Beyond birth: Insights into emotional wellbeing of mothers after very preterm birth

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Mothers and children share a close bond. Latest research shows just how close this bond is: maternal resilience and the long-term health and developmental trajectories of very preterm (VPT) children show a significant connection. The seminal cross-national study, conducted in 11 European countries by Lena Wohlers et al., furnishes invaluable insights into this connection, demonstrating how carefully designed targeted interventions can bolster maternal coping abilities, thus optimising outcomes for both mothers and their VPT infants.


Differences within countries

Among the 2,605 mothers, the mean score of the MHI-5 assessment was 71.3. The mean scores in Sweden (74.5), Denmark (79.4) and the Netherlands (82.3) were higher than the mean of the overall cohort. In contrast, the mean scores in France (65.3) and Poland (63.5) were significantly lower, indicating overall poorer emotional well-being within mothers compared to the northern countries and the score average.

Maternal factors associated with low scores

Various factors are linked to low emotional wellbeing within mothers. Lower scores were found for non-European born mothers (68.2) compared to native born mothers or mothers born in other European countries (71.7 and 71.6). Furthermore, even lower MHI-5 scores were found in single mothers (66.6) compared to mothers living with a partner (71.9). Mothers with a low educational level (mean 68.9) attained a lower score in comparison to those with a higher educational level (72.2). These mothers represented a vulnerable group within the sample, being at a higher risk for poor mental health.

Regarding perinatal and neonatal characteristics, scores were reduced for mothers with one previous delivery (70.3) and even lower for mothers with two or more deliveries (67.5) compared to mothers having their first child (72.6). These results indicate that caring for several children leads to higher stress in mothers when at least of one of them is VPT.

Infant components contributing low scores

All child’s health and developmental problems at five years of age were associated with a lower MHI-5 score in mothers. Examples for health problems are sensory impairment, cerebral palsy, developmental delay, speech delay, ADHD, autism, and epilepsy. Higher scores were found for mothers with children born at 28-29 weeks of gestation and with a physical or functional abnormality that is present at birth.

What about the fathers?

As 85% of the respondents of the questionnaire were mothers, the authors decided to shift their attention towards maternal wellbeing. However, they recognised that fathers are also affected by the VPT birth of their children. They advocated for further research on the fathers’ wellbeing.

Emotional wellbeing as part of regular check-ups

Given the interdependence of maternal emotional wellbeing and child development , assessments of maternal emotional wellbeing should become part of the obstetric, prenatal, and postnatal check-ups, as well as paediatric visits in early childhood. Also, an infant- and family-centred approach can empower both parents to better cope with the situation. Previous research has shown that mothers attending early intervention programs have lower levels of stress. The interventions should meet the individual needs of parents and families in terms of methods, duration, and frequency. The study authors suggest, however, that these interventions commence during the NICU stay and are continued at home to ensure the best possible outcomes for mothers, children, and other caregivers.

These findings demonstrate that very preterm birth has a negative influence on maternal and, presumably, paternal emotional well-being at five years after birth. Furthermore, the need for support and interventions for parents of VPT children is highlighted, starting in the NICU, and extending as necessary.


Paper available at: Children | Free Full-Text | Maternal Wellbeing Five Years after a Very Preterm Delivery: Prevalence and Influencing Factors in a European Cohort (

Full list of authors: Lena Wohlers, Rolf Maier, Marina Cuttini, Emilija Wilson, Valérie Benhammou, Jo Lebeer, Sabine Laroche, Iemke Sarrechia, Stavros Petrou, Nicole Thiele, Jennifer Zeitlin, Adrien Aubert.