Kayla N. Anderson, M.A. Martha A. Rueter, Ph.D. Bibiana D. Koh, Ph.D., LICSW Jennifer J. Connor, Ph.D., LMFT Ascan F. Koerner, Ph.D. Mark Damario, M.D. Outcomes of ART Multiples and their Families: A Look at Middle Childhood
Kayla N. Anderson, M.A. Martha A. Rueter, Ph.D.
Bibiana D. Koh, Ph.D., LICSW Jennifer J. Connor, Ph.D., LMFT
Ascan F. Koerner, Ph.D. Mark Damario, M.D.
Outcomes of ART Multiples and their Families:
A Look at Middle Childhood
What’s in the Literature? MulFple birth rates > 30% in U.S. (CDC, 2010)
Family Environment Quality Child Adjustment
MulFples Parent Mental Health1 MulFples Perinatal Health4
MulFples ParenFng Environment2 MulFples CogniFve Development5
MulFples Couple RelaFonship Quality3 MulFples EmoFonal Adjustment6
MulFples Behavioral Adjustment6
Limited Family Environment & EmoFonal/Behavioral Adjustment > 5 years-‐old (Except: Montgomery et al., 1999)
1 Ellison et al., 2005; Roca de-‐Bes et al., 2009; Ross et al., 2011; Vilksa & Unkila-‐Kallio, 2010 2 Freeman et al., 2007; Garel & Blondel, 1992; Garel et al., 1997; Glazebrook et al., 2004; Golombok et al., 2007; Holditch-‐Davis et al., 1999; Olivennes et al., 2005; Robin et al., 1991 3 Ellison et al., 2005; Freeman et al., 2007; Golombok et al., 2007; Olivennes et al., 2005 4 Zollner & Dietl, 2013 5 Bonduelle et al., 2003; Pinborg, 2005; Sutcliffe & Derom, 2006 6 Freeman et al., 2007; Golombok et al., 2007; Montgomery et al., 1999; Olivennes et al., 2005
This Study!
In ART families with children 6 – 12 years old:
MulFples Status
Parent Mental Health Parent-‐Child RelaFonship SaFsfacFon
Couple RelaFonship SaFsfacFon Child EmoFonal Adjustment Child Behavioral Adjustment
Study Participants
136 children were part of a mulFple (62 twin sets, 4 triplet sets); 176 singletons 27% of children were part of a mulFple birth
Mean age = 8.48 years old (SD = 1.43)
216 families with 312 ART children 6-‐12 years old
86% locaFon, 82% recruitment/parFcipaFon rate
University of Minnesota RMC PaFent records (mother)
Study Procedure & Measures Mothers (98%) completed an online survey
Study Concept Measurement
MulFples status 0 = singleton, 1 = mulFple
Parent mental health Adult Self Report Internalizing Scale (Achenbach & Rescorla, 2003)
Parent-‐child relaFonship saFsfacFon AdaptaFons of the Huston MOQ to assess parent-‐child relaFonships (Caughlin & Afifi, 2004)
Couple relaFonship saFsfacFon Huston Marital Opinion QuesFonnaire (Huston & VangelisF, 1991)
Child emoFonal & behavioral adjustment Child Behavior Checklist (Achenbach & Rescorla, 2001)
Child prematurity* 0 = not premature, 1 = premature
*Note: Other covariates included child age, child sex, parent age, parent educaFon, and family income.
Multiples & Family Environment Singletons Mul<ples
Note: Results reflect esFmated marginal means over and above the effects of the covariates.
Multiples & Child Adjustment Singletons Mul<ples
Note: Results reflect esFmated marginal means over and above the effects of the other covariates.
Multiples, Prematurity & the Family Environment
Singletons Mul<ples
*Prematurity was independently associated with the outcome (regardless of mulFples status), such that those with children born at term were less likely to have difficulFes (mental health or couple).
Multiples, Prematurity, & Child Adjustment
Singletons Mul<ples
*Prematurity was independently associated with apenFon problems (regardless of mulFples status), such that children born at full term were less likely to have apenFon problems.
Conclusions
Although mulFples and prematurity status are related (r = .43), they funcFon independently to influence adjustment
ART mulFples may have less externalizing and apenFon problem behavior when kids are in middle childhood
ART families with singletons and mulFples have similar family environment quality when children are 6-‐12 years old
Future Directions
ReplicaFon
Longitudinal data
More than maternal report
What is it about
mulFples?
How does prematurity
fit?
Contact: Kayla Anderson: [email protected]
Acknowledgements & Funding: • Data provided by: The Family CommunicaFon Project • Funding provided by:
• Minnesota Agricultural Experiment StaFon • UMN Grant-‐in-‐Aid • UMN College of EducaFon & Human Development Research Development Investment Grant
• M. Janice Hogan Fellowship
ConQlicts of Interest/Disclosure
In accordance with ACCME compliance standards, the authors of this manuscript have no conflicts of
interest to disclosure.
References • Achenbach, T. M. & Rescorla, L. A. (2001). Manual for the ASEBA School-‐Age Forms & Profiles. Burlington, VT:
University of Vermont Research Center for Children, Youth, & Families. • Achenbach, T. M. & Rescorla, L. A. (2003). Manual for the ASEBA Adult Forms & Profiles. Burlington, VT: University
of Vermont Research Center for Children, Youth, & Families. • Bonduelle, M., Ponjaert, I., Van Steirteghem, A., Derde, M.-‐P., Devroey, P., & Liebaers, I. (2003). Developmental
outcome at 2 years of age for children born ater ICSI compared with children born ater IVF. Human Reproduc@on, 18(2), 342-‐350.
• Caughlin, J. P. & Afifi, T.D. (2004). When is topic avoidance unsaFsfying? Examining moderators of the associaFon between avoidance and dissaFsfacFon. Human Communica@on Research, 30(4), 479-‐513.
• Centers for Disease Control (2010). 2010 Assisted reproducFve technology naFonal summary report. Retrieved: www.cdc.gov/art/ART2010/NaFonalSummary_index.htm.
• Ellison, M. A., Hotamisligil, S., Lee, H., Rich-‐Edwards, J. W., Pang, S. C., & Hall, J. E. (2005). Psychosocial risks associated with mulFple births resulFng from assisted reproducFon. Fer@lity and Sterility, 83(5), 1422-‐1428.
• Freeman, T., Golombok, S., Olivennes, F., Ramogida, C., & Rust, J. (2007). Psychological assessment of mothers and their assisted reproducFon triplets at age 3 years. Reproduc@ve BioMedicine Online, 15(Supplement 3).
• Garel, M. & Blondel, B. (1992). Assessment at 1 year of the psychological consequences of having triplets. Human Reproduc@on, 7(5), 729-‐732.
• Garel, M., Salobir, C., & Blondel, B. (1997). Psychological consequences of having triplets: a 4-‐year follow-‐up study. Fer@lity and Sterility, 67(6), 1162-‐1165.
• Glazebrook, C., Sheard, C., Cox, S., Oates, M., & Ndukwe, G. (2004). ParenFng stress in first-‐Fme mothers of twins and triplets conceived ater in vitro ferFlizaFon. Fer@lity and Sterility, 81(3), 505-‐511.
• Golombok, S., Olivennes, F., Ramogida, C., Rust, J., Freeman, T., & The Follow-‐Up Team (2007). ParenFng and the psychological development of a representaFve sample of triplets conceived by assisted reproducFon. Human Reproduc@on, 22(11), 2896-‐2902.
References • Holditch-‐Davis, D., Roberts, D., & Sandelowski, M. (1999). Early parental interacFons with and
percepFons of mulFple birth infants. Journal of Advanced Nursing, 30(1), 200-‐210. • Huston, T. L. & VangelisF, A. L. (1991). SocioemoFonal behavior and saFsfacFon in marital relaFonships.
Journal of Personality and Social Psychology, 61, 721-‐733. • Montgomery, T. R., Aiello, F., Adelman, R. D., Wasylyshyn, N., Andrews, M. C., Brazelton, T. B.,… Jones, H.
W. (1999). The psychological status at school age of children conceived by in-‐vitro ferFlizaFon. Human Reproduc@on, 14(8), 2162-‐2165.
• Olivennes, F., Golombok, S., Ramogida, C., Rust, J., & the Follow-‐Up Team. (2005). Behavioral and cogniFve development as well as family funcFoning of twins conceived by assisted reproducFon: findings from a large populaFon study. Fer@lity and Sterility, 84(3), 725-‐733.
• Pinborg, A. (2005). IVF/ICSI twin pregnancies: risks and prevenFon. Human Reproduc@on Update, 11(6), 575-‐593.
• Robin, M., Bydlowski, M., Cahen, F., & Josse, D. (1991). Maternal reacFons to the birth of triplets. Acta Genet Med Gemollol, 40, 41-‐51.
• Roca-‐de Bes, M., GuFerrez-‐Maldonado, J., & Gris-‐MarFnez, J. M. (2009). Psychosocial risks associated with mulFple births resulFng from assisted reproducFon: a Spanish sample. Fer@lity and Sterility, 92(3), 1059-‐1066.
• Ross, L. E., McQueen, K., Vigod, S., & Dennis, C. (2011). Risk for postpartum depression associated with assisted reproducFve technologies and mulFple births: a systemic review. Human Reproduc@on Update, 17(1), 96-‐106.
• Sutcliffe, A. G. & Derom, C. (2006). Follow-‐up of twins: Health, behaviour, speech, language outcomes and implicaFons for parents. Early Human Development, 82, 379-‐386.
• Vilksa, S. & Unkila-‐Kallio, L. (2010). Mental health of parents of twins conceived via assisted reproducFve technology. Current Opinion in Obstetrics and Gynecology, 22, 220-‐226.
• Zollner, U. & Dietl, J. (2013). Perinatal risks ater IVF and ICSI. Journal of Perinatal Medicine, 41, 17-‐22.