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Associations of Maternal Lifetime Trauma and Perinatal Traumatic Stress Symptoms With Infant Cardiorespiratory Reactivity to Psychological Challenge

From the Department of Psychiatry (M.B.E., J.S.), Children’s Hospital Boston, Boston, Massachusetts; Department of Psychiatry (M.B.E.) and Department of Medicine (R.J.W.), Harvard Medical School, Boston, Massachusetts; Department of Environmental Health (A.K., R.J.W.), Harvard School of Public Health, Boston, Massachusetts; Department of Mathematics and Statistics (J.S.), University of Massachusetts, Amherst, Massachusetts; Department of Psychology (T.R.), Southern Methodist University, Dallas, Texas; and Channing Laboratory (R.J.W.), Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts.

Address correspondence and reprint requests to Michelle Bosquet Enlow, Department of Psychiatry, Children’s Hospital Boston, 21 Autumn Street, 1st Floor, Boston, MA 02115. E-mail: michelle.bosquet{at}childrens.harvard.edu

Objective: To examine associations of maternal lifetime trauma and related psychological symptoms in the perinatal period with infant cardiorespiratory reactivity and behavioral distress in response to a laboratory stressor, using a novel advanced system recently adapted for infants.

Methods: Participants were mothers and their 6-month-old infants. Assessments included mothers’ self-reported lifetime exposure to trauma, perinatal traumatic stress, and current symptoms of posttraumatic stress disorder (PTSD) and depression. Through the use of a noninvasive respiratory inductance plethysmography device, heart rate and indices of respiratory volume, timing, and thoracoabdominal coordination were recorded continuously in 23 infants during the Still-Face Paradigm, a videotaped mother-infant dyadic assessment that included baseline, stressor, and recovery phases. Infant behavioral distress during the procedure was also assessed.

Results: Infants of mothers with low exposure to trauma and perinatal traumatic stress showed expected increases in behavioral distress and cardiorespiratory activation from baseline to stressor and decreases in these parameters from stressor to recovery. Infants of mothers exposed to multiple traumas and with elevated perinatal traumatic stress showed similar patterns of activation from baseline to stressor but failed to show decreases during recovery. These patterns were maintained after controlling for current maternal PTSD and depressive symptoms.

Conclusions: Maternal lifetime trauma exposure and traumatic stress during the perinatal period were associated with disrupted infant cardiorespiratory regulation and behavioral distress during a stressor protocol. These results support the concept of perinatal programming and its potential role in physical and mental health outcomes.

Key Words: perinatal programming • trauma • stress • autonomic reactivity

Abbreviations: PTSD = posttraumatic stress disorder; HPA = hypothalamic-pituitary-adrenal; ECG = electrocardiogram; SFP = Still-Face Paradigm; LSC-R = Life Stressor Checklist-Revised; EPDS = Edinburgh Postnatal Depression Scale; PCL-C = Posttraumatic Stress Disorder Checklist-Civilian Version; HR = heart rate; V_T = tidal volume; V’_min = minute ventilation; T_I = inspiratory duration; T_E = expiratory duration; T_TOT = total breath duration; T_I/T_TOT = respiratory timing; %RC = percentage of rib cage contribution to tidal volume; PhRIB = inspiratory thoracoabdominal asynchrony; PhREB = expiratory thoracoabdominal asynchrony; QDC = Qualitative Diagnostic Calibration.