The relationship of prenatal maternal depression or anxiety to maternal caregiving behavior and infant behavior self-regulation during infant heel lance: an ethological time-based study of behavior.

Fay F Warnock,Thaila Castral,Kenneth D Craig,Jila Mirlashari,Roger Bakeman

doi:10.1186/s12884-016-1050-5

Abstract

BackgroundSensitive and responsive maternal caregiving behavior strengthens infant self-regulatory capacities (HL), but this regulatory role may be diminished in some mothers with second-trimester prenatal exposure to depression and/ or anxiety (MDA). This study examined maternal and infant behavior during infant heel lance (HL) when mothers had or did not have MDA. Ethological methods and micro-analytic approaches capable of distinguishing and comparing time-based patterning in maternal and infant behavior were used to clarify biological mechanisms, such as MDA, that may underlie observed behavior. Aims were to examine group differences in caregiving behavior between mothers with and without MDA 5 min Pre-HL and 5 min Post-H, and relationships between MDA, maternal caregiving behavior and infant pain behavior self-regulation, concurrently.MethodsAt second trimester, mothers were assessed for symptoms of mild-severe depression or anxiety. Mothers whose scores exceeded predetermined cut-off scores on one or more of the mental health measures were allocated to the MDA-exposure group, those below to the non-MDA-exposure group. Reliable observers, blinded to MDA status and study phases, coded video records of the caregiving behavior of each study mother for the full duration of the 5 min Pre-HL and 5 min Post-HL study phases. Group differences and associations between mean measures of maternal mental health scores, time-based measures of maternal behavior, and time-based measures of infant pain behavior regulation (previously coded) were concurrently analyzed using comparative and correlational statistics.ResultsMDA-exposed mothers spent significantly more time not embracing, engaging or responding to infant cues than maternal controls Pre-HL and Post-HL. MDA was associated with atypical maternal caregiving behavior, which in turn was related to atypical infant pain behavior self-regulation during and after the HL.ConclusionOur findings have implication for practice. We recommend inclusion of mothers with MDA and their infants in interventions that strengthen the early mother-infant interaction and mother’s regulatory caregiving role. MDA and maternal caregiving behavior must be considered in future infant pain studies to examine if they confound effectiveness of mother driven caregiving interventions for neonatal pain. We highlight the importance of examining maternal mental health throughout the perinatal and postnatal trajectory, and particularly the newborn period.

Highlights

Sensitive and responsive maternal caregiving behavior strengthens infant self-regulatory capacities (HL), but this regulatory role may be diminished in some mothers with second-trimester prenatal exposure to depression and/ or anxiety (MDA)
Prenatal mental health measures and maternal and infant characteristics Of the 24 mothers, 12 had scores that exceeded the predefined cut-off for the Hamilton Anxiety Scale (HAM-A), or the Hamilton Depression Scale (HAM-D) or the Edinburgh Postnatal Depression Scale (EPDS)
We found that ten of 12 mothers allocated to the MDA-exposed group had comorbid anxiety and depression based on exceeding cut-off scores on two or more of the tools: HAM-A + HAM-D (n = 5) and HAM-A + HAM-D + EPDS (n = 5)

Summary

Introduction

Sensitive and responsive maternal caregiving behavior strengthens infant self-regulatory capacities (HL), but this regulatory role may be diminished in some mothers with second-trimester prenatal exposure to depression and/ or anxiety (MDA). Sensitive and responsive caregiving actions and interactions (typically provided by the mother) play a crucial role in protecting, buffering and strengthening infant ability to self-regulate to everyday stressors [1] This is important because, throughout the perinatal period, the self-regulatory capacities of the human infant continue to develop with rapid changes occurring in brain structure and function. Established evidence suggests that early exposure to everyday stressors including routine HL can overtax and disrupt the still immature newborn’s ability to self-regulate subsystems (autonomic, motor, state, attention, behavioral organization) [2], and confer damage to the structure and function of the developing pain system [3, 4]. Examples include the use of oral sucrose as well as mother driven caregiving interventions (eg., kangaroo mother care, breastfeeding, facilitated tucking) [6, 7]

Methods

Results

Discussion

Conclusion