ASSOCIAÇÕES ENTRE FATORES MATERNOS, INTERAÇÃO E DESFECHOS PRECOCES DO DESENVOLVIMENTO EM LACTENTES PRÉ-TERMO

Abstract

Introduction: Maternal health, gestational conditions, and the quality of mother-infant interaction exert a significant influence on child development. However, studies that follow preterm infants from the period of hospitalization through the first months after hospital discharge-combining early neuromotor assessments, standardized measures of neuropsychomotor performance, and indicators of mother-infant interaction dynamics-remain scarce. Objective: To investigate the associations among the quality of general movements (GMs), mother-infant interaction, perceived maternal stress, and infant development in preterm infants during hospitalization and after hospital discharge. Methods: This was a longitudinal analytical observational study conducted between October 2024 and October 2025. Infants were assessed at study enrollment, at hospital discharge, and at 3 months of corrected age for prematurity using the General Movements Assessment (GMA). At 4 months of corrected age, development was evaluated using the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III). Maternal stress was measured using the Perceived Stress Scale (PSS-14) when infants reached 40 weeks of postmenstrual age, and mother-infant interaction was assessed at 3 months using the Recorded Interaction Task (RIT). GMA categories were compared using Fisher’s exact test, with effect size expressed by Cramer’s V. Associations among mother-infant interaction, maternal stress, and BSID-III performance were examined using Spearman’s correlation, and significant variables were subsequently included in linear regression models. Results: A total of 57 mother-infant dyads participated in the study, of which 23 completed the full follow-up. A significant association was observed between GMs quality at admission and at hospital discharge (p = 0.003; V = 0.690). No association was found between GMs at discharge and at 3 months of age (p = 1.000). The quality of mother–infant interaction showed a moderate and significant correlation with language outcomes (ρ = 0.588; p = 0.013). When infant engagement was analyzed separately, this association was strong and statistically significant (ρ = 0.653; p = 0.005). In contrast, maternal interaction alone was not significantly associated with infant language performance (ρ = 0.434; p = 0.082). Regarding the cognitive domain, mother–infant interaction quality demonstrated a moderate and significant correlation both for the total score (ρ = 0.520; p = 0.033) and for infant engagement analyzed independently (ρ = 0.496; p = 0.043). Maternal interaction, in turn, did not show a statistically significant correlation with infant performance (ρ = 0.333; p = 0.192). No correlations were found between RIT scores and the motor domain of the BSID-III (ρ’s < 0.357; p’s > 0.159). Perceived maternal stress was moderately and negatively correlated with the language domain (ρ = −0.416; p = 0.048), indicating that higher levels of perceived maternal stress were associated with poorer infant language performance. No significant correlations were identified between maternal stress and the cognitive (ρ = −0.155; p = 0.480) or motor domains (ρ = −0.013; p = 0.951) of the BSID-III. In the multiple linear regression analysis, the model for language performance was statistically significant (Fp = 0.030), indicating that maternal stress exerted an effect on this domain. Higher stress levels were associated with poorer infant language performance, accounting for 32% of the variance in language scores. The model for cognition was not statistically significant (p = 0.314). Conclusion: The favorable trajectory of GMs reinforces the capacity for early neurological organization despite clinical vulnerability in the absence of brain injury. Interaction between mother and infant was a predictor of infant early language and cognition, and maternal stress was a predictor of early infant language. These findings are consistent with a dyadic framework of early development, in which biological risk, maternal emotional state, and dyadic engagement are interrelated and jointly associated with developmental trajectories.