title: Ethnic/racial diversity, maternal stress, lactation and very low birthweight infants.
abstract: OBJECTIVE
  (1) To compare maternal characteristics and psychological stress profile among African-American, Caucasian and Hispanic mothers who delivered very low birthweight infants. (2) To investigate associations between psychosocial factors, frequency of milk expression, skin-to-skin holding (STS), and lactation performance, defined as maternal drive to express milk and milk volume.
  
  
  METHODS
  Self-reported psychological questionnaires were given every 2 weeks after delivery over 10 weeks. Milk expression frequency, STS, and socioeconomic variables were collected.
  
  
  RESULTS
  Infant birthweight, education, and milk expression frequency differed between groups. Trait anxiety, depression and parental stress in a neonatal intensive care unit (PSS:NICU) were similar. African-American and Caucasian mothers reported the lowest scores in state anxiety and social desirability, respectively. Maternal drive to express milk, measured by maintenance of milk expression, correlated negatively with parental role alteration (subset of PSS:NICU) and positively with infant birthweight and STS. Milk volume correlated negatively with depression and positively with milk expression frequency and STS.
  
  
  CONCLUSIONS
  Differences between groups were observed for certain psychosocial factors. The response bias to self-reported questionnaires between groups may not provide an accurate profile of maternal psychosocial profile. With different factors correlating with maintenance of milk expression and milk volume, lactation performance can be best enhanced with a multi-faceted intervention program, incorporating parental involvement in infant care, close awareness and management of maternal mental health, and encouragement for frequent milk expression and STS.
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA. clau@bcm.edu
authors.forename: C
authors.initials: C
authors.lastname: Lau
authors.forename: N M
authors.initials: NM
authors.lastname: Hurst
authors.forename: E O
authors.initials: EO
authors.lastname: Smith
authors.forename: R J
authors.initials: RJ
authors.lastname: Schanler
mesh_terms: D000328:Adult; D003466:Cultural Characteristics; D005006:Ethnicity; D005260:Female; D005865:Gestational Age; D006801:Humans; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007774:Lactation / Q000208:ethnology / Q000523:psychology*; D011247:Pregnancy; D013315:Stress, Psychological; D011795:Surveys and Questionnaires