Maternal-infant Relationship Research Articles

Family-centered care for newborns: a global perspective and review.

Person-centered models of care built on newborn and family needs and rights, such as nonseparation immediately after birth and during the care process, can address the complex needs of the newborn, family, and health system. This is particularly important in low- and middle-income countries, where cost-effective modalities are highly needed to accelerate the survival of newborn babies. We conducted a systematic review to explore country experiences on implementation and challenges to implement and scale-up family-centered newborn care models of care. MEDLINE, CINAHL, EMBASE, and PsycINFO databases were searched to identify studies on patient-centered care and newborns between 1990 and 2023. Studies meeting our predefined inclusion criteria were quality assessed and relevant data extracted. We utilized the World Health Organization framework on integrated people-centered health services to summarize and analyze findings while highlighting patterns. Forty-one studies were included for review (including approximately 60% from low- and middle-income countries). Different research conducted over time highlighted how immediate and uninterrupted skin-to-skin care facilitates a series of critical processes for newborns, parents, and health system, including breastfeeding initiation and exclusivity rates, reduced incidence of post-partum depression, and prevention of infection and hospitalization. Thanks to the close contact of the kangaroo position or skin-to-skin contact, parents recount becoming more and more attached to and familiar with their baby, easily establishing a relationship. Overall, countries could transform the newborn care service in terms of family center care by adopting three simple rules: (i) minimizing mother-child separation; (ii) involving fathers; (iii) empowering parents from the time of birth. A paradigm shift is required to change the conventional model of provider-centric care to one of person-centered neonatal health care. Such an approach is feasible in diverse country settings and should be facilitated through political commitment and policies enabling early focus on the maternal-infant relationship. This could, in turn, help achieve improved dignity of care and help create a more efficient and responsive health system and society.

The Experience of Phenylketonuria in Pregnancy and the Developing Maternal-Infant Relationship: A Qualitative Study.

Phenylketonuria (PKU) is a rare metabolic condition characterised by an inability to metabolise phenylalanine (Phe), found in many foods. When pregnant with PKU, women must adhere to a strict low-Phe diet. If they do not, foetal abnormalities or pregnancy loss can occur. Pregnancies are therefore closely clinically monitored and dominated by dietary management, leaving little "space" for women's emotional experience. This article explores the emotional impact of PKU during pregnancy and how this effects pre-natal bonding. Based on interviews with six women with PKU, conducted whilst they were pregnant, this article explores their unusual and previously undocumented experience. Image-making during interviews allowed women to uncover aspects of their experience that might otherwise have remained hidden. Interpretative phenomenological analysis of the transcripts and images generated five themes summarising the women's experiences. Some themes reiterated findings from previous studies, for example, the huge cognitive burden associated with PKU pregnancies and the importance of both expert and informal support to successful pregnancy management. However, new understanding also emerged, including rich description of the emotional load of these pregnancies and strategies that women use to manage this. Anxiety about baby safety was central to their experiences, and the effect of this on pre-natal bonding was explored. This article calls for increased formal and informal support for women with the emotional aspects of their PKU pregnancies, for example, the creation of "attachment-aware" services that support women with their anxiety, promoting strong pre-natal attachment and subsequently protecting maternal and infant mental health throughout pregnancy and beyond.

The Protective Role of Maternal-Fetal Bonding for Postpartum Bonding Following a NICU Admission.

Admission of a newborn to a neonatal intensive care unit (NICU) can be a highly stressful event that affects maternal psychological well-being and disrupts the early maternal-infant bonding relationship. Determining factors that promote maternal-infant bonding among those with a NICU admission is essential for the development of effective interventions. Using a longitudinal clinic-based sample of diverse and low-income pregnant women, we examined whether maternal-fetal bonding measured during the second trimester moderated the association between NICU admission and postpartum bonding measured at six months post birth, controlling for demographic characteristics. Approximately 18% of the sample experienced a NICU admission at birth. NICU admission was associated with lower postpartum bonding (b = -8.74; p < .001, Model 1), whereas maternal-fetal bonding was associated with higher bonding reported at six months postpartum (b = 3.74, p < .001, Model 2). Results of the interaction revealed that women who reported higher maternal-fetal bonding reported higher postnatal bonding regardless of NICU admission status. Because maternal-fetal bonding can be enhanced through intervention, it is a promising target for reducing the risks of NICU admission for the early maternal-infant relationship.

A virtual mother-infant postpartum psychotherapy group for mothers with a history of adverse childhood experiences: open-label feasibility study

ObjectivesMothers with a history of adverse childhood experiences (ACE) are at elevated risk for postpartum mental illness and impairment in the mother-infant relationship. Interventions attending to maternal-infant interactions may improve outcomes for these parents and their children, but barriers to accessing in-person postpartum care limit uptake. We adapted a postpartum psychotherapy group for mothers with mental illness (e.g., mood, anxiety, trauma-related disorders) and ACE for live video-based delivery, and evaluated feasibility, acceptability, and preliminary efficacy in an open-label pilot study.MethodsWe recruited adults with children (6–18 months) from a perinatal psychiatry program in Toronto, Canada. The intervention was a live video-based 12-week interactive psychotherapy group focused on maternal symptoms and maternal-infant relationships. The primary outcome was feasibility, including feasibility of recruitment and retention, fidelity of the intervention, and acceptability to patients and group providers. Maternal clinical outcomes were compared pre- to post-intervention, as secondary outcomes.ResultsWe recruited 31 participants (mean age 36.5 years (SD 3.9)) into 6 groups; 93.6% (n = 29) completed post-group questionnaires, and n = 20 completed an optional post-group acceptability interview. Mean weekly group attendance was 83% (IQR 80–87); one participant (3.2%) dropped out. All group components were implemented as planned, except for dyadic exercises where facilitator observation of dyads was replaced with unobserved mother-infant exercises followed by in-group reflection. Participant acceptability was high (100% indicated the virtual group was easy to access, beneficial, and reduced barriers to care). Mean maternal depressive [Edinburgh Postnatal Depression Scale: 14.6 (SD 4.2) vs. 11.8 (SD 4.2), paired t, p = 0.005] and post-traumatic stress [Posttraumatic Stress Disorder Checklist for DSM-5: 35.5 (SD 19.0) vs. 27.1 (SD 16.7)], paired t, p = 0.01] symptoms were significantly lower post vs. pre-group. No differences were observed on mean measures of anxiety, emotion regulation or parenting stress.ConclusionsRecruitment and retention met a priori feasibility criteria. There were significant pre- to post-group reductions in maternal depressive and post-traumatic symptoms, supporting proceeding to larger-scale implementation and evaluation of the intervention, with adaptation of dyadic exercises.

Postpartum Depression and Maternal Care: Exploring the Complex Effects on Mothers and Infants.

Postpartum depression (PPD) is a common and debilitating mental health condition affecting many mothers worldwide. This review article aims to explore the complex effects of PPD on mothers and infants, focusing on maternal care. The transition to motherhood is a critical period characterized by numerous physical, psychological, and social changes, making women vulnerable to the onset of PPD. Consequently, PPD can significantly impact a mother's ability to provide optimal care for her infant, leading to potential adverse consequences for both parties. The article synthesizes existing research literature on the topic, encompassing studies from various disciplines, including psychology, psychiatry, obstetrics, and pediatrics. It begins by providing an overview of the prevalence and risk factors associated with PPD, emphasizing the importance of early detection and intervention. The impact of PPD on maternal caregiving behaviors, such as bonding, sensitivity, and responsiveness, is then examined, highlighting the potential disruptions in the mother-infant relationship. Furthermore, the article delves into the potential consequences of impaired maternal care on infant development, including emotional, cognitive, and social domains. Several factors contributing to the complex interplay between PPD and maternal care are discussed, including hormonal changes, psychosocial stressors, and the influence of social support networks. The review also addresses the bidirectional nature of the mother-infant relationship, whereby infant characteristics and behaviors can exacerbate or mitigate the effects of PPD on maternal care. Moreover, the article explores the role of healthcare providers and the importance of implementing effective screening, assessment, and treatment strategies for PPD to promote optimal maternal-infant outcomes. By consolidating current knowledge on the topic, this review article provides valuable insights into the multifaceted effects of PPD on both mothers and infants. Recognizing the significance of maternal care and understanding the mechanisms through which PPD disrupts it can inform the development of targeted interventions to promote early detection, effective treatment, and supportive interventions for mothers experiencing PPD. Ultimately, improving maternal mental health and enhancing maternal-infant relationships can yield long-term positive effects on mothers' and infants' well-being and development.

The role of midwives in supporting the development of the mother-infant relationship: a scoping review

BackgroundThe mother-infant relationship is complex and dynamic, informing the psychological development of the infant through bonding and attachment. Positive early interactions influence the quality of this relationship. Midwives are well placed to support the developing relationship between the mother and baby, yet there has been limited research exploring the role of the midwife in this context.AimTo explore interventions that have been provided by the midwife which support the development of the maternal-fetal or mother-infant relationship amongst a low-risk population from pregnancy, and up to six weeks postnatal. The review also sought to understand the types of interventions developed, format and delivery, outcomes measured and if cultural considerations had been incorporated.MethodsA scoping review of the research literature was undertaken using the Joanna Briggs Institute framework. Five online databases were searched for relevant articles published in English from 2000 to 2021.FindingsSixteen articles met the inclusion criteria. Three themes emerged: (1) viewing the fetus as separate from the mother, (2) focused activities on the maternal-infant relationship and (3) targeted educational interventions.DiscussionProviding focused activities and targeted education during the pre and postnatal periods support the development of the mother-infant relationship. Significantly, there was insufficient research that considered the influence of culture in supporting the mother-infant relationship.ConclusionFurther research is required to develop interventions that include a diverse sample to ensure culturally appropriate activities can be integrated into care during pregnancy and/or the postnatal period provided by midwives.

Leptin, Adiponectin, and Melatonin Modulate Colostrum Lymphocytes in Mothers with Obesity.

Pregnancy complicated by obesity is associated with adverse triggered gestational and neonatal outcomes, with reductions in the subtypes of CD4+ T-lymphocytes representing the modulators of inflammation. It needs to be better established how maternal nutritional statuses impact the neuroendocrine-immune system's action and affect the immunological mechanisms of the maternal-infant relationship via breastfeeding. This study examined the effects of maternal obesity on human colostrum lymphocytes and the intracellular mechanisms of lymphocyte modulation in the presence of leptin, adiponectin, and melatonin via cell proliferation; the release of intracellular calcium; and apoptosis induction. This cross-sectional study analyzed colostrum samples from 52 puerperal splits and divided them into overweight and eutrophic groups. Colostrum lymphocytes underwent immunophenotyping and cell proliferation by flow cytometry and intracellular calcium release and apoptosis assays by immunofluorescence in the presence or absence of hormones. Significant differences were considered when p < 0.05 by the chi-square or t-test. Maternal obesity reduced the population of T-lymphocytes and TCD4+ in human colostrum and proliferative activities (p < 0.05). These hormones restore lymphocyte proliferation to a level similar to the eutrophic group (p < 0.05). Leptin, adiponectin, melatonin hormones, and biological actions consolidated in the scientific literature also represent maternal and infant protection mechanisms via colostrum and the modulation of human colostrum lymphocytes.

Relationship among Maternal Perception of Childbirth Experience, Spiritual Health and Maternal-Infant Relationship in the Postpartum Women: A Cross-Sectional Study.

Birth represents an influential moment in women's lives that can be a powerful or traumatic experience. Therefore, the aim of this study was to assess the relationship among maternal perception of childbirth experience, spiritual health, and maternal-infant relationship in the postpartum women. This descriptive-analytical study was conducted on 305 postpartum women referred to Health Centers in Karaj. The data were collected using the Perception of Birth Scale (POBS), maternal postnatal relationship scale, and spiritual health questionnaire. In this study, the mean (standard deviation (SD) age of the participants was 27.50 (5.56) years. The Spearman's correlation test results showed that there was a significant positive relationship among the maternal perception of childbirth experience, the general maternal-infant relationship (r = 0.34, p < 0.001), quality of relationship (r = 0.17, p = 0.002), pleasure with interaction (r = 0.32, p < 0.001), and absence of hostility (r = 0.28, p < 0.001). In addition, a positive relationship was observed among spiritual health and general maternal-infant relationship (r = 0.21, p < 0.001), pleasure in interaction (r = 0.08, p = 0.164), absence of hostility (r = 0.15, p = 0.008), and the maternal perception of childbirth experience (r = 0.11, p = 0.039). It seems that to promote maternal-infant relationship, health care providers should not only try to promote physical intimacy between mother and infant but also create a positive emotional state for the mother during birth.

Prevalence and risk factors of postpartum depression in sub-Himalayan region

BackgroundPostpartum depression (PPD) is a common problem faced by women after childbirth. The adverse effects of PPD upon the maternal-infant relationship and child development reinforce the need for early identification and effective treatment models. This study intends to add to the existing knowledge about the prevalence of PPD and its associated risk factors in the hilly region in Himachal Pradesh. MethodsA hospital-based cross-sectional study was conducted on 426 women presenting for a postpartum visit at 6 weeks postpartum. Sociodemographic characteristics were recorded on a pretested questionnaire. Women were screened for postpartum depression using a validated EPDS (Edinburgh postnatal depression scale) prestructured questionnaire with 10 questions. Women were divided into two groups based on screening results. ResultsThe overall prevalence of PPD in the study was 17.4%. Out of sociodemographic factors, age (0.010) and family structure (0.008) were found to be significant. Nuclear family women were more prone to PPD. Domestic abuse (<0.001) is also a leading factor for PPD. By comparing obstetric and gender issues, it was found that the total number of previous living children (p-value <0.001), gender of previous living children (<0.001), and gender of newborns (<0.001) are the major determining factors of PPD. Another factor that was significantly related to PPD was an unwanted pregnancy. ConclusionsWe have found a high prevalence of PPD in our region that does not have screening protocols for the screening of such patients. We, therefore, propose routine screening for postpartum depression at 6 weeks postpartum.

Evaluation of a collaborative group intervention for mothers with moderate to severe perinatal mental illness and their infants in Australia.

ABSTRACTPerinatal mental illness is a known risk to maternal–infant attachment and healthy infant development. Mothers experiencing complex mental health issues in the first year following birth are less likely to become involved in parenting programs or day stay interventions because of their mental health difficulties and perceived stigma. Currently, most perinatal day or group treatment programs only include the mother and not their infant. This paper describes “Together in Mind,” a perinatal and infant mental health day program developed by the Queensland Centre for Perinatal and Infant Mental Health, targeting mothers with moderate to severe mental illness and their infants under 12 months. The service model was a 6‐week, 1 day per week psychoeducation intervention. Psychoeducational material and support were provided across each day session by an adult perinatal mental health clinician, an infant mental health clinician, and a child health nurse working in collaboration. The program was trialed across seven Hospital and Health Service sites in Queensland, Australia, during 2016–18. In total, 24 group day programs were delivered with 84 mothers and their infants. Pre and post intervention quantitative measures and a post‐program qualitative survey about participant satisfaction were collected. Statistically significant improvements in all quantitative measures showed a large to medium effect size on the: Health of the Nation Outcome Scale (HoNOS) (d = 0.82; p < .000); Depression, Anxiety and Stress Scale (DASS‐21) (d = 0.5; p < .000); Karitane Parenting Confidence Scale (KPCS) (d = 0.63; p < .000); Maternal Postnatal Attachment Scale (MPAS) (d = 0.49; p < .000), Ages and Stages Questionnaire: Social‐Emotional (6 months) (d = 0.83; p < .000). The results indicate collaboration and early intervention contributes to strengthening the emerging development of the maternal–infant relationship within the context of complex maternal mental health issues.

Personalized Profiling Reveals Donor- and Lactation-Specific Trends in the Human Milk Proteome and Peptidome

ABSTRACTBackgroundHuman milk is the most genuine form of personalized nutrition, whereby its nutritional and bioactive constituents support the changing needs of the growing infant. Personalized proteome profiling strategies may provide insights into maternal–infant relationships. Proteins and endogenous peptides in human milk play an important role as nutrients for growth and have distinct functionality such as immune defense. Comprehensive monitoring of all of the human milk proteinaceous components, including endogenous peptides, is required to fully understand the changing role of the human milk proteome throughout lactation.ObjectiveWe aimed to investigate the personalized nature of the human milk proteome and peptidome for individual mother–infant dyads.MethodsTwo individual healthy milk donors, aged 29 and 32 y and both of a normal BMI, were longitudinally observed over weeks 1, 2, 3, 4, 6, 8, 10, 12, and 16 postpartum. Milk collection was standardized. Comprehensive variations in the human milk proteinaceous components were assessed using quantitative LC-MS/MS methods.ResultsWe longitudinally profiled the concentrations of >1300 milk proteins and 2000 endogenous milk peptides spanning 16 wk of lactation for 2 individual donors. We observed many gradual and alike changes in both donors related to temporal effects, for instance early lactation was marked by high concentrations of proteins and peptides involved in lactose synthesis and immune development. Uniquely, in 1 of the 2 donors, we observed a substantial anomaly in the milk composition, exclusively at week 6, likely indicating a response to inflammation and/or infection.ConclusionsHere, we provide a resource for characterizing the lactational changes in the human milk proteome, encompassing thousands of proteins and endogenous peptides. Further, we demonstrate the feasibility and benefit of personalized profiling to monitor the influence of milk on the development of the newborn, as well as the health status of each individual mother–infant pair.

Social determinants of health, adverse childhood experiences, and maternal-infant relationship

Abstract Background Low strength of maternal-infant relationship (MIR) is consistently associated with early childhood obesity risk. Because obesity often persists once it develops, primary prevention is needed early. Home visiting programs support families with social determinants of health (SDH) and adverse childhood experiences (ACEs); SDH and ACEs contribute to health inequities. Addressing SDH and ACEs may facilitate improvements in MIR and ultimately mitigate early childhood obesity risk. Limited to no research has examined the association between ACEs, SDH, and MIR. In the context of a national, evidence-based home visiting program, we asked: are SDH and ACEs associated with low MIR? Methods This sample includes 6,972 children ages 0–&amp;lt;24 months enrolled in the Parents as Teachers home visiting program across the United States from sites using the Life Skills Progression (LSP) instrument through February 2020. Low MIR is dichotomized from a 1-5 scale, with low scores reflecting low nurturing, bonding, and responsiveness. We used the literature, theory, and a stepwise logistic regression model-building process to identify a parsimonious model for MIR. Results Preliminary results reflect 34.2% Hispanic or Latino, 22.7% non-Hispanic Black, 35.3% non-Hispanic Other race; 83.9% low income; 36.9% low education; and 13.4% mothers scoring low for MIR. Notable findings from modeling include: physical ACEs, captured here as child abuse or neglect (OR: 5.01, 95% CI: 4.10-6.11); mental illness ACEs, captured here as a mother/parent with mental illness (OR: 1.31, 95% CI: 1.05-1.63), or the mother/parent treated violently (OR: 1.95, 95% CI: 1.56-2.40). Protective associations include mothers' support of child development and self-esteem scores. Conclusions Understanding the complex interplay of SDH, ACEs, and MIR is critical for developing interventions that address “upstream” family characteristics in order to mitigate early childhood obesity risk. ACEs play a predominant role. Key messages This is the first known study to concurrently examine maternal-infant relationship, social determinants of health, and adverse childhood experiences. Home visiting programs may be critical partners in addressing these needs given their reach.

The effects of health counselling and follow-up care on maternal-infant attachment

ABSTRACT The aim of this study was to determine the effectiveness of follow-up care and health counselling provided by midwives and nurses in maternal-infant attachment level and relationships between sociodemographic factors. The study was designed as a quasi-experimental pattern with a control group on pretest-posttest. The sample size was determined using a power analysis and a total of 90 people were included in the study. The study demonstrated that the mean PAI score was high both in experimental and control groups and there was no difference between the groups (p > 0.05). In both groups, the mean MAI score was above the average scale score, but it was significantly higher in the group receiving health counselling and follow-up care compared to the score of the other group (p < 0.05). The study demonstrated that health counselling and follow-up care contributed significantly to the mother-infant attachment.

Interventions to Improve Maternal-Infant Relationships in Mothers With Postpartum Mood Disorders.

During the postpartum period, women may have changes in their mental health and experience postpartum mood disorders. Postpartum depression (PPD) is an especially prevalent postpartum mood disorder, affecting 10% to 15% of new mothers. Although PPD has detrimental effects on women's health, it can also affect maternal-infant attachment, bonding, and interaction, which influence the maternal-infant relationship and can lead to poor outcomes for infants later in life. The purpose of this review is to identify effective strategies for improving the maternal-infant relationship for mothers with postpartum mood disorders. A literature search was conducted via three databases: PubMed, Cochrane Library, and Medline using key search terms. A total of 1,347 articles were scanned to determine their relevance; 19 articles were selected for review. Inclusion criteria included articles in English that focused in the postpartum period and measured outcomes related to the maternal-infant relationship. Infant massage appears to benefit the maternal-infant relationship, whereas psychotherapy and education had mixed results. Pharmacological interventions were not found to improve maternal-infant relationships. Family involvement was shown to improve infant attachment, but not the maternal-infant relationship. Nurses should be aware of the importance of including interventions targeted at improving the maternal-infant relationship for women with postpartum mood disorders, especially PPD. However, data are limited, thus more research is needed to develop evidence-based strategies that can be implemented to support women experiencing postpartum mood disorders and their infants.

Infant Analgesia With a Combination of Breast Milk, Glucose, or Maternal Holding.

We studied neonatal cortical brain response to 4 types of nonpharmacological analgesia (oral glucose, expressed breast milk, maternal holding plus oral glucose, breastfeeding). We aimed to assess the differential effect of oral solutions (glucose, breast milk) given alone or combined with the maternal-infant relationship (holding, breastfeeding). Eighty healthy term newborns undergoing a heel stick were randomly assigned to 4 parallel groups of 20 infants each: group 1, infants received a glucose solution on a changing table; group 2, infants received expressed breast milk on a changing table; group 3, infants received a glucose solution in their mothers' arms; and group 4, infants were breastfed by their mothers. Cortical activation in parietal, temporal, and frontal cortices was assessed by multichannel near-infrared spectroscopy. Pain expression was also evaluated. Oral glucose alone or combined with maternal holding was associated with no cortical activation during heel stick. Expressed breast milk was associated with localized bilateral activation of somatosensory and motor cortices (P < .01). Breastfeeding was associated with extensive bilateral activation of somatomotor, somatosensory, and right parietal cortices (P < .01). Pain expression was lower with the maternal-infant relationship (P = .007). Oral glucose, either alone or combined with maternal holding, appears to block or weaken cortical pain processing. Breast milk alone is associated with localized cortical activation. Breastfeeding is associated with extensive activation and may act by extending cortical processing. Maternal relationship, both combined with oral glucose and in breastfeeding, shows the greatest analgesic effect, although the neural patterns involved are distributed differently.

THE FEASIBILITY OF USING "PREMIESTART," A MOTHER-PREMATURE INFANT INTERACTION PROGRAM, ON A NEONATAL UNIT IN ENGLAND.

This article explores the feasibility of running "PremieStart," a nine-individual-session maternal-premature infant interaction program, within a neonatal unit (NNU) in England. Four mothers of premature infants completed seven sessions on the NNU and two at home. Mothers and NNU staff provided feedback on PremieStart. Measures of maternal-infant relationship, maternal well-being, and maternal reflective functioning were completed before and after intervention. Thematic analysis of mothers' feedback highlighted the emotional, but cathartic, experience of engaging with PremieStart. NNU staff feedback indicated the need to include them more in PremieStart. Both mothers and staff were supportive of future implementation of PremieStart and highlighted the ongoing need for psychological support on the NNU. PremieStart was implemented with positive feedback from mothers and staff, with support shown for the continued use of PremieStart in the NNU. However, for future implementation, the self-report outcome measures need reviewing, and more involvement of fathers and NNU staff is needed. In addition, a larger sample with a control group should be utilized.

Risk Factors for Childhood Obesity in the First 1,000 Days: A Systematic Review.

Mounting evidence suggests that the origins of childhood obesity and related disparities can be found as early as the "first 1,000 days"-the period from conception to age 2 years. The main goal of this study is to systematically review existing evidence for modifiable childhood obesity risk factors present from conception to age 2 years. PubMed, Embase, and Web of Science were searched for studies published between January 1, 1980, and December 12, 2014, of childhood obesity risk factors present during the first 1,000 days. Prospective, original human subject, English-language research with exposure occurrence during the first 1,000 days and with the outcome of childhood overweight or obesity (BMI ≥85th percentile for age and sex) collected between age 6 months and 18 years were analyzed between December 13, 2014, and March 15, 2015. Of 5,952 identified citations, 282 studies met inclusion criteria. Several risk factors during the first 1,000 days were consistently associated with later childhood obesity. These included higher maternal pre-pregnancy BMI, prenatal tobacco exposure, maternal excess gestational weight gain, high infant birth weight, and accelerated infant weight gain. Fewer studies also supported gestational diabetes, child care attendance, low strength of maternal-infant relationship, low SES, curtailed infant sleep, inappropriate bottle use, introduction of solid food intake before age 4 months, and infant antibiotic exposure as risk factors for childhood obesity. Modifiable risk factors in the first 1,000 days can inform future research and policy priorities and intervention efforts to prevent childhood obesity.

The Nature and Nurture of Love: From Imprinting to Attachment in Cold War America

In the early twentieth century, when physicians and scientists in the U.S. and Britain debated what children needed to develop into healthy citizens, they spoke largely in terms of nutrition and environmental factors. But as infant and child mortality declined, concerns over children's emotional and psychological needs gradually assumed center stage. In response to the horrific violence of World War II, numerous researchers in the psychological and social sciences turned their attention to the role of emotions in fomenting political instability. Above all, they focused on that most primal of human relationships—the mother-child dyad. Only warm, consistent, and uninterrupted maternal love during infancy and early childhood, they argued, would yield an emotionally sound citizenry capable of sustaining peace and democracy in the new atomic age. In her learned and provocative study, The Nature and Nurture of Love, Marga Vicedo shows how this political and intellectual context gave rise to attachment theory, a highly influential school of thought that described mother love—the infant's attempts to connect with its mother and vice versa—as manifestations of biologically based instincts. The maternal-infant relationship, according to attachment theory, determines the quality of subsequent relationships and overall emotional well being. At the heart of Vicedo's study is John Bowlby, a British psychoanalyst and psychiatrist who, along with psychologist Mary Ainsworth, is today widely viewed as the theory's co-founder. The book also provides original and in-depth analyses of figures like ethologist Konrad Lorenz and psychologist Harry Harlow, whose works were enlisted to support attachment theory, and psychoanalyst Anna Freud and comparative psychologist Daniel Lehrman, who trenchantly critiqued it. The Nature and Nurture of Love represents a major contribution to the history of the psychological sciences (and mid-century science more broadly), for it is the first deeply researched historical account of attachment theory—a fact that is somewhat surprising, given the interest it elicits both within and beyond the academy. Yet Vicedo's book is not simply an historical account. Trained as both a philosopher and a historian of science, Vicedo puts her cards on the table, leveling a rigorous critique of the theory's central claims and founding works.

Maternal-infant relationship quality and risk of obesity at age 5.5 years in a national US cohort

BackgroundPoor quality relationships between mothers and toddlers have been associated with higher risk for childhood obesity, but few prospective studies of obesity have assessed maternal-child relationship quality in infancy. In addition it is not known whether the increased risk is associated with the mother’s or the child’s contribution to the relationship quality.MethodsWe analyzed data (n = 5650) from the Early Childhood Longitudinal Study, Birth Cohort, a national study of U.S. children born in 2001 and followed until they entered kindergarten. At 9 months of age, the Nursing Child Assessment Teaching Scale (NCATS) was used to assess the quality of observed playtime interactions between mothers and infants, yielding separate scores for maternal and infant behaviors. Obesity (BMI ≥95th percentile) at age 5.5 years was based on measured weight and height.ResultsThe prevalence (95% confidence interval) of obesity at 5.5 years of age was higher among children in the lowest quartile of maternal NCATS score (20.2% [95% CI: 17.2%, 23.2%]) than in the highest quartile (13.9% [11.3%, 16.5%]), but maternal NCATS score was not significantly associated with obesity after adjustment for race/ethnicity, maternal education and household income. The prevalence of obesity at 5.5 years of age was similar among children in the lowest quartile of infant NCATS score (17.4% [14.4%, 20.3%]) and in the highest quartile (17.6% 14.4%, 20.8%]), and was not changed with covariate adjustment.ConclusionsMaternal-infant relationship quality, assessed by direct observation at 9 months of age in a national sample, was not associated with an increased risk of obesity at age 5.5 years after controlling for sociodemographic characteristics.

Miserable labor pain? Myths and nursing care

Pain is a common, normal, and healthy physical phenomenon during childbirth. However, widely held public and clinical perspectives treat pain as a pathologic process and consider labor pain in a negative context. These perspectives ignore the positive effects of pain in the domains of protection, new life, expectation, purpose, preparation, and progression. The pain interpretation and pain experience of new mothers deeply impact their mental health, maternal-infant relationship, and transition to motherhood. This paper introduces the common myths related to labor pain, the three stages of pain transmission, and the current approaches to pain management. The authors hope childbirth caregivers may accept labor pain as a meaningful, pleasant, and positive gift, which is the first and most important step toward effective pain management.