Karina M Shreffler

University of Oklahoma Health Sciences Center | ouhsc · College of Nursing

Background Satisfaction with birth and healthcare provider experiences have long-term effects for maternal health. Research has shown that mothers who report more trust, respect, and self-efficacy in their relationship with their healthcare providers are more likely to report positive birthing experiences. Further, individuals with obesity, includi...

Substance use rates, particularly among women, increased substantially during the COVID-19 pandemic. Psychological and economic risks disproportionately experienced by women were associated with increase in substance use patterns during the pandemic. Using substances (i.e., tobacco, alcohol, cannabis) to cope with stress is well-documented; what is...

Food insecurity during pregnancy is associated with various adverse pregnancy outcomes for the mother and infant, but less is known about the role of periconception food insecurity and its links to maternal and child wellbeing in the postpartum period. In a sample of 115 diverse (41% white) and predominately low-income mothers, results of hierarchi...

Admission of a newborn to a neonatal intensive care unit (NICU) can be a highly stressful event that affects maternal psychological well-being and disrupts the early maternal-infant bonding relationship. Determining factors that promote maternal-infant bonding among those with a NICU admission is essential for the development of effective intervent...

This study explores the role of personality traits in the relationship between maternal adverse childhood experiences (ACEs) and perceived stress during pregnancy. Pregnancy can be a stressful time for new mothers. ACEs have been associated with elevated levels of pregnancy stress, and have also been linked to the Big Five dimensions of personality...

Introduction: Prior research has identified associations between pregnancy intendedness and maternal-foetal bonding, but no studies have examined the potential mediation of pregnancy happiness on the development of the maternal-infant relationship. Methods: In 2017-2018, a clinic-based pregnancy cohort of 177 low-income and racially diverse wome...

Several theories of fertility behavior assume that planning is important to women. Is this a reasonable assumption? To answer this question, the authors used the National Survey of Fertility Barriers. Among women with unsure or positive fertility intentions at wave 1, most (75 percent) agreed with the statement “It is important to plan my pregnanci...

Reproductive events such as infertility, abortion, or unintended pregnancies are often framed as discrete outcomes in scholarly research. This silo-ed approach is quite distinct from how people experience their reproductive lives as embodied and interconnected throughout the life course. In this analysis, we build on and further a “reproductive car...

Background: Mindfulness-based interventions have been shown to be efficacious for reducing psychological distress and mental health symptoms and promoting well-being, including during pregnancy and postpartum. There is promising, though limited, evidence showing that interventions that focus on improving the mother-infant relationship are associate...

Depression during pregnancy is common, and previous research suggests childhood adversity may increase the risk for prenatal depression. Support during pregnancy can buffer these risks, and paternal support is associated with improved maternal well-being during pregnancy. There is evidence to suggest that increased support from fathers may be parti...

Although mixed-methods research typically refers to any methodology that incorporates both qualitative and quantitative data collection and analysis in a single study (e.g., Creswell & Plano Clark, 2011), the true underlying objective of applying mixed-methods techniques is to draw upon the strengths of both approaches in order to address issues th...

Introduction: Adverse Childhood Experiences (ACEs) are associated with impaired vascular function in young adult women, and increased blood pressure and CVD risk later in life. Hypotheses: We hypothesized that exposure to ACEs would be associated with an increased risk of first trimester hypertension and subsequently with hypertensive complications...

Prenatal smoking is associated with adverse pregnancy and birth outcomes as well as health problems in early childhood. Recent research determined that maternal adverse childhood experiences (ACEs) increase the odds of smoking during pregnancy. We consider the role of protective and compensatory childhood experiences (PACEs) in an effort to examine...

Hispanic adolescents report earlier onset and higher substance use rates than their non-Hispanic White and Black peers. This study examines the associations between the immigration-related arrest of a family member and substance use among Hispanic early adolescents and explores the mediating role of depressive symptoms as the mechanism explaining t...

Objectives: Nearly half of all pregnancies in the U.S. are classified as unintended (e.g. unplanned, mistimed, or unwanted), which have been linked to numerous adverse consequences for maternal and child outcomes. Recent evidence suggests that happiness about a pregnancy is often a better predictor of maternal and infant health outcomes than pregn...

To determine whether a history of abortion is associated with the experience of infertility among women, 2,199 women who ever met medical criteria for infertility were studied. Data for the study come from the National Survey of Fertility Barriers (NSFB), a nationally representative telephone survey of US women aged 25–45. Linear and logistic regre...

Little is known about how “reproductive orientation” (i.e., trying to get pregnant, ambivalent about pregnancy, trying to avoid pregnancy, or having had a sterilization surgery) is associated with sexual satisfaction among women of childbearing age. Using data from the National Survey of Fertility Barriers (N = 2811), we examined the association of...

Objective To examine maternal childhood adversity in relation to increased risk for maternal and infant perinatal complications and newborn Neonatal Intensive Care Unit (NICU) admittance. Methods A sample of 164 women recruited at their first prenatal appointment participated in a longitudinal study through 6 weeks postdelivery. Participants self-...

This study models associations between pregnancy intendedness and prenatal maternal-fetal bonding with postnatal maternal-infant bonding. Unintended pregnancies are associated with disruptions in maternal-infant bonding, which has long-term adverse implications for maternal and child well-being. Given the high proportion of births that are unintend...

Pregnancy loss (i.e., miscarriage, stillbirth) is a relatively common and often traumatic experience. Although prior research has examined mental health consequences of pregnancy loss, to our knowledge, none have examined how the experience of pregnancy loss affects how women perceive or value the importance of motherhood. Using longitudinal data f...

Childhood exposure to adversity may increase an individual’s reactivity to subsequent stressors. In this paper, we examine how adverse childhood experiences (ACEs) are associated with experiencing greater perceived distress during the pandemic. In this volunteer clinical cohort study, 177 pregnant women (ages 16–38) were recruited from two universi...

This article proposes a model for understanding the effects of adverse childhood experiences (ACEs) as dynamic and interrelated biobehavioral adaptations to early life stress that have predictable consequences on development and health. Drawing upon research from multiple theoretical and methodological approaches, the intergenerational and cumulati...

Objectives To examine the association between childhood trauma exposure (i.e., extent of interpersonal trauma experienced in childhood) and attitudes toward teen parenthood. Study Design We used a cross-sectional sample of 416 urban middle and high school male and female students from Tulsa, OK recruited through a local public school district mail...

High levels of maternal pregnancy–specific stress are associated with an increased risk for adverse birth outcomes as well as anxiety and depression symptoms during and following pregnancy. There is evidence that early childhood experiences play an important role in maternal psychological health and well-being and may be important for shaping mater...

There are significant barriers in engaging pregnant and postpartum women that are considered high-risk (e.g., those experiencing substance use and/or substance use disorders (SUD)) into longitudinal research studies. To improve recruitment and retention of this population in studies spanning from the prenatal period to middle childhood, it is imper...

Latino parents have lower levels of school involvement compared to other ethnic groups, which is often attributed—though not tested—to low English language proficiency. Using a population-based sample of 637 7th grade Latino youth attending an urban school district, we find no significant difference in maternal school involvement when mothers and s...

Background The study was conducted to prospectively examine how pregnancy intendedness and prenatal provider counseling about postpartum contraceptive options are associated with lack of contraception use at 6 months post-birth (e.g., increased risk for a short interpregnancy interval). Methods Logistic regression models were used to examine risk...

Using data from a population survey, this article explores whether perceptions of having a fertility problem among 926 U.S. couples in heterosexual relationships (women aged 25–45 and male partners) are associated with distress. Most couples did not perceive a fertility problem (58%). In almost a third (30%) of the couples, only women perceived a f...

As more couples in the United States are delaying childbearing until their mid‐30s, the experience of infertility is becoming more common. Infertility can contribute to significant psychological distress and challenges for couple relationships. There are many medical treatment options for infertility, but they can be costly and often are unsuccessf...

Objective: To examine how measures of infertility based on medical criteria and based on self-perception relate to depressive symptoms among women with infertility. Background: Survey-based studies of depressive symptoms have used either measures of self-reported infertility based on meeting medical criteria or measures of self-perceived fertility...

As more couples in the United States are delaying childbearing until their mid‐30s, the experience of infertility is becoming more common. Infertility can contribute to significant psychological distress and challenges for couple relationships. There are many medical treatment options for infertility, but they can be costly and often are unsuccessf...

Studies of medical help-seeking presume that self-identifying as having a health problem precedes medical contact, but this ordering of the identity-behavior relationship has not been systematically examined. We used longitudinal data from the National Survey of Fertility Barriers (2004 to 2010) on 412 women with infertility to document the tempora...

Background Rapid repeat pregnancy (RRP; < 18 months between pregnancies) is associated with higher risk of adverse maternal and child health outcomes. Drawing from attachment theory, we sought to examine the association between maternal childhood neglect and RRP as well as identify a protective childhood experience—caregiving—that reduces the impac...

Study question: Is giving birth associated with improved subjective well-being among involuntarily childless women? Summary answer: Resolution of infertility is associated with increased life satisfaction and self-esteem, but not with a decrease in depressive symptoms. What is known already: Cross-sectional data and studies of treatment-seeker...

Although nulliparous women who are sterilized appear voluntarily “childfree,” the majority report non-contraceptive reasons for their surgical procedure. Using an analytical subsample of the National Survey of Fertility Barriers, we examined 105 women’s closed- and open-ended responses about the reasons for their sterilization surgeries and whether...

Barnett, Marshall, Raudenbush, and Brennan (1993) provide an approach to crosssectional couple data that increases the power and precision of the estimates and allows the simultaneous analysis of both partners. Following Barnett et al (1993), we constructed two parallel versions of the distress scale for each partner by matching standard deviations...

Teacher expectations of students have been consistently linked with student academic achievement. What is less known is how students’ actual behaviors and performance shape teachers’ perceptions of them, particularly when considering student gender and race/ethnicity. A diverse dyadic sample of 1,653 seventh graders with 63 reporting teachers was u...

Nearly one-third to one-half of U.S. women meets the medical criteria for infertility at some point in their reproductive lives. Yet many do not view lack of conception as problematic. Why might some women self-identify as having a fertility problem but others do not? Using two waves of the National Survey of Fertility Barriers, we conducted binary...

Objectives: Experiencing an immigration-related arrest of a family member adversely impacts youth well-being, yet the role of parental documentation status for exacerbating adverse mental health outcomes following these arrests has not been investigated. Method: Using a general population sample of Latino 7th-grade students in an urban public schoo...

Objective: This study aimed to examine the interaction between pregnancy loss and pregnancy intentions on women’s happiness about a subsequent pregnancy. Background: Anxiety about prior loss persist for women, even during subsequent pregnancies. It is unclear from prior research, whether a prior pregnancy loss shapes attitudes towards and feelings...

This pilot study explored the effects of a two-week mindfulness-based intervention designed to enhance maternal-fetal bonding among pregnant women. Participants who listened to their baby’s heartbeat every day for two weeks and received four texts per week with mindfulness-based activities to do from home reported a significant increase in reported...

Using a population-based sample of 1,311 seventh graders in an urban school district in the South Central United States, we examined the associations between early-life trauma, anger regulation, and early adolescent perceptions about sex and parenthood. Girls and boys with more trauma exposure were more likely to perceive adolescent parenthood as i...

Objective: This study aimed to examine the impact of newborns' Neonatal Intensive Care Unit (NICU) admittance on maternal postpartum depression. Background: Prior research on the parental psychological impacts of a NICU admittance typically includes a hospital sample of parents following birth, so the causality of NICU admittance and maternal de...

In this article, we show that social science research on fertility and infertility consists of largely separate research traditions, despite shared interest in pregnancies and births (or lack thereof). We describe four ways these two traditions differ: (1) publication trajectories and outlets, (2) fields of study and major theoretical frameworks, (...

In heterosexual couples, both partners’ intentions to have a baby (or not) are associated with the likelihood of a subsequent birth, yet most studies only measure women’s intentions. Therefore, little is known about the potential association of couple agreement or disagreement on intentions or on such values as importance of parenthood, career, and...

Approximately half of all pregnancies are unintended. Many (58%) are carried to term, but a substantial proportion of unintended pregnancies are terminated. In this paper, we draw from qualitative interviews with 33 women who experienced an unintended pregnancy in an effort to examine the meanings women attributed to their pregnancies and to explor...

Research suggests that Latino adolescents face challenges with respect to their perceptions of success in academia while falling behind in school competencies. This study examines pathways between parent characteristics, adolescent perceptions of parental academic importance, school connectedness, and academic aspirations/expectations for Latinos u...

Many Latino youth are U.S. citizens but live with parents whose immigration status is unauthorized. The association between parental documentation status and early adolescent academic attitudes and expectations is unclear. Using a general population sample of urban 7th grade students who self-identified as Latino in the South Central U.S. (n = 514)...

Attachment to caregivers plays a critical role in the social and emotional development of children. The foundation of the caregiver-infant relationship begins before birth and continues to develop after birth. There are both threats to prenatal and neonatal attachment and factors that promote early bonding and social and emotional development durin...

Only some individuals who have the medically defined condition ‘infertility’ adopt a self-definition as having a fertility problem, which has implications for social and behavioural responses, yet there is no clear consensus on why some people and not others adopt a medical label. We use interview data from 28 women and men who sought medical infer...

Infertility is a common yet often misunderstood experience. Infertility is an important topic for family scientists because of its effects on families, its relevance to research in related areas such as fertility trends and reproductive health, and its implications for practitioners who work with individuals and couples experiencing infertility. In...

We use path analysis to analyze heterosexual couples from the U.S. National Survey of Fertility Barriers, a probability-based sample of women and their male partners. We restrict the sample to couples in which the women are infertile. We estimate a path model of each partner’s relationship satisfaction on indicators of self-identifying as having a...

A child’s death augments how grieving parents view the world, the family, and the self. Using a representative sample of women ages 25–45 who have ever given birth, we assessed whether miscarriage, stillbirth, and child death impact self-esteem and whether this loss is moderated by maternal identity. We found that stillbirth and child death, but no...

BACKGROUND AND OBJECTIVE Little is known about how the experience of infertility or identification as someone with infertility shapes women's fertility intentions, desires, or birth outcomes. The purpose of this paper is to help fill this gap in knowledge for fertility-intentions research. METHODS Using data from the National Survey of Fertility Ba...

Do differences in experiences of motherhood (e.g., number of children, age at first child, and relationship type) by race/ethnicity and social class mean that attitudes toward motherhood also vary by social location? We examine attitudes toward being a mother among black, Hispanic, Asian, and white women of higher and lower socioeconomic status (SE...

Objective: To examine the associations between sterilisation reasons, regret, and depressive symptoms. Study design: Black, Hispanic, and non-Hispanic White US women ages 25-45 who participated in the National Survey of Fertility Barriers (NSFB) and reported a tubal sterilisation surgery were included in the sample for this study (n=837). Logist...

Despite decades of research indicating that employed women in the United States have fewer children than other women, it remains unclear what it is about work, beyond work hours, that constrains fertility. The current study links a sample of 1,800 women of childbearing age who are employed at least part-time from the National Survey of Fertility Ba...

Public awareness and utilization of assisted reproductive technology has been increasing, but little is known about changes in ethical concerns over time. The National Survey of Fertility Barriers, a national, probability-based sample of US women, asked 2031 women the same set of questions about ethical concerns regarding six reproductive technolog...

Background: Fewer than 50% of women who meet the medical/behavioral criteria for infertility receive medical services. Estimating the number of women who both meet the medical/behavioral criteria for infertility and who have pro-conception attitudes will allow for better estimates of the potential need and unmet need for infertility services in th...

Although attitudes strongly predict later sexual behaviors, few studies have investigated the factors that influence early adolescent attitudes toward sex. Using a general population sample of urban seventh-grade students (N = 1,736), we examined how supportive parenting, television viewing, perceived social norms, and having a friend and/or siblin...

How stable are women's pregnancy intentions across their reproductive lifespans? Are there demographic, social, or attitudinal characteristics that are associated with differing pregnancy intentions patterns? Patterns of intendedness across pregnancies were examined using a sample of 3,110 women ages 25-45 who have been pregnant at least twice from...

Interpersonal traumas experienced early in life adversely impact psychological well-being in children and adolescents, yet the specific role that social support can have in reducing negative outcomes following trauma exposure is unclear. Using a general population sample of seventh-grade students in an urban public school district in the South Cent...

Fertility intentions are associated with achieved fertility; therefore, understanding the factors associated with fertility intentions is important. Considerable research has examined factors associated with fertility intentions, but no one has explored the importance of motherhood to women. Guided by life course and identity theories, we use the N...

An important focus for North American feminists has been addressing and improving women’s reproductive autonomy (Lorber, 1989; Rapp, 2001; Roberts, 1997). Since the beginning of the second wave of feminist activism, there has been an ‘explosion’ of feminist research on reproduction (Feree and Hess, 2000; Ginsburg and Rapp, 1995). As feminist schola...

The purpose of the current investigation was to explore whether monitoring behavior (i.e., parental solicitation, child disclosure, and parental involvement) was directly and indirectly (via parental knowledge and parent–youth openness) related to adolescent adjustment (i.e., antisocial behavior, substance use, and school grades). The sample consis...

The literature has been mixed regarding how parent–child relationships are affected by the acculturation process and how this process relates to alcohol use among Latino youth. The mixed results may be due to, at least, two factors: First, staggered migration in which one or both parents arrive to the new country and then send for the children may...

Infertility is a discretionary health condition; although it carries with it important life course implications, treatment is rarely necessary for health reasons. Sociological theories of medical help-seeking emphasize demographic factors, perceived need, and enabling conditions in health services utilization, but we find that social cues are also...

Does the reason why women have no children matter with regard to level of childlessness concerns? Reasons include biomedical barriers, situational barriers, delaying motherhood, and choosing to be childfree. The concept of “childlessness concerns” captures the idea that holidays and family gatherings are difficult because of not having children or...

Prior research indicates a negative relationship between women’s labor force participation and fertility at the individual level in the United States, but little is known about the reasons for this relationship beyond work hours. We employed discrete event history models using panel data from the National Survey of Families and Households (N = 2,41...

We build on recent studies on the consequences of miscarriage and stillbirth for women to assess the (a) odds of divorce among women who experienced a loss compared to those who did not; and (b) fertility-specific characteristics that increase odds of divorce. Utilizing a nationally representative sample of 3,461 women who have ever been pregnant a...

Evidence of group differences in reproductive control and access to reproductive health care suggests the continued existence of "stratified reproduction" in the United States. Women of color are overrepresented among people with infertility but are underrepresented among those who receive medical services. The authors employ path analysis to uncov...

Using a non-hierarchical approach to identity theory, we construct a scale to analyze the characteristics associated with the importance of fatherhood in a national sample of male partners (N = 932) of U.S. women of reproductive age, including fathers and non-fathers. OLS multiple regression shows that economic situation is not associated with impo...

Although pregnancy loss—especially miscarriage—is a relatively common experience among reproductive-aged women, much of our understanding about the experience has come from small clinic-based or other nonrepresentative samples. We compared fertility-specific distress among a national sample of 1,284 women who have ever experienced a stillbirth or m...

We examine variation in fertility-specific distress (FSD) and general distress according to different experiences of infertility among 1027 US women who have experienced infertility within the previous 10 years. General distress was measured by a short form of the Center for Epidemiological Studies-Depression. Multiple regression analysis was condu...

In May 2004, the Australian government announced a “Baby Bonus” policy, paying women an initial A$3,000 per new child. We use household panel data from the Household, Income and Labour Dynamics in Australia Survey (N=14,932) and a simultaneous equations approach to analyze the effects of this bonus on fertility intentions and ultimately births. The...

Because research on infertile women usually uses clinic-based samples of treatment seekers, it is difficult to sort out to what extent distress is the result of the condition of infertility itself and to what extent it is a consequence of the experience of infertility treatment. We use the National Survey of Fertility Barriers, a two-wave national...

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Critical occupations refer to professions in which workers perform critical duties to protect and serve the public; the nature of these jobs often exposes workers to events and conditions that critically impact their mental and physical well-being. In addition to the traumatic experiences part and parcel to the job, characteristics of these critica...