulates interpersonal closeness and depen-
dence in times of need (Murray, Holmes, & Collins, 2006; Murray,
Holmes, & Griffin, 2000; Sroufe & Waters, 1977). Researchers
propose that felt security has, at its core, perceived positive regard
from close others, trust in their availability and responsiveness,
and perceived love by one’s partner. Felt security has thus been
conceptualized as encompassing self-esteem, attachment security,
relationship quality, and perceived social support (Collins &
Feeney, 2004; Murray et al., 2006; Murray, Holmes, Griffin,
Bellavia, & Rose, 2001; Reis, Clark, & Holmes, 2004). Further,
there is evidence of associations among these constructs in a
sample of pregnant women (Stapleton et al., 2012). Thus, although
the effects of maternal attachment security, social support, self-
esteem, and relationship quality on postpartum outcomes have
been examined separately (e.g., Berant et al., 2001; Hall, Kotch,
Browne, & Rayens, 1996), these constructs may more parsimoni-
ously reflect an overarching sense of felt security.
Attachment theory and the reserve capacity model suggest
that individuals’ reserves of inter- and intrapersonal resources,
such as attachment security, self-esteem, social support, and
relationship quality, contribute to a cognitive representation of
the self in relation to others that moderates effects of later-
encountered stressors. We therefore predicted that maternal felt
security might protect against detrimental effects of neonatal
medical problems on infant development. We therefore exam-
ined whether infant medical problems at birth predict infant
fussing and crying at 12 months and whether maternal felt
security moderates this association.
To examine whether mothers’ baseline felt security interacts
with a later-encountered infant medical stressor to predict later
fussing and crying, we assessed felt security prenatally as an
indicator of resources available at the onset of the stressor
unbiased by the experience of the stressor. Experience samp-
ling was used to assess maternal report of infant behavior
(Larson & Csikszentmihalyi, 1983). We controlled for preg-
nancy anxiety, as this might be confounded with mothers’
reports of infant fussing and crying (J. M. McGrath et al., 2008;
Mebert, 1991).
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812 SAWADA ET AL.
3. No validated measure of felt security that encompasses at-
tachment, relationship quality, self-esteem, and social support
exists. Before testing the central hypothesis that maternal felt
security would interact with infant health at birth to predict
infant fussing and crying, we therefore tested the structure of
felt security using confirmatory factor analysis (CFA), with
measures of attachment, romantic relationship quality, self-
esteem, and social support as indicators.
Method
Participants
Over a 5-year period, as part of the Montreal Prematurity Study,
women from a wide socioeconomic spectrum were recruited be-
tween 24 and 26 weeks gestation when they presented at one of
four Montreal hospitals for routine hospital ultrasound examina-
tions (Time 1). All women (N ϭ 5,092) were over age 17, pregnant
with a singleton fetus, and spoke English or French. Exclusion
criteria were placenta praevia, a major fetal anomaly in the current
pregnancy, an incompetent cervix diagnosis in a previous preg-
nancy, or chronic illnesses other than hypertension, asthma, or
diabetes (Kramer et al., 2009). At birth, infants were categorized as
healthy or as having a severe neonatal medical problem likely to be
a stressor for mothers (Time 2). Mothers were interviewed again at
6 months postpartum (Time 3).
A follow-up experience-sampling study was conducted in the
final year of the Montreal Prematurity Study. All mothers of
infants with a medical problem at birth who were 12 months old
when the follow-up study began were invited to participate (Time
4). For each mother of an infant with a medical problem at birth,
two mothers of infants who were healthy at birth were invited. The
latter comprised the control group. Of all mothers invited, 69%
agreed. Mothers who participated were not different from those
who did not on demographic variables, maternal felt security, or
infant medical problem versus control group classifications, ps Ͼ
.1. Participants who did not respond to felt security measures were
excluded from analyses (n ϭ 4). The final sample at Time 4
included 135 mothers (M ϭ 27.9 years). Demographic information
is in Table 1.
Procedure and Measures
Time 1. Nurses administered a psychosocial interview be-
tween 24 and 26 weeks gestation. The interview included English
or French measures assessing indicators of maternal felt security,
pregnancy anxiety, depression, sociodemographic information,
and medical history.
Maternal felt security. Indicators were social support, self-
esteem, attachment, and romantic relationship quality. A five-item
Arizona Social Support Interview (Barrera, 1981) assessed emo-
tional and instrumental social support received in the preceding 2
weeks. Three additional questions assessed (a) mothers’ expected
support postpartum, (b) the number of people currently available to
talk freely to/confide in, and (c), the number of people currently
available to help in a time of need. Self-esteem was assessed with
a four-item Rosenberg Self-Esteem Scale (␣ ϭ .73; Major, Rich-
ards, Cooper, Cozzarelli, & Zubek, 1998). Attachment was as-
sessed with a seven-item Experiences in Close Relationships Scale
(Brennan, Clark, & Shaver, 1998). As per Brennan et al. (1998),
the three items loading most highly on the anxiety dimension were
aggregated to form an anxiety score (␣ ϭ .62). The two highest-
loading fear-of-closeness items and the two highest-loading fear-
of-dependency items were aggregated to form an avoidance score
(␣ ϭ .49). Romantic relationship quality was assessed with a
three-item Quality of Marriage Index modified to include cohab-
iting relationships (␣ ϭ .78; Norton, 1983). Felt security scores
were calculated using the regression method in principal compo-
nents analysis.
Pregnancy anxiety and depressive symptoms. Pregnancy anx-
iety was measured with a four-item Pregnancy-Specific Anxiety
Scale (␣ ϭ .81; Mancuso, Schetter, Rini, Roesch, & Hobel, 2004).
Depressive symptoms were measured with a 20-item Center for
Epidemiologic Studies Depression Scale (␣ ϭ .89; Radloff, 1977).
Time 2. Shortly after birth, medical records were reviewed.
Mothers were categorized as having a healthy newborn or a
newborn with a medical problem defined as (a) early preterm
birth (Յ33 completed weeks of gestation) following spontane-
ous labor onset or prelabor membrane rupture, (b) neonatal
hospitalization Ն7 days, or (c) a birth complication not detected
by prenatal screening (e.g., congenital heart or urinary system
anomalies, musculoskeletal anomalies, obstetrical trauma, se-
vere fetal asphyxiation, or respiratory distress). Four medical
doctors (MDs) with expertise in perinatal epidemiology re-
viewed a list of all medical conditions in the sample. A condi-
tion was defined as a medical problem at birth if three MDs
thought it was a serious medical problem and a likely maternal
stressor throughout the first postnatal year. Mothers of healthy
infants born at Ն36 weeks gestation constituted the control
group. There were no differences in felt security, age, preg-
Table 1
Demographic Data in Percentages
Control
(n ϭ 93)
Medical problem
(n ϭ 42)
Primiparity 72 69
Marital/cohabitation status
Legally married 35.9 38.1
Cohabiting 60.9 59.5
Single 3.3 2.4
Place of birth
Province of Quebec 74.2 83.3
Other province in Canada 3.2 2.4
Other country 22.6 14.3
First language
French 74.2 88.1
English 8.6 4.8
Other 17.2 7.1
Maternal education
Secondary or less 33 23.8
College or university 67 76.2
Family income, CAD/year
Ͻ$15,000 11.8 9.8
$15,000 to Ͻ $30,000 17.6 14.6
$30,000 to Ͻ $50,000 23.5 9.8
$50,000 to Ͻ $80,000 29.4 46.3
Ն$80,000 17.6 19.5
Note. Demographic variables did not significantly differ between the
control and stressful birth groups, 2
Ͻ 5.34, n.s.
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813HEALTH AT BIRTH, FELT SECURITY, FUSSING AND CRYING
4. nancy anxiety, or depressive symptoms between medical-
problem-at-birth and control groups, ts Ͻ 1.48 (see Table 2).
Time 3. To measure mothers’ perceptions of infant health,
mothers were asked, “How would you rate the overall health of
your baby at birth?” and “How would you rate the overall health
of your baby at the present time?” in a 6-month postpartum
interview. Mothers responded on a 5-point scale (1 ϭ excellent,
5 ϭ bad; Idler & Benyamini, 1997).
Time 4. Mothers who participated in the 12-month postpar-
tum follow-up study provided data on infant fussing and crying
using experience sampling on personal digital assistants. Moth-
ers were paged at 10:00 a.m., 2:00 p.m., and 7:00 p.m. for 7
days and were asked to answer 11 questions about themselves
and their most recent interaction with their infant. One question
was, “In your last interaction your baby was ____.” Response
options were “happy/playful,” “sleepy,” “fussy,” “very upset/
crying,” “calm/quiet,” and “active/energetic.” These options are
similar to those used in previous diary research. For example,
previous studies have asked mothers to report when, throughout
the day, infants were asleep, awake content, awake fussy, awake
crying, or awake sucking, at a time of their convenience, using a
paper-and-pencil diary (Barr, Kramer, Boisjoly, McVey-White, &
Pless, 1988; Wells, Hinds, & Davies, 1997). Response selections of
“fussy” or “very upset/crying” were summed across days to
create an indirect indicator of frequency of infant fussing and
crying throughout the week. Reports of four or more fussy and
very upset/crying occasions were given a score of 4 to create a
fussing and crying scale of 0 to 4, to reduce the influence of
outliers and positive skew. The mean fussing and crying score
across groups was 1.42 (SD ϭ 1.23). Mothers’ perceptions of
infant health were also assessed at 12 months, with the same
procedure used at 6 months.
Statistical Analysis
Data analyses involved three steps. First, an independent
samples t test compared mothers’ ratings of infant health at
birth between the medical problem and control groups to cross-
validate participant classification by MDs.
Then, CFA was used to test whether prenatal maternal self-
esteem, attachment, quality of romantic relationship, and social
support are indicators of felt security. First, the Montreal Pre-
maturity Study sample (N ϭ 5,092) was randomly divided into
a derivation and a validation sample. Then, with the derivation
sample (n ϭ 2,549), CFA was conducted using structural equa-
tion modeling. This tested the goodness of fit of a one-factor
model in which mothers’ prenatal attachment anxiety and
avoidance, self-esteem, relationship quality, and the four social
support variables loaded on a single factor. We included cor-
related measurement errors among the four social support in-
dicators to account for the possibility that these indicators
would share unique variance not accounted for by the model.
The goodness of fit of an alternative two-factor model in which
the four social support indicators were loaded onto one factor,
and attachment anxiety and avoidance, self esteem, and rela-
tionship quality were loaded onto a second factor, was com-
pared with the goodness of fit of the one-factor model with the
Akaike information criterion (AIC; Kline, 1998), the compar-
ative fit index (CFI), and the root mean square error of approx-
imation (RMSEA; Byrne, 2010; Tabachnick & Fidell, 2007).
Finally, hierarchical multiple regression was used to test the
main study hypothesis that prenatal maternal felt security in-
teracts with infant health at birth to predict infant fussing and
crying. Bootstrapping was used to obtain a more robust estimate
of standard error.
Results
Validating Infant Health at Birth
An independent samples t test revealed that, consistent with
MD’s classifications, mothers of infants with medical problems
at birth rated their infants as less healthy at birth (M ϭ 2.45,
SD ϭ 1.23) than mothers in the control condition (M ϭ 1.36,
SD ϭ .70), t(127) ϭ Ϫ5.36, p Ͻ .01. However, mothers’ ratings
of infant health at 6 months did not differ between the medical-
problem-at-birth (M ϭ 1.33, SD ϭ .53) and control groups
(M ϭ 1.3, SD ϭ .57), t Ͻ 1, because the medical-problem-at-
birth group rated health at 6 months to be significantly better
than at birth, t(41) ϭ 6.08, p Ͻ .01. Mothers’ ratings of infant
health at 12 months also did not differ between the medical-
problem-at-birth (M ϭ 1.57, SD ϭ .67) and control groups
(M ϭ 1.56, SD ϭ .74), t Ͻ 1.
Modeling Maternal Prenatal Felt Security
Comparison of the fit indices from the CFA suggested that
the one-factor model was acceptable (CFI ϭ .95, RMSEA ϭ
.06, AIC ϭ 215.31) and yielded substantially better fit than the
two-factor model (CFI ϭ .76, RMSEA ϭ .11, AIC ϭ 752.39).
The one-factor solution was therefore retained. Standardized
estimates for all eight indicators of the one-factor solution were
statistically significant and varied from Ϯ.28 to .60. The vali-
dation sample (n ϭ 2,543) cross-validated the structure of the
one-factor model (CFI ϭ .96, RMSEA ϭ .055, AIC ϭ 182.54),
confirming its validity (see Figure 1 for an illustration).
Predicting Infant Fussing and Crying
Thirteen mothers responded to the fussing and crying
experience-sampling question less than seven times and were
therefore excluded from this hierarchical multiple regression
analysis. In the first step of the regression, maternal pregnancy
anxiety was not a significant predictor of infant fussing and
Table 2
Means and Standard Deviations According to Control or
Medical-Problem-at-Birth Classification
Measures
Control
(n ϭ 93)
Medical
problem
(n ϭ 42)
M SD M SD
Prenatal felt security Ϫ0.01 0.83 0.21 0.73
Age 27.70 4.60 28.70 4.72
Pregnancy anxiety 0.83 0.78 1.05 0.92
Prenatal depressive symptoms 11.12 7.06 9.76 8.74
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814 SAWADA ET AL.
5. crying, B ϭ .08, SE ϭ .14, ns. In the second step, maternal felt
security and infant health at birth were also not significant
predictors, Bs ϭ Ϫ.26 and .34, SEs ϭ .15 and .24, ps ϭ .088
and .17, respectively. In the third step, the product of the
predictor variables was entered to test the interaction between
maternal prenatal felt security and infant health at birth. This
interaction term was a significant predictor of infant fussing and
crying at 12 months, B ϭ Ϫ56, SE ϭ .27, p Ͻ .05.1
The results
of these regression analyses are presented in Table 3.
The simple slopes between maternal prenatal felt security and
infant fussing and crying were analyzed according to Aiken and
West (1991). Among mothers in the control group, prenatal felt
security did not significantly predict infant fussing and crying,
B ϭ Ϫ.13, SE ϭ .16, ns. However, among mothers in the medical-
problem-at-birth group, prenatal felt security significantly pre-
dicted infant fussing and crying, B ϭ Ϫ.69, SE ϭ .23, p Ͻ .01.
Among infants born with a medical problem, those with mothers
with high prenatal felt security fussed and cried less than those
with mothers with low prenatal felt security. Further, among
infants of mothers with low prenatal felt security, those with
medical problems at birth fussed and cried more at 12 months than
infants who were healthy at birth, B ϭ .89, SE ϭ .37, p Ͻ .05.
Among infants of mothers with high prenatal felt security, health
at birth did not significantly predict fussing and crying, B ϭ Ϫ.03,
SE ϭ .28, ns.
We reran the analyses, also controlling for maternal age, pre-
natal depressive symptoms, education, and income as a stricter test
of the hypothesis. None of the covariates were significantly related
to the outcome variable, all ps Ͼ .32. The interaction remained
statistically significant, B ϭ Ϫ.64, SE ϭ .32, p ϭ .05.
The simple effects remained highly significant for infants in the
medical-problem-at-birth group, B ϭ Ϫ.69, SE ϭ .30, p Ͻ .05, and
for infants whose mothers were low in prenatal felt security, B ϭ
1.05, SE ϭ .39, p Ͻ .01.
Discussion
Infant health at birth did not predict infant fussing and crying at
12 months. However, as hypothesized, infant health at birth inter-
acted with maternal prenatal felt security to predict frequency of
infant fussing and crying at 12 months. Among infants who were
healthy at birth, maternal prenatal felt security was not related to
fussing and crying. However, among infants born with a medical
problem, maternal prenatal felt security predicted fussing and
crying such that those with mothers with low felt security fussed
and cried more than those with mothers with high felt security.
Infants born with medical problems fussed and cried more than did
infants who were healthy at birth, only if their mothers had low
prenatal felt security but not if their mothers had high prenatal felt
security. The results of this study suggest that a mother’s bank of
preexisting psychosocial resources buffers the effects of infant
medical problems at birth on infant developmental outcomes at 12
months postpartum.
We hypothesize that elevated fussing and crying among infants
born with medical problems to low felt security mothers reflects
increased negative reactivity or decreased regulatory capabilities.
This may be directly related to infants’ early medical problems or
to exposure to stressors such as hospitalization, medical proce-
dures, and pain in the neonatal period. Increased infant negative
affect or decreased regulatory abilities may result in more chal-
lenging mother–infant interactions, and may persist into childhood
to predict emotional and behavioral disorders. However, infant
affect and behavior regulation capabilities may develop through
interactions with caregivers who are able to regulate their own
emotions effectively and provide sensitive care (Braungart-Rieker,
1
We also examined whether social support, attachment security, self-
esteem, or relationship quality individually interacted with infant health at
birth to predict infant fussing and crying in four separate regression
analyses. None of these variables significantly interacted with health at
birth to predict fussing and crying; all ps Ͼ .1
Figure 1. Prenatal felt security model.
Table 3
Hierarchical Multiple Regression Analyses Predicting Infant
Fussing and Crying at 12 Months From Prenatal Maternal Felt
Security and Infant Health at Birth
Infant fussing
and crying at
12 months
(n ϭ 122)
B SE
Step 1
Pregnancy anxiety .08 .14
Step 2
Prenatal maternal felt security Ϫ.26 .15
Infant health at birth .34 .24
Step 3
Maternal felt security ϫ Infant health at birth Ϫ.56ء
.27
Simple slope – Control Ϫ.13 .16
Simple slope – Medical problem Ϫ.69ءء
.23
ء
p Ͻ .05. ءء
p Ͻ .001.
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815HEALTH AT BIRTH, FELT SECURITY, FUSSING AND CRYING
6. Garwood, Powers, & Notaro, 1998; Calkins, Smith, Gill, & John-
son, 1998; Olafsen et al., 2008). We theorize that prenatal felt
security may be associated with better maternal well-being and
may thus provide a foundation for maternal, affect, cognition, and
behavior that support the development of infant affect and behav-
ior regulation among infants born with health problems.
There are several mechanisms whereby maternal felt security
measured in pregnancy might moderate infant fussing and crying
at 12 months postpartum. First, mothers’ prenatal felt security is
likely an indicator of mothers’ internal sense of security in close
relationships at the onset of the infant medical stressor. Research
on attachment, social support, and self-esteem suggests that moth-
ers with higher prenatal felt security might perceive close others as
more available and responsive in times of need, and that these
secure mental representations of the self in relation to close others
might attenuate mothers’ appraisals of threat and facilitate more
adaptive coping in the context of a stressor (Alexander, Feeney,
Hohaus, & Noller, 2001; Berant et al., 2001; Cutrona & Troutman,
1986; Florian, Mikulincer, & Bucholtz, 1995; Mikulincer & Flo-
rian, 1998; Ognibene & Collins, 1998). Mothers with higher pre-
natal felt security may thus experience the birth of an infant with
medical problems as less stressful and may perceive themselves as
more capable of coping with the challenges it presents. Maternal
prenatal felt security may thus buffer against the possible adverse
effects of this event on maternal well-being. Decreased maternal
stress or increased self-efficacy may facilitate the provision of
sensitive maternal care associated with the development of infant
affect and behavior regulation capabilities among mothers with
higher prenatal felt security. Second, prenatal felt security may be
an indicator of the level of observable social support that mothers
receive. In other words, mothers with higher prenatal felt security
may have a larger bank of tangible and social resources ready at
their disposal when the infant medical stressor occurs. Mothers
with higher prenatal felt security may receive more support be-
cause they are confident in drawing upon this reserve (Ognibene &
Collins, 1998). Alternatively, mothers with higher prenatal felt
security may receive more social support without necessarily seek-
ing it out or even noticing it. This observable support may directly
benefit the mother and the medically vulnerable infant.
Conversely, for mothers with low prenatal felt security, the birth
of an infant with a medical problem may lead to elevated stress and
decreased parenting efficacy. The birth of a medically fragile
infant is a stressor in and of itself. Further, mothers with low
prenatal felt security may perceive greater threat and perceive
themselves as having fewer psychological, social, and tangible
resources to cope than mothers with higher prenatal felt security.
In addition, they may concretely have fewer psychological, social,
and tangible resources. Regardless, this perceived or actual lack of
resources may compound the effects of an infant medical stressor
on their well-being. They may experience more distress, which
may negatively impact their ability to engage in interactions that
support the development of infant affect and behavior regulation.
This may result in increased infant fussing and crying at 12 months
postpartum.
Future research might examine how mothers’ felt security re-
lates to mothers’ stress appraisal and coping, as well as observable
receipt of social and tangible resources postpartum. This may
elucidate the extent to which the effects of felt security are medi-
ated by a perceived feeling of security in close relationships and
cognitive factors versus observable social support received.
We hypothesized that preexisting, prenatal psychosocial re-
sources may play a particularly important protective role. Al-
though psychosocial resources may be mobilized postpartum, ma-
ternal distress may be immediate, whereas the mobilization of
resources may take time. Maternal distress in the early postnatal
period may set in motion a pattern of less adaptive maternal
cognitions and behavior, and mother–infant interactions that may
persist beyond the duration of the stressful experience and con-
tinue, despite the later availability of resources mobilized after
birth (Minde, Whitelaw, Brown, & Fitzhardinge, 1983). However,
the current study cannot directly test the relative importance of
preexisting versus mobilized psychosocial resources, because post-
partum assessments of felt security indicators are likely biased by
mothers’ experience of the newborn’s medical stressor. Future
research should examine the issue of the relative importance of
preexisting versus mobilized resources.
Although we hypothesized that maternal reports of infant fuss-
ing and crying reflect actual levels of fussing and crying, an
alternate possibility is that low felt security mothers of infants with
medical problems experience elevated stress, and thus perceive
their infants as having more negative affect regardless of actual
levels of fussiness or negative affect. However, this seems un-
likely, as no association between maternal prenatal felt security
and maternal report of fussing and crying was found among infants
who were healthy at birth. Further, the regression analysis con-
trolled for mothers’ pregnancy anxiety. Because we do not have a
third-party report of our dependent measure, we cannot be sure of
whether maternal reports of infant fussing and crying in this study
reflect actual levels of fussing and crying or maternal perceptions
of negative infant affect. Regardless, the findings reported here
have important implications for child outcomes. Maternal percep-
tions of difficult infant temperament are related to maternal stress,
distress, and feelings of incompetence (Cutrona & Troutman,
1986; Östberg & Hagekull, 2000). Maternal perception of in-
creased infant fussing and crying may thus predict decreased
maternal well-being and ability to provide optimal care. However,
future research might further examine this issue by obtaining
objective reports of infant fussing and crying with sound-recording
equipment, for example.
Further, although the large size of the initial cohort allowed
cross-validation of the latent variable, the wide range of measures
needed in the multidisciplinary Montreal Prematurity Study re-
quired abbreviated versions of several measures. This resulted in
low to moderate reliability coefficients for some measures, such as
the attachment scales.
Despite these limitations, these findings expand on previous
research in several ways and the study has a number of strengths.
First, this study makes a unique contribution to the literature on
infant medical vulnerability and maternal stress and psychosocial
resources by demonstrating that prenatal maternal psychosocial
resources and infant medical problems at birth interact to predict
an infant developmental outcome at 12 months postpartum. Sec-
ond, the longitudinal design ensured that maternal measures of
psychosocial resources preceded, and were therefore not influ-
enced by, infant medical problems.
Third, this study employed a more comprehensive and parsimo-
nious measure of maternal psychosocial resources than is typically
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Thisarticleisintendedsolelyforthepersonaluseoftheindividualuserandisnottobedisseminatedbroadly.
816 SAWADA ET AL.
7. used in related research. Felt security has been conceptualized in
the adult attachment literature as encompassing attachment secu-
rity, perceived regard from close others, romantic relationship
quality, and the expectation that others are available and respon-
sive in times of need (Florian et al., 1995; Murray et al., 2006;
Murray et al., 2000; Murray et al., 2001). No validated measure of
felt security that reflects this conceptualization exists. We there-
fore modeled felt security using CFA, with attachment, self-
esteem, relationship quality, and social support as indicators. Felt
security scores were then computed and used to test the primary
hypothesis that this factor interacts with infant health problems at
birth to predict infant fussing and crying. The results of this study
suggest that attachment security, self-esteem, relationship quality,
and social support are indeed indicators of felt security, thus
contributing to an improved empirical understanding of this con-
struct. Further, although maternal prenatal felt security interacted
with infant health at birth to predict infant fussing and crying, none
of the individual indicators did. This suggests that mothers’ ag-
gregate resources matter. However, it is possible that with more
reliable measures of any of the felt security indicators, one may
have significantly interacted with health at birth. It is also possible
that some measures, like social support, could have direct or
indirect moderating effects by promoting attachment security. Fu-
ture research should examine these issues. In the meantime, the
finding that maternal prenatal felt security interacts with a stressor
to predict an infant outcome lays the groundwork for future re-
search on felt security, which may aim to develop a concise
measure or examine the buffering effects of felt security in other
contexts.
Fourth, the study used experience sampling, thus minimizing
memory bias associated with post hoc questionnaires and increas-
ing ecological validity. Few studies examining interactions be-
tween infant medical problems and maternal psychosocial re-
sources have used this methodology. This study makes a
significant contribution by demonstrating that felt security and
neonatal medical problems predict infant behavior with a measure
of mothers’ real-time, daily life experience.
Lastly, mothers’ ratings of infant health at 6 and 12 months did
not differ between infants with medical problems and infants who
were healthy at birth. This suggests that infants who are born with
medical problems and have mothers with low prenatal felt security
are not fussier simply because of persistently poorer (perceived)
health. Rather, these results suggest that medical problems at birth
combined with lower maternal prenatal felt security contribute to
patterns of mother–infant interactions that are associated with
increased maternal report of infant fussing and crying that persist
12 months postpartum, despite perceived improvements in infant
health. Future studies should investigate the relationship between
neonatal medical problems, maternal psychosocial resources, and
the child’s emotional and behavioral regulation beyond infancy.
The results of this study suggest the relevance and time course
of interventions that might increase felt security among mothers of
infants with medical problems or mothers at risk of having an
infant with medical problems. Resilience-promoting interventions
that increase felt security during pregnancy may be useful for
promoting more favorable maternal and infant outcomes after
birth.
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Received May 8, 2013
Revision received June 23, 2014
Accepted July 19, 2014 Ⅲ
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