The influence of multiple birth and bereavement on maternal and family outcomes 2 and 7 years after very preterm birth

•Mental health, stress and family functioning were similar in mothers of VPT children with singletons compared with multiples at ages 2 & 7.•Mothers who experienced bereavement were 3.6 times more likely to report elevated anxiety and depression when their VPT child was age 7.•There is a need for monitoring and offering ongoing support to bereaved mothers with surviving children after VPT birth.

BackgroundPsychological 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.MethodsParticipants were 162 mothers of 194 infants (129 singletons, 65 multiples) born at < 30 weeks' gestation or with a birth weight < 1250 g 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.ResultsMaternal 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.ConclusionsThe 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.