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Arch Womens Ment Health (2000) 3: 65–76

Original contribution
A longitudinal study of cognitive performance during pregnancy
and new motherhood
P. Casey

School of Humanities and Social Sciences, Charles Sturt University, Wagga Wagga, Australia

Summary of cognitive performance may be altered during


This longitudinal study examined the popular belief that cognitive pregnancy have not yielded a consistent picture.
performance is impaired during pregnancy. Both self-report and The review by Christensen et al. (1998) of seven
objective test data on cognitive performance were collected on six published studies of objective cognitive performance
occasions from three groups of women at three monthly intervals.
in pregnancy (1969–1993) reported that a signifi-
Ten women who initially planned a pregnancy, 18 women initially
in the first trimester of pregnancy, and 24 non pregnant controls cant impairment was found for approximately half
completed the study. At each data collection participants reported the tasks. The deficits occurred on tasks involving
their perceptions of current everyday memory, sleep, health, exer- explicit memory (conscious recollection of a past
cise, depression, anxiety and stress levels, and undertook a set
of cognitive tests examining vocabulary, reasoning, short term event), and implicit memory (an unconscious
memory, working memory, and semantic memory. A personality memory deducible from behaviour). However,
test was taken once. The planning group showed a significant Christensen et al. noted that the results were incon-
increase in reported forgetting during pregnancy, and significantly
more variability in sleep patterns than the control group over the
sistent across studies, while the methodologies some-
test period. However, there were no other differences between times used inadequate controls.
groups on self-report or objective test results at any time phase. More recently Keenan et al. (1998) reported a
The personality factor of conscientiousness and level of reported
decline in verbal memory performance from the
anxiety were significant predictors of reported absentmindedness
and forgetting on errands. The reported increase in forgetting in second to the third trimester of pregnancy relative to
some pregnant women is possibly related to a complex interaction controls, with a return to the second trimester per-
of personality and particular life situations. However, the precise formance level in the postpartum period. Similarly,
nature of any objective change in memory performance during
pregnancy is not yet clear. Buckwalter et al. (1999) found that their pregnant
subjects performed significantly better on several
Keywords: Pregnancy; cognition; memory; personality;
anxiety. verbal memory tasks two months after delivery rela-
tive to two months before delivery, and inferred
impairment in verbal memory during pregnancy.
Introduction
Another recent set of studies of cognitive change
It has been well documented that a substantial pro- in pregnancy presents a consistent but quite different
portion of pregnant women report a variety of cogni- picture from the one immediately above. While all of
tive changes during pregnancy and postpartum (e.g., the five recent studies summarised below found that
Parsons and Redman, 1991). Respondents have typi- pregnant women reported more forgetting than con-
cally described cognitive aspects of the experience of trols, the overall picture from objective tests was one
pregnancy as involving poorer everyday memory, of no differences.
with an increase in both concentration lapses and Christensen et al. (1998) found no differences be-
absentminded behaviour. However, results to date tween pregnant women and controls on any of a set
from objective tests seeking to pinpoint what aspects of cognitive tests. Participants were tested on atten-
66 P. Casey

tion, intentional explicit memory, incidental explicit signment is not an option. Silber proposed that com-
memory (memory for details of an experienced event parisons of groups of pregnant and non-pregnant
that was not intentionally noted for future recall), women should be by way of a longitudinal study, as
and implicit memory. Poyser (1998) likewise failed in Silber et al. (1990).
to find any differences on tests of retrospective The salient points of the response by Brown
memory, prospective memory (remembering to do (1994) to Silber (1994) were that areas such as im-
things), or working memory (holding something in plicit memory cannot be studied longitudinally be-
memory while performing another cognitive task). cause subjects must be unaware of the purpose of the
Janes et al. (1999) and Casey et al. (1999) adopted initial priming task, and participants would soon real-
an information processing approach to memory per- ise that initial priming tasks were related to later
formance, following the view that human memory tasks. Further, if the groups do not differ statistically
requires attending to, storing, working with, and on age, education, or in self-ratings of health or anxi-
retrieving information (Baddeley, 1993). A range of ety, then comparisons may be made. Moreover, lon-
tests was used in an effort to pinpoint the stage(s) at gitudinal studies run the risk of practice effects, and
which any objective change(s) may occur. Janes et al. still have to include a control group, with the practice
found no differences between pregnant women, new effects for the control group possibly being different
mothers and controls on tests of implicit memory, from the practice effects for the experimental group.
explicit memory, and one of two tests of working The position adopted here is that in areas such as
memory, but found that pregnant women and new pregnancy studies, where random allocation to con-
mothers scored significantly lower on the Wechsler ditions is not possible, neither longitudinal nor cross
backward digit span task (working memory). Casey sectional studies are free from potential methodo-
et al. found no differences between pregnant women, logical confoundings. However, such methodologies
new mothers, and controls on any memory test. The may be seen as complementary, and a longitudinal
memory test set was composed of implicit, explicit study may be especially useful in discovering at
(intentional and incidental), short term, working, which point of the pregnancy or postpartum period
semantic (world knowledge), and prospective any subjective or objective change in cognitive per-
(remembering to do something) memory tests. formance might occur.
Finally, McDowall and Moriarty (in press) found Most longitudinal studies of cognitive change in
no differences between pregnant women and con- pregnancy to date arguably have been less than com-
trols in performance on tests of both implicit and plete in one aspect or another. Either they have com-
explicit memory, although the pregnant women re- menced late in pregnancy (e.g., Condon et al., 1991;
ported that recently their memory had been worse Silber et al., 1990), or commenced prior to pregnancy
than normal. but not continued after birth (e.g., Schneider, 1989),
The overall picture, then, is one of consistency in or had inadequate controls (e.g., Schneider, 1989).
reported cognitive changes but uncertainty about
the nature of any objective change in cognitive
The present study
performance.
At the time that this study commenced1 no previous
study appeared to have carried out regular cognitive
Methodologies
tests of both pregnant women and controls over a
Most studies of cognitive change in pregnancy have period of time spanning from either prior to preg-
been cross sectional in design. However, Silber nancy or early in pregnancy, and continuing for
(1994) criticised the cross sectional approach to many months after delivery. This research aimed to
studying memory performance in pregnancy, with his carry out such a study and thus provide a more com-
explicit focus being the study by Sharp et al. (1993). plete description then has been available previously
Silber claimed that it was methodologically unsound of both objective cognitive performance and subjec-
to compare two, often relatively small groups on only tive impressions of memory during pregnancy and
one occasion and to then attempt some conclusion. following delivery.
He claimed that we needed to be sure that the groups
were comparable prior to testing, the inference being 1
The Keenan et al. (1998) longitudinal study was published
that this was not possible here because random as- during the running of this study.
Cognitive performance during pregnancy and new motherhood 67

The selection of cognitive areas for study was (e.g., names of flowers), the number of items re-
guided by practical and theoretical considerations. In trieved, or both.
a longitudinal study too many tests might lead to a A study of the experiences associated with the
very high drop out rate and so the cognitive perform- time of pregnancy and postpartum also requires
ance tests focussed on only three areas, namely, crys- measuring factors other than cognitive performance
tallised and fluid intelligence, short term and working in order to see if any such predictors offer a better
memory, and semantic memory. (Implicit memory, statistical or theoretical account of why such a high
an area from which conflicting results have been ob- proportion of pregnant women report cognitive
tained, was not studied because the area is not suit- changes. Casey et al. (1999) reported that sleep
able for longitudinal study.) change predicted a relatively high level of reported
Zachary (1996) has noted that clinical and forgetting irrespective of pregnancy status. Further,
research findings support the notion that when anxiety and depression have been reported as both
intellectual deterioration occurs, an individual’s being associated with self-reports of cognitive fail-
cognitive abilities are not affected equally. Rather, ures (e.g., Martin and Jones, 1984) and also increas-
well learned verbal skills such as vocabulary mean- ing during pregnancy (e.g., Condon et al., 1991).
ings (crystallised intelligence) are more resistant to Hence, levels of anxiety and depression require
deterioration than is the ability to reason abstractly monitoring in any longitudinal study. Finally,
(fluid intelligence). Hence, if there is some deteriora- Herrmann (1990) has reported that self-perceptions
tion in general cognitive ability in pregnancy, then of memory can be related to aspects of personality.
the performance of a pregnant group of women will Moreover, the personality factor of conscientious-
temporarily deteriorate on the abstract tasks but not ness from the NEO Five Factor Inventory of Costa
on the vocabulary tasks, but such a deviation will not and McCrae (1992) has been associated with level of
appear in the control group. physical health (Friedman et al., 1995). The reason
Working memory can be linked theoretically with for the link is not clear but it may be because well-
reported forgetting in pregnancy, and has only been organised people manage better the stresses of
considered recently. Working memory requires hold- everyday life. It may also be the case that well-
ing something in memory while doing another task organised people manage better the arguably in-
such as a computation. Hence, the reported increase creased complexity of life during pregnancy and
in absentmindedness in pregnancy (e.g., Casey et al., new motherhood, and so may report fewer lapses in
1999) might be associated with some temporary over- everyday memory during pregnancy. Hence the per-
loading of working memory capacity. If pregnancy sonality factor of conscientiousness was investigated
affects working memory, then the usual performance for its possible predictive power in regard to reported
difference between the less demanding Wechsler levels of everyday forgetting.
forward digit task and the more difficult backward In summary, the 16 plus month longitudinal study
digit task will temporarily increase during pregnancy. made comparisons between women who experienced
However, such a widening in performance difference pregnancy and controls on levels and patterns of:
will not be found for a control group. Further, there
(a) performance on vocabulary and abstract reason-
will be a temporary deterioration in performance on
ing tasks, and working and semantic memory
more complex working memory tasks of the kind
tasks;
used by Turner and Engle (1989). These more com-
(b) self-reports of anxiety, depression, sleep change,
plex tasks require participants to perform a dual task,
and ratings of everyday memory performance.
such as deciding on the meaningfulness or otherwise
of each of a set of sentences and then recalling the A cognitive deficit in pregnancy hypothesis pre-
final word of each sentence. dicts mean and variability differences between the
Finally, examination of ease of retrieval of mate- objective performance of pregnant women and con-
rial from semantic memory was included in the study trols. If decrements and later improvements in the
because pregnant women often report blocking in cognitive performance of women during pregnancy
naming items. If there is a problem with retrieval and postpartum occur consistently at a given time,
from semantic memory then, relative to controls, then there will be both particular mean differences
pregnant women will show a deterioration in either and overall variability differences across testing
the speed of retrieving members of a given category times between pregnant women and controls. If such
68 P. Casey

decrements and later improvements occur at variable absentmindedness, names, people, conversations, errands, re-
trieval failures, and places. The second questionnaire was the
times during pregnancy and postpartum then mean
DASS21, a 21 item version of the Lovibond and Lovibond (1995)
differences may not be found, but only differences in Depression, Anxiety, and Stress Scale.
variability across the testing times. A metacognitive Participants also completed the two subtests of the Shipley
change only position predicts that factors such as Institute of Living Scale (Zachary, 1996), one being a multiple
choice test of vocabulary and the other a test of abstract reasoning.
sleep change and personality may predict reported Next they were tested on the forward and backward digit compo-
memory performance but that there will be no nents of the Wechsler Adult Intelligence Scale (Wechsler, 1997).
change in objective performance. Participants were also given a test of working memory capacity
similar to one of a set used by Turner and Engle (1989). The test
required participants to listen to a set of sentences, each of which
had a single digit added after the end (e.g., It will rain tomorrow,
Subjects and methods 7). Some of the sentences were grammatically and semantically
The study began with 60 participants, 12 who were planning a regular while some were not (e.g., It is not a day hot, 5). Consider
pregnancy, 22 who were pregnant (M 5 13.9 6 4.3 weeks preg- the set, “It will rain tomorrow, 7”, and “It is not a day hot, 5”.
nant), and 26 controls. The group mean ages at the start of the Participants listened to the set, then had to report on the regularity
study were 32.5, 28.3 and 33.4 years, respectively. People choosing or otherwise of each sentence, and finally reported the digits. In
to discontinue and the unfortunate occurrence of miscarriages and this case, a correct response was, “Right, Wrong, 7, 5”. Note that
still births reduced the completion number to 52, with 10, 18, and the response had to be correct on both sentence regularity and
24 in each of the above groups respectively. digits in order to be scored as correct. There were three sets each
Participants were all from a rural area in the state of New South of 2, 3, 4, and 5 sentence-digit patterns, making for a maximum
Wales (Australia), and had volunteered in response to newspaper score of 12. So as to prevent the learning of responses, the test at
and television advertising. The newspaper article and television Time x 1 1 was a revised version of the test at Time x, with a
interview explained the purpose of the study, the commitment randomly selected half of the sentences having their grammatical
required, and that people were needed who were planning a preg- and sematic status reversed, a new set of digits being randomly
nancy (planning group), were in the first trimester of pregnancy allocated to the ends of the sentences, and then new blocks of
(pregnant group), or were appropriate controls. The selection of sentences constructed.
controls was monitored in order to ensure that the means for age Participants also were given a semantic memory task that re-
and education level were similar to those in the other two groups. quired them to list as many members of a category as quickly as
All volunteers spoke English as their first language. possible within a 30 second period. Two categories were tested on
Participants were tested six times, at three monthly intervals. each test occasion, and varied from test period to test period so
The mean weeks pregnant or postpartum (6SD) across the six that the participants could not prepare for the test. The categories
testing sessions for those completing the study from the initially were selected from the sets used by Casey (1989) and Casey and
pregnant group (n 5 18) were, respectively: 14 6 4, 25 6 2, and Heath (1988) in their study of category norms for Australians. The
37 6 2 weeks pregnant, and 9 6 2, 23 6 2, and 36 6 2 weeks titles of each pair of categories per session, in the order of testing
postpartum. In regard to the planning group (n 5 10), working session, were Flower and Fruit, Vehicle and Weapon, Emotion
within a small rural population insufficient volunteers were avail- and Drink, Sport and Bird, Furniture and Occupation, and Fruit
able to insist that only those volunteers would be accepted who and Bird. The final two categories, Fruit and Bird, were repeats to
became pregnant between the first and second testing sessions. enable comparison with earlier performance on these categories.
The outcome was that five of this group became pregnant between During the fifth data collection session, participants completed
the first and second test occasions, but the other five only became the NEO Five-Factor Inventory (NEO-FFI) personality scale
pregnant between the second and third test occasions. Testing (Costa and McCrae, 1992). The fifth session was chosen so as not
then occurred within each trimester and postpartum as for the to overload the earlier sessions, and also to test participants at a
initially pregnant group up to the completion of six tests, with all time when none were still at the pregnancy stage in case pregnancy
such participants being tested before, during, and after pregnancy. may have affected some responses in the personality test.
The first session began with subjects completing the consent Each session took approximately one hour. No feedback was
protocol2. Then participants gave details on age, highest education given on the results of any of the questionnaires or tests during the
level obtained, number of children, week of pregnancy if appropri- study but on completion all participants received feedback on
ate, the nature of any paid or unpaid work, and any change in sleep their results.
pattern or memory performance over the past three months.
At each data collection, participants gave details of any medi-
cation being taken, and rated their health, quality of sleep, and Statistical analyses
level of exercise, all ratings on a scale of 1 to 5. Participants also
completed two self-report questionnaires. The first questionnaire Statistical analyses were performed with the program Statistical
was Part F of the Short Inventory of Memory Experiences Package for the Social Sciences (SPSS, Version 9.0.1, 1999). Both
(Herrmann et al., 19783), consisting of 24 questions on the fre- descriptive and inferential statistics were computed. Means were
quency of occurrence of particular examples of forgetting. Re- compared using t-tests and analyses of variance with post hoc tests,
sponses were given on a 7 point scale ranging from “never” (1) up as appropriate. Where comparisons could be made within and
to “always” (7). The memory questions related to rote memory, between groups over time, the primary analyses were two way
analyses of variance, using group membership as a between sub-
ject variable, and time of testing as a within subjects factor. Par-
2
The study was approved by the Ethics in Human Research ticular interest lay in any interactions that might occur that
Committee of Charles Sturt University, Australia. reflected that the mean change in score from Time x to Time x 1
3
My thanks to Douglas Herrmann for providing and permis- 1 differed between the pregnant and control groups, and were
sion to use the SIME. tested by within subject contrasts. (Note that such tests were
Cognitive performance during pregnancy and new motherhood 69

not appropriate for the semantic memory tasks because different Age and education
categories were used at each test time and number of category
instances recalled can vary markedly from category to category.) There were no significant differences between
Bivariate correlations between variables were computed using
the planning, pregnant, and control groups in regard
Pearson’s product-moment r, point biserial r, and phi, as appropri-
ate. Unique contributions from predictor variables to explained to age and education. The mean ages (6SD) were
variability in a dependent variable were computed using multiple 30.9 (64.2), 28.2 (65.0), and 32.5 (67.2) years,
regression. respectively. In regard to education, each group
contained an even spread of high school, college, and
Results post-graduate education levels, with most partici-
pants in each group being at the college level of
Analyses were based on data from the 52 participants education.
that completed the study. Missing data were less than
2% (arising from the occasional recording equip-
Self reported levels of health, sleep, and exercise
ment malfunctioning and unavoidable interruptions
to testing sessions). The means and standard deviations for self reported
As explained in the Subjects and methods section levels of health, sleep, and exercise for each of the
in regard to the planning group, it was not possible to three groups at all six testing times are shown in
have all members of the planning group at the same Table 1. Comparisons of the means for the pregnant
stage of pregnancy and postpartum at each testing and control groups found no significant effects for
occasion. Hence, means from the planning group any of these variables either between groups or
could not be compared sensibly with means from the over time, nor were there any group by time
pregnant and control groups (other than at testing interactions.
Time 1). Thus inferential statistics for comparisons Analyses were also performed on the variability of
of means from the tests over testing times are based each subject’s six scores across the testing times.
on data from the pregnant and control groups only. There were no significant differences between any
However, meaningful comparisons could be made of the groups on variability of health and exercise
across all groups for variability over the six testing ratings. However, there was a significant F value for
occasions, and hence inferential statistics for these sleep, F(2, 49) 5 5.12, p 5 0.01, with Tukey post
comparisons are based on all three groups. The range hoc tests revealing that the planning group’s mean
of each participant’s scores over the six test times was variability in reported sleep level (2.5 6 1.0) was
used as the measure of variability. Note that tables of significantly larger than the mean variability in the
descriptive statistics will include results from all three control group (1.6 6 0.8), but was not significantly
groups at each testing time for the sake of complete- different from the variability in the pregnant group
ness of the results. (2.1 6 0.8).

Table 1. Means (6SDs) of rated levels of health, sleep, and exercise* across groups and times of reporting

Dependent variable Group Time 1** Time 2 Time 3 Time 4 Time 5 Time 6

Health planning 1.9 6 0.7 2.5 6 0.7 2.3 6 0.8 2.7 6 1.4 1.9 6 1.0 2.4 6 1.0
pregnant 2.2 6 0.9 2.3 6 1.2 1.9 6 0.8 2.4 6 1.1 2.3 6 1.2 2.4 6 1.1
control 1.8 6 0.9 2.0 6 0.8 2.3 6 0.9 2.5 6 1.1 2.1 6 0.9 2.7 6 1.1
Sleep planning 2.2 6 1.1 2.8 6 0.9 2.2 6 1.0 2.8 6 1.2 3.0 6 1.3 3.1 6 1.5
pregnant 3.0 6 1.1 3.1 6 1.0 2.8 6 1.4 3.1 6 1.4 3.3 6 1.0 2.8 6 1.1
control 2.6 6 1.1 2.7 6 1.2 2.9 6 1.0 2.8 6 1.1 2.5 6 0.9 2.6 6 1.1
Exercise planning 3.6 6 0.8 3.9 6 1.0 3.8 6 1.4 4.0 6 1.4 3.7 6 1.3 3.7 6 1.3
pregnant 3.7 6 1.1 3.6 6 1.0 3.2 6 1.2 3.7 6 1.2 3.4 6 1.3 3.4 6 1.1
control 3.4 6 1.2 3.3 6 1.2 3.0 6 1.2 3.0 6 1.2 3.2 6 1.1 3.0 6 1.2

* Ratings were on a scale of 1 to 5, with 1 indicating very good, very well, and very much, respectively, and 5 indicating very poor, very
poorly, and very little, respectively.
** For all tables with time references, for the Pregnant group, Times 1–3 refer to trimesters 1, 2, and 3, respectively. Times 4–6 refer to
postpartum times, being on average 9, 23, and 36 weeks, respectively. The Planning and Control Groups were tested at equivalent time
intervals.
70 P. Casey

Table 2. Mean (6SDs) DASS21* levels of depression, anxiety, and stress** across groups and times of reporting

Dependent variable Group Time 1 Time 2 Time 3 Time 4 Time 5 Time 6

Depression planning 6.4 6 6.7 7.0 6 6.9 10.4 6 10.5 8.4 6 8.2 5.6 6 6.8 5.0 6 3.9
pregnant 11.6 6 10.4 9.1 6 9.5 4.2 6 4.7 6.4 6 4.6 7.4 6 8.6 8.0 6 7.9
control 6.0 6 6.0 7.7 6 6.0 7.0 6 8.4 9.9 6 10.3 8.3 6 9.1 5.1 6 7.3
Anxiety planning 3.0 6 3.9 4.6 6 8.0 5.2 6 7.7 6.4 6 7.2 2.8 6 3.2 2.6 6 3.1
pregnant 8.2 6 5.2 8.1 6 6.4 6.9 6 6.6 4.3 6 4.7 4.9 6 6.8 4.9 6 6.7
control 4.3 6 4.7 5.2 6 6.4 7.0 6 9.0 6.1 6 8.7 5.8 6 7.1 4.5 6 5.5
Stress planning 10.8 6 5.1 11.2 6 8.2 15.2 6 13.4 13.6 6 8.2 10.6 6 5.8 11.8 6 6.4
pregnant 16.6 6 9.8 15.0 6 9.3 10.0 6 7.0 9.9 6 9.7 12.1 6 10.2 15.1 6 12.8
control 14.8 6 7.2 13.4 6 6.6 12.6 6 7.9 12.5 6 8.1 14.5 6 10.9 11.4 6 8.0

* Scores can vary from 0 to a maximum of 42 for each dependent variable.


** 21 Item Depression, Anxiety and Stress Scale.

Table 3. Means (6SDs) for verbal and abstract subscales* of the Shipley Institute of Living Scale across groups and times of testing

Group Shipley Test Scale Time 1 Time 2 Time 3 Time 4 Time 5 Time 6

Planning verbal 33.0 6 4.3 32.8 6 4.9 34.1 6 4.4 34.6 6 4.5 34.4 6 3.5 34.5 6 4.6
abstract 31.2 6 4.6 33.0 6 5.3 33.4 6 4.2 34.0 6 3.4 34.4 6 3.6 34.2 6 2.7
Pregnant verbal 31.8 6 5.2 32.2 6 4.8 33.2 6 5.1 31.9 6 5.7 32.5 6 5.3 32.9 6 5.4
abstract 29.8 6 5.8 32.2 6 5.2 33.8 6 4.9 33.9 6 3.8 33.3 6 4.8 34.4 6 3.9
Control verbal 30.3 6 4.0 30.4 6 4.5 31.0 6 4.1 31.3 6 4.2 32.0 6 3.5 31.1 6 4.3
abstract 29.7 6 5.6 31.8 6 5.5 31.5 6 5.4 31.9 6 5.5 32.2 6 5.9 33.3 6 5.9

* The maximum score for each scale is 40.

Sleep and health rating correlations consistently Results from objective memory tests
yielded medium sized correlations (0.4 to 0.5, p ,
Shipley Institute of Living Subscales
0.005) such that those who reported better sleep
(verbal and abstract)
reported better health. While higher levels of exer-
cise were associated with better health and sleep, the The means and standard deviations for group scores
correlations were relatively small (0.1 to 0.3), and not on the Shipley subscales across the six testing times
always significant. are shown in Table 3. Results from comparing the
means for the pregnant and control groups across the
six testing times for each subscale found no signifi-
The depression, anxiety and stress scale (DASS21)
cant between group differences, and no interaction
The means and standard deviations for depression, of group and time of testing. However, there was a
anxiety, and stress scores across the three groups at significant within subjects effect for each test, F(5,
all six testing times are shown in Table 2. Comparisons 195) 5 4.46 and 13.74, respectively, p , 0.001, indi-
of the pregnant and control groups’ mean scores cating a practice effect, one which was consistent
found no significant between group or over time across both groups4.
effects, and no group by time interaction. Likewise, A similar analysis was conducted with the depend-
there were no significant differences across the three ent variable being the difference between the verbal
groups in variability of subjects’ scores over time. and abstract scales for each subject at each testing
There was a pattern of highly significant, medium
sized correlations between scores on depression and
4
For the sake of readability, the fine details of practice effects
ratings for health and sleep (0.4 to 0.6), such that the
that are consistent across groups are not given unless they are
relatively depressed reported poorer health and considered to be of importance. Details of practice effects are
sleep. available from the author.
Cognitive performance during pregnancy and new motherhood 71

occasion. Again there were no significant group dif- Results from comparing the backward digit span
ferences nor any interaction, but there was a signifi- means for the pregnant and control groups across the
cant within subjects effect, F(5, 195) 5 6.87, p , 0.001, six testing times found no significant between group
reflecting the fact that the abstract scores improved differences, and no interaction between group and
more over testing times than did the verbal scores. time of testing. However, again there was a signifi-
Planning, pregnant, and control groups were com- cant within subjects effect, F(5, 200) 5 7.92, p ,
pared on the variability in each participant’s scores 0.001, reflecting a practice effect.
across the six testing occasions for both the verbal Further, a test of the differences between the for-
and abstract tasks. No significant differences in ward and backward digit span scores for the pregnant
variability were found. and control groups across the six testing times found
no significant difference between the groups, and no
group by time interaction. There was a significant
Forward and backward digit span tests
within subjects effect, F(5, 200) 5 2.83, p , 0.025,
The means and standard deviations for group scores within subject contrasts finding that the difference
on the forward and backward digit span tests across between the forward and backward spans at test
the six testing times are shown in Table 4. Results Time 4 was significantly less than at other test times,
from comparing the forward digit span means for the F(1, 40) 5 10.75, p , 0.005.
pregnant and control groups across the six testing Finally, the planning, pregnant, and control
times found no significant between group differences. groups were compared on the variability in each par-
However, there was a significant within subjects ticipant’s scores across the six testing occasions for
effect, F(5, 200) 5 3.72, p , 0.005. Further, there was both forward and backward digit tasks. No significant
also a significant time by group interaction, F(5, 200) differences in variability were found.
5 2.40, p , 0.02. Further examination of the interac-
tion result using within subject contrasts that com-
Sentence-digit span test
pared score at Time x with score at Time x 1 1 found
no significant effects. (Within subject contrasts that The means and standard deviations for group scores
compared means at Time x with the mean of scores on the sentence-digit span test across the six testing
across all previous test times revealed that the inter- times are shown in Table 5. Comparisons of the
action was related to the control group’s relatively means for the pregnant and control groups found
low mean at Time 4, F(1, 40) 5 6.06, p , 0.02.) no significant between group, within group, or

Table 4. Mean (6SDs) Wechsler forward and backward digit spans* across groups and times of testing

Group Digit direction Time 1 Time 2 Time 3 Time 4 Time 5 Time 6

Planning forward 5.9 6 0.9 6.1 6 1.0 6.0 6 1.1 6.2 6 0.8 6.5 6 0.8 6.1 6 0.9
back 4.1 6 1.2 4.1 6 0.8 4.4 6 0.9 3.9 6 0.9 4.1 6 0.9 4.3 6 0.9
Pregnant forward 6.4 6 1.2 6.6 6 1.3 6.8 6 1.2 6.9 6 1.3 7.1 6 0.8 6.8 6 1.5
back 4.5 6 1.2 4.4 6 1.2 4.6 6 1.6 4.9 6 1.4 5.0 6 1.7 5.2 6 1.5
Control forward 6.1 6 1.1 6.6 6 1.1 6.4 6 1.1 6.1 6 1.1 6.4 6 1.0 6.5 6 1.2
back 4.2 6 1.0 4.4 6 1.2 4.5 6 1.2 4.8 6 1.3 4.7 6 1.3 4.6 6 1.1

* For those familiar with the Wechsler digit span tests, note that these scores are the mean digit spans, not the number of test items
responded to correctly.

Table 5. Mean (6SDs) sentence-number working memory spans according to group*

Group Time 1 Time 2 Time 3 Time 4 Time 5 Time 6

Planning 5.3 6 2.4 6.0 6 2.1 6.3 6 2.0 5.6 6 1.8 6.4 6 2.0 6.3 6 2.7
Pregnant 5.9 6 2.2 6.2 6 2.3 5.8 6 2.1 6.4 6 2.5 6.2 6 2.5 6.1 6 2.6
Control 5.9 6 2.2 5.8 6 2.8 6.1 6 2.8 6.1 6 2.2 6.0 6 2.4 6.3 6 2.3

* Scores could range from 0 to 12.


72 P. Casey

interaction effects, F , 1.0 in all cases. Likewise, a nancy (e.g., Casey et al., 1999). The means and stan-
comparison of the variability in all three groups over dard deviations for scores on these SIME variables
the six test times found no significant effects. are shown in Table 7.
There were no significant differences between the
Semantic memory tests pregnant and control groups in the mean levels of
reported forgetting for absentmindedness, errands,
Comparisons across the pregnant and control groups
or overall forgetting scores at any one testing time.
were made of both the number of category instances
However, there was an interaction between group
recalled in the first 5 seconds and the number of
and time of test at Time 1 and Time 2, F(1, 38) 5 7.80,
category instances recalled in the 30 seconds avail-
p , 0.01. As can be seen from Table 7, this interaction
able overall. There were no significant differences
related to the pregnant group showing a mean drop in
between the groups for any category for either time
reported absentmindedness from Time 1 to Time 2
period. Further analyses were made comparing re-
while the control group showed an increase.
sponse frequencies within each of the categories that
There were no significant differences across the
were tested on two occasions, namely Fruit and Bird.
three groups in variability of subjects’ reported for-
There were no significant main effects and no signifi-
getting scores over time. However, for absentmin-
cant interactions. The means and standard deviations
dedness the F value approached significance (F[2, 49]
for group scores for the 30-second recall period for
5 2.54, p 5 0.09), with the mean variability of indi-
the semantic memory categories of Fruit and Bird
vidual scores over time within each of the planning,
only are shown in Table 6.
pregnant, and control groups, respectively, being
1.73 6 0.90, 1.80 6 0.93, and 1.26 6 0.68.
Subjective memory experiences: The short
It was noteworthy that the mean absentmin-
inventory of memory experiences (SIME) dedness and errands scores for the planning group
The focus here was on self reported SIME levels of participants showed a marked increase with the onset
overall forgetting, absentmindedness, and forgetting of pregnancy and a subsequent fall some months after
on errands, the last two being areas especially noted childbirth. These features are not captured by the
from past studies as showing an increase during preg- means shown in Table 7 because not all the planning
group became pregnant at the one time and there was
Table 6. Mean (6SDs) number of examples emitted for each of the
also considerable variability within the group. For
categories Fruit 1 (Test Time 1), Bird 1 (Test Time 4), Fruit 2 (Test reported absentmindedness in the planning group
Time 6), and Bird 2 (Test Time 6) in a 30 second period overall, the mean increase of 1.17 (61.29) between
test Time 1 and testing when first pregnant was
Group Fruit 1 Bird 1 Fruit 2 Bird 2
significant, t(9) 5 2.87, p , 0.025, and the mean
Planning 12.3 6 2.5 11.9 6 3.4 13.7 6 3.7 11.7 6 2.7 decrease in reported absentmindeness of 1.1 (61.41)
Pregnant 13.9 6 4.1 12.1 6 3.8 14.2 6 2.9 12.3 6 3.5 between when first pregnant and test Time 6 was also
Control 14.4 6 3.2 11.1 6 3.1 14.0 6 3.4 11.9 6 3.4
significant, t(9) 5 22.47, p , 0.05. For errands at the

Table 7. Mean (6SDs) scores on the Short Inventory of Memory Experiences (SIME)* across groups and times of reporting for the SIME
overall, absentmindedness, and forgetting on errands

Dependent variable Group Time 1 Time 2 Time 3 Time 4 Time 5 Time 6

SIME planning 3.3 6 0.8 3.4 6 1.0 3.4 6 0.9 3.8 6 1.1 3.4 6 0.6 3.4 6 0.7
Overall pregnant 3.5 6 0.9 3.8 6 0.9 3.7 6 0.9 3.5 6 0.8 3.5 6 0.8 3.6 6 0.9
control 3.5 6 0.9 3.8 6 0.9 3.7 6 0.9 3.5 6 0.8 3.5 6 0.8 3.6 6 0.9
Absentm** planning 3.3 6 1.1 3.7 6 1.4 3.7 6 1.3 3.8 6 1.3 3.8 6 1.0 3.3 6 0.8
pregnant 3.9 6 1.3 3.5 6 1.3 3.4 6 1.4 3.4 6 1.3 3.7 6 1.5 3.3 6 1.3
control 3.4 6 1.1 3.8 6 1.0 3.6 6 1.1 3.6 6 1.1 3.5 6 1.1 3.5 6 1.2
Errands planning 3.5 6 1.2 3.7 6 1.8 3.9 6 1.5 4.2 6 1.4 3.5 6 1.2 3.3 6 1.1
pregnant 3.8 6 1.6 3.5 6 1.5 3.6 6 1.5 3.6 6 1.6 3.7 6 1.7 3.5 6 1.5
control 3.4 6 1.3 3.8 6 1.3 3.7 6 1.2 3.4 6 1.2 3.5 6 1.3 3.8 6 1.4

* Scale runs from 1 for “never happens” to 7 “always happens”.


** Absentmindedness.
Cognitive performance during pregnancy and new motherhood 73

comparable testing times, the mean increase of 1.26 Absentmindedness


(61.27) was significant, t(9) 5 2.98, p , 0.025, while
Data screening revealed that the scores for the
the mean decrease of 1.30 (61.52) after child birth
anxiety variable were markedly right skewed. These
was also significant, t(9) 5 22.71, p , 0.05. There
scores were recoded as either Normal (scores below
were no such significant increases or decreases for
8) or Anxious (scores of 8 and above), using the
either the pregnant or control groups across equiva-
norms for the DASS21 scale. Regressing absentmin-
lent testing occasions for either variable. Finally,
dedness score on conscientiousness, recoded anxiety,
within the planning group there was no relationship
and rated sleep level, produced a significant multiple
between reported change in everyday levels of forget-
correlation with absentmindedness for all six testing
ting and performance on any of the objective tests.
occasions, multiple R ranging from 0.38 to 0.61 (M 5
0.53 6 0.08). The variability in levels of reported
What best uniquely predicts reported forgetting?
absentmindedness scores accounted for by the pre-
Results of multiple regression analyses
dictor set (using adjusted R2) ranged from 0.09 to
The aim here was to find the combination of vari- 0.33 (M 5 0.25 6 0.09). Significance tests using
ables that best accounted for SIME scores on re- ANOVA produced F(3, 47) values ranging from 3.35
ported levels of absentmindedness and forgetting on (p , 0.05) to 9.30 (p , 0.001).
errands. Both theoretical interests and results from Each predictor made a uniquely significant
preliminary bivariate correlational analyses resulted contribution to explained variability on at least
in choosing the following set of predictors: rated two occasions. Conscientiousness was the most
sleep, anxiety level (as measured by the DASS21), consistent uniquely significant predictor of level of
and the personality factor of conscientiousness (as absentmindedness, followed by level of anxiety. In
measured by the NEO-FFI). fact, a model which used conscientiousness and
Pregnancy status was not included in these anxiety as predictors always accounted for a signifi-
analyses because it did not predict level of reported cant proportion of variability in absentmindedness,
forgetting at any stage. Anxiety was chosen over adjusted R2 ranging from 0.09 to 0.33 (M 5 0.22 6
depression because it was highly correlated with 0.05).
depression and was a better predictor of absentmin-
dedness. Sleep level was selected because of its being
a significant predictor in the Casey et al. study (1999), Errands
and the fact that here there was a consistent, albeit
Regressing errands score on conscientiousness,
not always significant, pattern of those reporting
recoded anxiety, and rated sleep level, produced a
poor sleep also reporting more absentmindedness.
significant multiple correlation with errands for the
The personality factor of conscientiousness was se-
final four of the six testing occasions, multiple R on
lected because this factor relates to levels of planning
the six test occasions ranging from 0.34 to 0.55 (M 5
and organising, a factor that may correlate negatively
0.45 6 0.09). The variability in levels of reported
with absentmindedness and forgetting on errands.
errands scores accounted for by the predictor set
The correlation matrix for reported absentmin-
(using adjusted R2) ranged from 0.06 to 0.26 (M 5
dedness, forgetting on errands, rated sleep, and rated
0.16 6 0.09). Significance tests using ANOVA pro-
anxiety, all at test Time 5, and conscientiousness
duced F(3, 47) values ranging from 2.07 (p 5 0.1) to
(tested at Time 5) is shown in Table 8.
6.92 (p , 0.001).
Conscientiousness again was the most consistent
Table 8. Correlations at testing Time 5 between reported
absentmindedness level, reported level of forgetting on errands, uniquely significant predictor of reported forget-
conscientiousness (consc), anxiety level, and rated sleep level ting on errands, with rated anxiety and rated sleep
level only once each making a uniquely significant
Errands Consc Anxiety Sleep
contribution to explained variability in forgetting on
Absentmindedness 0.82** 20.52** 0.32* 0.28* errands. A model which used only conscientiousness
Errands 20.45** 0.34* 0.24 and anxiety as predictors accounted for a significant
Conscientiousness 0.15 20.01
proportion of variability in errands on four of the six
Anxiety 0.23
testing occasions, adjusted R2 ranging from 0.07 to
* p , 0.05; ** p , 0.001. 0.27 (M 5 0.14 6 0.09).
74 P. Casey

Summary of findings the context of the data patterns shown in Table 4.


Hence, this result can be reasonably attributed to
The initially pregnant and control groups did not
chance rather than systematic variability in perfor-
differ on mean scores on depression, anxiety, stress,
mance related to pregnancy.
rated health, rated sleep, or rated exercise level at
The finding of no other significant differences be-
any of the six testing times. However, the planning
tween pregnant women and controls on any objective
group showed more variability in rated sleep levels
test at any stage of testing is consistent with recent
over the six testing times than did the control group.
findings by Casey et al. (1999) and Christensen et al.
In regard to objective test scores, there were no sig-
(1998). The findings of no differences between
nificant differences between the pregnant and con-
groups in the patterns of variability on objective test
trol groups on mean scores at any stage, other than
performance nor any decrease in performance dur-
at test Time 4 when there was a drop in the control
ing pregnancy are also consistent with the finding
group’s mean forward digit span score. Further, there
by Schneider (1989) that pregnant women do not
were no significant differences between the planning,
experience any cognitive decline during pregnancy.
pregnant and control groups on variability in objec-
However, some studies continue to find evidence
tive test performance across the six testing occasions.
that cognitive performance deteriorates in some
In regard to reported levels of forgetting, the only
areas during pregnancy. For example, Buckwalter
significant effects were: (a) a significant increase in
et al. (1998) and Keenan et al. (1998) found evidence
reported levels of absentmindedness and forgetting
for a decline in aspects of verbal memory during
on errands in the planning group once the members
pregnancy.
of this group became pregnant, followed by a signifi-
The interpretation of both difference and no dif-
cant decline postpartum; and (b) a significant interac-
ference findings in this area is difficult because of the
tion for reported absentmindedness at Times 1 and 2
near impossibility of conducting true experiments.
such that the pregnant group mean decreased while
For example, do non-significant results come about
the control group mean increased. The most con-
from a lack of power, a lack of control over variables
sistent unique predictors of reported forgetting were
unrelated to pregnancy, or because there are no
personality and anxiety levels, with sleep rating being
differences? Are the significant difference results
a unique significant predictor less often.
from quasi experiments simply reflecting differences
between the two groups that are unrelated to
pregnancy?
Discussion
Consider the question of power, and use digit span
In regard to reported levels of sleep and forgetting, as an example of the test area. If we expected a digit
the findings that the planning group showed more span difference between pregnant women and con-
variability in reported sleep levels relative to the con- trols of between 0.5 and 1.0, with both forward and
trol group, and marked changes in reported levels of backward digit span tests having a standard deviation
absentmindedness and forgetting on errands during of about 1, then effect size would be medium to large,
pregnancy, are consistent with previous findings between 0.5 and 1.0. For such an effect size range,
(e.g., Casey et al., 1999). The interaction between with 20 participants per group, power would be be-
group (pregnant and control) and time of test at tween 46% and 80% for a one tailed test (Cohen,
Time 1 and Time 2 is consistent with an increase in 1988). However, with a smaller expected effect size,
reported absentmindedness during the first trimester power here would be much weaker. If only a medium
of pregnancy, but may also be an artefact here of the to large effect size is of consequence then the sample
control group’s increase in mean reported absent- sizes for the initially pregnant and control groups in
mindedness at Time 2. the present study were arguably adequate. However,
The only statistically significant difference on the if it can be shown that small effect sizes in digit span
objective tests between the pregnant and control and other test areas matter, then clearly more power
groups related to the digit span data where the for- is required, and larger, possibly more homogeneous
ward digit span mean scores for the control group samples are needed.
showed a sudden drop relative to the pregnant Answers to the above questions can also be sought
group’s scores between test Times 3 and 4. However, in results from replications of studies. Consider the
this result makes little sense either conceptually or in areas of working memory and general intellectual
Cognitive performance during pregnancy and new motherhood 75

functioning, two areas that have been covered consequences of particular life events such as anxiety,
extensively. and how individuals perceive their performance on
Working memory, the simultaneous storage and everyday cognitive tasks, especially memory. The
processing of information, has been examined in findings here that score on the personality factor of
many recent pregnancy studies. Performance on digit conscientiousness was a unique predictor of level of
span tests, forms of working memory tests, has now reported absentmindedness and forgetting on errands
been examined here and in four other studies seems especially worth pursuing. It may be the case
(Buckwalter et al., 1998; Casey et al., 1999; Janes et that a heightened sensitivity to cognitive performance
al., 1999; and Schneider, 1989). There have been no is part of some people’s overall response to the many
effects for forward digit span, with the only signifi- changes in everyday life resulting from pregnancy, the
cant effect for backward digit span being a lower nature of such a response within each person being
span for pregnant and postpartum women relative to related in part to personality factors.
controls in Janes et al.. Span tests, which require the
participant to perform two tasks simultaneously such
Conclusion
as reading sentences aloud while retaining the final
word of each sentence for later recall, have been used The evidence from this longitudinal study suggests
here and in three other studies (Casey et al., 1999; that there may be no objective change in memory
Janes et al., 1999; and Poyser, 1998). No significant performance during pregnancy but rather percep-
effects have been found in any of the studies. Argu- tions of memory performance change (a metame-
ably, then, it is likely that working memory is not mory change). Further, how one perceives one’s
affected during pregnancy. memory performance in everyday life may be very
Several other studies have also included tests that much a function of personality and anxiety level, with
related to general intellectual functioning (e.g., sleep quality perhaps also being relevant. However,
Buckwalter, 1998; Christensen, 1999). The evidence it is also possible that there are reliable changes in
from these studies and the scores here on the Shipley the everyday cognitive performance of a subset
Institute of Living scales suggest that there is no gen- of pregnant women but objective tests to date have
eral loss of intellectual functioning in pregnancy. not been measuring adequately the everyday
An area for further investigation is verbal memory experiences of such women.
where Buckwalter et al. (1998) and Keenan et al. In regard to the everyday experiences of pregnant
(1998) have found evidence for poorer performance women, the evidence from the planning group data is
during pregnancy. However, the exact nature of ver- that there is a diversity of experiences in regard to
bal memory and what particular tests measure will memory during pregnancy. Finally, the potential
have to be looked at closely in future studies because uniqueness of the cognitive aspect of the experience
no differences between pregnant women and con- of pregnancy may not be best captured by quantita-
trols and no changes over pregnancy have been tive tests but rather qualitative studies may be
found in a number of studies which have used verbal needed to better grasp the nature of the experience.
memory tests. For example, there were no differ-
ences in semantic memory performance both here
and in Casey et al. (1999), no differences in verbal Acknowledgment
recognition in Christensen (1999) and Poyser (1998), I am grateful for the support of two grants from Charles Sturt
and no decline in comprehension performance in University (Australia). I am also especially grateful to the partici-
pants who gave so much of their time and energy to assist with this
Schneider (1989). study. I wish to acknowledge my appreciation of the professional
Studies in more naturalistic settings may also be manner in which my two research assistants, Margaret Casey and
needed in order to obtain more ecologically valid Christine Huntsdale, assisted me with the data collection. Finally,
I wish to acknowledge the very helpful comments from a reviewer
evidence of what many pregnant women report that
on an earlier version of this paper and the encouragement of the
they are experiencing. It may be that in laboratory journal editor.
type tasks people are on their best cognitive behav-
iour as it were, and such tasks do not capture the
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