Maternal Depressive Symptomatology Research Articles

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.

Maternal stress and depressive symptoms associated with quality of developmental care in 25 Italian Neonatal Intensive Care Units: A cross sectional observational study

BackgroundParents of very preterm infants are at great risk for experiencing stress and depression. The so called developmental care oriented approach used in Neonatal Intensive Care Units have beneficial effects for parents. However the actual level of developmental care may vary among units and little is known about how the routine adoption of developmental care affects maternal stress and depression. ObjectivesTo investigate the extent to which level of quality of developmental care routinely carried out in 25 tertiary Neonatal Intensive Care Units across Italy affects maternal stress and depression. Participants178 mothers of healthy very preterm infants with gestational age ≤29wk and/or birth weight ≤1500g and without documented neurologic pathologies were recruited consecutively. 180 full-term mothers were recruited as the control group. MethodsTo distinguish the quality of developmental care level, each unit was assessed using a specifically developed questionnaire. We compared negative emotional states of mothers by splitting the 25 Neonatal Intensive Care Units into units with high-care and low-care based on median splits for two main care factors: (1) The Infant Centered Care index (consisting of measures of parent involvement, including ability to room in, frequency and duration of kangaroo care and nursing interventions aimed at decreasing infant energy expenditure and promoting autonomic stability). (2) The Infant Pain Management index (consisting of measures to decrease painful experiences including pharmacologic and nursing care practices). Maternal stress was assessed by the Parental Stressor Scale: Neonatal Intensive Care Unit questionnaire. Maternal depressive symptomatology was assessed by the Edinburgh Postnatal Depression Scale questionnaire. ResultsPreterm mothers from low-care units in the Infant Pain Management reported higher scores in their perception of stress associated with behavior and appearance of the infant than mothers from high-care units (p=0.05). Preterm mothers from high-care units in the Infant Pain Management reported a depressive symptomatology score average similar to that reported by full-term mothers. No significant Infant Centered Care effect was found both for maternal stress and depression. ConclusionsThe findings suggest that implementing more practices useful to reduce infants’ painful experience can mitigate the stress and depressive symptomatology of the preterm mothers.

Prenatal Maternal Depression Associates with Microstructure of Right Amygdala in Neonates at Birth

Antenatal maternal cortisol levels associate with alterations in the amygdala, a structure associated with emotion regulation, in the offspring. However, because offspring brain and behavior are commonly assessed years after birth, the timing of such maternal influences is unclear. This study aimed to examine the association between antenatal maternal depressive symptomatology and neonatal amygdala volume and microstructure and thus establish evidence for the transgenerational transmission of vulnerability for affective disorders during prenatal development. Our study recruited Asian mothers at 10 to 13 weeks pregnancy and assessed maternal depression at 26 weeks gestation using the Edinburgh Postnatal Depression Scale. Structural magnetic resonance imaging and diffusion tensor imaging were performed with 157 nonsedated, 6- to 14-day-old newborns and then analyzed to extract the volume, fractional anisotropy, and axial diffusivity values of the amygdala. Adjusting for household income, maternal age, and smoking exposure, postconceptual age at magnetic resonance imaging, and birth weight, we found significantly lower fractional anisotropy (p = .009) and axial diffusivity (p = .028), but not volume (p = .993), in the right amygdala in the infants of mothers with high compared with those with low-normal Edinburgh Postnatal Depression Scale scores. The results reveal a significant relation between antenatal maternal depression and the neonatal microstructure of the right amygdala, a brain region closely associated with stress reactivity and vulnerability for mood anxiety disorders. These findings suggest the prenatal transmission of vulnerability for depression from mother to child and that interventions targeting maternal depression should begin early in pregnancy.

Does breastfeeding offer protection against maternal depressive symptomatology?: A prospective study from pregnancy to 2 years after birth.

Mothers who breastfeed typically exhibit lower levels of depressive symptomatology than mothers who do not. However, very few studies have investigated the directionality of this relationship. Of the prospective studies published, all but one focus exclusively on whether maternal depression reduces rates of subsequent breastfeeding. This study again examines this relationship, but also the reverse-that breastfeeding might predict lower levels of later depression. Using multilevel modeling, we investigated the relationship between breastfeeding and self-reported depressive symptomatology in 205 women followed prenatally and at 3, 6, 12, and 24 months after birth. Consistent with previous research, women with prenatal depressive symptomatology weaned their infants 2.3 months earlier, on average, than women without such symptomatology. We also found, however, that women who breastfed more frequently at 3 months postpartum showed greater subsequent declines in depressive symptomatology over time compared to women who breastfed less frequently, resulting in lower absolute levels of depressive symptoms by 24 months postpartum, controlling for important confounds. In sum, these findings are consistent with a bidirectional association between breastfeeding and depression, with prenatal depression predicting less breastfeeding soon after birth and breastfeeding predicting declines in maternal depression up to 2 years after birth. We discuss mechanisms that could potentially explain these associations and avenues for future research.

A longitudinal study of maternal attachment and infant developmental outcomes

Extant research has demonstrated that compared to adults with insecure attachment styles, more securely attached parents tend to be more responsive, sensitive, and involved parents, resulting in improved outcomes for their children. Less studied is the influence of a mother's attachment style on her attachment to her unborn child during pregnancy and the consequent developmental outcomes of the child during early childhood. Thus, the aim of this prospective longitudinal study was to examine the relationship between maternal-fetal attachment (MFA) during pregnancy and infant and toddler outcomes and the role of mothers' attachment style on early childhood developmental outcomes in an economically disadvantaged sample of women and their children. Gamma regression modeling demonstrated that an avoidant maternal attachment style (b = .98, 95% CI [.97, .98], p < 0.001) and post-partum depressive symptomatology (b = .97, 95% CI [.96-.99], p = 0.03) were significant predictors of early childhood development. Women demonstrating higher avoidant attachment styles and greater depressive symptomatology were more likely to have children demonstrating early childhood developmental delays than those women with less avoidant attachment styles and less depressive symptomatology. Furthermore, women reporting higher MFA during pregnancy had more secure attachment styles, and their children had more optimal early childhood development than those women reporting lower MFA and less secure attachment styles. Findings have implications for enhancing early intervention programs aimed at improving maternal and childhood outcomes. An earlier identification of disruptions in attachment may be beneficial in tailoring interventions focused on the mother-child dyad.

Maternal Symptomatology and Parent–Child Relationship Functioning in a Diverse Sample of Young Children Exposed to Trauma

Children under the age of 6 years are disproportionately exposed to interpersonal trauma. Research describing type and frequency of exposure to trauma among this young population is limited. Additionally, few studies have assessed the role of multiple indicators of parental functioning on children's behavior following trauma exposure. The current study was conducted with 216 ethnically and socioeconomically diverse mother-child dyads to examine the impact of maternal symptoms and parent-child functioning on child's behavior after trauma exposure. Children experienced an average of over 5 traumatic events prior to age 6 years, and mothers had experienced an average of over 13 traumatic events during their lifetime. With child's trauma history in the model, maternal depressive symptomatology (β = .30) and parent-child dysfunction (β = .32) each uniquely accounted for variance in children's behavioral and emotional functioning. The findings of this study underscore the need for clinical interventions that address the parent-child relationship and parental symptomatology following young children's exposure to trauma.

The Relation Between Co-rumination, Maternal Depressive Symptoms and Child Psychopathology

Little is known about which processes explain the well-established link between maternal and child symptomatology. Interpersonal coping processes may be worth exploring, as depressed mothers have characteristic coping styles that may influence interactions with their children. We examined two interpersonal coping processes as potential factors explaining how depressive symptomatology in mothers impacts child psychopathology: parent-child co-rumination (dwelling on negative affect, over-analyzing problems) and impaired problem-solving. We analyzed 198 aggressive children (most of whom also had elevated internalizing symptoms) who engaged in structured discussions with their mothers. Coders rated the extent to which dyads problem-solved and co-ruminated during discussions, and mothers filled out questionnaires assessing maternal and child symptoms. Path analysis tested whether higher levels of co-rumination and poor problem-solving statistically mediated the relation between depressive symptoms in mothers and child internalizing and externalizing behaviour. Maternal depressive symptomatology was correlated with greater child symptoms, higher rates of co-rumination and poorer problem-solving. Statistical mediation was non-significant. Results support the established link between maternal depression and child psychopathology, and suggest that dysphoric mothers and their children engage in maladaptive coping interactions.

Is Maternal Depressive Symptomatology Effective on Success of Exclusive Breastfeeding During Postpartum 6 Weeks?

The aim of this prospective study was to examine the relationship between success of exclusive breastfeeding and postpartum depressive symptomatology. Our hypothesis was that mothers with depressive symptoms initially fail exclusive breastfeeding. One hundred ninety-seven mothers were enrolled in the study. The participants were interviewed twice. The first visit was within the first 48 hours after birth. The Edinburgh Postnatal Depression Scale (EPDS) was completed by the participants. The second interview was performed at 6 weeks. Participants answered questions regarding methods of breastfeeding for 6 weeks, any methodological problems, and nipple pain. The EPDS was again completed by the participants at 6 weeks. All newborns were term infants. All the participants were divided into two groups: exclusive breastfeeding and mixed-feeding (partial breastfeeding and/or bottle feeding). Both groups were compared in terms of features, such as mode of delivery, parity, prevalence of depressive symptomatology (at 48 hours and 6 weeks), and delayed onset of lactation within the first 48 hours. Statistical significance was found for only three variables: delayed onset of lactation within the first 48 hours, gestational age, and the problems related to breastfeeding methods. Clinicians should pay special attention to any lactation difficulty during the first week postpartum. Early lactation difficulties are associated with greater risk of early termination of breastfeeding and lower breastfeeding success.

1294 Is Maternal Depressive Symptomatology Effective on Exclusive Breastfeeding During Postpartum 6 Weeks?

AimThe aim of this prospective study was to examine the relationship between exclusive breastfeeding and postpartum depressive symptomatology. Our hypothesis was that mothers with depressive symptoms initially, fail exclusive breastfeeding.MethodsOne...

Re: Maternal Depressive Symptomatology: 16-Month Follow-up of Infant and Maternal Health-Related Quality of Life

As a Doctor of Nursing Practice working as Nursing Unit Director in a maternal/newborn setting at an academic medical center, I read with great interest Darcy et al's[1][1] recent article “Maternal Depressive Symptomatology: 16-Month Follow-up of Infant and Maternal Health-Related Quality of Life

Interactive Relations Among Maternal Depressive Symptomatology, Nutrition, and Parenting

Theoretical models linking maternal nutrition, depressive symptomatology, and parenting are underdeveloped. However, existing literature suggests that iron status and depressive symptomatology interact in relation to problematic parenting styles (authoritarian, permissive). Therefore, in the current study the authors investigate these interactive relations in a sample of breastfeeding mothers (n = 105) interviewed at three months postpartum. Participants completed questionnaires (from December 2008 to January 2011) regarding their depressive symptomatology and parenting styles. Iron status (i.e., hemoglobin, soluble transferrin receptors, and serum ferritin concentrations) was assessed from blood samples. Significant interactions were found between iron status and depressive symptomatology in relation to authoritarian parenting style (low warmth, high punishment and directiveness). For those women with hemoglobin below 14.00 g/dL, depressive symptomatology was positively related to authoritarian parenting style (p < 0.001). Thus, screening for poor iron status and depressive sympatomology in postpartum women may help to identify those at risk for problematic parenting. Dietary interventions may help to eliminate relations between depressive symptoms and problematic parenting.

T-O-125 INFANT SLEEP LOCATION: BED SHARING, ROOM SHARING AND SOLITARY SLEEPING AT 6 AND 12WEEKS POSTPARTUM

Objectives: Parents may have their infant sleep with them in the same bed (bed sharing (BS)), in the same room, but a separate bed (room sharing (RS)), or a separate room in a separate bed (solitary sleeping (SS)); prevalence estimates of these choices are limited. Little is known regarding the effects of infant sleep location (ISL) on infant or maternal sleep or other health outcomes. Methods: Healthy first-time mothers (n=246) in an RCT of a sleep intervention provided information regarding planned and actual ISL at 6 and 12 weeks postpartum when maternal and infant sleep were measured using actigraphy. Other outcomes included subjective maternal sleep disturbance, breastfeeding exclusivity, fatigue, and depressive symptomatology. Results: Most women (65%) planned RS with their infant; the next most common plan was to use both BS and RS (22%). The most common usual ISL was RS, with 46% of infants RS at 6 weeks and 39% at 12 weeks. Usual BS was common; at 6 weeks 17% of families were usually BS and 12% at 12 weeks. BS to any extent was quite common at 6 (51%) and 12 weeks (41%) postpartum. At 6 weeks, usually BS mothers had shorter stretches of sleep than those usually SS (130 mins vs 156 mins ; p=0.03) and more awakenings than those usually RS and SS (11.2 vs 8.9 vs 8.3; p=0.001). At 12 weeks, mothers who were usually RS had shorter stretches of sleep than those usually SS (164 mins vs 192 mins; p=0.04). There were no significant differences between ISL groups on any other outcomes.

Larger amygdala but no change in hippocampal volume in 10-year-old children exposed to maternal depressive symptomatology since birth

Maternal separation and poor maternal care in animals have been shown to have important effects on the developing hippocampus and amygdala. In humans, children exposed to abuse/maltreatment or orphanage rearing do not present changes in hippocampal volumes. However, children reared in orphanages present enlarged amygdala volumes, suggesting that the amygdala may be particularly sensitive to severely disturbed (i.e., discontinous, neglectful) care in infancy. Maternal depressive symptomatology has been associated with reductions in overall sensitivity to the infant, and with an increased rate of withdrawn, disengaged behaviors. To determine if poor maternal care associated with maternal depressive symptomatology has a similar pattern of association to the volumes of the hippocampus and amygdala in children, as is the case for severely disturbed infant care (orphanage rearing), we measured hippocampal and amygdala volumes as well as stress hormone (glucocorticoid) levels in children exposed (n = 17) or not (n = 21) to maternal depressive symptomatology since birth. Results revealed no group difference in hippocampal volumes, but larger left and right amygdala volumes and increased levels of glucocorticoids in the children of mothers presenting depressive symptomatology since birth. Moreover, a significant positive correlation was observed between mothers' mean depressive scores and amygdala volumes in their children. The results of this study suggest that amygdala volume in human children may represent an early marker of biological sensitivity to quality of maternal care.

Physiological regulation in cigarette exposed infants: An examination of potential moderators

The primary purpose of this study was to examine pathways from prenatal cigarette exposure to physiological regulation at 2 months of age. Specifically, we explored the possibility that any association between prenatal cigarette exposure and infant physiological regulation was moderated by fetal growth, prenatal or postnatal environmental tobacco smoke (ETS) exposure or maternal depressive symptomatology during pregnancy. We evaluated whether exposed infants who were also exposed to ETS after birth, were small for gestational age (SGA) or had mothers with higher depressive symptoms during pregnancy had the highest levels of physiological dysregulation. Respiratory sinus arrhythmia (RSA) was obtained from 234 (166 exposed and 68 nonexposed) infants during sleep. As expected, cigarette-exposed infants had significantly lower RSA than nonexposed infants. This association was not moderated by prenatal or postnatal ETS exposure, or maternal depressive symptomatology during pregnancy. However, small for gestational age status did moderate this association such that nonexposed infants who were not small for gestational age had a significantly higher RSA than nonexposed small for gestational age infants and exposed infants. These findings provide additional evidence that prenatal cigarette exposure is directly associated with dysregulation during infancy.

The impact of allostatic load on maternal sympathovagal functioning in stressful child contexts: Implications for problematic parenting

The present study applies an allostatic load framework to an examination of the relationship between maternal psychosocial risk factors and maladaptive parenting behaviors. Specifically, the implications of low socioeconomic status and maternal depressive symptoms for maternal sympathovagal functioning during young children's distress were examined, as well as whether that functioning was, in turn, associated with maternal insensitivity, hostility, intrusiveness, and disengagement during mother-child dyadic interaction. Consistent with an allostatic framework, three patterns of sympathovagal functioning were expected to emerge: normative arousal, hyperarousal, and hypoarousal profiles. Furthermore, meaningful associations between maternal psychosocial risk factors, maladaptive parenting behaviors, and the three profiles of sympathovagal functioning were anticipated. Participants included 153 mother-toddler dyads recruited proportionately from lower and middle socioeconomic status backgrounds. Mothers' sympathovagal response to their child's distress was assessed during the Strange Situation paradigm, and mothers' parenting behavior was assessed during a dyadic free-play interaction. As hypothesized, normative arousal, hyperarousal, and hypoarousal profiles of maternal sympathovagal functioning were identified. Maternal depressive symptomatology predicted the hyperarousal profile, whereas socioeconomic adversity predicted hypoarousal. Moreover, allostatic load profiles were differentially associated with problematic parenting behaviors. These findings underscore the role of physiological dysregulation as a mechanism in the relationship between proximal risk factors and actual maladaptive parenting behaviors.

Maternal Depressive Symptomatology: 16-Month Follow-up of Infant and Maternal Health-Related Quality of Life

The purpose of this study was to document risk factors for depressive symptoms during the postpartum period among working mothers and to determine longitudinal effects of depressive symptoms on maternal health-related quality of life and infant health and development. Mother-infant dyads from a community-based cohort study of working mothers were recruited when infants were 4 months old and were interviewed every 4 months until infants were 16 months old. Depressive symptoms and health-related quality of life were assessed using the Center for Epidemiologic Studies Depression Scale and the Short Form-12 Health Survey, respectively. Infant development and health-related quality of life were measured with the Ages and Stages Questionnaire and the Infant-Toddler Quality of Life Questionnaire, respectively. Depressive symptoms were elevated among mothers who were younger, less educated, African American, unmarried, and impoverished. Mothers with significant depressive symptoms had significantly poorer physical and mental health-related quality of life, reported greater pain for their infant, and had more health-related concerns about their child. Maternal depressive symptoms at 4 months predicted infant poorer health-related quality of life at 8, 12, and 16 months. Several characteristics, including age, education level, race, marital status, and poverty, can help primary care physicians identify working mothers at risk for depressive symptoms. Identification of these symptoms is important; they are correlated with poorer maternal health-related quality of life and they predict poorer children's health-related quality of life.

Prospective study of maternal depressive symptomatology among Japanese women

Background The primary objective of this study was to analyze the pattern of depressive moods related to pregnancy and postpartum in a dataset collected prospectively. A secondary objective was to assess the association between (1) low moods during pregnancy and postpartum depressive symptoms, and (2) maternity blues and postpartum depressive symptom. Method Three hundred eighty-seven women completed self-administered questionnaires. The participants were asked to respond to Stein's Maternity Blues Scale (Stein's Scale) on five consecutive days after delivery and to the Edinburgh Postnatal Depression Scale (EPDS) during both pregnancy and postpartum. Results 32.0% of the women were identified as having a score of more than 9 on EPDS during pregnancy and postpartum. 21.6% of the women scored above the Stein's Scale cut-off point for at least 1 day during the 5-day period following delivery. The odds ratio (95% CI) for postpartum low mood if the women experienced low mood during pregnancy was 4.46 (2.48–8.04), while the odds ratio for postpartum depressive symptoms if the women experienced symptoms of maternity blues was 5.48 (2.74–10.98). In logistic regression analysis, the number of days in which women scored over the cut-off point by Stein's Scale proved to be the more significant predictor of scoring over the EPDS cutoff (8/9) [OR (95% CI)=2.74 (1.89–3.96)]. Conclusion The rate of maternity blues in our findings was similar to the rates previously reported in Japan, but lower than the rates observed in Western countries. Furthermore, our longitudinal study confirms the likelihood of subsequent postpartum depressive symptoms if low moods during pregnancy and/or maternity blues are present.

Maternal depressive symptomatology and child behavior: transactional relationship with simultaneous bidirectional coupling.

The present study investigated reciprocal relationships between adolescent mothers and their children's well-being through an analysis of the coupling relationship of mothers' depressive symptomatology and children's internalizing and externalizing behaviors. Unlike studies using discrete time analyses, the present study used dynamical systems to model time continuously, which allowed for the study of dynamic, transactional effects between members of each dyad. Findings provided evidence of coupling between maternal depressive symptoms and children's behaviors. The most robust finding was that as maternal depressive symptoms became more or less severe, children's behavior problems increased or decreased in a reciprocal manner. Results from this study extended upon theoretical contributions of such authors as Richters (1997) and Granic and Hollenstein (2003), providing empirical validation from a longitudinal study for understanding the ongoing, dynamic relationships between at-risk mothers and their children.

Maternal Depressive Symptoms in Relation to Perinatal Mortality and Morbidity: Results From a Large Multiethnic Cohort Study

To explore whether 1) maternal depressive symptoms during pregnancy are associated with preterm birth (PTB), small for gestational age (SGA), a low Apgar score and child loss; 2) maternal smoking mediates the associations; and 3) the associations differ by ethnic background. Pregnant women in Amsterdam were approached during their first prenatal visit to participate in the Amsterdam Born Children and their Development study. They filled out a questionnaire covering sociodemographic data, life-style, and (psychosocial) health. Depressive symptoms were assessed with the Center for Epidemiologic Studies Depression scale. The baseline sample consisted of 8,052 women; the main ethnic groups were: Dutch, Creole, Turkish, and Moroccan. The prevalence of perinatal outcomes was: 5.4% (PTB); 12.3% (SGA); l 1.5% (low Apgar score); and 1.4% (child loss). The prevalence of high depressive symptomatology was 30.6%. After adjustment for maternal age, parity, education, ethnicity, prepregnancy body mass index, hypertension, alcohol and drug use, and a small mediation effect of maternal smoking, high versus low levels of depressive symptoms were associated with SGA (odds ratio [OR], 1.19; p = .02) and a low Apgar score (OR, 1.74; p = .01), but not with PTB (OR, 1.16; p = .18) and child loss (OR, 1.28; p = .24). Stratified analyses by ethnic background showed a tendency toward higher risks, although insignificant, among Creole women. Several pathways may explain the detrimental effects of maternal depressive symptomatology on perinatal health outcomes, including a psychoendocrinological pathway involving the hormone cortisol or mediation effects by maternal risk behaviors. Further research should explore the underlying pathways, in particular among ethnic subgroups.

Enhancing attachment security in the infants of women in a jail-diversion program

Pregnant female offenders face multiple adversities that make successful parenting difficult. As a result, their children are at risk of developing insecure attachment and attachment disorganization, both of which are associated with an increased likelihood of poor developmental outcomes. We evaluated the outcomes of participants in Tamar's Children, a 15-month jail-diversion intervention for pregnant, nonviolent offenders with a history of substance abuse. All women received extensive wrap-around social services as well as the Circle of Security Perinatal Protocol (Cooper, Hoffman, & Powell, 2003). We present data on 20 women and their infants who completed the full dosage of treatment (a residential-living phase from pregnancy until infant age six months and community-living phase until 12 months). Results indicated that (1) program infants had rates of attachment security and attachment disorganization comparable to rates typically found in low-risk samples (and more favorable than those typically found in high-risk samples); (2) program mothers had levels of maternal sensitivity comparable to mothers in an existing community comparison group; and (3) improvement over time emerged for maternal depressive symptomatology, but not other aspects of maternal functioning. Given the lack of a randomized control group, results are discussed in terms of the exploratory, program-development nature of the study.