Postpartum Depression and Early Predictors of Lower Maternal Confidence at 12 to 15 Months after Delivery

The objective of the present study is to assess the association of early postpartum depression and maternal confidence with low maternal confidence at 12-15 months after delivery. Prospective study performed from 2013 to 2015 with 358 postpartum women who had participated in a cluster trial to treat their depression during pregnancy. At 6-8 months after birth, we reviewed socio-demographics, obstetric data and Postpartum Depression (PPD) with the Patient Health Questionnaire-9. Maternal Confidence (MC) was assessed at 6-8 and 12-15 months after birth with the Maternal Confidence Questionnaire. Low and High MC was defined using 50% percentile. The crude and adjusted Odds Ratios (OR) with the 95% Confidence Interval (CI) were calculated using Poisson regression with robust variance. Multivariate models estimated the ORs between postpartum depression and LMC at 12-15 months adjusted for socio-demographic variables, maternal characteristics and previous LMC. Statistical analysis was performed with STATA12 and the significance level was considered equal or lower than 5%. Among a sample of women who were depressed during pregnancy, 19% had probably moderate to severe depression, at the beginning of the child' second year of life. Low maternal confidence was associated with previous low maternal confidence (OR = 1.71; 95% CI 1.33:2.20, p = <0.001) and vaginal delivery but not with previous PPD. Based on our findings, detection and treatment of women presenting confidence problems at the first months after delivery may prevent later mother self-efficacy problems.

Antenatal and postnatal association of maternal bonding and mental health in Fukushima after the Great East Japan Earthquake of 2011:The Japan Environment and Children's Study (JECS)

BACKGROUND

Japan Environmental and Children's Study (JECS) was under way in Fukushima at the time of the triple disaster. It was initially to assess the effects of environmental factors on children's health, but given the situation particular to the accident, it could also offer an additional source of material with which to examine the psychological impacts of the disaster on mothers. This study aimed to examine the characteristics of mental health of Fukushima mothers after the triple disaster by comparing the scores in Fukushima with the nationwide scores. Then, it aimed to examine associations between their maternal bonding and mental health both during pregnancy and following birth.

METHODS

The JECS administered the Kessler 6-item psychological distress scale (K6) during pregnancy and the Edinburgh Postnatal Depression Scale (EPDS) 1 month following birth to 97 454 eligible women. In conjunction with the JECS, this study analysed the scores of 11 630 women in Fukushima which were obtained in the JECS between 2011 and 2015, and compared them with the nationwide scores during the same time period.

RESULTS

The proportion of mothers having 'negative feelings toward pregnancy' was significantly higher in Fukushima Regional centre (RC) than in the other 13 RCs between 2011 and 2014. No significant difference in the 'lack of affection' scores following birth was found between Fukushima RC and other RCs in 2012 and 2013, but the score in Fukushima RC was significantly lower in 2014 and 2015. The K6 scores in Fukushima RC were significantly higher than in other RCs in all years, and the EPDS scores following birth in Fukushima RC were also higher than in the 13 RCs in all years. The results of multivariate analysis showed a significant association between 'mothers' negative feelings toward pregnancy' and depressive symptoms, except in Fukushima RC in 2011. Also, it showed another significant association between 'lack of affection' and postpartum depressive symptoms from 2012 to 2015 in both Fukushima RC and 13 RCs. K6 scores during pregnancy were significantly associated with EPDS scores throughout the study period in both Fukushima RC and 13 RCs.

LIMITATIONS

Due to the lack of information on participants' residential region at the municipal level in the JECS, it was unable to measure regional differences within Fukushima prefecture.

CONCLUSION

This study shed light on the relationship between maternal bonding and mental health both during pregnancy and following birth by using the sequential and periodic national data sets. While showing the maternal characteristics associated with depressive symptoms during pregnancy and following birth in Japan, it distinguished the characteristics between Fukushima and nationwide. It raised the possibility that providing mothers in Fukushima with supports to increase their bonding toward their pregnancy could prevent the development of depressive tendency. The results could suggest that not only depression prevention measures but also maternal bonding support could be necessary in the region.

Examining the Effectiveness of WhatsApp-Based Spiritual Posts on Mitigating Stress and Building Resilience, Maternal Confidence and Self-efficacy Among Mothers of Children with ASD

Spiritual posts delivered via WhatsApp were found effective for mothers of children with ASD in mitigating parenting stress and building parental self-efficacy, confidence and resilience as compared to a control group. Intervention compliance was a prerequisite, and, middle-class mothers, highly qualified, salaried/self-employed, who perceived full support from their spouses/families and who also participated in other support groups or skill development programs benefitted most. Latent class analyses revealed six subgroups of participants likely to gain most from the intervention: middle class mothers, highly qualified, salaried/self-employed, who participated in other skill development programs, above threshold posts readers and homework doers. Spirituality built mothers' psychological resources, but dyadic interventions may be needed for dealing with challenges and uncertainties of autistic child's emotional/behavioral characteristics.

Assessing the effectiveness of a pediatrician-led newborn parenting class on maternal newborn-care knowledge, confidence and anxiety: A quasi-randomized controlled trial

BACKGROUND

The postpartum hospital stay is a unique opportunity for clinicians to educate parents on the importance of promoting early child development. Pediatricians are well-positioned to address both medical and developmental concerns during critical periods of development, yet very few parenting interventions are led by pediatricians.

AIMS

To assess the impact of a novel one-hour long pediatrician-led Newborn Class on maternal knowledge, confidence, and anxiety.

METHODS

We conducted a quasi-randomized controlled trial to evaluate the effectiveness of the Newborn Class. First-time mothers who delivered a full-term singleton vaginally with no major complications and attended the class were recruited. Mothers who expressed a desire to attend the class but were discharged before a class was offered served as controls.

OUTCOME MEASURES

Maternal self-perceived parental confidence and anxiety were measured using standardized scales [Karitane Parenting Confidence Scale (KPCS) and State-Trait Anxiety Inventory for Adults (STAI-AD)]. Knowledge on newborn care was assessed using a novel scale.

RESULTS

A total of 84 participants (intervention n = 36, control n = 48) were included in the study. Mothers who attended the class showed significantly higher levels of knowledge compared to the control group (Knowledge test, Two-tailed t-test, mean [SD], 8.08 [1.06] vs 6.78 [1.25]; P<0.001) as well as significantly higher parenting confidence levels (KPCS, Two-tailed t-test, mean [SD], 39.31 [3.88] vs 35.20 [3.99]; P<0.001). No change was observed in the overall level of anxiety (STAI-AD, Two-tailed t-test, mean [SD], 35.50 [8.73] vs 38.5 [9.53]; P=0.164).

CONCLUSIONS

A short pediatrician-led parenting intervention may be an effective tool in improving maternal confidence and newborn care knowledge. Given the importance of the newborn period in establishing healthy developmental trajectories, there is a crucial need for cost- and time-effective intervention that can be widely implemented to promote parental knowledge and confidence with the ultimate goal of fostering healthy development in children.

Maternal confidence for physiologic birth: Associated prenatal characteristics and outcomes

OBJECTIVES

Pregnancy, labor, and birth are normal, physiologic processes. Women often seek information during pregnancy to enhance their confidence for physiologic birth. Little is known about confidence for physiologic birth and associated prenatal characteristics and birth outcomes such as provider type, source of labor and birth information, mode of birth, and use of pain medication in labor. The purpose of this study was to examine prenatal confidence for physiologic birth and associated prenatal characteristics and birth outcomes.

DESIGN

This study was completed as part of a multi-phased instrument development study, the Preparation for Labor and Birth (P-LAB) instrument. P-LAB confidence scores were examined for their relationship with variables including labor type, provider type, source of labor support, pain medication use, and birth mode.

SETTING AND PARTICIPANTS

Women (N = 192) from five prenatal clinics in the Midwestern United States who had completed the P-LAB instrument participated in postpartum telephone interviews.

FINDINGS

Women with previous birth experience had higher confidence than nulliparous women. Prenatal care providers were reported as main source of labor and birth information. Confidence for birth was associated with intention to not use pain medication in labor. Women's overall intention to use or not use pain medication was consistent with use. Prenatal confidence was not associated with mode of birth.

IMPLICATIONS FOR FUTURE RESEARCH

Special emphasis should be paid to nulliparous women when developing interventions to enhance confidence for physiologic birth. Women rely on their care providers for information regarding labor and birth, therefore one area to strengthen confidence for physiologic birth is within the provider-patient relationship.

First-time mothers' confidence mood and stress in the first months postpartum. A cohort study

OBJECTIVES

The aims were to describe first-time mothers' confidence, mood and stress 2 and 6 months postpartum and to investigate the extent to which the tools measuring maternal confidence and maternal mood used alone or together at 2 months postpartum predict first-time maternal confidence, mood and stress 6 months postpartum.

DESIGN

A cohort including 513 first-time mothers' self-reported questionnaires concerning three scales: The Karitane Parenting Confidence Scale (KPCS), the Edinburgh Postnatal Depression Scale (EPDS), and the Parental Stress Scale (PSS) collected 2 and 6 months postpartum. Descriptive statistic, simple and multiple linear regression analysis were used.

RESULTS

First-time mothers' with confidence scores below the clinical cut-off (KPCS <40) fell significantly from 25% to 14% (p < 0.001), symptoms of depression above the clinical cut-off (EPDS ≥ 8) fell significantly from 16% to 12% (p < 0.001), and parental stress as a mother fell significantly from a mean of 32.88 to 30.98 (p < 0.001). The KPCS assessed at 2 months postpartum was the strongest predictor for both maternal confidence (R² = 0.38) and parental stress (R² = 0.26) 6 months postpartum.

CONCLUSION

The results support the assumption that parenthood is a complicated period for first-time mothers characterised by low confidence, symptoms of depression and high stress which improve over time for the majority of mothers. The KPCS at 2 months postpartum was the strongest predictor of the measures used. Further research is needed to identify parents who are struggling, especially for health professionals' whose role is to support parents in their parenthood the first period after birth.

Social-Emotional Development of Toddlers: Randomized Controlled Trial of an Office-Based Intervention

PURPOSE

During the toddler years, temper tantrums and impulsive behaviors are the norm. These behaviors can frustrate even the most experienced mothers.

DESIGN AND METHODS

A prospective, double blind, randomized controlled trial using pre-test/post-test experimental design was used to examine the effectiveness of an office-based educational program to improve maternal confidence and the social-emotional development of toddlers. The Toddler Care Questionnaire (TCQ) was administered to all mothers as a pre and post intervention test. The treatment intervention was a videotaped (DVD) parenting skills intervention on the social-emotional development of toddlers and on maternal confidence in caring for toddlers.

RESULTS

Sixty mothers and 60 toddlers entered the study with 29 mothertoddler dyads randomized to the treatment group and 31 to the control group. Twenty-six (26) mother-toddler dyads in the treatment and 25 mother-toddler dyads in the control group completed the study. Pairwise comparisons of adjusted means showed significant improvements for both toddler groups on the Brigance toddler screen, and no statistically significant difference in gains between the groups. The mixed model results for the TCQ showed an overall significant improvement from preto post-test, and a non-significant interaction between group and time indicting no significant difference in gains seen by treatment groups.

CONCLUSIONS

Brief educational programs on DVD's are an efficient way to offer information to mothers while in the office waiting area.

PRACTICE IMPLICATIONS

Pediatric nurses who encounter mothers who struggle with caring for their toddlers may find brief-office based interventions a valuable tool for educating parents.