|
1
|
Sarantaki A, Nomikou A, Tzimourta K, Orovou E, Gourounti K, Barbounaki S. Fuzzy‑set qualitative comparative analysis and fuzzy cognitive maps: Exploring pregnancy outcomes and maternal depression. MEDICINE INTERNATIONAL 2025; 5:30. [PMID: 40230503 PMCID: PMC11995386 DOI: 10.3892/mi.2025.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2024] [Accepted: 03/10/2025] [Indexed: 04/16/2025]
Abstract
The maternal antenatal attachment scale (MAAS), the pregnancy outcome questionnaire (POQ) and the Centre for Epidemiologic Studies Depression Scale (CESD), among other approaches, have been developed to address pregnancy-related psychological issues. However, the need to develop and validate effective scales to screen the complex experiences of pregnant women continues to be extensively discussed in the literature. The aim of the present study was to build and validate fuzzy models that represent the necessary and sufficient causal combinations that lead to higher levels of anxiety regarding pregnancy outcomes, maternal prenatal attachment to the unborn child and depressive symptoms, respectively. For this purpose, measurements from the MAAS, POQ and CESD scales, along with demographic data, were collected from 135 pregnant women, including cases of natural conception (NC) and assisted reproduction (ART) births. Fuzzy-set qualitative comparative analysis (FSQCA) was employed to produce sets of causal combinations, which were validated against their consistency and coverage. These combinations were then used to develop and validate fuzzy cognitive maps (FCMs) to model the fluctuations in the status of pregnant women. To the best of our knowledge, the present study is the first to utilize FSQCA or FCM to address this issue. The results indicated that the POQ was the distinguishing factor between NC and ART that led to higher MAAS levels. Marital status (MS) and state anxiety were found to lead to higher POQ levels for pregnancies derived from NC. For pregnancies following ART, the factors to consider include income, week of pregnancy, MS, MAAS intensity and trait anxiety. POQ was found to lead to higher levels of CESD for ART pregnancies, while NC, MS and state anxiety are also prerequisites. On the whole, the present study demonstrates that the proposed FSQCA- and FCM-based approach enables obstetricians and midwives to incorporate their expertise in evaluating cases on an individual basis, while also providing a framework for creating intelligent systems to support healthcare policy decisions.
Collapse
Affiliation(s)
- Antigoni Sarantaki
- Midwifery Department, Faculty of Health and Care Sciences, University of West Attica, 12243 Athens, Greece
| | - Anastasia Nomikou
- Midwifery Department, Faculty of Health and Care Sciences, University of West Attica, 12243 Athens, Greece
| | - Katerina Tzimourta
- Biomedical Technology and Digital Health Laboratory, Department of Electrical and Computer Engineering, Faculty of Engineering, University of Western Macedonia, 50100 Kozani, Greece
| | - Eirini Orovou
- Midwifery Department, University of Western Macedonia, 50100 Kozani, Greece
| | - Kleanthi Gourounti
- Midwifery Department, Faculty of Health and Care Sciences, University of West Attica, 12243 Athens, Greece
| | | |
Collapse
|
|
2
|
Navon-Eyal M, Taubman-Ben-Ari O. Psychological Well-being during Pregnancy: The Contribution of Stress Factors and Maternal-Fetal Bonding. J Reprod Infant Psychol 2025; 43:47-61. [PMID: 37294055 DOI: 10.1080/02646838.2023.2222143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/01/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Pregnancy and anticipation of the birth of the first child is considered a happy and exciting time. However, the stress involved in pregnancy has been found to put women at greater risk of impaired psychological well-being, or higher distress. Confusion in the theoretical literature between the terms 'stress' and 'distress' makes it difficult to understand the underlying mechanism that may enhance or reduce psychological well-being. We suggest that maintaining this theoretical distinction and examining stress from different sources, may allow us to gain new knowledge regarding the psychological well-being of pregnant women. OBJECTIVE Drawing on the Calming Cycle Theory, to examine a moderated mediation model for the explanation of the dynamic between two stress factors (COVID-19-related anxiety and pregnancy stress) that may pose a risk to psychological well-being, as well as the protective role of maternal-fetal bonding. METHODS The sample consisted of 1,378 pregnant women who were expecting their first child, recruited through social media and completed self-report questionnaires. RESULTS The higher the COVID-19-related anxiety, the higher the pregnancy stress, which, in turn, was associated with lower psychological well-being. However, this effect was weaker among women who reported greater maternal-fetal bonding. CONCLUSION The study expands knowledge of the dynamic between stress factors and psychological well-being during pregnancy, and sheds light on the unexplored role of maternal-fetal bonding as a protective factor against stress.
Collapse
Affiliation(s)
- Meital Navon-Eyal
- The Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University, Ramat Gan, Israel
| | - Orit Taubman-Ben-Ari
- The Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University, Ramat Gan, Israel
| |
Collapse
|
|
3
|
Lehnig F, Linde K, Schmidt V, Nagl M, Martini J, Stepan H, Kersting A. Reliability and validity of the original and brief German version of the Maternal Antenatal Attachment Scale (MAAS): Longitudinal study findings. PLoS One 2024; 19:e0316374. [PMID: 39739751 DOI: 10.1371/journal.pone.0316374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Accepted: 12/10/2024] [Indexed: 01/02/2025] Open
Abstract
BACKGROUND Maternal-foetal attachment (MFA) seems essential for adapting to motherhood and the healthy development of the child, with direct implications for clinical practice. It is often assessed using the Maternal Antenatal Attachment Scale (MAAS), which covers two dimensions: quality and intensity of attachment. However, studies including the MAAS presented missing or inadequate psychometric properties. Therefore, the current study aimed to investigate the reliability and validity of both the original and the recently introduced brief German version of the MAAS. MATERIALS AND METHODS Data from 184 pregnant women from a longitudinal study were used. Women (≥ 18 years old) were recruited between the 18th and 22nd weeks of gestation while waiting for routine prenatal diagnostic appointments. Participants answered the MAAS, together with other questionnaires measuring maternal mental health, self-esteem, and social support. For both versions of the MAAS (19 items vs. 13 items), item characteristics, confirmatory factor analysis, internal consistency, and test-retest reliability were calculated and compared. Moreover, associations between the brief German MAAS and theoretically related constructs were analysed using correlation coefficients. RESULTS In this study, item analyses revealed better psychometric properties for the brief German MAAS than for the original MAAS, with a significant reduction in items with inadequate discriminatory power. The internal consistency (α ≥ .69) and test-retest reliability (ICC ≥ .62) were acceptable to good for both MAAS versions. With regard to structural validity, factor analysis of the German MAAS presented acceptable to good global model fit indices for the model with correlated factors (GFI > .90; RMSEA ≤ .08; SRMR < .10) in the current sample. In contrast, most global model fit indices of the original MAAS were not acceptable. The construct validity of the German MAAS was demonstrated on the basis of small-to-moderate correlations with a variety of constructs (e.g., measures of depression, anxiety, stress). CONCLUSIONS According to the present results, the brief German version of the MAAS represents a reliable and valid measurement instrument of MFA for use in clinical practice. Further studies examining possible cut-off values are needed to identify pregnant women with significant attachment difficulties who may benefit from additional support.
Collapse
Affiliation(s)
- Franziska Lehnig
- IFB AdiposityDiseases, Leipzig University Medical Center, Leipzig, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Katja Linde
- IFB AdiposityDiseases, Leipzig University Medical Center, Leipzig, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Viktoria Schmidt
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Michaela Nagl
- IFB AdiposityDiseases, Leipzig University Medical Center, Leipzig, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Julia Martini
- Faculty of Medicine, Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Holger Stepan
- Department of Obstetrics, University of Leipzig, Leipzig, Germany
| | - Anette Kersting
- IFB AdiposityDiseases, Leipzig University Medical Center, Leipzig, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| |
Collapse
|
|
4
|
Letot J, Devouche E, Audic M, Paul A, Wendland J. Exploring the psychometric qualities of prenatal attachment inventory in France. L'ENCEPHALE 2024; 50:616-622. [PMID: 38311487 DOI: 10.1016/j.encep.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 10/20/2023] [Accepted: 11/06/2023] [Indexed: 02/06/2024]
Abstract
OBJECTIVES The aim of the study was to explore the structure of the Prenatal Attachment Inventory (PAI) on a French sample of pregnant women. METHODS Three hundred and nine pregnant women were recruited in gynecology-obstetrics departments and on social networks. To be included, women had to be pregnant, aged between 18 and 45 years old, and not have somatic complications of pregnancy. The women completed a questionnaire including questions on sociodemographic information, and the PAI. The structure of PAI was explored with an exploratory structural equation model (ESEM). RESULTS Three factorial solutions were explored: two-, three- and four-factor. The 2-factor solution was excluded due to its CFI, TLI and RMSEA indexes, which were lower than the reference values. The choice between the 3- and 4-factor solutions was made according to the clinical meaning of the items included in the factors. The 3-factor solution was retained with the factors: "current and future representations of the baby", "maternal-fetal relationship", and "proprioceptive feeling". The scale had good internal consistency. CONCLUSIONS The PAI is the first standardized multidimensional assessment tool for maternal-fetal attachment in the French language. In view of the results obtained, this tool can be disseminated and used by professionals in perinatal care.
Collapse
Affiliation(s)
- Jessica Letot
- Laboratoire de Psychopathologie et Processus de Santé, Université Paris-Cité, 92100 Boulogne-Billancourt, France; Équipe mobile d'intervention précoce périnatale, service de psychiatrie de l'enfant et de l'adolescent, CHU Pitié-Salpêtrière, 75013 Paris, France.
| | - Emmanuel Devouche
- Laboratoire de Psychopathologie et Processus de Santé, Université Paris-Cité, 92100 Boulogne-Billancourt, France; Laboratoire de recherche en pédopsychiatrie, groupe hospitalier du Havre, Le Havre, France
| | - Mélina Audic
- Laboratoire de Psychopathologie et Processus de Santé, Université Paris-Cité, 92100 Boulogne-Billancourt, France
| | - Amélie Paul
- Laboratoire de Psychopathologie et Processus de Santé, Université Paris-Cité, 92100 Boulogne-Billancourt, France
| | - Jaqueline Wendland
- Laboratoire de Psychopathologie et Processus de Santé, Université Paris-Cité, 92100 Boulogne-Billancourt, France; Unité petite enfance et parentalité Vivaldi, CHU Pitié-Salpêtrière, 28, allée Vivaldi, 75012 Paris, France
| |
Collapse
|
|
5
|
Infurna MR, Fazio L, Bevacqua E, Costanzo G, Falgares G, Maiorana A, Giannone F, Antonucci LA. Understanding the relationship between childhood emotional abuse and neglect and psychological distress in pregnant women: the role of prenatal attachment. BMC Psychol 2024; 12:520. [PMID: 39354645 PMCID: PMC11443666 DOI: 10.1186/s40359-024-02024-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 09/20/2024] [Indexed: 10/03/2024] Open
Abstract
BACKGROUND Childhood abuse and neglect pose important risk factors for the development of psychopathology during pregnancy. However, only a few studies have assessed the effects of a specific type of abuse during the perinatal period, namely, psychological maltreatment, which includes emotional abuse and neglect. These studies have found that women who have experienced psychological maltreatment exhibit higher levels of antenatal depressive symptoms and greater difficulties forming attachment with their babies than women who have not experienced this kind of adversity. The aim of this study was to examine how emotional abuse and neglect experiences may favor the occurrence of psychological distress in pregnant women, and whether prenatal attachment might explain this association. METHODS Participants comprised 128 Italian pregnant women ranging in age from 21 to 46 years (Mage = 33.4; SD = 6.10). Women responded to the following self-report instruments: CECA.Q and CTQ-SF, for the assessment of psychological maltreatment experiences; MAAS, for the evaluation of prenatal attachment; and PAMA, for the assessment of perinatal psychological distress. RESULTS Pearson correlations revealed a positive association between childhood neglect and perinatal psychological distress and a negative association between childhood neglect and prenatal attachment scores. No significant correlations were found for emotional abuse. Perinatal psychological distress was negatively associated with prenatal attachment. Mediation analyses showed significant associations between childhood neglect and the dimensions of perinatal affectivity and prenatal maternal attachment. Prenatal maternal attachment mediated the relationship between neglect and perinatal psychological distress. CONCLUSIONS The transition to motherhood is a sensitive period, particularly for women who have experienced abuse and neglect during childhood. These experiences may negatively impact a woman's disposition to emotionally and behaviorally engage in the formation of a bond with their unborn baby. These results may have important prevention and clinical implications and thus warrant further exploration.
Collapse
Affiliation(s)
- Maria Rita Infurna
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy.
| | - Leonardo Fazio
- Department of Medicine and Surgery, LUM University 'Giuseppe Degennaro', Casamassima, Bari, Italy
| | - Eleonora Bevacqua
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Giulia Costanzo
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Giorgio Falgares
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Antonio Maiorana
- HCU Obstetrics and Gynecology, ARNAS Civico Di Cristina-Benfratelli Hospital, Palermo, Italy
| | - Francesca Giannone
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | | |
Collapse
|
|
6
|
Mangialavori S, Fontana A, Terrone G, Topino E, Trani L, Trincia V, Lisi G, Ducci G, Cacioppo M. Maternal Perinatal Depression, Alexithymia, and Couple Functioning: Which Relationship Exists with Prenatal Attachment. Behav Sci (Basel) 2024; 14:773. [PMID: 39335988 PMCID: PMC11428927 DOI: 10.3390/bs14090773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 08/27/2024] [Accepted: 08/28/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Prenatal attachment refers to the affective investment that parents develop towards their unborn baby during pregnancy. Studies have identified depressive symptoms, affect dysregulation, and poor marital adjustment as potential risk factors for poor prenatal attachment. However, no research has concurrently examined these factors. This study aims to explore the simultaneous impact of depressive symptomatology, alexithymia, and couple functioning on prenatal attachment to develop a more comprehensive understanding of the factors shaping the emotional bond between expectant mothers and their fetuses. METHODS This cross-sectional study involved 344 women (mean age = 34.1, SD = 4.6) in their last trimester of pregnancy recruited from the National Health System. The participants completed the Edinburgh Postnatal Depression Scale, the Twenty-Item Toronto Alexithymia Scale, the Dyadic Adjustment Scale, and the Maternal Antenatal Attachment Scale. RESULTS Regression analyses indicated that perinatal depression and alexithymia negatively affected the Quality of Prenatal Attachment, while Dyadic Cohesion served as a protective factor. CONCLUSIONS The results emphasize the need for early identification of perinatal depression and alexithymia, along with targeted interventions aimed at supporting Dyadic Cohesion during pregnancy. These efforts are crucial for fostering positive prenatal attachment and enhancing maternal mental health.
Collapse
Affiliation(s)
- Sonia Mangialavori
- Department of Pathophysiology and Transplantation, University of Milano, 20122 Milan, Italy
| | - Andrea Fontana
- Department of Human Science, Libera Università Maria Santissima Assunta, LUMSA, 00193 Rome, Italy
| | - Grazia Terrone
- Department of History, Cultural Heritage, Education and Society, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Eleonora Topino
- Department of Human Science, Libera Università Maria Santissima Assunta, LUMSA, 00193 Rome, Italy
| | - Lucrezia Trani
- Department of Human Science, Libera Università Maria Santissima Assunta, LUMSA, 00193 Rome, Italy
| | | | - Giulia Lisi
- Department of Mental Health, ASL Roma 1, 00135 Rome, Italy
| | - Giuseppe Ducci
- Department of Mental Health, ASL Roma 1, 00135 Rome, Italy
| | - Marco Cacioppo
- Department of Human Science, Libera Università Maria Santissima Assunta, LUMSA, 00193 Rome, Italy
| |
Collapse
|
|
7
|
Bjertrup AJ, Kofoed J, Egmose I, Wendelboe K, Southgate V, Væver MS, Miskowiak KW. Prenatal affective cognitive training to reduce the risk of postpartum depression (PACT): study protocol for a randomized controlled trial. Trials 2024; 25:478. [PMID: 39010232 PMCID: PMC11247870 DOI: 10.1186/s13063-024-08316-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 07/03/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Postpartum depression (PPD) affects 30-50% of women with a history of previous depression or bipolar disorder and 8% of women with no history of depression. Negative cognitive biases in the perception of infant cues and difficulties with emotion regulation are replicated risk factors. Current interventions focus on detecting and treating rather than preventing PPD. The aim of this randomized controlled intervention trial is therefore to investigate the potential prophylactic effects of prenatal affective cognitive training for pregnant women at heightened risk of PPD. METHODS The study will enrol a total of 292 pregnant women: 146 at high risk and 146 at low risk of PPD. Participants undergo comprehensive assessments of affective cognitive processing, clinical depressive symptoms, and complete questionnaires at baseline. Based on the responses, pregnant women will be categorized as either at high or low risk of PPD. High-risk participants will be randomized to either prenatal affective cognitive training (PACT) or care as usual (CAU) immediately after the baseline testing. The PACT intervention is based on emerging evidence for efficacy of affective cognitive training approaches in depression, including cognitive bias modification, attention bias modification, mindfulness-inspired emotion regulation exercises, and working memory training. Participants randomised to PACT will complete five individual computerised and virtual reality-based training sessions over 5 weeks. The primary outcome is the difference between intervention arms in the incidence of PPD, assessed with an interview 6 months after birth. We will also assess the severity of depressive symptoms, rated weekly online during the first 6 weeks postpartum. DISCUSSION The results will have implications for future early prophylactic interventions for pregnant women at heightened risk of PPD. If the PACT intervention reduces the incidence of PPD, it can become a feasible, non-invasive prophylactic strategy during pregnancy, with positive mental health implications for these women and their children. TRIAL REGISTRATION ClinicalTrials.gov NCT06046456 registered 21-09-2023, updated 08-07-2024.
Collapse
Affiliation(s)
- Anne J Bjertrup
- The Neurocognition and Emotion in Affective Disorders Centre (NEAD), Psychiatric Centre Copenhagen, Mental Health Services in the Capital Region of Denmark, Frederiksberg, Denmark.
| | - Jeanne Kofoed
- The Neurocognition and Emotion in Affective Disorders Centre (NEAD), Psychiatric Centre Copenhagen, Mental Health Services in the Capital Region of Denmark, Frederiksberg, Denmark
| | - Ida Egmose
- Department of Psychology, Faculty of Social Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Katrine Wendelboe
- Department of Psychology, Faculty of Social Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Victoria Southgate
- Department of Psychology, Faculty of Social Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mette S Væver
- Department of Psychology, Faculty of Social Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kamilla W Miskowiak
- The Neurocognition and Emotion in Affective Disorders Centre (NEAD), Psychiatric Centre Copenhagen, Mental Health Services in the Capital Region of Denmark, Frederiksberg, Denmark
- Department of Psychology, Faculty of Social Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
|
8
|
Carvalho Hilje C, Bauer NH, Reis D, Kapp C, Ostermann T, Vöhler F, Längler A. The role of breastfeeding and formula feeding regarding depressive symptoms and an impaired mother child bonding. Sci Rep 2024; 14:11417. [PMID: 38763963 PMCID: PMC11102907 DOI: 10.1038/s41598-024-62168-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 05/14/2024] [Indexed: 05/21/2024] Open
Abstract
Associations between depressive symptoms and breastfeeding are well documented. However, evidence is lacking for subdivisions of feeding styles, namely exclusive breastfeeding, exclusive formula feeding and a mixed feeding style (breastfeeding and formula feeding). In addition, studies examining associations between mother-child-bonding and breastfeeding have yielded mixed results. The aim of this study is to provide a more profound understanding of the different feeding styles and their associations with maternal mental health and mother-child-bonding. Data from 307 women were collected longitudinally in person (prenatally) and by telephone (3 months postnatally) using validated self-report measures, and analyzed using correlational analyses, unpaired group comparisons and regression analyses. Our results from a multinomial regression analysis revealed that impaired mother-child-bonding was positively associated with mixed feeding style (p = .003) and depressive symptoms prenatal were positively associated with exclusive formula feeding (p = .013). Further studies could investigate whether information about the underlying reasons we found for mixed feeding, such as insufficient weight gain of the child or the feeling that the child is unsatiated, could help prevent impaired mother-child-bonding. Overall, the results of this study have promising new implications for research and practice, regarding at-risk populations and implications for preventive measures regarding postpartum depression and an impaired mother-child-bonding.
Collapse
Affiliation(s)
- Clara Carvalho Hilje
- Department of Pediatrics, Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany
- Professorship for Integrative Pediatrics, Institute for Integrative Medicine, Witten/Herdecke University, Witten, Germany
| | - Nicola H Bauer
- Institute of Midwifery Science, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Daniela Reis
- Department of Pediatrics, Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany.
- Professorship for Integrative Pediatrics, Institute for Integrative Medicine, Witten/Herdecke University, Witten, Germany.
| | - Claudia Kapp
- Department of Psychology and Psychotherapy, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Thomas Ostermann
- Department of Psychology and Psychotherapy, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Franziska Vöhler
- Department of Obstetrics, Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany
| | - Alfred Längler
- Department of Pediatrics, Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany
- Professorship for Integrative Pediatrics, Institute for Integrative Medicine, Witten/Herdecke University, Witten, Germany
| |
Collapse
|
|
9
|
Grisbrook MA, Dewey D, Cuthbert C, McDonald S, Ntanda H, Letourneau N. The Association between Cesarean Section Delivery and Child Behavior: Is It Mediated by Maternal Post-Traumatic Stress Disorder and Maternal Postpartum Depression? Behav Sci (Basel) 2024; 14:61. [PMID: 38247713 PMCID: PMC10813011 DOI: 10.3390/bs14010061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/28/2023] [Accepted: 01/13/2024] [Indexed: 01/23/2024] Open
Abstract
Cesarean sections (C-sections) account for up to 21% of births worldwide. Studies have linked delivery via C-section with an increased risk of child behavior problems, such as internalizing and externalizing behaviors. Maternal postpartum depression (PPD) is also linked to child behavioral problems and may play a mediating role in the association between the mode of delivery and child behavior. Mixed findings between mode of delivery and PPD may be due to a failure to distinguish between C-section types, as unplanned/emergency C-sections are linked to post-traumatic stress disorder (PTSD), which has been linked to PPD. The objectives of this study were to determine whether, (1) compared with spontaneous vaginal delivery (SVD) and planned C-section, unplanned/emergency C-sections are associated with increased child behavior problems at two to three years of age and (2) maternal PTSD and PPD mediate the association between delivery type and child behavior problems. A secondary data analysis was conducted on 938 mother-child dyads enrolled in the Alberta Pregnancy Outcomes and Nutrition (APrON) study. Conditional process modeling was employed. Child behavior was assessed using the Child Behavior Checklist (CBCL) 1.5-5 years, and maternal PPD and PTSD were assessed using the Edinburgh Postnatal Depression Scale (EPDS) and the Psychiatric Diagnostic Screening Questionnaire (PDSQ), respectively. No associations were found between delivery type and child behaviors; however, the indirect effect of emergency C-section on child behaviors was significant via the mediating pathway of maternal PTSD on PPD symptoms.
Collapse
Affiliation(s)
- Marie-Andrée Grisbrook
- Faculty of Nursing, University of Calgary, Calgary, AB T2N 4N1, Canada; (M.-A.G.); (C.C.)
| | - Deborah Dewey
- Alberta Children’s Hospital Research Institute, Owerko Centre, Calgary, AB T2N 1N4, Canada; (D.D.); (H.N.)
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada;
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Colleen Cuthbert
- Faculty of Nursing, University of Calgary, Calgary, AB T2N 4N1, Canada; (M.-A.G.); (C.C.)
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada;
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Sheila McDonald
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada;
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Henry Ntanda
- Alberta Children’s Hospital Research Institute, Owerko Centre, Calgary, AB T2N 1N4, Canada; (D.D.); (H.N.)
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Nicole Letourneau
- Faculty of Nursing, University of Calgary, Calgary, AB T2N 4N1, Canada; (M.-A.G.); (C.C.)
- Alberta Children’s Hospital Research Institute, Owerko Centre, Calgary, AB T2N 1N4, Canada; (D.D.); (H.N.)
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada;
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| |
Collapse
|
|
10
|
Navon-Eyal M, Taubman-Ben-Ari O. Emotional and relational protective factors during pregnancy and psychological well-being and personal growth after childbirth. J Reprod Infant Psychol 2023:1-15. [PMID: 37982409 DOI: 10.1080/02646838.2023.2284290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/11/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Studies in the perinatal literature tend to focus on potential negative outcomes, but little attention has been paid to the protective factors that may be associated with better psychological well-being or positive mental changes, such as personal growth. OBJECTIVE Drawing on the Broaden and Build Theory of Positive Emotions, the study employed a prospective design and a sequential mediation model to examine the mechanism by which protective factors during pregnancy (dispositional gratitude, perceived relationship quality with the partner, perceived maternal-foetal bonding) may be associated, in sequence, with higher psychological well-being and personal growth after childbirth among first-time mothers. METHODS The sample consisted of 515 women who were recruited through social media and completed questionnaires in two phases: Time 1, during the second half of their pregnancy; and Time 2, around 12 weeks after the birth of their first baby. RESULTS Results show that gratitude was associated with higher perceived relationship quality during pregnancy, which was associated with higher maternal-foetal bonding, which in turn was associated with higher psychological well-being and personal growth after childbirth. The indirect effects were significant. CONCLUSION The study expands knowledge of positive outcomes in the transition to motherhood, and demonstrates that positive emotions, such as gratitude, may be the first link in the chain of factors predicting better outcomes from pregnancy to childbirth.
Collapse
Affiliation(s)
- Meital Navon-Eyal
- The Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University, Ramat Gan, Israel
| | - Orit Taubman-Ben-Ari
- The Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University, Ramat Gan, Israel
| |
Collapse
|
|
11
|
Karapanos I, Bolou A, Nazer M, Iliodromiti S, Greco E. Strategies to communicate pregnancy complications: a systematic review and practical points for healthcare professionals. Curr Opin Obstet Gynecol 2023; 35:411-419. [PMID: 37560805 DOI: 10.1097/gco.0000000000000899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
PURPOSE/METHODS This systematic review aims to provide an overview of strategies available for healthcare professionals (HCPs) to effectively communicate unexpected news in pregnancy, specifically for the most common pregnancy complications. Three medical databases and grey literature were searched until March 2023 using subject headings and keywords. Snowball techniques were also used. The articles were reviewed at each stage of screening independently by two separate authors. Qualitative, quantitative and mixed methods studies were included. RECENT FINDINGS Forty-three studies were included and grouped according to the gestational age of the pregnancy complication - miscarriage, increased risk screening, foetal conditions, stillbirth. The main key points for communication were outlined at each specific complication and eventually the six common themes that emerged from all the categories were included in the acronym PRICES (Preparation - Referral - Individualized care - Clarity - Empowerment - Sensitivity). SUMMARY Given the negative impact of failed communications both in pregnancy outcomes and patients' experience, we advocate that communication training for HCP providing pregnancy care should be mandatory, and skills should be updated at regular intervals. Tools like our acronym PRICES can be used during teaching HCPs how to communicate more effectively.
Collapse
Affiliation(s)
- Ioannis Karapanos
- Women's Health Research Unit, Wolfson Institute of Population Health Sciences, Queen Mary University of London, Barts and The London School of Medicine and Dentistry
| | - Angeliki Bolou
- Women's Health Research Unit, Wolfson Institute of Population Health Sciences, Queen Mary University of London, Barts and The London School of Medicine and Dentistry
- School of Health Sciences, Institute for Lifecourse Development: Centre for Chronic Illness and Ageing, Faculty of Education, Health & Human Sciences, University of Greenwich
| | - Maya Nazer
- Queen Mary University of London Barts and The London School of Medicine and Dentistry, London, UK
| | - Stamatina Iliodromiti
- Women's Health Research Unit, Wolfson Institute of Population Health Sciences, Queen Mary University of London, Barts and The London School of Medicine and Dentistry
| | - Elena Greco
- Women's Health Research Unit, Wolfson Institute of Population Health Sciences, Queen Mary University of London, Barts and The London School of Medicine and Dentistry
| |
Collapse
|
|
12
|
Saravanan V, Desai G, Satyanarayana VA. Antenatal predictors of postnatal maternal attachment and competence after assisted conception-a prospective cohort study in South India. Arch Womens Ment Health 2023:10.1007/s00737-023-01340-1. [PMID: 37393349 DOI: 10.1007/s00737-023-01340-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/17/2023] [Indexed: 07/03/2023]
Abstract
The aim of this study is to examine the influence of antenatal factors such as anxiety, depression, perceived stress, marital satisfaction, maternal antenatal attachment, and social support on postnatal maternal attachment and competence in women who received assisted reproductive treatment. A prospective longitudinal cohort design was adopted with two groups-50 women who received assisted reproductive treatment and 50 women who had natural conception. Both the groups were assessed using self-report measures over three time points: T1, 7th month of pregnancy; T2, 2 weeks postpartum; and T3, 3 months postpartum. A final sample of 44 women who had assisted conception and 47 women who had natural conception completed assessments across all three time points. Descriptive, bivariate analyses, and stepwise multiple linear regression analyses were carried out. In the assisted conception group, maternal antenatal attachment, depression, and marital satisfaction significantly predicted postnatal maternal-infant attachment. Perceived social support, depression, and duration of marriage significantly predicted postnatal maternal competence. In the naturally conceived group, maternal antenatal attachment and social support significantly predicted postnatal maternal-infant attachment; perceived stress significantly predicted postnatal maternal competence. Antenatal depressive symptoms and relational factors significantly influenced postnatal maternal attachment and competence highlighting the need for screening and targeted psychological interventions during pregnancy.
Collapse
Affiliation(s)
- Vaishalee Saravanan
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bangalore, 560029, Karnataka, India
| | - Geetha Desai
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Veena A Satyanarayana
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bangalore, 560029, Karnataka, India.
| |
Collapse
|
|
13
|
Wendland J, Galli L, Benarous X. Prenatal attachment in women with twin versus singleton pregnancy: Socio-demographic, mental health and pregnancy-related predictors. Early Hum Dev 2023; 182:105789. [PMID: 37207472 DOI: 10.1016/j.earlhumdev.2023.105789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/24/2023] [Accepted: 05/04/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND While twin pregnancy (TP) is associated with increased maternal physical and psychological risks, little is known about how this context interferes with prenatal attachment. AIMS To compare the level of prenatal attachment between women with TP and singleton pregnancy (SP), and to investigate socio-demographic, maternal mental health and pregnancy-related predictors. STUDY DESIGN Case-control study in a university hospital. SUBJECTS 119 women with TP during their last trimester of pregnancy versus 103 women with SP. OUTCOME MEASURES The Prenatal Attachment Inventory (PAI), the Edinburgh Postnatal Depression Scale (EPDS), in addition to the collection of general socio-demographic and medical data. RESULTS The mean PAI total score did not significantly differ between the two groups. In the group of women with TP, low but statistically significant correlations were found between the PAI total score and the EPDS total score (r = -0.21) and with maternal age (r = -0.20). CONCLUSIONS No major difference in prenatal attachment was found in women TP compared to those with SP. A higher level of depressive symptoms is worth considering to explore the risk of suboptimal attachment in this population. Questions were raised about the applicability of usual measures of prenatal attachment in this context.
Collapse
Affiliation(s)
- Jaqueline Wendland
- Psychopathology and Health Processes Laboratory, Institute of Psychology, Cité Paris University, Paris, France; Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière University Hospital, APHP, Paris, France
| | - Lea Galli
- Psychopathology and Health Processes Laboratory, Institute of Psychology, Cité Paris University, Paris, France
| | - Xavier Benarous
- Department of Child and Adolescent Psychopathology, Amiens University Hospital, Amiens, France; INSERM Unit U1105 Research Group for Analysis of the Multimodal Cerebral Function, University of Picardy Jules Verne (UPJV), Amiens, France.
| |
Collapse
|
|
14
|
Kawamura E, Asano M. Changes, differences, and factors of parenthood in high-risk pregnant women and their partners in Japan. BMC Pregnancy Childbirth 2023; 23:205. [PMID: 36964602 PMCID: PMC10037369 DOI: 10.1186/s12884-023-05519-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/14/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Various stressors exists for pregnant women worldwide, especially negative social and environmental influences that can increase the number of high-risk pregnant women. These may cause a difficult transition to parenthood for women and their partners. However, limited studies have focused on and examined parenthood. Therefore, this study aimed to identify the changes in parenthood from pregnancy to post-discharge after childbirth among high-risk pregnant women and their partners, as well as the presence or absence of gender differences and the factors associated with parenthood. METHODS This longitudinal quantitative study used a self-administered anonymous questionnaire distributed among 127 pregnant women and their partners who visited a high-risk pregnant outpatient clinic. The Scale of Early Childrearing Parenthood (SECP; three subareas, 33 items) was administered thrice: during pregnancy (T1), after childbirth (T2), and after discharge (T3). RESULTS The analysis included 85 T1 (37 fathers and 48 mothers), 36 T2 (13 fathers and 23 mothers), and 31 T3 (11 fathers and 20 mothers) responses. There was a significant increase in the SECP scores for both parents from T1 to T3. Mothers had a greater increase in the SECP scores from T1 to T2 than fathers. In addition, fathers' mean SECP scores at T1 and T2 were higher compared with those of the mothers. Mothers' and fathers' SECP scores at each time point showed no significant differences. At all time points, the SECP scores were commonly and significantly associated with infertility treatment, physical and mental condition, postpartum depression at T2, and parenting stress at T3. CONCLUSIONS Because parenthood in the infertility treatment group was significantly higher throughout the series, we need to support such couples so that childbirth does not become their main goal. We suggest interventions for factors that impede parenthood development, understand the various backgrounds of the parents, and support the couple individually while also considering them as a unit.
Collapse
Affiliation(s)
- Eriko Kawamura
- Nagoya University Graduate School of Medicine, 1-1-20 Daiko Minami, Higashi-Ku, Nagoya, Aichi, 461-8673, Japan.
| | - Midori Asano
- Nagoya University Graduate School of Medicine, 1-1-20 Daiko Minami, Higashi-Ku, Nagoya, Aichi, 461-8673, Japan
| |
Collapse
|
|
15
|
Bay H, Akyüz MD, Hadımlı AP, Kazandi M. Prenatal attachment, foetal health locus of control and influencing factors in pregnancy. Int J Nurs Pract 2023; 29:e13132. [PMID: 36642418 DOI: 10.1111/ijn.13132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 08/19/2022] [Accepted: 12/29/2022] [Indexed: 01/17/2023]
Abstract
AIM The aim of this study was to determine prenatal attachment and foetal health locus of control in pregnant women and factors affecting these parameters. METHODS This cross-sectional study was conducted with 156 pregnant women (77 low-risk and 79 high-risk pregnancies). The study was carried out between August 2015 and February 2016. The data collection instruments included a Participant Information Form, the Prenatal Attachment Inventory and the Foetal Health Locus of Control Scale. RESULTS Pregnant women's education and foetal health locus of control levels had positive and significant effects on prenatal attachment, and education had an effect on foetal health locus of control. Foetal health locus of control explained 6.3% of the total variance in prenatal attachment levels. CONCLUSION As the educational statuses of pregnant women affected their prenatal attachment and foetal health locus of control, information, counselling and care should be prioritized for women with low education levels, in line with their needs. This is particularly important in terms of improving the control of pregnant women with lower prenatal attachment levels or internal locus of control over foetal health.
Collapse
Affiliation(s)
- Habibe Bay
- Faculty of Health Sciences, Department of Midwifery, Selcuk University, Konya, Turkey
| | | | - Aytül Pelik Hadımlı
- Faculty of Health Sciences, Department of Midwifery, Ege University, Izmir, Turkey
| | - Mert Kazandi
- Faculty of Medicine, Department of Gynecology and Obstetrics, Ege University, İzmir, Turkey
| |
Collapse
|
|
16
|
Tohme P, Abi-Habib R, Nassar E, Hamed N, Abou-Ghannam G, Chalouhi GE. The Psychological Impact of the COVID-19 Outbreak on Pregnancy and Mother-infant Prenatal Bonding. Matern Child Health J 2022; 26:2221-2227. [PMID: 35972590 PMCID: PMC9379892 DOI: 10.1007/s10995-022-03464-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 11/25/2022]
Abstract
This study aimed to assess the impact of the COVID-19 stress and anxiety on prenatal attachment during the second trimester of gestation. Pregnancy is an important stage for mothers-to-be in creating representations of themselves as a "mother", with the developing attachment relationship to the unborn child considered as a milestone in the future parent's developmental trajectory. The outbreak of the COVID-19 pandemic and the national health measures installed can hence have consequences on these representations and on prenatal attachment. Our sample consisted of 95 mothers that were recruited from a prenatal ultrasound screening center. Results suggested that the COVID-19 pandemic significantly affected prenatal attachment (PAI) with significant correlations between PAI total score and age, anxiety (DASS) and stress (IES-R). When entered in one model looking for predictors of PAI total score, age and COVID-19 stress were the only variables found to significantly predict prenatal attachment. We argue for a cultural component in explaining these results, hypothesizing that stress could trigger defensive strategies, leading to more investment in the attachment relationship, potentially playing the role of a protective factor.
Collapse
Affiliation(s)
- Pia Tohme
- Department of Social And Education Sciences, School of Arts and Sciences, Lebanese American University, Beirut, Lebanon
| | - Rudy Abi-Habib
- Department of Social And Education Sciences, School of Arts and Sciences, Lebanese American University, Beirut, Lebanon.
| | - Elma Nassar
- Department of Social And Education Sciences, School of Arts and Sciences, Lebanese American University, Beirut, Lebanon
| | - Nouran Hamed
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Gaël Abou-Ghannam
- Department of Obstetrics and Gynecology, Bellevue Medical Center, Beirut, Lebanon
| | - Gihad E Chalouhi
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| |
Collapse
|
|
17
|
Fan P, Zhang Z, Liu Y, Xiong Y. Parent-Performed Infant Massage for Improving Parental Mental State Within 18 Months Postpartum: A Systematic Review. J Psychosoc Nurs Ment Health Serv 2022; 61:52-59. [PMID: 36099486 DOI: 10.3928/02793695-20220906-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim of the current review was to assess whether parent-performed infant massage (PPIM) could effectively improve the mental state of parents during the postpartum period. Several international electronic databases were thoroughly searched for relevant articles. Included studies observed the influence of PPIM on the mental state of parents of healthy full-term infants within 18 months postpartum or medically stable preterm infants during hospitalization after birth. Nine studies were included, which observed one or more aspects of parental mental state, including depression, anxiety, parental stress, or general mood state. Characteristics of participants, massage protocols, and outcome measures were heterogenous; hence, results regarding the influence of PPIM on parental mental state were inconsistent. Upon further investigation, 10-minute, home-based PPIM for at least 4 weeks is advisable for maternal depression within 5 months postpartum. Moreover, PPIM in a neonatal intensive care unit is advisable for improving the general mood of mothers of preterm infants. Additional methodologically rigorous studies are needed to provide stronger evidence. [Journal of Psychosocial Nursing and Mental Health Services, 61(4), 52-59.].
Collapse
|
|
18
|
Goecke TW, Schöberl GI, Beckmann MW, Beetz AM. Der Bindungsstil der Mutter und ihr perinatales Wohlbefinden
beeinflussen die frühkindliche Entwicklung. Z Geburtshilfe Neonatol 2022; 226:325-332. [DOI: 10.1055/a-1872-1046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
ZusammenfassungImmer mehr Kinder zeigen bereits in der frühen Kindheit Anzeichen von
Verhaltensauffälligkeiten und Dysregulationen. Es wird ein Einfluss der
pränatalen Bindung der Schwangeren zu ihrem ungeborenen Kind sowie ihres
peripartalen Wohlbefindens angenommen. In einer prospektiven Studie an 161
Erstgebärenden wurde über standardisierte Fragebögen im
dritten Trimenon und 3 Wochen, 6 Monate und 18 Monate postpartum die
pränatale Bindung der Mutter zum Kind, den maternalen Bindungsstil, die
Bindung in der Paarbeziehung und die prä- und postpartale
Depressivität, sowie Entwicklungsauffälligkeiten des Kindes im
Alter von 18 Monaten erfasst. Im allgemeinen linearen Modell (ALM) waren eine
länger vorliegende prä- und postpartale Depressivität
der Mutter sowie Anzeichen einer unsicheren pränatalen Bindung zum Kind
mit einer höheren Rate an kindlichen Verhaltensauffälligkeiten
assoziiert. Die Befunde untermauern die Bedeutung der frühzeitigen
Wahrnehmung von Depressivität bei Frauen während und nach der
Schwangerschaft durch medizinische Fachkräfte und der Einleitung von
entsprechenden Hilfen, um die Häufigkeit kindlicher
Verhaltensauffälligkeiten zu reduzieren.
Collapse
Affiliation(s)
- Tamme W. Goecke
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen,
Germany
- Klinik für Gynäkologie und Geburtshilfe, RoMed Klinikum
Rosenheim, Rosenheim, Germany
| | | | | | - Andrea M. Beetz
- Professur für Heilpädagogik und
Inklusionspädagogik, IU Internationale Hochschule, Erfurt,
Germany
| |
Collapse
|
|
19
|
Pulliainen H, Sari-Ahlqvist-Björkroth, Ekholm E. Does interactive ultrasound intervention relieve minor depressive symptoms and increase maternal attachment in pregnancy? A protocol for a randomized controlled trial. Trials 2022; 23:313. [PMID: 35428357 PMCID: PMC9012065 DOI: 10.1186/s13063-022-06262-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 03/31/2022] [Indexed: 11/29/2022] Open
Abstract
Background Perinatal depression, especially minor depression, is common during pregnancy and is likely to continue into the postpartum period. It may impair the mother’s health, the infant’s neurodevelopment, and the mother-infant relationship. Screening for perinatal depression is recommended; however, there is no consensus on how to treat depressive symptoms while simultaneously supporting the mother-infant relationship. Ultrasound examination has been shown to improve maternal-fetal attachment among pregnant women. Our aim is to develop a four-dimensional (4D) based interactive ultrasound intervention and test whether it relieves minor depressive symptoms and improves maternal-fetal attachment. Previous studies show that supporting the mother-infant relationship aids in relieving maternal depression. Until now, few studies have combined pregnancy ultrasound and psychological support. Methods A controlled randomized setting was designed to assess whether interactive 4D-ultrasound intervention would decrease maternal depressive symptoms, strengthen maternal-fetal attachment, and mother-infant relationship. An obstetrician and a psychologist specialized in infant mental health conduct the interventions. The focus is to jointly observe the behavior of the fetus according to the mothers’ wishes. Altogether, 100 women scoring 10–15 on Edinburgh Pre-/Postnatal Depression Scale (EPDS) and with singleton pregnancy are recruited using a web-based questionnaire. Half of the participants will be randomized to the intervention group and will undergo three interactive ultrasound examinations. The primary outcomes are a decrease in perinatal depressive symptoms assessed with EPDS and an increase in maternal attachment. The maternal attachment was assessed using the Working Model of the Child Interview (WMCI), the Maternal Antenatal Attachment Scale (MAAS), and the Maternal Postnatal Attachment Scale (MPAS). Secondly, we hypothesize that if the intervention decreases prenatal depressive symptoms and improves prenatal attachment, the decrease in depressive symptoms and improvement in mother-infant relationship is seen postnatally. Discussion Ultrasound is widely used during pregnancy. The interactive approach is unique and may be feasible as part of routine screenings and maternity clinic visits. Intervention that decreases depression and simultaneously supports maternal-fetal attachment would be a valuable addition to the treatment of minor depression among pregnant women. Trial registration ClinicalTrials.gov NCT03424642. Registered on January 5 2018.
Collapse
|
|
20
|
McNamara J, Risi A, Bird AL, Townsend ML, Herbert JS. The role of pregnancy acceptability in maternal mental health and bonding during pregnancy. BMC Pregnancy Childbirth 2022; 22:267. [PMID: 35351015 PMCID: PMC8966290 DOI: 10.1186/s12884-022-04558-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 03/08/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Pregnancy is an important time for women's mental health and marks the foundations of the emerging bond between mother and baby. This study aimed to investigate the role of pregnancy acceptability and intendedness in maternal mental health and bonding during pregnancy. METHODS Data were collected from a community sample of 116 Australian pregnant women (M = 29.54, SD = 5.31) through a series of self-report questionnaires pertaining to mental health and antenatal bonding. RESULTS Lower pregnancy acceptability was correlated with higher depression, anxiety and total distress, lower physical and environmental quality of life and lower antenatal bonding. Women who reported their pregnancy was intended reported higher physical quality of life than those who reported their pregnancy was unintended. The relationship between total distress and antenatal bonding was moderated by women's degree of pregnancy acceptability (low versus high). For women with low acceptability, higher distress was associated with lower bonding, but there was no such association for women with high pregnancy acceptability. The moderation model examining associations between distress and pregnancy acceptability explained 15% of the variance in antenatal bonding scores. CONCLUSION Consideration of women's appraisal of their pregnancy acceptability may provide a valuable framework for identifying individuals who may be at risk for mental health and bonding difficulties.
Collapse
Affiliation(s)
- Josephine McNamara
- School of Psychology, University of Wollongong, Wollongong, NSW, 2522, Australia.,Early Start, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Alixandra Risi
- School of Psychology, University of Wollongong, Wollongong, NSW, 2522, Australia.,Early Start, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Amy L Bird
- School of Psychology, University of Waikato, Hamilton, Waikato, 3240, New Zealand
| | - Michelle L Townsend
- School of Psychology, University of Wollongong, Wollongong, NSW, 2522, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Jane S Herbert
- School of Psychology, University of Wollongong, Wollongong, NSW, 2522, Australia. .,Early Start, University of Wollongong, Wollongong, NSW, 2522, Australia.
| |
Collapse
|
|
21
|
Effects of negative and positive affect on antenatal maternal attachment: The mediational role of resilience and self-esteem. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-021-02571-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
|
22
|
Eitenmüller P, Köhler S, Hirsch O, Christiansen H. The Impact of Prepartum Depression and Birth Experience on Postpartum Mother-Infant Bonding: A Longitudinal Path Analysis. Front Psychiatry 2022; 13:815822. [PMID: 35706472 PMCID: PMC9189288 DOI: 10.3389/fpsyt.2022.815822] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 04/27/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Negative effects of impaired postpartum mother-infant-bonding on mental health of mothers, their newborn children and subsequent child development are well documented. Previous research demonstrated an association between a negative birth experience and postpartum mental health affecting postpartum mother-infant bonding. This study investigates the extent to which prepartum depression and birth experience influence the postpartum mental health of mothers and their bonding toward their newborns, and whether these influences differ according to parity and self-reported prior mental health problems. METHOD Three hundred and fifty-four women (18-43 years; M = 30.13, SD = 5.10) filled in the Edinburgh Postnatal Depression Scale (EPDS), the Maternal-Fetal Attachment Scale (MFAS), Salmon's Item List (SIL) assessing the birth experience, and the Postpartum Bonding Questionnaire (PBQ) at pre- and postpartum; they were also asked about birth complications and parity status. RESULTS Primipara reported significantly more birth complications (p = 0.048), with path analysis confirming this result (p < 0.001). Birth complications were associated with a more negative rating of the overall birth experience (p < 0.001). Mothers with self-reported prior mental health problems had higher prepartum depression scores (p < 0.001) but did not differ in other variables from mothers without prior self-reported mental health problems. Differences in depression scores between mothers with self-reported prior mental health problems and those without vanished at postpartum assessment (p > 0.05). Path-analysis highlighted the key role of postpartum depression, which was the only significant predictor of postpartum impairment in maternal-child bonding (p < 0.001). Birth experience and prepartum depression scores exerted an indirect effect on postpartum maternal-child bonding, mediated by postpartum depression. DISCUSSION The present study demonstrates the relevance of prepartum mental health of expectant mothers, especially of those who self-report prior mental health problems. The results support that reducing mental health problems of pregnant mothers might contribute to a more positive birth experience and potentially reduce postpartum depressive symptoms. As postpartum depression is associated with impaired parent-child bonding, such targeted interventions could promote child development. Group differences between primiparous and multiparous mothers suggest that the birth experience may be an influential factor for postpartum mental health.
Collapse
Affiliation(s)
- Pia Eitenmüller
- Department of Clinical Child and Adolescent Psychology, Philipps University Marburg, Marburg, Germany
| | - Siegmund Köhler
- Department of Obstetrics and Gynecology, University of Giessen-Marburg, Marburg, Germany
| | - Oliver Hirsch
- Department of Psychology, FOM University of Applied Sciences, Siegen, Germany
| | - Hanna Christiansen
- Department of Clinical Child and Adolescent Psychology, Philipps University Marburg, Marburg, Germany
| |
Collapse
|
|
23
|
Biaggi A, Hazelgrove K, Waites F, Fuste M, Conroy S, Howard LM, Mehta MA, Miele M, Seneviratne G, Pawlby S, Pariante CM, Dazzan P. Maternal perceived bonding towards the infant and parenting stress in women at risk of postpartum psychosis with and without a postpartum relapse. J Affect Disord 2021; 294:210-219. [PMID: 34303299 DOI: 10.1016/j.jad.2021.05.076] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 04/19/2021] [Accepted: 05/30/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Postpartum psychosis (PP) is the most severe psychiatric disorder associated with childbirth. However, there is little research on maternal bonding towards the infant and parenting stress in this clinical population. METHODS We investigated maternal bonding during pregnancy and post-partum in 75 women: 46 at risk of PP (AR), because of a DSM-IV diagnosis of bipolar disorder, schizoaffective disorder or previous PP, and 29 healthy controls. Of the AR women, 19 developed a psychiatric relapse within 4 weeks' post-partum (AR-unwell), while 27 remained symptom-free (AR-well). We investigated childhood maltreatment, parenting stress and psychiatric symptoms as potential predictors of maternal bonding. RESULTS In pregnancy, AR-unwell women reported a more negative affective experience towards their infants than AR-well women (d = 0.87, p = .001), while postnatally there was no significant difference in bonding. In contrast, AR women as a group reported a more negative affective experience than HC postnatally (d = 0.69, p = .002; d = 0.70, p = .010), but not antenatally. Parenting stress and psychiatric symptoms significantly predicted less optimal postnatal bonding (b = -0.10, t = -4.29, p < .001; b = -0.37, t = -4.85, p < .001) but only psychiatric symptoms explained the difference in bonding between AR and HC (b = -1.18, 95% BCa CI [-2.70,-0.04]). LIMITATIONS A relatively small sample size precluded a more in-depth investigation of underlying pathways. CONCLUSION This study provides new information on maternal bonding in women at risk of PP, and particularly in those that do and do not develop a postpartum relapse. The results suggest that improving maternal symptoms and parenting stress in the perinatal period in women at risk of PP could also have positive effects on bonding.
Collapse
Affiliation(s)
- Alessandra Biaggi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RX, UK.
| | - Katie Hazelgrove
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RX, UK
| | - Freddie Waites
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RX, UK; Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Montserrat Fuste
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, SE5 8AF, UK; Perinatal Parent-Infant Mental Health Service, Goodmayes Hospital, North East London Foundation Trust, London, IG3 8XD, UK
| | - Susan Conroy
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RX, UK
| | - Louise M Howard
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Mitul A Mehta
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neurosciences, King's College London, London, SE5 8AF, UK; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Maddalena Miele
- Perinatal Mental Health Service, St Mary's Hospital, Imperial College London and Central North West London NHS Foundation Trust, London, W2 1PF, UK
| | - Gertrude Seneviratne
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RX, UK
| | - Susan Pawlby
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RX, UK
| | - Carmine M Pariante
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RX, UK; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RX, UK; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| |
Collapse
|
|
24
|
Doke PP, Vaidya VM, Narula APS, Datar MC, Patil AV, Panchanadikar TM, Wagh GN. Assessment of difference in postpartum depression among caesarean and vaginally delivered women at 6-week follow-up in hospitals in Pune District, India: an observational cohort study. BMJ Open 2021; 11:e052008. [PMID: 34593503 PMCID: PMC8487184 DOI: 10.1136/bmjopen-2021-052008] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 08/24/2021] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES To compare the proportion of postpartum depression at 6 weeks among women who had caesarean delivery and women who had vaginal delivery and to assess its association with some sociodemographic factors. DESIGN This is a descriptive comparative study with prospective enrolment. We followed the enrolled women and assessed them for postpartum depression 6 weeks after delivery. SETTING We conducted the study in Pune District, India from July 2017 to December 2018. The study sites were all non-teaching government hospitals performing five or more caesarean sections per month and two teaching hospitals: one government and one private. PARTICIPANTS We included in the study group women who have undergone caesarean section in the participating hospitals and were residents of Pune District. Women who delivered vaginally and matched in age and parity were included in the comparison group. We followed 1556 women in each group. MAIN OUTCOME MEASURES An Edinburgh Postnatal Depression Scale score of 10 or more for each woman was the primary outcome. χ2 test and multivariable binary logistic regression were performed to assess the effect of mode of delivery on postpartum depression. RESULTS The proportion of postpartum depression at 6 weeks was 3.79% among women who had caesarean delivery and 2.35% among those who had vaginal delivery (χ2=4.50, p=0.03). The adjusted OR was 1.86 (95% CI 1.14 to 3.03). Women of age less than 25 years had higher risk of postpartum depression. The adjusted OR was 2.10 (95% CI 1.21 to 3.65). The study did not observe any association between postpartum depression and income, education, occupation or sex of the newborn child. CONCLUSIONS We conclude that young women particularly those who had caesarean delivery should be screened 6 weeks after delivery.
Collapse
Affiliation(s)
- Prakash P Doke
- Community Medicine, Bharati Vidyapeeth Deemed University Medical College, Pune, India
| | - Varsha Mahesh Vaidya
- Community Medicine, Bharati Vidyapeeth Deemed University Medical College, Pune, India
| | | | | | | | | | - Girija Narendrakumar Wagh
- Obstetrics and Gynaecology, Bharat Vidyapeeth Deemed University Medical College, Pune, Maharastra, India
| |
Collapse
|
|
25
|
Míguez MC, Vázquez MB. Risk factors for antenatal depression: A review. World J Psychiatry 2021; 11:325-336. [PMID: 34327125 PMCID: PMC8311510 DOI: 10.5498/wjp.v11.i7.325] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/20/2021] [Accepted: 05/20/2021] [Indexed: 02/06/2023] Open
Abstract
Depression is the most prevalent mental disorder in pregnancy, and yet it is less studied than postpartum depression despite the consequences it may have on both the pregnant woman and her offspring. Therefore, it would be important to know which risk factors may favour the appearance of antenatal depression in order to carry out appropriate prevention interventions. The aim of the present review was to identify the main risk factors of antenatal depression. We searched in databases PubMed and PsycINFO for articles published about the factors associated with antenatal depression from January 2010 through December 2020. The literature review identified three main groups of antenatal depression risk factors: sociodemographic, obstetric, and psychological. First, among the sociodemographic variables, the low level of studies and the economic income clearly stood out from the rest. Then, not having planned the pregnancy was the main obstetric variable, and finally, the main psychological risk factors were having a history of psychological disorders and/or depression as well as presenting anxiety, stress, and/or low social support during pregnancy. This review shows that the antenatal depression is affected by multiple factors. Most can be identified at the beginning of the pregnancy, and some are risk factors potentially modifiable through appropriate interventions, such as psychological factors. For this reason, it is important to carry out a good screening for depression during pregnancy and consequently, be able to prevent its appearance or treat it if necessary.
Collapse
Affiliation(s)
- M Carmen Míguez
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Santiago de Compostela, Santiago de Compostela 15782, Spain
| | - M Belén Vázquez
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Santiago de Compostela, Santiago de Compostela 15782, Spain
| |
Collapse
|
|
26
|
Sherin M, Gildner TE, Thayer ZM. COVID-19-Related Changes to Pregnant People's Work-Plans Increase Prenatal Depression. Front Glob Womens Health 2021; 2:639429. [PMID: 34816196 PMCID: PMC8594024 DOI: 10.3389/fgwh.2021.639429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/22/2021] [Indexed: 12/16/2022] Open
Abstract
The COVID-19 pandemic has caused unprecedented rates of unemployment in the United States. Pregnant workers may be especially affected as they are over-represented in low-wage service and hospitality industries impacted by the pandemic. We surveyed an online convenience sample of currently working pregnant people living in the U.S. (n = 1,417) to determine whether COVID-19-related changes to how long individuals planned to work during their pregnancy, and uncertainty about these changes, were associated with prenatal depression. As hypothesized, both COVID-19-related work-plan changes (OR = 1.81, 95% CI 1.36-2.42, p < 0.001) and uncertainty about the precise nature of these changes (OR = 2.62, 95% CI 1.14-6.0, p = 0.022) were associated with significantly higher odds of a clinically-significant depression score. These effects appeared to be even greater among individuals who continued working outside the home during the pandemic. Since the U.S. is one of the few countries in the world that does not guarantee paid parental leave, pregnant people may be forced to choose between keeping their jobs and risking infection during the COVID-19 pandemic. Our results demonstrate a need for immediate suspension of the eligibility requirements for the Family and Medical Leave Act and/or universal access to both paid family leave and prenatal depression screening. This would help to alleviate these concerns and provide pregnant people with more options while preserving their employment status and financial security.
Collapse
Affiliation(s)
- Margaret Sherin
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Theresa E. Gildner
- Department of Anthropology, Dartmouth College, Hanover, NH, United States
- Department of Anthropology, Washington University in St. Louis, St. Louis, MO, United States
| | - Zaneta M. Thayer
- Department of Anthropology, Dartmouth College, Hanover, NH, United States
| |
Collapse
|
|
27
|
Mannocci A, Massimi A, Scaglietta F, Ciavardini S, Scollo M, Scaglione C, La Torre G. HAPPY MAMA Project (PART 1). Assessing the Reliability of the Italian Karitane Parenting Confidence Scale (KPCS-IT) and Parental Stress Scale (PSS-IT): A Cross-Sectional Study among Mothers Who Gave Birth in the Last 12 Months. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084066. [PMID: 33921481 PMCID: PMC8070573 DOI: 10.3390/ijerph18084066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 01/25/2023]
Abstract
The purposes of this study were: (1) to adapt two validated questionnaires used to evaluate maternal confidence (KPCS-IT) and maternal stress (PSS-IT) to the Italian context, in order to (2) measure the stress level and the self-efficacy in an Italian sample of mothers. The validation process has provided the construction of an online questionnaire. It was administered on a convenience mothers sample with at least a child aged 0–12 months, twice (T0 and T1) with a two day interval. Assessment of instrument stability over time was estimated by applying test–retest reliability between T0 and T1, and the Cronbach’s alpha coefficient. A cross-sectional study was carried out to assess the second aim. Italian mothers with at least one child living at home aged between 0–12 months were recruited. Statistical reliability methods were applied to assess the internal validity of the two questionnaires. PSS-IT was analyzed using univariate and multivariate statistical analyses in order to study the association between KPCS-IT, demographic and maternal characteristics. Statistical significance was established as p < 0.05. The Cronbach’s alpha reported a good level of internal consistency of the questionnaires: PSS-IT alpha = 0.862; KPCS-IT alpha = 0.801. 32% of the mothers declared low maternal confidence and the mean value of PSS-IT was 35.4 (SD = 8). The significant inverse correlation was found between the PSS-IT and the KPCS-IT (coeff = −0.353; p < 0.001): this means that a high level of perceived self-efficacy reduces the maternal stress level. The study identifies that interventions on maternal confidence can be useful to support mothers in the first months after delivery in order to prevent stress risk: the perceived self-efficacy is as a modifiable factor and the results of the study indicate that it significantly reduces the PSS-IT and EPDS scores. In future, more field trials are necessary in order to assess the realistic and feasible interventions on maternal confidence and competence to prevent maternal distress.
Collapse
Affiliation(s)
- Alice Mannocci
- Faculty of Economics, Universitas Mercatorum, 00186 Rome, Italy
- Correspondence:
| | - Azzurra Massimi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (A.M.); (F.S.); (S.C.); (M.S.); (C.S.); (G.L.T.)
| | - Franca Scaglietta
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (A.M.); (F.S.); (S.C.); (M.S.); (C.S.); (G.L.T.)
| | - Sara Ciavardini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (A.M.); (F.S.); (S.C.); (M.S.); (C.S.); (G.L.T.)
| | - Michela Scollo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (A.M.); (F.S.); (S.C.); (M.S.); (C.S.); (G.L.T.)
| | - Claudia Scaglione
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (A.M.); (F.S.); (S.C.); (M.S.); (C.S.); (G.L.T.)
| | - Giuseppe La Torre
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (A.M.); (F.S.); (S.C.); (M.S.); (C.S.); (G.L.T.)
| |
Collapse
|
|
28
|
Salami M. Interplay of Good Bacteria and Central Nervous System: Cognitive Aspects and Mechanistic Considerations. Front Neurosci 2021; 15:613120. [PMID: 33642976 PMCID: PMC7904897 DOI: 10.3389/fnins.2021.613120] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/06/2021] [Indexed: 12/12/2022] Open
Abstract
The human gastrointestinal tract hosts trillions of microorganisms that is called “gut microbiota.” The gut microbiota is involved in a wide variety of physiological features and functions of the body. Thus, it is not surprising that any damage to the gut microbiota is associated with disorders in different body systems. Probiotics, defined as living microorganisms with health benefits for the host, can support or restore the composition of the gut microbiota. Numerous investigations have proved a relationship between the gut microbiota with normal brain function as well as many brain diseases, in which cognitive dysfunction is a common clinical problem. On the other hand, increasing evidence suggests that the existence of a healthy gut microbiota is crucial for normal cognitive processing. In this regard, interplay of the gut microbiota and cognition has been under focus of recent researches. In the present paper, I review findings of the studies considering beneficial effects of either gut microbiota or probiotic bacteria on the brain cognitive function in the healthy and disease statuses.
Collapse
Affiliation(s)
- Mahmoud Salami
- Physiology Research Center, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, Iran.,Department of Neuroscience, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| |
Collapse
|
|
29
|
Probiotics as a treatment for prenatal maternal anxiety and depression: a double-blind randomized pilot trial. Sci Rep 2021; 11:3051. [PMID: 33542275 PMCID: PMC7862351 DOI: 10.1038/s41598-021-81204-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 12/23/2020] [Indexed: 02/07/2023] Open
Abstract
Probiotic use may be an efficacious treatment option to effectively manage symptoms of prenatal maternal anxiety and depression. Our primary aim was to test feasibility and acceptability for a probiotic randomized controlled trial (RCT) in pregnant women with pre-existing symptoms. This double-blind pilot RCT included 40 pregnant women with low-risk pregnancies and elevated depressive symptoms and/or anxiety. Once daily, participants orally consumed a probiotic (Ecologic Barrier) or a placebo, from 26 to 30 weeks gestation until delivery. A priori key progression criteria for primary outcomes were determined to decide whether or not a full RCT was feasible and acceptable. Secondary outcomes included depressive symptoms, anxiety, stress, and maternal bonding to offspring. In 19 months, 1573 women were screened; following screening, 155 women (10%) were invited for participation, of whom 135 (87%) received study information, and 40 women (30%) were included. Four out of six a priori determined criteria for success on feasibility and acceptability were met. After 8 weeks of intervention, there was no significant difference between the probiotic and placebo groups for secondary outcomes. The pilot trial was feasible and acceptable, but hampered by recruitment method and study design. Secondary endpoints did not reveal differences between the groups for improving maternal mood.
Collapse
|
|
30
|
Zhang L, Wang L, Cui S, Yuan Q, Huang C, Zhou X. Prenatal Depression in Women in the Third Trimester: Prevalence, Predictive Factors, and Relationship With Maternal-Fetal Attachment. Front Public Health 2021; 8:602005. [PMID: 33575242 PMCID: PMC7870992 DOI: 10.3389/fpubh.2020.602005] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/23/2020] [Indexed: 12/11/2022] Open
Abstract
Objective: The prevalence of prenatal depression in pregnant women has found to be high, which may adversely affect the intimacy of a mother to her fetus. Few studies have investigated the relationship between prenatal depression and maternal-fetal attachment in pregnant Chinese women. This study is thus designed to evaluate the prevalence rate, predictive factors of prenatal depression in Chinese pregnant women in the third trimester of pregnancy, and the effect of prenatal depression on maternal-fetal attachment. Methods: A total of 340 pregnant women in the third trimester of pregnancy were recruited from a hospital in Anhui Province. The Edinburgh Postpartum Depression Scale (EPDS) was rated to assess the prenatal depression; the Pittsburgh Sleep Quality Index (PSQI) and Zung Self-Rating Anxiety Scale (SAS) were used to assess sleep quality and anxiety level for all participants. The Maternal Antenatal Attachment Scale (MAAS) was used to assess maternal-fetal attachment. Results: The prevalence of prenatal depression in the participants was high (19.1%) in our study. The scores of prenatal anxiety and sleep disorders were higher with prenatal depression than in those without prenatal depression (47.6 ± 9.5 vs. 38.9 ± 6.9; 8.3 ± 3.3 vs. 6.1 ± 2.7, all p < 0.01). MAAS quality was lower in prenatal depression women than those in non-prenatal depression women (43.8 ± 5.6 vs. 46.4 ± 4.5, p < 0.01). Correlation analysis showed that prenatal depression was associated with parity, prenatal education, education level, marital satisfaction, anxiety and sleep disorders (all p < 0.05). Furthermore, binary logistic regression results showed that anxiety and sleep disorders were risk factors for prenatal depression. Prenatal education, higher marriage satisfaction were protective factors for prenatal depression. In addition, correlation analysis also showed that prenatal depression was positively correlated with MAAS intensity, but negatively correlated with MAAS quality. Conclusions: Our results indicated a high prevalence of prenatal depression in women in the third trimester. Prenatal education and higher marital satisfaction were protective factors for prenatal depression; antenatal anxiety and sleep disorders during pregnancy were risk factors for prenatal depression. Prenatal depression was negatively correlated with MAAS quality, but positively correlated with MAAS intensity.
Collapse
Affiliation(s)
- Ling Zhang
- College of Mental Health and Psychological Science, Anhui Medical University, Hefei, China.,Chaohu Hospital, Anhui Medical University, Hefei, China
| | - Lei Wang
- College of Mental Health and Psychological Science, Anhui Medical University, Hefei, China.,Chaohu Hospital, Anhui Medical University, Hefei, China
| | - Shu Cui
- College of Mental Health and Psychological Science, Anhui Medical University, Hefei, China.,Chaohu Hospital, Anhui Medical University, Hefei, China
| | - Qiuyu Yuan
- College of Mental Health and Psychological Science, Anhui Medical University, Hefei, China.,Chaohu Hospital, Anhui Medical University, Hefei, China
| | - Cui Huang
- College of Mental Health and Psychological Science, Anhui Medical University, Hefei, China.,Chaohu Hospital, Anhui Medical University, Hefei, China
| | - Xiaoqin Zhou
- College of Mental Health and Psychological Science, Anhui Medical University, Hefei, China.,Chaohu Hospital, Anhui Medical University, Hefei, China
| |
Collapse
|
|
31
|
Ertmann RK, Bang CW, Kriegbaum M, Væver MS, Kragstrup J, Siersma V, Wilson P, Lutterodt MC, Smith-Nielsen J. What factors are most important for the development of the maternal-fetal relationship? A prospective study among pregnant women in Danish general practice. BMC Psychol 2021; 9:2. [PMID: 33397501 PMCID: PMC7784374 DOI: 10.1186/s40359-020-00499-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 12/02/2020] [Indexed: 12/13/2022] Open
Abstract
Background Development of the maternal antenatal attachment (MAA) constitutes an important aspect of the transition into motherhood. Early identification of women at risk of developing a poor MAA provides possibilities for preventive interventions targeting maternal mental health and the emerging mother-infant relationship. In this study, we investigate the relative importance of an extensive set of psychosocial, pregnancy-related, and physiological factors measured in the first trimester of pregnancy for MAA measured in third trimester. Methods A prospective study was conducted among pregnant women in Danish general practice (GP). Data were obtained in the first and the third trimester from pregnancy health records and electronic questionnaires associated with routine GP antenatal care visits. The Maternal Antenatal Attachment Scale (MAAS) was used to assess maternal antenatal attachment. The relative importance of potential determinants of maternal antenatal attachment was assessed by the relative contribution of each factor to the fit (R2) calculated from multivariable regression models. Results The sample consisted of 1328 women. Low antenatal attachment (Total MAAS ≤ 75) was observed for 513 (38.6%) women. Perceived social support (having someone to talk to and having access to practical help when needed) emerged as the most important determinant. Furthermore, scores on the MAAS decreased with worse self-rated health, poor physical fitness, depression, increasing age, having given birth previously, and higher education. Conclusion Pregnant women reporting lack of social support and general low physical and mental well-being early in pregnancy may be at risk for developing a poor MAA. An approach targeting both psychosocial and physiological well-being may positively influence expectant mothers’ successful adaptation to motherhood.
Collapse
Affiliation(s)
- Ruth K Ertmann
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Christine W Bang
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Margit Kriegbaum
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mette S Væver
- Departmant of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Kragstrup
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Philip Wilson
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Centre for Rural Health, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK
| | - Melissa C Lutterodt
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | |
Collapse
|
|
32
|
Bjertrup AJ, Jensen MB, Schjødt MS, Parsons CE, Kjærbye-Thygesen A, Mikkelsen RL, Moszkowicz M, Frøkjær VG, Vinberg M, Kessing LV, Væver MS, Miskowiak KW. Cognitive processing of infant stimuli in pregnant women with and without affective disorders and the association to postpartum depression. Eur Neuropsychopharmacol 2021; 42:97-109. [PMID: 33158668 DOI: 10.1016/j.euroneuro.2020.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 08/21/2020] [Accepted: 10/16/2020] [Indexed: 11/26/2022]
Abstract
Pregnancy and childbirth are among the strongest risk factors for depression but the neurocognitive mechanisms underlying this enhanced risk are unknown. This study investigated emotional and non-emotional cognition in 57 pregnant women with or without an affective disorder during their third trimester, and the association between cognitive biases and subsequent postpartum depression (PPD). Of the pregnant women, 22 had a diagnosis of unipolar disorder (UD) and seven of bipolar disorder (BD) in full or partial remission, while 28 had no history of affective disorder. We included a control group of 29 healthy non-pregnant women. First, participants were interviewed, completed non-emotional and emotional cognitive tests and lastly filled out questionnaires. The participants were assessed two times after birth: at a home visit shortly after birth, and with a telephone interview to assess PPD in the first six months after birth. Healthy pregnant women rated infant cries less negatively than non-pregnant women, possibly reflecting preparation for motherhood. Pregnant women with UD exhibited a negative bias in ratings of infant cries, whereas pregnant women with BD showed a positive bias in ratings of infant happy faces and recognition of adult facial expressions. Across all pregnant women, more negative ratings of infant cries were associated with enhanced risk of PPD. Negatively biased perception of infant cries during pregnancy may thus signal vulnerability toward PPD.
Collapse
Affiliation(s)
- A J Bjertrup
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark; Copenhagen Affective Disorders research Center (CADIC), Psychiatric Centre Copenhagen, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen University Hospital, Rigshospitalet, Edel Sauntes Allé 10, DK-2100 Copenhagen, Denmark
| | - M B Jensen
- Copenhagen Affective Disorders research Center (CADIC), Psychiatric Centre Copenhagen, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen University Hospital, Rigshospitalet, Edel Sauntes Allé 10, DK-2100 Copenhagen, Denmark
| | - M S Schjødt
- Copenhagen Affective Disorders research Center (CADIC), Psychiatric Centre Copenhagen, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen University Hospital, Rigshospitalet, Edel Sauntes Allé 10, DK-2100 Copenhagen, Denmark
| | - C E Parsons
- Interacting Minds Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - A Kjærbye-Thygesen
- Department of Obstetrics and Gynecology, Faculty of Health and Medical Sciences, University of Copenhagen, Hvidovre, Denmark
| | - R L Mikkelsen
- Copenhagen Affective Disorders research Center (CADIC), Psychiatric Centre Copenhagen, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen University Hospital, Rigshospitalet, Edel Sauntes Allé 10, DK-2100 Copenhagen, Denmark
| | - M Moszkowicz
- Child and Adolescent Psychiatric Center, Infant Psychiatric Unit, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen Denmark
| | - V G Frøkjær
- Neurobiology Research Unit, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen Denmark
| | - M Vinberg
- Copenhagen Affective Disorders research Center (CADIC), Psychiatric Centre Copenhagen, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen University Hospital, Rigshospitalet, Edel Sauntes Allé 10, DK-2100 Copenhagen, Denmark; Psychiatric Research Unit, Psychiatric Centre North Zealand, Faculty of Health and Medical Sciences, University of Copenhagen, Hillerød, Denmark
| | - L V Kessing
- Copenhagen Affective Disorders research Center (CADIC), Psychiatric Centre Copenhagen, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen University Hospital, Rigshospitalet, Edel Sauntes Allé 10, DK-2100 Copenhagen, Denmark
| | - M S Væver
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - K W Miskowiak
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark; Copenhagen Affective Disorders research Center (CADIC), Psychiatric Centre Copenhagen, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen University Hospital, Rigshospitalet, Edel Sauntes Allé 10, DK-2100 Copenhagen, Denmark.
| |
Collapse
|
|
33
|
Jussila H, Pelto J, Korja R, Ekholm E, Pajulo M, Karlsson L, Karlsson H. The association of maternal-fetal attachment with smoking and smoking cessation during pregnancy in The FinnBrain Birth Cohort Study. BMC Pregnancy Childbirth 2020; 20:741. [PMID: 33256653 PMCID: PMC7708161 DOI: 10.1186/s12884-020-03393-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 11/04/2020] [Indexed: 11/20/2022] Open
Abstract
Background Smoking in pregnancy constitutes a preventable risk factor for fetal/child development and maternal-fetal attachment (MFA) seems to contain a momentum that can break the chain of adverse outcomes by promoting maternal prenatal health practices. This study aimed to explore the association of MFA with smoking at any time during pregnancy and smoking cessation in early pregnancy, and the modifying role of MFA on the expected effects of education and prenatal psychological distress (PPD) on prenatal smoking behavior. Methods The pregnant women (n = 3766) participated in the The FinnBrain Birth Cohort Study in Finland between December 2011 and April 2015. The binary outcomes, smoking at any time during pregnancy and smoking cessation in early pregnancy, were obtained from self-reports at gestational weeks (gwks) 14 and 34 and The Finnish Medical Birth Register. MFA was assessed with the Maternal-Fetal Attachment Scale (MFAS) at gwks 24 and 34. Logistic regression analyses were used to determine the association between MFA and maternal prenatal smoking behavior. Findings The prevalence of smoking was 16.5%, and 58.1% of the smokers quit smoking during pregnancy. The independent associations of total MFA scores with prenatal smoking behavior were not established (aOR = 1.00-1.02, multiplicity adjusted p > 0.05). A higher score in the altruistic subscale of MFA, Giving of self, associated with a higher probability of smoking cessation (24 gwks: aOR = 1.13, 95% CI [1.04, 1.24], p = 0.007, multiplicity adjusted p = 0.062; 34 gwks: aOR = 1.17, 95% CI [1.07, 1.29], p < 0.001, multiplicity adjusted p = 0.008). The modifying effect of MFA on the observed associations between PPD and smoking in pregnancy and between maternal education and smoking in pregnancy / smoking cessation in early pregnancy was not demonstrated. Conclusions The altruistic dimension of maternal-fetal attachment associates with an increased probability of smoking cessation during pregnancy and therefore strengthening altruistic maternal-fetal attachment may constitute a promising novel approach for interventions aiming at promoting smoking cessation during pregnancy.
Collapse
Affiliation(s)
- Heidi Jussila
- Doctoral Programme of Clinical Investigation, Department of Child Psychiatry, University of Turku, Turku, Finland. .,FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Lemminkäisenkatu 3, 20014, Turku, Finland.
| | - Juho Pelto
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Lemminkäisenkatu 3, 20014, Turku, Finland
| | - Riikka Korja
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Lemminkäisenkatu 3, 20014, Turku, Finland.,Department of Psychology , University of Turku , Turku, Finland
| | - Eeva Ekholm
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Lemminkäisenkatu 3, 20014, Turku, Finland.,Department of Obstetrics and Gynecology , Turku University Hospital , Turku, Finland
| | - Marjukka Pajulo
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Lemminkäisenkatu 3, 20014, Turku, Finland.,Department of Child Psychiatry , University of Turku , Turku, Finland
| | - Linnea Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Lemminkäisenkatu 3, 20014, Turku, Finland.,Centre for Population Health Research , University of Turku and Turku University Hospital , Turku, Finland.,Department of Child Psychiatry , Turku University Hospital and University of Turku , Turku, Finland
| | - Hasse Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Lemminkäisenkatu 3, 20014, Turku, Finland.,Department of Psychiatry , Turku University Hospital and University of Turku , Turku, Finland
| |
Collapse
|
|
34
|
Nilova V, Ward L, Hall P. Women's experiences of parenting toddlers following postnatal depression. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1111/ajpy.12138] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Valeria Nilova
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia,
| | - Lynn Ward
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia,
| | - Pauline Hall
- Perinatal Mental Health Team, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia,
| |
Collapse
|
|
35
|
Bang KS, Lee I, Kim S, Yi Y, Huh I, Jang SY, Kim D, Lee S. Relation between Mother's Taekyo, Prenatal and Postpartum Depression, and Infant's Temperament and Colic: A Longitudinal Prospective Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7691. [PMID: 33096813 PMCID: PMC7589274 DOI: 10.3390/ijerph17207691] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/09/2020] [Accepted: 10/20/2020] [Indexed: 12/04/2022]
Abstract
This longitudinal cohort correlational study aimed to confirm the relation among taekyo or traditional prenatal practice, prenatal depression, postpartum depression, maternal-fetal interaction, and infant temperament and colic using a prospective design. We recruited 212 women 16-20 weeks pregnant from July 2017 to September 2018; they were followed up until six months postpartum. Data from 97 participants were used in the final analysis. We used the Edinburgh Postnatal Depression Scale, Cranley's Maternal-Fetal Attachment Scale, and What My Baby Is Like as measurement tools. We observed a significant correlation between prenatal maternal depression in the first to third trimesters and 6-8 weeks and six months postpartum. In addition, infant temperament at six months old showed a significant negative correlation with prenatal and postpartum depression: the higher the prenatal and postpartum depression level, the more difficult the infant's temperament. Taekyo practice was significantly related to maternal-fetal attachment (r = 0.45-0.68, p < 0.001). Difficult infants showed more colic episodes than any other type of infant (χ2 = 18.18, p < 0.001). Prenatal and postnatal maternal depression affected infants' temperament and colic episodes. The management of mothers' mental health before and after pregnancy is important for infants' and mothers' health.
Collapse
Affiliation(s)
- Kyung-Sook Bang
- The Research Institute of Nursing Science, College of Nursing, Seoul National University, Seoul 03080, Korea; (K.-S.B.); (I.L.); (S.K.); (I.H.)
| | - Insook Lee
- The Research Institute of Nursing Science, College of Nursing, Seoul National University, Seoul 03080, Korea; (K.-S.B.); (I.L.); (S.K.); (I.H.)
| | - Sungjae Kim
- The Research Institute of Nursing Science, College of Nursing, Seoul National University, Seoul 03080, Korea; (K.-S.B.); (I.L.); (S.K.); (I.H.)
| | - Yunjeong Yi
- Department of Nursing, Kyung-In Women’s University, Incheon 21041, Korea;
| | - Iksoo Huh
- The Research Institute of Nursing Science, College of Nursing, Seoul National University, Seoul 03080, Korea; (K.-S.B.); (I.L.); (S.K.); (I.H.)
| | - Sang-Youn Jang
- College of Nursing, Seoul National University, Seoul 03080, Korea; (D.K.); (S.L.)
| | - Dasom Kim
- College of Nursing, Seoul National University, Seoul 03080, Korea; (D.K.); (S.L.)
| | - Sujin Lee
- College of Nursing, Seoul National University, Seoul 03080, Korea; (D.K.); (S.L.)
| |
Collapse
|
|
36
|
Rollè L, Giordano M, Santoniccolo F, Trombetta T. Prenatal Attachment and Perinatal Depression: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2644. [PMID: 32290590 PMCID: PMC7216181 DOI: 10.3390/ijerph17082644] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 04/05/2020] [Accepted: 04/08/2020] [Indexed: 11/17/2022]
Abstract
Pregnancy is a period of complex bio-psychological changes, during which the development of an attachment bond to the fetus takes on a central role. Depressive symptoms are common during this period. Both symptoms of depression and low levels of prenatal attachment are related to negative outcomes in caregivers and infants. Following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement, this systematic review analyzes and systematizes 41 studies concerning the association between prenatal attachment and perinatal depression. The majority of the studies reported a significant association between the two. Specifically, prenatal depressive symptoms were found to be negatively associated with prenatal attachment. Furthermore, lower levels of prenatal attachment were related to higher postnatal depressive symptoms, although fewer studies assessed this association. While these results were found across different populations, conflicting findings emerged, suggesting they should be interpreted with caution, particularly in male samples and in non-normative pregnancies (e.g., high-risk pregnancies, medically assisted pregnancies, and pregnancies with previous perinatal losses). These results are clinically important for the perinatal screening process and for implementing preventive and treatment programs. However, future studies are needed to further confirm and generalize these results.
Collapse
Affiliation(s)
| | - Maura Giordano
- Department of Psychology, University of Turin, 10124 Torino, Italy; (L.R.); (F.S.); (T.T.)
| | | | | |
Collapse
|
|
37
|
Palma E, Armijo I, Cifuentes J, Ambiado S, Rochet P, Díaz B, Gutierrez J, Mena C. Hospitalisation in high-risk pregnancy patients: is prenatal attachment affected? J Reprod Infant Psychol 2020; 39:30-42. [PMID: 32223427 DOI: 10.1080/02646838.2020.1740661] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: To compare prenatal attachment in women hospitalised due to high-risk pregnancy with prenatal attachment in non-hospitalised patients. To describe the impact of social support, socio-demographic factors and the nature of the pregnancy on prenatal attachment, anxiety and depression. Study Design: An exploratory, cross-sectional and descriptive study utilising the Maternal Antenatal Attachment Scale, the Edinburgh Postnatal Depression Scale and the State-Trait Anxiety Inventory. The sample comprised 80 hospitalised and 88 non-hospitalised patients. Result: No difference in prenatal attachment was found between the two groups. The hospitalised group presented higher levels of depressive symptomatology and anxiety. Social support had a significant effect on the hospitalised group, improving attachment quality. Conclusion: Incorporation of members of the patient's support network may help to improve quality of prenatal attachment during hospitalisation. Detection and treatment of anxiety and/or depression in hospitalised patients is recommended given their impact on the mental health of mother and baby.
Collapse
Affiliation(s)
- Elisa Palma
- Neonatal Intensive Care Unit, Clínica INDISA , Santiago, Chile
| | - Ivan Armijo
- Facultad de Psicología, Universidad del Desarrollo , Santiago, Chile
| | | | - Sergio Ambiado
- Neonatal Intensive Care Unit, Clínica INDISA , Santiago, Chile
| | - Pilar Rochet
- Neonatal Intensive Care Unit, Clínica INDISA , Santiago, Chile
| | - Blanca Díaz
- Neonatal Intensive Care Unit, Clínica INDISA , Santiago, Chile
| | - Javiera Gutierrez
- Facultad de Psicología, Universidad Alberto Hurtado , Santiago, Chile
| | - Constanza Mena
- Neonatal Intensive Care Unit, Clínica INDISA , Santiago, Chile
| |
Collapse
|
|
38
|
Sanjuan PM, Pearson MR, Fokas K, Leeman LM. A mother's bond: An ecological momentary assessment study of posttraumatic stress disorder symptoms and substance craving during pregnancy. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2020; 34:269-280. [PMID: 31829665 PMCID: PMC7064398 DOI: 10.1037/adb0000543] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pregnant women with substance use disorder (SUD) comprise an underserved population with complex treatment needs, including complications from trauma histories and comorbid psychological disorders. Using ecological momentary assessment, we examined momentary fluctuations in posttraumatic stress disorder (PTSD) symptoms, prenatal bonding, and substance craving, among pregnant women in SUD treatment who had a history of trauma. We hypothesized that (a) PTSD symptoms and prenatal bonding would each be associated with substance craving and (b) PTSD symptoms would be negatively associated with prenatal bonding, and this would at least partially account for the association between PTSD symptoms and substance craving (i.e., indirect effect). Participants (n = 32) were on average 27.1 weeks pregnant (SD = 5.27), 27.8 years old (SD = 4.54), and predominantly Hispanic/Latina (66%). At the within subjects level, higher momentary ratings of PTSD symptoms were associated with lower quality (but not intensity of preoccupation) of prenatal bonding, which in turn was associated with greater craving. Lower quality of prenatal bonding partially mediated the positive association between PTSD symptoms and craving, which remained strong after accounting for prenatal bonding. Our results provide some preliminary support for considering interventions aimed at stabilizing or decreasing PTSD symptoms and stabilizing or increasing prenatal bonding to reduce substance craving and, thus, the risk of perinatal substance use among women with SUD and trauma histories. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
Collapse
Affiliation(s)
| | | | - Kathryn Fokas
- Center on Alcoholism, Substance Abuse, and Addictions
| | | |
Collapse
|
|
39
|
Jussila H, Ekholm E, Pajulo M. A New Parental Mentalization Focused Ultrasound Intervention for Substance Using Pregnant Women. Effect on Self-reported Prenatal Mental Health, Attachment and Mentalization in a Randomized and Controlled Trial. Int J Ment Health Addict 2020. [DOI: 10.1007/s11469-019-00205-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
AbstractThe effect of a novel mentalization-based parenting intervention was explored on prenatal self-reported mentalization (P-PRFQ), attachment (MFAS), depression (EPDS) and anxiety (STAI) among women with substance use problems. The participants were 90 pregnant women referred to obstetric outpatient care due to recent or current substance use and randomized into intervention (n = 46) and control (n = 44) groups. The intervention group received three interactive 4D ultrasound sessions and a week-by-week pregnancy diary. The control condition was constituted of treatment-as-usual in obstetric care. Unfortunately, the efficacy of the intervention on maternal prenatal mental health, attachment, and parental mentalization was not substantiated. The negative results may be related to the small sample size, the patient-reported outcomes, or insufficient efficacy within this high-risk group. In the context of high psychosocial risks and follow-up by Child Welfare Services, the patient-reported outcomes may have underestimated prenatal adversity. The role of the research context, methodology, and possible sources of bias in the outcome assessment are discussed.The trial registration number in the ClinicalTrials.gov: NCT03413631
Collapse
|
|
40
|
Napoli A, Lamis DA, Berardelli I, Canzonetta V, Sarubbi S, Rogante E, Napoli PL, Serafini G, Erbuto D, Tambelli R, Amore M, Pompili M. Anxiety, Prenatal Attachment, and Depressive Symptoms in Women with Diabetes in Pregnancy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020425. [PMID: 31936358 PMCID: PMC7013564 DOI: 10.3390/ijerph17020425] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/03/2020] [Accepted: 01/04/2020] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to evaluate the relationship between anxiety, prenatal attachment, and depressive symptoms among women with diabetes in pregnancy. Participants were 131 consecutive pregnant women between the ages of 20 and 45 with a diagnosis of gestational or pregestational type 1 or type 2 diabetes. Data on previous psychiatric symptoms were obtained from the Anamnestic and Social Questionnaire and the Mini-International Neuropsychiatric Interview (MINI). Information on prenatal attachment was collected using The Prenatal Attachment Inventory (PAI), and The Edinburgh Postnatal Depression Scale (EPDS) assessed depressive symptoms in the third trimester of pregnancy (at a mean of 25 weeks). Results demonstrated that in women affected by diabetes in pregnancy, two facets of prenatal attachment (anticipation, interaction) were negatively correlated with depressive symptoms, and a history of anxiety, assessed with the MINI, moderated the relation between the prenatal attachment interaction factor and depressive symptoms during pregnancy.
Collapse
Affiliation(s)
- Angela Napoli
- Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy;
| | - Dorian A. Lamis
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Centre, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy; (D.A.L.); (I.B.); (V.C.); (P.-L.N.); (D.E.)
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Isabella Berardelli
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Centre, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy; (D.A.L.); (I.B.); (V.C.); (P.-L.N.); (D.E.)
| | - Valeria Canzonetta
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Centre, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy; (D.A.L.); (I.B.); (V.C.); (P.-L.N.); (D.E.)
| | - Salvatore Sarubbi
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy; (S.S.); (E.R.)
| | - Elena Rogante
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy; (S.S.); (E.R.)
| | - Pietro-Luca Napoli
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Centre, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy; (D.A.L.); (I.B.); (V.C.); (P.-L.N.); (D.E.)
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (G.S.); (M.A.)
| | - Denise Erbuto
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Centre, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy; (D.A.L.); (I.B.); (V.C.); (P.-L.N.); (D.E.)
| | - Renata Tambelli
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, 00185 Rome, Italy;
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (G.S.); (M.A.)
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Centre, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy; (D.A.L.); (I.B.); (V.C.); (P.-L.N.); (D.E.)
- Correspondence: ; Tel.: +39-06-3377-5675; Fax: +39-06-3377-5342
| |
Collapse
|
|
41
|
Garthus-Niegel S, Staudt A, Kinser P, Haga SM, Drozd F, Baumann S. Predictors and Changes in Paternal Perinatal Depression Profiles-Insights From the DREAM Study. Front Psychiatry 2020; 11:563761. [PMID: 33192683 PMCID: PMC7658469 DOI: 10.3389/fpsyt.2020.563761] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/28/2020] [Indexed: 11/13/2022] Open
Abstract
In contrast to the large body of research on maternal perinatal depression, paternal perinatal mental health has received little attention; and longitudinal studies on paternal perinatal depression, following (expectant) fathers over time, are exceedingly rare. This population-based study aimed to (1) estimate prevalence rates of perinatal depression symptoms among German (expectant) fathers, (2) identify differential profiles of perinatal depression in (expectant) fathers, (3) determine modifiable predictors of latent depression profiles, and (4) estimate how membership in subgroups changes during the perinatal period. Data were derived from the longitudinal cohort study DREAM (Dresden Study on Parenting, Work, and Mental Health), including 1,027 (expectant) fathers responding to the Edinburgh Postnatal Depression Scale (EPDS) during pregnancy and 8 weeks postpartum. Unobserved profiles of paternal perinatal depression and movement between profiles were investigated using latent transition analysis. A number of potential predictors with regard to lifestyle and current life situation were included as covariates. We found that rates of paternal depression symptoms decreased with 9% during pregnancy to 5% at 8 weeks postpartum. Further, four latent depression profiles emerged: most (expectant) fathers did not exhibit any depression symptoms (not depressed), whereas some reported mainly the absence of joy (anhedonic) and some experienced mainly self-blame and worries (anxious-worried). The depressive profile was characterized by endorsement to most symptoms of perinatal depression. Perceived social support and relationship satisfaction appeared to be protective against paternal depression symptoms. Differential transitioning or stability patterns in profile membership during the perinatal period were found, whereas the depressive profile showed to be the least stable. This prospective population-based cohort study is the first study to identify paternal perinatal depression profiles together with their predictors and changes during the perinatal period. Future research is warranted to examine whether the identified paternal depression profiles have differential outcomes, particularly in the context of person-centered prevention and intervention strategies. Further, longitudinal trajectories of paternal depression ought to be studied, taking into account additional measurement points as well as modifiable risk factors.
Collapse
Affiliation(s)
- Susan Garthus-Niegel
- Department of Medicine, Faculty of Human Sciences, Medical School Hamburg, Hamburg, Germany.,Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway.,Faculty of Medicine, Institute and Policlinic of Occupational and Social Medicine, Technische Universität Dresden, Dresden, Germany
| | - Andreas Staudt
- Faculty of Medicine, Institute and Policlinic of Occupational and Social Medicine, Technische Universität Dresden, Dresden, Germany
| | - Patricia Kinser
- School of Nursing, Virginia Commonwealth University, Richmond, VA, United States
| | - Silje Marie Haga
- Department for Infant Mental Health, Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Filip Drozd
- Department for Infant Mental Health, Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Sophie Baumann
- Faculty of Medicine, Institute and Policlinic of Occupational and Social Medicine, Technische Universität Dresden, Dresden, Germany
| |
Collapse
|
|
42
|
Grieb ZA, Ragan CM. The effects of perinatal SSRI exposure on anxious behavior and neurobiology in rodent and human offspring. Eur Neuropsychopharmacol 2019; 29:1169-1184. [PMID: 31427116 DOI: 10.1016/j.euroneuro.2019.07.239] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/10/2019] [Accepted: 07/27/2019] [Indexed: 12/22/2022]
Abstract
While the postpartum period is typically associated with increased positive affect, many women will develop a depressive- or anxiety-related disorder during this time, which can degrade the mother-infant bond and lead to detrimental consequences for the infant. Given the potential for negative consequences, effective treatments have been critical, with selective serotonin reuptake inhibitors (SSRIs) being the most commonly-prescribed pharmaceutical agents to treat postpartum depression and anxiety. However, SSRIs can readily cross the placenta and are present in breast milk, so they might, therefore, unintentionally interact with the developing fetus/infant. There is already experimental evidence that perinatal SSRI exposure has a number of long-term effects on offspring, but this review focuses on the current literature examining the timing and consequences of perinatal SSRI exposure specifically on anxiety-like behaviors in rodents and humans, with an emphasis on the anxiety-related brain regions of the amygdala and hippocampus. This review also discusses discrepancies between the rodent and human literatures and how they might inform future studies. Finally, some key factors to consider when examining the role of perinatal SSRIs on offspring anxiety will be discussed, such as the duration of SSRI exposure and the potential neuroprotective effects of SSRIs. Given the extensive prescribing of SSRIs, the potential health consequences of perinatal SSRI exposure, and the discrepancies in the literature, it will be necessary to critically examine the factors underlying offspring anxiety outcomes.
Collapse
Affiliation(s)
- Z A Grieb
- Neuroscience Institute, 880 Petit Science Center, Georgia State University, Atlanta, GA 30303, United States.
| | - C M Ragan
- Department of Psychology, Library Student Faculty Building, Room 63, Purdue University Northwest, Westville, IN 46391, United States
| |
Collapse
|
|
43
|
Pulliainen H, Niela-Vilén H, Ekholm E, Ahlqvist-Björkroth S. Experiences of interactive ultrasound examination among women at risk of preterm birth: a qualitative study. BMC Pregnancy Childbirth 2019; 19:338. [PMID: 31533655 PMCID: PMC6751623 DOI: 10.1186/s12884-019-2493-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 09/05/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Pregnant women who are at risk of preterm birth are often stressed, anxious and depressed because of worries and fears related to the health of the unborn baby, their own health and uncertainty about the future. Only a few studies have assessed the types of psychological support that would relieve these stress symptoms among women with high-risk pregnancies. The aim of this study was to describe 1) how women at risk of preterm birth experienced an interactive 3/4-dimensional (3/4D) ultrasound examination, and 2) their need for psychological support during the antenatal period. METHODS This qualitative study was conducted at one university hospital in Finland in 2017. Women with a singleton pregnancy of 26-32 gestational weeks (gwks) were included in the study. The interactive 3/4D ultrasound included a joint observation of the baby, based on the mother's wishes, with an obstetrician and psychologist. After the examination, the experiences were explored with a semi-structured interview. The data was analyzed using inductive thematic analysis. RESULTS The women enjoyed the fact that the staff were focused on her fetus and genuinely present during the session and also enabled the women to actively participate. Watching the baby and her/his activities made the baby more concrete and relieved their concerns. The need for additional psychological support varied individually. CONCLUSIONS Interactive ultrasound examination is an interesting way to awaken mental images, increase attachment, and reduce stress. The results imply that an interactive way of jointly looking at the fetus supports pregnant women at risk of preterm birth and may be useful in clinical practice.
Collapse
Affiliation(s)
| | | | - Eeva Ekholm
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland
| | | |
Collapse
|
|
44
|
Čėsnaitė G, Domža G, Ramašauskaitė D, Volochovič J, Bužinskienė D. Factors affecting the maternal-foetal relationship. Acta Med Litu 2019; 26:118-124. [PMID: 31632186 DOI: 10.6001/actamedica.v26i2.4032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background Mother's attachment to her unborn child has a strong impact on a pregnant woman's attitude towards her health, postnatal attachment, and the child's physical and emotional growth. The purpose of our study was to identify the factors that impact the maternal-foetal relationship. Materials and methods The study was conducted at the Centre of Obstetrics and Gynaecology of the tertiary-level Vilnius University Hospital Santaros Klinikos in Vilnius, Lithuania. An original questionnaire of nine parts was developed that the questionnaire included information on demographical data, gynaecological and obstetrical history, a relationship assessment scale, the index of happiness, an antenatal depression risk questionnaire, and the Maternal-Antenatal Attachment Scale. Results The study included 388 pregnant women. It was found that the level of education, obstetrical issues during pregnancy, and the risk of postnatal depression negatively impacted the maternal-foetal relationship (p < 0.05). Mothers who were elder in family birth order, also those whose pregnancy was of a longer duration, who had a better-quality romantic relationship with partner, and whose socioeconomic fulfilment was higher were all found to have a better quality of maternal-foetal bonding (p < 0.05). Conclusions The early recognition of low attachment and right application of various means of psychologic intervention might improve the quality of pregnancy, maternity, and childhood.
Collapse
Affiliation(s)
- Gerda Čėsnaitė
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Gintautas Domža
- Clinic of Obstetrics and Gynaecology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius, Lithuania.,Vilnius University Hospital Santaros klinikos, Vilnius, Lithuania
| | - Diana Ramašauskaitė
- Clinic of Obstetrics and Gynaecology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius, Lithuania.,Vilnius University Hospital Santaros klinikos, Vilnius, Lithuania
| | - Jelena Volochovič
- Clinic of Obstetrics and Gynaecology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius, Lithuania.,Vilnius University Hospital Santaros klinikos, Vilnius, Lithuania
| | - Diana Bužinskienė
- Clinic of Obstetrics and Gynaecology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius, Lithuania.,Vilnius University Hospital Santaros klinikos, Vilnius, Lithuania
| |
Collapse
|
|
45
|
Arguz Cildir D, Ozbek A, Topuzoglu A, Orcin E, Janbakhishov CE. Association of prenatal attachment and early childhood emotional, behavioral, and developmental characteristics: A longitudinal study. Infant Ment Health J 2019; 41:517-529. [PMID: 31508826 DOI: 10.1002/imhj.21822] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This study examines the associations between prenatal attachment and child development, socioemotional behavioral problems, and competence at early childhood. It also inquires whether maternal depression and anxiety at the prenatal period and at early childhood are associated with child outcomes. The study consisted of 83 mothers and their children. Data regarding the prenatal attachment, depression, and anxiety were collected during Weeks 28 to 40 of gestation. When the children were 21 to 31 months old, the Brief Infant and Toddler Social Emotional Assessment (BITSEA) and the Ankara Developmental Screening Inventory (ADSI) were applied to children along with Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI) administered to mothers. Results showed that prenatal attachment scores significantly correlated with BITSEA-Competency subscale scores and ADSI total scores at early childhood, r(83) = 0.246, P = .025, and r(82) = 0.316, P = .004, respectively. Prenatal attachment levels were found to be the predictors of both behavioral and emotional competence and development at early childhood, b = 0.081, t(83) = 2.273, P = .014, and b = 0.281, t(83) = 3.225, P = .002, respectively. In addition, prenatal attachment was shown to be even a stronger predictor of development than was worsening maternal depression at early childhood, b = -0.319, t(83) = 2.140, P = .035. Our results indicate that fostering prenatal attachment may be beneficial for better infant outcomes at early childhood.
Collapse
Affiliation(s)
- Deniz Arguz Cildir
- Tepecik Teaching and Research Hospital, Department of Child and Adolescent Psychiatry, İzmir, Turkey
| | - Aylin Ozbek
- Dokuz Eylul University Faculty of Medicine, Department of Child and Adolescent Psychiatry, İzmir, Turkey
| | | | - Esmahan Orcin
- Dokuz Eylul University Faculty of Medicine, Department of Child and Adolescent Psychiatry, İzmir, Turkey
| | | |
Collapse
|
|
46
|
Cuijlits I, van de Wetering AP, Endendijk JJ, van Baar AL, Potharst ES, Pop VJM. Risk and protective factors for pre- and postnatal bonding. Infant Ment Health J 2019; 40:768-785. [PMID: 31430393 DOI: 10.1002/imhj.21811] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Since disturbances in the mother-child bond increase the risk of negative consequences for child development, it is important to identify risk and protective factors for bonding as well as longitudinal associations. Previous research has used different bonding instruments during pregnancy and the postnatal phase, leading to inconsistent results. In the current study, the same instrument was used during the various phases. In a large, community-based sample (N = 793), general information, feelings of pre- and postnatal bonding (Pre- and Postnatal Bonding Scale), depressive symptoms (Edinburgh Postnatal Depression Scale), and partner support (subscale Tilburg Pregnancy/Postnatal Distress Scale) were measured at both 32 weeks of pregnancy and 8 months postnatally. Partner support was found to be a protective factor for suboptimal pre- and postnatal bonding, as was the engagement with fetal movements for prenatal bonding. High maternal educational level was a risk factor for suboptimal prenatal bonding, as were depressive symptoms for suboptimal postnatal bonding. The associations between most prenatal determinants and postnatal bonding were mediated by prenatal bonding, which underlines the importance of promoting prenatal bonding. Professionals in clinical practice should be aware of partner support, engagement with fetal movements, and postnatal depressive symptoms: All these factors offer opportunities for improving the bonding processes.
Collapse
Affiliation(s)
- I Cuijlits
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.,Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - A P van de Wetering
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - J J Endendijk
- Department of Child and Adolescent studies, Utrecht University, Utrecht, The Netherlands
| | - A L van Baar
- Department of Child and Adolescent studies, Utrecht University, Utrecht, The Netherlands
| | - E S Potharst
- UvA minds-Academic Treatment Centre for Parent and Child, University of Amsterdam, Amsterdam, The Netherlands
| | - V J M Pop
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| |
Collapse
|
|
47
|
Göbel A, Barkmann C, Goletzke J, Hecher K, Schulte-Markwort M, Arck P, Diemert A, Mudra S. Psychometric properties of 13-item versions of the maternal and paternal antenatal attachment scales in German. J Reprod Infant Psychol 2019; 38:455-467. [PMID: 31370689 DOI: 10.1080/02646838.2019.1643833] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess scale reliability and factorial validity of the Maternal and Paternal Antenatal Attachment Scale in a German sample. BACKGROUND Prenatal bonding to the child is an important aspect for parents and has been associated with the early parent-child relationship. The maternal and paternal versions of the Antenatal Attachment Scale (MAAS/PAAS) with the dimensions bonding quality and intensity are among the best-established questionnaires for parental-fetal bonding. However, a German translation of the PAAS and investigations of the factor structure of both MAAS and PAAS are still lacking. METHOD 263 women and 128 men from Hamburg, Germany, were assessed during pregnancy (total sample N = 391). RESULTS Factor analyses did not support the original factor structures of both scales. Still, two factors equivalent to the original quality and intensity dimensions were identified. Scale reliability for the extracted factors was satisfying to good for both instruments. CONCLUSION The revised 13-item versions for MAAS and PAAS are proposed as reliable and valuable measurements of parental-foetal bonding. The scales contribute to the cross-cultural comparison of research on maternal and paternal-foetal bonding. Identifying parents with bonding difficulties already prenatally can enable specific forms of support addressing the parent-child-relationship in the peripartum period. ABBREVIATIONS Maternal Antenatal Attachment Scale (MAAS). Paternal Antenatal Attachment Scale (PAAS). confirmatory factor analysis (CFA). Root Mean Squared Error of Approximation (RMSEA). Standardized Root Mean Square Residual (SRMR). Comparative Fit Index (CFI). Tucker Lewis Index (TLI). principal axis factoring (PAF). mean (M). standard deviation (SD). standard error (SE). item difficulty (Pi). Kaiser-Meyer-Olkin value (KMO).
Collapse
Affiliation(s)
- Ariane Göbel
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Centre Hamburg-Eppendorf , Hamburg, Germany
| | - Claus Barkmann
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Centre Hamburg-Eppendorf , Hamburg, Germany
| | - Janina Goletzke
- Department of Obstetrics and Foetal Medicine, University Medical Centre Hamburg-Eppendorf , Hamburg, Germany
| | - Kurt Hecher
- Department of Obstetrics and Foetal Medicine, University Medical Centre Hamburg-Eppendorf , Hamburg, Germany
| | - Michael Schulte-Markwort
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Centre Hamburg-Eppendorf , Hamburg, Germany
| | - Petra Arck
- Department of Obstetrics and Foetal Medicine, University Medical Centre Hamburg-Eppendorf , Hamburg, Germany
| | - Anke Diemert
- Department of Obstetrics and Foetal Medicine, University Medical Centre Hamburg-Eppendorf , Hamburg, Germany
| | - Susanne Mudra
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Centre Hamburg-Eppendorf , Hamburg, Germany
| |
Collapse
|
|
48
|
McNamara J, Townsend ML, Herbert JS. A systemic review of maternal wellbeing and its relationship with maternal fetal attachment and early postpartum bonding. PLoS One 2019; 14:e0220032. [PMID: 31344070 PMCID: PMC6657859 DOI: 10.1371/journal.pone.0220032] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 07/08/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND An emerging body of literature suggests there is a relationship between a pregnant woman's psychological wellbeing and the development of maternal-fetal attachment (MFA) and early postpartum bonding. The nature of this relationship is not well understood because of the limited theoretical framework surrounding the construct of MFA and variations in study methods and data collection points. In this systematic review, we synthesize the published literature to determine the nature of the relationship from the antenatal to early postnatal period and to provide recommendations for future research and clinical practice. METHOD Using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) approach, four electronic databases were searched for peer-reviewed empirical studies, published in English. Articles were considered for inclusion if data was collected on at least one domain of maternal wellbeing/mental health and MFA during pregnancy or MFA during pregnancy and the mother-infant relationship during the early postpartum period (up to 12 weeks). No date parameters were applied to the search strategy. The review was registered with PROPSERO (registration number: CRD42018096174). RESULTS 25 studies examining maternal mental health and MFA/postpartum bonding were selected for inclusion in this review. Key findings identified from the review were: a need to validate existing mental health measures or develop new measures specific for use in antenatal populations; inconsistencies in data collection points throughout pregnancy and postpartum; a lack of consensus about the construct of MFA and the way it is assessed; and a continued focus on postpartum outcomes. CONCLUSION Scientific gaps remain in our understanding of the relationship between maternal mental health and both MFA and postpartum bonding which limit our theoretical understanding of the MFA construct. Recommendations for future research are to employ prospective longitudinal designs that span the full pregnancy and postpartum period, and for consistency in the terminology and methodology used when considering MFA. A re-focus of research attention on the theory behind MFA will allow a richer and more holistic account of the emerging relationship between mother and baby.
Collapse
Affiliation(s)
- Josephine McNamara
- School of Psychology and Early Start, University of Wollongong, Wollongong, New South Wales, Australia
| | - Michelle L. Townsend
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Jane S. Herbert
- School of Psychology and Early Start, University of Wollongong, Wollongong, New South Wales, Australia
| |
Collapse
|
|
49
|
Probiotics in pregnancy: protocol of a double-blind randomized controlled pilot trial for pregnant women with depression and anxiety (PIP pilot trial). Trials 2019; 20:440. [PMID: 31315657 PMCID: PMC6637581 DOI: 10.1186/s13063-019-3389-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 05/02/2019] [Indexed: 12/28/2022] Open
Abstract
Background Maternal prenatal depressive or anxiety symptoms are associated with adverse maternal and infant health outcomes. With prevalence rates of maternal prenatal depression and anxiety ranging between 10 and 20%, attempts to identify effective interventions to reduce symptoms are priority. There are indications that probiotics can reduce symptoms of maternal depression or anxiety. Probiotics ingested by the mother may thus offer a promising and accessible intervention to complement existing treatments. Methods The Probiotics in Pregnancy (PIP) pilot trial is a double-blind, placebo-controlled, randomized pilot trial. While one group orally consumes a probiotic mixture (Ecologic® Barrier; 2,5 × 109 colony forming units/g; 2 g; daily), the other group consumes a placebo, from between 26 and 30 weeks gestation until delivery. Subjects are randomly allocated (1:1) to the intervention or placebo group. Forty healthy pregnant women with symptoms of depression or anxiety and uncomplicated pregnancies at randomization will be included. The primary aim is to determine the feasibility and acceptability of a probiotic trial to reduce symptoms of maternal depression or anxiety in pregnancy. The secondary aim is to exploratorily compare the potential effect of probiotics, compared to placebo, on depressive and/or anxiety symptoms, maternal stress (i.e. reported/hair cortisol), maternal vaginal and intestinal microbiota, and by possibly affecting maternal mood and microbiota, maternal bonding to offspring, infant microbiota and infant crying. Discussion Results of this pilot trial will help determine whether or not to proceed with a full trial after the pilot trial, and if so, whether revisions should be made to the study protocol and procedures before conducting a full randomized controlled trial. Additionally, they are expected to provide insights into whether changes in psychological, behavioral and biological parameters can be attributed to the probiotic intervention. Trial registration Netherlands Trial Register, NTR6219. Registered on 28 February 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3389-1) contains supplementary material, which is available to authorized users.
Collapse
|
|
50
|
Early maladaptive schemas as predictors of maternal bonding to the unborn child. BMC Psychol 2019; 7:23. [PMID: 30975192 PMCID: PMC6460656 DOI: 10.1186/s40359-019-0297-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 03/29/2019] [Indexed: 11/10/2022] Open
Abstract
Background The quality of an expectant mother’s bonding to the fetus has been shown to be associated with important developmental outcomes. Previous studies suggest that bonding quality is predicted by, for example, social support, psychological well-being, and depression. However, little is known regarding the role of maternal cognition in maternal-fetal bonding. Early maladaptive schemas (EMSs) are negative and stable assumptions about oneself and one’s relationships with others that are developed during childhood and adolescence. In the present study, we examined the associations between EMSs and the quality of the bonding to the fetus in expectant mothers. Methods The present investigation is part of a larger study in which 220 pregnant women (approximately 12% of the pregnant women in the region) and 130 of their partners were recruited from October 2015 until December 2017. The sample for the current study comprised 165 pregnant women (mean age 30.8 years, SD 4.1 years). The participants completed the Young Schema Questionnaire Short Form 3 (YSQ-S3) between gestational weeks 24 and 37 and the Maternal Antenatal Attachment Scale (MAAS) and the Edinburgh Postnatal Depression Scale (EPDS) between gestational weeks 31 and 41. Results All EMS domains correlated significantly and negatively with scores for quality of maternal-fetal bonding on the MAAS. Only the Disconnection and Rejection domain correlated significantly and negatively with MAAS scores for intensity of preoccupation with the fetus. The Disconnection and Rejection domain was a significant independent predictor of the quality of maternal-fetal bonding. Symptoms of depression mediated the effect of the EMS domains on the quality of maternal-fetal bonding. The EMS domains Disconnection and Rejection, Impaired Autonomy and Performance, and Impaired Limits showed significant direct effects on bonding quality. Conclusions EMSs are related to expectant mothers’ self-reported bonding to their fetuses. This association was mediated by the mothers’ symptoms of depression. The results may have implications for the early identification of pregnant women at risk of bonding difficulties and encourage more studies on cognitive schemas and mechanisms for maternal-fetal bonding.
Collapse
|