Associations between maternal mental health and child emotional and behavioral problems: does prenatal mental health matter?

"Association between perinatal mood disorders of parents and child health outcomes"

PURPOSE

Perinatal mood disorders affect both parents, impacting their children negatively. Little is known on the association between parental perinatal mood disorders and pediatric outcomes in Japan considering relevant covariates. Our objective was to investigate the association between paternal and maternal perinatal mood disorders and adverse physical and psychological child outcomes by the age of 36 months, adjusting for covariates such as the child's sex, age of parent at child's birth, perinatal mood disorders of the other parent, and perinatal antidepressant use.

METHODS

We identified parents in the JMDC Claims Database in Japan from 2012 to 2020. Perinatal mood disorders were defined using International Classification of Diseases, 10th codes for mood disorders during the perinatal period combined with psychiatric treatment codes. We evaluated the association between parental perinatal mood disorders and pediatric adverse outcomes by the age of 36 months using Cox proportional hazard models adjusted for the covariates.

RESULTS

Of the 116,423 father-mother-child triads, 2.8% of fathers and 2.3% of mothers had perinatal mood disorders. Paternal perinatal mood disorders were not significantly associated with adverse child outcomes. After adjusting for paternal perinatal mood disorders and antidepressant use, maternal perinatal mood disorders were associated with delayed motor development, language development disorders, autism spectrum disorders, and behavioral and emotional disorders (adjusted hazard ratio [95% confidence interval]: 1.65 [1.01-2.69], 2.26 [1.36-3.75], 4.16 [2.64-6.55], and 6.12 [1.35-27.81], respectively).

CONCLUSIONS

Paternal perinatal mood disorders were not associated with adverse child outcomes in this population. Maternal perinatal mood disorders were associated with multiple child outcomes.

Maternal depression and early childhood development among children aged 24-59 months: the mediating effect of responsive caregiving

This study examined whether maternal depression is related to Early Childhood Developmental (ECD) delay among children by quantifying the mediating contribution of responsive caregiving. We used data from 1235 children (Children's mean age = 50.4 months; 582 girls, 653 boys, 93.9% were Han), selected through convenience sampling, in 2021. 4.7% of children had ECD delay, 34.3% of mothers had depression. Children with depressed mothers were less likely to receive responsive caregiving (OR 4.35, 95% CI 2.60-7.27), and those who did not receive responsive caregiving were more likely to experience ECD delay (OR 3.89, 95% CI 1.89-8.02). Responsive caregiving partly mediated the relationship between maternal depression and ECD. Early intervention for children with depressed mothers is worthy of further investigation.

Windows of opportunity: how age and sex shape the influence of prenatal depression on the child brain

Maternal prenatal depression can affect child brain and behavioural development. Specifically, altered limbic network structure and function is a likely mechanism through which prenatal depression impacts the life-long mental health of exposed children. While developmental trajectories are influenced by many factors that exacerbate risk or promote resiliency, the role of child age and sex in the relationship between prenatal depression and the child brain remains unclear. Here, we review studies of associations between prenatal depression and brain structure and function, with a focus on the role of age and sex in these relationships. After exposure to prenatal depression, altered amygdala, hippocampal and frontal cortical structure, as well as changes in functional and structural connectivity within the limbic network are evident during the fetal, infant, preschool, childhood, and adolescent stages of development. Sex appears to play a key role in this relationship, with evidence of differential findings particularly in infants, with males showing smaller and females larger hippocampal and amygdala volumes following prenatal depression. Longitudinal studies in this area have only begun to emerge within the last five years and will be key to understanding critical windows of opportunity. Future research focused on the role of age and sex in this relationship is essential to further inform screening, policy, and interventions for children exposed to prenatal depression, interrupt the intergenerational transmission of depression, and ultimately support healthy brain development.

Prenatal psychological distress and 11β-HSD2 gene expression in human placentas: Systematic review and meta-analysis

BACKGROUND

The placenta acts as a buffer to regulate the degree of fetal exposure to maternal cortisol through the 11-Beta Hydroxysteroid Dehydrogenase isoenzyme type 2 (11-β HSD2) enzyme. We conducted a systematic review and meta-analysis to assess the effect of prenatal psychological distress (PPD) on placental 11-β HSD2 gene expression and explore the related mechanistic pathways involved in fetal neurodevelopment.

METHODS

We searched PubMed, Embase, Scopus, APA PsycInfo®, and ProQuest Dissertations for observational studies assessing the association between PPD and 11-β HSD2 expression in human placentas. Adjusted regression coefficients (β) and corresponding 95% confidence intervals (CIs) were pooled based on three contextual PPD exposure groups: prenatal depression, anxiety symptoms, and perceived stress.

RESULTS

Of 3159 retrieved records, sixteen longitudinal studies involving 1869 participants across seven countries were included. Overall, exposure to PPD disorders showed weak negative associations with the placental 11-β HSD2 gene expression as follows: prenatal depression (β -0.01, 95% CI 0.05-0.02, I2=0%), anxiety symptoms (β -0.02, 95% CI 0.06-0.01, I2=0%), and perceived stress (β -0.01 95% CI 0.06-0.04, I2=62.8%). Third-trimester PPD exposure was more frequently associated with lower placental 11-β HSD2 levels. PPD and placental 11-β HSD2 were associated with changes in cortisol reactivity and the development of adverse health outcomes in mothers and children. Female-offspring were more vulnerable to PPD exposures.

CONCLUSION

The study presents evidence of a modest role of prenatal psychological distress in regulating placental 11-β HSD2 gene expression. Future prospective cohorts utilizing larger sample sizes or advanced statistical methods to enhance the detection of small effect sizes should be planned. Additionally, controlling for key predictors such as the mother's ethnicity, trimester of PPD exposure, mode of delivery, and infant sex is crucial for valid exploration of PPD effects on fetal programming.

Maternal Depression and Sleep Problems in Early Childhood: A Meta-Analysis

Both prenatal and postnatal maternal depression have been associated with increased sleep problems in early childhood. However, this association is less consistent for postnatal depression, and the strength of the association remains unclear. The aim of the current study was to provide a quantitative synthesis of the literature to estimate the magnitude of the association between maternal depression and sleep problems in early childhood. Medline, PsycINFO, PsycARTICLES, Web of Science, and Scopus were searched for prospective longitudinal studies from 1970 to December 2022. Of 117 articles screened, 22 studies met the inclusion criteria. Both prenatal depression (OR = 1.82; 95% CI = 1.28-2.61) and postnatal depression (OR = 1.65; 95% CI = 1.50-1.82) were associated with increased likelihood of sleep problems in early childhood. The heterogeneity between the studies was significant and high both for prenatal (Q = 432.323; I2 = 97.456, P < .001) and postnatal depression (Q = 44.902, I2 = 65.594, P < .001), which mean that conclusions are tentative and need to be considered within the possible influence of unmeasured confounding. However, mitigating depression symptoms in mothers both during pregnancy and in the postnatal period would be an effective strategy for reducing sleep problems in children.

Multiple Risk in Pregnancy- Prenatal Risk Constellations and Mother-Infant Interactions, Parenting Stress, and Child Externalizing and Internalizing Behaviors: A Prospective Longitudinal Cohort Study from Pregnancy to 18 Months Postpartum

Multiple risk is associated with adverse developmental outcomes across domains. However, as risk factors tend to cluster, it is important to investigate formation of risk constellations, and how they relate to child and parental outcomes. By means of latent class analysis patterns of prenatal risk factors were identified, and relations to interactional quality, parenting stress, and child internalizing and externalizing behaviors were investigated. An array of prenatal risk factors was assessed in 1036 Norwegian pregnant women participating in a prospective longitudinal community-based study, Little in Norway. Mother-infant interactions were videotaped and scored with the Early Relational Health Screen (ERHS) at 12 months. The Parenting Stress Index (PSI) and Infant-Toddler Social and Emotional Assessment (ITSEA) were administered at 18 months. First, we analyzed response patterns to prenatal risks to identify number and characteristics of latent classes. Second, we investigated whether latent class membership could predict mother-child interactional quality, parenting stress, and child internalizing and externalizing behavior after the child was born. Results revealed three prenatal risk constellations: broad risk (7.52%), mental health risk (21.62%) and low-risk (70.86%). Membership in the broad risk group predicted lower scores on interactional quality, while membership in the mental health risk group predicted less favorable scores on all outcome measures. Prenatal risks clustered together in specific risk constellations that differentially related to parent, child and interactional outcomes.

Correlates of maternal depression, anxiety and functioning across an urban-rural gradient in northern Ecuador

Maternal depression remains under characterised in many low- and middle-income countries, especially in rural settings. We aimed to describe maternal depression and anxiety symptoms in rural and urban communities in northern Ecuador and to identify socioeconomic and demographic factors associated with these symptoms. Data from 508 mothers participating in a longitudinal cohort study were included. Depression and anxiety symptoms were assessed using the Hopkins Symptom Checklist (HSCL-25), and maternal psychological functioning was assessed using a checklist of daily activities. Tobit regression models were used to examine associations with sociodemographic variables and urbanicity. The median HSCL-25 score was 1.2 (IQR: 0.4) and 14% of women scored above the threshold for clinically relevant symptoms. Rural women reported similar food insecurity, less education, younger age of first pregnancy, and lower socio-economic status compared to their urban counterparts. After adjusting for these factors, rural women reported lower HSCL-25 scores compared to women lin urban areas (β = -0.48, 95%CI:0.65, -0.31). Rural residence was also associated with lower depression and anxiety HSCL-25 sub-scale scores, and similar levels of maternal functioning, compared to urban residence. Our results suggest that both household and community-level factors are risk factors for maternal depression and anxiety in this context.

"More Than Just a Manicure" Qualitative Experiences of Maternal Self-Care During COVID-19

Background

The COVID-19 pandemic presented families with novel challenges. Mothers were at particular risk for parental burnout, however, there is limited research on self-care behaviors to ameliorate it explicitly for mothers of young children (aged 3 and younger). Moreover, there has been little in-depth analysis on barriers to self-care and how mothers realistically implement it in their lives.

Methods

In this article, we explore influences on and barriers to self-care in mothers of young children during the COVID-19 pandemic. Using a content analysis approach, we used verbal testimony from mothers to create a coding framework and applied that framework to the sample (N = 717).

Results

Qualitative analyses revealed that beauty and personal care were the most utilized self-care acts. Two major barriers were lack of childcare and limited time. Social support was the most frequently reported asset to engaging in self-care. Participants noted that the pandemic significantly restricted their access to activities and social support.

Conclusions

These findings emphasize the need to encourage mothers to prioritize self-care and incorporate their support systems to facilitate engagement. These results can inform programming to increase self-care behaviors in mothers, particularly during times of high environmental stressors. Future research should examine how resources can be allocated toward barriers of self-care to reduce burnout and improve quality of life.

Developing Specialist Perinatal Mental Health Services: the door of opportunity

The development of Specialist Perinatal Mental Health Services in Ireland in recent years (2018-2021) is described. The paper highlights the role of unexpected opportunity in advancing this much needed service for women, infants and their families. It also emphasises the need for funding combined with an implementation mechanism to ensure that the service emerging is true to the Model of Care designed and is available in a uniform manner to women nationally.

Fertile ground: reproductive health consideration in mental health ward policy

OBJECTIVES

Women of childbearing age often experience mental health problems, receive psychotropic medication and are admitted to mental health units. Approximately 40% of pregnancies are unplanned and many women experience perinatal mental health problems. It is therefore vital that consideration is given to reproductive health in mental health policy. We aimed to evaluate the consideration of pregnancy and breastfeeding in the policies of an inpatient mental health service.

METHODS

The policies of a regional inpatient psychiatric unit were independently reviewed by two researchers. Policies that had implications for pregnancy and breastfeeding for patients were identified. Whether or not these policies considered pregnancy and breastfeeding and the detail of this consideration was evaluated.

RESULTS

One hundred and thirteen policies were evaluated. Forty had implications for pregnancy but only 10 of these mentioned pregnancy and only 3 in detail. Only 3 of the 28 policies that had relevance to breastfeeding mothers mentioned it and none discussed it in detail. Key areas of omission included prescribing, seclusion and restraint and cultural and religious considerations.

CONCLUSION

Pregnancy and breastfeeding were almost entirely absent in the ward policies of our inpatient unit. Their consideration in the acute setting is vital. An individual or group of individuals should be responsible for ensuring that reproductive health is considered in all policies as well as in a larger specific policy suitable for referencing. The rights of the reproductive woman should be comprehensively considered in inpatient mental health care policy.

Exploring the associations between serious psychological distress and the quantity or frequency of tobacco, alcohol, and cannabis use among pregnant women in the United States

Serious Psychological Distress (SPD) and prenatal exposure to substances are associated with adverse outcomes for pregnant individuals and their developing offspring. This study aims to examine the relationship between SPD and quantity, or frequency of substance use among pregnant women in the United States (US). Descriptive and negative binomial regression analyses of the 2015-2019 National Survey on Drug Use and Health (NSDUH) were conducted among 3373 pregnant women (18 to 44 years old) to examine the association between SPD and (1) average number of cigarettes smoked in the past 30 days, (2) number of days of binge drinking in the past 30 days, and (3) number of days of cannabis use in the past 30 days. About 6% of the study population experienced SPD in the past 30 days. Compared to pregnant women who did not report SPD, pregnant women experiencing SPD showed greater rates in the number of cigarettes smoked during the past 30 days (IRR = 2.1, 95%CI = 1.1, 4.5), the number of days of binge drinking in the past 30 days (IRR = 5.1, 95%CI = 1.7, 15.4), and the number of days of cannabis use in the past 30 days (IRR = 2.9, 95%CI = 1.3, 6.5). Our results extend findings from prior research by documenting an association between SPD and the quantity and frequency of substance use among pregnant women in the US. Individual and structural interventions addressing SPD and/or substance might help reduce the impact of these comorbid conditions on expectant parents and their offspring.

The feasibility and acceptability of a single-session Acceptance and Commitment Therapy (ACT) intervention to support women self-reporting fear of childbirth in a first pregnancy

OBJECTIVE

To assess the feasibility and acceptability of a single-session Acceptance and Commitment Therapy intervention to help women manage fear of childbirth during a first pregnancy.

DESIGN

A mixed-methods approach including qualitative feedback and pre/post-intervention self-report measures. Pregnant women (14-37 weeks gestation) were recruited via the UK National Health Service and attended a single-session (<3 hours) Acceptance and Commitment Therapy intervention alongside routine antenatal care. Data were analysed using content and statistical analyses.

MAIN OUTCOME MEASURES

Fear of childbirth, anxiety and wellbeing were the main outcome measures. Secondary to these, intolerance of uncertainty and valued life domains (e.g. relationships, recreation) as hypothesised mechanisms of change, were also assessed.

RESULTS

33 expressions of interest were received, 21 women signed up, 15 participated, and 11 completed follow-up measures (participation rate: 33%). Findings demonstrated clinical and statistical reductions in fear of childbirth and anxiety alongside positive feedback on the intervention. Intolerance of uncertainty and wellbeing were low at baseline and remained unchanged.

CONCLUSION

A single-session Acceptance and Commitment Therapy intervention to manage fear of childbirth is potentially feasible and acceptable. A pilot randomised controlled trial is warranted. Further research should explore efficacy and how Acceptance and Commitment Therapy may reduce perinatal distress.

The role of social adversity on emotional dysregulation during infancy and early childhood

PURPOSE

The purpose of this study was to investigate if social adversity is associated with mother reported emotional dysregulation behaviors and trajectories during infancy and early childhood.

DESIGN & METHODS

A secondary data analysis from the Durham Child Health and Development study study included 206 child-mother dyads. Three models were used to explore the relationship between social adversity and mother reported emotional dysregulation during infancy (Infant Behavior Questionnaire-Revised) and early childhood (Child Behavior Checklist - Dysregulation Profile). Linear mixed effects models were adopted to investigate if social adversity was associated with mother reported emotional dysregulation longitudinally. Regression analysis was conducted to explore if social adversity was associated with maternal reported emotional dysregulation trajectory slope scores and maternal reported emotional dysregulation trajectory class. Maternal psychological distress and the child's sex assigned at birth were included as covariates in each analysis.

RESULTS

Infants with greater social adversity scores had significantly higher maternal reported fear responses across the first year of life. Social adversity was associated with maternal reported distress to limitations trajectory, dysregulated recovery class, and dysregulated distress to limitations class. During early childhood social adversity was significantly associated with maternal reported emotional dysregulation but not trajectories which showed little variability.

CONCLUSION & PRACTICAL IMPLICATIONS

Our results indicate that social adversity is associated with maternal reported emotional dysregulation during infancy and early childhood. Nursing and other professionals can participate in early screening to determine risk and provide intervention.

Maternal-infant bonding and partner support during pregnancy and postpartum: Associations with early child social-emotional development

The first 1000 days after conception are considered critical for healthy development and well-being throughout life. Fundamental to health practices during pregnancy and positive parenting after birth is the development of maternal-infant bonding. Previous research has demonstrated the importance of having an involved partner during pregnancy and in parenting for optimal maternal-infant bonding. The current study examined maternal-infant bonding and partner support during pregnancy and the postpartum period, and their associations with early child social-emotional development. A total of 227 women completed the Pre- and Postnatal Bonding Scale (PPBS) and Tilburg Pregnancy Distress Scale (TPDS) during pregnancy (32 weeks of gestation) and at 8 months postpartum, assessing maternal-infant bonding and partner support. Additionally, a questionnaire on social-emotional behavior of the Bayley Scales of Infant and Toddler Development was administered to mothers to measure child development at 2 years of age. Path analyses revealed an indirect positive effect of prenatal maternal-infant bonding on child social-emotional development through postnatal maternal-infant bonding, as well as mediating effects of pre- and postnatal maternal-infant bonding on the association between pre- and postnatal partner support and child social-emotional development. Our findings support the notion that an emotional connection from mother to child originates in pregnancy and that experiencing positive feelings towards the fetus promotes positive maternal-infant bonding after birth and social-emotional capacities of the child. Additionally, having a supportive partner during pregnancy and postpartum, might be essential for the development of optimal maternal-infant bonding.

Structural and Intermediary Social Determinants of Health and the Emotional and Behavioral Health of US Children

Children grow up in homes where varying environmental and socioeconomic contexts have a bearing on their emotional and behavioral health (EBH). This study used data from a representative sample of the child supplement of the US National Health Information Survey (NHIS) and applied the social determinants of health (SDoH) framework to explore factors associated with child EBH. We conducted a path analysis of the child's EBH measured by the strengths and difficulties questionnaire (SDQ) from their macro and socioeconomic contexts, e.g., policy, household, and other health system risk factors. For children in the sample, aged 4 to 17 years old (n = 9205), most path relationships to child SDQ scores were statistically significant. The total effects from a child's visit to a mental health specialist (0.28) and child's age (0.22) had the highest coefficients to child SDQ scores. A modified model showed a better fit with X2 (4) = 22.124, RMSEA = 0.021, and 90% CI [0.013-0.03], CFI = 0.98. Findings indicate that child factors such as being older, the use of mental healthcare services, and family socioeconomic status were significantly associated with EBH, calling attention to the need for more responsive policy and behavioral health interventions that address household/familial and child-level factors, critical determinants of child wellbeing.

Factor Structure and Measurement and Structural Invariance of the Edinburgh Postnatal Depression Scale during the Perinatal Period among Japanese Women: What Is the Best Model?

The Edinburgh Postnatal Depression Scale (EPDS) is a widely used screening tool for perinatal depression. Its factor structure is still a debatable topic. Our study aimed to examine the factor structure and measurement invariances of the Japanese version of the EPDS from late pregnancy to early postpartum. A total of 633 women were followed with the EPDS at three times over the perinatal period: late pregnancy (n = 633), 5 days after childbirth (n = 445), and 1 month after childbirth (n = 392). We randomly divided the participants into two groups: one for exploratory factor analyses (EFAs) and another for confirmatory factor analyses (CFAs). The result of the EFAs indicated different factor models at each time point. Hence, CFAs were performed using the second sample set to compare different models including the ones previously reported. A 3-factor model consisting of depression (items 7, 9), anxiety (items 4, 5), and anhedonia (items 1, 2) (Kubota et al., 2018) was consistently stable during the whole perinatal period. Kubota's 3-factor model showed invariance across the perinatal period.

Maternal perinatal depression and child brain structure at 2-3 years in a South African birth cohort study

Maternal perinatal depression is associated with risk of adverse child developmental outcomes and differences in offspring brain structure. Evidence from low- and middle-income countries is lacking as is an investigation of antenatal, postnatal, and persistent depression in the same sample. In a South African birth cohort, we investigated the effect of antenatal and postpartum maternal depressive symptoms on offspring brain structure at 2-3 years of age. Magnetic resonance imaging was performed, extracting cortical thickness and surface areas in frontal cortex regions of interest and subcortical volumes using FreeSurfer software. Maternal depressive symptoms were measured using the Edinburgh Postpartum Depression Scale and the Beck Depression Inventory II antenatally and at 6-10 weeks, 6 months, 12 months, and 18 months postpartum and analyzed dichotomously and continuously. Linear regressions were used controlling for child age, sex, intracranial volume, maternal education, age, smoking, alcohol use and HIV. 146 children were included with 38 (37%) exposed to depressive symptoms antenatally and 44 (35%) exposed postnatally. Of these, 16 (13%) were exposed to both. Postpartum, but not antenatal, depressive symptoms were associated with smaller amygdala volumes in children (B = -74.73, p = 0.01). Persistent maternal depressive symptoms across pregnancy and postpartum were also independently associated with smaller amygdala volumes (B = -78.61, p = 0.047). Differences in amygdala volumes among children exposed to postnatal as well as persistent maternal depressive symptomatology underscore the importance of identifying women at-risk for depression during the entire perinatal period.

The effects of maternal prenatal depression on child mental health: The moderating role of maternal childhood trauma

BACKGROUND

There is a large body of evidence suggesting that maternal prenatal depression significantly predicts mental health problems in children. However, little is known about the role of maternal childhood trauma within this effect.

METHODS

The current study utilized a sample of 187 mother-child dyads (51.3 % boys) from the Shanghai Sleep Birth Cohort (SSBC), a six-year prospective longitudinal study. The effects of maternal depression at late pregnancy (Center for Epidemiological Survey-Depression Scale) on the child mental health at six years old (Strengths and Difficulties Questionnaire) were analyzed, with different types of maternal childhood trauma (Childhood Trauma Questionnaire) being examined as moderators.

RESULTS

The results showed that maternal prenatal depression positively predicted child mental health problems (β = 0.13, p < .05) and there was a significant moderating effect of maternal childhood emotional abuse (β = -0.05, p < .05); that is, in mothers with high childhood emotional abuse, child mental health problems remained high regardless of maternal prenatal depression (β = -0.02, p = .78), while in mothers with low childhood emotional abuse, maternal prenatal depression significantly predicted child behavioral and emotional problems (β = 0.20, p < .05).

LIMITATIONS

Relatively high socio-economic status samples, retrospective reports of maternal childhood trauma and the single reporter were the limitations of this study.

CONCLUSIONS

The findings provided new insights into the impact of maternal prenatal depression on child mental health, highlighting the importance of intervention efforts targeting mothers with prenatal depression and childhood trauma history.

The effect of COVID-19 lockdowns on women's perinatal mental health: a systematic review

BACKGROUND

Risk factors for poor maternal perinatal mental health include a previous mental health diagnosis, reduced access to perinatal services, economic concerns and decreased levels of social support. Adverse maternal perinatal mental health can negatively influence the psychological wellbeing of infants. The outbreak of the COVID-19 pandemic presented an additional stressor. While literature on the impact of COVID-19 on perinatal mental health exists, no systematic review has focused specifically on maternal perinatal mental health during periods of COVID-19 lockdown.

AIMS

This systematic review explores how periods of COVID-19 lockdown impacted women's perinatal mental health.

METHODS

Searches of CINAHL, PsycARTICLES, PsycINFO, PubMed, Scopus and Web of Science were conducted for literature from 1st January 2020-25th May 2021. Quantitative, peer-reviewed, cross-sectional studies published in English with perinatal women as participants, and data collected during a period of lockdown, were included. Data was assessed for quality and narratively synthesized.

FINDINGS

Sixteen articles from nine countries met the inclusion criteria. COVID-19 lockdowns negatively impacted perinatal mental health. Risk factors for negative perinatal mental health noted in previous literature were confirmed. In addition, resilience, educational attainment, trimester, and ethnicity were identified as other variables which may influence mental health during perinatal periods experienced during lockdown. Understanding nuance in experience and harnessing intra and interpersonal support could advance options for intervention.

CONCLUSION

Developing resources for perinatal women that integrate informal sources of support may aid them when normal routine is challenged, and may mediate potential long-term impacts of poor perinatal maternal health on infants.

Mothering Ideology: A Qualitative Exploration of Mothers' Perceptions of Navigating Motherhood Pressures and Partner Relationships

Good mother ideology refers to beliefs that women are only 'good' mothers if they adhere to the tenets of dominant parenting discourse, such as intensive mothering ideology, which prioritizes children's needs and child-raising above all else. Undergirded by this ideology, mothers' attempts to navigate the transition to motherhood are fraught with pressures, and the transition is associated with negative health outcomes for mothers and children; yet existing research gives little attention to the quality or dynamics of the partner relationship as part of this transition. The current study examined motherhood pressure and the impact on partner relationships through individual, semi-structured interviews with 19 mothers living in Australia who were 18 years or older in a heterosexual relationship with at least one child under the age of five. Thematic analysis revealed four key themes: discourses on motherhood: criticisms of mothers and internalised guilt; transformation of identity; entrenchment of gender roles through childrearing; and positive relationship dynamics: supportive fathers and challenging gender roles. This study contributes to the larger body of literature highlighting the complexity of dominant mothering ideology and its entanglement with and impact on partner relationships. Further, this study includes mothers' perceptions of how they navigate these pressures within the relationship with their partner and the family unit. These findings have implications for programs to support mothers and other caregivers, as well as challenge unrealistic standards for motherhood.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11199-022-01345-7.

DNA methylation as a mediator in the association between prenatal maternal stress and child mental health outcomes: Current state of knowledge

BACKGROUND

Prenatal maternal stress is increasingly recognized as a risk factor for offspring mental health challenges. DNA methylation may be a mechanism, but few studies directly tested mediation. These few integrative studies are reviewed along with studies from three research areas: prenatal maternal stress and child mental health, prenatal maternal stress and child DNA methylation, and child mental health and DNA methylation.

METHODS

We conducted a narrative review of articles in each research area and the few published integrative studies to evaluate the state of knowledge.

RESULTS

Prenatal maternal stress was related to greater offspring internalizing and externalizing symptoms and to greater offspring peripheral DNA methylation of the NR3C1 gene. Youth mental health problems were also related to NR3C1 hypermethylation while epigenome-wide studies identified genes involved in nervous system development. Integrative studies focused on infant outcomes and did not detect significant mediation by DNA methylation though methodological considerations may partially explain these null results.

LIMITATIONS

Operationalization of prenatal maternal stress and child mental health varied greatly. The few published integrative studies did not report conclusive evidence of mediation by DNA methylation.

CONCLUSIONS

DNA methylation likely mediates the association between prenatal maternal stress and child mental health. This conclusion still needs to be tested in a larger number of integrative studies. Key empirical and statistical considerations for future research are discussed. Understanding the consequences of prenatal maternal stress and its pathways of influence will help prevention and intervention efforts and ultimately promote well-being for both mothers and children.

Impact of the Timing of Maternal Peripartum Depression on Infant Social and Emotional Development at 18 Months

The study assessed how the timing of maternal perinatal depressive symptoms affects infant socio-emotional characteristics at age 18 months. The study was a longitudinal cohort study that included six assessment points from the third trimester of pregnancy up to age 18 months (±1 month). Assessment of mothers included the Edinburgh Postnatal Depression Scale and the State-Trait Anxiety Inventory, while assessments of infant included the Infant Toddler Social and Emotional Assessment (ITSEA) at 18 months. Mothers were categorized into one of the following groups: mothers who presented postnatal depression only (n = 19); mothers who presented both prenatal and postnatal depression (n = 14), and mothers who never showed perinatal depression symptoms (n = 38). Mothers who presented both prenatal and postnatal depression showed significantly higher levels of depressive score, reactivity to stress and level of anxiety trait compared to mothers of the two other groups. Infants of prenatally and postnatally depressed mothers had higher scores on the internalizing subscore of the ITSEA. The number of depression episodes during the study period was positively correlated with the externalizing and internalizing subscores of the ITSEA. These findings support the need to provide specific screening to identify women with prenatal depression.

Associations between oral habits, dental anxiety, dental service utilization, and maternal mental health status among 6- to 12-year-old children in Ile-Ife, Nigeria

PURPOSE

The current study sought to determine the associations between maternal mental health and oral habits, dental anxiety, and dental service utilization of 6- to 12-year-old children in Ile-Ife, Nigeria.

METHODS

Data were obtained from a household survey involving 1411 mothers and their 6- to 12-year-old children. Data collected were the confounding (maternal age, child's age at last birthday, sex at birth and socioeconomic status), independent (maternal psychological distress, and depression status) and dependent (child's non-nutritive oral habits, dental anxiety level, and most recent dental visit) variables. Bivariate analyses were conducted to test the associations between the dependent and independent variables. After controlling for confounding variables, the associations between the dependent and independent variables were determined using multivariable linear and logistic regression analyses.

RESULTS

Overall, 479 (33.9%) reported one oral habit, 189 (13.4%) reported two and 99 (7.0%) children reported three or more oral habits. Only 25 (1.7%) children reported a dental visit in the year preceding the study. Higher maternal psychological distress was associated with higher dental anxiety in children (AOR: 0.094; 95% CI - 0.080 to - 0.293; p < 0.001). There was no significant association between maternal psychological distress, child's non-nutritive oral habits, and the child's most recent dental visit. There was also no association between maternal depression and the child's non-nutritive oral habits, dental anxiety level, and most recent dental visit.

CONCLUSION

Maternal psychological distress was a significant risk indicator for dental anxiety, but not for dental service utilization or non-nutritive oral habits among children in Ile-Ife, Nigeria. Maternal educational status was also associated with dental anxiety. Further research is needed to elucidate the study's findings.

Effect of transcutaneous auricular vagus nerve stimulation on major depressive disorder with peripartum onset: A multicenter, open-label, controlled proof-of-concept clinical trial (DELOS-1)

BACKGROUND

Postpartum depression has a high prevalence in the United States (~13 %) and often goes undertreated/untreated. We conducted a multicenter, open-label, proof-of-concept trial to assess the Nēsos wearable, non-invasive, transcutaneous auricular vagus nerve stimulation (taVNS) system for the treatment of major depressive disorder with peripartum onset (PPD).

METHODS

Women (n = 25), ages 18 to 45, within 9 months postpartum, and diagnosed with PPD were enrolled at 3 sites. The study included 6 weeks open-label therapy and 2 weeks observation. Efficacy outcomes included change from baseline (CFB) in Hamilton Rating Scale for Depression (HAMD17) total scores, HAM-D17 response and remission, and patient and clinician global impression of change (PGIC, CGIC) scores. Analysis included descriptive statistics and mixed-effects models for repeated measures.

RESULTS

The most common AEs (≥5 %) were discomfort (n = 5), headache (n = 3), and dizziness (n = 2); all resolved without intervention. No serious AEs or deaths occurred. Baseline mean HAM-D17 score was 18.4. Week 6 least squares (LS) mean CFB in HAM-D17 score was -9.7; 74 % achieved response and 61 % achieved remission. At week 6, at least some improvement was reported by 21 of 22 (95 %) clinicians on CGIC and 22 of 23 (96 %) participants on PGIC.

LIMITATIONS

This was a single-arm, open-label study, and enrollment was limited to participants with mild-to-moderate peripartum depression.

CONCLUSION

Results from this proof-of-concept study suggest that the Nēsos taVNS system is well tolerated and may be an effective non-invasive, non-pharmacological treatment for major depressive disorder with peripartum onset. Further evaluation in larger sham-controlled studies is needed.

CLINICALTRIALS

govNCT03972995.

Follow-up of infants with colic into childhood: Do they develop behavioural problems?

AIM

To assess whether infants with colic (IC) demonstrate persisting developmental dysregulation into childhood, manifested as behavioural problems, and to determine if these behavioural problems are associated with parenting factors.

METHODS

Preschool children with a history of IC at the age of 0-3 months, as defined by the Wessel criteria, were invited to participate in an observational follow-up study, in which their caregivers completed the Child Behaviour Checklist (CBCL). Raw scores and clinical-range scores on the internalising, externalising and total behavioural problems scales were compared with a Dutch normative sample using independent t-tests and Chi-square tests. For the clinical-range scores, multivariable logistic regressions (odds ratios [99% confidence interval, CI]) were used to adjust for confounders and to identify variables associated with behavioural problems.

RESULTS

Two hundred and fifty-eight children with a history of IC (median age 5.1 (interquartile range, IQR 4.6-5.5) years, 51.9% boys) were included. The cases had a significantly higher adjusted risk (adjusted odds ratios (aORs) [99% CI]) of scoring in the clinical range of the emotionally reactive, internalising and total problems scale (2.96 [1.24-7.06]; 2.50 [1.35-4.62]; 2.98 [1.46-6.07], respectively). Internalising (P < 0.001), externalising (P < 0.001) and total (P < 0.001) behavioural problems in children with a history of IC were associated with higher parenting stress scores.

CONCLUSIONS

Children with a history of IC demonstrated significantly more internalising behavioural problems at preschool age compared to the norm sample. Specific advice and support need to be available for parents to understand and regulate the behaviour of their child, from infancy to childhood.

An evolutionary perspective on the association between grandmother-mother relationships and maternal mental health among a cohort of pregnant Latina women

Grandmothers are often critical helpers during a mother's reproductive career. Studies on the developmental origins of health and disease demonstrate how maternal psychological distress can negatively influence fetal development and birth outcomes, highlighting an area in which soon-to-be grandmothers (henceforth "grandmothers") can invest to improve both mother and offspring well-being. Here, we examine if and how a pregnant woman's mental health- specifically, depression, state-anxiety, and pregnancy-related anxiety- is influenced by her relationship with her fetus' maternal and paternal grandmother, controlling for relationship characteristics with her fetus' father. In a cohort of pregnant Latina women in Southern California (N = 216), we assessed social support, geographic proximity, and communication between the fetus' grandmothers and pregnant mother. We assessed maternal mental health with validated questionnaire-based instruments. We find that both social support from and communication with the maternal grandmother were statistically associated with less depression, while no paternal grandmother relationship characteristics were statistically significant in association with any mental health variable. These results align with the idea that maternal grandmothers are more adaptively incentivized to invest in their daughters' well-being during pregnancy than paternal grandmothers are for their daughters-in-law. Results suggest that the positive association of maternal grandmothers with mothers' mental health may not hinge on geographic proximity, but rather, potentially function through emotional support. This work represents a novel perspective describing a psychological and prenatal grandmaternal effect.

Prenatal smoking, alcohol and caffeine exposure and offspring externalizing disorders: a systematic review and meta-analysis

BACKGROUND AND AIMS

Several studies have indicated an association between maternal prenatal substance use and offspring externalizing disorders; however, it is uncertain whether this relationship is causal. We conducted a systematic review to determine: (1) if the literature supports a causal role of maternal prenatal substance use on offspring externalizing disorders diagnosis and (2) whether these associations differ across externalizing disorders.

METHODS

We searched Web of Science, Embase, PsycINFO and Medline databases. Risk of bias assessment was conducted using the Newcastle-Ottawa Scale (NOS), and where possible meta-analysis was conducted for studies classed as low risk of bias. We included studies of any design that examined prenatal smoking, alcohol or caffeine use. Studies in non-English language, fetal alcohol syndrome and comorbid autism spectrum disorders were excluded. Participants in the included studies were mothers and their offspring. Measurements included prenatal smoking, alcohol or caffeine use as an exposure, and diagnosis of attention-deficit hyperactivity disorder (ADHD), conduct disorder (CD) and oppositional defiant disorder (ODD) in offspring as an outcome.

RESULTS

We included 63 studies, 46 of which investigated smoking and ADHD. All studies were narratively synthesized, and seven studies on smoking and ADHD were meta-analysed. The largest meta-analysis based on genetically sensitive design included 1 011 546 participants and did not find evidence for an association [odds ratio (OR)_{1-9 cigarettes}  = 0.90, 95% confidence interval (CI) = 0.83-1.11; OR _{> 10 cigarettes}  = 1.04, 95% CI = 0.79-1.36). Studies on alcohol exposure in all the outcomes reported inconsistent findings and no strong conclusions on causality can be made. Studies on caffeine exposure were mainly limited to ADHD and these studies do not support a causal effect.

CONCLUSIONS

There appears to be no clear evidence to support a causal relationship between maternal prenatal smoking and offspring attention-deficit hyperactivity disorder. Findings with alcohol and caffeine exposures and conduct disorder and oppositional-defiant disorder need more research, using more genetically sensitive designs.

Autistic mothers' perinatal well-being and parenting styles

LAY ABSTRACT

Autistic people can have difficulties during pregnancy and after giving birth, such as difficulty getting health care that meets their needs. Autistic people may therefore have lower well-being than non-autistic people during this time. We asked autistic and non-autistic people to fill in questionnaires measuring stress, depression, anxiety and satisfaction with life. They were asked to do this once during pregnancy, once 2 to 3 months after giving birth and once 6 months after giving birth. At 6 months after giving birth, they also filled in questionnaires about parenting. The autistic parents had higher stress, depression and anxiety scores than the non-autistic parents. For both groups, scores for anxiety went down over time. There were no differences between the groups on satisfaction with their life or how confident they were as a parent. There were no differences between the groups on most areas of parenting style, although autistic parents scored lower on parenting discipline. This study suggests that autistic people may be more stressed, depressed and anxious than non-autistic people during pregnancy and after giving birth. Autistic people therefore need good quality support during this time. This study also suggests that autistic and non-autistic parents may be just as likely to parent in positive ways such as being sensitive to their baby's needs.

A Systematic Review of Longitudinal Studies Investigating the Association Between Early Life Maternal Depression and Offspring ADHD

OBJECTIVE

The systematic review sought to understand the relationship between maternal depression and later ADHD in children.

METHOD

Three databases were used to identify the studies (Medline, Web of Science and PsychInfo) resulting in 1,223 studies being screened and 14 articles being included in the review.

RESULTS

The majority of studies (N = 11) reported a significant relationship between maternal depression (across both prenatal and postnatal periods) and ADHD symptoms in children. This relationship remained significant when temperament, or past ADHD symptoms were controlled for. Several methodological issues were identified including; overreliance on maternal report and parental ADHD not being accounted for in most studies.

CONCLUSION

The review adds to the literature regarding the temporal relationship between maternal depression and the development of ADHD in children, and thus supports the case for improving access to mental health services for mothers as a preventative strategy in the development of child psychopathology.

Post-Migration Stressors and Mental Health for African Migrants in South Australia: A Qualitative Study

We conducted a qualitative study involving African migrants (n = 20) and service providers (n = 10) in South Australia to explore mental health stressors, access to mental health services and how to improve mental health services for African migrant populations. This paper presents the views and experiences of African migrants about the post-migration stressors they faced in resettlement that pose mental health challenges. The participants were recruited using the snowball sampling technique. To align with the COVID-19 pandemic protocol, the data collection was conducted using one-on-one online interviews through Zoom or WhatsApp video calls. Data analysis was guided by the framework analysis. The post-migration stressors, including separation from family members and significant others, especially spouses, imposed significant difficulties on care provision and in managing children’s attitudes and behavior-related troubles at school. African cultural practices involving the community, especially elders in care provision and disciplining children, were not consistent with Australian norms, compounding the mental health stressors for all involved. The African cultural norms, that do not allow young unmarried people to live together, also contributed to child–parent conflicts, enhancing parental mental stressors. Additionally, poor economic conditions and employment-related difficulties were post-migration stressors that the participants faced. The findings indicate the need for policy and intervention programs that address the above challenges. The provision of interventions, including social support such as subsidized or free childcare services, could help leverage their time and scheduled paid employment, creating time for effective parenting and improving their mental health and wellbeing. Future studies exploring what needs to be achieved by government and non-governmental institutions to support enhanced access to social and employment opportunities for the African migrant population are also recommended.

Maternal stress, child behavior and the promotive role of older siblings

BACKGROUND

In the first years of their lives, children develop the cognitive, social and emotional skills that will provide the foundations for their lifelong health and achievements. To increase their life prospects and reduce the long-term effects of early aversive conditions, it is therefore crucial to understand the risk factors that negatively affect child development and the factors that are instead beneficial. In this study, we tested (i) the effects of different social and environmental stressors on maternal stress levels, (ii) the dynamic relationship between maternal stress and child behavior problems during development, and (iii) the potential promotive (i.e. main) or protective (i.e. buffering) effect of siblings on child behavior problems during development.

METHODS

We used longitudinal data from 373 mother-child pairs (188 daughters, 185 sons) from pregnancy until 10 years of age. We assessed maternal stress and child behavior problems (internalizing and externalizing) with validated questionnaires, and then used linear mixed models, generalized linear mixed models and longitudinal cross-lagged models to analyze the data.

RESULTS

Our results showed that higher maternal stress levels were predicted by socio-environmental stressors (i.e. the lack of sufficient social areas in the neighborhood). Moreover, prenatal maternal stress reliably predicted the occurrence of behavior problems during childhood. Finally, the presence of older siblings had a promotive function, by reducing the likelihood that children developed externalizing problems.

CONCLUSIONS

Overall, our results confirm the negative effects that maternal stress during pregnancy may have on the offspring, and suggest an important main effect of older siblings in promoting a positive child development.

Association of maternal depression and anxiety with toddler social-emotional and cognitive development in South Africa: a prospective cohort study

OBJECTIVE

A robust literature has identified associations between prenatal maternal depression and adverse child social-emotional and cognitive outcomes. The majority of prior research is from high-income countries despite increased reporting of perinatal depression in low/middle-income countries (LMICs). Additionally, despite the comorbidity between depression and anxiety, few prior studies have examined their joint impact on child neurodevelopment. The objective of the current analysis was to examine associations between prenatal maternal depression and anxiety with child social-emotional and cognitive development in a cohort from the Western Cape Province of South Africa.

DESIGN

Prenatal maternal depression and anxiety were measured using the Edinburgh Postnatal Depression Scale and the State-Trait Anxiety Inventory Scale at 20-24 weeks' gestation. Child neurobehaviour was assessed at age 3 using the Brief Infant-Toddler Social Emotional Assessment and the Bayley Scales of Infant Development III Screening Test (BSID-III ST). We used linear regression models to examine the independent and joint association between prenatal maternal depression, anxiety and child developmental outcomes.

RESULTS

Participants consisted of 600 maternal-infant dyads (274 females; gestational age at birth: 38.89 weeks±2.03). Children born to mothers with both prenatal depression and trait anxiety had higher social-emotional problems (mean difference: 4.66; 95% CI 3.43 to 5.90) compared with children born to mothers with no prenatal depression or trait anxiety, each condition alone, or compared with mothers with depression and state anxiety. Additionally, children born to mothers with prenatal maternal depression and trait anxiety had the greatest reduction in mean cognitive scores on the BSID-III ST (mean difference: -1.04; 95% CI -1.99 to -0.08).

CONCLUSIONS

The observed association between comorbid prenatal maternal depression and chronic anxiety with subsequent child social-emotional and cognitive development underscores the need for targeting mental health support among perinatal women in LMICs to improve long-term child neurobehavioural outcomes.

Prenatal determinants of depressive symptoms in childhood: Evidence from Growing Up in New Zealand

BACKGROUND

Young people who experience depression are at an increased risk of adverse psychosocial and developmental outcomes that can persist over the lifecourse. Identifying maternal prenatal risk factors that may contribute to childhood depressive symptoms can be useful when considering mental health intervention.

METHODS

The current study included 3,925 children from the Growing Up in New Zealand (GUiNZ) study who had complete data for self-reported depressive symptoms and mothers' antenatal information. Depressive symptoms were measured at age 8 using the Centre for Epidemiological Studies Depression Scale for Children (CESD-10) short form questionnaire. Hierarchical linear regression was used to determine the relationship between prenatal factors and depressive symptoms at age 8.

RESULTS

When controlling for sociodemographic characteristics, our hierarchical linear regression revealed that the most significant maternal prenatal predictors of high depressive symptoms at age 8 were maternal perceived stress, smoking during pregnancy, body mass index (BMI) in the overweight/obese range, and paracetamol intake.

LIMITATIONS

One limitation with the current study was a reduction in the sample due to attrition. This may have affected our statistical power, reflected in our modest effect sizes. The sample remained both socioeconomically and ethnically diverse, however our results should be interpreted with respect to the sample and not the whole New Zealand population.

CONCLUSIONS

A combination of maternal mental health and lifestyle factors contribute to depressive symptoms for children, possibly through foetal programming. Our results emphasise the importance of mental and physical health support for expectant mothers.

Quality of life of mothers of children and adolescents with mental health problems in Mongolia: associations with the severity of children's mental health problems and family structure

BACKGROUND

In low- and middle-income countries (LMICs), most parents of children with mental health problems receive limited support from social and health services while caring for their children. However, research on the quality of life (QOL) of these parents in LMICs is limited. This study aimed to investigate the association between maternal QOL and children's mental health problems, and other related factors in Mongolia.

METHODS

A cross-sectional analysis of children aged 4-17 years who lived in Ulaanbaatar and visited the National Mental Health Centre in Mongolia and their mothers was conducted. The mothers' QOL was assessed using the WHOQOL-BREF, and the severity of children's mental health problems was assessed using the Strengths and Difficulties Questionnaire (SDQ). Multivariate linear regression analyses were performed using the mothers' WHOQOL domain scores as dependent variables and the children's SDQ scores and demographic and socioeconomic factors as explanatory variables.

RESULTS

A total of 242 child-mother dyads were included in this study, and 231 dyads were included in the multivariate regression analyses. Children's SDQ internalising scores were negatively associated with all four maternal QOL domain scores, while their externalising scores were negatively associated with maternal physical and psychological domain scores. Non-cohabitation of fathers was negatively associated with physical, social, and environmental domain scores, and non-cohabitation of grandparents was associated with psychological and environmental domain scores.

CONCLUSIONS

In Mongolia, maternal QOL is influenced by the severity of children's mental health problems and family member support. These findings highlight the importance of developing systems to support all families.

Is collaborative care a key component for treating pregnant women with psychiatric symptoms (and additional psychosocial problems)? A systematic review

Mental disorders during pregnancy are common, with long-lasting negative effects on mother and child. Treatment of these women is challenging, because of the high incidence of additional psychosocial problems and barriers on population and healthcare level. Collaborative care, collaboration between mental health and obstetric care professionals, may help to overcome these problems. The aim of this review is to review antenatal mental health interventions and analyse the impact of collaborative care. Two independent reviewers searched for RCT's in PubMed, Embase and PsycINFO. Trials studying the effect of psychological or pharmacological interventions on the mental health of pregnant women with psychiatric symptoms (and psychosocial problems) were eligible for inclusion. Two reviewers independently abstracted data and assessed study quality and risk of bias. Each study was scored on collaborative care criteria: multi-professional approach to patient care, structured management plan, scheduled patient follow-ups and enhanced interprofessional communication. Thirty-five studies were included. Most trials studied the effect of cognitive behavioural therapy and interpersonal psychotherapy on antenatal depression. Almost all interventions met at least one collaborative care criteria. Interventions were mostly provided by multiple professionals, but interprofessional communication rarely took place. Interventions that met more criteria did not more often show a positive effect on maternal mental health. There is lack of research on antenatal psychiatric disorders other than depressive and on long-term treatment outcomes. Collaborative care is partly implemented in most current interventions, but more trials (including interprofessional communication) are needed to be conclusive whether collaborative care is a key component in antenatal mental healthcare.

Advances in pharmacotherapy for postpartum depression: a structured review of standard-of-care antidepressants and novel neuroactive steroid antidepressants

Postpartum depression is one of the most common morbidities of childbearing, yet it is underdiagnosed and undertreated with negative consequences for mother and offspring. Despite the widespread use of standard-of-care antidepressants as the mainstay of treatment for postpartum depression, there is limited evidence on their safety and efficacy due to their slow onset of action and suboptimal outcomes. The emergence of gamma-aminobutyric acidergic neuroactive steroids may offer faster response and remission times and improved patient outcomes. This article reviews the evidence base for the efficacy of standard-of-care antidepressants, hormonal therapeutics including progestins and estradiol, and gamma-aminobutyric acidergic neuroactive steroids in the treatment of postpartum depression, as well as the safety of infant exposure to these agents during lactation.

Social and Relational Health Risks and Common Mental Health Problems Among US Children: The Mitigating Role of Family Resilience and Connection to Promote Positive Socioemotional and School-Related Outcomes

Nearly 70% (67.6%) of US children with mental, emotional, and behavioral problems (MEB) experienced significant social health risks (SHR) and/or relational health risks (RHR). Shifts are needed in child mental health promotion, prevention, diagnosis, and treatment to address both RHR and SHR. Public health approaches are needed that engage families, youth, and the range of child-serving professionals in collaborative efforts to prevent and mitigate RHR and SHR and promote positive mental health at a community level. Building strong family resilience and connection may improve SR and, in turn, academic and social outcomes among all US children with or without MEB.

Associations between religiosity and perinatal anxiety symptoms among women of Mexican descent

BACKGROUND

Over half of pregnant women experience anxiety symptoms, however perinatal mental health disparities exist. Women of Mexican descent exhibit higher levels of anxiety symptoms which may be linked to sociocultural stressors. However, little is known about culturally relevant factors that may protect against anxiety in this fast-growing population, such as religiosity, an important facet of Mexican culture.

METHODS

Pregnant women of Mexican descent (n = 197) were recruited from a local community clinic and followed into the postpartum period. Women completed surveys assessing religiosity, acculturation, acculturative stress, and anxiety symptoms.

RESULTS

Higher levels of religiosity were associated with lower levels of anxiety symptoms throughout pregnancy, but not postpartum (b = -1.01, p = .002). Additionally, religiosity significantly buffered the relationship between acculturative stress and anxiety symptoms during early (R² = .13, b = -.12, p = .041), mid- (R² = .19, b = -.19, p < .001) and late pregnancy (R² = .14, b = -.13, p = .023), and at six weeks postpartum (R² = .08, b = -.12, R² = .08, p = .016).

LIMITATIONS

The study was limited to women of Mexican descent and it is possible that other immigrant groups may exhibit different patterns of religiosity and anxiety symptoms.

CONCLUSIONS

These results suggest that religiosity may be protective against maternal anxiety among women of Mexican descent, which has important implications for culturally relevant perinatal interventions and treatments.

Prenatal maternal mental health symptoms predict infant leptin at birth

Childhood obesity can be predicted by metabolic signaling at birth. Understanding what exposure factors, such as prenatal mental health, predict metabolic signaling at birth are important for understanding the etiology of childhood metabolic dysregulation. Drawing on data from the Born in Bradford (BiB) multi-ethnic birth cohort in the United Kingdom (N ​= ​2962 dyads), this study examined associations between maternal prenatal mental health symptoms and infant leptin and adiponectin. We tested whether total maternal prenatal symptoms as well as specific symptom subscales forecasted infant cord blood levels of leptin and adiponectin. We found that higher total maternal mental health symptoms and somatic symptoms, specifically, predicted lower infant cord blood leptin. We did not find evidence that maternal prenatal mental health symptoms predicted adiponectin. Together, our findings suggest that maternal mental health symptoms may become biologically embedded through infant metabolic changes via leptin.

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Maternal prenatal mental health symptoms predict infant cord blood leptin at birth.

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Somatic maternal prenatal mental health symptoms predict infant cord blood leptin at birth.

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Maternal prenatal mental health symptoms do not predict infant cord blood adiponectin at birth.

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Maternal prenatal mental health may become biologically embedded in infants via leptin.

Maternal exposure to psychosocial job strain during pregnancy and behavioral problems in the 11-year-old children: a Danish cohort study

Maternal psychosocial stress may impact child neurodevelopment, but little is known regarding psychosocial job strain. We hypothesized high psychosocial job strain during pregnancy was associated with behavioural problems in the 11-year-old children. Mothers in the Danish National Birth Cohort (1996-2002) were included if they worked, provided information on job strain [Karasek's model: high job strain (often job demand/seldom job control) and passive (seldom or sometimes job demands/seldom job control)] during early pregnancy. At the 11-year follow-up, children (N = 30,592), mothers (N = 30,993), and teachers (N = 12,810) responded to the Strength and Difficulties Questionnaire (SDQ), a screening tool for child behaviour. Scores for hyperactivity, conduct, emotional and peer problems were dichotomised [80% (no) vs. 20% (yes)] according to Danish norms (yes/no). Maternal job strain was not associated with behavioural problems with teachers as informants. When assessed by child or mother, high maternal job strain increased risk of child behavioural problems, but risks were more pronounced for mothers in passive jobs [maternal assessment of total difficulties/odds ratio (95% confidence interval): high strain-girls: 1.16 (0.97-1.40); boys: 1.24 (1.02-1.50). Passive girls: 1.43 (1.21-1.68); boys: 1.25 (1.05-1.49)]. This is one of the first studies on this topic. The different types of maternal job strain were partly associated with child behavioural problems at 11 years; more so if mothers worked in passive rather than the hypothesized high strain jobs. Findings showing dependency on informant could not only indicate unmeasured confounding or rater's bias, but also selection in the smaller numbers of teacher informants or different environments of interaction with the children.

Sleep heterogeneity in the third trimester of pregnancy: Correlations with depression, memory impairment, and fatigue

This study aimed to identify sleep subtypes during pregnancy using a person-centered method, explore the underlying factors of these subtypes, and investigate the associations of these subtypes with depression, memory impairment, and fatigue. Accordingly, self-report measures were administered to 1,825 pregnant women to assess demographics, prenatal factors, childhood trauma, personality traits, sleep problems, depression, memory impairment, and fatigue. Data were analyzed using latent class analysis, chi-squared tests, analysis of variance, multinomial logistical regression, and multivariate linear regression analyses. The profiles of "good sleep quality," "poor sleep efficiency," "daily disturbances," and "poor sleep quality" were identified. The results also revealed several factors underlying these subtypes that affect sleep quality: rumination, perinatal complications, high neuroticism, low resilience, history of abortion, and postgraduate education. Further, the "daily disturbances" and the "poor sleep quality" groups reported higher depression, memory impairment, and fatigue than the "good sleep quality" group. Thus, this study elucidated the heterogeneity of sleep subtypes during pregnancy in the Chinese population. Such findings may promote the development of tailored interventions for specific sleep subtypes in pregnant women.

SARS-CoV-2 Infection in Pregnant Women: Neuroimmune-Endocrine Changes at the Maternal-Fetal Interface

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) has devastating effects on the population worldwide. Given this scenario, the extent of the impact of the disease on more vulnerable individuals, such as pregnant women, is of great concern. Although pregnancy may be a risk factor in respiratory virus infections, there are no considerable differences regarding COVID-19 severity observed between pregnant and nonpregnant women. In these circumstances, an emergent concern is the possibility of neurodevelopmental and neuropsychiatric harm for the offspring of infected mothers. Currently, there is no stronger evidence indicating vertical transmission of SARS-CoV-2; however, the exacerbated inflammatory response observed in the disease could lead to several impairments in the offspring's brain. Furthermore, in the face of historical knowledge on possible long-term consequences for the progeny's brain after infection by viruses, we must consider that this might be another deleterious facet of COVID-19. In light of neuroimmune interactions at the maternal-fetal interface, we review here the possible harmful outcomes to the offspring brains of mothers infected by SARS-CoV-2.

Risk of Preterm Birth and Newborn Low Birthweight in Military Women with Increased Pregnancy-Specific Anxiety

INTRODUCTION

Prenatal maternal anxiety and depression have been implicated as possible risk factors for preterm birth (PTB) and other poor birth outcomes. Within the military, maternal conditions account for 15.3% of all hospital bed days, and it is the most common diagnostic code for active duty females after mental disorders. The majority of women (97.6%) serving on active duty are women of childbearing potential. Understanding the impact that prenatal maternal anxiety and depression can have on PTB and low birthweight (LBW) in a military population is critical to providing insight into biological pathways that alter fetal development and growth. The purpose of the study was to determine the impact of pregnancy-specific anxiety and depression on PTB and LBW within a military population.

MATERIAL AND METHODS

Pregnancy-specific anxiety and depression were measured for 246 pregnant women in each trimester. Individual slopes for seven different measures of pregnancy anxiety and one depression scale were calculated using linear mixed models. Logistic regression, adjusted and unadjusted models, were applied to determine the impact on PTB and LBW.

RESULTS

For each 1/10 unit increase in the anxiety slope as it related to well-being, the risk of LBW increased by 83% after controlling for parity, PTB, and active duty status. Similarly, a 1/10 unit rise in the anxiety slope related to accepting pregnancy, labor fears, and helplessness increased the risk of PTB by 37%, 60%, and 54%, respectively.

CONCLUSIONS

Pregnancy-specific anxiety was found to significantly increase the risk of PTB and LBW in a military population. Understanding this relationship is essential in developing effective assessments and interventions. Results emphasize the importance of prenatal maternal mental health to fetal health and birth outcomes. Further research is needed to determine the specific physiological pathways that link prenatal anxiety and depression with poor birth outcomes.

Maternal depressive and anxiety symptoms and the risk of attention deficit hyperactivity disorder symptoms in offspring aged 17: Findings from the Raine Study

BACKGROUND

While previous studies have suggested that maternal anxiety and depressive symptoms are associated with increased risk of attention-deficit/hyperactivity disorder (ADHD) in their offspring in early and late childhood, studies exploring the risk in late adolescence are however lacking. This study aims to examine the association between maternal anxiety and depressive symptoms and the risk of ADHD symptoms in late adolescence (at age 17).

METHODS

We used data from the Raine Study. Maternal depressive and anxiety symptoms were measured when the child was 10 years of age using the Depression, Anxiety, and Stress Scale (DASS). Offspring ADHD symptoms at age 17 were assessed using the DSM-oriented scales of the child behavior checklist (CBCL). Log-binomial regression was used to explore the associations.

RESULTS

We found an increased risk of ADHD symptoms in offspring of mothers with comorbid anxiety and depressive symptoms when compared with offspring of mothers with no symptoms [RR 5.60 (95%CI 3.02-10.37)]. There was a nearly three-fold increase in the risk of ADHD symptoms in offspring of mothers with increased anxiety symptoms compared with offspring of mothers who were in the normal range [RR 2.84 (95%CI 1.18-6.83)]. No association was observed with maternal depressive symptoms.

CONCLUSION

This study found an increased risk of ADHD symptoms in the offspring of mothers with anxiety as well as comorbid anxiety and depressive symptoms but not among the offspring of mothers with depressive symptoms. Early screening and intervention for ADHD symptoms in offspring with maternal anxiety and comorbid anxiety and depressive symptoms are warranted.

A pilot study of a group-based perinatal depression intervention on reducing depressive symptoms and improving maternal-fetal attachment and maternal sensitivity

To conduct a pilot study of a group-based perinatal depression intervention, the Mothers and Babies Course, on depressive symptomatology, maternal-fetal attachment, and maternal sensitivity, 60 pregnant women with moderate to severe depressive symptomatology were randomized to a 6-week intervention or usual care group at their initial prenatal care visit. Measures of depressive symptomatology and maternal-fetal attachment were collected at baseline and 36 weeks gestation. At 12 weeks postpartum, participants completed a measure of depressive symptomatology, and an objective measure of maternal sensitivity was collected. Participants randomized to the intervention group completed an average of 5.2 sessions, and 70% of women completed all six sessions. Exploratory analyses showed that at 12 weeks postpartum, participants randomized to the intervention group had an 8.32-point decrease from baseline on the Edinburgh Postnatal Depression Scale (EPDS) as compared to a 4.59-point decrease among participants randomized to usual care. Participants randomized to the intervention group had a mean change score of 12.60 in maternal-fetal attachment via the Maternal Fetal Attachment Scale (MFAS) as compared to 4.60 among participants in usual care. Maternal sensitivity scores, assessed via the Nursing Child Assessment Satellite Training-Feeding Scale (NCAST-Feeding), were higher at 12 weeks postpartum for women in the intervention group as compared to women in usual care (59.2 and 51.8, respectively). Our pilot study findings provide preliminary support for the benefits of a perinatal depression intervention, delivered in a group setting, on reducing depressive symptomatology, and improving maternal-fetal attachment and maternal sensitivity. Further research, conducted with larger samples, is necessary to determine the effect of this intervention on indicators of maternal attachment.

Prevalence and risk factors of perinatal depression among women in rural Bihar: A community-based cross-sectional study

BACKGROUND

Perinatal depression (PND) is one of the most common mental disorders occurring during the perinatal period among women. Few studies examined prevalence and risk factors of PND from rural settings in India. This study aimed to estimate the prevalence of perinatal depression and identify social risk factors for it among women from rural Bihar.

MATERIALS AND METHODS

A cross sectional study was conducted in a community setting in rural areas of Bihar. All perinatal women were screened through a door to door survey and recruited after obtaining informed consent. A semi-structured proforma was used to collect sociodemographic characteristics and family related variables. Edinburgh postnatal depression scale (EPDS) was used to screen for perinatal depression.

RESULTS

A total of 564 perinatal women were recruited into the study. The estimated prevalence of PND was 23.9 % (95 % CI: 20.6,27.6). Multivariate analysis showed perinatal depression was associated with physical illness in the mother, previous history of abortion, poor financial status and ill-treatment by in-laws.

CONCLUSION

Prevalence of perinatal depression among women is high in rural settings of North India. A multitude of factors ranging from physical, obstetric, economic and family related confer a high risk for PND. Comprehensive interventions are needed to address these risk factors of perinatal depression.