Maternal self-confidence during the first four months postpartum and its association with anxiety and early infant regulatory problems

Maternal self-confidence has become an essential concept in understanding early disturbances in the mother-child relationship. Recent research suggests that maternal self-confidence may be associated with maternal mental health and infant development. The current study investigated the dynamics of maternal self-confidence during the first four months postpartum and the predictive ability of maternal symptoms of depression, anxiety, and early regulatory problems in infants. Questionnaires assessing symptoms of depression (Edinburgh Postnatal Depression Scale), anxiety (State-Trait Anxiety Inventory), and early regulatory problems (Questionnaire for crying, sleeping and feeding) were completed in a sample of 130 women at three different time points (third trimester (T1), first week postpartum (T2), and 4 months postpartum (T3). Maternal self-confidence increased significantly over time. High maternal trait anxiety and early infant regulatory problems negatively contributed to the prediction of maternal self-confidence, explaining 31.8% of the variance (R = .583, F_3,96 = 15.950, p < .001).Our results emphasize the transactional association between maternal self-confidence, regulatory problems in infants, and maternal mental distress. There is an urgent need for appropriate programs to reduce maternal anxiety and to promote maternal self-confidence in order to prevent early regulatory problems in infants.     

Perceived partner support in pregnancy predicts lower maternal and infant distress

Maternal postpartum emotional distress is quite common and can pose significant risk to mothers and infants. The current study investigated mothers' relationships with their partners during pregnancy and tested the hypotheses that perception of prenatal partner support is a significant predictor of changes in maternal emotional distress from midpregnancy to postpartum, and contributes to maternal ratings of infant distress to novelty. Using a prospective longitudinal design, 272 adult pregnant women were interviewed regarding their partner support, relationship satisfaction, and interpersonal security (attachment style and willingness to seek out support), and they completed standardized measures of prenatal symptoms of depression and anxiety (distress). At 6 to 8 weeks' postpartum, mothers reported these symptoms again and completed measures of their infants' temperament. Structural equation modeling (SEM) was used to test direct and indirect contributions of partner support, relationship satisfaction, and interpersonal security to maternal and infant postpartum distress. Mothers who perceived stronger social support from their partners midpregnancy had lower emotional distress postpartum after controlling for their distress in early pregnancy, and their infants were reported to be less distressed in response to novelty. Partner support mediated the effects of mothers' interpersonal security and relationship satisfaction on maternal and infant outcomes. A high-quality, supportive partner relationship during pregnancy may contribute to improved maternal and infant well-being postpartum, indicating a potential role for partner relationships in mental health interventions, with possible benefits for infants as well.     

Maternal avoidance,anxiety cognitions and interactive behaviour predicts infant development at 12 months in the context of anxiety disorders in the postpartum period

BackgroundFew studies have examined the relation between anxiety disorders in the postpartum period and cognitive as well as language development in infancy.AimsThis longitudinal study investigated whether anxiety disorder in the postpartum period is linked to infant development at twelve months. A closer look was also taken at a possible link between maternal interaction and infant development.Study designSubjects were videotaped during a Face-to-Face-Still-Face interaction with their infant (M = 4.0 months). Specific maternal anxiety symptoms were measured by self-report questionnaires (Anxiety Cognition Questionnaire (ACQ), Body Sensations Questionnaire (BSQ), Mobility Inventory (MI)) to check for a connection with infant development. The Bayley Scales of Infant and Toddler Development-III (Bayley-III) were used to assess infant language and cognitive development at one year of age.Subjectsn = 34 mothers with anxiety disorder (SCID-I; DSM-IV) and n = 47 healthy mothers with their infant.Outcome measuresInfant performance on Bayley-III language and cognitive scales.ResultsInfants of mothers with anxiety disorder yielded significantly lower language scores than infants of controls. No significant group differences were found regarding infant cognitive development. Exploratory analyses revealed the vital role of “maternal avoidance accompanied” in infant language and cognitive development. Maternal neutral engagement, which lacks positive affect and vocalisations, turned out as the strongest negative predictor of cognitive development. Maternal anxiety cognitions and joint activity in mother-infant interaction were the strongest predictors of infant language performance.ConclusionsResults underline the importance to also consider the interaction behaviour of women with anxiety disorders to prevent adverse infant development.     

Maternal depression and infant temperament characteristics

One hundred-thirty-nine women participated in this longitudinal study from the third trimester of pregnancy through 8-months postpartum. Women completed depression scales at several time points and rated their infant's characteristics and childcare stress at 2- and 6-months postpartum. Mothers' reports of infant temperament were significantly different for depressed and non-depressed mothers, with depressed mothers reporting more difficult infants at both measurement points. These differences remained after controlling for histories of maternal abuse or prenatal anxiety, which occurred more often in the depressed mothers. There were no significant differences in childcare stress or perceived support between the groups. Infant temperament and childcare stress did not change over time. Recommendations for practice include consistent ongoing evaluations of the "goodness of fit" within the dyad and exploring interventions for depressed mothers that provide guidance about interactions with their infants and the appropriateness of the infant behaviors.     

Stability of maternal postnatal bonding between 3 and 6 months: Associations with maternal mental health and infant temperament

Maternal bonding is key for infant development and well-being. Research to date focused on prenatal bonding experience, with fewer studies looking at the postnatal period. Moreover, evidence suggests significant associations among maternal bonding, maternal mental health, and infant temperament. The joint impact of maternal mental health and infant temperament on maternal postnatal bonding remains unclear, with limited research reporting longitudinal data. Hence, the present study aims (1) to explore the impact of maternal mental health and infant temperament on postnatal bonding at both 3 and 6 months of age, (2) to explore postnatal bonding stability from 3 to 6 months, and (3) to determine which factors are linked with 3-to-6-month changes in bonding. At the infants' 3 months (n = 261) and 6 months of age (n = 217), mothers provided measures of bonding, depressive and anxious symptoms, and infant temperament via validated questionnaires. At 3 months, higher levels of maternal bonding were predicted by lower levels of anxiety and depression in the mothers and by higher infants' regulation scores. At 6 months, lower levels of anxiety and depression predicted higher levels of bonding. Moreover, mothers showing decreases in bonding were characterized by 3-to-6-month increases in depression and anxiety, as well as increased reported difficulties in regulation dimensions of infant temperament. This study highlights the impact of both maternal mental health and infant temperament on maternal postnatal bonding in a longitudinal sample and could offer useful information for early childhood prevention and care.     

Caregiving behavior and interactions of prenatally depressed mothers (antidepressant‐treated and non‐antidepressant‐treated) during newborn acute pain

This exploratory study aimed to examine time‐based measures of the behaviors and interactions of prenatally depressed serotonin reuptake inhibitors (SRI)‐medicated mothers to their infant's pain (n = 10) by comparing them with similar measures obtained from prenatally depressed nonmedicated mothers and their infants (n = 10), and nondepressed mothers and their infants (n = 10). During the second trimester of their pregnancy, the 30 study mothers were assessed for depression and anxiety, with no further measures of maternal mood taken. Maternal and infant interactions were continuously videorecorded while the infant underwent a scheduled heel lance for routine blood screening that occurred when study infants were between the ages of 24 and 60 hr. Maternal behavior and infant cry, for all 30 cases, were coded second‐by‐second for the full duration of each infant's heel lance using a reliable coding system and analyzed using odds ratio and regression analyses. Infants exposed to prenatal SRIs and depressed maternal mood were more likely to have lower Apgar scores and to exhibit weak and absent cry. Even when duration of the heel lance was controlled for, women with depression during the second trimester were more likely to exhibit depressed behavior at 2 days' postpartum despite sustained SRI antidepressant treatment. Both groups of prenatally depressed mothers were more likely to exhibit diminished response to their infants' pain cue although nonmedicated mothers' expressions of depressed behavior were more similar to healthy controls. Comprehensive understanding is essential to optimize the clinical care of mothers and their infants in this complex setting. This study contributes preliminary new findings that warrant prospective and longitudinal studies to clarify further the impacts of prenatal SRI and maternal mental mood (e.g., chronic depression and anxiety) effects on the mother–infant interaction and infant pain and stress reactivity.     

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.     

Bed-sharing, breastfeeding and maternal moods in Barbados

Bed-sharing among Barbadian mothers and infants was studied in relationship to maternal and infant characteristics. This prospective study followed 226 healthy, well-nourished mother–infant dyads at birth, 7 weeks, 3 months, and 6 months postpartum. At each age, approximately half of the infants shared the same beds as their mothers. Bed-sharing was associated with demographic characteristics, especially fewer home conveniences, and also maternal characteristics, including less information seeking by the mother and younger maternal age at first pregnancy. Bed-sharing was also associated with lower infant birth weights. Maternal moods were significantly correlated with bed-sharing, such that mothers who reported having more despair and anxiety were also more likely to sleep with their infants. Bed-sharing was also significantly associated with increased breastfeeding at all infant ages, but this relationship was no longer significant once the effects of maternal moods were controlled. This study emphasizes the importance of assessing maternal moods in studies evaluating the risk and benefits of bed-sharing.     

Evaluating a home‐based dyadic intervention: Changes in postpartum depression,maternal perceptions,and mother–infant interactions

Psychotherapeutic treatments that focus on improving the relational processes between mothers with postpartum depression (PPD) and their infants, as well as the mother's individual therapeutic needs, have a great potential to positively impact the mother, her infant, and their relationship (K.J. Nylen, T.E. Moran, C.L. Franklin, & M. O'Hara, 2006 ). Utilizing pilot data from an evaluation of a home‐based dyadic therapy for mothers with PPD and their infants, this article reports on a recent academic–community partnership study. The effectiveness of the intervention was examined, specifically regarding changes in mother's mood, parenting experience, and relationship with her infant. In addition, associations were examined among maternal self‐report variables measuring change from pre‐ to posttreatment in PPD, psychological distress, and maternal perceptions of parenting and those variables measuring change in observer ratings of maternal–infant interactions. Results showed improvements in mothers' depression, distress, and perceptions of parenting as well as many ratings of mothers' interactions with their infants. However, only improvements in maternal perceptions of parenting, such as maternal self‐esteem and parenting stress, were associated with better mother–‐infant interactions. Importance of this research for the field of infant mental health as well as clinical implications are discussed.     

Affect expression in prenatally psychotropic exposed and nonexposed mother–infant dyads

This prospective study examined infant, maternal, and dyadic affective profiles at three months postpartum in infant–mother dyads that were exposed to psychotropic medications in utero compared with nonexposed control dyads. Control dyads of nondepressed mothers and their infants showed many similarities in affect expression with mother–infant dyads who were exposed to selective serotonin reuptake inhibitors (SSRIs) alone for treatment of maternal depression. In contrast, mothers who received SSRIs and Rivotril (Benzodiazepine derivative) for treatment of depression and anxiety expressed both positive and negative affect towards their infants. Clinical implications regarding use of psychotropic medications such as SSRIs alone or in combination with other drugs for treatment of maternal anxiety and depression during pregnancy are discussed. Clinicians should be aware of the possible differential response in maternal–infant interaction in a mixed diagnosis group (i.e., depression and anxiety) regarding infant temperament, possibly suggesting latent behavioral teratogenicity with psychotropics. ©2002 Michigan Association for Infant Mental Health.     

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.     

Early infant temperament shapes the nature of mother-infant bonding in the first postpartum year

ObjectiveThis study examined longitudinal relations between maternal bonding and infant temperament in the first nine months after birth.DesignOur sample consisted of 281 women, enrolled at five maternity hospitals, who completed questionnaires during the first week (T1), at six weeks (T2) and nine months postpartum (T3). Maternal bonding was assessed using the Mother-to-Infant Bonding Scale at T1 and T2 and the Postpartum Bonding Questionnaire at T3. Infant temperament was measured using the Infant Characteristics Questionnaire, completed by the mothers at T2 and T3.ResultsThe results of a path model showed a long-term effect flowing from the child to the mother, with infant temperament at T2 predicting maternal bonding at T3 over and above stability in bonding. At T3, bonding was linked more strongly to child temperament at T2 than to child temperament assessed concurrently at T3. Maternal bonding did predict infant temperament, but this was true only of bonding reported at T1 and infant temperament at T2, that is, not of bonding assessed at T2 and infant temperament at T3.ConclusionOur results indicate that maternal bonding in the first week postpartum may temporarily affect child temperament, but infant’s temperament several weeks after birth – rather than several months postpartum – plays a pervasive role in shaping the long-lasting nature of the mother-child relationship. Our findings thus seem to support the suggestion that the early postpartum weeks represent an important period in the development of maternal bonding.     

Perinatal depression influences on infant negative affectivity: Timing,severity, and co-morbid anxiety

Accumulating evidence suggests that antenatal depression predicts infants’ negative affectivity, albeit with variable effect sizes. With a prospective longitudinal design, we sought to explain that variability by addressing questions about timing of the depression across pregnancy and the early postpartum, the role of high symptom levels relative to diagnosed depression, comorbidity with anxiety, and the potential mediating role of neuroendocrine functioning. Primiparous women (n = 77) with histories of depression prior to pregnancy were assessed for cortisol levels monthly beginning by mid-pregnancy. Depression symptom levels and diagnostic status were similarly assessed monthly in pregnancy and also until infants reached three months of age, when mothers completed the Infant Behavior Questionnaire-Revised to measure infant negative affectivity. Antenatal depression symptoms and infant negative affectivity were positively associated (r = .39). Controlling for depression symptom levels in other trimesters, only second trimester depression symptoms predicted higher infant negative affectivity (β = .44). With postpartum depression symptom levels in the model, only antenatal depression symptoms predicted infant negative affectivity (β = .45). In the context of depression, neither antenatal anxiety symptoms nor anxiety disorder diagnosis were associated with infant NA scores. The hypothesized role of elevated maternal cortisol as a mechanism for the association between antenatal depression and infant NA was not supported. Our findings contribute to efforts to more precisely identify infants of perinatally depressed mothers who are at greater risk for elevated negative affectivity, suggesting a window of vulnerability in mid pregnancy and the need for further study of potential mechanisms.     

Predicting maternal reactivity/sensitivity: The role of infant emotionality,maternal depressiveness/anxiety,and social support

It was hypothesized that an accumulation of unfavorable conditions, i.e., high negative emotionality and low positive emotionality of the infant, maternal depression and anxiety, and lacking social and emotional support can attenuate mothers' reactivity/sensitivity. Maternal reactivity/sensitivity was observed during home visits and in the laboratory. Infant negative and positive emotionality was assessed by mother reports and behavioral observations. Maternal depressiveness/anxiety as well as social support were assessed via questionnaires. All mothers were primiparous and had healthy infants. Data collection was conducted at the infants' ages of four months (37 dyads) and eight months (33 dyads). The sample consisted of 19 male and 18 female infants (four‐months' measurement). Whereas the presence of a single risk factor was not related to maternal reactivity/sensitivity, the combination was. A decrease in maternal reactivity/sensitivity over the course of time was demonstrated for mothers who had to deal with high negative emotionality of the infant in combination with either high depressiveness/anxiety or low social support at the infants' age of four months. No significant main or interaction effects could be shown for infant positive emotionality. ©2004 Michigan Association for Infant Mental Health.     

Effects of maternal postpartum depression in a well‐resourced sample: Early concurrent and long‐term effects on infant cognitive,language, and motor development

This study examined early and long‐term effects of maternal postpartum depression on cognitive, language, and motor development in infants of clinically depressed mothers. Participants were 83 mothers and their full‐term born children from the urban region of Copenhagen, Denmark. Of this group, 28 mothers were diagnosed with postnatal depression three to four months postpartum in a diagnostic interview. Cognitive, language, and motor development was assessed with the Bayley Scales of Infant and Toddler Development third edition, when the infants were 4 and 13 months of age. We found that maternal postpartum depression was associated with poorer cognitive development at infant age four months, the effect size being large (Cohen's d = 0.8) and with similar effects for boys and girls. At 13 months of age infants of clinical mothers did not differ from infants of non‐clinical mothers. At this time most (79%) of the clinical mothers were no longer, or not again, depressed. These results may indicate that maternal depression can have an acute, concurrent effect on infant cognitive development as early as at four months postpartum. At the same time, in the absence of other risk factors, this effect may not be enduring. The main weaknesses of the study include the relatively small sample size and that depression scores were only available for 35 of the non‐clinical mothers at 13 months.     

Maternal sensitivity,infant temperament,and the development of early feeding problems

Early feeding problems, assessed in maternal reports about general problems and refusal behaviors, were investigated in a normal sample (n = 115) at the ages of 10 months and 2 years. In a longitudinal design, stability of feeding problems was studied. A model for development of nonorganic failure to thrive proposed by Chatoor (1989: Chatoor & Egan, 1983) was used as a guide in selection of potential antecedents to early feeding problems. The predictive value of parent-rated infant temperament and directly observed maternal sensitivity for explaining variance in feeding problems was explored. The results showed moderate stability for feeding problems. Feeding problems at both ages were predicted by interactions between infant temperament and maternal sensitivity. At 10 months feeding problems were marginally associated with an interaction between sensitivity and infant manageability (degree of negative emotionality); less sensitive mothers with less manageable infants reported more refusal behaviors. At the age of 2 years irregular infants were reported to have more problems if their mothers were less sensitive to their signals. The results are discussed in relation to studies of more severe feeding problems in infancy, and the Chatoor model was found to contribute to an understanding of the development of everyday infant feeding problems in a normal sample. © 1997 Michigan Association for Infant Mental Health     

Maternal and Infant Temperament Characteristics as Contributors to Parenting Stress in the First Year Postpartum

Although prominent models emphasize that maternal, child, and situational variables are associated with parenting stress, previous research has often neglected to examine associations between maternal and infant temperament characteristics and stress experienced in the parenting role. Additionally, while predictors of global parenting stress have been examined, predictors of stress related to specific aspects of the parenting role have been largely unexplored. The present study examined maternal and infant temperament characteristics as predictors of parenting stress, both globally and specifically. Mothers (n = 159) completed measures of depressive and anxiety symptoms and a measure of adult temperament when their infants were 4 months old. At 6 months postpartum, caregivers completed a measure of infant temperament, and at 8 months postpartum, a measure of parenting stress. Results indicated that maternal effortful control and infant negative emotionality predicted global maternal parenting stress. Additionally, all maternal and infant temperament variables, with the exception of maternal negative affectivity and infant surgency/extraversion, were uniquely predictive of at least one specific aspect of parenting‐related stress. Findings emphasize the importance of considering maternal and infant temperament characteristics as contributors to parenting stress in the first year postpartum. Implications of these findings for future research and intervention are discussed. Copyright © 2013 John Wiley & Sons, Ltd.     

Influences of maternal postpartum depression on fathers and on father–infant interaction

Maternal postpartum depression (PPD) has been shown to negatively influence mother–infant interaction; however, little research has explored how fathers and father–infant interaction are affected when a mother is depressed. This study examined the influence of maternal PPD on fathers and identified maternal and paternal factors associated with father–infant interaction in families with depressed as compared with nondepressed mothers. A convenience sample of 128 mother–father–infant triads, approximately half of which included women with significant symptoms of PPD at screening, were recruited from a screening sample of 790 postpartum women. Mothers and fathers completed measures of depression, marital satisfaction, and parenting stress at 2 to 3 months' postpartum and were each videotaped interacting with their infants. Results indicate that maternal PPD is associated with increased paternal depression and higher paternal parenting stress. Partners of depressed women demonstrated less optimal interaction with their infants, indicating that fathers do not compensate for the negative effects of maternal depression on the child. Although mother–infant interaction did not influence father–infant interaction, how the mother felt about her relationship with the infant did, even more so than maternal depression. The links between maternal PPD, fathers, and father–infant interaction indicate a need for further understanding of the reciprocal influences between mothers, fathers, and infants.     

Pathways from marital aggression to infant emotion regulation: the development of withdrawal in infancy

Associations between marital conflict and infant emotion regulation exist, but explanatory pathways have not been explored. For older children, parental behavior partially mediates this association through a "spillover" process. We test: associations between mothers' and fathers' verbally aggressive marital conflict, infant temperament, and infant withdrawal; mediating effects of negative maternal behavior, and moderating effects of infant temperament, exposure to marital arguments, and contact with father. Eighty mothers, 73 fathers, and their 6-month-old infants participated; parents reported marital aggression prenatally, mothers reported infant exposure to arguments, direct caregiving by father, and infant temperament at 5 months. Negative maternal behavior, infant withdrawal, distress to novelty, activity, and look away were observed at 6 months. Mothers' and fathers' aggressive marital conflict predicted infant withdrawal, interactively with exposure to marital arguments and extent of father caregiving, as did infant temperament and negative maternal behavior. Maternal behavior did not mediate between marital conflict and withdrawal.     

Contextual basis of maternal perceptions of infant temperament

To elucidate the differential saliency of infant emotions to mothers across interactive contexts, the authors examined the moderating role of observed infant affect during interactions with mother in the relation between maternal and laboratory-based ratings of infant temperament. Fifty-nine developmentally healthy 9-month-old infants were judged for degree of infant positive, infant negative, and mother-infant mutually positive affect during the course of object-focused and routine home-based activities with mother. Mothers completed the Infant Behavior Questionnaire (M. K. Rothbart, 1981), and infants underwent the Laboratory Temperament Assessment Battery (H. H. Goldsmith & M. K. Rothbart, 1999). Results revealed that maternal and observer ratings of infant negativity converged when infants manifested high degrees of negative affect during routine home-based activities. Maternal and observer ratings of infant positivity converged when infants experienced low mutually positive affect during play. These findings support the hypothesis that maternal perceptions are based on mothers' experiences with their infants but that the salience of infant temperamental characteristics to mothers varies across emotion and interactive context.