What Influences Maternal Stress in The NICU Among Mothers of Preterm Infants?

Purpose: To assess the levels of stress and anxiety in mothers of preterm infants across various gestational ages (GA) and identify GA-specific factors contributing to maternal stress. Patients and Methods: Stress and worry were measured in 146 mothers of infants ≤32 weeks GA and 101 mothers >32 weeks GA using the Parental Stressor Scale: Neonatal Intensive Care Unit (PSS: NICU) and Worry Index (WI) questionnaires. PSS: NICU questions were distributed across the following subscales: Sights and Sounds (subscale1 (S1), Infant Appearance and Behavior (S2), and Parental Role Alteration (S3). Results: Mothers of infants ≤32 weeks GA had higher total PSS: NICU and WI scores than those >32 weeks' GA (p=0.005 and p=0.023, respectively). S3 was the most stressful subscale in both groups, followed by S2. The factors associated with higher stress in mothers of extremely/very preterm infants: seizures (p=0.022 for total PSS:NICU, p=0.030 for S2, and p=0.008 for S3), infection (p=0.045 for total PSS:NICU, p=0.039 for S2), depression (p=0.049 for total PSS:NICU), cesarean section (p=0.024 for S3), and twins (p=0.048 for S3). Higher WI was associated with lower education and C-section (p=0.038 and p=0.000, respectively). The factors associated with higher stress in the mothers of moderate/late preterm neonates: unemployment (p=0.043 for S3), vaginal delivery (p=0.035 for total PSS:NICU, p=0.048 for S3), and older children (p=0.042 for S3). Higher WI was associated with lower educational level (p=0.036), unemployment (p=0.035), depression (p=0.039), and seizures (p=0.021). Conclusion: NICU-related stress and WI levels were higher in mothers of infants with GA ≤32 weeks and were correlated with GA. In extremely/very preterm infants, higher maternal stress was linked to seizures, infection, C-section, twins, low education, and maternal depression. In moderate/late preterm neonates, stress was associated with unemployment, vaginal delivery, and having older children. Parental role alteration was the main stressor in all groups.