Confidence in infant care and recognition of infant behavior among women with multiple socio-environmental risks who deliver premature infants

Background: The difficulty that mothers of a premature infant have in recognizing behavioral cues (RIB) and gaining confidence in premature infant care (CPIC) may be exacerbated by multiple socio-environmental risk factors (SE risks). Objective: To describe the relationship between number of SE risks, RIB and CPIC. Methods: We analyzed baseline interview data from an ongoing randomized trial testing a behavioral intervention for 135 mothers and premature infants (29-34 weeks gestational age) with at least two of nine SE risks. SE risks included minority status (97.8%; African-American = 47.4%, Latina = 50.4%); poverty (<185% Federal Poverty Level, 91.1%); depressive symptoms/mental illness (51.1%); < high school education (37.0%); 2+ children <24 months (33.3%); high trait anxiety (27.4%); low social support (23.0%); age <20 (17.0%); and 4+ children (17.0%). Multivariable logistic regression examined the effect of 5+ SE risks on mothers' CPIC and RIB (recognition of pictures illustrating behavioral states and cues). Results: For these mothers, 28.9% had 5+ total SE risks, 40.6% had low RIB (<80% of items correct) and 23.7% had low CPIC (<80% of maximum score). Mothers with 5+ SE risks had a 2.6 times increased odds (95% CI = 1.2, 6.0) of low CPIC, controlling for Latina ethnicity, an independent predictor (OR = 4.9, 95% CI = 2.3, 10.4). SE risks and ethnicity were not associated with low RIB. Discussion: All mothers of premature infants need help recognizing premature infant behavioral state and cues, and mothers with multiple SE risks need additional support to gain confidence in infant care.