Infant‐holding biases in mothers and affective symptoms during pregnancy and after delivery

Several authors have reported that participants have a leftward bias when holding a newborn or young infant. Our study of mothers met before and after their infant's birth sought to ascertain whether particular combinations of affective symptoms (depression, anxiety) and holding positions (horizontal versus vertical) were related to holding‐side biases. Our results showed that (a) mothers displayed a significant leftward (71%) holding bias, (b) mothers with affective symptoms held their newborn on the right side and more frequently in the vertical position, and (c) hemispheric specialization for perceiving visual emotions had no significant effect on the holding‐side biases of new mothers. These results suggest that maternal affective symptoms have a dominant effect on the determination of holding‐side preferences, when associated with a particular holding position. Copyright © 2008 John Wiley & Sons, Ltd.     

Infant-holding bias variations in mother–child relationships: A longitudinal study

This longitudinal study examined the associations between maternal depressive symptoms and infant holding bias in a sample of N = 43 women during three prospective sessions: during pregnancy, two months after childbirth, and when the child was 19 months of age. The majority of mothers (65.8% on average) held their children on the left side of their body at all three sessions; approximately 30% demonstrated a change in their preference, in particular between the pre- and first post-natal session. Examination of reciprocal associations between holding bias and depression revealed that prior and concurrent depression did not predict changes in holding-side biases, whereas women's holding preferences when their infant was two months old predicted change in pre- to postnatal depressive symptoms; women favouring a right-sided holding bias were significantly more likely to report increased depressive symptoms across the perinatal period, whereas a left-sided holding bias was associated with decreased depressive symptomatology.     

Prenatal depression predicts postpartum maternal attachment in low-income Latina mothers with infants

Although maternal attachment is an important predictor of infant attachment security and other developmental outcomes, little is known about the formation of maternal attachment in the first few months of the infant's life, particularly among ethnic minority mothers. The current study examined the predictors of postpartum maternal attachment in a sample of 217 Latina women enrolled in a perinatal depression prevention trial. Mothers’ attachment to their infants was measured at 6-8 weeks postpartum using the Maternal Postnatal Attachment Scale. A variety of predictors of early attachment were explored including: depressive symptoms during pregnancy, pregnancy intention, feelings about the pregnancy, and the quality of the partner relationship. The strongest predictor of lower maternal attachment was depressive symptoms late in pregnancy; pregnancy intention was marginally predictive of attachment, with lower scores being associated with unwanted pregnancies. The study fills a critical gap in our understanding of the role of depressive symptoms during pregnancy in shaping mothers’ early attachment to their infants.     

Infant Emotion Regulation Strategy Moderates Relations between Self‐Reported Maternal Depressive Symptoms and Infant HPA Activity

Children of mothers with depressive symptoms often have high cortisol levels. Research shows that various child characteristics (e.g., attachment pattern, internalizing behaviours, and temperament) moderate this association. We suggest that these characteristics share common variance with emotion regulation strategy. Therefore, we examine infant emotion regulation strategy as a moderator of the association between maternal depressive symptoms and infant hypothalamic–pituitary–adrenal (HPA) function. We hypothesize that infants who utilize more independent emotion regulation strategies and have mothers who report higher depressive symptoms will exhibit elevated cortisol levels. Participants were 193 mothers and infants (15 months old) recruited from the community. Self‐reported maternal depressive symptoms were assessed. Infant independent regulatory behaviours (withdrawal, wandering away, distraction, scanning, orienting to another object) were coded in the context of a Toy Frustration Task. Infant cortisol was collected via saliva samples at baseline, +20, and +40 minutes. Results indicate that infant emotion regulation strategy moderates the relation between mothers' self‐reported depressive symptoms and infant total cortisol output (AUC_G) and cortisol reactivity (AUC_I). Infants who employed more independent regulatory behaviours and have mothers with higher depressive symptoms experience greater cortisol secretion. We discuss the findings in relation to parent‐infant interactions and the adaptive nature of emotion regulation strategies, as they relate to HPA regulatory capacities. Copyright © 2015 John Wiley & Sons, Ltd.     

Early interactive behaviours in preterm infants and their mothers: Influences of maternal depressive symptomatology and neonatal birth weight

The study evaluated the quality of preterm infant–mother interactions, considering severity of birth weight (ELBW and VLBW) and maternal depression, compared to full term babies. 69 preterm infants (29 ELBW and 40 VLBW) and 80 full-term (FT) infants and their mothers were recruited. At 3 months of corrected age, the quality of mother–infant interaction was evaluated through Global Rating Scales; moreover, infant level of development and maternal depression were assessed through Griffith Development Mental Scales and Edinburgh Postnatal Depression Scale. Results showed adequate sensitivity in preterm infants’ mothers and higher involvement with their infants, compared to full term mothers, but ELBW ones exhibited an intrusive interactive pattern and a higher prevalence of depressive symptoms. The study underlined the relevance of paying special attention to both ELBW infants and their mothers, in order to support the parenting role and the co-construction of early interactions.     

Infant colic and maternal depression

The combined impact of infant colic and maternal depression on infant, parent, and family difficulties was examined. The sample included 93 consecutive patients seen at an outpatient Colic Clinic. Most mothers had private insurance and completed high school. Infants were approximately 2 months of age. Questionnaires completed by the mother prior to treatment onset were used to measure depressive symptoms in the mothers, infant cry, sleep and temperament, characteristics, parenting stress, maternal self‐esteem, social support, and family function. Moderate to severe depressive symptoms were reported by 45.2% of the mothers. More severe depressive symptoms in the mothers were related to fussy/difficult infant temperament, more parenting stress, lower parental self‐esteem, and more family‐functioning problems. Pediatric health care providers need to be aware that the combined effects of colic and maternal depression can be problematic for the family. ©2005 Michigan Association for Infant Mental Health.     

Goodness of fit between prenatal maternal sleep and infant sleep: Associations with maternal depression and attachment security

The current study prospectively examined the ways in which goodness of fit between maternal and infant sleep contributes to maternal depressive symptoms and the mother-child relationship across the first years of life. In a sample of 173 mother-child dyads, maternal prenatal sleep, infant sleep, maternal depressive symptoms, and mother-child attachment security were assessed via self-report, actigraphy, and observational measures. Results suggested that a poor fit between mothers’ prenatal sleep and infants’ sleep at 8 months (measured by sleep diary and actigraphy) was associated with maternal depressive symptoms at 15 months. Additionally, maternal depression mediated the association between the interplay of mother and infant sleep (measured by sleep diary) and mother-child attachment security at 30 months. Findings emphasize the importance of the match between mother and infant sleep on maternal wellbeing and mother-child relationships and highlight the role of mothers’ perceptions of infant sleep.     

Maternal postpartum depressive symptoms predict delay in non-verbal communication in 14-month-old infants

We investigated the potential relationship between maternal depressive symptoms during the postpartum period and non-verbal communication skills of infants at 14 months of age in a birth cohort study of 951 infants and assessed what factors may influence this association. Maternal depressive symptoms were measured using the Edinburgh Postnatal Depression Scale, and non-verbal communication skills were measured using the MacArthur-Bates Communicative Development Inventories, which include Early Gestures and Later Gestures domains. Infants whose mothers had a high level of depressive symptoms (13+ points) during both the first month postpartum and at 10 weeks were approximately 0.5 standard deviations below normal in Early Gestures scores and 0.5–0.7 standard deviations below normal in Later Gestures scores. These associations were independent of potential explanations, such as maternal depression/anxiety prior to birth, breastfeeding practices, and recent depressive symptoms among mothers. These findings indicate that infants whose mothers have postpartum depressive symptoms may be at increased risk of experiencing delay in non-verbal development.     

Feeding upon awakening in breastfeeding and bottlefeeding mothers does not affect the awakening cortisol response

An acute breastfeeding stimulus is generally followed by a transient decrease in cortisol levels in mothers. It is currently not clear whether breastfeeding upon waking up would affect the awakening cortisol response (ACR), a significant increase in salivary cortisol levels occurring within 30-45 min after awakening. In the present study, we measured the amplitude and stability of the ACR in response to infant feeding in women who were exclusively bottle-feeding (n = 16), or breastfeeding (n = 13) or feeding their child solid food (n = 12). The results show that the type of infant feeding did not affect the amplitude and stability of the ACR. Given that the ACR has been reported to reflect physical and psychological well-being, our finding that infant feeding upon waking up might not be a confounding factor in ACR studies on the postpartum population represents valuable methodological information.     

Antenatal and postnatal depressive symptoms: Association with quality of mother–infant interaction

Antenatal and postnatal depression are independently associated with an increased risk of adverse infant development. A key linking mechanism is the quality of mother–infant interaction.ObjectivesThis study assesses the association between postnatal depressive symptoms (PDS) and their severity, with the quality of mother–infant interaction and compare the quality of mother–infant interaction and severity of the symptoms depending on the presence or absence of antenatal depressive symptoms (ADS).Methodsobservational study in 177 psychosocial risk mother–infant dyads from Chile (infant aged 2–12 months).ResultsMothers with PDS had lower maternal sensitivity and a more intrusive/controlling style than mothers without PDS, although the severity of the symptoms was not associated with lower maternal sensitivity. Maternal sensitivity did not differ in the postnatal depressed mothers depending on the presence of ADS, although the mothers differed in interaction style and the severity of symptoms. Mothers with ADS and PDS presented with a predominant intrusive/controlling interaction style and more severe depressive symptoms, whereas those with only PDS presented with a predominant nonresponsive/passive interaction style and reduced severity of symptoms.ConclusionsThe results corroborate the need to offer treatment and dyadic interventions to antenatal and postnatal depressive mothers and postulate that the presence of antenatal depressive symptoms may influence the subsequent mother–infant interaction style and greater severity of symptoms.     

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.     

Neonatal sex and birth-order effects on behaviors of mothers and temporary caretakers during bottle-feeding

This study examined the effects of neonatal sex and birth order on maternal caretaking patterns for pre-attachment behaviors shown by mothers and instrumental behaviors seen in both mothers and temporary caretakers. Observational category scores were obtained for mothers of 20 newborn infants and for temporary caretakers observed in a 15 min bottle-feeding situation. A repeated measures analysis of variance design was used to partition categories into caretaking classifications and to evaluate the effects of infant sex and birth order. Significant main effects for caretaker (p less than .05) were obtained: six mother-high, pre-attachment categories, and seven mother-low, instrumental behavior categories. Maternal scores sensitive to infant sex and birth order were identified from Caretaker x Sex x Birth Order interactions (p less than .05). Birth order differences affected maternal behaviors directed toward sons more substantially than those directed toward daughters. Mothers held first-born sons upright in tactual contact with the trunk, whereas daughters were held supine on the lap and exposed to frequent maternal smiling.     

MATERNAL SELF‐REPORTED DEPRESSIVE SYMPTOMS AND MATERNAL CORTISOL LEVELS INTERACT TO PREDICT INFANT CORTISOL LEVELS

Three basic findings have emerged from research on maternal depressive symptoms and offspring hypothalamic–pituitary–adrenal functioning: (a) Mothers’ depressive symptoms are positively associated with their offsprings’ cortisol stress response, (b) numerous individual and interpersonal maternal characteristics moderate this association, and (c) maternal and infant cortisol levels are highly correlated. In combination, these findings have suggested that maternal cortisol levels may moderate the relation between maternal depressive symptoms and infant cortisol responsivity; the current study assessed this hypothesis. Participants were 297 mother–infant dyads who were recruited from the community. Maternal depressive symptoms were assessed via self‐report. Dyads participated in two differentially stressful infant challenges when infants were 16 and 17 months old. Mother and infant salivary cortisol was collected before and after challenges. Results indicate that maternal cortisol levels moderated associations between maternal depressive symptoms and infant cortisol levels across both challenges. Infants showed higher cortisol levels if their mothers had both higher depressive symptoms and higher cortisol levels, as compared to infants of mothers with higher depressive symptoms and lower cortisol, and to infants of mothers with lower depressive symptoms and either higher or lower cortisol levels. We discuss findings in relation to environmental and biological factors that may contribute to the intergenerational transmission of depressive symptoms.     

Self-Perceived Competence as a Mediator Between Maternal Feedback and Depressive Symptoms in Adolescents

Self-report, other-report, clinical interview, and behavioral observations of evaluative maternal feedback (e.g., positive feedback, criticism), adolescent depressive symptoms, and self-perceived competence were obtained from 72 adolescents and their mothers. Most path analyses supported the hypothesis that adolescent self-perceived competence completely mediates the relation between negative maternal feedback and adolescent depressive symptoms, even after controlling for prior levels of depression. Consistent with Cole's competency-based model of depression (D. A. Cole, 1990), these results suggest that high levels of negative maternal feedback (coupled with low levels of positive feedback) are associated with adolescent negative self-perceptions, which in turn place adolescents at risk for depressive symptoms.     

Vocal and facial expression matching in infants of mothers with depressive symptoms

This study investigated vocal and facial expression matching in 24 10-month-old infants. Half of the mothers had reported depressive symptoms [i.e., elevated scores on the Center for Epidemiological Studies-Depression Index (CES-D)] during the previous week. Infants were tested using a two-screen preference procedure in which they were presented side-by-side videos of different facial expressions modeled by one female reciting a children's story. A centrally located speaker was used to present a vocal expression soundtrack that matched one of the facial expressions. Separate analyses of variances (ANOVAs) were conducted to analyze the proportion total matching and proportion total looking to the happy and sad expressions. Infants of mothers who reported depressive symptoms displayed less accurate matching of the happy facial and vocal expressions and looked more to sad facial expressions compared to infants of mothers who had not reported depressive symptoms above the normal range. Infants' performance on the expression matching task appears to be related to their primary caregivers' reports of depressive symptoms during the previous week. However, other factors that may be related to the group differences also need to be considered. For example, maternal reports of depressive symptoms may be a marker for other underlying factors that may have affected their infants' performance. © 1997 Michigan Association for Infant Mental Health     

Maternal depression: A review of relevant treatment approaches for mothers and infants

The negative impact of postpartum depression on the mother‐infant relationship and infant development more generally has been well documented. Compared to infants of nondepressed mothers, infants of depressed mothers have been shown to be less securely attached to their caregivers and often have cognitive, emotional, and behavioral deficits that persist well into childhood. Recent evidence has suggested that reduction of maternal depressive symptoms may itself not be sufficient to prevent negative effects on children. Rather, treatments that target the mother‐infant relationship may have great potential in providing a buffer against the potentially damaging effects of postpartum depression. Based on our review of several treatment‐outcome studies, we conclude that mother‐infant psychotherapies and home‐based interventions are generally efficacious in their goal of ameliorating detrimental consequences for children of depressed mothers. Nonetheless, the field must continue to investigate the extent to which treatment gains are maintained over time and the mechanisms by which protective effects occur. It is likely that the most efficacious treatment approaches will be those that address the needs of the mother, the infant, and their relationship.     

Predicting maternal sensitivity: The roles of postnatal depressive symptoms and parasympathetic dysregulation

Previous research has established that maternal depression is a risk factor for a variety of negative developmental outcomes among infants and children. Although low levels of maternal sensitivity have been hypothesized to explain this risk, the biological mechanisms underlying the association between maternal depressive symptoms and low levels of maternal sensitivity have been largely underexplored. This study examined the roles of postnatal depressive symptoms and parasympathetic nervous system functioning as predictors of low levels of maternal sensitivity, during a stressful mother–infant interaction—the reunion phase of the Still‐Face Paradigm. Depressive symptoms and traitlike predispositions toward parasympathetic dysregulation, as indexed by low resting levels of respiratory sinus arrhythmia, were associated independently with less sensitive parenting. Discussion considers that during stressful mother–infant interactions, both mothers with depressive symptoms and mothers predisposed to parasympathetic dysregulation may have fewer emotional, physiological, and psychological resources with which to respond sensitively to their infants' cues.     

Acoustic parameters of infant-directed singing in mothers with depressive symptoms

The purpose of this study was to explore the relationship between mothers’ depressive symptoms and the acoustic parameters of infant-directed (ID) singing. Participants included 80 mothers and their 3- to 9-month-old infants. A digital recording was made of each mother's voice while singing to her infant. Extraction and analyses of vocal data revealed a main effect of tempo, meaning that as mothers reported more depressive symptoms, they tended to sing faster to their infants. Additionally, an interaction effect indicated that mothers with depressive symptoms were more likely to sing with tonal key clarity to their male infants. These findings suggest that as mothers experience depressive symptoms, their ID singing may lack the sensitivity and emotional expression that infants need for affect regulation. An intervention that combines interaction coaching and ID singing may help mothers with depressive symptoms to engage in sensitive and emotionally synchronized interactions with their infants.     

Postpartum feeding attitudes, maternal depression, and breastfeeding in Barbados

Maternal feeding attitudes, maternal moods and infant feeding practices during the first 6 months postpartum were assessed in 226 healthy, well-nourished Barbadian mother-infant dyads. Factor analysis of the feeding attitudes questionnaire resulted in six independent factors. The belief that breastfeeding was better than bottle-feeding was associated with higher family income, more information seeking behavior and older maternal age at the time of her first pregnancy. Women who believed that breastfeeding was better at 7 weeks postpartum were also more likely to breastfeed at concurrent and later ages, up to 6 months postpartum. This belief was also associated with less maternal depression at 7 weeks and 6 months. The association between feeding attitudes and actual feeding practices was significant even after correcting for maternal moods and other background variables. Conversely, after controlling for feeding attitudes, maternal mood at 7 weeks was still significantly associated with infant feeding practices at 6 months. Thus, feeding attitudes and maternal moods were closely linked, but each contributed independently and uniquely to different aspects of breastfeeding, especially at 6 months. These findings suggest that early intervention addressing maternal feeding attitudes, may improve the extent of breastfeeding and the health of children in this setting.     

Continuity of paternal social support and depressive symptoms among new mothers

The present study examined trajectories of paternal support and maternal depressive symptoms over the first two years after the birth of a child. First-time mothers (N = 582) were assessed 6 times during the first 24 months of their child's life. At each assessment they reported on a number of ways in which their child's father provided support, and at three of the assessments, their own depressive symptomatology was assessed. Latent growth curve models revealed that while higher support was related to lower depressive symptomatology, both paternal support and maternal depression tended to decrease over time. The relationships between paternal support and maternal depression are complex and suggest the importance of considering the multiple ways that parents influence one another over time.