Maternal perinatal mental health: Associations with bonding,mindfulness, and self-criticism at 18 months’ postpartum

The perinatal period is a time of significant transition for women, with changes in maternal mental health from pregnancy to 18 months’ postpartum. This study specifically analyzes maternal self-criticism and mindfulness during pregnancy and at 18 months’ postpartum, and their associations with bonding. A longitudinal study (30 weeks’ gestation–18 months’ postpartum) assessed 32 mother–infant dyads, examining changes in maternal depression, anxiety, self-criticism, and mindfulness. In addition, associations between maternal variables during pregnancy and bonding were investigated. Maternal depression and self-criticism significantly increased from pregnancy to postpartum. Maternal anxiety, self-criticism, and facets of mindfulness during pregnancy were also associated with mother–infant bonding at 18 months. Maternal mental health during pregnancy is subject to change postchildbirth. The lack of control and autonomy accompanying motherhood may result in an increase in self-criticism during this period. Such feelings may elevate a woman's vulnerability to postpartum depression and have consequences for later maternal bonding. Early identification of at-risk mothers is important to increase likelihood of positive outcomes.     

Sandra Day O'Connor and the justification of abortion

The recent Supreme Court decision upholding Roe v. Wade and in particular, the dissent by Justice Sandra Day O'Connor, sheds new light on the issue of abortion. Let us consider any stage of a pregnancy when abortion is medically safe for the mother. If at that stage it is also medically viable to save the fetus, is an abortion performed at that stage of pregnancy morally justifiable? For example, if it is, or becomes, medically safe to perform abortions after first trimester of pregnancy and at the same time saving a fetus is, or becomes, medically viable or not unusual during some stage of the second trimester, can abortions during and after that stage of pregnancy be justified? With a number of qualifications I shall argue the thesis that as a general rule, but not an absolute rule, abortion in these instances is not usually justifiable. For if it is, then one will also have to grant the moral justification for a number of other highly questionable medical practices. This thesis is not to be identified with the stronger claim that abortions of viable fetuses can never be performed. There are surely exceptions such as when the life or health of the mother is in danger. But, I shall argue, the justification for making such exceptions is on different grounds than is sometimes claimed because one must weigh the health of the mother against the life of another human being.     

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.     

Maternal romantic attachment,and antenatal and postnatal mother–infant attachment in a sample of Polish women

In this exploratory study, we evaluated the relationship between a woman's self-reported romantic attachment style (as measured with The Attachment Styles Questionnaire), her experience of pregnancy, antenatal (The Maternal–Fetal Attachment Scale) and postnatal (Postpartum Bonding Questionnaire) attachment with her baby, and depressive symptomatology (The Edinburgh Postnatal Depression Scale). In the first stage of the study 162 pregnant females participated; of these, 64 were followed up in the second stage. The maternal romantic attachment style predicted attachment with the baby in the antenatal, but not in the postpartum period. The anxious-ambivalent romantic attachment style predicted more interaction with and attributing more characteristics to the foetus, secure attachment style was positively correlated with role taking, and avoidant—with attributing more characteristics to the foetus. In the postpartum period, the correlation between antenatal and postnatal attachment was only moderate; role taking during pregnancy correlated with anxiety about care for an infant. However, our study shows the association of the profile of anxious-ambivalent romantic attachment with postpartum depression, which heightens the risk of postnatal mother–infant bonding impairments.     

Pregnancy reduction in Jewish law

10% of infertile women who become pregnant with the aid of hormonal stimulation become pregnant with multiple fetuses. 20% of mothers of triplets experience preeclampsia and 35% risk serious postpartum hemorrhage. Risk increases with the number of fetuses for venous stasis, varicose veins, phlebothrombosis, thrombophlebitis, and embolic phenomena. Risk increases proportionally with increased number of fetuses for fetal morbidity and mortality. Selective abortion is often used as a method of reducing risk to both the woman and the fetuses, thus increasing the chance that 1 or 2 fetuses will be born healthy. A related issue is the selective reduction of fetuses in multiple pregnancies that may have a genetic defect like Hurler's syndrome, microcephaly, Tay-Sachs disease, spina bifida, hemophilia A, or thalassemia major. In cases where 1 fetus in a set of twins is so inclined, the reduction of the defective fetus increased the success of the remaining co-twin. Selective reduction should not pose a problem for Jewish women since the procedure does not violate any Jewish legal or moral rules. In Jewish law an unborn fetus is not considered a person until it is born. Until the 40th day of pregnancy it is considered as 'mere fluid.' In order to stress the positive aspect of selective reduction it should be called "enhanced survival of multifetal pregnancies."     

Prevalence of mood symptoms and depressions during pregnancy: implications for clinical practice and research

A review of the literature demonstrates that the incidence of new mental disorders and their prevalence during pregnancy is similar to the 12-month incidence of mental disorders in women during other periods of their lives. The prevalence of severe mood, behavior, and cognitive symptoms during pregnancy is rather high. Severe mental symptoms during pregnancy have been reported to be associated with an increased rate of complications during pregnancy and delivery, preterm deliveries, low birth weight, a higher rate of postpartum depression, and a longer-term impact on the offspring's development. Several pre-pregnancy risk factors to develop dysphoric symptoms have been reported, but their utility for primiparous women with no previous history of mental disorders is unclear. The association of mental symptoms with general symptoms and biological changes during pregnancy is also unclear. Given the short- and long-term impact of dysphoric symptoms and stress during pregnancy on mother and child, efficacious, efficient, and safe prevention and treatment modalities are essential and achievable. Clarification of the nature and phenotyping of mental and general symptoms during pregnancy is an important step for the development of effective interventions.     

妊娠期肝内胆汁淤积症研究中的认识论

妊娠期肝内胆汁淤积症是一种常见的妊娠晚期并发症,临床上以皮肤瘙痒和黄疸为特征,伴有胆汁酸、肝酶等生化指标的异常。其对母体影响较小,但可以引起早产、胎窘和不明原因的死胎,对围生儿的严重危害使其受到了产科医生的重视。因此,有必要通过回顾妊娠期肝内胆汁淤积症的认识过程来看医学认识发展中所体现的哲学观点。     

Maternal representations during pregnancy and early motherhood

The aim of the present study was to study the maternal representations of pregnant women and mothers in their early postpartum period, by beginning the process of validating the maternal representations questionnaire L'entretien R₁ and by developing a means to assess the content‐free aspects of the representations. Participants were 23 primiparous (first‐time mothers) pregnant women in their fourth to seventh month of pregnancy and 22 primiparous mothers in their early (zero to six months) postpartum period. It was found that the four subscales of L'entretien (self‐as‐mother, self‐as‐person, own‐mother, and partner) produced meaningful results for Turkish subjects. The results were compatible with the idea of integrated representations of self‐as‐person and self‐as‐mother even in the second trimester of their pregnancy and also showed that they could differentiate themselves from their mothers as early as that period. The results revealed no significant differences in the content and content‐free dimensions of the representations of pregnant women and mothers. ©2004 Michigan Association for Infant Mental Health.     

妊娠期糖尿病管理策略

妊娠期糖尿病(gestational diabetes mellitus,GDM)是指妊娠期发生或首次发现的不同程度的糖代谢异常。未加控制的妊娠期高血糖可对母子产生极大的围产期和远期危害。妊娠后糖代谢发生明显变化妊娠期血糖的管理和控制与非孕期不同。GDM一经确诊,应及时干预,加强母儿监测,控制妊娠期血糖,以降低母儿并发症,改善围生儿结局;产后对母儿严密随访,异常者给予相应处理,以减少或延缓产妇在产后发展为成为2型糖尿病的可能及预防子代发生肥胖、高血压、糖尿病等代谢综合征的发生。     

Timing of Early Maternal Mental Health and Child Cortisol Regulation

Maternal mental health problems can negatively impact children's physiological stress regulation. Yet, little is known of their long‐term effects, especially related to the timing of maternal symptoms. We examined how maternal mental health problems during pregnancy versus in the early postpartum period predict children's cortisol levels and diurnal patterns at 10–12 years. Participants were a selection (N = 102) of an original sample of 805 Finnish families, who were followed from the second trimester of pregnancy (T1) to child's age of 2 months (T2) and 12 months (T3), and again at child's age of 10–12 years (T4). Based on the timing of psychological distress and depressive symptoms (T1–T3), the mothers could be assigned to three distinct mental health trajectory groups: mothers with prenatal mental health problems (n = 15), mothers with early postpartum mental health problems (n = 15) and mothers without mental health problems (n = 72). Children's cortisol (T4) was measured by saliva samples through five within‐1‐day assessments. The results show that maternal prenatal mental health problems predicted a relatively steep increase of child cortisol from awakening to 1 h later, indicating an intensified cortisol awakening response (CAR). Mothers' early postpartum mental health problems instead predicted a reduced CAR. Both maternal prenatal and postnatal mental health problems thus predicted children's later stress regulation, but in unique ways. We discuss the specific roles of direct biochemical effects during pregnancy and postpartum mother–infant interaction quality as modifiers of the hypothalamic–pituitary–adrenal system. Copyright © 2015 John Wiley & Sons, Ltd.     

阿司匹林在高血压治疗中的应用与意义

高血压,即使是经过了治疗,仍较正常人有较高的心血管并发症的发生。高血压有关的并发症对患者的生活质量及预后有较大的影响。其首要死亡原因是缺血性事件。阿司匹林是经过大量安慰剂对照、随机临床试验证实、可降低首次心肌梗死及缺血性脑卒中危险的抗血小板药物。近年来有关阿司匹林在防治缺血性心血管病方面的循证医学证据逐渐增多,国内及国际的心血管病防治指南均推荐应用阿司匹林。随着卒中预防领域内几项关键性的临床试验（ESPRIT、CHARISMA及WHS）的公布,美国心脏协会／美国卒中协会写作委员会对2006版指南的内容进行了更新。本文结合新的临床试验的证据,对阿司匹林在高血压治疗中的意义进行了分析,以期能更适当地应用阿司匹林,减少与高血压有关的缺血事件,提高人口的生存质量及寿命。     

Depression during and following pregnancy: quality of family relationships

Fifty-four primiparous women were administered the Zung Self-rating Depression Scale and the Objective Social Perception Inventory during the last trimester of pregnancy. Four to 8 weeks postpartum, they again responded to the SRDS. A poor relationship with the husband, as rated during pregnancy, was significantly associated with depression during pregnancy and was also predictive of depression after childbirth. No parallel association between relationship with the mother and depression pre- or postpartum was noted.     

Evidence for a neuroendocrinological foundation of human affiliation: plasma oxytocin levels across pregnancy and the postpartum period predict mother-infant bonding

Although research on the neurobiological foundation of social affiliation has implicated the neuropeptide oxytocin in processes of maternal bonding in mammals, there is little evidence to support such links in humans. Plasma oxytocin and cortisol of 62 pregnant women were sampled during the first trimester, last trimester, and first postpartum month. Oxytocin was assayed using enzyme immunoassay, and free cortisol was calculated. After the infants were born, their interactions with their mothers were observed, and the mothers were interviewed regarding their infant-related thoughts and behaviors. Oxytocin was stable across time, and oxytocin levels at early pregnancy and the postpartum period were related to a clearly defined set of maternal bonding behaviors, including gaze, vocalizations, positive affect, and affectionate touch; to attachment-related thoughts; and to frequent checking of the infant. Across pregnancy and the postpartum period, oxytocin may play a role in the emergence of behaviors and mental representations typical of bonding in the human mother.     

阿司匹林在缺血性脑卒中二级预防应用的现况调查

调查缺血性脑卒中患者二级预防中阿司匹林的使用情况,并初步分析其影响因素。本研究为现况调查,调查对象为神经内科门诊与病房就诊既往诊断明确的脑梗死或短暂性脑缺血发作患者,调查其近两周内的阿司匹林使用情况及相关影响因素。经过调查初步得出缺血性脑卒中幸存者应该给予抗血小板药物,除非预计患者不久将死亡或有严重的禁忌证,阿斯匹林应用比例少,剂量不足,应引起患者及医务人员的重视,临床医师应遵循临床指南给与正确的指导。     

From pregnancy to motherhood: The structure of representative and narrative change

The aim of this work was to identify ways of objectifying the course of mothers' represen tations of their babies and themselves as mothers during pregnancy and the postpartum period. A sample of 51 women attending a Family Guidance Clinic for psychoprophylaxis courses was studied using semistruc tured interviews that were administered in the 7th month of pregnancy and on the 5th day and in the 4th month postpartum. This paper describes a method for classifiying themes identified in the mothers' representations of the baby and of the self-as-mother as wish-organized, defense-organized, fear-organized, or disorganized. This classification derives from the presumed clinical function of the narrative themes in the mothers' representational world. Themes about the baby and about the self-as-mother were primarily fear-organized at the 7th month of pregnancy. On the 5th day postpartum, there was no prevailing thematic organization. At 4 months postpartum, representations of the baby were primarily fear-organized and almost never disorganized. We speculate that themes about the baby and the self-as-mother that are disorganized may have negative prognostic significance.     

Difficulties in the Treatment of Depression During Pregnancy and Postpartum Depression

Treatment with women who become depressed during pregnancy or who develop postpartum depression can be challenging. In certain cases where women have a poor parental representation rooted in a negative relationship with their own mothers, a powerful resistance emerges and can take the form of abandoning the treatment. For women who have a history of abandonment by one of the parents, this particular aspect of the relationship may be repeated. In others, where there is a great deal of anger towards the parent, in spite of conscious wishes to be different, there is an identification with this negative parental image; the new mother feels herself to be a bad mother and flees the treatment as a way to protect the baby. Biological as well as psychological factors present during pregnancy and postpartum depression, as well as the impact of the mother’s depression on the developing infant are described and clinical vignettes are provided to illustrate the main points.     

Psychological changes over the course of pregnancy: a study of attitudes toward the fetus/neonate

Pregnant women's attitudes towards their fetus over the course of the pregnancy were studied in relation to physiological events of pregnancy, namely seeing the fetus via ultrasound and experiencing fetal movement. A consecutive series of primiparae (n = 129) was randomly assigned, at recruitment between 10 and 14 weeks menstrual age, to conditions of high (n = 67) or low (n = 62) feedback real time ultrasound. Thereafter, women were assessed at 16 and 32 weeks gestation, within 24 hours of delivery and by questionnaire at 3 months postpartum. On each occasion women completed attitude rating scales concerning their pregnancy and their fetus or neonate. These scales were subjected to principal components analysis and two main dimensions were derived for ratings of both attitudes towards the pregnancy and the fetus/neonate. No relationship was found between factor scores and ultrasound feedback condition, although scores on the fetal attachment dimension showed a significant linear increase over the pregnancy. Women reporting fetal movement at 16 weeks displayed significantly higher scores on the fetal-attachment dimension at all three assessment points. Multiple regression analyses were utilized to identify predictors of initial reactions to the neonate and attachment ratings at 3 months postpartum. At delivery, ratings of attachment to the neonate were related to drug requirements in labor and attachment ratings at 32 weeks. Reactions to the neonate at delivery and ratings of postpartum mood emerged as significant predictors of maternal attachment at 3 months postpartum. These results are discussed in the context of research attempting to establish the importance of postpartum bonding.     

Gender Role Attitudes across the Transition to Adolescent Motherhood in Mexican‐Origin Families

Using longitudinal data collected at four time points from 191 dyads of Mexican‐origin adolescent first‐time mothers and their mother figures, we examined changes in and socialization of traditional gender role attitudes across the transition to parenthood using latent growth curve modeling and actor – partner interdependence modeling. Longitudinal growth models indicated that, regardless of nativity status, adolescent mothers' and their foreign‐born mother figures' gender role attitudes became more egalitarian across adolescents' transition to parenthood, spanning from the 3rd trimester of pregnancy to 36 months postpartum. Furthermore, actor‐partner interdependence modeling suggested that adolescents' and their mother figures' gender role attitudes during adolescents' third trimester of pregnancy equally contributed to subsequent increases in one another's gender role attitudes at 10 months postpartum. Importantly, this reciprocal socialization process was not moderated by adolescent mothers' nor by their mother figures' nativity status. Findings suggest that it is important to understand the cultural and intergenerational family processes that contribute to the development of gender role attitudes during the transition to parenthood for adolescent mothers and their mother figures in Mexican‐origin families.     

妊娠期高血压疾病的系统论思考

妊娠期高血压疾病是妊娠期常见而又严重危害母儿健康的疾病。从胎盘浅着床,血管内皮受损,遗传因素,免疫机制探讨了妊娠期高血压疾病的发病机制。随着研究的深入,免疫机制在妊娠期高血压疾病的发病中的作用越来越受到重视。介绍了APS最新的治疗进展,为今后的APS发病机制研究及临床治疗带来更多的启示。     

Maternal representations and emotional availability among drug‐abusing and nonusing mothers and their infants

Both negative and idealized maternal prenatal representations may constitute a risk for mother–infant interaction. This study analyzed the role of maternal prenatal representations and pre‐ to postnatal representational change in predicting mother–infant emotional availability (EA) among 51 drug‐abusing mothers and their infants who participated in either psychodynamic group therapy (PGT) or received psychosocial support (PSS) and among 50 nonusing comparison dyads. Maternal representations of her child, the child's father, her own mother, self‐as‐mother, and self‐as‐woman were measured during pregnancy and at 4 and 12 months' postpartum with the Interview of Maternal Representations (M. Ammaniti et al., 1992 ; M. Ammaniti, R. Tambelli, & P. Perucchini, 1998). EA was measured with the Emotional Availability Scales, fourth edition (Z. Biringen, 2008 ) at 4 and 12 months. The results showed that drug‐abusing mothers had more negative prenatal representations of the self‐as‐woman and of the child's father. Postnatally, PSS mothers tended to first idealize their child, but later to experience disillusionment of idealization. Both negative and idealized prenatal representations of the self‐as‐mother predicted mother–infant EA problems, but only among the PGT mothers. For all mothers, negative representational change was detrimental for the mother–infant EA whereas for drug‐abusing mothers, also increasing idealization from the prenatal period to the postnatal period was harmful. Clinicians working with drug‐abusing mothers should aim at supporting the development of a realistically positive view of motherhood.