Fetal heart rate is linked to fetal well-being and later neurodevelopmental outcomes. Prenatal maternal psychological distress may influence fetal heart rate through physiological changes in utero. However, few studies have examined how maternal distress relates to fetal heart rate, or whether these associations differ by fetal sex. We hypothesized that prenatal maternal depressive and anxiety symptoms and emotion dysregulation would associate with higher fetal heart rate and lower variability, with stronger effects among males. Participants were 159 third-trimester mothers, with a range of scores on emotion dysregulation. Exclusion criteria included substance use, gestational diabetes, pre-eclampsia, and twin pregnancies. Twenty minutes of fetal heart rate data were collected remotely. Depressive and anxiety symptoms, and emotion dysregulation were self-reported via questionnaires. Higher maternal anxiety was related to higher fetal heart rate for males, but not females. We found no interactions with fetal sex for depressive symptoms or emotion dysregulation. Higher symptoms of depression and anxiety predicted lower fetal heart rate variability, but there were no significant interactions with fetal sex. Prenatal maternal distress has differential effects on fetal heart rate and heart rate variability. Fetal heart rate also varied by sex in relation to maternal anxiety, suggesting that sex-specific factors and anxiety-related physiological changes may uniquely influence fetal development. Clinically, this underscores the importance of screening for and addressing prenatal maternal mental health, with potential benefits for both maternal and fetal well-being.

Objective: Early behavioral dysregulation places children at elevated risk for later psychopathology. Maternal emotion dysregulation during pregnancy is a transdiagnostic vulnerability that may shape child regulatory development through both prenatal biological influences and postnatal caregiving. However, less is known about the specific postnatal mechanisms through which prenatal emotion dysregulation confers risk for toddler behavioral dysregulation. This study examined whether prenatal maternal emotion dysregulation was associated with toddler behavioral dysregulation indirectly through infant parasympathetic regulation (baseline respiratory sinus arrhythmia; RSA) and postnatal parenting stress.Methods: Participants were 385 mothers and their infants recruited during the third trimester. At the third trimester, maternal emotion dysregulation was assessed using the Difficulties in Emotion Regulation Scale. At 7 months postpartum, parenting stress was measured using the Parenting Stress Index, and infant parasympathetic regulation was assessed using baseline RSA during a neutral resting period. At 18 months, toddler behavioral dysregulation was evaluated using the Infant-Toddler Social Emotional Assessment. We tested direct and indirect pathways among prenatal maternal emotion dysregulation, postnatal parenting stress, infant baseline RSA, and toddler behavioral dysregulation with structural equation models.Results: Higher prenatal maternal emotion dysregulation was associated with greater postnatal parenting stress and lower infant baseline RSA. Postnatal parenting stress was concurrently associated with higher infant baseline RSA and higher toddler behavioral dysregulation. Infant RSA was not directly associated with toddler behavioral dysregulation. Parenting stress partially accounted for associations between prenatal maternal emotion dysregulation and toddler behavioral outcomes.Conclusion: This study provides evidence for prospective indirect pathways in which maternal emotion dysregulation during pregnancy contributes to elevated parenting stress in infancy, which is linked to both infant parasympathetic regulation and toddler behavioral dysregulation. Although prenatal maternal emotion dysregulation was associated with infant baseline RSA, infant RSA was not associated with toddler dysregulation, suggesting partly distinct pathways of physiological and behavioral regulation development. These findings highlight pregnancy and infancy as important periods in early child development.

This Registered Report tested perinatal predictors of infant resting respiratory sinus arrhythmia (RSA), an index of parasympathetic functioning. Maternal RSA was collected at a resting state during the third trimester of pregnancy (N = 385, 56.9% of the pregnant mothers were White, non-Hispanic/Latina). Newborn attention and arousal were assessed shortly after birth. When infants (48% are male, and 50.7% are White, non-Hispanic/Latino) were 7 months old, their resting RSA was measured, and maternal sensitivity during a free-play interaction was coded. Greater maternal prenatal RSA was found to be associated with greater infant resting RSA. This longitudinal and intergenerational association was not significantly moderated or mediated by newborn neurobehavior or maternal sensitivity. Findings suggest that infant RSA may have roots in mothers' parasympathetic functioning during pregnancy.

Variations in fetal heart rate variability (HRV) may serve as early indicators of risk for later psychopathology. These individual differences could further interact with the postpartum environment to shape developmental outcomes. The present study investigated the relation between fetal HRV and toddler psychopathology in the context of postnatal parenting stress as an index of infants' early parenting environment. Mother-infant dyads (N = 159) were followed from the third trimester through 18 months postpartum. Fetal HRV was collected remotely during a 20-minute baseline at 34-40 weeks' gestation. Parents reported on parenting stress at 7 months, and toddler socioemotional outcomes at 18 months using questionnaires. Fetal HRV was not significantly associated with internalizing or externalizing problems alone. Parenting stress was positively associated with internalizing problems, but no interaction with fetal HRV was found. However, a significant interaction emerged for externalizing problems: lower fetal HRV predicted greater externalizing symptoms at higher levels of parenting stress. This study is among the first to investigate if interactions between fetal HRV and the postpartum caregiving environment associate with toddler transdiagnostic risk. These results highlight parenting stress as a promising intervention target, especially for babies with lower fetal HRV who may be at greater risk for psychopathology.

The COVID-19 pandemic introduced challenges for keeping participants and research assistants safe during laboratory visits. One solution was administering research assessments in the participant's home via an online platform, despite limited evidence of whether online tasks have similar effects as laboratory contexts. The present study compares physiological responses to a virtual adaptation of an infant cry stimulus-which is commonly used to evoke and measure autonomic nervous system responses among pregnant individuals-to a traditional laboratory-based cry task. Respiratory sinus arrhythmia (RSA), electrodermal activity (EDA), and heart rate (HR) were collected during infant cry presentation from 120 pregnant women in their third trimester. Half of the participants observed the infant cry stimulus in the laboratory before the pandemic, and the other half had the task delivered remotely using online teleconferencing technology in their homes. Results revealed that EDA increased and RSA decreased in response to the infant cry stimulus. HR did not significantly change from baseline to the infant cry stimulus. Importantly, whether the participants watched the infant cry stimulus at home versus in the laboratory did not affect their autonomic responses to the stimulus. These results demonstrate the ability of remote tasks to elicit an attachment-relevant stress response in pregnant women for remote data collection.

Purpose: Depressive symptoms during the perinatal period have broad and enduring health implications for birthing parents and their offspring. Rising prevalence rates of perinatal depression highlight the need for research examining factors influencing depressive symptoms during pregnancy, and trajectories during the early postnatal period. Grounded in bioecological systems theory, this longitudinal multimethod study examined whether prenatal bioecological factors predict depressive symptoms from pregnancy to 36 months postpartum. Methods: Participants were 162 pregnant individuals, oversampled for high emotion dysregulation, who completed a life stress interview and physiological assessment during the 3rd trimester and a self-report measure of depression at five time-points (3rd trimester, within 48 h of birth, 7, 18, and 36 months postpartum). Multilevel models were used to test study aims. Results: Participants exhibited the highest levels of depressive symptoms at 3rd trimester, and substantial variability in depressive symptom trajectories over time. Lower resting respiratory sinus arrhythmia (RSA), an index of parasympathetic nervous system functioning, in the 3rd trimester was associated with higher concurrent depressive symptoms. Higher levels of stress related to partner relationships, finances, and health were concurrently associated with more depressive symptoms during pregnancy and decreases in depressive symptoms over time. Specifically, depressive symptoms decreased only for individuals who reported high levels of stress during pregnancy. Limitations: Although grounded in bioecological systems theory, this study did not assess the macrosystem. Conclusions: Results of this study underscore the importance of multilevel predictors of perinatal health and highlights potential targets for preventing depression and promoting well-being during the perinatal transition.

Separate literatures have demonstrated that mothers' experiences with trauma during childhood or pregnancy are associated with maternal prenatal health risks, adverse childbirth outcomes, and offspring internalizing and externalizing disorders. These literatures largely align with the intergenerational transmission or fetal programming frameworks, respectively. However, few studies have tested the effects of maternal childhood and prenatal trauma simultaneously on mothers' and infants' health outcomes, and no studies have examined these effects on newborn neurobehavioral outcomes. Thus, in the present study, we examined how the developmental timing of pregnant women's traumatic life experiences associated with their physical health and psychopathology (Aim 1) as well as their newborns' birth and neurodevelopmental outcomes (Aim 2; for pre-registered aims and hypotheses, see https://osf.io/ygnre/?view_ only=cbe17d0ac7f24af5a4d3e37e24eebead). One hundred and fifty-two 3rd trimester pregnant women (Mage = 29 years; 17.1% Hispanic/Latina) completed measures of trauma history and psychopathology. Then, 24-48 h after birth, trained clinicians conducted newborn neuro-behavioral exams (n = 118 newborns; 52.6% female). Results indicated that lifetime traumatic experiences associated with multiple prenatal maternal health outcomes, including depression, anxiety, emotion dysregulation, and pregnancy complications. Pregnant women's experiences with childhood trauma, but not adulthood or prenatal trauma, predicted higher neurobehavioral attention scores among female newborns. Our discussion highlights the importance of considering the developmental timing of maternal trauma on perinatal outcomes and contextualizes our findings within the intergenerational transmission and fetal programming literatures. Data Availability: Data pertaining to R01MH119070 (MPIs Crowell & Conradt) and that support these findings are uploaded to the NIMH repository.

This study tested whether newborn attention and arousal provide a foundation for the dynamics of respiratory sinus arrhythmia (RSA) in mother-infant dyads. Participants were 106 mothers (Mage  = 29.54) and their 7-month-old infants (55 males and 58 White and non-Hispanic). Newborn attention and arousal were measured shortly after birth using the NICU Network Neurobehavioral Scale. Higher newborn arousal predicted a slower return of infant RSA to baseline. Additionally, greater newborn attention predicted mothers' slower return to baseline RSA following the still-face paradigm, and this effect only held for mothers whose infants had lower newborn arousal. These findings suggest that newborn neurobehavior, measured within days of birth, may contribute to later mother-infant physiological processes while recovering from stress.

Initial studies found that mental health symptoms increased in pregnant and postpartum individuals during the COVID-19 pandemic. Less research has focused on if these putative increases persist over time and what factors influence these changes. We examined the longitudinal change in mental health symptoms in pregnant and postpartum individuals and investigated moderation by maternal emotion dysregulation and the incidence of coronavirus. Pregnant and postpartum individuals at the University of Utah were invited to join the COVID-19 and Perinatal Experiences (COPE) Study. Beginning on April 23, 2020 participants were sent a survey comprised of demographics, medical and social history, pregnancy information and self-assessments (Time 1). Participants were contacted 90 days later and invited to participate in a follow-up questionnaire (Time 2). Daily coronavirus case counts were accessed from the state of Utah and a 7-day moving average calculated. Within-subject change in mental health symptom scores, as measured by the Brief Symptom Inventory, was calculated. Linear mixed effects regression modeling adjusted for history of substance abuse and mental health disorders. 270 individuals responded between April 23rd, 2020 and July 15th, 2021. Mental health symptom scores improved by 1.36 points (0.7-2.0 p < 0.001). The decrease in mental health symptoms was not moderated by the prevalence of COVID-19 cases (p = 0.19) but was moderated by emotion dysregulation (p = 0.001) as defined by the Difficulties in Emotion Regulation Scale short form. Participants with higher emotion dysregulation also had higher mental health symptom scores. Mental health symptoms improved over the course of the pandemic in the same pregnant or postpartum participant. Our findings do not negate the importance of mental health care during the pandemic. Rather, we believe this identifies some aspect of resiliency and adaptability. Examining emotion dysregulation, or asking about a history of mental health, may be helpful in identifying persons at higher risk of heightened responses to stressors.

Pregnant women struggling with emotion dysregulation may be more likely to engage in a wide range of health risk behaviors. This protocol describes a study on intergenerational transmission of emotion dysregulation from the third trimester of pregnancy to 18 months postpartum. Biobehavioral markers of emotion dysregulation are typically measured in laboratory settings which was prohibited by many universities during the COVID-19 pandemic. We describe how markers of emotion dysregulation (e.g. maternal, fetal, and infant heart rate variability) are collected remotely. We detail how data collection can be augmented to reach diverse populations who may not otherwise participate in laboratory-based research.

During pregnancy, a woman's emotions can have longstanding implications for both her own and her child's health. Within-person emotional concordance refers to the simultaneous measurement of emotional responses across multiple levels of analysis. This method may provide insight into how pregnant women experience emotions in response to stress. We enrolled 162 pregnant women and assessed concordance through autonomic physiology (electrodermal activity [EDA], respiratory sinus arrhythmia [RSA]), and coded behavior (Pmsocial, Flight, Displacement) during the Trier Social Stress Test-Speech. We used multilevel models to examine behavioral-physiological concordance and whether self-reported emotion dysregulation moderated these effects. Participants exhibited EDA-Prosocial concordance, suggesting that prosocial behavior may be a marker of stress. Emotion dysregulation did not moderate concordance. These findings provide novel information about behavioral coping to stress in pregnancy. Given the importance of observed behavior in the maintenance and treatment of psychopathology, these findings may provide a launchpad for future perinatal intervention research.

The COVID-19 pandemic has significantly disrupted research activities globally. Researchers need safe and creative procedures to resume data collection, particularly for projects evaluating infant mental health interventions. Remote research is uniquely challenging for psychophysiological data collection, which typically requires close contact between researchers and participants as well as technical equipment frequently located in laboratory settings. In accordance with public health guidance, we adapted procedures and developed novel protocols for a "virtual assessment" in which women and infants provided behavioral and psychophysiological data from their own homes while researchers coordinated remotely. Data collected at virtual visits included video-recorded parent-child interactions and autonomic nervous system data. Adaptations were designed to optimize safety and data quality while minimizing participant burden. In the current paper, we describe these adaptations and present data evaluating their success across two sites in the United States (University of Delaware and University of Utah), focusing specifically on autonomic nervous system data collected during the well-validated Still-Face Paradigm (SFP). We also discuss advantages and challenges of translating traditional lab procedures into the virtual assessment model. Ultimately, we hope that disseminating these procedures will help other researchers resume safe data collection related to infant mental health during the COVID-19 pandemic and beyond.

Background: Paternal stress is often assessed by maternal report and is posited to influence infant development indirectly by contributing to a mother's stress and experiences during pregnancy. Far less is known about how direct effects of prenatal paternal stress, as described by fathers themselves, are related to an infant's physiological functioning. We assessed fathers' own experiences of stress and examined its direct impact on infant respiratory sinus arrhythmia (RSA), a biological index of self-regulation, at seven-month postpartum. Method: During the third trimester of pregnancy, the UCLA Life Stress Interview was conducted to assess chronic stress in mothers and fathers (N = 90). Infant baseline RSA and RSA reactivity in response to the Still-Face paradigm were assessed at seven-month postpartum. Results: Infants of fathers with high prenatal stress showed lower baseline RSA, possibly reflective of poor infant psychophysiological regulation. The predictive role of paternal stress remained significant after controlling for maternal stress. Conclusions: Our findings provide emerging empirical evidence to support the influence of prenatal paternal stress on infant RSA, highlighting the important role of fathers for child development.

There is limited understanding of factors across the lifespan that influence pregnant women's respiratory sinus arrhythmia (RSA), which could have implications for their health and offspring development. We examined associations among 162 English- and Spanish-speaking pregnant women's childhood maltreatment history, emotion dysregulation, recent life stress, and resting RSA during the third trimester. Moderated mediation analyses indicated that more severe childhood maltreatment history (95% confidence interval (CI) [0.26, 0.63]) and higher emotion dysregulation (95% CI [0.001, 0.006]) predicted more stress during pregnancy, and childhood maltreatment history interacted with emotion dysregulation to predict resting RSA (95% CI [-0.04, -0.0003]). Exploratory analyses revealed that women's health-related stress during pregnancy mediated the relation between emotion dysregulation and RSA regardless of childhood maltreatment severity (95% CI [-0.007, -0.002]). These findings suggest that women's resting RSA during pregnancy may reflect physical and emotional stress accumulation across the lifespan and that relations between early life adversity and prenatal psychophysiology may be buffered by protective factors, such as emotion regulation. In addition, these findings underscore the importance of distinguishing between types of prenatal stress. Given the implications for women's health and offspring development, we urge researchers to continue exploring factors associated with pregnant women's psychophysiology.

The World Health Organization recently reported that maternal mental health is a major public health concern. As many as one in four women suffer from psychiatric disorders at some point during pregnancy or the first postpartum year. Furthermore, self-injurious thoughts and behaviors (SITBs) represent one of the leading causes of death among women during this time. Thus, efforts to identify women at risk for serious forms of psychopathology and especially for SITBs are of utmost importance. Despite this urgency, current single-diagnostic approaches fail to recognize a significant subset of women who are vulnerable to perinatal stress and distress. The current study was among the first to investigate emotion dysregulation—a multilevel, transdiagnostic risk factor for psychopathology—and its associations with stress, distress, and SITBs in a sample of pregnant women (26–40 weeks gestation) recruited to reflect a range of emotion dysregulation. Both self-reported emotion dysregulation and respiratory sinus arrhythmia, a biomarker of emotion dysregulation, demonstrated expected associations with measures of mental health, including depression, anxiety, borderline personality pathology, and SITBs. In addition, selfreported emotion dysregulation was associated with blunted respiratory sinus arrhythmia responsivity to an ecologically valid infant cry task. Findings add to the literature considering transdiagnostic risk during pregnancy using a multiple-levels-of-analysis approach.

The World Health Organization recently reported that maternal mental health is a major public health concern. As many as one in four women suffer from psychiatric disorders at some point during pregnancy or the first postpartum year. Furthermore, self-injurious thoughts and behaviors (SITBs) represent one of the leading causes of death among women during this time. Thus, efforts to identify women at risk for serious forms of psychopathology and especially for SITBs are of utmost importance. Despite this urgency, current single-diagnostic approaches fail to recognize a significant subset of women who are vulnerable to perinatal stress and distress. The current study was among the first to investigate emotion dysregulation-a multilevel, transdiagnostic risk factor for psychopathology-and its associations with stress, distress, and SITBs in a sample of pregnant women (26-40 weeks gestation) recruited to reflect a range of emotion dysregulation. Both self-reported emotion dysregulation and respiratory sinus arrhythmia, a biomarker of emotion dysregulation, demonstrated expected associations with measures of mental health, including depression, anxiety, borderline personality pathology, and SITBs. In addition, self-reported emotion dysregulation was associated with blunted respiratory sinus arrhythmia responsivity to an ecologically valid infant cry task. Findings add to the literature considering transdiagnostic risk during pregnancy using a multiple-levels-of-analysis approach.