A Randomized Controlled Trial to Improve Mother-Infant Synchrony Among Women With Childhood Adversity

Childhood adversity (e.g., abuse, neglect, or household dysfunction), is a common experience significantly contributing to the leading causes of death and increased US economic health burdens. Childhood adversity causes long-term alterations on the nervous, endocrine, and immune systems well into adulthood, including dampening of the neuropeptide oxytocin (OXT). A healthy OXT system facilitates responsive social engagement and promotes maternal-infant (M-I) synchrony (reciprocal gaze, affect speech, and touch). Optimal M-I synchrony fuels early brain development and prevents low empathy, disruptive behavior, poor social adaptation, cognitive deficits, and psychopathology in children. The investigators posit that mothers with childhood adversity will have more difficulty with M-I synchrony, due in part to a dampened OXT system, and will benefit from interventions that improve responsive, nurturing, engagement by epigenetic regulation of the OXT system. Most interventions are costly, complex, and time-consuming. The investigators aim to fill this gap by testing whether a simple early behavioral intervention (ATVV) will improve OXT system function and M-I synchrony in mothers with childhood adversity.

The ATVV (Auditory, Tactile, Visual, Vestibular) is a 15-minute behavioral intervention that is a multisensory infant massage contingent on infant cues. The investigators extend the known success of ATVV with preterm infants to full-term infants. The investigators will compare M-I synchrony at 3 postnatal months in 250 first-time mothers (and their full-term infants) randomized to apply ATVV daily from birth to 3 months (n =125) or receive infant care education in an attention control group (n = 125). The investigators apply a rigorous measure of M-I synchrony that micro-codes video-recorded M-I behavior quantifying shared gaze, affect, speech, and touch. Coding requires only 3-minutes of interaction and is valid when infants can reliably interact starting by 3 months of age. The investigators will also assess ATVV's effect on maternal and infant peripheral OXT level, a known biomarker of M-I synchrony. OXT levels relate to quality of M-I synchrony, yet the investigators extend this knowledge to identify an epigenetic role of the oxytocin receptor gene (OXTR). The investigators will analyze maternal plasma for OXTR methylation, OXTR gene expression, OXTR protein, and oxytocin peptide in pregnancy, and at 1, 2, and 3 postnatal months (along with infant saliva OXT).

The investigators propose a single-site, randomized, two-group, attention-controlled clinical trial (N=250 M-I dyads) to test the efficacy of the ATVV multisensory behavioral intervention to improve OXT system function and M-I synchrony. Adult, nulliparous, English or Spanish speaking women carrying a single fetus, and scoring 2 or higher on the Adverse Childhood Experiences scale will be enrolled. The investigators will obtain baseline OXT, demographics and survey data in the third trimester. Soon after birth (pre-hospital discharge), M-I dyads who continue to be eligible (e.g., full-term gestation) are randomized into the intervention group (n = 125) and taught to administer ATVV daily for 3 months or randomized into the Attention Control group (n = 125) and taught normal safe infant care. There are postnatal study visits at 1, 2 and 3 months. The investigators follow-up with a phone call at 6 postnatal months (3-months after the intervention period ends) to assess self-report parenting behavior (a proxy for quality of M-I interaction) that the investigators also measure at postnatal months 1, 2, and 3.

Aim 1: Evaluate the efficacy of daily ATVV over 3 postnatal months among mothers with childhood adversity. The investigators hypothesize that compared to the Attention Control group (n=125), M-I dyads in the ATVV group (n=125) will exhibit:

H1: Higher oxytocin function (i.e., decreased OXTR methylation at candidate sites, and increased OXTR messenger ribonucleic acid (mRNA), OXTR protein, and OXT in maternal plasma, and increased OXT in infant saliva) at 1, 2, and 3 postnatal months.