Maternal anxiety disorders predict excessive infant crying: a prospective longitudinal study

Burden of mental, behavioral, and neurodevelopmental disorders in the Finnish most preterm children: a national register study

Etiologies and the whole picture in childhood mental, behavioral, and neurodevelopmental disorders related to gestational age are unclear. This study included all Finnish children (N = 341,632) born between January 1, 2001, and December 31, 2006, whose data including their mothers (N = 241,284) were collected from national registers. Children with unclear gestational age (GA) (N = 1245), severe congenital malformations (N = 11,746), and moderate/severe/undefined cognitive impairment (N = 1140), and those who died during the perinatal period (N = 599) were excluded. The main outcome was the prevalence of mental and behavioral disorders (International Classification of Disorders) at 0 - 12 years of age in association with GA, adjusted for gender and prenatal variables. Out of all included (N = 326,902) children 16.6% (N = 54,270) were diagnosed to have any mental health disorder at 0 - 12 years. Adjusted Odd Ratio (OR) were for any disorder in preterm (< 37 weeks) 1.37 [1.28 - 1.46] and 4.03 [3.08 - 5.26] in extreme preterm (≤ 28 weeks) versus term born children, p < 0.05. The lower the GA at birth, the higher the risk for multiple disorders and earlier onset of disorder, p < 0.05. Adjusted ORs were for male/female 1.94 [1.90 - 1.99], maternal mental health disorder (yes/not) 1.99 [1.92 - 2.07], and smoking during pregnancy (yes/not) 1.58 [1.54 - 1.62], and these risks were more common in preterm versus term born children (p < 0.05). Extreme early birth was a strong risk factor per se for any or multiple and early shown mental health disorders. Other risk factors for mental health accumulated to preterm children.

Validating a model to detect infant crying from naturalistic audio

Human infant crying evolved as a signal to elicit parental care and actively influences caregiving behaviors as well as infant-caregiver interactions. Automated cry detection algorithms have become more popular in recent decades, and while some models exist, they have not been evaluated thoroughly on daylong naturalistic audio recordings. Here, we validate a novel deep learning cry detection model by testing it in assessment scenarios important to developmental researchers. We also evaluate the deep learning model's performance relative to LENA's cry classifier, one of the most commonly used commercial software systems for quantifying child crying. Broadly, we found that both deep learning and LENA model outputs showed convergent validity with human annotations of infant crying. However, the deep learning model had substantially higher accuracy metrics (recall, F1, kappa) and stronger correlations with human annotations at all timescales tested (24 h, 1 h, and 5 min) relative to LENA. On average, LENA underestimated infant crying by 50 min every 24 h relative to human annotations and the deep learning model. Additionally, daily infant crying times detected by both automated models were lower than parent-report estimates in the literature. We provide recommendations and solutions for leveraging automated algorithms to detect infant crying in the home and make our training data and model code open source and publicly available.

Prenatal anxiety during the pandemic context is related to neurodevelopment of 6-month-old babies

Prenatal anxiety and depression in pandemic context could introduce changes in the fetal developmental trajectories that, ultimately, could alter the adaptive behaviors of the offspring, potentially affecting, for example, general neurodevelopment. The sample consisted of 105 mother-child dyads, recruited between March and May 2020. The dyads were evaluated longitudinally, prenatally and postnatally (6 months). The Pandemic Impact Questionnaire, the State-Trait Anxiety Inventory, and the Beck-II Depression Inventory were used to assess indicators of maternal anxiety and depression, respectively. Regarding the babies, their mothers responded to Age and Stages: 3, which assesses different dimensions of early neurodevelopment, in addition to a closed questionnaire to identify sociodemographic and maternal and child health variables. A series of mediation models were tested to examine the association between prenatal psychopathology/negative experiences of the pandemic and neurodevelopment. The results indicated that the negative experiences of the pandemic were indirectly associated with the socio-individual and fine motor neurodevelopment of the offspring, through maternal anxiety symptoms, during the third trimester, which functioned as a mediator.  Conclusions: This study provides evidence on the mediating effects of maternal anxiety on infant neurodevelopment in contexts of early adversity. It is important to point out the need to implement public health policies that allow a timely evaluation of neurodevelopmental variables during early childhood, which can implement early interventions to reduce the risks associated with these deficits. What is Known: • Effects of maternal mental health have been reported, effects on child neurodevelopment, in motor, cognitive, linguistic and socio-emotional dimensions. • Contexts of early adversity have been associated with maternal mental health and offspring development. What is New: • The context of pandemic adversity caused by COVID-19 is associated with motor and socio-individual neurodevelopment, mediated by maternal prenatal anxiety.

Maternal anxiety, exposure to the COVID-19 pandemic and socioemotional development of offspring

The COVID-19 pandemic context may predispose mothers to increased maternal psychopathology, which may be associated with offspring socioemotional development. The aim of this study is to analyze the relationships between prenatal anxiety and depression and exposure to the COVID-19 pandemic with offspring socioemotional development, controlling for postnatal anxiety and depression. A total of 105 mother-child dyads were assessed in pre- and postnatal periods. Questionnaires were used to assess the impact of the pandemic, indicators of psychopathology, and the socioemotional development of the offspring. Results suggest that negative pandemic experiences are indirectly associated with offspring socioemotional development via prenatal maternal anxiety symptomatology and after controlling for postnatal anxiety and depression. These indicators predispose to emotional deficits and increase the risks of psychopathological and neurodevelopmental disorders. It is important to adopt health policies that provide timely assessment of development in early childhood to reduce the risks associated with these deficits.

The need of having a plan in excessive infant crying - A qualitative study of parents' experiences of healthcare support

AIM

Excessive infant crying increases parents' concerns regarding their infant's health and the burden of parenting. We aimed to gain insight into the healthcare support needs of parents with excessively crying infants.

METHODS

An exploratory qualitative study was conducted in the Netherlands. We performed semi-structured interviews with parents of 12 infants between June and December 2020, followed by inductive and deductive thematic analysis.

RESULTS

Parents described what their needs were with regard to the assessment of infant crying and support by professionals. Long-lasting crying made parents feel that there must be a somatic cause. If they could soothe their infant, they gained more confidence that their infant was healthy. We identified four interrelated themes: (i) confidence in the professional; (ii) seeking a somatic cause for the crying; (iii) seeking acknowledgment; and (iv) exhaustion of parents and feelings of failure.

CONCLUSION

Parental support needs were best fulfilled by professionals who took them seriously, demonstrated medical expertise, and offered a practical plan. Perinatal parental education on normal infant behaviour and infant soothing techniques might improve parental self-efficacy at an early stage and prevent medicalization of excessive crying.

The effect of the Ebe Evimde application on the self-efficacy and anxiety levels of mothers: Randomized controlled trial

Objective

Family health can be improved by making home visits with mobile applications. This study was carried out to evaluate the effect of a mobile application and web-based software called Ebe Evimde (My Home Midwife), which was designed by the researchers for use in the postpartum period, on mothers' self-efficacy and anxiety levels.

Methods

Home visits to 60 mothers in the intervention group, who are over 18 years of age, who have given birth at term, who have no complications in mother and baby, and who are in the second to fifth postpartum days, were made with the online home visits mobile support application Midwifery Home software and their self-efficacy and anxiety levels were evaluated. Mothers were divided into two groups as intervention (60) and control group (60) using a random number table.

Results

While there was a significant difference between the pretest and posttest self-efficacy levels of the intervention group, there was no difference between the pretest and posttest self-efficacy levels of the control group. When the groups obtained from the Postpartum Specific Anxiety Scale were examined, it was seen that there was a negative and very strong significant relationship between the pretest and posttest scores of the mothers in the intervention group, while when the relationship between the pretest and posttest scores of the mothers in the control group was examined; no significant relationship was observed.

Conclusion

The practice of Ebe Evimde (My Home Midwife) had a positive effect on mothers' self-efficacy and postpartum anxiety levels.

Infant carrying is associated with reduced maternal repetitive negative thinking and increased maternal mental health

INTRODUCTION

Mental disorders, such as postnatal depression, are common in mothers. Repetitive negative thinking has been identified as a cognitive factor underlying the resulting difficulties in mother-infant interactions.

METHOD

The present online survey investigated associations between infant carrying (baby-wearing) and maternal repetitive negative thinking and positive mental health.

RESULTS

Repetitive negative thinking was significantly lower, and positive mental health was significantly higher while carrying compared to overall levels. There were no relations between maternal mental health and frequency of carrying. Maternal activities during carrying are portrayed.

CONCLUSION

These results are the first indication that carrying could be a low threshold, easily administered intervention method for maternal mental health problems.

Infant crying problems related to maternal depressive and anxiety symptoms during pregnancy: a prospective cohort study

Background

Infant crying may cause concerns among new parents and is a frequent reason for seeking help from their general practitioner (GP). The etiology of crying problems in infancy is not fully understood, but recent studies have found associations with maternal mental factors. It is well-established that postpartum depression is related to infant crying problems while the influence of maternal mental problems in pregnancy on infant crying is less investigated. We aimed to explore whether maternal depressive symptoms or maternal anxiety during pregnancy were related to crying problems by the newborn child.

Methods

In this prospective cohort study, 1290 pregnant women and their newborn children were followed throughout pregnancy until 8 weeks postpartum. Depressive symptoms and anxiety symptoms were assessed three times during pregnancy and again 8 weeks postpartum with the Major Depressive Inventory (MDI) and the Anxiety Symptoms Scale (ASS). Eight weeks postpartum the mothers were also asked whether their child cried in a way they found problematic. Multivariable regression was used to assess the association between depressive and anxiety symptoms during pregnancy and crying problems, and to adjust for potential confounders.

Results

We found statistically significant associations between high scores of depressive symptoms and anxiety symptoms in pregnancy and infant crying problems. Previously reported strong associations postpartum between depressive symptoms, anxiety symptoms and infant crying problems were also observed in the present data.

Conclusion

These results indicate that mental problems during pregnancy are associated with having a child with crying problems after birth. If more focus is given to maternal mental problems during pregnancy, the healthcare system might be able to detect and help these women, which would be beneficial for both mother and child.

Predictors of Early Postpartum Maternal Functioning Among Women Veterans

INTRODUCTION

The perinatal period constitutes an important window of opportunity for optimizing healthy development of offspring but is heavily influenced by maternal mental health. Maternal pregnancy-related anxiety (PrA), depression, and post-traumatic stress disorder (PTSD) have been implicated in adverse outcomes for both mother and child. The current study examined whether psychopathology during pregnancy and postpartum was associated with greater experienced parenting stress and bonding difficulties in women veterans, who may be predisposed to develop psychopathology due to heightened risk of exposure to traumatic events.

METHODS

Pregnant veterans (N = 28) completed self-report questionnaires regarding their PrA, depression and PTSD symptoms during pregnancy and postpartum, as well as on their experience of parenting stress and bonding with their infant.

RESULTS

PrA was a more robust predictor of postpartum depression (PPD) than depression during pregnancy. PPD, in turn, was significantly associated with bonding and parenting stress, such that more depressed mothers were more likely to experience greater general bonding difficulties, increased rejections and pathological anger towards their infants, greater anxiety towards their infants, and more parenting stress.

CONCLUSIONS

PrA might be a high-yield modifiable risk factor in the prevention of PPD for women veterans and their subsequent experiences with high parenting stress and bonding difficulties.

Sleep, biological rhythms and anxiety in the perinatal period: a systematic review protocol

INTRODUCTION

Pregnancy and new parenthood is an exciting time, but also a stressful life event that can predispose to mental health challenges. Perinatal anxiety is one such challenge, and is an important contributor to parental distress and other negative outcomes. Sleep and biological rhythms are often disrupted in the perinatal period. These disruptions have been associated with postpartum depression, and in some cases with perinatal anxiety. However, the literature concerning the association with perinatal anxiety is inconsistent and may be methodologically limited. To our knowledge, there has been no comprehensive review published characterising the relationships between sleep, biological rhythms, and perinatal anxiety and related disorders to date. In this systematic review, we will summarise the current state of the literature concerning these relationships, allowing us to highlight gaps and potentially inform clinical understanding of perinatal anxiety, sleep and biological rhythms.

METHODS AND ANALYSIS

Primary research articles will be eligible for inclusion if they assess perinatal anxiety or related disorders using validated criteria (self-report or diagnostic), assess sleep and biological rhythms in the perinatal period, include >4 participants and meet other inclusion/exclusion criteria. We will conduct comprehensive searches of MEDLINE, PsycINFO, Embase and CINAHL, with coverage spanning from database conception to search date (August 1, 2021). Key search concepts include (1) the perinatal period, (2) sleep/biological rhythms and (3) anxiety. Risk of bias will be evaluated using the Cochrane Risk of Bias Tool. Data will be narratively synthesised, with quantitative synthesis included if possible. When relevant, strength of evidence will be assessed using Grading of Recommendations Assessment, Development and Evaluation criteria, and potential publication bias will be assessed.

ETHICS AND DISSEMINATION

Research ethics approval is not required. Study results will be reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results will be disseminated to relevant stakeholders as conference presentation(s) and submitted for publication in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

200166.

Occurrence and determinants of parental psychosocial stress and mental health disorders in parents and their children in early childhood: rationale, objectives, and design of the population-based SKKIPPI cohort study

PURPOSE

The postnatal period is a vulnerable time for parents and children but epidemiological and health care utilisation data for Germany on parental mental health during early childhood is scarce. This protocol describes the rationale, aim and study design of a population-based cohort study to assess the occurrence and determinants of psychosocial stress and mental health disorders, as well as the use and cost of health care and social services in early childhood.

METHODS

As part of the collaborative SKKIPPI project, we will contact a random sample of 30,000 infants listed in the residents' registration offices of three German towns and we expect to include 6,000 mother-child pairs. Both parents are invited to fill out an online screening questionnaire. Mothers with indications of psychosocial stress will be interviewed to assess mental health disorders, regulatory problems of their children, as well as health care and social services utilisation, with a follow-up assessment after 6 months.

RESULTS

After description of sociodemographic and health data, we will analyse occurrences, patterns, and potential determinants (maternal age, social status, household factors, migration status etc.) of psychosocial stress and mental health disorders in the mothers and their children in early childhood.

CONCLUSIONS

Our study will identify potential risk and protective factors for postnatal mental health and health care utilization of psychosocially burdened families. This will help to improve prevention and treatment strategies to strengthen the parent-child relationship, to reduce persisting vulnerability of children, and to improve health care and social services.

TRIAL REGISTRATION

The study has been registered in the German Clinical Trial Registry on February 8th 2019 (DRKS-ID: DRKS00016653).

Infantile Functional Gastrointestinal Disorders and Maternal Psychological Status: A Narrative Review

BACKGROUND

Functional gastrointestinal disorders are often extremely distressing for the infant and parents, leading to infant discomfort and crying, parental anxiety, repeated healthcare consultations, and escalating healthcare costs.

AIM

In this narrative review, we analyzed the relationship between maternal psychological status during pregnancy and postpartum and the main infantile functional gastrointestinal disorders.

MATERIALS AND METHODS

The narrative review was conducted searching scientific databases for articles reporting on infantile functional gastrointestinal disorders in association with maternal depressive or anxiety disorders.

RESULTS

Seven studies were suitable.

DISCUSSION

Maternal psychological disorders may be correlated to infantile functional gastrointestinal disorders. Whether it is the excessive crying that favors the onset of maternal psychological disorders or, in contrast, an altered attachment style due to the maternal status that facilitates the onset of functional gastrointestinal disorders in the infant is still an open question. Recent findings revealed that both anxious and depressed mothers are more likely to have an adverse gut microbiome.

CONCLUSION

A healthy interaction of the mother-baby dyad is advantageous in ensuring the mental and physical development of the offspring. Gynecologists, general practitioners and pediatricians should be alert for early identification of mothers at risk with the aim to initiate timely targeted interventions. Further research on the role of microbiota and the possible therapeutic approaches with probiotics is required.

Efficacy of a partially hydrolysed formula, with reduced lactose content and with Lactobacillus reuteri DSM 17938 in infant colic: A double blind, randomised clinical trial

BACKGROUND & AIMS

We aimed to compare the efficacy of a partially hydrolysed formula (pHF) with reduced lactose content and Lactobacillus reuteri DSM 17938 (L. reuteri) with a standard formula in infant colic (IC).

METHODS

We performed a double blind, parallel-group randomized active-controlled. Inclusion criteria were: exclusively formula fed, full term infants, aged <4 months, diagnosis of IC. All the enrolled infants were randomized to receive either pHF with reduced lactose content and L. reuteri (Group A) or standard formula (Group B). The treatment duration was 4 weeks and children were followed-up to 8 weeks. The primary outcome was the mean infant crying duration at 28 days.

RESULTS

Two-hundred-forty-one children were randomized to the treatments' group (Group A = 124; Group B = 117). Mean daily crying time at 28th day was significantly lower in Group B when compared to Group A [104.7 (87-122.4) versus 146.4 min (129.2-163.7), treatment effect -41.8 (95% C.I.: -66.5 to -17.1), p = 0.001]. No significant adverse event was reported in both groups.

CONCLUSIONS

Standard formula showed a lower overall crying time respect to the intervention formula (ClinicalTrials.govNCT02813772).

Save the children by treating their mothers (PriVileG-M-study) - study protocol: a sequentially randomized controlled trial of individualized psychotherapy and telemedicine to reduce mental stress in pregnant women and young mothers and to improve Child's health

BACKGROUND

As early as pregnancy, maternal mental stress impinges on the child's development and health. Thus, this may cause enhanced risk for premature birth, lowered fetal growth, and lower fetal birth weight as well as enhanced levels of the stress hormone cortisol and lowered levels of the bonding hormone oxytocin. Maternal stress further reduces maternal sensitivity for the child's needs which impairs the mother-child-interaction and bonding. Therefore, prevention and intervention studies on mental stress are necessary, beginning prenatally and applying rigorous research methodology, such as randomized controlled trials, to ensure high validity.

METHODS

A randomized controlled trial is used to assess the impact of psychotherapy and telemedicine on maternal mental stress and the child's mental and physical health. Mentally stressed pregnant women are randomized to an intervention (IG) and a not intervened control group. The IG receives an individualized psychotherapy starting prenatal and lasting for 10 months. Afterwards, a second randomization is used to investigate whether the use of telemedicine can stabilize the therapeutic effects. Using ecological momentary assessments and video recordings, the transfer into daily life, maternal sensitivity and mother-child-bonding are assessed. Psycho-biologically, the synchronicity of cortisol and oxytocin levels between mother and child are assessed as well as the peptidome of the colostrum and breast milk, which are assumed to be essential for the adaptation to the extra-uterine environment. All assessments are compared to an additional control group of healthy women. Finally, the results of the study will lead to the development of a qualification measure for health professionals to detect mental stress, to treat it with low-level interventions and to refer those women with high stress levels to mental health professionals.

DISCUSSION

The study aims to prevent the transgenerational transfer of psychiatric and somatic disorders from the mother to her child. The effects of the psychotherapy will be stabilized through telemedicine and long-term impacts on the child's and mothers' mental health are enhanced. The combination of psychotherapy, telemedicine and methodologies of ecological momentary assessment, video recording and bio banking are new in content-related and methodological manner.

TRIAL REGISTRATION

German Clinical Trials Register: DRKS00017065. Registered 02 May 2019. World Health Organization, Universal Trial Number: U1111-1230-9826. Registered 01 April 2019.

Use of Prescribed Psychotropics during Pregnancy: A Systematic Review of Pregnancy, Neonatal, and Childhood Outcomes

This paper reviews the findings from preclinical animal and human clinical research investigating maternal/fetal, neonatal, and child neurodevelopmental outcomes following prenatal exposure to psychotropic drugs. Evidence for the risks associated with prenatal exposure was examined, including teratogenicity, neurodevelopmental effects, neonatal toxicity, and long-term neurobehavioral consequences (i.e., behavioral teratogenicity). We conducted a comprehensive review of the recent results and conclusions of original research and reviews, respectively, which have investigated the short- and long-term impact of drugs commonly prescribed to pregnant women for psychological disorders, including mood, anxiety, and sleep disorders. Because mental illness in the mother is not a benign event, and may itself pose significant risks to both mother and child, simply discontinuing or avoiding medication use during pregnancy may not be possible. Therefore, prenatal exposure to psychotropic drugs is a major public health concern. Decisions regarding drug choice, dose, and duration should be made carefully, by balancing severity, chronicity, and co-morbidity of the mental illness, disorder, or condition against the potential risk for adverse outcomes due to drug exposure. Globally, maternal mental health problems are considered as a major public health challenge, which requires a stronger focus on mental health services that will benefit both mother and child. More preclinical and clinical research is needed in order to make well-informed decisions, understanding the risks associated with the use of psychotropic medications during pregnancy.

Involvement of prolactin in newborn infant irritability following maternal perinatal anxiety symptoms

BACKGROUND

Newborn irritability could be an unique and special status and/or adverse neurobehavioral outcomes which was independent of serious disease. To determine whether maternal perinatal anxiety symptoms was associated with newborn irritability, and whether the alteration of serum prolactin in newborns were involved in newborn irritability.

METHODS

205 pregnant women were recruited: normal group (n = 100), and anxiety group (n = 105), which was randomly divided to Newborn Behavioral Observations (NBO)+anxiety group(n = 65) and control+anxiety group(n = 40). Newborn Irritability was assessed by Neonatal Behavioral Assessment Scale(NBAS). Serum prolactin, cortisol and 5-HT in mothers and infants were measured.

RESULTS

1. The scores of irritability items in the newborns of anxiety group were higher than that of the normal group (p < 0.05). 2. Lower serum PRL, 5-HT and higher serum cortisol were found in the newborns of anxiety group compared with that of the control group both postpartum 2d and 15 (p < 0.05). 3. The level of serum PRL in newborn infants were significantly and negatively correlated to the scores of irritability items (p < 0.05). 4. After 7 rounds of NBO interventions, the anxiety scores of mothers and the scores of irritability items of newborns in the NBO intervention group were all lower than those of the control group (p < 0.05) .

LIMITATIONS

In future experiments, we should explore the effect of PRL in the breast milk on newborn infant serum PRL.

CONCLUSIONS

Prolactin could be a potential mediator in newborn irritability following maternal perinatal anxiety symptoms.

Infant colic: mechanisms and management

Infant colic is a commonly reported phenomenon of excessive crying in infancy with an enigmatic and distressing character. Despite its frequent occurrence, little agreement has been reached on the definition, pathogenesis or the optimal management strategy for infant colic. This Review aims to delineate the definitional entanglement with the Rome IV criteria, which were published in 2016, as the leading, most recent diagnostic criteria. Moreover, neurogenic, gastrointestinal, microbial and psychosocial factors that might contribute to the pathophysiology of infant colic are explored. This Review underlines that a comprehensive medical history and physical examination in the absence of alarm symptoms serve as guidance for the clinician to a positive diagnosis. It also highlights that an important aspect of the management of infant colic is parental education and reassurance. Management strategies, including behavioural, dietary, pharmacological and alternative interventions, are also discussed. Owing to a lack of large, high-quality randomized controlled trials, none of these therapies are strongly recommended. Finally, the behavioural and somatic sequelae of infant colic into childhood are summarized.

Maternal anxiety and depressive disorders prior to, during and after pregnancy and infant interaction behaviors during the Face-to-Face Still Face Paradigm at 4 months postpartum: A prospective-longitudinal study

BACKGROUND

Few studies prospectively examined the role of maternal anxiety and depressive disorders for early infant psychosocial stress responsivity.

AIMS

To investigate the role of lifetime maternal anxiety and depressive disorders for various early infant interaction behaviors during the Face-to-Face Still Face Paradigm (FFSFP) at 4 months postpartum.

STUDY DESIGN/SUBJECTS

Prospective-longitudinal study among n = 251 mothers (and their infants) from early pregnancy until 4 months postpartum.

PREDICTOR

Cumulated lifetime diagnoses of maternal anxiety and depressive disorders, repeatedly assessed with the CIDI-V from early pregnancy until 4 months postpartum.

OUTCOME MEASURES

Infant positive and negative facial expressions and vocalizations, distancing behavior, self- and object-touch, observed during the FFSFP at 4 months postpartum.

RESULTS

As indicated by fractional logit models, higher proportions of object-touch were seen among infants of mothers with anxiety only (still face: 7.8%) and comorbid anxiety and depression (still face: 7.9%; reunion: 2.9%) vs. no anxiety and no depression. Higher proportion changes in object-touch were found among infants of mothers with anxiety only (play to still face: 6.4%) and comorbid anxiety and depression (play to still face: 7.2%; play to reunion: 2.7%) vs. no anxiety and no depression. Higher proportion changes in distancing behavior were seen among infants of mothers with comorbid anxiety and depression (still face to reunion: 1.1%; play to reunion: 1.3%) vs. no anxiety and no depression.

CONCLUSIONS

Particularly mothers with anxiety only and comorbid anxiety and depression and their infants might profit from targeted early interventions to foster favorable interaction behaviors in early infancy and thereafter.

Mental health and well-being in parents of excessively crying infants: Prospective evaluation of a support package

BACKGROUND

During the first 4 months of age, approximately 20% of infants cry a lot without an apparent reason. Most research has targeted the crying, but the impact of the crying on parents, and subsequent outcomes, need to receive equal attention. This study reports the findings from a prospective evaluation of a package of materials designed to support the well-being and mental health of parents who judge their infant to be crying excessively. The resulting "Surviving Crying" package comprised a website, printed materials, and programme of Cognitive Behaviour Therapy-based support sessions delivered to parents by a qualified practitioner. It was designed to be suitable for United Kingdom (UK) National Health Service (NHS) use.

METHODS

Parents were referred to the study by 12 NHS Health Visitor/Community Public Health Nurse teams in one UK East Midlands NHS Trust. Fifty-two of 57 parents of excessively crying babies received the support package and completed the Edinburgh Postnatal Depression Scale and Generalized Anxiety Disorder-7 anxiety questionnaire, as well as other measures, before receiving the support package and afterwards.

RESULTS

Significant reductions in depression and anxiety were found, with numbers of parents meeting clinical criteria for depression or anxiety halving between baseline and outcome. These improvements were not explained by reductions in infant crying. Reductions also occurred in the number of parents reporting the crying to be a large or severe problem (from 28 to 3 parents) or feeling very or extremely frustrated by the crying (from 31 to 1 parent). Other findings included increases in parents' confidence, knowledge of infant crying, and improvements in parents' sleep.

CONCLUSIONS

The findings suggest that the Surviving Crying package may be effective in supporting the well-being and mental health of parents of excessively crying babies. Further, large-scale controlled trials of the package in NHS settings are warranted.

Gastro-oesophageal reflux: a mixed methods study of infants admitted to hospital in the first 12 months following birth in NSW (2000-2011)

BACKGROUND

Gastro-oesophageal reflux (GOR) is common in infants. When the condition causes pathological symptoms and/or complications it is considered gastro-oesophageal reflux disease (GORD). It appears to be increasingly diagnosed and causes great distress in the first year of infancy. In New South Wales (NSW), residential parenting services support families with early parenting difficulties. These services report a large number of babies admitted with a label of GOR/GORD. The aim of this study was to explore the maternal and infant characteristics, obstetric interventions, and reasons for clinical reporting of GOR/GORD in NSW in the first 12 months following birth (2000-2011).

METHODS

A three phase, mixed method sequential design was used. Phase 1 included a linked data population based study (n = 869,188 admitted babies). Phase 2 included a random audit of 326 medical records from admissions to residential parenting centres in NSW (2013). Phase 3 included eight focus groups undertaken with 45 nurses and doctors working in residential parenting centres in NSW.

RESULTS

There were a total of 1,156,020 admissions recorded of babies in the first year following birth, with 11,513 containing a diagnostic code for GOR/GORD (1% of infants admitted to hospitals in the first 12 months following birth). Babies with GOR/GORD were also more likely to be admitted with other disorders such as feeding difficulties, sleep problems, and excessive crying. The mothers of babies admitted with a diagnostic code of GOR/GORD were more likely to be primiparous, Australian born, give birth in a private hospital and have: a psychiatric condition; a preterm or early term infant (37-or-38 weeks); a caesarean section; an admission of the baby to SCN/NICU; and a male infant. Thirty six percent of infants admitted to residential parenting centres in NSW had been given a diagnosis of GOR/GORD. Focus group data revealed two themes: "It is over diagnosed" and "A medical label is a quick fix, but what else could be going on?"

CONCLUSIONS

Mothers with a mental health disorder are nearly five times as likely to have a baby admitted with GOR/GORD in the first year after birth. We propose a new way of approaching the GOR/GORD issue that considers the impact of early birth (immaturity), disturbance of the microbiome (caesarean section) and mental health (maternal anxiety in particular).

Systematic review on maternal depression versus anxiety in relation to excessive infant crying: it is all about the timing

Different types of studies suggest a link between maternal depression/anxiety and excessive infant crying (EC). However, comparability is hampered due to different designs, definitions and measurements. This systematic review investigates the specific role of maternal depression and anxiety considering them as preceding, concurrent and subsequent conditions of EC. A computerised literature search was conducted in January 2017 using Medline, PubMed, PsycINFO and Web of Science. After screening n = 399 records for inclusion/exclusion criteria, n = 33 records based on n = 30 projects were eligible for systematic qualitative data synthesis. All studies on maternal depression/anxiety and EC within the first 3 years of life were included. Included studies investigated predominantly maternal depression (25/30) and secondly maternal anxiety (17/30). Significant positive results were found in the majority of studies for maternal depression (21/25) as well as for maternal anxiety (12/17) in relation to EC. In-depth analyses further revealed that concurrent and subsequent maternal depression was robustly related with EC, whilst preceding maternal depression was not. In contrast, preceding and concurrent (but not subsequent) maternal anxiety was consistently related to subsequent EC. Maternal depression is more likely a correlate or even a consequence of EC, whereas anxiety is rather a temporally preceding condition and thus a potential risk factor or risk marker for both subsequent EC and associated maternal depression. Interventions for EC should address concurrent maternal depression, whilst preventive approaches might target preceding maternal anxiety as early as prior to or during pregnancy.

The Relations Between Maternal Prenatal Anxiety or Stress and Child's Early Negative Reactivity or Self-Regulation: A Systematic Review

In the present review, we examine the association between maternal prenatal stress or anxiety and children's early negative reactivity or self-regulation. The review includes 32 studies that focus on pregnancy-related anxiety, state or trait anxiety, perceived stress, and stressful life events in relation to child's crying, temperament, or behavior during the first 2 years of life. We searched four electronic databases and 32 studies were selected based on the inclusion criteria. Twenty-three studies found an association between maternal prenatal anxiety or stress and a child's negative reactivity or self-regulation, and typically the effect sizes varied from low to moderate. The association was found regardless of the form of prenatal stress or anxiety and the trimester in which the prenatal stress or anxiety was measured. In conclusion, several forms of prenatal anxiety and stress may increase the risk of emotional and self-regulatory difficulties during the first 2 years of life.

Efficacy of a standardized extract of Matricariae chamomilla L., Melissa officinalis L. and tyndallized Lactobacillus acidophilus (HA122) in infantile colic: An open randomized controlled trial

BACKGROUND

Infant colic (IC) is a prevalent physiological event of infants, which can disrupt the child's home environment. We aimed to investigate the effectiveness of a mixture of Matricariae chamomilla L., Melissa officinalis L. and tyndallized Lactobacillus acidophilus (HA122) compared with Lactobacillus reuteri DSM 17938 and with simethicone for the treatment of IC.

METHODS

A multicenter randomized comparative study was conducted in infants with colic, according to Rome III criteria, who were randomly assigned to receive M. chamomilla L., M. officinalis L. and tyndallized L. acidophilus (HA122) (Colimil^® Plus^® ; Milte Italia Spa, Milan, Italy) (Group A), L. reuteri DSM 17938 (Group B) and simethicone (Group C). Treatment was given to subjects for 28 days.

KEY RESULTS

One-hundred and seventy-six patients completed the study. Mean daily crying time at day 28 was significantly lower in group A (-44, 95% CI: -58 to -30, P<.001) and group B (-35, 95% CI: -49 to -20, P<.001) when compared to group C. No significant difference was observed between Group A and Group B (mean difference: -9 minutes, 95% CI -23 to +5, P=.205). At day 28, 39 of 57 (68.4%) of infants in Group C responded to the treatment compared with 57 out of 60 patients (95%) of Group A and 51 out of 59 (86.4%) of Group B (P<.001).

CONCLUSIONS

This study suggests that administration of M. chamomilla L., M. officinalis L. and tyndallized L. acidophilus (HA122) and L. reuteri DSM 17938 are significantly more effective than simethicone in IC.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov: NCT02708238.

Fathers make a difference: positive relationships with mother and baby in relation to infant colic

BACKGROUND

Maternal psychological factors like depression, anxiety and stress have been associated with infant fussiness or colic. However, little research exists on whether positive factors such as social support and the happiness of the mother-partner relationship are associated with lower rates of infant fussiness or colic.

OBJECTIVES

We investigated the association between infant colic and three types of maternal support: general maternal social support (during pregnancy and post partum), the happiness of the mother-partner relationship (during pregnancy and post partum) and partner involvement in caring for the newborn.

METHODS

Participants were 3006 women in the First Baby Study, a prospective study of the effect of mode of first delivery on subsequent childbearing. Women were interviewed by telephone during pregnancy and 1 month after first childbirth and asked about social support and if their baby had a variety of problems since birth, including 'Colic - crying or fussiness three or more hours a day'. Multivariable logistic regression models were used to model the association between maternal support and infant colic, controlling for confounders, including maternal race or ethnicity, insurance, marital status, smoking, mode of delivery, maternal post-partum depression, breastfeeding, other neonatal illnesses and newborn gestational age.

RESULTS

Infant colic was reported by 11.6% of new mothers. High general maternal social support (in comparison with low), measured during pregnancy, was associated with lower reported infant colic (adjusted odds ratio (AOR), 0.55, 95% confidence interval (CI), 0.40-0.75) and measured post partum (AOR, 0.51, 95% CI, 0.39-0.67); high relationship happiness (in comparison with low), measured during pregnancy (AOR, 0.71, 95% CI, 0.54-0.93), and measured post partum (AOR, 0.22, 95% CI, 0.12-0.40); and high partner involvement with newborn care (in comparison with low) (AOR, 0.60, 95% CI, 0.44-0.81).

CONCLUSION

Higher levels of maternal social support during pregnancy and post partum are associated with lower rates of maternal reported infant colic.

The role of maternal anxiety and depressive disorders prior to and during pregnancy and perinatal psychopathological symptoms for early infant diseases and drug administration

BACKGROUND

Maternal mental health prior to and during pregnancy has been shown to be associated with inflammatory diseases and gastrointestinal complaints in the offspring. Unfortunately, many studies merely focused on perinatal distress without consideration of lifetime anxiety and depressive disorders.

AIMS

To prospectively investigate associations of anxiety and depressive disorders prior to and during pregnancy as well as perinatal distress with infants' inflammatory diseases, gastrointestinal complaints and corresponding drug administration.

STUDY DESIGN

Prospective-longitudinal study initiated in 2009/2010.

SUBJECTS

N=306 (expectant) mothers with and without DSM-IV lifetime anxiety and depressive disorders (Composite International Diagnostic Interview for Women) and low vs. high severity of psychopathological symptoms during pregnancy (Brief Symptom Inventory) enrolled in early pregnancy and repeatedly assessed during peripartum period.

OUTCOME MEASURES

Infant inflammatory diseases, gastrointestinal complaints and drug administration assessed via questionnaire (maternal report) at four months postpartum (n=279).

RESULTS

Severe psychopathological symptoms during pregnancy were associated with inflammatory diseases and anti-infective medication, whereas anxiety and depressive disorders prior to and during pregnancy were related to gastrointestinal complaints (diarrhea, colic complaints) and corresponding medication.

CONCLUSIONS

These results have to be discussed with caution, because information on infants' diseases were based exclusively on maternal self-reports. However, they suggest promising directions regarding our current knowledge about the relevance of maternal perinatal distress for infant inflammatory diseases (e.g. fetal programming). Moreover, the association between maternal anxiety and depressive disorders and infant gastrointestinal complaints may be explained by an anxious misinterpretation of 'normal' infant signals or a transmission of adverse gut microbiota, respectively.

Identifying women at risk for sustained postpartum anxiety

INTRODUCTION

To describe the prevalence of sustained postpartum anxiety and to develop a multifactorial predictive model to assist in targeted screening procedures.

METHODS

In a population-based cohort in a health region near Vancouver, Canada, 522 mothers completed a mailed questionnaire at 1, 4, and 8 weeks postpartum measuring socio-demographic, biological, pregnancy-related, life stressor, social support, obstetric, and maternal adjustment factors. We undertook a sequential logistic regression analysis to develop a multifactorial predictive model of sustained postpartum anxiety, as measured by a State Trait Anxiety Inventory (STAI) score >40 at 1 week and/or 4 weeks, and 8 weeks postpartum.

RESULTS

The prevalence of sustained postpartum anxiety was 12.6% (95% CI 9.6-16.2). In the multivariable model, predictors of sustained anxiety in the postpartum period were perceived stress at 1 week (1 SD increase; aOR 3.74, 95% CI 2.17-6.44) and partner social support at 1 week (1 SD increase; aOR 0.59, 95% CI 0.40-0.85). Depression symptomatology at 1 week, child care stress, and maternal self-esteem were non-significant.

LIMITATIONS

Single women and women from ethnic minority backgrounds were underrepresented in the sample.

CONCLUSIONS

A large proportion of women experience sustained postpartum anxiety. High perceived stress and low partner social support can be used to facilitate early identification of women likely to experience persistent anxiety in the postpartum period and suggest the need for urgent access to psychotherapeutic services for these women. These factors may also be potential targets for individual or couples therapy to treat postpartum anxiety.

Identifying women at risk for postpartum anxiety: a prospective population-based study

OBJECTIVE

To develop a multifactorial model to predict anxiety symptomatology at 8 weeks postpartum.

METHOD

In a population-based study, 522 women in a health region near Vancouver, Canada, completed questionnaires at 1, 4, and 8 weeks postpartum. Questionnaires included risk factors measured at 1 week (sociodemographic, biological, pregnancy-related, life stressors, social support, obstetric, and maternal adjustment). Sequential logistic regression was completed to develop a predictive model of anxiety symptomatology at 8 weeks (State-Trait Anxiety Inventory score >40).

RESULTS

The prevalence of anxiety symptomatology at 1, 4, and 8 weeks postpartum was 22.6%, 17.2%, and 14.8% respectively. In multivariable models, anxiety symptomatology at 1 week (aOR 2.78, 95% CI: 1.04-7.43), multiparous parity (aOR 3.29, 95% CI: 1.28-8.48), history of psychiatric problems (aOR 3.07, 95% CI: 1.19-7.97), perceived stress (1 SD increase: aOR 4.92, 95% CI: 2.62-9.26), and childcare stress (1 SD increase: aOR 1.63, 95% CI: 1.01-2.64) were independent predictors of anxiety symptomatology at 8 weeks.

CONCLUSION

While a significant proportion of women experience anxiety symptomatology following childbirth, multiparous women with a psychiatric history who have high levels of diverse stress are at greatest risk. These key factors may be used to promote early identification and secondary preventive interventions.

Anxiety disorders in postpartum women: A systematic review and meta-analysis

BACKGROUND

Evidence suggests that postpartum anxiety is relatively common among postpartum women. Anxiety meeting diagnostic criteria for a disorder represents anxiety at its most severe, distressing, and persistent, and thus it is most important to identify, understand, and treat. This paper describes a comprehensive systematic review of anxiety disorders among postpartum women, along with meta-analysis of prevalence.

METHODS

Findings are based on a thorough search of the literature, strict inclusion of only studies which utilized the gold standard of diagnostic interviews for anxiety disorder determination, and critical appraisal and review of included studies. A random effects meta-analysis was used to determine prevalence.

RESULTS

Fifty-eight studies were included in the review: 13 addressed prevalence, 5 incidence, 14 onset, 16 course, 13 correlates and risk factors, 15 outcomes, and 2 treatments for postpartum anxiety disorders. An estimated 8.5% of postpartum mothers experience one or more anxiety disorders.

LIMITATIONS

Many limitations relate to the state of the current literature, including a small number of studies to answer specific research questions for each disorder, methodological limitations, and considerable heterogeneity across studies.

CONCLUSIONS

Anxiety disorders are common among postpartum women. The review summarizes the current status of research on postpartum anxiety disorders and underscores the need for increased research to more accurately determine prevalence, understand course, identify risk factors and outcomes, and determine effective treatments. Greater clinical attention to these disorders is warranted to ameliorate the negative consequences of postpartum anxiety disorders on women and families.

Maternal anxiety versus depressive disorders: specific relations to infants' crying, feeding and sleeping problems

BACKGROUND

Maternal depression has been associated with excessive infant crying, feeding and sleeping problems, but the specificity of maternal depression, as compared with maternal anxiety remains unclear and manifest disorders prior to pregnancy have been widely neglected. In this prospective longitudinal study, the specific associations of maternal anxiety and depressive disorders prior to, during and after pregnancy and infants' crying, feeding and sleeping problems were investigated in the context of maternal parity.

METHODS

In the Maternal Anxiety in Relation to Infant Development (MARI) Study, n = 306 primiparous and multiparous women were repeatedly interviewed from early pregnancy until 16 months post partum with the Composite International Diagnostic Interview for Women (CIDI-V) to assess DSM-IV anxiety and depressive disorders. Information on excessive infant crying, feeding and sleeping problems was obtained from n = 286 mothers during postpartum period via questionnaire and interview (Baby-DIPS).

RESULTS

Findings from this study revealed syndrome-specific risk constellations for maternal anxiety and depressive disorders as early as prior to pregnancy: Excessive infant crying (10.1%) was specifically associated with maternal anxiety disorders, especially in infants of younger and lower educated first-time mothers. Feeding problems (36.4%) were predicted by maternal anxiety (and comorbid depressive) disorders in primiparous mothers and infants with lower birth weight. Infant sleeping problems (12.2%) were related to maternal depressive (and comorbid anxiety) disorders irrespective of maternal parity.

CONCLUSIONS

Primiparous mothers with anxiety disorders may be more prone to anxious misinterpretations of crying and feeding situations leading to an escalation of mother-infant interactions. The relation between maternal depressive and infant sleeping problems may be better explained by a transmission of unsettled maternal sleep to the fetus during pregnancy or a lack of daily structure and bedtime routine with the infant. Maternal disorders prior to pregnancy require more attention in research and clinical practice.

Imaging the "At-Risk" Brain: Future Directions

OBJECTIVES

Clinical neuroscience is increasingly turning to imaging the human brain for answers to a range of questions and challenges. To date, the majority of studies have focused on the neural basis of current psychiatric symptoms, which can facilitate the identification of neurobiological markers for diagnosis. However, the increasing availability and feasibility of using imaging modalities, such as diffusion imaging and resting-state fMRI, enable longitudinal mapping of brain development. This shift in the field is opening the possibility of identifying predictive markers of risk or prognosis, and also represents a critical missing element for efforts to promote personalized or individualized medicine in psychiatry (i.e., stratified psychiatry).

METHODS

The present work provides a selective review of potentially high-yield populations for longitudinal examination with MRI, based upon our understanding of risk from epidemiologic studies and initial MRI findings.

RESULTS

Our discussion is organized into three topic areas: (1) practical considerations for establishing temporal precedence in psychiatric research; (2) readiness of the field for conducting longitudinal MRI, particularly for neurodevelopmental questions; and (3) illustrations of high-yield populations and time windows for examination that can be used to rapidly generate meaningful and useful data. Particular emphasis is placed on the implementation of time-appropriate, developmentally informed longitudinal designs, capable of facilitating the identification of biomarkers predictive of risk and prognosis.

CONCLUSIONS

Strategic longitudinal examination of the brain at-risk has the potential to bring the concepts of early intervention and prevention to psychiatry.

Obesity and anxiety during pregnancy and postpartum: A systematic review

BACKGROUND

Obesity and anxiety during the perinatal period are common and associated with poor health outcomes for the mother and the child. Despite the well-documented health risks of both pregnancy obesity and anxiety, associations between the two have rarely been explored. With this review we aim to provide a systematic overview of the current state of evidence concerning associations between ante- and postnatal anxiety and pregnancy obesity, excessive gestational weight gain, and postpartum weight retention.

METHODS

We conducted a systematic literature search in PubMed, Web of Science, and PsychINFO.

RESULTS

13 Records matched our inclusion criteria. Five out of seven studies focusing on pregnancy obesity and anxiety suggest a positive association with ante- or postnatal anxiety. Surprisingly, no study examined anxiety disorders according to DSM and it remains unknown whether anxiety symptomatology reaches clinical relevance. Results from a small number of life-style intervention studies (n=3) suggest that interventions could benefit from a stronger focus on mental health. There were not enough studies on associations between excessive gestational weight gain (n=2) or postpartum weight retention (n=3) and anxiety making it difficult to draw conclusions about possible associations.

LIMITATION

The number of included studies is rather small and studies were included irrespective of the study quality which might limit the generalizability of the results.

CONCLUSIONS

The majority of the included studies suggest that obese pregnant women might constitute a subgroup that is especially vulnerable for comorbid anxiety and in need of targeted psychological support. However, further high-quality studies, particularly including anxiety disorders, are needed.

Effects of Antenatal Maternal Depression and Anxiety on Children's Early Cognitive Development: A Prospective Cohort Study

Introduction

Studies have shown that depression or anxiety occur in 10–20% of pregnant women. These disorders are often undertreated and may affect mothers and children’s health. This study investigates the relation between antenatal maternal depression, anxiety and children’s early cognitive development among 1380 two-year-old children and 1227 three-year-old children.

Methods

In the French EDEN Mother-Child Cohort Study, language ability was assessed with the Communicative Development Inventory at 2 years of age and overall development with the Ages and Stages Questionnaire at 3 years of age. Multiple regressions and structural equation modeling were used to examine links between depression, anxiety during pregnancy and child cognitive development.

Results

We found strong significant associations between maternal antenatal anxiety and poorer children’s cognitive development at 2 and 3 years. Antenatal maternal depression was not associated with child development, except when antenatal maternal anxiety was also present. Both postnatal maternal depression and parental stimulation appeared to play mediating roles in the relation between antenatal maternal anxiety and children’s cognitive development. At 3 years, parental stimulation mediated 13.2% of the effect of antenatal maternal anxiety while postnatal maternal depression mediated 26.5%.

Discussion

The partial nature of these effects suggests that other mediators may play a role. Implications for theory and research on child development are discussed.

A Review of the Effects of Anxiety During Pregnancy on Children's Health

Background:

Although pregnancy is often portrayed as a time of great joy, that’s not the reality for all women. The adverse, long-term, stable, and sometimes, irreparable effects of anxiety during pregnancy can change pregnancy into an agonizing and unpleasant event of women’s life span.

Aim:

The aim of this study was to explore the adverse effects of anxiety in pregnancy on children’s health in order to promote child health.

Methods:

In this narrative review the researchers searched in public databases like Google Scholar general search engine, and then more specific: Science Direct, Scientific Information Database, Magiran, Irandoc, Pubmed, Scopus, Cochrane library, and Psych info using Medical Subject Headings (MeSH) keywords: anxiety, maternal anxiety, pregnancy, pregnancy outcome, control and prevention restricted to English / Persian language, during the 20 years ago. Then those articles written by renowned experts were selected. At first, a list of 60 papers generated from the initial search. Then reviewers studied titles and abstracts and finally, quality assessment of full text studies was performed by two independent reviewers. Researchers reviewed summary of all articles sought, ultimately used data from 25 full articles to compile this review paper.

Results:

The findings were classified into four groups Biological, Mental, Behavioral, and Medical effects of anxiety during pregnancy.

Conclusions:

The effects of anxiety during pregnancy on offspring’s health are serious and thought-provoking to which the need for identifying and screening of anxiety disorders in prenatal care is necessary.

Risk factors and course patterns of anxiety and depressive disorders during pregnancy and after delivery: a prospective-longitudinal study

BACKGROUND

Peripartum anxiety and depressive disorders are associated with adverse consequences for mother and child. Thus, it is important to examine risk factors, correlates and course patterns of anxiety and depressive disorders during pregnancy and after delivery.

METHODS

In the prospective-longitudinal Maternal Anxiety in Relation to Infant Development (MARI) Study, n=306 expectant mothers were recruited from gynaecological outpatient settings in Germany and completed up to seven waves of assessment from early pregnancy until 16 months postpartum. Anxiety and depressive disorders and potential risk factors/correlates were assessed with the Composite International Diagnostic Interview for Women (CIDI-V), medical records and additional questionnaires.

RESULTS

Although peripartum anxiety and depressive disorders appeared to be persistent in some women, others reported major changes with heterogeneous courses and shifts between diagnoses and contents. There was a considerable amount of incident disorders. Strongest predictors for peripartum anxiety and depressive disorders were anxiety and depressive disorders prior to pregnancy, but psychosocial (e.g. maternal education), individual (e.g. low self-esteem), and interpersonal (e.g. partnership satisfaction, social support) factors were also related.

LIMITATION

Knowing the aims of the study, some participants may have been more encouraged to report particular symptoms, but if so, this points to the importance of a comprehensive assessment in perinatal care.

CONCLUSION

Peripartum time is a sensitive period for a considerable incidence or persistence/recurrence of anxiety and depressive disorders albeit the course may be rather heterogeneous. Interventional studies are needed to examine whether an alteration of associated factors could help to prevent peripartum anxiety and depressive disorders.

What Dyadic Reparation Is Meant to Do: An Association with Infant Cortisol Reactivity

BACKGROUND

The latency to reparation of interactive mismatches (interactive repair) is argued to regulate infant distress on a psychobiological level, and maternal anxiety disorders might impair infant regulation.

SAMPLING AND METHODS

A total of 46 dyads (19 mothers with an anxiety disorder, 27 controls) were analyzed for associations between interactive repair and infant cortisol reactivity during the Face-to-Face-Still-Face paradigm 3-4 months postpartum. Missing cortisol values (n = 16) were imputed. Analyses were conducted on both the original and the pooled imputed data.

RESULTS

Interactive repair during the reunion episode was associated with infant cortisol reactivity (original data: p < 0.01; pooled data: p < 0.01) but not maternal anxiety disorder (p > 0.23). Additional stepwise regression analyses found that latency to repair during play (p < 0.01), an interaction between distress during the first trimester of pregnancy and latency to repair during reunion (p < 0.01) and infant self-comforting behaviors during the reunion episode (p = 0.04) made independent contributions to cortisol reactivity in the final regression model.

CONCLUSIONS

This is the first study demonstrating that interactive repair is related to infant psychobiological stress reactivity. The lack of a relation to maternal anxiety disorder may be due to the small sample size. However, this result emphasizes that infants respond to what they experience and not to the maternal diagnostic category.