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Prospective-memory functioning is affected during pregnancy and

postpartum
Peter G. Rendella; Julie D. Henryb
a
Australian Catholic University, Melbourne, Victoria, Australia b University of New South Wales,
Sydney, NSW, Australia

First published on: 14 March 2008

To cite this Article Rendell, Peter G. and Henry, Julie D.(2008) 'Prospective-memory functioning is affected during
pregnancy and postpartum', Journal of Clinical and Experimental Neuropsychology, 30: 8, 913 — 919, First published on:
14 March 2008 (iFirst)
To link to this Article: DOI: 10.1080/13803390701874379
URL: http://dx.doi.org/10.1080/13803390701874379

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 JOURNAL OF CLINICAL AND EXPERIMENTAL NEUROPSYCHOLOGY
2008, 30 (8), 913–919

Prospective-memory functioning is affected during

NCEN

pregnancy and postpartum

Peter G. Rendell1 and Julie D. Henry2

Prospective Memory and Pregnancy

1
Australian Catholic University, Melbourne, Victoria, Australia
2
University of New South Wales, Sydney, NSW, Australia

Although there is considerable anecdotal and empirical evidence showing that retrospective memory may be
adversely affected during pregnancy and postpartum, it remains unclear whether capacity for prospective memory
is also impaired. In Phase 1 of the present study 20 participants in their third trimester of pregnancy were
compared with 20 nonpregnant matched controls on a laboratory measure of prospective memory that closely
represents the types of prospective-memory tasks that actually occur in everyday life, in addition to a naturalistic
Downloaded By: [Universidad de Sevilla] At: 05:03 12 February 2011

time-logging prospective-memory task that was conducted over a period of 7 days as part of their day-to-day
lives. In Phase 2, 15 of the pregnant women were retested on the time-logging task approximately 13 months after
giving birth. The results indicated that although pregnancy was not associated with deficits on the laboratory
measure of prospective memory, significant impairment was observed on the naturalistic measure. These prelim-
inary data therefore provide the first empirical evidence showing that pregnancy may be associated with increased
difficulty in implementing delayed intentions in everyday life.

Keywords: Prospective memory; Pregnancy; Postpartum; Naturalistic and laboratory measures; Memory for
delayed intentions; Everyday memory.

INTRODUCTION & Cubis, 1999; Crawley, Dennison, & Carter, 2003;

Women frequently report problems with retrospec-
tive memory, both during pregnancy and postpar-
tum. Whilst until recently much of the evidence for
deficits in this capacity was anecdotal (see, e.g.,
Crawley, 2002; Parsons & Redman, 1991), a rela-
tively large body of empirical evidence has now
accumulated, with most of these studies supporting
the view that retrospective memory is adversely
affected (see Brett & Baxendale, 2001; Buckwalter,
et al., 1999; Condon, Derham, & Kneebone, 1991;
de Groot, Hornstra, Roozendaal, & Jolles, 2003; de
Groot, Vuurman, Hornstra, & Jolles, 2006; Keenan,
Yaldoo, Stress, Fuerst, & Ginsburg, 1998; Sharp,
Brindle, Brown, & Turner, 1993; but for studies not
showing adverse affect, see Casey, Huntsdale,
Angus, & Janes, 1999; Christensen, Poyser, Pollitt,
McDowall & Moriarty, 2000; and for a review, see
Henry & Rendell, 2007).
However, only two studies to date have investi-
gated how prospective memory (or memory for
future intentions) is affected in pregnancy and/or
postpartum (Casey et al., 1999; Crawley, 2002).
Crawley (2002) asked pregnant women recruited at
various stages of pregnancy (ranging from the first
to the third trimester; N = 198) and nonpregnant
female controls (N = 132) to indicate whether they
had experienced any change in the ability to
remember things to be done in the future and, if so,
whether it was a change for the better or for the
worse. For the pregnant participants the change
referred to was pregnancy, and for the control par-
ticipants (all of whom had recently left home to go
to university) the change referred to was leaving

This research was supported by an Australian Research Council Small Grant. We thank Fergus Craik for helpful comments on an
earlier version of this article and Amelia Cambrell for help with data collection.
Address correspondence to Peter Rendell, School of Psychology, Australian Catholic University, Locked Bag 4115, Fitzroy,
Melbourne, Victoria, Australia 3065 (E-mail: p.rendell@patrick.acu.edu.au).

© 2008 Psychology Press, an imprint of the Taylor & Francis Group, an Informa business
http://www.psypress.com/jcen DOI: 10.1080/13803390701874379
 914 RENDELL AND HENRY
home. The difference in ratings between pregnant
and nonpregnant participants on this measure was
significant, with fewer pregnant women rating their
prospective memory as better than before. How-
ever, a limitation of this study was its reliance solely
on self-reported cognitive change. In the second
study, Casey et al. (1999) tested prospective mem-
ory using an objective test in which participants
were asked to ring a given phone number one week
after taking part in a laboratory testing session in
order to report on their memory functioning during
the past week. Whilst the difference failed to attain
significance, there was a trend showing that partici-
pants in the pregnant/postpartum group were less
likely than the nonpregnant group to ring back a
week later as requested (29% vs. 39%).
Although the results from both of these studies
are consistent with the possibility that individuals
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who are pregnant or postpartum may experience
increased difficulty with prospective memory, they
are limited by solely relying on a self-report meas-
ure of this construct (Crawley, 2002), or use of a
single-response prospective-memory task where
performance cannot be discriminated beyond cor-
rect or incorrect on a one-off trial (Casey et al.,
1999). Thus, these studies provide relatively limited
information regarding the extent, scope, or impli-
cations of problems experienced by those who are
pregnant or postpartum. They also fail to identify
or investigate the conditions under which prospec-
tive-memory failures are most likely to occur.
The aim of the current study was therefore to con-
duct a preliminary assessment of how prospective
memory is affected in pregnancy and postpartum
across both laboratory and naturalistic contexts. The
laboratory assessment involved using Virtual Week, a
measure that closely represents the types of prospec-
tive-memory tasks that actually occur in everyday
life, and provided an opportunity to investigate the
different sorts of failures that occur (see Rendell &
Craik, 2000; Rendell, Jensen, & Henry, 2007b). This
task has been found to be a sensitive marker of
prospective-memory impairment in various clinical
populations (Henry, Rendell, Kliegel, & Altgassen,
2007; Rendell, Gray, Henry, & Tolan, 2007a; Rendell
et al., 2007b). The naturalistic assessment involved
using a time-logging task that was actually conducted in
participants’ day-to-day lives. The assessment of pro-
spective memory across these two different settings is
important given that a recent meta-analytic review of
prospective memory and aging confirmed that
age-related deficits in laboratory-based prospective-
memory tasks are equivalent in magnitude to the
age-related benefits observed in naturalistic prospec-
tive-memory tasks (Henry, MacLeod, Phillips, &
Crawford, 2004; see also Rendell & Craik, 2000).
The present study is the first to provide a preliminary
assessment of the possibility that prospective-
memory function during pregnancy/postpartum also
differs as a function of assessment context.
METHOD
Participants and design
Pregnant women were recruited from a prenatal
clinic; the nonpregnant controls were friends of the
pregnant women. All pregnant participants were
observed to be in good health and had uncompli-
cated pregnancies and deliveries. Phase 1 involved a
between-groups design in which the independent
measure was pregnancy status (pregnant or nonpreg-
nant; n = 20 in each group), and the dependent
measures of interest were (a) performance on a labo-
ratory measure of prospective memory (Virtual
Week), and (b) performance on a naturalistic meas-
ure of prospective memory (a time-logging task, con-
ducted over 7 days). Phase 2 involved a within-group
design, in which test phase was the independent
measure (pregnant or postpartum; n = 15 at each
time point), and the dependent measure of interest
was performance on the same naturalistic measure of
prospective memory as that used in Phase 1.
A total of 20 women in their third trimester of
pregnancy and 20 nonpregnant female controls
participated in Phase 1. These two groups did not
differ with regard to age (M = 32.0, SD = 3.87 vs.
M = 31.6, SD = 4.63, respectively), years of educa-
tion (M = 13.3, SD = 3.01 vs. M = 14.2, SD = 3.03,
respectively), vocabulary as indexed by the Mill Hill
Vocabulary Test (M = 14.6, SD = 2.33 vs. M = 15.5,
SD = 1.93), or self-rated health (M = 2.3, SD = 1.02
vs. M = 1.9, SD = 0.69, respectively, where 1 =
excellent and 5 = poor; all ps > .05). However, rela-
tive to controls, the pregnant women rated their
sleeping over the last few weeks as significantly worse
(M = 3.7, SD = 0.87 vs. M = 2.3, SD = 0.85, respec-
tively, where 1 = excellent and 5 = poor); t(38) =
5.35, p < .001. Importantly, the two groups were
matched on the number of children and working
level. Thus, in both groups 70% (14 women) had no
children, and 70% were working full-time, with the
remaining 30% working either part-time or not at all.1
1
Limiting the reported analyses to those participants without
children did not change the pattern of results, and thus the
reported analyses include all participants, with the exception of
those with responses that were a little late on the time-logging
task. Hence analyses of the time-logging task limited to those
without children are reported in the Results section.
 PROSPECTIVE MEMORY AND PREGNANCY 915

In Phase 2, 15 of the pregnant women were
retested postpartum approximately 13 months after
completion of Phase 1 (M = 12.9, SD = 2.34). This
period of time postpregnancy is consistent with other
studies that have investigated cognitive functioning
postpartum (see, e.g., Crawley et al., 2003;
Silber, Almkvist, Larsson, & Uvnas-Moberg, 1990;
Waldenstrom, 2003). Of the remaining 5, 2 were preg-
nant again, 1 had moved interstate, and 2 declined to
participate. Whereas at the time of the first testing ses-
sion most were working full-time, at the time of the
second testing session most were working part-time.
A total of 60% of these participants did not have any
children at the time of the first testing session.
Materials
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the details incorrectly or recalled the correct item
at the incorrect time; miss indicated that the partic-
ipant did not remember the target item at any time.
Items scored no content indicated that individuals
remembered to do “something” at the correct time,
but were unable to remember task content. No
content indicated success on the prospective-mem-
ory component on the task and failure on the ret-
rospective component.
Finally, to obtain a naturalistic measure of pro-
spective memory, a time-logging task (Rendell &
Thomson, 1999). was used. Participants were given
a portable time-logging device and were required to
log the time at prescribed times over 7 chronological
days. The time-logging task was selected because it
met the two criteria previously identified as key for
naturalistic as compared to laboratory prospective-
memory tasks (Kliegel, Rendell, & Altgassen, in

Virtual Week was used as the laboratory measure of

press; Phillips, Henry, & Martin, 2007; Rendell &
prospective memory (see Rendell & Craik, 2000). Vir-
Craik, 2000). First, the task was embedded within
tual Week is a board game, in which participants
the daily life of participants rather than in a testing
move around the board with the roll of a dice. The
session controlled by the experimenter. Secondly, the
times of day that people are typically awake are
task was conducted over several days rather than
marked on the board, with each circuit of the board
the short period of a laboratory task. The same
representing a day. As participants moved around the
time-logging device (Sharp ZQ-5200 Organizer) as
board, they are required to make choices about daily
that used by Rendell and Thomson (1999) in their
activities and to remember to carry out lifelike activi-
assessment of prospective memory and aging was
ties (prospective-memory tasks). Each “day” of
used. Organizers were encased in a hard black plas-
Virtual Week includes 10 prospective-memory tasks
tic protective case, and the dimensions in the closed
(4 regular, 4 irregular, and 2 time-check tasks), and in
position were 145 mm (width) × 80 mm (depth) ×
this study participants completed 7 virtual days. The
17.8 mm (height). The organizers opened to reveal a
4 regular prospective-memory tasks simulate the
keyboard on the bottom half and a display screen
kinds of regular task that occur as one undertakes
and extra function keys on the top half. The same
normal duties, 2 of which are time based (i.e., trig-
instructions and procedure as those used by Rendell
gered by passing a particular time on the board), and
and Thomson (1999) were also used in the present
2 of which are event based (i.e., triggered by some
study. Thus, participants were briefed fully on how
information shown on an Event Card). The 4 irregu-
to use the time-stamp key on the organizer to log the
lar prospective-memory tasks simulate the kinds of
time and were also given a sheet explaining the time-
occasional task that occur in everyday life; again, 2 of
logging procedure. This sheet and the briefing
these tasks are time based, and 2 are event based. The
stressed the need for participants to keep the organ-
2 time-check tasks require the participant to “break
izer with them at all times, including when they were
set” from the board game activity and monitor real
away from home. Rendell and Thomson (1993) did
time on the stop-clock that was displayed promi-
not find any order effects when they had partici-
nently, and to indicate when a specified period of
pants repeating the week of time logging after an
time has passed. Henry et al. (2007) reported a split-
interval of a few weeks, and thus the same version of
half reliability for Virtual Week of .90 overall. This
the task was given in both Phase 1 and Phase 2, with
compares favorably with other measures of prospec-
the prescribed time schedule as follows: 8:20 a.m.,
tive memory, which have been found to be as low as
12:35 p.m., 4:10 p.m., and 8:55 p.m.
20% (Keleman, Weinberg, Alford, Mulvey, &
Kaeochinda, 2006; Schmidt, Berg, & Deelman, 2003).
Answers on Virtual Week were scored in the fol- RESULTS
lowing five categories: Correct scores indicated
that the target item was remembered at the correct Virtual Week
time; late items were remembered after the correct
time criterion but before the end of the virtual day; The proportion of correct prospective-memory
participants were marked wrong when they recalled responses are presented in Table 1 as a function of
 916 RENDELL AND HENRY

TABLE 1
Proportion of correct responses and different types of error on Virtual Week as a function of type of prospective-memory
task for the pregnant women and the nonpregnant controls

Regular Irregular Time-check

Pregnant Nonpregnant Pregnant Nonpregnant Pregnant Nonpregnant

M SD M SD M SD M SD M SD M SD

Correct responses .93 .07 .95 .05 .68 .14 .71 .13 .66 .28 .68 .24
Type of error
Late .03 .04 .03 .04 .03 .03 .03 .03 .21 .17 .19 .12
No content .00 .00 .00 .00 .08 .07 .10 .05 .00 .00 .00 .00
Wrong .02 .05 .00 .01 .03 .03 .03 .05 .01 .03 .02 .10
Missed .03 .03 .02 .02 .18 .12 .13 .09 .12 .24 .11 .21

Note. Regular, irregular, and time-check represent types of prospective-memory task.

pregnancy status (pregnant group, nonpregnant .60

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control group) and prospective-memory task Pregnant

(regular, irregular, time-check). These data were .50 Nonpregnant
analyzed with a 2 × 3 mixed analysis of variance
(ANOVA) with the between-subjects variable of Proportion Correct .40
pregnancy status and the within-subjects variable
of prospective-memory task. These two variables .30
did not significantly interact, F(2, 76) = 0.02, p >
.05, and there was no significant main effect of .20
pregnancy status, F(1, 38) = 0.46, p > .05; Cohen’s
.10
d = 0.22 (Cohen, 1988, defines effect sizes of 0.2 as
small, 0.5 as medium, and 0.8 as large) but there
.00
was a main effect of prospective-memory task, On-time Little late Later Missed
F(2, 76) = 33.91, p < .001.
Figure 1. Percentage of correct responses and different types of
Post hoc Tukey tests on the main effect for pro- error on the time-logging task for the pregnant women and the
spective-memory task revealed that participants nonpregnant controls (n = 20 in each group). Error bars rep-
made significantly more correct responses on regu- resent one standard error of the mean.
lar tasks (M = .94, SD = .06) than on both the
time-check task (M = .67, SD = . 26) and the irreg-
the two groups did not differ with regard to the
ular tasks (M = .69, SD = .14), and on both these
percentage of responses that were very late (>10
last two tasks participants did not significantly
minutes); F(1, 38) = 0.42, p = .52, d = 0.21, the
differ. Table 1 also shows the pattern of errors on
pregnant group had a significantly lower proportion
Virtual Week. For each of the error types (late, no
of responses that were on time, F(1, 38) = 8.22, p =
content, wrong, and missed) there was no main
.007, d = 0.93, or a little late (<11 minutes), F(1, 38)
effect of pregnancy status. Further, error type and
= 6.61, p = .014, d = 0.83, and missed a signifi-
pregnancy status did not significantly interact, and
cantly greater number of responses, F(1, 38) = 13.80,
it can be seen that for both groups the vast major-
p = .001, d = 1.21. Analyses of covariance
ity of the errors involved a failure to respond
(ANCOVAs) in which self-rating of sleep quality
(missed responses). Thus, the content of the
was covaried indicated that perceived sleep did not
prospective-memory tasks was nearly always either
account for any of these relationships, except for
remembered reasonably accurately or not remem-
the proportion of responses that were a little late,
bered at all.
which no longer differed significantly between
groups, F(1, 38) = 2.35, p = .134, d = 0.50. Analy-
Time-logging task sis of just those participants without children
revealed the same pattern of differences, with the
In Figure 1 the mean percentage of correct and exception of responses that were a little late. There
incorrect responses on the time-logging task are were no significant differences between the groups
presented as a function of pregnancy status (preg- for responses that were a little late, F(1, 26) = 2.49,
nant group, nonpregnant control group). Whilst p = .127, d = 0.62, as well as very late responses,

.60
Pregnant
.50
Postpartum
Proportion Correct
.40
.30
.20
.10
.00
On-time Little late Later
Figure 2. Percentage of correct responses and different types of
error on the time-logging task for the pregnant women during
pregnancy and postpartum (n = 15). Error bars represent one
standard error of the mean.
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F(1, 26) = 0.15, p = .702, d = 0.15. The pregnant
group had a lower proportion of responses on time,
F(1, 26) = 8.02, p = .009, d = 1.11, and greater
proportion of missed responses, F(1, 26) = 13.80,
p = .001, d = 1.46. These differences remained sig-
nificant after covarying for self ratings of sleep using
ANCOVA: on time, F(1, 25) = 11.19, p = .003,
d = 1.34; missed, F(1, 25) = 7.78, p = .01, d = 1.12.
In Figure 2 the same data are presented, but for
the pregnant women who took part both during
pregnancy and 13 months postpartum (n = 15). It
can be seen that relative to pregnant women,
women who are postpartum do not differ with
respect to their proportion of on-time responses,
F(1, 14) = 0.25, p = .626, d = 0.26. However, post-
partum women have substantially reduced the
proportion of missed responses, F(1, 14) = 14.41,
p = .002, d = 2.03, and instead were more often a little
late (<11 min), F(1, 14) = 4.85, p = .045, d = 1.18,
and very late (>11 min), F(1, 14) = 13.17, p = .003,
d = 1.94. However, postpartum women also rated
their sleep quality as being significantly better than
that during pregnancy, t(14) = 2.65, p = .019, d =
1.42. After covarying for differences in sleep qual-
ity, the effect of pregnancy status on the time-
logging task remained significant for missed
responses, F(1, 13) = 7.77, p = .015, d = 1.55, and
for very late responses, F(1, 13) = 8.26, p = .013,
d = 1.59, but not for responses that were a little
late, F(1, 13) = 1.17, p = .298, d = 0.60.
DISCUSSION
Summary of major findings
The results of this preliminary study indicate that
pregnancy is associated with increased difficulties in
PROSPECTIVE MEMORY AND PREGNANCY 917
implementing delayed intentions in daily life, but
that these difficulties may only manifest in everyday
life, and not in laboratory environments. Where def-
icits were observed, the nature of the difficulties
appeared to vary qualitatively during pregnancy
and postpartum; whilst pregnant women were on
time far less frequently and missed a larger propor-
tion of responses, following pregnancy fewer
responses were missed, but any responses that were
made were more likely to be late. Further, these def-
icits in prospective memory could not simply be
attributed to differences in perceived sleep quality.
Missed
Pregnant versus nonpregnant women
No differences were observed between pregnant and
nonpregnant women on the laboratory measure of
prospective memory (Virtual Week), irrespective of
the precise nature of the task demands (i.e., whether
tasks were regular or irregular, or involved time-
checks), suggesting that in controlled laboratory
conditions pregnancy does not affect the capacity to
implement delayed intentions. This failure to iden-
tify a difference between pregnant and nonpregnant
women on Virtual Week therefore contrasts with
the self-report data presented by Crawley (2002), in
which it was found that pregnant women differed
significantly from control participants who were
also undergoing a major life change (leaving home),
with significantly fewer pregnant women rating
their prospective memory as better than before.
However, although a limitation of Crawley’s (2002)
study was its reliance solely on self-reported cognitive
change, it is of interest that participants in this study
were presumably providing ratings of how their
prospective-memory performance had changed in
day-to-day life. Indeed, whilst the laboratory findings
involving Virtual Week failed to detect any difference
between pregnant and nonpregnant women, there was
a significant difference on the time-logging prospective
-memory task, with pregnant women being on time
far less frequently and missing a larger proportion of
responses. These results are important, as whilst find-
ing (or failing to find) a deficit in prospective memory
in laboratory settings is clearly of considerable
theoretical interest, of greater practical importance is
establishing whether the efficacy of prospective memory
is compromised in day-to-day life, and the present
data suggest that prospective-memory impairment
may be observed in day-to-day life.
Pregnancy versus postpartum
With regard to the within-subject comparisons of
women during pregnancy, and later during
 918 RENDELL AND HENRY
postpartum, at both time points the women per-
formed equally poorly on the time-logging task
with respect to the proportion of on-time
responses. However, the women at the two testing
phases did differ significantly in their pattern of
errors. Whilst the pregnant women missed a larger
proportion of responses at the postpartum stage
these women were less likely to forget entirely, but
to be late with their response. The disruption of
pregnancy in relation to errors therefore appears to
have more impact than the disruption associated
with postpartum, with responses more likely to be
missed completely by the pregnant women.
Limitations and future directions
A number of limitations of the present study need
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to be acknowledged and, in particular, the
repeated assessment of the time-logging task in the
pregnancy group only. Thus, it might be argued
that any changes (and, specifically, improvements)
observed are attributable to test–retest effects and
not the changing status from pregnancy to post-
partum. Whilst it is not possible to discount this
possibility, it is important to note that the general
pattern of change from pregnancy to postpartum
was not one of improvement (the proportion of on-
time responses was virtually identical across the
two assessment occasions) but, rather, change with
respect to the nature of the errors that were made.
Further, the test–retest interval in this study was
approximately 13 months. Rendell and Thompson
(1993) have shown no evidence of practice effects
on the time-logging task, even with a test–retest
interval of a much shorter duration (4 weeks).
However, another important limitation to the
present study that is more difficult to discount
relates to the issue of statistical power. Given the
relative lack of prior empirical research, it is diffi-
cult to predict the magnitude of anticipated effect
sizes for measures of prospective memory in this
population. However, it is informative to note that
pregnancy effects on retrospective memory have
been shown to be relatively small in magnitude.
Indeed, in a recent meta-analytic review of this lit-
erature, Henry and Rendell (2007) found that the
largest mean effect size (Cohen’s d) for any behav-
ioral measure of retrospective memory was 0.45
and hence qualified as an effect of only small to
moderate magnitude. In the present study the
effect size for the laboratory measure of prospec-
tive memory assessed in the present study was of a
small magnitude (d = 0.22), and thus insufficient
power may have contributed to the failure to iden-
tify a significant group effect on this measure.
However, whilst issues relating to power mean that
interpretation of null results in the present study need
to be relatively cautious (and, specifically, the absence
of pregnancy effects on the laboratory measure of
prospective memory), these data nevertheless provide
clear evidence of substantial difficulties in prospective
remembering in day-to-day life for women who are
pregnant and postpartum. Indeed, relative to the
healthy control group, pregnant women presented
with deficits on the naturalistic measure that were
large in magnitude (for four of the five dependent
measures, Cohen’s d was in excess of 0.80). These
data therefore suggest that prospective remembering
may be an aspect of cognitive performance that is
particularly disrupted for this population.
In conclusion, in a review of the pregnancy litera-
ture, Brett and Baxendale (2001) concluded that
almost invariably studies that have assessed subjec-
tive reports of cognitive change during pregnancy
find that women perceive their cognitive functioning
as being adversely affected, with estimates ranging
from 50 to 80% of participants tested, and noted
that “Forgetfulness and ‘a poor memory’ appear to
head the list of difficulties across these studies”
(p. 342). The present study provides preliminary evid-
ence suggesting that the magnitude of prospective-
memory impairment observed in laboratory settings
may underestimate the degree of impairment experi-
enced in day-to-day life. Further research is needed
to identify the mechanisms that underpin these diffi-
culties, as well as the extent to which these difficulties
have functional consequences.
Original manuscript received 8 August 2007
Revised manuscript accepted 17 December 2007
First published online 14 March 2008
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