Quality of couple relationship and associated factors in parents of NICU-cared infants during the first year after birth

The transition to parenthood can be challenging, often impacting couple relationships negatively. Factors like reduced marital quality, increased strain, decreased sexual contentment, and increased risk of depression are common. Positive associations with relationship satisfaction include female sex, younger age, higher education, better income, and social support. Partner support during distress is crucial for intimacy and trust, acting as a buffer against relationship strain and enhancing maternal self-rated health. Equal engagement in parenthood and equitable household tasks are also vital. Parents of NICU infants face additional distress, increasing the risk of relationship strain. While some studies suggest long-term negative effects on couple relationships due to psychological distress and depression related to NICU hospitalization, others indicate that shared emotional experiences might strengthen the relationship. The impact of preterm birth on couple relationships is also varied and complex. This study aimed to describe factors associated with NICU parents' couple relationship quality one year postpartum and compare the trajectory of relationship quality with parents of term and healthy infants. The hypothesis was that parents of preterm/ill infants would experience significantly more relationship strain.

Existing literature highlights the challenges of the transition to parenthood, often leading to decreased marital quality and increased stress. Positive factors associated with relationship satisfaction include demographics and social support. Partner support is crucial for buffering stress and enhancing well-being. Equal parental involvement and equitable household task distribution are also important. Parents of NICU infants face unique challenges, with increased risks of psychological distress and depression. Studies have shown conflicting results on the long-term impact of NICU hospitalization on couple relationships, with some showing negative effects and others suggesting that shared emotional experiences may strengthen the bond. Preterm birth's influence on the couple relationship is also complex and multifaceted, with both positive and negative effects reported.

This study used a longitudinal comparative cohort design, drawing data from the ongoing PANC study. Parents from six NICUs and four MUs in Sweden participated. The NICUs varied in care levels (II and III). Recruitment occurred during the COVID-19 pandemic, with varying visiting restrictions across units. All parents at participating units were informed about the study and invited to participate if they met inclusion criteria (at least 18 years old, spoke one of four languages, infant did not need palliative care, and social services were not involved). Questionnaires were administered 1 month, 6 months, and 1 year after discharge. The Quality of Dyadic Relationship (QDR36) scale assessed relationship quality, the Edinburgh Postnatal Depression Scale (EPDS) measured depressive symptoms, and the Social Support Survey (MOS-SSS) assessed social support. A generalized linear model analyzed factors associated with couple relationship quality at one year postpartum. A linear mixed-effects model analyzed the trajectory of QDR36 index and its dimensions over time for NICU and MU parents. The sample size calculation ensured sufficient power to detect a small effect size. Missing data were analyzed for randomness and handled accordingly.

A total of 923 parents answered the first questionnaire (439 from NICUs and 484 from MUs). The study included 323 NICU parents (178 mothers and 145 fathers) and 364 MU parents (205 mothers and 159 fathers) who completed the 1-year questionnaire. NICU parents were more likely to be first-time parents, have multiple births, experience lower gestational weeks at birth, longer hospital stays, and have infants with illnesses or impairments. For NICU mothers, factors associated with a better couple relationship at one year postpartum included younger age, being born outside Sweden, better social support, and a hospital stay of 7–14 days. Not sleeping together with the partner and infant during hospitalization and performing most household tasks were negatively associated. For NICU fathers, younger age was positively associated, while EPDS scores ≥10 and multiple births were negatively associated. The QDR36 index decreased slightly over the first year for both NICU and MU parents, with no significant differences between groups. Cohesion and sensuality decreased most across all groups. Mothers rated sexuality significantly higher than fathers.

The study's key finding of no significant difference in couple relationship quality between NICU and MU parents contradicts some previous research suggesting negative impacts from NICU experiences. The relatively high baseline relationship quality and slight decrease over time in both groups might suggest resilience among parents. The findings support the importance of social support, aligning with Bowen Family Systems Theory, which emphasizes the extended family's role in stabilizing the nuclear family. The positive association between a 7–14-day hospital stay and better relationship quality for mothers could reflect time for processing, support, and mutual adjustment before returning home. The negative association between not sharing sleep with the partner and infant and lower relationship quality emphasizes the importance of togetherness in navigating the NICU experience. The impact of fathers' depressive symptoms on relationship quality aligns with previous studies. The relatively low prevalence of depression might limit the generalizability of these findings.

This study demonstrates that couple relationship quality remains relatively high in both NICU and MU parents over the first year postpartum, with no significant differences between groups. Social support, a moderate hospital stay, shared experiences during hospitalization, and addressing parental depression are crucial for maintaining strong couple relationships. Future research should explore interventions to optimize social support systems and promote parental togetherness during NICU stays, particularly in diverse cultural contexts.

The low participation rate (20-22% in the first questionnaire) might limit the generalizability of the findings. The higher education level among participants compared to the general population might introduce bias. The study's conduct during the COVID-19 pandemic, with associated visiting restrictions, might affect generalizability to other contexts. Lack of data on non-participants prevents a thorough assessment of selection bias. The relatively low prevalence of depression among participants might limit the generalizability of findings related to depression’s impact on couple relationships.