Maternal Postnatal Attachment Research Articles

The contributions of maternal oxytocin and maternal sensitivity to infant attachment security

ABSTRACT This study investigated links between maternal postnatal oxytocin, maternal sensitivity, and infant attachment security. At 3-months postpartum, participants (n=88) took part in a structured parent-infant interaction. Maternal oxytocin levels were assessed via blood, before and after the interaction. At 12-months postpartum, mother-child dyads completed the Strange Situation Procedure. Neither baseline oxytocin, oxytocin response, or maternal sensitivity were identified as significant independent predictors of infant attachment security or organisation. However, an interaction effect was identified, with higher maternal sensitivity being associated with secure infant attachment for mothers who showed an increase in oxytocin during parent–child interaction. Results indicate that maternal sensitivity, when accompanied by an increase in maternal oxytocin during parent–child interaction, is associated with the establishment of a positive early parent–child attachment relationship. This adds to the growing body of evidence highlighting maternal oxytocin response as a key adaptive process in the postpartum period.

Maternal Attachment Representations during Pregnancy, Perinatal Maternal Depression, and Parenting Stress: Relations to Child's Attachment.

Background: This paper aimed to explore the associations between maternal representations of attachment evaluated during pregnancy, pre and postnatal maternal depression, parenting stress and child’s attachment at 15 months after childbirth. Methods: Mothers (n = 71), and their infants participated in a longitudinal study of maternal attachment, pre and postnatal depression, parenting stress and child attachment. Adult Attachment Interview (AAI) was conducted between 24 and 26 weeks of pregnancy (Time 1), depression was assessed using the Edinburgh Perinatal Depression Scale (EPDS) (at Time 1 and 6 months after childbirth, i.e., Time 2), parenting stress was assessed using the Parenting Stress Index—Short Form (PS-SF) (at Time 2) and the Strange Situation Procedure (SSP) at child’s 15 months of age (Time 3). Results: Free-autonomous maternal classification of attachment increases the likelihood of secure child classification in her offspring, while decreases that of avoidance and ambivalence. Insecure maternal representation of attachment evaluated during pregnancy and higher levels of parenting stress at six months after childbirth was associated with higher rates of infant insecure attachment at 15 months. Conclusions: Our study validates the importance of considering maternal representations of attachment crucial in determining the quality of the caregiving environment, thereby the healthy development of children, despite the presence of other contextual risk.

Early-life maternal attachment and risky health behaviours in adolescence: findings from the United Kingdom Millennium Cohort Study

BackgroundEarly uptake of multiple risky behaviours during adolescence, such as substance use, antisocial and sexual behaviours, can lead to poor health outcomes without timely interventions. This study investigated how early-life maternal attachment, or emotional bonds between mothers and infants, influenced later risky behaviours in adolescence alongside other potential explanatory pathways using the United Kingdom Millennium Cohort Study.MethodsTotal maternal attachment scores measured at 9 months using the Condon (1998) Maternal Postnatal Attachment Scale compared higher and lower attachment, where mothers in the lowest 10th percentile represented lower attachment. Multiple risky behaviours, defined as two or more risky behaviours (including smoking cigarettes, vaping, alcohol consumption, illegal drug use, antisocial behaviour, criminal engagement, unsafe sex, and gambling), were scored from 0 to 8 at age 17. Five multivariate logistic regression models examined associations between maternal attachment and multiple risky behaviours among Millennium Cohort Study members (n = 7796). Mediation analysis sequentially adjusted for blocks of explanatory mechanisms, including low attachment mechanisms (multiple births, infant prematurity, sex, breastfeeding, unplanned pregnancy and maternal age at birth), maternal depression, and social inequalities (single-parent status, socioeconomic circumstance by maternal education and household income) at 9 months and poor adolescent mental health at 14 years.ResultsChildren of mothers with lower maternal attachment at 9 months had 23% increased odds of multiple risky behaviours at 17 years (OR: 1.23, 95% CI: 1.00–1.50) in the unadjusted baseline model. All five explanatory blocks attenuated baseline odds. Low attachment mechanisms attenuated 13%, social inequalities 17%, and poor mental health 17%. Maternal depression attenuated the highest proportion (26%) after fully adjusting for all factors (30%).ConclusionsLower maternal attachment in early life predicted increased adolescent multiple risky behaviours. Almost a third of the excess risk was attributable to child, maternal and socioeconomic factors, with over a quarter explained by maternal depression. Recognising the influence of early-life risk factors on adolescent health could innovate current policies and interventions addressing multiple risky behaviour uptake affecting health inequalities across the life course.

Study protocol: childhood outcomes of fetal genomic variants: the PrenatAL Microarray (PALM) cohort study

BackgroundThe implementation of genomic testing in pregnancy means that couples have access to more information about their child’s genetic make-up before birth than ever before. One of the resulting challenges is the management of genetic variations with unclear clinical significance. This population-based study will help to close this critical knowledge gap through a multidisciplinary cohort study of children with and without genomic copy number variants (CNVs) diagnosed before birth. By comparing children with prenatally-ascertained CNVs to children without a CNV, we aim to (1) examine their developmental, social-emotional and health status; (2) measure the impact of prenatal diagnosis of a CNV on maternal perceptions of child health, behavior and development; and (3) determine the proportion of prenatally-ascertained CNVs of unknown or uncertain significance that are reclassified as benign or pathogenic after 2 or more years.MethodsThis study will establish and follow up a cohort of mother-child pairs who have had a prenatal diagnosis with a chromosomal microarray from 2013-2019 in the Australian state of Victoria. Children aged 12 months to 7 years will be assessed using validated, age-appropriate measures. The primary outcome measures will be the Wechsler Preschool and Primary Scale of Intelligence IV (WPSSI-IV) IQ score (2.5 to 7 year old’s), the Ages and Stages Questionnaire (12-30 months old), and the Brief Infant- Toddler Social and Emotional Assessment (BITSEA) score. Clinical assessment by a pediatrician will also be performed. Secondary outcomes will be scores obtained from the: Vineland Adaptive Behavior Scale, Maternal Postnatal Attachment Questionnaire, the Vulnerable Child Scale, Profile of Mood States, Parent Sense of Competence Scale. A descriptive analysis of the reclassification rates of CNVs after ≥2 years will be performed.DiscussionThis study protocol describes the first Australian cohort study following children after prenatal diagnostic testing with chromosomal microarray. It will provide long-term outcomes of fetal genomic variants to guide evidence-based pre-and postnatal care. This, in turn, will inform future efforts to mitigate the negative consequences of conveying genomic uncertainty during pregnancy.Trial registrationACTRN12620000446965p; Registered on April 6, 2020.

Maternal Stress, Depression, and Attachment in the Neonatal Intensive Care Unit Before and During the COVID Pandemic: An Exploratory Study.

The main aim of the present study was to investigate the effects of the COVID-19 pandemic on the mothers’ postnatal depression, stress, and attachment during their stay in the Neonatal Intensive Care Unit (NICU). Twenty mothers of very premature infants born before 32weeks of gestational age were recruited at the Geneva University Hospital between January 2018 and February 2020 before the COVID-19 pandemic started. Mothers were screened for postnatal depression after their preterm infant’s birth (Edinburgh Postnatal Depression Scale, EPDS), then for stress (Parental Stressor Scale: Neonatal Intensive Care Unit, PSS:NICU), and attachment (Maternal Postnatal Attachment Scale, MPAS) at infant’s term-equivalent age. Data were compared with 14 mothers recruited between November 2020 and June 2021 during the COVID-19 pandemic. No significant differences were found in the scores for depression, stress, and attachment between the two groups. However, a non-statistically significant trend showed a general increase of depression symptoms in mothers during the COVID-19 pandemic, which significantly correlated to the attachment and stress scores. Moreover, the PSS:NICU Sights and Sounds score was significantly positively correlated with EPDS scores and negatively with the MPAS score only in the During-COVID group. To conclude, we discussed a possible dampened effect of the several protective family-based actions that have been adopted in the Geneva University Hospital during the health crisis, and we discussed the most appropriate interventions to support parents in this traumatic period during the COVID-19 pandemic.

The effect of in-person and virtual prenatal care education of the spouses of primiparous women on the father and mother\u2019s attachment to infant: a quasi-experimental and controlled study

IntroductionConsidering the important role of education in promoting parents’ attachment to the infant, temporal and spatial limitations, and the need to use new educational methods for spouses’ participation in childbirth preparation classes, the present study was conducted to compare the effect of in-person and virtual prenatal care education of the spouses of primiparous women on the father and mother’s attachment to the infant.MethodsThis is a quasi-experimental clinical trial that was conducted on primiparous pregnant women referring to three prenatal clinics in Tehran, Iran. Sampling was done by continuous method and pregnant women were divided into three groups of face-to-face education (n = 28), virtual education (n = 31), and control (n = 29). The content of the training program in the virtual and face-to-face groups was similar, which was presented in 4 sessions. At 18–20 weeks of gestation, demographic characteristics and pregnancy records were obtained from the samples, and 12 weeks after the delivery, maternal postnatal attachment scale, and postnatal paternal-infant attachment questionnaire were completed. Both intention-to-treat analysis and per-protocol analysis were performed.ResultsThere was a statistically significant difference between the two groups of in-person education and control, and also virtual education and control for both intention-to-treat and per-protocol analysis (p < 0.05). However, no statistically significant difference was found between the two groups of in-person and virtual education. Results showed a large and medium effect size between the two groups of in-person education and control, and virtual education and control in terms of father-infant attachment score, respectively. There was also no statistically significant difference between the three groups after the educational intervention in terms of the mother-infant attachment score for both intention-to-treat and per-protocol analysis.ConclusionConsidering that education by both in-person and virtual methods had the same effect on improving the score of father-infant attachment, it is suggested that to increase the participation of spouses of pregnant women in the process of prenatal care, the spouses of pregnant women should have the option of virtual education in addition to in-person training.Trial registrationTCTR.ir TCTR20200515011. Registered on May 12, 2020.

Effect of Mindfulness-Based Stress Reduction Program on “Coping Behaviors” and “Attachment” of Mothers of Neonates with Congenital Anomalies: A Randomized Clinical Trial

Background: Reduction of stress in mothers of neonates with congenital anomalies is necessary to improve their coping behaviors and attachment to their neonates. In this regard, the present study aimed to determine the effect of mindfulness-based stress reduction (MBSR) program on “coping behaviors” and attachment of mothers of neonates with congenital anomalies. Methods: This randomized clinical trial (code: IRCT20190123042471N1) was conducted on 70 mothers of neonates with congenital anomalies under medical treatment in two medical-education centers of Shahid Beheshti University of Medical Sciences, Tehran, Iran in 2019. The subjects were selected based on the inclusion criteria and were randomly assigned to two groups of intervention and control (n=35 per group). The intervention group, which included 10 subgroups of 1-3 subjects, received a modified four-session MBSR program (once a week, 1-1.5 h per session). The control group received routine care in the hospital during their hospitalization. The Coping Health Inventory for Parents questionnaire and Maternal Postnatal Attachment Scale tool were completed by the intervention and control groups, both before and after the intervention. The data were analyzed in SPSS (version 25.0) using multivariate analysis of variance. Results: The MBSR program affected the pattern of coping behaviors and maternal-neonatal attachment. There was an increase in the mean scores of coping behaviors and maternal-neonatal attachment in the intervention group, compared to the control group (p <0.05). Conclusion: The MBSR program is recommended as a cost-effective and reliable method for promoting coping behaviors and attachment of mothers to their neonates hospitalized in neonatal intensive care units.

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.

Implementation of Virtual and Face-to-Face Childbirth Preparation Training for the Spouses of the Primiparous Women to Reduce the Fear of Childbirth, Improve the Pregnancy Experience, and Enhance Mother- and Father-Infant Attachment: Protocol for a Quasiexperimental Clinical Trial.

Background Men have a special role to play in promoting maternal and child health during pregnancy, childbirth, and postpartum period. The health of women also requires the participation and cooperation of men. The aim of this study is to compare the effect of virtual and face-to-face childbirth preparation training for spouses of the primiparous women on the pregnancy experience, fear of childbirth (FOC), and mother- and father-infant attachment. Methods The primiparous women attending the prenatal clinics of Lolagar Hospital and Azadi and Tehransar health centers of Tehran along with their husbands will be studied. The inclusion criteria for the women's husbands are the first experience of becoming a father, being at least 18 years of age, and the ability to read and write. The exclusion criteria for women's husbands are the history of physical/mental illness; being a smoker; and consuming alcohol, drugs, or psychotropic substances. The participants will be selected by the convenience sampling method and will be divided into three groups of study A, study B, and control. Spouses in study groups A and B will receive childbirth training through virtual and face-to-face methods with similar content, respectively. The control group only receives ordinary prenatal care. At the 18–20 weeks of gestation, demographic information, pregnancy experience scale (PES), and version A of Wijma delivery expectancy/experience questionnaire (WDEQ-A) will be completed. At 37-38 weeks of gestation, the PES and WDEQ-A questionnaires will be completed again and maternal postnatal attachment scale (MPAS) and postnatal paternal-infant attachment questionnaire (PPAQ) will be completed by the parents 12 weeks after the delivery. Discussion. Improving the experience of pregnancy, especially reducing the FOC and creating a positive attitude towards it, is a vital strategy to promote vaginal childbirth and reduce the number of cesarean sections requested by women. Achieving this will reduce the cost of health care and improve the quality of life during pregnancy, after childbirth, and during the growth and development of infants. Ethics and Dissemination. This research has been funded by the Iran University of Medical Sciences, approved by the Thailand Registry of Clinical Trials, and will commence in May 2020. Results will be disseminated through peer-reviewed journals and shared with the academic and medical community to pregnancy and childbirth outcomes. This trial is registered with TCTR20200515011.

A multi-center survey on the postpartum mental health of mothers and attachment to their neonates during COVID-19 in Hubei Province of China.

BackgroundThere is an emerging literature on the mental health of both pre- and post-partum mothers during the coronavirus disease 2019 (COVID-19) pandemic.MethodsAs of April 1, 2020, 23 mothers confirmed with COVID-19, 15 mothers suspected with COVID-19 but with negative polymerase chain reaction tests, and 33 mothers without COVID-19 (Control Group) were recruited for a study from Hubei Province in China. The Maternal Postnatal Attachment Scale (MPAS), the Zung Self-rating Anxiety Scale, and the Zung Self-rating Depression Scale were applied to investigate the attachment of mothers to their neonates and the postpartum mental health of mothers within the first 3 months after delivery (between 20 to 89 days).ResultsThe period of mother-child separation among the confirmed group (33.9±20.9 days) was significantly longer than that of suspected group (16.7±12.2 days) and control group (10.7±8.4 days). The total score of the MPAS in mothers confirmed with COVID-19 (45.5±4.2) was significantly lower (indicating less mother-child attachment) than that in the suspected (50.5±4.7) and control (48.8±4.6) groups. A negative correlation was noted between the mother-child separation time and the MPAS scores, including the subscale scores of attachment (MPAS acore: Spearman’s ρ =−0.33, 95% CI: −0.095 to −0.538, P=0.005; Subscale score of attachment: Spearman’s ρ =−0.40, 95% CI: −0.163 to −0.592, P=0.001). The incidence of postpartum anxiety in the confirmed, suspected and control groups was 4.3%, 6.7% and 12.1%, respectively; and the incidence of postpartum depression was 39.1%, 33.3% and 30.3%, respectively. No significant difference was found with regards to maternal postpartum anxiety and depression among the three groups.ConclusionsDecreased mother-child attachment found among mothers confirmed with COVID-19, indicates that further intervention is needed to ensure mother-child interaction to appropriately develop attachment. Mother-child attachment experienced disruption due to prolonged mother-child separation necessitated by the COVID-19 management protocol, which needs to be revised to reduce prolonged mother-child separation. Additionally, mothers with and without COVID-19 suffered a high incidence of depression, which warrants further mental health investment for pregnant mothers during the COVID-19 pandemic.

Associations between maternal technology use, perceptions of infant temperament, and indicators of mother-to-infant attachment quality

BackgroundPrevious research suggests parents' use of technological devices, such as TV and mobile devices, within family contexts may decrease the quality of parent-child interactions. During early infancy, mothers report engaging with technological devices during infant feeding and care interactions, however, few studies have explored potential associations between maternal technology use and the quality of mother-to-infant attachment. AimTo examine associations between maternal technology use during mother-infant interactions and indicators of mother-to-infant attachment during early infancy. Study designCross-sectional survey. MethodsMothers (n = 332) of infants aged 2 to 6 months were recruited via MTurk, a crowdsourcing platform, to participate in an online survey. Participants responded to a series of validated questionnaires that assessed maternal technology use during mother-infant interactions (Maternal Distraction Questionnaire), infant temperament (Infant Behavior Questionnaire-Revised Very Short Form), and indicators of mother-to-infant attachment, including quality of attachment, absence of hostility toward motherhood, and pleasure in mother-infant interactions (Maternal Postnatal Attachment Questionnaire). ResultsGreater technology use during mother-infant interactions was significantly associated with greater infant negative affectivity (β = 0.26, p < .0001). Greater technology use was also significantly associated with lower mother-to-infant attachment quality (β = −0.21, p = .0001), and greater hostility toward motherhood (β = −0.39, p < .0001). Associations between technology use and indicators of mother-to-infant attachment were not mediated by infant negative affectivity. ConclusionsMaternal technology use was associated with greater perceptions of infant negative affectivity and poorer mother-to-infant attachment quality; further research is needed to understand mechanisms underlying these associations.

ПРОЯВЛЕНИЯ КРИЗИСА ОДНОГО ГОДА В СВЯЗИ С ХАРАКТЕРИСТИКАМИ СЕМЕЙНОГО ВЗАИМОДЕЙСТВИЯ

The study involved 117 people from 43 families of Saint-Petersburg. Among them there were 31 triads “mother – father -child” and 12 dyads “mother - child”, i.e. 43 children (20 boys and 23 girls), 43 mothers and 31 fathers. The age of children differed from 10 months to 2 years. The sample was divided into 2 age groups: from 10 months to 1 year 6 months; and from 1 year 7 months to 2 years. The methods we used were the following: “Manifestations of the crisis of the first year” questionnaire by V. Vasilenko, “Child and parent emotional interaction” questionnaire by E. Zakharova, Maternal postnatal attachment scale by J. Condon, Parental Attitude Research Instrument (РARI) by E.S. Schaefer &amp; R.Q. Bell, Test of marriage satisfaction by Y.E. Aleshina, L.Y. Gozman, E.M. Dubovskaya. The study revealed that constructive formations of the crisis prevail over negativistic manifestations; the main formation is autonomous child speech. The postcritical phase has not been identified. The data in general show the well-being in the child and parent emotional interaction, the high maternal attachment to children, and prevalence of attitudes towards optimal emotional contact with the child and the high level of marriage satisfaction. At the same time we revealed reduced indicators of ability to perceive the child's state (29% mothers and 48% fathers), understand what causes the child’s state (26% mothers and 39% fathers), influence to the child's state (29% mothers and 26% fathers). Constructive formations of the crisis are positively correlated with the sensitivity of the mother, the maturity of her behavioral manifestations in interaction and negatively correlated with positive feelings in interaction and emotional acceptance from fathers, as well as with the maternal attitudes to excessive concentration on the child. Negativistic manifestations of the crisis are less pronounced in the case of mother’s ability to influence to the child’s state, to support him, the child’s emotional acceptance and mother’s marriage satisfaction, and more pronounced in the case of maternal attitudes to the excessive emotional distance with the child, severity and, at the same time, to partnership with the child. Thus, the mother’s sensitivity, maturity of her behavioral manifestations in interaction and parental attitudes combined with some "conditional love" from fathers can be regarded as resources for the successful flowing of the crisis of the first year. Parents need to move from strengthening their previous parenting methods to searching for new forms of interaction.

Newborn Behavioral Observation, maternal stress, depressive symptoms and the mother-infant relationship: results from the Northern Babies Longitudinal Study (NorBaby)

BackgroundFamilies can experience the postpartum period as overwhelming and many report a special need for support. The Newborn Behavioral Observation (NBO) aims to promote a positive parent-infant relationship by sensitising parents to the infant’s signals. This article evaluates the NBO as a universal preventive intervention within the regular well-baby clinic service on measures of maternal depressive symptoms, parental stress, the mother-infant relationship and satisfaction/benefit of the postpartum follow-up.MethodsThis investigation is part of a larger longitudinal study comprising 220 women and 130 of their partners recruited between 2015 and 2017. The study had a non-randomised cluster-controlled design with 6 measurement points. This article is based on a sample of 196 women using data from T1 (gestational weeks 13–39), T4 (5–15 weeks postpartum) and T5 (3–9 months postpartum). Participants were allocated to a group receiving the NBO (n = 82) and a care as usual comparison group (n = 114). We measured maternal depressive symptoms and parental stress using the Edinburgh Postnatal Depression Scale (EPDS) and the Parenting Stress Index (PSI). The mother-infant relationship was assessed with the Parental Reflective Functioning Questionnaire (PRFQ), the Maternal Postnatal Attachment Scale (MPAS) and the Maternal Confidence Questionnaire (MCQ). Participants also answered questions about satisfaction/benefit of the postpartum follow-up.ResultsA Mann-Whitney U test indicated that participants in the NBO-group learned significantly more than the comparison group from the follow-up about the baby’s signals in relation to sleep/sleep patterns, social interaction and crying/fuzziness. Multivariate analyses of covariance (MANCOVA) and repeated measures ANCOVA found no significant differences between the groups for the mother-infant relationship domain and few differences in depressive symptoms and parental stress. The repeated measures ANCOVA found that participants in the NBO-group scored slightly higher on parental stress, although the difference was small.ConclusionsThe results indicate that the NBO-group learned more than the comparison group about reading their child’s signals in important everyday situations. However, the benefits of the NBO were limited for depressive symptoms, parental stress and self-reported mother-infant relationship. The study sample was generally well-functioning, and the results indicate that the benefits of the NBO may be limited within a well-functioning sample.Trial registrationClinicalTrials, NCT02538497, Registered 2 September 2015.

Adult attachment style and maternal-infant bonding: the indirect path of parenting stress

BackgroundThe quality of maternal-infant bonding is related to important child outcomes. The literature has assumed that the ability to form relationships is a relatively stable trait, and research studies have suggested that a mother’s attachment style in close adult relationships is related to mother-infant bonding. The transition to parenthood is also often stressful, and the adult attachment style may relate to parenting stress in the first year after birth. Such stress could possibly have a negative relationship with the mother-infant bond. In the present study, we examined the associations between maternal adult attachment styles and the quality of mother-infant bonding and whether this relationship is mediated by parenting stress.MethodsThe present study sample comprised 168 women (mean age 31.0 years, SD 4.23 years). Between weeks 31 and 41 of gestation, the anxious and avoidant adult attachment dimensions were measured with the Experiences in Close Relationships questionnaire (ECR). Between 5 and 15 weeks after birth mother-infant bonding and parenting stress were measured with the Maternal Postnatal Attachment Scale (MPAS) and the Parenting Stress Index-Parent Domain (PSI-PD), respectively.ResultsBoth attachment-related avoidance and attachment-related anxiety correlated significantly and negatively with mother-infant bonding. However, a regression analysis showed that only attachment-related avoidance was a significant predictor of mother-infant bonding when controlling for demographic variables and maternal mental health history. The relationship between the adult attachment style and bonding was mediated by parenting stress. Higher scores on attachment avoidance and anxiety were related to increased stress, which was related to decreased quality of bonding. The overall parent domain and the subscale of competence in the parent-related stress dimension mediated between attachment avoidance and bonding, and the overall parent domain and the subscales of competence and role restriction mediated between attachment anxiety and bonding. There was no direct relationship between the adult attachment style and mother-infant bonding when parenting stress was included as a mediator.ConclusionsThis study illustrates that maternal adult attachment style relates to mother-infant bonding. This relationship was mediated by parenting stress. The results may have implications for the early identification of mothers at risk of having bonding difficulties.

The experiences of mothers with preterm infants within the first-year post discharge from NICU: social support, attachment and level of depressive symptoms

BackgroundThe estimated global premature birth rate for 2014 was 10.6%, equating to an estimate of 14.84 million live premature births. The experience of premature birth does not impact solely on the infant and mother as individuals but occurs in the context of a critical point in time when they are developing a relationship with one another. The aim of this study was to investigate the relationships between social support, mother to infant attachment, and depressive symptoms of mothers with preterm infants within the first 12 months’ post discharge from the Neonatal Intensive Care Unit (NICU).MethodsA correlational cross-sectional study design was used. Data were collected using a four-part online survey which included the Perinatal Social Support Questionnaire (PICSS), Maternal Postnatal Attachment Scale (MPAS) and the Edinburgh Postnatal Depression Scale (EPDS) with mothers of preterm infants (n = 140).ResultsThe prevalence of postnatal depression was 37.9% (95% CI: 29.8 to 46.4%). In univariable analyses, history of depression (p = 0.005), aged 35–39 years (p = 0.006), no formal social support (p = 0.040), less informal social supports (p = 0.018), lower overall maternal attachment (p < 0.001) and lower overall functional social support (p < 0.001) were significantly associated with a higher level of depressive symptoms. Lower scores on two of the maternal attachment subscales (quality of attachment and absence of hostility) and all four of the functional social support subscales were significantly associated with a higher level of depressive symptoms (p < 0.001 for all). In the multivariable analysis, prior history of depression (p = 0.028), lower score of maternal attachment (p < 0.001) and lower emotional functional social support (p = 0.030) were significantly associated with a higher level of depressive symptoms.ConclusionWomen who experience a premature birth, have a prior history of depression, poor infant attachment and poor emotional social support have a higher level of depressive symptoms. Results emphasise the need for professionals to encourage mobilisation of maternal formal and informal social supports. It is important to intervene early to address maternal emotional well-being and enhance the developing mother-preterm infant relationship.

Can a traumatic childbirth experience affect maternal psychopathology and postnatal attachment bond?

The aim of the present study was to explore the relationship between the experience of childbirth as a traumatic event and the quality of postnatal attachment to child, analyzing the role of depressive symptomatology on this relationship. A sample of 103 women, aged from 26 to 46 years (M = 35.05, SD = 4.51) filled in questionnaires to assess postpartum stress symptoms related to the childbirth experience, postnatal attachment toward their newborns, and level of depressive symptomatology. A mediation analysis was carried out. The level of postpartum stress symptoms positively affects maternal depressive symptomatology and negatively affects the quality of postnatal attachment. Moreover, the relationship between a traumatic childbirth experience and postnatal attachment is both direct and indirect. In fact, a traumatic childbirth experience also affects the level of postnatal depression that, in turn, negatively affects the quality of postnatal attachment bond. The presence of postpartum distress symptoms affects the well-being of mothers, and these conditions interfere with the ability of women to develop good attachment bonds with their children. These results showed the relevance of paying attention to pregnant women, to help them to live childbirth in a positive and non-stressful way.

Trajectories of clinical and parenting outcomes following admission to an inpatient mother-baby unit

BackgroundThis study aimed to examine trajectories of clinical and parenting outcomes following admission to a mother-baby unit (MBU), and to explore factors associated with these trajectories.MethodsWomen admitted to an MBU completed the Edinburgh Postnatal Depression Scale (EPDS), Depression, Anxiety and Stress Scale (DASS-21), Karitane Parenting Confidence Scale (KPCS) and Maternal Postnatal Attachment Scale (MPAS) at admission, discharge and 3 months following discharge. Questions assessing psychosocial risk and adult attachment style were also completed at admission, and information relating to service engagement in the time since discharge was collected at follow-up. Additional clinical and demographic information was extracted from the patient medical record.ResultsSeventy-five women participated in the study. Overall, significant improvements in mean scores on measures of anxiety and parenting confidence were maintained 3-months following discharge. However, the majority of women (93.3%) followed trajectories that were characterised by deterioration in self-reported mother-infant attachment following discharge. 62.9 and 34.6% of women followed trajectories of increased symptoms of depression and stress between discharge and follow-up, respectively. Across measures, the least optimal trajectories, or least optimal scores, at follow-up were associated with less secure maternal attachment style (associated with more anxiety symptoms, poorer parenting confidence and maternal-infant attachment), older maternal age (more depressive symptoms) and increased psychosocial risk (more anxiety symptoms).ConclusionsThe findings of this study highlight the clinical implications of anxious attachment style for the mental health and parenting outcomes of women admitted to an MBU and the importance of incorporating mother-infant therapy as part of an ongoing management plan. Comprehensive discharge planning and transitional care to help ensure women discharged from an MBU are best supported in the longer term is recommended.

Effect of Telenursing on Attachment and Stress in Mothers of Preterm Infants

Background: The necessity of professional nursing support to increase the role of families in neonatal care and their empowerment has been a subject of growing attention. The aim of this study was to determine the effect of telenursing on attachment and stress in the mothers of premature infants. Methods: In this clinical trial, 50 mothers with premature infants who were admitted to neonatal intensive care unit (NICU) at Shahid Beheshti Hospital in Isfahan with a gestational age of more than 33 weeks were selected by convenience sampling method. They were randomly assigned to two groups of intervention (n=25) and control (n=25). The intervention group received an educational program designed through telephone and counseling center for the mothers of premature infants that started one week after the admission and continued one week after discharge. However, the control group only received the usual care provided in the NICU. One week after the admission of the infant, Maternal Postnatal Attachment (MPA) and Parent Stressor Scale: Neonatal Intensive Care Unit (PSS-NICU) questionnaires were completed. The PSS-NICU questionnaire and MPA questionnaire were completed at the time of discharge and one week after the discharge by the participants, respectively. Results: The average increase in total attachment scores one week after discharge was significantly higher in the intervention group, compared to that of the control group (P<0.05). Moreover, the average decrease in the total stress score of the intervention group at the time of discharge in comparison to pre-intervention was significantly higher than that of the control group (P<0.05). Conclusion: Considering the positive effects of telenursing on increasing attachment and mitigating the stress of mothers with premature infants, it is suggested to employ this supporting method to enhance the attachment and reduce the stress of mothers.

A single Spanish version of maternal and paternal postnatal attachment scales: validation and conceptual analysis.

BackgroundPostnatal bonding constitutes a major process during the postpartum period, and there is evidence that bonding difficulties have negative consequences for parents’ mental health and the child’s development. However, the conceptualization of postnatal bonding presents inconsistencies, as well as problems in having instruments that encompasses the father figure. The objective was to adapt the maternal postnatal attachment scale (MPAS) and the paternal postnatal attachment scale (PPAS) to Spanish, to evaluate its validity and reliability and to analyze the construct dimensionality of both questionnaires from a gender perspective.MethodsInstrumental design. In 2016–2017, a sample of 571 mothers and 376 fathers, with children between 6 and 11 months of age, responded to the Spanish version of MPAS and PPAS, respectively. After a process of translation-back-translation of the instrument, we empirically analyzed the internal consistency (Cronbach alpha, composite reliability (CR)) construct and concurrent validity (with regard to postpartum depression and dyadic adjustment). Additionally, we studied the instrument’s content validity, using the Delphi methodology; and the differential analysis in both samples (mothers and fathers), examining the invariance.ResultsA short version of 15 items was obtained, common for mothers and fathers. The results of the Delphi methodology showed a 100% inter-judge agreement, highlighting the absence of differences in the adequacy of the items as a function of the parents’ gender. Confirmatory factor analysis showed a good fit of three original factors proposed by the authors. The global Cronbach alpha coefficients in the total sample were adequate (mothers, 0.70; fathers, 0.78); and Cronbach alpha of each dimension in the case of mothers was 0.50 (Quality of bonding), 0.55 (Absence of hostility), and 0.60 (Pleasure in interaction); in the case of fathers, it was respectively 0.54, 0.64, and 0.72. CR of each dimension were: quality of bonding, 0.74 in mothers and 0.80 in fathers; absence of hostility, 0.93 in mothers and 0.94 in fathers; pleasure in interaction, 0.83 in mothers and 0.90 in fathers. With regard to the analysis of group invariance, the results revealed empirical evidence of configural and metric invariance. Concurrent validity showed moderate negative correlations for postnatal depression (mothers, r = −0.41, p < 0.001; fathers, r = −0.38, p < 0.001), and positive correlations for dyadic adjustment (mothers, r = 0.39, p < 0.001; fathers, r = 0.44, p < 0.001).DiscussionA new version of the instrument was generated, with good psychometric properties, adequate for use both with mothers and with fathers. This scale helps evaluate postnatal maternal and paternal bonding, allowing to study it from within the family system, a necessary step forward to advance perinatal mental health.

Maternal–foetal attachment independently predicts the quality of maternal–infant bonding and post-partum psychopathology

Purpose: The aim of this study was to evaluate the association of maternal antenatal attachment and post-partum psychopathology, maternal–infant bonding, while checking for antenatal psychopathology, for lifetime psychiatric diagnosis and for the known risk factors for peripartum depression.Methods: One hundred and six women recruited at the first month of pregnancy (T0) were evaluated with the structured interview for DSM-IV TR (SCID-I) to assess the presence of lifetime psychiatric diagnosis and with the Perinatal Depression Predictor Inventory-Revised (PDPI-R), the Edinburgh Postnatal Depression Scale (EPDS), and the State–Trait Anxiety Inventory (STAI). At the sixth month of pregnancy (T1) and at the first month post-partum (T2), all patients were evaluated with the PDPI-R, the EPDS, the STAI, at T1, with the Maternal Antenatal Attachment Scale (MAAS), and at T2 with the Maternal Postnatal Attachment Scale (MPAS).Results: Multivariate regression analyses showed that maternal–foetal attachment was the variable most significantly associated with postnatal symptoms of depression and anxiety and with quality of maternal-infant attachment. The logistic regression analyses showed that antenatal attachment may predict postnatal depressive and anxiety symptoms (respectively, OR: 0.83 – IC [0.74 − 0.95], p = .005, OR: 0.88 – IC [0.79 − 0.98], p = .02), and the quality of maternal postnatal attachment (OR: 1.17 – IC [1.08 − 1.27], p < .001), also after taking into account the known risk factors for perinatal depression, the sociodemographic variables and lifetime psychiatric diagnosis.Conclusion: The quality of maternal–foetal bonding may independently predict the quality of maternal–infant attachment and post-partum depressive and anxiety symptoms. A comprehensive assessment of maternal risk factors for perinatal psychopathology during pregnancy should include the evaluation of antenatal attachment that could be modifiable by specific interventions promoting the quality of maternal bonding.