A self‐comfort oriented pattern of regulatory behavior and avoidant attachment are more likely among infants born moderate‐to‐late preterm

Abstract

Infants born preterm (<37 gestational weeks, GW) are at increased risk for regulatory difficulties and insecure attachment. However, the association between infants' regulatory behavior patterns and their later attachment organization is understudied in the preterm population. We addressed this gap by utilizing a Portuguese sample of 202 mother-infant dyads. Specifically, we compared the regulatory behavior patterns of 74 infants born moderate-to-late preterm (MLPT, 32-36 GW) to those of 128 infants born full-term (FT, 37-42 GW) and evaluated the associations of these regulatory patterns with later attachment. Infants' regulatory behavior patterns (Social-Positive Oriented, Distressed-Inconsolable, or Self-Comfort Oriented) were evaluated in the Face-to-Face-Still-Face paradigm at 3 months, and their attachment organization (secure, insecureavoidant, or insecure-ambivalent) was evaluated in the Strange Situation at 12 months corrected age. In both samples, the Social-Positive-Oriented regulatory pattern

Early life attachment in term and preterm infants

“…Our results differ from the reported higher frequencies of avoidant (Fuertes et al, 2022) and disorganized attachment style (Wolke et al, 2014), and disorganized attachment scores (Zengin Akkus et al, 2021) in preterm infants compared to term infants from 12 months of age. Since we explored attachment at nine months, our data could suggest that any impact of prematurity on attachment takes longer to manifest.…”

“…Although more preterm infants were assigned to Cluster II, prematurity did not significantly associate with Cluster II (Table S4) perhaps due to insufficient statistical power to detect a small effect size by logistic regression analyses. Since Cluster II predominantly captured infants assigned an avoidant attachment style, our results are consistent with the reported higher frequencies of avoidant attachment in preterm infants compared to term infants from 12 months of age (Fuertes et al, 2022).…”

“…Socioeconomic deprivation negatively correlated with infants' fretfulness during the reunion episode of the SFP, suggesting infants strategies to re-engage with caregivers after separation may vary across socioeconomic backgrounds. Although socioeconomic deprivation did not confound significant associations between prematurity and attachment in this sample, prematurity could be more likely to impact attachment when it is associated with family socioeconomic disadvantage (Fuertes et al, 2022, Wille, 1991. Future studies could explore interactions between prematurity, socioeconomic deprivation and attachment further.…”

“…Since we explored attachment at nine months, our data could suggest that any impact of prematurity on attachment takes longer to manifest. Moreover, prematurity could be more likely to impact attachment when it is associated with family socioeconomic disadvantage (Fuertes et al, 2022, Wille, 1991), and the compounding effects of socioeconomic deprivation on infant attachment could also be more evident later in infancy. Additionally, more insecure resistant attachment (López-Maestro et al, 2017, Sierra-García et al, 2018) and anxious attachment scores (Zengin Akkus et al, 2021) have been found in preterm infants of GA < 32 weeks at 18 months of age, whereas only one infant was assigned a resistant attachment style in this study.…”

“…Some studies found no difference in attachment styles between preterm (gestational age at birth (GA) < 37 weeks) and term infants (Rode et al, 1981, Frodi and Thompson, 1985, Goldberg et al, 1986, Plunkett et al, 1986, Easterbrooks, 1989, Butcher et al, 1993, Brisch et al, 2005. Other studies reported that moderate-to-late preterm infants (GA 32 -36 weeks) were more frequently assigned an avoidant attachment style (Fuertes et al, 2022), preterm infants of GA < 32 weeks were more commonly assigned a disorganized attachment style (Wolke et al, 2014), and very preterm infants (GA < 26 weeks) were more frequently assigned a resistant attachment style (López-Maestro et al, 2017, Sierra-García et al, 2018. All the aforementioned studies followed similar methodologies and assessed attachment from 12 months of age, but studies demonstrating differences in attachment were more recent, and included larger cohorts of preterm infants with a lower mean GA. Neonatal Intensive Care Unit (NICU) practices and outcomes have substantially evolved since the 1990s, resulting in much higher survival rates of extremely preterm infants and better developmental outcomes (Bell et al, 2022).…”