Associations between prenatal maternal mental health indices and mother-infant relationship quality 6 to 18 months' postpartum: A systematic review

Associations between maternal smartphone use and mother-infant responsiveness: A cluster analysis of potential risk and protective factors

Contradictory results in the extant literature suggests that additional risk factors should be considered when exploring the impacts of maternal smartphone use on mother-infant relationships. This study used cluster analysis to explore whether certain risk factors were implicated in mother-infant dyads with high smartphone use and low mother-infant responsiveness. A cross-sectional survey of 450 participants in the UK measured infant social-emotional development, maternal depressive, anxiety and stress symptoms, wellbeing, social support, smartphone use, and mother-infant responsiveness. Participants were predominantly White (95.3%) and living with a partner (95.2%), with infants who were born full-term (88.9%). Cluster analysis identified three clusters characterized as; cluster (1) "infant at risk" showing high infant development concerns, high maternal smartphone use, and low mother-infant responsiveness; cluster (2) "mother at risk" showing high maternal depressive, anxiety, and stress scores, low social support, high maternal smartphone use, and low mother-infant responsiveness, and cluster (3) "low risk" showing low maternal smartphone use and high mother-infant responsiveness. Significant differences were found between all risk factors, except for maternal smartphone use and mother-infant responsiveness between clusters 1 and 2 suggesting that both clusters require early intervention, although interventions should be tailored towards the different risk factors they are presenting with.

Mother's mental health and the interaction with her moderate preterm baby in the NICU

INTRODUCTION

Moderate preterm infants, born between 320/7 and 336/7 weeks, represent a significant number of preterm-born infants; however, they remain a poorly studied group despite their vulnerability. The objective of this correlational study is to describe the impact of having a moderate preterm infant hospitalised in the NICU on the mothers' mental health and how this relates to the interaction between the dyad.

METHOD

During the hospitalisation period, 85 moderate preterm mother-infant dyads participated in this study. The participants provided self-reports of depression, parental stress, and skin to skin and breastfeeding practices. Also, mother-infant interaction was assessed in the NICU with an observational scale.

RESULTS

Mothers evidenced high levels of stress and depressive symptoms during the hospitalization. The stress experienced by these women was significant, although weakly, associated with the interaction with their babies; and mothers of small for gestational age babies showed difficulties in this area.

CONCLUSIONS

The results of this study could represent a contribution to a better understanding of the relation between the characteristics of moderate preterm babies, maternal emotional wellbeing, and the quality of mother-infant interactions in NICU settings.

Depression During the Postpartum Period and Impacts on Parent-Child Relationships: A Narrative Review

Although controversy exists around labels for postpartum depression (PPD), focusing efforts on terms distracts the research community from better understanding the impact of depression on parent-infant relationships. The purpose of this article is to provide a narrative review of research related to how depression experienced in the postpartum period impacts parent-infant relationships. Our review indicates that PPD is pervasive, symptoms often appear during pregnancy, and it has the potential to negatively impact parent-infant relationships. Based on the recent review of literature, intervention efforts should focus on identification and treatment of PPD as early as possible to mitigate detrimental long-term impacts on parent-child relationships.

Parent-child interactions in early life mediating association between prenatal maternal stress and autistic-like behaviors among preschoolers

A range of studies have shown that prenatal maternal stress (PNMS) exposure is associated with offspring autistic-like behaviors, however the potential pathways remain unexplored. This study aimed to evaluate the mediating role of parent-child interactions in early life in the association between PNMS exposure and preschoolers' autistic-like behaviors. Data from 65,928 child-parent dyads were obtained via a primary caregiver-reported questionnaire administered as part of the Longhua Child Cohort Study. To strengthen confidence in the reliability of the results, the analyses were initially conducted on a random selection of 70% of the total sample, and then validated on the remaining 30% of the sample. Analysis of covariance and multiple linear models were employed to estimate the associations between PNMS exposure, parent-child interactions in early life, and children's autistic-like behaviors. The results showed that PNMS exposure was positively associated with the presence of autistic-like behaviors at preschool age. The total indirect effect of the frequency of positive parent-child interactions in early life accounted for 9.69% or 8.99% of the variance of the association. Our findings indicate that parent-child interactions in early life might function as potential mediators of the association between PNMS and the increased risk of offspring autistic-like behaviors.

Effects of the glucocorticoid receptor gene (NR3C1) and subjective birth experience on the risk of postpartum depression and maternal bonding

Postpartum depression (PPD) is a serious health care issue that affects a substantial share of women giving birth. PPD is considered a severe stress response that is likely associated with impaired HPA-axis activity. However, genetic findings regarding HPA-axis effects on PPD are scarce and inconsistent. Inconsistencies may be due to the neglect of environmental (stressful) events such as perinatal trauma or averse subjective birth experiences associated with PPD. Therefore, the present study aims to investigate whether the NR3C1 gene and subjective birth experience interact on PPD and postpartum bonding to the child. N = 277 mothers provided gene samples and self-report data on PPD and postpartum bonding. We genotyped 11 polymorphisms on the NR3C1 gene (including the prominent BCL1) and conducted haplotype analyses. A negative subjective birth experience was associated with both PPD and maternal postpartum bonding. Our results further show a significant main effect of NR3C1 haplotype (F_{1, 275} = 6.42, p = .012, η² =.023) and a haplotype x birth experience interaction (F_{1, 274} = 4.57, p = .033, η² =.016) on PPD. We did not find any NR3C1 haplotype effects on bonding. Our results support the assumption that the glucocorticoid receptor coding NR3C1 gene is involved in the development of PPD. These gene effects become particularly important in presence of a negative environmental event such as the subjective birth experience. This finding allows more targeted preventions in terms of being particularly sensitive to potentially harming environmental influences that may present even stronger risk factors for genetically vulnerable women.

Maternal perinatal hypertensive disorders and parenting in infancy

Maternal mental health strongly influences parenting during infancy. However, it is unclear whether maternal physical health conditions in the perinatal period may also impact parenting. Examining the association of hypertensive disorders - a common physical health problem in pregnancy - with subsequent parenting behaviors is an important first step in understanding the connection between maternal physical health and parenting during this critical developmental period. This study evaluated whether hypertensive disorders of pregnancy (HDP) and hypertensive disorders (HD) diagnosed after the birth of the infant were associated with parenting self-efficacy, parenting stress, and observed parental responsiveness during mother-infant interactions at 6 and 12 months postpartum among a sample of racially and ethnically diverse mothers and their infants (N = 295). Results showed that mothers with an HDP or HD diagnosis had lower levels of parenting self-efficacy, higher levels of parenting stress, and lower levels of observed parental responsiveness compared to mothers without an HDP or HD diagnosis. Given that women with childhood adversity are at higher risk for experiencing HDP/HD and may have more difficulties with parenting compared to women without childhood adversity, we utilized a sample of mothers wherein most had experienced at least one form of adversity in their childhoods. Exploratory analyses revealed that HDP/HD moderated the relation between early life experiences and parenting outcomes in all but one model. Associations between HDP/HD and parenting are discussed, with implications for how we understand maternal physical health as a determinant of parenting in the perinatal period.

An explanatory model of parental sensitivity in the mother-father-infant triad

Quality of early family interactions has been associated with child development, bonding, and mental health. Childhood adversity, stress, and depression impact parenting, affecting the quality of the interaction within the mother-father-child triad. The aim of the present study was to analyze the influence of parents' adverse childhood experiences, depressive symptoms, and parental stress, on their sensitive response toward their tooddler and quality of traidic interactions. A correlational cross-sectional method was used. The sample included 80 mother-father-child triads, of toddlers with social-emotional difficulties. Parents early adverse experiences, parental stress, and depressive symptoms were assessed through self-report measures. Observational measures on parental sensitivity and triadic interaction were used. For mothers and fathers, adverse childhood experiences were associated with depressive symptoms in adulthood. Sensitivity toward their child and stress were positively associated among both parents. Symptoms of depression in mothers were associated with lower sensitivity toward their child, but in fathers, their sensitive response was influenced by the level of parental stress in the mother. In both parents, greater sensitivity in the dyadic interaction with the child was associated with a higher quality of the triadic interactions, in the triad as a whole, and in the regulation and involvement of the child.

Psychological Well-Being, Prenatal Attachment, and Quality of Early Mother-Infant Interaction: A Pilot Study With a Sample of Mothers With or Without Cancer History

Given the positive impact of high-quality mother–infant interaction on child development, and that such relationship might be hindered by maternal stresses such past cancer, research is needed to understand protective and risk factors in this clinical population. As almost no data is available on the impact of history of cancer on the quality of mother–infant interaction, a multicentric and longitudinal pilot study was conducted. Differences in women’s prenatal psychological well-being and attachment (T1, third trimester), and postnatal quality of mother–infant interaction (T2, 2–5 months) were assessed in a sample of Italian mothers with (N = 11) or without cancer history (N = 13). Results showed that women did not differ significantly in their prenatal well-being (assessed with the Profile of Mood States questionnaire) and levels of attachment (assessed with the Prenatal Attachment Inventory). Looking at mother–infant interactions (assessed using the Global Rating Scale at T2), while maternal sensitivity, warmth and intrusiveness, and infant distress and attentiveness did not differ between the two groups, in the clinical group, mothers were more remote and less absorbed in the infant, and infants showed fewer positive communications. These findings might shed light on potential protective and risk factors for early parenting and later child outcomes in this clinical population.

The Dutch Infant Caregiving Assessment Scales: Psychometric properties in mothers with and without a severe psychiatric disorder

OBJECTIVES

This study examines the psychometric properties of the Dutch adaptation of the Infant Caregiving Assessment Scales (INCAS). This standardized observation procedure is the first to assess both emotional and instrumental caregiving skills of mothers with a severe psychiatric disorder, during the postpartum period.

METHODS

Mothers with and without a severe psychiatric disorder (N = 123) were observed at home at the infant age of 6 weeks during daily caregiving; changing a diaper, bathing, dressing, and feeding. Recordings of observations were coded independently by trained coders, blind for group membership. Subsequently, the component structure, internal consistency, interrater reliability, and concurrent validity of the INCAS were examined.

RESULTS

Principal component analysis largely confirmed the two a priori defined caregiving domains. The internal consistencies of the emotional and instrumental domains were deemed excellent and good, respectively. The interrater reliability was substantial for the emotional domain and moderate for the instrumental domain. Furthermore, evidence for good concurrent validity of the emotional domain was found. Lastly, significant correlations were found between specific instrumental caregiving skills and maternal neuropsychological functioning.

CONCLUSION

Psychometric findings support the INCAS as a comprehensive and reliable instrument for standardized assessment of caregiving by mothers with a severe psychiatric disorder.

Integrated Family Approach in Mental Health Care by Professionals From Adult and Child Mental Health Services: A Qualitative Study

OBJECTIVE

A multiple case-study in which each case was evaluated by adult and child mental health professionals who used an integrated family approach in their treatments. In this approach, treatment focuses on the mental disorders of the parents as well as on the development of the young child and family relationships. This study evaluated the experiences of professionals from adult and child mental health services using this approach. The aim of the study is identifying key elements of this approach, processes involved in treatment, and barriers to its success, with the aim of contributing to the development of practice based integrated mental health care for the whole family.

BACKGROUND

Parental mental disorders have an impact on parenting and child development. To stop detrimental cascade effects and prevent parent and child from being caught up in the intergenerational transmission of psychopathology, an integrated family approach in mental health care is needed. Methods: A qualitative case study design using a grounded theory approach. Data were collected through 19 group interviews of professionals (N = 37) from adult and infant mental health teams who worked together in the treatment of a family.

RESULTS

Professionals from the two services were comfortable coping with complexity and felt supported to perform their treatments by staying in touch with each other in multi-disciplinary consultations. They indicated that by attuning the treatment components to each other and tailoring them to the capabilities of the family, their treatments had more impact. A flexible attitude of all involved professionals and commitment to the interest of all family members was essential.

CONCLUSION

According to professionals, treatment with an integrated family approach in mental health care is of value for families by addressing the distinct roles, positions and relationships, by implementing a flexible complementary treatment plan, and by empowering professionals by multi-disciplinary consultations.

Emotional availability in women with bipolar disorder and major depression: A longitudinal pregnancy cohort study

OBJECTIVE

Poorer mother-infant interaction quality has been identified among women with major depression; however, there is a dearth of research examining the impact of bipolar disorder. This study sought to compare mother-infant emotional availability at 6 months postpartum among women with perinatal major depressive disorder, bipolar disorder and no disorder (control).

METHODS

Data were obtained for 127 mother-infant dyads from an Australian pregnancy cohort. The Structured Clinical Interview for the DSM-5 was used to diagnose major depressive disorder (n = 60) and bipolar disorder (n = 12) in early pregnancy (less than 20 weeks) and review diagnosis at 6 months postpartum. Prenatal and postnatal depressive symptoms were measured using the Edinburgh Postnatal Depression Scale, along with self-report psychotropic medication use. Mother and infant's interaction quality was measured using the Emotional Availability Scales when infants reached 6 months of age. Multivariate analyses of covariance examining the effects of major depressive disorder and bipolar disorder on maternal emotional availability (sensitivity, structuring, non-intrusiveness, non-hostility) and child emotional availability (responsiveness, involvement) were conducted.

RESULTS

After controlling for maternal age and postpartum depressive symptoms, perinatal disorder (major depressive disorder, bipolar disorder) accounted for 17% of the variance in maternal and child emotional availability combined. Compared to women with major depressive disorder and their infants, women with bipolar disorder and their infants displayed lower ratings across all maternal and child emotional availability qualities, with the greatest mean difference seen in non-intrusiveness scores.

CONCLUSIONS

Findings suggest that perinatal bipolar disorder may be associated with additional risk, beyond major depressive disorder alone, to a mother and her offspring's emotional availability at 6 months postpartum, particularly in maternal intrusiveness.

Human-Animal Interaction and Perinatal Mental Health: A Narrative Review of Selected Literature and Call for Research

There is a paucity of research exploring how relationships with household pets may impact maternal mental health. We are unaware of any study to date that has examined associations between individuals' relationships with their pets and psychological adjustment in the perinatal period. Using a biobehavioral lens, this paper provides a narrative overview of the literature on perinatal mental health and human-animal interaction (HAI). We focus on the role of social relationships, stress, and stress reduction in relation to perinatal mental health; the role of HAI in perceptions of social support, stressors, and stress reduction; and gaps in empirical knowledge concerning the role of HAI in perinatal mental health. Finally, we integrate contemporary biobehavioral models of perinatal mental health and HAI (i.e., Comprehensive Model of Mental Health during the Perinatal Period and the HAI-HPA Transactional Model) to propose a new conceptual framework that depicts ways in which HAI during the perinatal period may influence maternal and child health and wellbeing. To our knowledge, this is the first paper to consider the role of HAI in biobehavioral responses and mental health during the perinatal period. We conclude with recommendations for future research and improved perinatal care.

Maternal-fetal attachment in pregnant Italian women: multidimensional influences and the association with maternal caregiving in the infant's first year of life

Background

Maternal–Fetal Attachment (MFA) describes the cognitive-representational, emotional, and behavioral aspects of the mother–fetus relationship that develops during pregnancy.

We present two studies conducted on pregnant Italian women. In Study I, we aimed to explore multifaceted associations of MFA with variables important for a healthy pregnancy (e.g., maternal mental health, the couple’s relationship). In Study II, we investigated the predictive role of MFA on observed maternal caregiving during the first months of the infant’s life.

Methods

In Study I, 113 pregnant Italian women were assessed on MFA (Maternal Antenatal Attachment Scale, MAAS), maternal depression (Beck Depression Inventory-II, BDI-II), maternal anxiety (State Trait Anxiety Inventory – State version, STAI), adjustment of the couple (Dyadic Adjustment Scale, DAS), and perceived parental care (The Parental Bonding Instrument, PBI). In Study II, 29 mother–infant pairs were followed up at 4 months to assess observational variables of maternal caregiving through the Emotional Availability Scale (EAS) and to test for an association with MFA in pregnancy.

Results

Study I showed a significant association between MFA and the quality of the couple relationship (β = .49, P < .001) and between MFA and the recall of memories of care received in childhood (β = .22, P = .025). Study II showed a predictive effect of MFA on maternal structuring observed during mother–infant interactions at 4 months of age (β = 0.36, P = .046).

Conclusion

The study points out relevant relationship contexts that might receive care and support throughout pregnancy to protect MFA. The findings also provide thoughtful insights on the role of MFA in early maternal caregiving, suggesting that MFA might be a candidate as one putative antecedent of mother–infant interaction processes.

A Review of the Involvement of Partners and Family Members in Psychosocial Interventions for Supporting Women at Risk of or Experiencing Perinatal Depression and Anxiety

A maternal experience of perinatal mental health conditions can have serious short- and long-term consequences for child development and family relationships. Women with perinatal depression and/or anxiety are primarily supported by their partner/spouse and family. The aim of this review was to synthesise data from studies that have examined the inclusion of partners or family members in psychosocial interventions for women at risk of or experiencing perinatal depression and/or anxiety. A systematic search of five databases was conducted to identify literature published between 2010 and 2020. Nine empirical studies met the eligibility criteria and were independently assessed by two authors using the National Heart, Lung and Blood Institute Quality Assessment Tools and data were extracted and narratively synthesised guided by TIDieR (Template for Intervention Description and Replication) checklist. Eligible studies detailed diverse interventions facilitated by a variety of programme facilitators, with no central model of intervention or study outcome measures evident across the studies. All studies except one reported a significant change in maternal depression and anxiety scores. The interventions had limited evaluation of the woman’s, partner’s or family member’s experiences of involvement in the intervention. Further research is required to firmly establish the effectiveness of co-designed interventions to support the sustainable integration of such interventions into routine perinatal mental health services.

Perinatal depression screening in Australia: A position paper

Perinatal depression can have enduring adverse effects on women and their children and families, incurring substantial ongoing economic and personal costs. A significant proportion of the cost of perinatal depression relates to adverse impacts on the child, most likely mediated through impairment to the mother-infant relationship. In recognition of this problem, Australia has invested in routine perinatal depression screening. Our previous research produced convergent findings suggesting that expected benefits for children have not yet been realised through perinatal depression screening. We question the potential of including a measure of personality in current perinatal depression screening for identifying maternal mental health problems and suboptimal mother-infant relationships. This paper reviews our previous research findings within the broader context of perinatal depression screening. We propose a position, that perinatal depression screening in Australia should be redesigned to more precisely detect vulnerable mother-infant relationships, parenting, maternal mental health, and infant psychosocial and psychological development. Practice change to appropriately target antenatal interventions may more efficiently improve both maternal and child outcomes, thereby contributing to greater efficiency and cost savings for the health system.

Current Resources for Evidence-Based Practice, November 2020

An extensive review of new resources to support the provision of evidence-based care for women and infants. The current column includes a discussion of diversity in the maternity care workforce and commentaries on reviews focused on burnout in midwifery and a cross-national comparison of guidelines for uncomplicated childbirth.

P-CRS: A Clinical Scale to Assess the Parent-Child Relationship in Infancy and Early Childhood

This study aimed to examine the ability of a new clinician-report tool, the Parent-Child Relationship Scale (P-CRS), to assess the individual contributions that parents and their children make within the parent-child relationship, as well as interactions between parents and children in terms of developmental psychopathology. As clinical diagnoses in early childhood is both important and difficult, it is necessary to identify tools that can effectively contribute to evaluating parent-child relationships during the diagnostic process. A sample of 268 mother-child dyads, taken from both public and private clinical settings, was assessed. Clinicians were asked to assess these dyads using the P-CRS after four to five sessions of clinical evaluation. The results indicated that the three areas assessed by the P-CRS-"Interaction", "Child" and "Parent"-could have different impacts on the various aspects of the parent-child relationship within distinct diagnostic groups. Thus, our findings support the use of the P-CRS to assist with clinical diagnosis during early childhood.

Prenatal Attachment and Perinatal Depression: A Systematic Review

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.

Marital communication skills training to promote marital satisfaction and psychological health during pregnancy: a couple focused approach

BACKGROUND

Studies showed that decreased marital satisfaction and increased risk of depression and anxiety were mutually related. Therefore, this study was conducted to evaluate the effect of communication skills training with a couple focused approach on marital satisfaction and psychological symptoms among pregnant women.

METHODS

This experimental study was performed on 60 pregnant women with low marital satisfaction who were divided into two groups of intervention and control. The women in the intervention group and their husbands participated in a communication training program based on the couple focused approach. The levels of anxiety, depression, and marital satisfaction were evaluated before and then one and three months after the intervention using valid questionnaires.

RESULTS

The results indicated that after the intervention, compared to the pre-intervention period, the levels of marital satisfaction increased while the levels of depression and anxiety decreased significantly in the intervention group (p < 0.05). The comparison of the groups revealed significant differences in the scores of marital satisfaction, depression, and anxiety in the intervention and control groups at the intervals of one month and three months after the intervention (p < 0.05).

CONCLUSIONS

The research findings indicated that communication skills training program based on the couple focused approach and an emphasis on the needs of pregnant women during the pregnancy can improve the marital satisfaction and psychological health of pregnant women.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials IRCT2017012932264N2, Date of registration: 2017-06-28 Retrospectively registered.