title: Twin birth: an additional risk factor for poorer quality maternal interactions with very preterm infants?
abstract: BACKGROUND
  Twin birth can be considered an additional risk factor for poor interactions between mothers and their very preterm (VP; <32 weeks' gestation) infants.
  
  
  OBJECTIVE
  To explore if mothers of (VP) twins experience higher levels of stress than mothers of singletons and if mother-twin infant dyads experience poorer quality interactions.
  
  
  METHODS
  Mothers of VP twin infants (N=17) were closely matched to mothers of VP singleton infants (N=17). Mother-infant interaction was assessed before discharge from hospital and during a home visit at three months corrected age using the Nursing Child Assessment Teaching Scale (NCATS). Mothers' responsiveness to their infants was assessed using the Responsivity subscale of the Home Observation for Measurement of the Environment (HOME) and mothers completed the Parenting Stress Index short form (PSI-SF).
  
  
  RESULTS
  Mothers of twins had significantly lower HOME responsiveness scores (median 9 vs. 10) at three months corrected age and were more likely to have total PSI-SF scores in the clinical range (>90th percentile) compared to mothers of singletons (Fishers exact probability=0.05). Twin infants had lower mean Total Child Domain NCATS scores than singletons both at discharge (9.07 vs. 11.33) and at three months corrected age (13.18 vs. 15.71) indicating they were less responsive communicators.
  
  
  CONCLUSIONS
  VP twins present a greater challenge than singletons as their mothers experience high levels of parenting stress. Although mothers appear to compensate for twin infants' poorer clarity of cues in a structured, one to one task, mothers of twins were less responsive than mothers of singletons in an unstructured setting.
authors.affiliation: Division of Psychiatry, Institute of Mental Health, University of Nottingham, Nottingham NG7 2TU, UK. charlotte.beer@nottingham.ac.uk
authors.forename: C
authors.initials: C
authors.lastname: Beer
authors.forename: C
authors.initials: C
authors.lastname: Israel
authors.forename: S
authors.initials: S
authors.lastname: Johnson
authors.forename: N
authors.initials: N
authors.lastname: Marlow
authors.forename: A
authors.initials: A
authors.lastname: Whitelaw
authors.forename: C
authors.initials: C
authors.lastname: Glazebrook
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000523:psychology*; D008297:Male; D009034:Mother-Child Relations; D011247:Pregnancy; D059285:Pregnancy, Twin / Q000523:psychology; D012307:Risk Factors; D013315:Stress, Psychological / Q000453:epidemiology; D014427:Twins / Q000523:psychology*