Unplanned pregnancy and risk of maternal depression: secondary data analysis from a prospective pregnancy cohort

Purpose: to evaluate the relationship between unplanned pregnancy (UP), a common problem in high and low income countries and maternal depression (MD). Methods: Secondary analysis of data from a prospective cohort study with pregnant women recruited from 10 primary care clinics of the public sector in São Paulo, Brazil. Participants were questioned about pregnancy intention at 20–30 weeks of gestation. The Self Report Questionnaire score >7 was used to evaluated the presence of depression during pregnancy and 11 months after childbirth. Four groups of MD were defined: never; antenatal only; postnatal only; persistent (both antenatal/postnatal). Multinomial logistic regression was used to assess the relationship between UP and MD, controlling for confounding. Results: Data were analysed for 701 at the postpartum period. Five hundred and sixty-two (67.8%) women did not plan the pregnancy. Women with UP had 2.5 more risk of being depressed during both assessments (during pregnancy and postpartum) when compared to women with a planned pregnancy (RR: 2.5; 95% CI: 1.47:4.30). In the adjusted models, women with UP were significantly more likely to have persistent depression (RR: 2.3; 95% CI: 1.2:4.3). Conclusion: UP is an independent risk factor for persistent depression, but not for postpartum depression     

Antecedents of fathers’ perception of child behavior at child age 12 months

This study investigates whether fathers’ adverse childhood experiences (ACE) and attachment style reported during pregnancy predict fathers’ perception of child behavior assessed 12 months postpartum, expressed by the Parenting Stress Index (PSI), Child Domain. Prospective fathers (N = 835) were recruited to “The Little in Norway (LiN) study” (Moe & Smith) at nine well-baby clinics in Norway, with data collection composed of five time points during pregnancy and two time points postpartum (6 and 12 months). The main analyses included linear regression, path-analysis modeling, and intraclass correlation based on mixed effects modeling. First, linear regression analyses showed that neither fathers’ ACE nor attachment style significantly predicted perceived child behavior postpartum directly. Furthermore, path analyses showed that ACE and less secure attachment style (especially avoidant attachment) measured early in pregnancy strongly predicted negatively perceived child behavior, mediated by fathers’ mental health symptoms during pregnancy and partner disharmony postpartum. Second, intraclass correlation analyses showed that fathers’ perceived child behavior showed substantial stability between 6 and 12 months postpartum. Family interventions beginning in pregnancy may be most beneficial given that fathers’ early experiences and perceptions of attachment in pregnancy were associated with later partner disharmony and stress.     

Parents’ postnatal depressive symptoms and their children's academic attainment at 16 years: Pathways of risk transmission

The aim of the study was to examine whether parents’ increased postnatal depressive symptoms predicted children's academic attainment over time and whether the parent–child relationship, children's prior academic attainment, and mental health mediated this association. We conducted secondary analyses on the Avon Longitudinal Study of Parents and Children data (12,607 mothers, 9,456 fathers). Each parent completed the Edinburgh-Postnatal Depression Scale at 8 weeks after the child's birth (predictor) and a questionnaire about the mother–child and father–child relationship at 7 years and 1 month (mediator). The children's mental health problems were assessed with the teacher version of the Strengths and Difficulties Questionnaire at 10–11 years (mediator). We used data on the children's academic attainment on UK Key Stage 1 (5–7 years; mediator) and Key Stage 4 (General Certificate of Secondary Education 16 years) (outcome). We adjusted for the parents’ education, and child gender and cognitive ability. The results revealed that parents’ depressive symptoms at 8 weeks predicted lower academic performance in children at 16 years. Mothers’ postnatal depressive symptoms had an indirect effect through children's mental health problems on academic outcomes at 16 years via negative mother–child relationship, and prior academic attainment. There was a significant negative indirect effect of fathers’ postnatal depressive symptoms on academic attainment at 16 years via negative father–child relationship on child mental health. The findings suggest that the family environment (parental mental health and parent–child relationship) and children's mental health should be potential targets for support programmes for children of depressed parents.     

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.     

Socioeconomic Factors in Relation to Discrepancy in Parent versus Teacher Ratings of Child Behavior

Discrepancies between observers are common in studies of child behavior problems that rely on behavior ratings. Although modest concordance between informants is well-documented, little is known about characteristics that predict discrepancies. In 477 children aged 5 to 12 years, maternal age and indicators of socioeconomic status (SES; maternal education, family income) were evaluated in relation to score discrepancies between the Child Behavior Checklist and Teacher Report Form for Total, Externalizing and Internalizing Problems. Family income <?$35,000 was independently associated with discrepancies in which mothers rated more clinically significant child behavior problems than teachers for Total, Externalizing and Internalizing Problems [odds ratio (OR)?=?3.26, 95 % confidence interval (CI), 1.19–8.96, OR?=?2.76, 95 % CI 1.03–7.34 and OR?=?3.07, 95 % CI 1.30–7.26, respectively]. Maternal education was not associated with discrepancies, but younger mothers were less likely to rate child’s behavior in the clinical range for Externalizing Problems than teachers (OR per year of age?=?0.88, 95 % CI 0.81–0.96). These results suggest that studies that utilize only maternal or teacher report of child behavior may have misclassification of outcomes that is dependent on SES and could produce biased results.     

Attachment and coparenting representations in men during the transition to parenthood

Coparenting is based on parents’ representations of themselves as coparents. Attachment theory can be a useful framework to understand the way that different coparenting representations are developed during the transition to parenthood. This study aimed to analyze the association between men's attachment and coparenting representations at the first trimester of pregnancy and from the first trimester of pregnancy to 6 months’ postpartum. A sample of 86 men was recruited and completed self-report measures of attachment and coparenting representations at the first and third trimester of pregnancy and at 1 and 6 months’ postpartum. At the first trimester of pregnancy, higher attachment avoidance was associated with higher lack of coparenting support. From the first trimester of pregnancy to 6 months’ postpartum, higher attachment avoidance was associated with (a) a steeper increase on lack of coparenting support, (b) an increase on coparenting conflict (while low attachment avoidance was associated with a decrease), and (c) a lower decrease on coparenting disagreement. This study may contribute to coparenting research by showing new evidence on attachment theory as a useful framework to understand how different coparenting representations are developed in men during the transition to parenthood.     

Correlation between maternal and infant cortisol varies by breastfeeding status

ObjectiveThe objective of this study was to examine associations of mother and infant salivary cortisol, measured three times over the course of a day, and assess whether these varied by breastfeeding status.MethodsWe conducted a cross-sectional study of 54 mothers and their infants aged 4–11 months. Mothers collected their own saliva and that of their infants upon awakening, 30 min after waking and at bedtime. Breastfeeding status was reported by mothers and cortisol level was measured in saliva in μg/dl using standard techniques. We used generalized linear models to evaluate relationships between maternal and infant cortisol levels, and assessed whether the relationship differed by breastfeeding status: formula only compared to partial and full breastfeeding, adjusting for infant sex, race, age, maternal education, and family income.ResultsThirty-four infants received formula only and 20 were either partially or fully breastfed. Breastfeeding was associated with higher household income, higher maternal education, and white race. Cortisol levels were higher among breastfed infants at all three time points. After adjustment, maternal cortisol levels were related with infant cortisol at bedtime only (regression estimate 0.06; 95% CI: 0.10, 1.1; p = 0.02). The adjusted association between bedtime maternal and infant cortisol was stronger among breastfeeding dyads than among formula-feeding dyads (regression estimate 1.0; 95% CI: 0.1, 2.0; p = 0.04 vs. 0.6; CI: −0.1, 1.3; p = 0.10). In addition, we assessed the influence of maternal education and household income in our adjusted model; income strengthened the observed association, whereas maternal education did not change the estimate.ConclusionsBreastfeeding mothers and infants had significant correlations for cortisol at bedtime, while formula-feeding dyads did not. These data suggest that several factors may contribute to cortisol synchrony observed in mother/infant dyads, including the transfer of cortisol in human milk, physical interaction such as skin-to-skin contact, and shared environment. In addition, our findings support household income as a possible contributor.     

The impact of breastfeeding on mothers' attentional sensitivity towards infant distress

Background

Maternal response towards infant distress has an important impact on infant development. In animals it is established that lactation and pup suckling plays an important role in maintaining maternal responses. Previous research suggests that breastfeeding is associated with sensitive maternal responses in human mothers. However, this may be because women who are more sensitive to their infant choose to breastfeed. The current study investigated the attentional sensitivity towards infant distress in women who went on to breast or formula feed during pregnancy as well as after birth. We hypothesised that differences in breast and formula feeding mothers would only emerge after birth once feeding had commenced.

Method

Women were recruited during pregnancy through community midwives as part of a longitudinal study. 51 women were seen during late pregnancy and between 3 and 6 months after birth (27 were breast and 24 were formula feeding). Sensitivity to infant distress was measured as the extent of women's attentional bias towards infant distress stimuli.

Results

After birth, we found that our index of attentional bias towards infant distress was 37 ms (0.5 S.D.s) (CI; 6-69, p = 0.021) higher in breastfeeding compared to formula feeding mothers. However, mothers who went on to breastfeed did not show greater attentional bias towards infant distress already during late pregnancy.

Conclusions

Our results suggest that the act of breastfeeding may influence mothers’ attentional sensitivity towards infant distress. Previous research suggests breastfeeding is indicative of sensitive parenting. The current findings may suggest a mechanism by which breastfeeding and/or associated infant interaction could contribute to this sensitivity.     

Like mother,like child? Maternal determinants of children's early social-emotional development

Social-Emotional competencies evolve early in life. For example, early emotion regulation is learned primarily in the context of mother–child interaction, which may allow for maternal influences to shape children's social-emotional development. The aim of the current study was to longitudinally examine maternal determinants of children's early social-emotional development in a community-based sample of first-time mothers (N = 61, aged 22–39 years). Specifically, we used structural equation modeling to examine how maternal emotion regulation difficulties and subclinical depression directly and indirectly, through sensitivity and postnatal bonding, assessed at 6 to 8 months predicted child outcomes at 12 to 16 months. We found that mothers’ sensitivity predicted fewer social-emotional and behavioral problems and that stronger bonding predicted fewer problems and more social-emotional competencies. Emotion regulation difficulties were significantly associated with depressive symptoms; yet, when accounting for shared variances, both factors differentially predicted less positive child outcomes such that more difficulties indirectly, through poorer bonding, predicted greater delay in competencies, and more symptoms indirectly, through less sensitivity, predicted more problems. Current findings underline the significance of maternal factors impacting the quality of mother–child interaction for children's positive development. Potential implications for early prevention programs to support children who are otherwise at risk for negative emotional outcomes due to mothers’ emotional state postpartum are discussed.     

Association between intimate partner violence during pregnancy and maternal pregnancy complications among recently delivered women in Bangladesh

Intimate partner violence (IPV), an actual or threatened physical, sexual, or psychological abuse by a current or former partner or spouse, is a common global public health issue. Understanding both the prevalence of IPV during pregnancy and its potential impact on the health of pregnant women is important for the development and implementation of interventions to prevent maternal morbidity and mortality. The purpose of this study was to explore the association between maternal experiences of IPV during pregnancy and pregnancy complications. A health‐facility‐based cross‐sectional study was conducted from July 2015 to April 2016 among 400 randomly selected women who were admitted to the postnatal wards of Rajshahi Medical College Hospital for delivery. Data were collected through face‐to‐face interviews using a structured questionnaire. Multivariable logistic regressions were performed to assess relationships between variables of interest after controlling for potential confounders. Results indicated that 39.0% of women reported physical IPV and 26.3% of women reported sexual IPV during pregnancy. Additionally, 69.5% of women experienced medical complications (MCs); of this group, 44.3% experienced obstetric complications (OCs) and 79.3% experienced any pregnancy complication (AC) during their last pregnancy. The experience of physical IPV during pregnancy was significantly associated with the experience of MCs (adjusted odds ratio (AOR): 2.05, 95% confidence interval (CI): 1.15–4.01), OCs (AOR: 4.23, 95% CI: 2.01–7.12) and AC (AOR: 5.26, 95% CI: 2.98–10.52). Women who experienced sexual IPV during pregnancy were also at increased risk of suffering from any MC, any OC, and AC. Maternal experience of IPV during pregnancy is positively associated with pregnancy complications. Preventing IPV directed at pregnant women might reduce maternal morbidity and mortality in Bangladesh.

     

DOES FATHERS' PRENATAL MENTAL HEALTH BEAR A RELATIONSHIP TO PARENTING STRESS AT 6 MONTHS?

This study aimed to explore fathers’ mental health and retrospectively reported adverse childhood experiences during pregnancy, as well as various pathways predicting self‐reported stress at 6 months’ postpartum as assessed by the Parenting Stress Index (PSI; R.R. Abidin, 1990 ). A total of 835 fathers contributed data to the study. Data collection comprised five time points during pregnancy and one at 6 months’ postpartum. The main analyses were performed using linear regression and path analyses. First, linear regression analyses showed that paternal anxiety symptoms during pregnancy predicted stress scores in the PSI child domain at 6 months (coefficient = 0.36). Second, path analyses showed that depressive symptoms during pregnancy predicted parenting stress in the child domain, mediated by spousal disharmony at 6 months’ postpartum (coefficient = 0.77). Third, adverse childhood experiences scores predicted parenting stress in the child domain by two different pathways: one mediated by anxiety symptoms in pregnancy (coefficient = 0.29) and the other by depressive symptoms in pregnancy and experienced spousal disharmony at 6 months’ postpartum (coefficient = 0.77). The findings suggest that fathers’ symptoms of anxiety and depression during pregnancy as well as adverse childhood experiences predict paternal stress and a negative perception of their children's behavior at 6 months’ postpartum.     

Exploring Gender Differences in the Association Between Childhood Physical Abuse and Thyroid Disorders

This study used a regional subsample (n = 13,070) from the 2005 Canadian Community Health Survey to explore the independent contribution of childhood physical abuse to thyroid conditions in adulthood. Gender-specific logistic regression analyses controlled for age and race, in addition to 5 clusters of variables: childhood stressors, health behaviors, general stress levels, mental health, and socioeconomic status. No significant relationship between childhood abuse and thyroid conditions was found in men; however, childhood physical abuse was associated with higher odds of thyroid conditions among women, independent of a wide range of factors. In a fully adjusted model, abused women had 40% higher odds of thyroid conditions compared to their non abused peers, 95% CI [1.05, 1.87]. Future research on gender differences in the abuse–thyroid relationship is warranted.     

Role of psychosocial risk factors in predicting maternal and paternal depressive symptomatology during pregnancy

The aim of the present study was to investigate the role of several psychosocial risk factors in predicting depressive symptomatology during pregnancy in mothers and fathers, respectively. A total of 146 primiparous mothers and 105 primiparous fathers reporting a psychosocial risk condition were recruited independently from maternity and child health services, during the second trimester of pregnancy. All parents were evaluated for depressive symptomatology, anxiety, and perceived social support. Two hierarchical multiple regression analyses were performed to determine the role of psychosocial factors in predicting depressive symptomatology during pregnancy, in mothers and fathers. Marital dissatisfaction, personal history of depression, and personal trait anxiety were identified as significant predictors of depressive symptomatology during pregnancy, both in mothers and in fathers. Family history of substance abuse, conflictual relationship with the parents in the past year, and bereavement in the past year were identified as significant factors contributing to elevated depressive symptoms during pregnancy in mothers, but not fathers. In this study, several psychosocial risk factors were consistently related to an increase in maternal and paternal depressive symptoms during pregnancy; some of these factors seem to be specifically related to maternal depressive mood.     

Evaluation of early relational disturbance in high-risk populations: Borderline personality disorder features,maternal mental state,and observed interaction

Despite the longstanding theoretical association in the attachment literature between maternal trauma history and disturbances in the mother–infant interaction, few studies have investigated mechanisms of transmission of traumatogenic relational patterns in high-risk mother–infant dyads. This study investigated interrelationships among maternal trauma history, distorted maternal representations (DMRs, i.e. disturbed thoughts and feelings about the infant and self-as-parent), maternal mentalisation (i.e. capacity to conceive of self and other's intentions in terms of mental states including thoughts, feelings, and desires), and quality of interaction in a clinical sample of mothers with Borderline Personality Disorder (BPD) features and their infants (N = 61). Measures used included the Childhood Trauma Questionnaire, Parent Development Interview, Mother–Infant Relationship Scale, Borderline Symptom Checklist-23, and the Emotional Availability Scales. The results indicated BPD features mediated the relationship between maternal trauma history and DMRs predicting disturbance in interaction. In addition, analyses showed that maternal mentalisation had a buffering effect between DMRs and maternal non-hostility and yet the severity of BPD features moderated the relationship between mentalisation and DMRs. The findings suggest postpartum borderline pathology may adversely impact the experience of being a parent for women with a relational trauma history including deficits in mentalisation (i.e. hypermentalising) and disturbances in the mother–infant interaction. Implications for research and clinical practice are discussed.     

New Fathers’ Perceptions of Dyadic Adjustment: The Roles of Maternal Gatekeeping and Coparenting Closeness

Although the association between maternal gatekeeping and relationship functioning has been explored by a few studies, none of these have focused on fathers’ perceptions of these constructs. Given that today's new fathers are challenged by elevated expectations for active parenting and coparenting even as most new mothers remain primary caregivers of infant children, this is a critical omission. This study examined the associations between new fathers’ perceptions of maternal gatekeeping and change in dyadic adjustment as mediated through coparenting closeness. Maternal gatekeeping was reported by 182 fathers at 3 months postpartum, coparenting closeness was reported at 3 and 6 months postpartum, and dyadic adjustment was reported during the third trimester of pregnancy and at 9 months postpartum. Fathers’ perceptions of relative change in coparenting closeness from 3 to 6 months mediated associations between fathers’ perceptions of maternal gatekeeping at 3 months and relative change in dyadic adjustment from the third trimester to 9 months postpartum. In particular, findings indicate that greater perceived maternal gate opening was associated with higher levels of dyadic adjustment through higher levels of coparenting closeness, whereas greater perceived maternal gate closing was associated with lower levels of dyadic adjustment through lower levels of coparenting closeness. This study highlights the importance of studying fathers in the context of the family system and the role of the coparenting relationship at the transition to parenthood in couple relationship functioning.     

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

Maternal mental disorders can significantly impact on children's psychosocial and psychological development, incurring substantial ongoing economic and personal costs. A key mediating mechanism is mother–infant relationship quality (MIRQ). Research studies and perinatal mental health screening initiatives have predominantly focused on depressive symptoms and perinatal depression as predictors of MIRQ. While maternal depression is associated with suboptimal MIRQ, the findings have not been consistent. Personality characteristics are associated with parenting and proneness to depression, presenting a potential addition to prenatal mental health assessment. We conducted a systematic review of studies that have examined the link between prenatal depressive symptoms and/or personality characteristics with postnatal MIRQ. Our findings suggest that both maternal personality traits and depressive symptoms measured in early pregnancy are associated with postnatal MIRQ. A measure of personality characteristics may enhance prenatal mental health assessment, affording opportunities for targeted intervention commencing in pregnancy to improve MIRQ, parenting, maternal mental health outcomes, and infant psychosocial and psychological development, and thereby contributing to the reduction of human and economic cost burdens.     

Association between substance use disorders and self- and other-directed aggression: An integrated model approach

Our study's objective is to determine whether substance use disorders’ association with aggression differs according to the type of substance and/or the form of aggression, within the same population. We used data from the National Survey on Drug Use and Health across 2008–2014, with a pooled sample of 270,227 adult respondents. We used regression models to estimate the odds ratios for those having alcohol and/or drug use disorder(s) perpetrating (a) each form of aggression compared with no aggression and (b) other-directed compared with self-directed aggression. Alcohol use disorder alone and drug use disorder(s) alone were both associated with significantly increased odds of committing self-directed, other-directed, and combined aggression. Individuals with drug use disorder(s) alone were more likely to commit other-directed than self-directed aggression (adjusted odds ratio = 1.46, 95% CI = 1.04–2.05). Individuals with alcohol use disorder alone were not likely to commit one over the other (adjusted odds ratio = 1.20, 95% CI = 0.90–1.61). In conclusion, the integrated model of aggression based on the stress–diathesis model is a relevant framework to study risk factors for aggression. Further research is needed to identify longitudinal predictors of directionality of aggression.     

Maternal depression and infant attachment security: A meta-analysis

The purpose of this study is to clarify the magnitude of the association between maternal depression and infant attachment nonsecurity, and to identify possible moderators of this relationship. An extensive literature search was conducted using multiple databases of both published and unpublished studies. A meta-analysis was conducted to determine the relationship between maternal depression and infant attachment security and to establish the effect size. The main findings from this meta-analysis, which included 42 studies, indicate that there is a small, yet significant, relationship between maternal depression and infant attachment nonsecurity. The rate of nonsecurity in infants of mothers with depression was approximately 20% higher than expected rates in a nonclinical population, and the association between depressive symptoms and nonsecurity was small, but significant. Infants of mothers with depression were nearly twice as likely to have a nonsecure attachment than were infants of healthy mothers. Depression measure and maternal sample source were identified as significant moderators of the odds ratio effect size. Results of this study demonstrate that there is a significant relationship between maternal depression and infant attachment nonsecurity, and suggest that interventions that focus on both maternal mental health and the attachment relationship are warranted.     

Psychosocial factors associated with reports of physical dating violence among U.S. adolescent females

The present study, based upon the national 2005 Youth Risk Behavior Survey of U.S. high school students, provides the most current and representative data on dating violence among adolescent females (N = 7,179). The dependent variable was physical dating violence. The independent variables included four dimensions: violence, suicide, substance use, and sexual risk behavior. Unadjusted odds ratios (OR) and 95% confidence intervals (CI), were examined followed by multivariate logistic regression analyses, which included all significant independent variables from the bivariate analyses. Adjusted OR and 95% CI were computed to assess the significance of the relationships. In terms of prevalence, 10.3% of female adolescents reported experiencing physical dating violence. Black girls (OR = 1.47) and girls who reported sad/hopeless feelings (OR = 1.42) considered suicide (OR = 1.55), engaged in physical fighting (OR = 2.17), had recent sexual partners (OR = 2.10), or had unprotected sexual intercourse (OR = 1.70) were more likely to report physical dating violence. These findings suggest dating violence against adolescent females is widespread and associated with a host of other risk factors that deserve further attention through longitudinal research and intervention efforts.     

Effects of male postpartum depression on father–infant interaction: The mediating role of face processing

It is estimated that postpartum depression affects up to 25% of men. Despite such high prevalence, the majority of studies on postpartum depression are focused on mothers, and the role of paternal depression and its effects on infant development have been overlooked by researchers and clinicians. The present study aimed to fill this gap by investigating the effect of paternal postpartum depression on father–infant interactions. In addition, we examined whether differences in face recognition mediated the effects of paternal postpartum depression on father–infant interactions. A total of 61 father–infant dyads (17 postpartum depression, 44 controls) took part in the study. Results revealed that compared to controls, fathers with postpartum depression had a worse pattern of interaction with their infants on measures of responsiveness, mood, and sensitivity; they also had greater difficulty in recognizing happy adult faces, but greater facility in recognizing sad adult faces. Depressed fathers attributed greater intensities to sad adult and infant faces. The tendency to attribute greater intensity to sad adult faces was confirmed as a partial mediator of the effect of paternal postpartum depression on measures of father responsiveness and as a full mediator of the effects of paternal depression on father sensitivity. Clinical implications and suggestions for further studies are discussed.