Sarah Maylott, PhD, studies moms-to-be at high risk of mental health challenges and how to prevent those problems from being passed on to their babies. But since she had her first child three and a half months ago, her work hits closer to home.
“I grew up nannying, and I’ve listened to babies crying, and I’ve always felt, ‘I'm good. I’ve got this.’ But now, if a baby cries, I have such a deep reaction to it,” she said. “Even a normal, healthy pregnancy is a struggle sometimes. I can’t imagine how amplified that is for women who are having high emotion dysregulation.”
Emotion dysregulation (trouble with managing emotions, controlling behavior, and achieving goals) is linked to anxiety, depression, substance abuse, and at its most extreme, borderline personality disorder. In a study published earlier this month in the journal Pediatrics Research, Maylott, a postdoctoral associate, and Elisabeth Conradt, PhD, associate professor in the Duke Department of Psychiatry and Behavioral Sciences, documented the complexity of emotional dysregulation in pregnant women and showed that it is linked to neurobehavior in their newborns.
The researchers studied 192 pregnant women at risk for emotion dysregulation, 30 of whom were prescribed medication for opioid use disorder (methadone or buprenorphine). Opioid use during pregnancy is linked to neurobehavioral challenges in newborns, Maylott said, but drug use can be intertwined with emotional dysregulation. “We really wanted to disentangle what was happening here,” she said.
To do that, they measured patterns in the pregnant moms’ “respiratory sinus arrhythmia (RSA) reactivity.” RSA reactivity looks at changes in heart rate that coincide with changes in breathing, Conradt said. “When you inhale, your heart rate increases, and when you exhale, your heart rate decreases. That variability in your heart rate helps you flexibly respond and adapt to changes in the environment.”
RSA reactivity is an accepted marker of emotional regulation, but it has not been well studied in pregnant women, Conradt said. The researchers measured the pregnant women’s RSA reactivity while watching a video of a calming landscape, a video of a child playing, a video of a child crying (more stressful), and then a final calming video. They also measured emotional dysregulation using a self-report questionnaire called the Difficulties in Emotion Regulation Scale.
The researchers expected to find just two RSA patterns in this group of women: one that was dysregulated and one that was more normal or flexible.
Instead, they found three patterns. Two of them (“increasing” and “blunted”) were linked to higher levels of emotional dysregulation in the moms and more neurobehavioral dysregulation in their newborn babies. Most of the women in the study (65%) who were in treatment for opioid use had a “blunted” profile, Maylott said. "There was a little bit of flexibility in responding over the course of the tasks that they did, but there wasn't much change.”
A third profile (“decreasing”) was more flexible and was linked to low levels of emotional dysregulation in the moms and less neurobehavioral dysregulation in the newborns.
This study included a fairly small sample size, but further study to explore these unexpectedly complex patterns could inform future interventions that could help both baby and mom, Maylott said.
“It’s important to understand this area of rapid development in order to best support parents and infants. Emotion dysregulation is modifiable, and there are interventions that are effective in reducing it,” Maylott said. “These results could have important implications for reducing opioid use and potentially improving newborn neurobehavioral outcomes.”
“A lot of people think that what happens to babies before they're able to form memories doesn't matter,” Conradt said. “But we do know that prenatal exposures and experiences can affect children's outcomes. So it is critical that we support pregnant women and pregnant people as well as their babies.”
Conradt has applied for funding for a clinical study in which she would treat pregnant women with emotion dysregulation at Duke to find out if an intervention can prevent problems for babies before they’re born. One such therapy is dialectical behavior therapy. “It's a really comprehensive therapy that teaches moms how to manage their emotions,” she said.
“Pregnancy is a phenomenal time to intervene with moms who are using opioids because they are so concerned about how their opioid use has affected their baby, and they want to do everything that they can to improve their baby's outcomes,” Conradt said. “I've done a lot of work clinically with moms using opioids. I've never met a mom who isn't concerned about how their use has affected their baby and what they can do to support their baby's outcomes.”