Promoting mother-infant relationships and underlying neural correlates: Results from a randomized controlled trial of a home-visiting program for adolescent mothers in Brazil

Fernanda Speggiorin Pereira Alarcão, Elizabeth Shephard, Daniel Fatori, Renata Amável, Anna Chiesa, Lislaine Fracolli, Alicia Matijasevich, Helena Brentani, Charles A Nelson, James Leckman, Eurípedes Constantino Miguel, Guilherme V Polanczyk, Fernanda Speggiorin Pereira Alarcão, Elizabeth Shephard, Daniel Fatori, Renata Amável, Anna Chiesa, Lislaine Fracolli, Alicia Matijasevich, Helena Brentani, Charles A Nelson, James Leckman, Eurípedes Constantino Miguel, Guilherme V Polanczyk

Abstract

Poverty and teenage pregnancy are common in low-and-middle-income countries and can impede the development of healthy parent-child relationships. This study aimed to test whether a home-visiting intervention could improve early attachment relationships between adolescent mothers and their infants living in poverty in Brazil. Analyses were conducted on secondary outcomes from a randomized controlled trial (NCT0280718) testing the efficacy of a home-visiting program, Primeiros Laços, on adolescent mothers' health and parenting skills and their infants' development. Pregnant youth were randomized to intervention (n = 40) or care-as-usual (CAU, n = 40) from the first trimester of pregnancy until infants were aged 24 months. Mother-infant attachment was coded during a mother-infant interaction when the infants were aged 12 months. Electrophysiological correlates of social processing (mean amplitude of the Nc component) were measured while infants viewed facial images of the mother and a stranger at age 6 months. Infants in the intervention group were more securely attached and more involved with their mothers than those receiving CAU at 12 months. Smaller Nc amplitudes to the mother's face at 6 months were associated with better social behavior at 12 months. Our findings indicate that the Primeiros Laços Program is effective in enhancing the development of mother-infant attachment.

Trial registration: ClinicalTrials.gov NCT02807818.

Keywords: EEG; home-visiting intervention; infant social development; maternal care competencies; mother-infant attachment.

Conflict of interest statement

Guilherme V. Polanczyk has been in the past 3 years a consultant member of the advisory board and/or speaker for Shire/Takeda and Medice. He received travel expenses for continuing education support from Shire/Takeda and royalties from Editora Manole. The other authors report no conflicts of interest.

© 2021 The Authors. Developmental Science published by John Wiley & Sons Ltd.

Figures

FIGURE 1
FIGURE 1
CONSORT diagram of participant enrolment, assessment and randomization
FIGURE 2
FIGURE 2
Grand average waveforms and topographical plots of the Nc ERP component by condition and group. Grand averaged waveforms (A) are plotted by group and condition at the frontal (top) and central (bottom) electrode clusters with the Nc component indicated. Topographies of the Nc are shown for (B) control (CAU) infants and (C) intervention infants in the mother (top) and stranger (bottom) conditions
FIGURE 3
FIGURE 3
Associations between neural correlates of social development at 6 months and attachment behavior at 12 months. Scatterplot shows the significant positive correlation between mean amplitude of the Nc component while viewing the mother's face at frontal scalp at age 6 months and infants' attachment behavior (EAS child involvement index) at 12 months. The regression line represents the correlation computed in the intervention and CAU groups combined; for information purposes only, intervention and CAU infants are plotted in different colors (blue = intervention, yellow = control)

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