Maternal Depressive Symptoms at 2 to 4 Months Post Partum and Early Parenting Practices

Breastfeeding and depression: a systematic review of the literature

BACKGROUND

Research has separately indicated associations between pregnancy depression and breastfeeding, breastfeeding and postpartum depression, and pregnancy and postpartum depression. This paper aimed to provide a systematic literature review on breastfeeding and depression, considering both pregnancy and postpartum depression.

METHODS

An electronic search in three databases was performed using the keywords: "breast feeding", "bottle feeding", "depression", "pregnancy", and "postpartum". Two investigators independently evaluated the titles and abstracts in a first stage and the full-text in a second stage review. Papers not addressing the association among breastfeeding and pregnancy or postpartum depression, non-original research and research focused on the effect of anti-depressants were excluded. 48 studies were selected and included. Data were independently extracted.

RESULTS

Pregnancy depression predicts a shorter breastfeeding duration, but not breastfeeding intention or initiation. Breastfeeding duration is associated with postpartum depression in almost all studies. Postpartum depression predicts and is predicted by breastfeeding cessation in several studies. Pregnancy and postpartum depression are associated with shorter breastfeeding duration. Breastfeeding may mediate the association between pregnancy and postpartum depression. Pregnancy depression predicts shorter breastfeeding duration and that may increase depressive symptoms during postpartum.

LIMITATIONS

The selected keywords may have led to the exclusion of relevant references.

CONCLUSIONS

Although strong empirical evidence regarding the associations among breastfeeding and pregnancy or postpartum depression was separately provided, further research, such as prospective studies, is needed to clarify the association among these three variables. Help for depressed pregnant women should be delivered to enhance both breastfeeding and postpartum psychological adjustment.

A longitudinal analysis of maternal depressive symptoms and children's food consumption and weight outcomes

OBJECTIVE

Maternal depressive symptoms negatively impact mothers' parenting practices and children's development, but the evidence linking these symptoms to children's obesity is mixed.

DESIGN

We use a large sample to examine contemporaneous and lagged associations between maternal depressive symptoms and children's BMI, obesity and food consumption, controlling for background characteristics.

SETTING

Data from the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B), a longitudinal study of children from infancy through kindergarten in the USA, were collected at four waves from 2001 to 2007, when children were 9 months, 2 years, 4 years and 5½years of age, through surveys, child assessments and observations.

SUBJECTS

A sub-sample of children from the ECLS-B is used (n 6500).

RESULTS

Between 17 % and 19 % of mothers reported experiencing depressive symptoms; 17 % to 20 % of children were obese. Maternal depressive symptoms were associated with a small decrease in the likelihood her child was obese (0·8 percentage points) and with lower consumption of healthy foods. The duration of maternal depressive symptoms was associated with higher BMI (0·02 sd) among children whose parents lacked college degrees.

CONCLUSIONS

Results indicate that mothers' depressive symptoms have small associations with children's food consumption and obesity. Among children whose parents lack college degrees, persistent maternal depressive symptoms are associated with slightly higher child BMI. Findings highlight the need to control for depression in analyses of children's weight. Interventions that consider maternal depression early may be useful in promoting healthy weight outcomes and eating habits among children.

Maternal distress in early life predicts the waist-to-hip ratio in schoolchildren

We report on life course stress determinants of overweight in children, using data from the longitudinal follow-up of the nested case-control arm of the SAGE (study of asthma genes and the environment) birth cohort in Manitoba, Canada. Waist and hip measurements were obtained during a clinic visit at age 9-11 years. Multiple linear regression was conducted to determine the relationship between the waist-to-hip ratio and maternal smoking during pregnancy, postpartum maternal distress and stress reactivity in children (cortisol, cortisol-DHEA [dihydroepiandrostrenone] ratio quartiles) following a clinic stressor at age 8-10 years. We found waist-to-hip risk at age 9-11 years to be elevated among boys and girls whose mothers had experienced distress in the postnatal period. This association varied by gender and asthma status. In healthy girls, postpartum distress increased waist-to-hip ratio by a factor of 0.034 (P < 0.01), independent of the child's stage of puberty and adrenarche, cortisol-DHEA ratio and duration of exclusive breastfeeding. Among girls with asthma, maternal smoking during pregnancy was associated with an increased waist-to-hip ratio, if the mother also experienced distress in the postpartum period (0.072, P = 0.038). Among asthmatic boys, an association between maternal distress and waist-to-hip ratio was evident at the highest cortisol-DHEA ratios. Stress-induced changes to leptin and infant over-eating pathways were proposed to explain the postnatal maternal distress effects. Drawing on the theories of evolutionary biology, our findings underscore the significance of postnatal stress in disrupting hypothalamic-pituitary-adrenal axis function in infants and increasing risk for child overweight.

Association of birth of girls with postnatal depression and exclusive breastfeeding: an observational study

OBJECTIVES AND HYPOTHESIS

To examine the influence of gender of the baby on exclusive breastfeeding and incidence of postnatal depression (PND). We hypothesise that in a society with a male gender bias there may be more PND and less exclusive breastfeeding of the girl child.

DESIGN

Prospective study.

SETTING

The study was conducted in an urban, tertiary hospital in Delhi.

PARTICIPANTS

Mothers delivering normally with their babies roomed-in.1537 eligible women participated in the study.

PRIMARY AND SECONDARY OUTCOME MEASURES

Exclusive breastfeeding within the first 48 h of life and score on the Edinburgh Postnatal Depression Scale (EPDS) were recorded.

RESULTS

3466 babies were born in the hospital. There were 792 girls for every 1000 boys. Among primiparous women, the sex ratio was 901 girls per 1000 boys. For second babies, the sex ratio was 737:1000. If the first child was a girl the birth ratio fell to 632. 1026 mothers were exclusively breastfeeding. Exclusive breastfeeding of boys was significantly higher (70.8% vs 61.5%, p<0.001). The EPDS score was significantly higher with the birth of girls (EPDS 6.0±3.39 vs 5.4±2.87, p<0.01). Women with an EPDS score >11 were less likely to exclusively breastfeed (p<0.01).

CONCLUSIONS

The results point to a pro-male gender bias evidenced by a low sex ratio at birth, higher EPDS score in mothers of girls and less breastfeeding of female children.

Postnatal depression: a family medicine perspective

The prevalence of postnatal depression (PND) was reported to be 6.8% in an obstetric setting in Singapore. Since primary care physicians are the healthcare clinicians most likely to interact with postnatal mothers in Singapore, they are in the best position to screen for PND and help new mothers. PND affects the well-being of the mother, her baby and those around her. If left untreated, depression can result in lasting adverse outcomes such as unfavourable parenting practices, impaired mother-infant bonding, impaired intellectual and emotional development of the infant, maternal suicide, and even infanticide. The Edinburgh Postnatal Depression Scale and the Patient Health Questionnaire-2 are effective screening tools that can be easily used in primary care settings for screening at-risk mothers. Herein, we discuss the management options available in primary care settings, as well as share some local resources available to mothers and the benefits of timely intervention.

Maternal negative affect is associated with emotional feeding practices and emotional eating in young children

BACKGROUND

Although mothers of young children frequently experience negative affect, little is known about the association between these symptoms and their children's eating behaviors. We aimed to test a model in which maternal negative affect would be related to maternal emotional eating which in turn would be associated with child emotional eating through maternal feeding practices (emotional and instrumental feeding) in a cross-sectional sample of mothers and their children.

METHODS

A sample of 306 mothers (mean age = 35.0 years, SD = 0.46) of 2-year-old children completed a survey assessing symptoms of depression, anxiety and stress, maternal emotional eating, maternal feeding practices, and child emotional eating.

RESULTS

Maternal symptoms of depression, anxiety, and stress were correlated with maternal emotional eating (p < .001), and child emotional eating (p < .05). The initial model proposed was not a good fit to the data. Modification indices indicated that the model would be improved if a direct pathway was added between maternal and child emotional eating. As this model was theoretically plausible these changes were made. The resulting model proved a good fit to the data, χ2 = 17.36, p = .098, and explained 29% of the variance in child emotional eating.

CONCLUSIONS

High levels of negative affect and associated emotional eating in mothers may contribute to the use of instrumental and emotional feeding practices. Our findings suggested that maternal negative affect has an indirect effect on children's emotional eating, primarily through mothers' own emotional eating and feeding her child to regulate the child's emotions.

Maternal postnatal mental health and later emotional-behavioural development of children: the mediating role of parenting behaviour

BACKGROUND

Maternal postnatal mental health difficulties have been associated with poor outcomes for children. One mechanism by which parent mental health can impact on children's outcomes is via its effects on parenting behaviour.

METHOD

The longitudinal relationships between maternal postnatal distress, parenting warmth, hostility and child well-being at age seven were examined for 2200 families participating in a population-based longitudinal study of Australian children.

RESULTS

The relationship between postnatal distress and children's later emotional-behavioural development was mediated by parenting hostility, but not parenting warmth, even after accounting for concurrent maternal mental health. Postnatal distress was more strongly associated with lower parenting warmth for mothers without a past history of depression compared with mothers with a past history of depression.

CONCLUSIONS

These findings underscore the contribution of early maternal well-being to later parenting and child outcomes, highlighting the importance of mental health and parenting support in the early parenting years. Implications for policy and practice are discussed.

Prevalence of infant television viewing and maternal depression symptoms

BACKGROUND

Early television (TV) viewing has been linked with maternal depression and has adverse health effects in children. However, it is not known how early TV viewing occurs. This study evaluated the prevalence at which parents report TV viewing for their children if asked in the first 2 years of life and whether TV viewing is associated with maternal depression symptoms.

METHODS

Using a cross-sectional design, TV viewing was evaluated in children 0 to 2 years of age in 4 pediatric clinics in Indianapolis, IN, between January 2011 and April 2012. Families were screened for any parental report of depression symptoms (0-15 months) and for parental report of TV viewing (before 2 years of age) using a computerized clinical decision support system linked to the patient's electronic health record.

RESULTS

There were 3254 children in the study. By parent report, 50% of children view TV by 2 months of age, 75% by 4 months of age, and 90% by 2 years of age. Complete data for both TV viewing and maternal depression symptoms were available for 2397 (74%) of children. In regression models, the odds of parental report of TV viewing increased by 27% for each additional month of child's age (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.25-1.30; p < .001). The odds of TV viewing increased by almost half with parental report of depression symptoms (OR, 1.47; CI, 1.07-2.00, p = .016). Publicly insured children had 3 times the odds of TV viewing compared to children with private insurance (OR, 3.00; CI, 1.60-5.63; p = .001). Black children had almost 4 times the odds (OR, 3.75; CI, 2.70-5.21; p < .001), and white children had one-and-a-half times the odds (OR, 1.55; CI, 1.04-2.30; p = .032) of TV viewing when compared to Latino children.

CONCLUSIONS

By parental report, TV viewing occurs at a very young age in infancy, usually between 0 and 3 months and varies by insurance and race/ethnicity. Children whose parents report depression symptoms are especially at risk for early TV viewing. Like maternal depression, TV viewing poses added risks for reduced interpersonal interactions to stimulate infant development. This work suggests the need to develop early targeted developmental interventions. Children as young as 0 to 3 months are viewing TV on most days. In the study sample of 0 to 2 year olds, the odds of TV viewing increased by more than a quarter for each additional month of child's age and by as much as half when the mother screened positive for depression symptoms.

Postpartum depression: perceptions of a diverse sample of low-income women

Postpartum depression (PPD) continues to significantly impact women and their families during the perinatal period. Consequences of untreated PPD in the mother may lead to impaired mother-infant bonding, recurring psychiatric illness, and fewer positive parenting behaviors. North Carolina participates in the Pregnancy Risk Assessment Monitoring System (PRAMS) survey and has the second highest self-reported rate of postpartum depressive symptoms at 19.0%. The full study used both quantitative and qualitative methods. The qualitative approach, an interpretive Heideggerian perspective, elicited the postpartum clients' perceptions of risk factors, how those perceptions affected the pregnancy experience, and how self-efficacy played a role in their perceived ability to make healthy choices. The sample was comprised of 60 pregnant women between the ages of 18 and 40. Four themes were found: (1) Feeling joy and apprehension at once, (2) Depression is something you think about (3) Rearranging your thinking, and (4) Garnering support. The women in this study believed that support was an indispensable tool in dealing with feelings of sadness and depression. Critical aspects of becoming involved in their pregnancy included changing their expectations and knowing how to detect and seek help when depressive symptoms occurred.

An intervention to reduce postpartum depressive symptoms: a randomized controlled trial

Depressive symptoms and depression are a common complication of childbirth, and a growing body of literature suggests that there are modifiable factors associated with their occurrence. We developed a behavioral educational intervention targeting these factors and successfully reduced postpartum depressive symptoms in a randomized trial among low-income black and Latina women. We now report results of 540 predominantly white, high-income mothers in a second randomized trial. Mothers in the intervention arm received a two-step intervention that prepared and educated mothers about modifiable factors associated with postpartum depressive symptoms (e.g., physical symptoms, low self-efficacy), bolstered social support, and enhanced management skills. The control arm received enhanced usual care. Participants were surveyed prior to randomization, 3 weeks, 3 months, and 6 months postpartum. Depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS of 10 or greater). Prevalence of depressive symptoms postpartum was unexpectedly low precluding detection of difference in rates of depressive symptoms among intervention versus enhanced usual care posthospitalization: 3 weeks (6.0 vs. 5.6 %, p = 0.83), 3 months (5.1 vs. 6.5 %, p = 0.53), and 6 months (3.6 vs. 4.6 %, p = 0.53).

Postpartum depression, infant feeding practices, and infant weight gain at six months of age

INTRODUCTION

This study examined postpartum depression (PPD) as a potential risk factor for non-adherence to infant feeding guidelines and subsequent infant weight gain.

METHODS

Participants were mother-infant dyads from the Infant Feeding Practices Study II (N = 1447). Main study variables were PPD, breastfeeding intensity, addition of cereal to infant formula, and age of introduction to solid foods.

RESULTS

In logistic models adjusted for sociodemographic factors, mothers with PPD were 1.57 times (95% confidence interval [CI]: 1.16, 2.13) more likely to breastfeed at low intensity and 1.77 times (95% CI: 1.16, 2.68) more likely to add cereal to infant formula. Although PPD was associated with the early introduction to solid foods (odds ratio: 1.42; 95% CI: 1.07, 1.89), this relationship was not significant after adjusting for potential confounders. A small but significantly greater average weight gain at 6 months was observed among infants of mothers with PPD (10.15 lb, SD = 2.32 vs. 9.85 lb, SD = 2.32).

DISCUSSION

Screening for PPD at well-child visits may lead to improved maternal health outcomes and the prevention of early life risk factors for childhood obesity.

Who's feeding baby? Non-maternal involvement in feeding and its association with dietary intakes among infants and toddlers

This study examined non-maternal involvement in feeding during the first 2 years of life and its association with breastfeeding duration, early introduction of complementary foods, and dietary intakes of selected foods and beverages. Data were from the Infant Care, Feeding and Risk of Obesity Study, a cohort of 217 low-income, African-American mother-infant dyads, followed from 3 to 18 months postpartum. Non-maternal caregivers (NMCs) were defined as persons involved in feeding an infant/toddler 50% or more of the total daily feedings. Use of any NMC and the type of NMC was tabulated for each study visit (3, 6, 9, 12, and 18 months). At each time point, more than half of all households reported a NMC. Fathers, grandmothers, and licensed childcare providers were the most common types of NMCs. In longitudinal models adjusted for confounding variables, NMC use was associated with a decreased likelihood of continued breastfeeding, and an increased likelihood of infants and toddlers consuming juice or whole fruit. Given the high prevalence of non-maternal involvement in feeding, interventions targeting multiple family members are warranted as they are likely to be more effective than those targeting the mother alone.

Oxytocin and postpartum depression: delivering on what's known and what's not

The role of oxytocin in the treatment of postpartum depression has been a topic of growing interest. This subject carries important implications, given that postpartum depression can have detrimental effects on both the mother and her infant, with lifelong consequences for infant socioemotional and cognitive development. In recent years, oxytocin has received attention for its potential role in many neuropsychiatric conditions beyond its well-described functions in childbirth and lactation. In the present review, we present available data on the clinical characteristics and neuroendocrine foundations of postpartum depression. We outline current treatment modalities and their limitations, and proceed to evaluate the potential role of oxytocin in the treatment of postpartum depression. The aim of the present review is twofold: (a) to bring together evidence from animal and human research concerning the role of oxytocin in postpartum depression, and (b) to highlight areas that deserve further research in order to bring a fuller understanding of oxytocin's therapeutic potential. This article is part of a Special Issue entitled Oxytocin and Social Behav.

The critical period of infant feeding for the development of early disparities in obesity

Childhood obesity is an increasing public health problem, particularly among minority infants and young children. Disparities in overweight prevalence persist and widen with age, highlighting the need to identify factors contributing to early excess weight gain. We review the behavioral, social and macro-environmental factors contributing to the development of obesogenic early feeding practices among African-American infants and young children. We then examine the sociodemographic, household factors, feeding beliefs and infant characteristics associated with age-inappropriate feeding of liquids and solids (inappropriate feeding) among mothers and infants participating the U.S. Infant Care and Risk of Obesity Study, a cohort study of 217 low-income, first-time mothers and infants followed from 3 to 18 months of age. Maternal and infant anthropometry, infant diet, and maternal and household characteristics were collected at home visits at 3, 6, 9, 12 and 18 months of age. Mixed logistic regression was used to estimate the association between maternal and infant characteristics and inappropriate feeding. Rates of age-inappropriate feeding are high; over 75% of infants received solids or juice by 3 months of age. The odds of age-inappropriate feeding were higher among mothers who were single, depressed or believed that their infant is a "greedy" baby. Inappropriate feeding was associated with higher daily energy intake in infants (β = 109.28 calories, p = 0.01) and with increased odds of high infant weight-for-length (WFL; OR = 1.74, 95%CI: 1.01-3.01). Our findings suggest that age-inappropriate complementary feeding influences current energy intakes and infant WFL, factors that may increase long-term obesity risk by shaping infant appetite, food preferences, and metabolism. Given the intractability of pediatric obesity, understanding the role of early feeding in shaping long-term health disparities is critical for developing prevention strategies to stem obesity in early childhood.

Psychological stress and hospitalization for childhood asthma-a nationwide cohort study in two Nordic countries

OBJECTIVE

Exposures to psychological stress in early life may contribute to the development or exacerbation of asthma. We undertook a cohort study based on data from several population-based registers in Denmark and Sweden to examine whether bereavement in childhood led to increased asthma hospitalization.

METHODS

All singleton children born in Denmark during 1977-2008 and in Sweden during 1973-2006 were included in the study (N=5,202,576). The children were followed from birth to the date of first asthma hospitalization, emigration, death, their 18(th) birthday, or the end of study (31 December 2007 in Sweden and 31 December 2008 in Denmark), whichever came first. All the children were assigned to the non-bereaved group until they lost a close relative (mother, father or a sibling), from when they were included in the bereaved group. We evaluated the hazard ratio (HR) of first hospitalization for asthma in bereaved children using Cox proportional hazards regression models, compared to those who were in the non-bereaved group. We also did a sub-analysis on the association between bereavement and first asthma medication.

RESULTS

A total of 147,829 children were hospitalized for asthma. The overall adjusted HR of asthma hospitalization in bereaved children was 1.10 (95% confidence interval (CI): 1.04-1.16), compared to non-bereaved children. The risk of asthma hospitalization was increased in those who lost a close relative at age of 14-17 years (HR=1.54, 95% CI: 1.23-1.92), but not in younger age groups. The association between bereavement and asthma hospitalization did not change over time since bereavement. In the sub-analysis in singleton live births during 1996-2008 recorded in the DMBR, bereavement was associated with a lower use of asthma medication (HR=0.87, 95% CI: 0.80-0.95).

CONCLUSIONS

Our data suggests that psychological stress following bereavement in late adolescence is associated with an increased risk of asthma hospitalization or lowers the threshold for asthma hospitalization.

Cumulative poor psychosocial and behavioral health among low-income women at 6 weeks postpartum

BACKGROUND

During the postpartum period, women may experience unfavorable psychosocial and behavioral health in multiple domains with adverse effects on parenting and maternal and infant health. Yet, little is known about the accumulation of poor health across the domains of depressive symptoms; body image; diet and physical activity; substance use including smoking and alcohol; and general self-care at 6 weeks postpartum, the usual end of maternity care.

OBJECTIVES

The aims of this study were to evaluate relationships among the domains comprising psychosocial and behavioral health and to examine the distribution and risk factors associated with cumulative poor psychosocial and behavioral health at 6 weeks postpartum.

METHODS

This study was a secondary analysis of cumulative poor health assessed by self-report scales for depressive symptoms, body image dissatisfaction, diet and exercise, substance use, and general self-care among 419 low-income White, African American, and Hispanic women at 6 weeks postpartum. Multivariable Poisson and logistic regression were used in key analyses.

RESULTS

The correlation among psychosocial and behavioral domains had a range of r = .50-.00. In this sample of women, 45% had two or more domains in which they had poor health. The model testing risk factors for cumulative poor health was significant (likelihood ratio chi-square = 39.26, df = 11, p < 0.05), with two significant factors: not exclusively breastfeeding (odds ratio [OR] = 1.459, 95% confidence interval [CI] [1.119, 1.901]) and Hispanic ethnicity (OR = 0.707, 95% CI [0.582, 0.858], psuedo-R = .029). Within individual domains, significant risk factors (body mass index, not exclusively breastfeeding, ethnicity, education level, and parity) varied by domain.

DISCUSSION

Many low-income women postpartum have poor psychosocial and behavioral health in multiple domains, which constitute areas for health promotion and early disease prevention.

Postnatal depression is a public health nursing issue: perspectives from norway and ireland

The framework provided by the Millennium Development Goals includes maternal health as an area of priority. Postnatal depression (PND) is a serious public health issue because it occurs at a crucial time in a mothers' life, can persist for long periods, and can have adverse effects on partners and the emotional, behavioural, and cognitive development of infants and children. Internationally, public health nurses (PHNs) are key professionals in the delivery of health care to mothers in the postpartum period, and international research collaborations are encouraged. Two researchers from the European Academy of Nursing Science (EANS) identified a need to collaborate and strengthen research capacity and discussion on postnatal depression, a public health nursing issue in both countries. Within the context of public health and public health nursing in Ireland and Norway, the aim of this paper is to present a discussion on the concept of PND, prevalence, and outcomes; screening issues for PHNs; and the research evidence of the benefits of social support in facilitating recovery for new mothers.

The role of maternal self-care in new motherhood

OBJECTIVE

To examine the following: (1) women's perceptions regarding the role of maternal self-care, (2) specific applications of self-care in new motherhood and (3) barriers to practising effective self-care.

DESIGN

three focus groups were conducted in order to study women's perspectives regarding the key components of new motherhood.

SETTING

Recruitment took place in Allegheny County, surrounding Pittsburgh. The focus groups were held at the University of Pittsburgh's Medical School.

PARTICIPANTS

Thirty-one adult women who had given birth in the year prior to enrollment participated in the study.

METHODS

The focus group conversations were recorded and transcribed for purposes of qualitative analysis. Conversation related to maternal self-care, which was identified as a component of new motherhood, was grouped into one of three categories: (1) women's valuations of self-care, (2) effective applications of self-care and (3) barriers to good self-care practice.

FINDINGS

Two ideologies regarding the role of self-care emerged. In one conception of effective mothering, self-care was of primary importance. On the contrary, some women associated a sometimes extreme form of self-sacrifice with new motherhood. Effective applications of self-care included taking time to exercise, allowing the infant's father to care for the child for a period of time and going out to restaurants. Barriers to good self-care practice were time, other limited resources such as money and social support and difficulty accepting help and setting boundaries.

KEY CONCLUSIONS

Additional focus groups should be conducted with the purpose of studying maternal self-care exclusively. This work is an important first step in identifying ways to help new mothers better care for themselves.

The long-term psychiatric and medical prognosis of perinatal mental illness

The perinatal period provides an important window into a woman's long-term health. Perinatal mental illness is a common condition conferring potential serious long-term psychiatric and medical consequences for the mother and family. It is known that childbirth acts as a powerful trigger for depressive episodes in some women, and that women with histories of a mood disorder are particularly vulnerable. Some evidence links perinatal mental illness with obstetrical complications and reduced lactation initiation and duration. Therefore, perinatal mental illness may be a marker for long-term risk, and may contribute directly to subsequent cardiometabolic disease through both neuroendocrine mechanisms and the effects of mental illness on health behaviours. In clinical practice, these associations underscore the importance of screening and treating women with perinatal mental illness to ensure best possible long-term outcomes. Early screening and treatment may both mitigate the primary disease process and reduce the risk of comorbid medical conditions.

Screening for postnatal depression in Chinese-speaking women using the Hong Kong translated version of the Edinburgh Postnatal Depression Scale

INTRODUCTION

The Edinburgh Postnatal Depression Scale (EPDS) may not be a uniformly valid postnatal depression (PND) screen across populations. We evaluated the performance of a Chinese translation of 10-item (HK-EPDS) and six-item (HK-EPDS-6) versions in post-partum women in Singapore.

METHODS

Chinese-speaking post-partum obstetric clinic patients were recruited for this study. They completed the HK-EPDS, from which we derived the six-item HK-EPDS-6. All women were clinically assessed for PND based on Diagnostic and Statistical Manual, Fourth Edition-Text Revision criteria. Receiver-operator curve (ROC) analyses and likelihood ratio computations informed scale cutoff choices. Clinical fitness was judged by thresholds for internal consistency [α ≥ 0.70] and for diagnostic performance by true-positive rate (>85%), false-positive rate (≤10%), positive likelihood ratio (>1), negative likelihood ratio (<0.2), area under the ROC curve (AUC, ≥90%) and effect size (≥0.80).

RESULTS

Based on clinical interview, prevalence of PND was 6.2% in 487 post-partum women. HK-EPDS internal consistency was 0.84. At 13 or more cutoff, the true-positive rate was 86.7%, false-positive rate 3.3%, positive likelihood ratio 26.4, negative likelihood ratio 0.14, AUC 94.4% and effect size 0.81. For the HK-EPDS-6, internal consistency was 0.76. At 8 or more cutoff, we found a true-positive rate of 86.7%, false-positive rate 6.6%, positive likelihood ratio 13.2, negative likelihood ration 0.14, AUC 92.9% and effect size 0.98.

DISCUSSION

The HK-EPDS (cutoff ≥13) and HK-EPDS6 (cutoff ≥8) are fit for PND screening for general population post-partum women. The brief six-item version appears to be clinically suitable for quick screening in Chinese speaking women.

Maternal depression, family functioning and children's longitudinal development

Analysis of data from the Canadian National Longitudinal Survey of Children and Youth reveals that 6% of children are born to mothers who experienced symptoms of depression during their first 2 years of life. The prevalence rises steadily until children are 10 years of age when it reaches 9%, and thereafter remains relatively stable. Children of depressed mothers are at increased risk of having low receptive vocabulary and displaying inattention or physical aggression at ages 4 to 5 years, only partially attributable to family demographic factors, family functioning and parenting qualities. Maternal depression occurring when the child was 2 to 3 years of age, was a risk factor for anxiety in 10 and 11 year olds. Timing or duration of maternal depression had no effect on math achievement. The risk of poor child outcome was greatest for mothers who experienced depression continuously or when their child was 2 to 3 years or older. Nurses need to assess and intervene to reduce the impact of depression on mothers and their children's development, well beyond the postpartum period.

Postpartum mothers' napping and improved cognitive growth fostering of infants: results from a pilot study

Little is known about how maternal sleep disturbances in the postpartum period affect mother-infant interaction. The study was designed to assess if less maternal sleep disturbance and less fatigue were associated with more positive mother-child interaction, independent of maternal depression symptoms. Twenty-three mothers completed 1 week of actigraphy and self-report measures of fatigue and depression symptoms. To determine the quality of mother-infant interaction, mothers and infants were then observed in a structured, video-recorded teaching episode. Greater maternal napping frequency was associated with better cognitive growth fostering of the infant (r s = .44, p < .05), a subscale of the interaction assessment. Maternal napping, not the quality or quantity of nocturnal sleep, appears to be associated with improvements in mother-infant interactions.

A pilot study of heart rate variability biofeedback therapy in the treatment of perinatal depression on a specialized perinatal psychiatry inpatient unit

Heart rate variability biofeedback (HRVB) therapy may be useful in treating the prominent anxiety features of perinatal depression. We investigated the use of this non-pharmacologic therapy among women hospitalized with severe perinatal depression. Three questionnaires, the State Trait Anxiety Inventory (STAI), Warwick-Edinburgh Mental Well-Being Scale, and Linear Analog Self Assessment, were administered to 15 women in a specialized inpatient perinatal psychiatry unit. Participants were also contacted by telephone after discharge to assess continued use of HRVB techniques. The use of HRVB was associated with an improvement in all three scales. The greatest improvement (-13.867, p < 0.001 and -11.533, p < 0.001) was among STAI scores. A majority (81.9 %, n = 9) of women surveyed by telephone also reported continued frequent use at least once per week, and over half (54.6 %, n = 6) described the use of HRVB techniques as very or extremely beneficial. The use of HRVB was associated with statistically significant improvement on all instrument scores, the greatest of which was STAI scores, and most women reported frequent continued use of HRVB techniques after discharge. These results suggest that HRVB may be particularly beneficial in the treatment of the prominent anxiety features of perinatal depression, both in inpatient and outpatient settings.

A review of postpartum depression, preterm birth, and culture

Postpartum depression (PPD) varies worldwide and is considered a serious issue because of its devastating effects on mothers, families, and infants or children. Preterm birth may be a risk factor for PPD. In 2005, the global incidence of preterm birth was estimated to be 9.6%, and of these births, 85% occurred in Africa and Asia. Among Asian countries, Pakistan has a preterm birth rate of 15.7% and the highest prevalence rate of PPD (63.3%). A literature review was therefore undertaken to better understand the potential contribution of preterm birth to PPD and to identify gaps in the scientific literature. Limited studies compare prevalence rates of PPD in mothers of full-term infants and mothers of preterm infants. Furthermore, meta-analyses examining predictors of PPD have not included preterm birth as a variable. The interrelationship between preterm birth and PPD may be explained by early parental stress and mother-infant interaction among mothers of preterm infants. Culture plays an important role in shaping communication between mothers and their infants and defines social support rituals that may or may not mediate PPD. More research is needed to provide evidence for practice.

Risk factors for postpartum depression among abused and nonabused women

OBJECTIVE

The objective of the study was to compare risk factors for postpartum depression among women exposed vs not exposed to intimate partner violence and to assess the timing of abuse in relation to postpartum depression.

STUDY DESIGN

This was a retrospective cohort study utilizing data from the Canadian Maternity Experiences Survey, a telephone survey at 5-10 months postpartum. Survey questions were adapted from the Canadian Violence Against Women Survey and the Edinburgh Post-Natal Depression Scale.

RESULTS

Among abused women, younger (15-19 years), and older (35 years old and older), age was associated with postpartum depression, adjusted odds ratio (aOR, 2.29; 95% confidence interval [CI], 1.17-4.51) and (aOR, 2.33; 95% CI, 1.02-5.34) as was unemployment (aOR, 1.41; 95% CI, 1.06-1.84), foreign birth (aOR, 2.04; 95% CI, 1.35-3.09], and low income (aOR, 1.68; 95% CI, 1.25-2.25) among nonabused women. Postpartum depression was significantly associated with abuse occurring only prior to pregnancy (aOR, 3.28; 95% CI, 1.86-5.81), starting postpartum (aOR, 4.76; 95% CI, 1.41-16.02), and resuming postpartum (aOR, 3.81; 95% CI, 1.22-11.88).

CONCLUSION

Among pregnant women, subgroups defined by abuse exposure differ in their risk profile for postpartum depression.

Pregravid body mass index is associated with early introduction of complementary foods

OBJECTIVE

To determine whether women who entered pregnancy overweight or obese were less likely to follow American Academy of Pediatrics guidelines for introducing complementary foods to infants after 4 months of age. In addition, we explored whether psychological factors accounted for any of the effect of pregravid body mass index on age of complementary food introduction.

DESIGN

A prospective cohort study from 2001 to 2005 that recruited pregnant women between 15 to 20 gestational weeks with follow-up through 12 months postpartum from University of North Carolina hospitals (n=550).

STATISTICAL ANALYSIS

Multinomial models were used to estimate relative risk ratios. The outcome was age of complementary food introduction, categorized as younger than 4 months of age, 4 to 6 months, and 6 months or later (referent). Maternal body mass index was categorized as underweight (<18.5), normal weight (18.5 to 24.9), and overweight/obese (≥25). A series of regression analyses tested mediation by psychological factors measured during pregnancy (depressive symptoms, stress, and anxiety).

RESULTS

More than a third of the study population (35.7% of 550) entered pregnancy overweight/obese. The majority of participants (75.3%) introduced foods to their infants between 4 and 6 months of age. Compared with normal-weight women, those who were overweight/obese before pregnancy were more likely (relative risk ratios=2.22 [95% CI 1.23 to 4.01]) to introduce complementary foods before the infant was 4 months old, adjusting for race, education, and poverty status. Depressive symptoms, stress, and anxiety did not account for any of the effect of pregravid overweight/obesity on early food introduction.

CONCLUSIONS

The results suggest that overweight and obese women are more likely to introduce complementary foods early and that psychological factors during pregnancy do not influence this relationship. Future studies need to explore why overweight/obese women are less likely to meet the American Academy of Pediatrics recommendations for the introduction of complementary food.

Impact of maternal depressive symptoms on growth of preschool- and school-aged children

OBJECTIVE

The aim of our study was to examine whether maternal depressive symptoms at 9 months postpartum adversely affect growth in preschool- and school-aged children.

METHODS

We used data from the US nationally representative Early Childhood Longitudinal Study, Birth Cohort. We fit multivariable logistic regression models to study maternal depressive symptoms at 9 months postpartum (using the Center for Epidemiologic Studies Depression Scale) in relation to child growth outcomes, ≤ 10% height-for-age, ≤ 10% weight-for-height, and ≤ 10% weight-for-age at 4 and 5 years.

RESULTS

At 9 months, 24% of mothers reported mild depressive symptoms and 17% moderate/severe symptoms. After adjustment for household, maternal, and child factors, children of mothers with moderate to severe levels of depressive symptoms at 9 months' postpartum had a 40% increased odds of being ≤ 10% in height-for-age at age 4 (odds ratio = 1.40, 95% confidence interval: 1.04-1.89) and 48% increased odds of being ≤ 10% in height-for-age at age 5 (odds ratio = 1.48, 95% confidence interval: 1.03-2.13) compared with children of women with few or no depressive symptoms. There was no statistically significant association between maternal depressive symptoms and children being ≤ 1 0% in weight-for-height and weight-for-age at 4 or 5 years.

CONCLUSIONS

Maternal depressive symptoms during infancy may affect physical growth in early childhood. Prevention, early detection, and treatment of maternal depressive symptoms during the first year postpartum may prevent childhood height-for-age ≤ 10th percentile among preschool- and school-aged children.

Maternal perinatal depression in the neonatal intensive care unit: the role of the neonatal nurse

The onset of depressive symptoms during pregnancy or the first year postpartum, termed perinatal depression, occurs in approximately 15 percent of women. Perinatal depression can have a significant negative impact on health outcomes for the mother and her infant including maternal emotional distress and parenting difficulties and infant behavioral and developmental problems. Nurses caring for patients in the neonatal intensive care unit (NICU) are in a key position to affect positive change in the lives of families affected by perinatal depression. An overview of antepartum and postpartum depression is provided that has been tailored to the educational needs of the neonatal nurse. A discussion of the role of neonatal nurses in the identification and treatment of perinatal depression follows in order that neonatal nurses may improve both short- and long-term outcomes for mothers, infants, and families in the NICU affected by perinatal depression.

Postpartum depression is a family affair: addressing the impact on mothers, fathers, and children

The purpose of this paper is to present research on the effects of postpartum depression (PPD) on mothers, fathers, and children that point to a re-conceptualization of PPD as a mental health condition that affects the whole family. As such, the objectives of this paper are to discuss: (1) the incidence and effects of PPD on mothers and fathers; (2) common predictors of PPD in mothers and fathers, and (3) the effects of PPD on parenting and parent-child relationships, and (4) the effects of PPD on children's health, and their cognitive and social-emotional development. Finally, the implications for screening and intervention if depression is re-conceptualized as a condition of the family are discussed.

High pregnancy-related anxiety and prenatal depressive symptoms as predictors of intention to breastfeed and breastfeeding initiation

BACKGROUND

Perinatal mood disorders affect up to 20% of women in the United States. Little is known about how disorders in maternal mood may affect rates of breastfeeding.

OBJECTIVE

To determine the impact of prenatal depressive symptoms and high pregnancy-related anxiety on (1) prenatal intention to breastfeed and (2) breastfeeding initiation.

METHODS

We prospectively followed 1436 pregnant women enrolled in the cohort study Project Viva. The main outcome measures were (1) mother's second trimester self-report of intention to use all or mostly formula in the first week of life and (2) failure to initiate breastfeeding. We defined prenatal depressive symptoms as a second trimester Edinburgh Postpartum Depression Scale (EPDS) score of > or =13 and high pregnancy-related anxiety as a "very much" response to three or more questions on a first trimester pregnancy anxiety scale.

RESULTS

Of the 1436 participants, 9% (n = 125) had prenatal depressive symptoms indicative of depression, and 10% (n = 141) reported high pregnancy-related anxiety; 11% (n = 159) intended to give mostly or only formula in the first week of life, and 86% (n = 1242) initiated breastfeeding. In multivariate analyses, women with prenatal depressive symptoms (OR 1.92, 95% CI 1.11, 3.33) and high pregnancy-related anxiety (OR 1.99, 95% CI 1.12, 3.54) were roughly two times more likely than women without these mood disorders to plan to formula feed. However, neither prenatal depressive symptoms (OR 1.06, 95% CI 0.61, 1.84) nor high pregnancy-related anxiety (OR 1.28, 95% CI 0.74, 2.20) was associated with failure to initiate breastfeeding.

CONCLUSIONS

In a healthcare setting highly supportive of breastfeeding, women with prenatal depressive symptoms and possibly those with high pregnancy-related anxiety were less likely to plan prenatally to breastfeed, although this tendency did not translate into lower breastfeeding initiation rates.

Maternal caffeine consumption and infant nighttime waking: prospective cohort study

OBJECTIVE

Coffee and other caffeinated beverages are commonly consumed in pregnancy. In adults, caffeine may interfere with sleep onset and have a dose-response effect similar to those seen during insomnia. In infancy, nighttime waking is a common event. With this study, we aimed to investigate if maternal caffeine consumption during pregnancy and lactation leads to frequent nocturnal awakening among infants at 3 months of age.

METHODS

All children born in the city of Pelotas, Brazil, during 2004 were enrolled on a cohort study. Mothers were interviewed at delivery and after 3 months to obtain information on caffeine drinking consumption, sociodemographic, reproductive, and behavioral characteristics. Infant sleeping pattern in the previous 15 days was obtained from a subsample. Night waking was defined as an episode of infant arousal that woke the parents during nighttime. Multivariable analysis was performed by using Poisson regression.

RESULTS

The subsample included 885 of the 4231 infants born in 2004. All but 1 mother consumed caffeine in pregnancy. Nearly 20% were heavy consumers (≥300 mg/day) during pregnancy and 14.3% at 3 months postpartum. Prevalence of frequent nighttime awakeners (>3 episodes per night) was 13.8% (95% confidence interval: 11.5%-16.0%). The highest prevalence ratio was observed among breastfed infants from mothers consuming ≥300 mg/day during the whole pregnancy and in the postpartum period (1.65; 95% confidence interval: 0.86-3.17) but at a nonsignificant level.

CONCLUSIONS

Caffeine consumption during pregnancy and by nursing mothers seems not to have consequences on sleep of infants at the age of 3 months.

A Longitudinal Study of the Relation Between Depressive Symptomatology and Parenting Practices

This longitudinal study examined whether mothers' depressive symptomatology predicted parenting practices in a sample of 199 mothers of 3-year-old children with behavior problems who were assessed yearly until age 6. Higher maternal depressive symptoms were associated with higher overreactivity and laxness and lower warmth when children were 6 years old. Higher maternal depressive symptoms were also related to increases in overreactivity across the preschool years. Moreover, depression and parenting practices (overreactivity and laxness) covaried over time within mothers. These results provide evidence of a strong link between maternal depression and parenting during the preschool years.

Preventing and treating postpartum depression in women – a municipality model

Objective: The objective of this paper is to describe and discuss a municipal model for prevention, identification and treatment of postpartum depression (PPD).

Major findings: The changed care in the municipality was associated with a significant difference in Edinburgh Postnatal Depression Scale scores between the intervention municipality and the usual care municipality at 6 weeks, 3, 6 and 12 months postpartum. The women who had been depressed at least once during the first postpartum year reported significantly higher levels of parenting stress at 12 months. The public health nurses found the scale easy to score and easy for the mothers to complete, and they were confident that they identified PPD more frequently than before.

Conclusion: The results of the present study suggest a basis for a municipality model that gives the primary health care system better possibilities to help women with mental health problems in the postpartum period. The changed care consisted of several elements considered important for the result of this study. The results can be incorporated in a descriptive model for prevention, identification and treatment in municipalities. The components are (1) preconditions in the municipality, (2) initiatives to prevent PPD, (3) identification of women with PPD, (4) treatment of PPD and (5) follow-up.

Eating disorders and trauma history in women with perinatal depression

OBJECTIVE

Although the prevalence of perinatal depression (depression occurring during pregnancy and postpartum) is 10%, little is known about psychiatric comorbidity in these women. We examined the prevalence of comorbid eating disorders (ED) and trauma history in women with perinatal depression.

METHODS

A research questionnaire was administered to 158 consecutive patients seen in a perinatal psychiatry clinic during pregnancy (n=99) or postpartum (n=59). Measures included Structured Clinical Interview for DSM (SCID) IV-based questions for lifetime eating psychopathology and assessments of comorbid psychiatric illness including the State/Trait Anxiety Inventory (STAI), Patient Health Questionnaire (PHQ-9), Edinburgh Postnatal Depression Scale (EPDS), and Trauma Inventory.

RESULTS

In this cohort, 37.1% reported a putative lifetime ED history; 10.1% reported anorexia nervosa (AN), 10.1% reported bulimia nervosa (BN), 10.1% reported ED not otherwise specified-purging subtype (EDNOS-P), and 7.0% reported binge eating disorder (BED). Women with BN reported more severe depression (EPDS score, 19.1, standard deviation [SD 4.3], p=0.02; PHQ-severity 14.5, SD 7.4, p=0.02) than the referent group of women with perinatal depression and no ED history (EPDS 13.3, SD=6.1; PHQ 9.0, SD=6.2). Women with AN were more likely to report sexual trauma history than the referent group (62.5% vs. 29.3%, p<0.05), and those with BN were more likely report physical (50.0%, p<0.05) and sexual (66.7%, p<0.05) trauma histories.

CONCLUSIONS

ED histories were present in over one third of admissions to a perinatal psychiatry clinic. Women with BN reported more severe depression and histories of physical and sexual trauma. Screening for histories of eating psychopathology is important in women with perinatal depression.

Pregravid body mass index, psychological factors during pregnancy and breastfeeding duration: is there a link?

Breastfeeding rates in the United States are low, and one possible reason may be the high prevalence of overweight/obesity among women of childbearing age. This analysis examined the association between pregravid body mass index and breastfeeding duration, and explored whether depressive symptoms, perceived stress and anxiety during pregnancy mediated this relationship. Participants (n = 550) in the Pregnancy, Infection and Nutrition Postpartum Study were recruited through prenatal clinics prior to 20 weeks gestation and followed to 12 months post-partum. Duration of any breastfeeding was categorized as none, less than 4 months, 4-6 months, 7-12 months and more than 12 months (referent). Exclusive breastfeeding was categorized as less than 1 month, 1 to less than 4 months and 4 months or more (referent). Being overweight/obese before pregnancy (35.7% of 550) was inversely associated with the durations of any and exclusive breastfeeding. Women who entered pregnancy overweight or obese were more likely to not initiate breastfeeding [relative risk ratio (RRR)=5.39 (95% confidence interval: 2.41, 12.04)] and to breastfeed less than 4 months [RRR=2.38 (1.33, 4.27)] compared with women of normal weight status. Among women who initiated breastfeeding, being overweight or obese vs. normal weight was related to exclusively breastfeeding less than 1 month [RRR=2.09 (1.24, 3.51)]. We did not find evidence to support mediation by depressive symptoms, perceived stress or anxiety during pregnancy. Future research needs to explore the reasons behind the association between overweight/obesity and breastfeeding duration.

Identifying mothers with postpartum depression early: integrating perinatal mental health care into the obstetric setting

With prevalence rates of postnatal depression (PND) as high as at least 7%, there was a need for early detection and intervention of postpartum mental illness amongst Singaporean mothers. This is a report on the first year results of our country's first PND Intervention Programme. The programme consists of two phases: (1) postpartum women were screened with the Edinburgh Postnatal Depression Scale and provided appropriate care plans; (2) individualized clinical intervention using a case management multidisciplinary team model. Screening for PND was generally acceptable, as 64% eligible women participated voluntarily. Nine percent (126) were identified as probable cases from 1369 women. Forty-one women accepted intervention and achieved 78% reduction in the EPDS symptom scores to below the cutoff of 13, 76% had improvement in GAF functioning scores, and 68% had improved health quality scores. Preliminary results are promising, and this intervention model can be replicated.

Maternal depression and early childhood growth in developing countries: systematic review and meta-analysis

OBJECTIVE

To investigate the relationship between maternal depression and child growth in developing countries through a systematic literature review and meta-analysis.

METHODS

Six databases were searched for studies from developing countries on maternal depression and child growth published up until 2010. Standard meta-analytical methods were followed and pooled odds ratios (ORs) for underweight and stunting in the children of depressed mothers were calculated using random effects models for all studies and for subsets of studies that met strict criteria on study design, exposure to maternal depression and outcome variables. The population attributable risk (PAR) was estimated for selected studies.

FINDINGS

Seventeen studies including a total of 13,923 mother and child pairs from 11 countries met inclusion criteria. The children of mothers with depression or depressive symptoms were more likely to be underweight (OR: 1.5; 95% confidence interval, CI: 1.2-1.8) or stunted (OR: 1.4; 95% CI: 1.2-1.7). Subanalysis of three longitudinal studies showed a stronger effect: the OR for underweight was 2.2 (95% CI: 1.5-3.2) and for stunting, 2.0 (95% CI: 1.0-3.9). The PAR for selected studies indicated that if the infant population were entirely unexposed to maternal depressive symptoms 23% to 29% fewer children would be underweight or stunted.

CONCLUSION

Maternal depression was associated with early childhood underweight and stunting. Rigorous prospective studies are needed to identify mechanisms and causes. Early identification, treatment and prevention of maternal depression may help reduce child stunting and underweight in developing countries.

New insights into perinatal depression: pathogenesis and treatment during pregnancy and postpartum

Maternal perinatal mental health has enormous consequences for the well-being of the mother, her baby, and the family. Although it is well documented that perinatal depression is both common and morbid, with a prevalence of 10% to 15% in the general population, there remain many critically important unanswered questions about the pathogenesis of perinatal depression and most effective treatment regimens. Current lines of evidence from both human and animal models implicate hormonal dysregulation, abnormalities in hypothalamic-pituitary-adrenal axis activity, and the contributions of genetics and epigenetics as playing key roles in the development of perinatal reproductive mood disorders. Investigations into both human and animal models of perinatal depression offer much promise for the future identification of the underlying pathophysiology and subsequent early identification and/or prevention and appropriate treatment for women at risk for postpartum depression. Lastly, although it is generally accepted that pregnancy is not protective with regard to new onset or relapse of depression, the way to best treat maternal depression during pregnancy and lactation remains hotly debated. Future research in this area will more clearly elucidate the underlying pathogenesis, the potential long-term impact of perinatal depression on the developing fetus, and how best to counsel pregnant women about the risks of untreated major depressive disorder versus the risks of psychopharmacologic treatment during pregnancy and lactation.

Postpartum mental health screening and diagnosis by obstetrician-gynecologists

Postpartum depression (PPD) and postpartum psychosis (PPP) can impact mother, infant, and family. Obstetrician-gynecologists (ob-gyns) are often the most frequent medical contact for postpartum women, and so are in a position to identify women needing psychological care. This study assessed ob-gyns' knowledge, attitudes, and practices regarding diagnosing PPD/PPP. A survey was sent to 400 members of the American College of Obstetricians and Gynecologists who have volunteered to participate in research. Response rate was 56%. Routine screening for PPD and PPP is conducted by 72% and 30% of respondents, respectively. Personal experience (through friend, family, or self) was associated with increased screening. Perceived PPP screening barriers are similar to those found in the PPD literature: time constraints, lack of training, and lack of knowledge of diagnostic criteria. In responding to standardised vignettes, physicians were more likely to over-diagnose, than under diagnose PPD/PPP. This study is the first to provide exploratory data of ob-gyns' knowledge, attitudes, and practice regarding PPD and PPP. Ob-gyns are screening for PPD/PPP, though not universally so. Future research should identify ways to mitigate screening barriers.

Infants perceived as "fussy" are more likely to receive complementary foods before 4 months

OBJECTIVE

Our purpose was to assess early infant-feeding patterns in a cohort of low-income black mothers and to examine associations between maternal perception of infant temperament and complementary feeding (CF) before 4 months.

METHODS

We used cross-sectional data from the 3-month visit (n = 217) of the Infant Care, Feeding and Risk of Obesity Study to assess relationships between early feeding of solids or juice and 6 dimensions of perceived infant temperament. Descriptive statistics were used to assess infant-feeding patterns, and logistic regression models were fit for each diet-temperament relationship found significant in the bivariate analyses.

RESULTS

Seventy-seven percent of the infants were fed solid foods at 3 months, 25% were fed juice, and 6% were exclusively breastfed. In multivariable analyses, 2 dimensions of perceived infant temperament were associated with early feeding of solid foods (distress-to-limitations odds ratio [OR]: 1.97 [95% confidence interval (CI): 1.12-3.44]; activity-level OR: 1.75 [95% CI: 1.07-2.85]), whereas 1 dimension, low-intensity pleasure, was associated with early feeding of juice (OR: 0.51 [95% CI: 0.34-0.78]). Maternal characteristics significantly associated with early CF included breastfeeding, obesity, and depressive symptoms.

CONCLUSIONS

Low-income black mothers may represent a priority population for interventions aimed at improving adherence to optimal infant feeding recommendations. That maternal perceptions of several domains of perceived infant temperament are related to early CF suggests that this is an important factor to include in future observational research and in the design of interventions.

Improving the professional support for parents of young infants

The objective of this study was to discuss ideas for improving child health services on the basis of findings of an observational study that was designed to explore the role of child health nurses in supporting parents during the first 6 months following the birth of an infant. As part of a larger study in a child health service in urban Australia, surveys were used to collect data from two independent samples of both parents and nurses at an 8-month interval. Data were condensed using factor analysis; regression analyses were used to determine which aspects of care were most important for the parents, and importance–performance analysis was used to determine which aspects of care needed improvement. While the majority of parents valued support from child health nurses, a need for improvement was identified in empowering parents to make their own decisions, discussing emotional issues with parents, providing continuity of care and giving consistent advice. Organisations should value and provide support for child health nurses in their invisible, non-quantifiable work of supporting families. The structure of child health services should also provide child health nurses continuity of care with the families they support.

Infant feeding methods and maternal sleep and daytime functioning

OBJECTIVE

Our purpose was to explore maternal actigraphically measured sleep, subjective sleep reports, and daytime functioning on the basis of current feeding method status during postpartum weeks 2 through 12.

METHODS

Objectively measured total sleep time, sleep efficiency, and fragmentation, subjectively reported numbers of nocturnal awakenings, total nocturnal wake time, and sleep quality, and sleepiness/fatigue measured by using the fatigue visual analog scale, the Stanford Sleepiness Scale, or the Epworth Sleepiness Scale were assessed.

RESULTS

We did not find differences between women who were exclusively breastfeeding, exclusively formula feeding, or using a combination of the 2 methods, with respect to the assessed parameters.

CONCLUSIONS

Efforts to encourage women to breastfeed should include information about sleep. Specifically, women should be told that choosing to formula feed does not equate with improved sleep. The risks of not breastfeeding should be weighed against the cumulative lack of evidence indicating any benefit of formula feeding on maternal sleep.

Do Verbal Interactions with Infants During Electronic Media Exposure Mitigate Adverse Impacts on their Language Development as Toddlers?

The goal of this study was to determine whether verbal interactions between mothers and their 6-month-old infants during media exposure ('media verbal interactions') might have direct positive impacts, or mitigate any potential adverse impacts of media exposure, on language development at 14 months. For 253 low-income mother-infant dyads participating in a longitudinal study, media exposure and media verbal interactions were assessed using 24-hour recall diaries. Additionally, general level of cognitive stimulation in the home [StimQ] was assessed at 6 months and language development [Preschool Language Scale-4] was assessed at 14 months. Results suggest that media verbal interactions play a role in the language development of infants from low-income, immigrant families. Evidence showed that media verbal interactions moderated adverse impacts of media exposure found on 14-month language development, with adverse associations found only in the absence the these interactions. Findings also suggest that media verbal interactions may have some direct positive impacts on language development, in that media verbal interactions during the co-viewing of media with educational content (but not other content) were predictive of 14-month language independently of overall level of cognitive stimulation in the home.

Redesigned community postpartum care to prevent and treat postpartum depression in women--a one-year follow-up study

AIM

To investigate the effect of a redesigned follow-up care programme on prevention and treatment of postpartum depression.

BACKGROUND

Postpartum depression may have negative consequences on child development, maternal health and the relationship between parents. Early identification and treatment might prevent longer-term depression.

DESIGN

A quasi-experimental post-test design with non-equivalent groups.

METHOD

The study population was postpartum women with a live-born child, residing in one of two municipalities in Norway. A total of 2247 women were enrolled: 1806 in the experimental municipality and 441 in the comparison municipality. Public health nurses (26) in the experimental municipality were trained to identify postpartum depression using the Edinburgh Postnatal Depression Scale and clinical assessment and to provide supportive counselling.

MEASUREMENTS

The Edinburgh Postnatal Depression Scale at six weeks, three, six and 12 months postpartum and the Parenting Stress Index at 12 months postpartum.

RESULTS

The redesigned postpartum care programme yielded a significant group difference in the Edinburgh Postnatal Depression Scale score at six weeks (p < 0.01), odds ratio (OR) 0.6, three months (p < 0.01), OR 0.4, six months (p < 0.01), OR 0.5 and 12 months postpartum (p < 0.01), OR 0.6. Women who had been depressed at least once during the first postpartum year reported significantly higher levels of parenting stress at 12 months.

CONCLUSION

The findings of this study suggest that redesigned postpartum care comprising training of health professionals, increased focus on mental health problems and support for the parents is a useful approach to managing postpartum depression in the community.

RELEVANCE TO CLINICAL PRACTICE

Public health nurses are well positioned to identify and treat depressed mothers and provide referrals when needed. A small investment in training nurses to identify and treat postpartum depression can be cost-effective in the longer term. These findings have implications for service delivery in public health.

Maternal Depressive Symptoms and Parenting of Children From Birth to 12 Years

Maternal depression, especially in the early years of child development, affects parenting behaviors that have been repeatedly linked to poor outcomes in children. However, recurrent maternal depression may be a more potent predictor of parenting than depression that only occurs in the early years. Longitudinal population data were used to examine the influence of depression in the first 2 years postpartum alone or in combination with recurrent episodes of depression on self-reported parenting behaviors known to influence children’s development. Growth curve hierarchical linear modeling was used to examine the relationships among depression in the early years, recurrent depression, and parenting during children’s first 12 years of life. Findings revealed that 63% of the depressed mothers reported recurrent episodes of depression. Self-reported parenting behaviors characterized by positive forms of discipline, firmness, and consistency were related to recurrent episodes of depression, whereas warmth and nurturant parenting behaviors were unaffected by recurrent episodes.