Transition to parenthood among in vitro fertilization patients at 2 and 9 months postpartum
2001; Elsevier BV; Volume: 76; Issue: 3 Linguagem: Inglês
10.1016/s0015-0282(01)01942-2
ISSN1556-5653
AutoresDorothy A. Greenfeld, Susan C. Klock,
Tópico(s)Assisted Reproductive Technology and Twin Pregnancy
ResumoThe success of IVF has led to the birth of thousands of children. It has been suggested that IVF mothers will have more difficulty than their naturally conceiving counterparts with pregnancy and the transition to parenthood (1Olshansky E.F Identity of self as infertile an example of theory generating research.Adv Nurs Sci. 1987; 9: 54-63PubMed Google Scholar, 2Bernstein J Lewis J Seibel M.M Effect of previous infertility on maternal fetal attachment, coping styles and self-concept during pregnancy.J Wom Health. 1994; 3: 125-133Crossref Scopus (32) Google Scholar, 3Colpin H Demyttenaere K Vanemeulebroeke L New reproductive technology and the family the parent-child relationship following in vitro fertilization.J Child Psychol Psychiatry. 1995; 35: 1429-1441Crossref Scopus (66) Google Scholar, 4Burns L.H An exploratory study of parenting after infertility.Fam Syst Med. 1987; 8: 177-189Crossref Scopus (50) Google Scholar, 5Van Balen F Development of IVF children.Dev Rev. 1998; 18: 30-46Crossref PubMed Scopus (74) Google Scholar). Studies assessing IVF women during pregnancy have failed to find any differences between IVF and control-group women on measures of anxiety, attachment, and self-esteem (6McMahon C Ungerer J Beaurepaire J Tennant C Saunders D Anxiety during pregnancy and fetal attachment after in-vitro fertilization conception.Hum Reprod. 1997; 12: 176-182Crossref PubMed Scopus (119) Google Scholar, 7Klock S.C Greenfeld D.A The psychological status of in vitro fertilization (IVF) patients during pregnancy a longitudinal study.Fertil Steril. 2000; 73: 1159-1164Abstract Full Text Full Text PDF PubMed Scopus (83) Google Scholar, 8Reading A Chang L.C Kerin J.F Attitudes and anxiety levels in women conceiving through in vitro fertilization and gamete intrafallopian transfer.Fertil Steril. 1989; 52: 95-99PubMed Scopus (31) Google Scholar). After delivery, Australian IVF women did not differ from non-IVF women on measures of anxiety, depression, and marital satisfaction, but differences were noted in sexuality, parental efficacy, and infant temperament (9McMahon C Ungerer J Tennant C Saunders D Psychosocial adjustment and the quality of the mother-child relationship at four months postpartum after conception by in vitro fertilization.Fertil Steril. 1997; 68: 492-500Abstract Full Text PDF PubMed Scopus (122) Google Scholar, 10Gibson F.L Ungerer J.A Tennant C Saunders D Parental adjustment and attitudes to parenting after in vitro fertilization.Fertil Steril. 2000; 73: 565-574Abstract Full Text Full Text PDF PubMed Scopus (105) Google Scholar). These studies were limited because of demographic differences between the IVF and control group samples.We studied the psychological adjustment to pregnancy and first-time parenting after IVF in a well-matched sample of American women. The pregnancy-related data has been reported (7Klock S.C Greenfeld D.A The psychological status of in vitro fertilization (IVF) patients during pregnancy a longitudinal study.Fertil Steril. 2000; 73: 1159-1164Abstract Full Text Full Text PDF PubMed Scopus (83) Google Scholar); this paper focuses on the postpartum data. Assessments of marital adjustment, depression, anxiety, self-esteem, parenting stress, infant temperament, and the rewards and concerns of parenting were completed at 2 and 9 months postpartum.Subject recruitment and inclusion criteria have been reported (8Reading A Chang L.C Kerin J.F Attitudes and anxiety levels in women conceiving through in vitro fertilization and gamete intrafallopian transfer.Fertil Steril. 1989; 52: 95-99PubMed Scopus (31) Google Scholar). At the time of the 2-month postpartum assessment (time 1 [T1]), there were 56 IVF women and 32 non-IVF women; at 9 months postpartum (time 2 [T2]), there were 53 IVF women and 28 non-IVF women. Questionnaires were mailed to subjects for completion. Measures included marital adjustment (11Belsky J, Spanier G, Rovine M. Stability and change in marriage across the transition to parenthood. J Marriage Fam 1983;August:567–77.Google Scholar), depression (12Beck A, Ward C, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatr 1961;4:561–71.Google Scholar), state and trait anxiety (13Speilberger C. Manual for the State Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press 1989.Google Scholar), self-esteem (14Rosenberg M Conceiving the Self. Basic Books, New York1979Google Scholar), parenting stress (15Abidin R.R Parenting Stress Index. 3rd ed. Psychological Assessment Resources, Odessa, FL1995Google Scholar), infant temperament (16Rothbart M.K Measurement of temperament in infancy.Child Dev. 1981; 52: 569-578Crossref Google Scholar), and the rewards and concerns of parenting (17Barnett R.C Marshall N.L Worker and mother roles, spill over effects and psychological distress.Wom Health. 1992; 18: 9-40Crossref Scopus (101) Google Scholar). The study protocol was approved by the institutions’ human subject review boards.Seventy-one percent of IVF and 96% of non-IVF women delivered singletons, 23% of IVF women and 4% of controls had twins, and 6% of IVF women had triplets (χ2 = 8.51, P<.01). There were no significant differences in mothers’ assessment of babies’ health. There were no significant differences between groups in length of maternity leave, type or amount of childcare used, and division of labor of childcare tasks by wives and husbands.The T1 psychological adjustment data are given in Table 1. There were no differences between groups on measures of marital adjustment, depression, anxiety, self-esteem, or parenting stress, and mean scores were in the normal range. For infant temperament, a significant difference was found in infant soothability (meanIVF = 4.6, SD = 0.9; meannon-IVF = 5.1, SD = 0.5, F = 4.09, P<.04) (1.41 df). On the rewards and concerns of parenting items, IVF women reported lower reward scores related to breastfeeding (meanIVF = 2.4, SD = 1.1 (1.85 df); meannon-IVF = 3.0, SD = 1.0, F = 6.7, P<.01). Non-IVF women reported greater concern with changes in sexual functioning (meanIVF = 1.7, SD = .7 (1.86 df); meannon-IVF = 2.2, SD = .7, F = 8.4, P<.004) and concerns with husband’s ability to share in child care responsibilities (meanIVF = 1.5, SD =0.6 (1.86 df); meannon-IVF = 2.0, SD = 0.8, F = 6.7, P<.01).Table 1IVF and control group mean scores (SD) on measures of self-esteem, depression, anxiety, parenting stress, and marital adjustment.legendThere were no statistically significant differences between groups on any of the above measures., legendGreenfeld. Transition to parenthood after IVF. Fertil Steril 2001.VariableTime 1 (2 mo postpartum)Time 2 (9 mo postpartum)IVF (n = 56)non-IVF (n = 32)IVF (n = 53)non-IVF (n = 28)Self-esteem13.7 (4.3)12.7 (3.8)14.2 (4.4)13.8 (4.2)Depression7.7 (7.1)6.8 (3.4)6.0 (5.1)5.7 (3.1)State anxiety31.4 (10.2)29.7 (9.9)29.6 (8.2)28.8 (8.0)Trait anxiety31.4 (10.0)31.7 (7.8)31.2 (8.7)31.0 (7.1)Parenting stress index scalesDefensiveness13.2 (5.1)13.0 (3.7)12.5 (5.0)14.0 (5.0)Parental distress23.8 (7.6)23.7 (6.0)22.1 (7.4)23.5 (8.0)Parent/child dysfunction17.5 (6.0)16.5 (5.9)14.4 (3.5)15.3 (4.6)Difficult child18.8 (6.1)18.5 (5.8)16.5 (5.2)16.4 (6.8)Total PSI60.5 (16.5)58.8 (15.1)53.1 (13.4)55.3 (17.4)Marital adjustmentWorking partnership6.2 (1.1)6.0 (1.1)Romantic/sexual4.8 (1.5)5.0 (1.4)Friendship6.5 (1.0)6.2 (1.2)Satisfaction6.2 (1.2)6.2 (1.1)legend There were no statistically significant differences between groups on any of the above measures.legend Greenfeld. Transition to parenthood after IVF. Fertil Steril 2001. Open table in a new tab At T2 (9 months postpartum), there were no significant differences between groups on measures of depression, anxiety, self-esteem, parenting stress, and assessment of infant temperament (Table 1). Individual item differences were found on the concerns of parenting items. Non-IVF women had a higher mean score for the item concerning irreversible changes in attractiveness (meanIVF = 1.6; meannon-IVF = 2.0, F = 5.8 (1.71 df), P<.01) and restriction of independence due to parenting (meanIVF = 1.7; meannon-IVF = 2.1, F = 4.2 (1.71 df), P<.04).Paired t-tests were used to determine whether there were changes in psychological adjustment from T1 to T2 according to the Parenting Stress Index. Among IVF women, parenting stress decreased over time with lowered scores on the Parent/Child Dysfunction subscale (T1 = 17.7, T2 = 14.2, t = 3.83, P<.01), the Difficult Child subscale (T1 = 19.2, T2 = 16.5, t = 3.25, P<.002), and total Parenting Stress Index scores (T1 = 60.7, T2 = 52.0, t = 4.08, P<.001). For the control group, the only significant change in scores across time was a deterioration in self-esteem, as indicated by increased scores from T1 to T2 (T1 = 12.2, T2 = 13.2, t = −2.35, P<.02).The results of our longitudinal study suggest that the clinical lore raising doubts about IVF mothers’ capacity to adapt to the demands of motherhood is in error. We did not find differences between the IVF and non-IVF groups on standard psychological measures. This indicates that IVF mothers are for the most part facing the same issues that non-IVF mothers are and they are coping equally well. These findings are similar to those of European studies (18Golombok S Cook R Bish A Murray C Families created by the new reproductive technologies quality of parenting and social and emotional development of the children.Child Dev. 1995; 66: 285-298Crossref PubMed Google Scholar, 19Montgomery T.R Aiello F Adelman R.D Wasylshyn N Andrews M.C Brazelton T.B et al.The psychological status at school age of children conceived by in vitro fertilization.Hum Reprod. 1999; 14: 2162-2165Crossref PubMed Scopus (33) Google Scholar, 20Golombok S Brewaeys A Cook R Giavazzi M Guerra D Mantovanie A et al.The European study of assisted reproduction families family functioning and child development.Hum Reprod. 1996; 11: 2324-2331Crossref PubMed Scopus (230) Google Scholar). In fact, over time, IVF mothers had a significant reduction of parenting stress over time. Although some specific behavioral and attitudinal differences were noted on the rewards and concerns of parenting items, these differences, in our opinion, do not support the longstanding clinical lore that IVF mothers are somehow less able to cope with the transition to first-time parenting. The success of IVF has led to the birth of thousands of children. It has been suggested that IVF mothers will have more difficulty than their naturally conceiving counterparts with pregnancy and the transition to parenthood (1Olshansky E.F Identity of self as infertile an example of theory generating research.Adv Nurs Sci. 1987; 9: 54-63PubMed Google Scholar, 2Bernstein J Lewis J Seibel M.M Effect of previous infertility on maternal fetal attachment, coping styles and self-concept during pregnancy.J Wom Health. 1994; 3: 125-133Crossref Scopus (32) Google Scholar, 3Colpin H Demyttenaere K Vanemeulebroeke L New reproductive technology and the family the parent-child relationship following in vitro fertilization.J Child Psychol Psychiatry. 1995; 35: 1429-1441Crossref Scopus (66) Google Scholar, 4Burns L.H An exploratory study of parenting after infertility.Fam Syst Med. 1987; 8: 177-189Crossref Scopus (50) Google Scholar, 5Van Balen F Development of IVF children.Dev Rev. 1998; 18: 30-46Crossref PubMed Scopus (74) Google Scholar). Studies assessing IVF women during pregnancy have failed to find any differences between IVF and control-group women on measures of anxiety, attachment, and self-esteem (6McMahon C Ungerer J Beaurepaire J Tennant C Saunders D Anxiety during pregnancy and fetal attachment after in-vitro fertilization conception.Hum Reprod. 1997; 12: 176-182Crossref PubMed Scopus (119) Google Scholar, 7Klock S.C Greenfeld D.A The psychological status of in vitro fertilization (IVF) patients during pregnancy a longitudinal study.Fertil Steril. 2000; 73: 1159-1164Abstract Full Text Full Text PDF PubMed Scopus (83) Google Scholar, 8Reading A Chang L.C Kerin J.F Attitudes and anxiety levels in women conceiving through in vitro fertilization and gamete intrafallopian transfer.Fertil Steril. 1989; 52: 95-99PubMed Scopus (31) Google Scholar). After delivery, Australian IVF women did not differ from non-IVF women on measures of anxiety, depression, and marital satisfaction, but differences were noted in sexuality, parental efficacy, and infant temperament (9McMahon C Ungerer J Tennant C Saunders D Psychosocial adjustment and the quality of the mother-child relationship at four months postpartum after conception by in vitro fertilization.Fertil Steril. 1997; 68: 492-500Abstract Full Text PDF PubMed Scopus (122) Google Scholar, 10Gibson F.L Ungerer J.A Tennant C Saunders D Parental adjustment and attitudes to parenting after in vitro fertilization.Fertil Steril. 2000; 73: 565-574Abstract Full Text Full Text PDF PubMed Scopus (105) Google Scholar). These studies were limited because of demographic differences between the IVF and control group samples. We studied the psychological adjustment to pregnancy and first-time parenting after IVF in a well-matched sample of American women. The pregnancy-related data has been reported (7Klock S.C Greenfeld D.A The psychological status of in vitro fertilization (IVF) patients during pregnancy a longitudinal study.Fertil Steril. 2000; 73: 1159-1164Abstract Full Text Full Text PDF PubMed Scopus (83) Google Scholar); this paper focuses on the postpartum data. Assessments of marital adjustment, depression, anxiety, self-esteem, parenting stress, infant temperament, and the rewards and concerns of parenting were completed at 2 and 9 months postpartum. Subject recruitment and inclusion criteria have been reported (8Reading A Chang L.C Kerin J.F Attitudes and anxiety levels in women conceiving through in vitro fertilization and gamete intrafallopian transfer.Fertil Steril. 1989; 52: 95-99PubMed Scopus (31) Google Scholar). At the time of the 2-month postpartum assessment (time 1 [T1]), there were 56 IVF women and 32 non-IVF women; at 9 months postpartum (time 2 [T2]), there were 53 IVF women and 28 non-IVF women. Questionnaires were mailed to subjects for completion. Measures included marital adjustment (11Belsky J, Spanier G, Rovine M. Stability and change in marriage across the transition to parenthood. J Marriage Fam 1983;August:567–77.Google Scholar), depression (12Beck A, Ward C, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatr 1961;4:561–71.Google Scholar), state and trait anxiety (13Speilberger C. Manual for the State Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press 1989.Google Scholar), self-esteem (14Rosenberg M Conceiving the Self. Basic Books, New York1979Google Scholar), parenting stress (15Abidin R.R Parenting Stress Index. 3rd ed. Psychological Assessment Resources, Odessa, FL1995Google Scholar), infant temperament (16Rothbart M.K Measurement of temperament in infancy.Child Dev. 1981; 52: 569-578Crossref Google Scholar), and the rewards and concerns of parenting (17Barnett R.C Marshall N.L Worker and mother roles, spill over effects and psychological distress.Wom Health. 1992; 18: 9-40Crossref Scopus (101) Google Scholar). The study protocol was approved by the institutions’ human subject review boards. Seventy-one percent of IVF and 96% of non-IVF women delivered singletons, 23% of IVF women and 4% of controls had twins, and 6% of IVF women had triplets (χ2 = 8.51, P<.01). There were no significant differences in mothers’ assessment of babies’ health. There were no significant differences between groups in length of maternity leave, type or amount of childcare used, and division of labor of childcare tasks by wives and husbands. The T1 psychological adjustment data are given in Table 1. There were no differences between groups on measures of marital adjustment, depression, anxiety, self-esteem, or parenting stress, and mean scores were in the normal range. For infant temperament, a significant difference was found in infant soothability (meanIVF = 4.6, SD = 0.9; meannon-IVF = 5.1, SD = 0.5, F = 4.09, P<.04) (1.41 df). On the rewards and concerns of parenting items, IVF women reported lower reward scores related to breastfeeding (meanIVF = 2.4, SD = 1.1 (1.85 df); meannon-IVF = 3.0, SD = 1.0, F = 6.7, P<.01). Non-IVF women reported greater concern with changes in sexual functioning (meanIVF = 1.7, SD = .7 (1.86 df); meannon-IVF = 2.2, SD = .7, F = 8.4, P<.004) and concerns with husband’s ability to share in child care responsibilities (meanIVF = 1.5, SD =0.6 (1.86 df); meannon-IVF = 2.0, SD = 0.8, F = 6.7, P<.01). At T2 (9 months postpartum), there were no significant differences between groups on measures of depression, anxiety, self-esteem, parenting stress, and assessment of infant temperament (Table 1). Individual item differences were found on the concerns of parenting items. Non-IVF women had a higher mean score for the item concerning irreversible changes in attractiveness (meanIVF = 1.6; meannon-IVF = 2.0, F = 5.8 (1.71 df), P<.01) and restriction of independence due to parenting (meanIVF = 1.7; meannon-IVF = 2.1, F = 4.2 (1.71 df), P<.04). Paired t-tests were used to determine whether there were changes in psychological adjustment from T1 to T2 according to the Parenting Stress Index. Among IVF women, parenting stress decreased over time with lowered scores on the Parent/Child Dysfunction subscale (T1 = 17.7, T2 = 14.2, t = 3.83, P<.01), the Difficult Child subscale (T1 = 19.2, T2 = 16.5, t = 3.25, P<.002), and total Parenting Stress Index scores (T1 = 60.7, T2 = 52.0, t = 4.08, P<.001). For the control group, the only significant change in scores across time was a deterioration in self-esteem, as indicated by increased scores from T1 to T2 (T1 = 12.2, T2 = 13.2, t = −2.35, P<.02). The results of our longitudinal study suggest that the clinical lore raising doubts about IVF mothers’ capacity to adapt to the demands of motherhood is in error. We did not find differences between the IVF and non-IVF groups on standard psychological measures. This indicates that IVF mothers are for the most part facing the same issues that non-IVF mothers are and they are coping equally well. These findings are similar to those of European studies (18Golombok S Cook R Bish A Murray C Families created by the new reproductive technologies quality of parenting and social and emotional development of the children.Child Dev. 1995; 66: 285-298Crossref PubMed Google Scholar, 19Montgomery T.R Aiello F Adelman R.D Wasylshyn N Andrews M.C Brazelton T.B et al.The psychological status at school age of children conceived by in vitro fertilization.Hum Reprod. 1999; 14: 2162-2165Crossref PubMed Scopus (33) Google Scholar, 20Golombok S Brewaeys A Cook R Giavazzi M Guerra D Mantovanie A et al.The European study of assisted reproduction families family functioning and child development.Hum Reprod. 1996; 11: 2324-2331Crossref PubMed Scopus (230) Google Scholar). In fact, over time, IVF mothers had a significant reduction of parenting stress over time. Although some specific behavioral and attitudinal differences were noted on the rewards and concerns of parenting items, these differences, in our opinion, do not support the longstanding clinical lore that IVF mothers are somehow less able to cope with the transition to first-time parenting.
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