title: The influence of multiple birth and bereavement on maternal and family outcomes 2 and 7years after very preterm birth.
abstract: Psychological distress has been reported by mothers of infants born very preterm (VPT) and by mothers of multiples (twins and triplets). This study examined the influence of i) multiple birth and ii) bereavement associated with a multifetal pregnancy, on mental health, parenting stress and family functioning for mothers of children born VPT across early childhood.
  
  
  
  Participants were 162 mothers of 194 infants (129 singletons, 65 multiples) born at <30weeks' gestation or with a birth weight<1250g who completed questionnaires when their children were two and seven years corrected age. Fifteen mothers (9%) experienced bereavement associated with a multifetal pregnancy. Maternal mental health was assessed using the General Health Questionnaire at two years and Hospital Anxiety and Depression Scale at seven years. Parenting stress and family functioning were assessed using the Parenting Stress Index and Family Assessment Device.
  
  
  
  Maternal mental health, stress and family functioning were similar in mothers of VPT singletons and multiples. However compared with mothers who had not experienced bereavement, mothers who had were 3.6 times [95% confidence interval (95% CI) 1.05, 12.5] more likely to report elevated anxiety symptoms and 3.6 times [95% CI 1.05, 12.3] more likely to report elevated depressive symptoms when their VPT child was seven years old.
  
  
  
  The results of this study highlight the need for monitoring and offering ongoing support to bereaved mothers with surviving VPT children. However, within the context of VPT birth, multiple birth does not increase the risk for maternal psychological distress in early childhood.
authors.affiliation: LaTrobe University, Victoria, Australia; Murdoch Childrens Research Institute, Victoria, Australia; University of Melbourne, Victoria, Australia; Royal Women's Hospital, Victoria, Australia. Electronic address: k.treyvaud@latrobe.edu.au.
authors.forename: Karli
authors.initials: K
authors.lastname: Treyvaud
authors.affiliation: Universite Laval, Quebec, Canada.
authors.forename: Andrea C
authors.initials: AC
authors.lastname: Aldana
authors.affiliation: Murdoch Childrens Research Institute, Victoria, Australia.
authors.forename: Shannon E
authors.initials: SE
authors.lastname: Scratch
authors.affiliation: Murdoch Childrens Research Institute, Victoria, Australia.
authors.forename: Alexandra M
authors.initials: AM
authors.lastname: Ure
authors.affiliation: Murdoch Childrens Research Institute, Victoria, Australia.
authors.forename: Carmen C
authors.initials: CC
authors.lastname: Pace
authors.affiliation: Murdoch Childrens Research Institute, Victoria, Australia; University of Melbourne, Victoria, Australia.
authors.forename: Lex W
authors.initials: LW
authors.lastname: Doyle
authors.affiliation: Murdoch Childrens Research Institute, Victoria, Australia; University of Melbourne, Victoria, Australia.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Anderson
mesh_terms: D001007:Anxiety / Q000523:psychology; D001601:Bereavement; D002648:Child; D002675:Child, Preschool; D003863:Depression / Q000523:psychology; D005195:Family Relations / Q000523:psychology*; D005260:Female; D005313:Fetal Death; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D062071:Infant, Extremely Premature / Q000523:psychology*; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature / Q000523:psychology; D008137:Longitudinal Studies; D008603:Mental Health; D009035:Mothers / Q000523:psychology*; D009099:Multiple Birth Offspring / Q000523:psychology*; D011247:Pregnancy; D011272:Pregnancy, Multiple; D013315:Stress, Psychological / Q000523:psychology; D011795:Surveys and Questionnaires; D014310:Triplets; D014427:Twins
keywords: Maternal anxiety; Maternal depression; Multiple birth; Preterm