Mother-baby Dyads Research Articles

« Accordanse » : une chorégraphie des interactions

BackgroundThis article focuses on presenting the elaboration and creation of an original therapeutic program set up in perinatal care which insert dancing in mental care. “Accordance” is a weekly session dedicated to the care of the mother, the child, and their interactions, based on a corporeal and drive approach. It is designed for three mother-baby dyads treated in a Day Hospital Perinatal Service. MethodWe focus essentially on one dyad's clinical observations. Analysing this dyad's observations through a qualitative methodology and basing on psychanalytical theory, we study how dance allows the reinitiating of drive in mothers and enroll the babies in the drive circuit. ResultatsWe show how drive stimulated through dance has effects on mother's libidinal investment, on the sensory-motor and psycho-affective baby's development and also on their affective tuning. DiscussionSubmerged on this choreographic and musical bath, the mother finds the pleasure of her corporal sensations that favorite a wishing movement to which the baby answers. She can now awake sensual enjoyment on her baby, prerequisite for all of the mental and relational activity. The baby makes his first dancing steps in mother's look, drive circuit loop itself and the primordial meeting can happen. ConclusionThrough the creation of a sensory and drive co-modality, dance take a singular path favoring the emergence of an affective tuning and this creating a harmonious “interactions’ choreography”.

Impacto da saúde mental materna na interação mãe-bebê e seus efeitos sobre o desenvolvimento infantil

Os prejuízos na saúde mental da mãe podem afetar seus comportamentos em interações com o bebê, que são importantes preditores do desenvolvimento infantil no primeiro ano de vida. Este estudo investigou o impacto da depressão pós-parto e da ansiedade na interação mãe-bebê e seus efeitos no desenvolvimento aos três meses de vida. Participaram do estudo 64 díades mãe-bebê que foram filmadas em um episódio de brincadeira livre. As mães responderam ao SRQ-20 e ao BDI para avaliação da saúde mental. O desenvolvimento dos bebês foi avaliado com a EDCC. As análises de regressão confirmaram o poder preditivo da depressão sobre a frequência de sorrisos maternos e também da estimulação tátil ou com objetos sobre os comportamentos motores do bebê. As evidências do impacto da depressão pós-parto sobre os comportamentos sensíveis da mãe e da estimulação não-verbal sobre o desenvolvimento motor nos primeiros meses de vida são discutidas.

Mother–baby dyads enrolled in PMTCT care in western Kenya: characteristics and implications for ART programmes

The objective of the study was to establish the mother–baby pair characteristics that contribute to vertical transmission of HIV and elucidate on remediation. We assessed for factors increasing the odds of HIV transmission in children born to HIV-infected mothers in western Kenya. We used a retrospective study which reviewed routinely collected data of 1 028 mother–baby pairs enrolled in a prevention of mother-to-child transmission (PMTCT) programme in western Kenya from January to December 2015. We compared the transmission rates amongst mothers known to have a positive HIV status before conception (known positives/KPs) versus the transmission amongst those who were newly diagnosed during maternal and child health (MCH) clinic attendance (new positives/NPs). We compared the socio-demographic and clinical characteristics of the mothers using chi square and Kruskal–Wallis tests at 95% confidence interval (CI). We assessed for factors associated with the infants’ HIV status using a logistic regression model. The results revealed that 60% (622) of the mothers were KPs, and that KPs and NPs had mother-to-child transmission (MTCT) rates of 5.5% and 20.7% respectively. Close to 90% of the NP Mothers were at an early HIV clinical stage at enrolment and 40% were enrolled after delivery. The infants of NPs were enrolled at a mean age of 18.3 weeks compared to 6.6 weeks for the infants of the KPs. On adjusted multivariable analysis, child's age at enrolment (AOR = 1.05, 95%CI = 1.036–1.064) and mother's status at conception (AOR = 1.96, 95%CI = 1.042–3.664) were significantly associated with the infant's HIV status. None of the HIV infected infants had received nevirapine prophylaxis. Most of the mothers enrolling into the PMTCT programme have a known HIV-positive status, however, NPs are the largest contributors to continued MTCT.

Risk factors for perinatal transmission of HIV among women attending prevention of mother-to-child transmission clinics in Northwest Nigeria

ABSTRACTDespite the effectiveness of antiretroviral therapy (ART) in the prevention of mother-to-child transmission of HIV (PMTCT), some HIV-infected women in PMTCT care are at risk of transmitting HIV to their babies. Using a 1:1 unmatched case–control study design, we assessed the risk factors for perinatal transmission among women who received ART for PMTCT in Sokoto State, Nigeria. Data were abstracted from medical records of cases (94 HIV-infected babies) and controls (94 HIV-uninfected babies) and their mothers who accessed PMTCT services in three purposefully selected secondary health facilities. We conducted univariate and multivariate logistic regressions to determine if sociodemographic characteristics, time of enrolment, type of maternal ART, receipt of infant antiretroviral (ARV) prophylaxis, place of delivery, or feeding practice were associated with HIV infection among HIV-exposed babies. Sixteen percent of the mothers of babies in the case group had early enrolment while 90% of those in the control group enrolled early. Infant prophylaxis was received in 54% of cases and 95% of controls. In both groups, 99% of the mothers practiced mixed feeding. In the univariate analysis, factors that were significantly associated with HIV infection were religion (islam), rural residence, late⁠ enrolment, and non-receipt of infant ARV prophylaxis. In the multivariate analysis, rural residence (Adjusted odds ratio (aOR) = 8.01, 95% CI = 1.79–35.78), late enrolment (aOR = 41.72, 95% CI = 15.16–114.79), and non-receipt of infant ARV prophylaxis (aOR = 4.1, 95% CI = 1.18–14.33) remained statistically significant. Findings from this study indicate that eliminating MTCT in Nigeria requires interventions that will enhance timely access of ART by mother-baby dyads.

Metáforas conceptuais na relação mãe-bebê nos primeiros anos de vida

Este trabalho tem como objetivo identificar metáforas conceptuais utilizadas na relação entre mãe e filho nos primeiros anos de vida. Utilizamos, como alicerce teórico, os postulados de cunho cognitivista de Lakoff e Johnson (2002 [1980]), as contribuições de Sardinha (2007), os estudos sobre a relação entre metáfora e cultura (KOVECSES, 2005, 2010) e metáfora e ideologia (GOATLY, 2007), entre outros. O corpus é constituído por um conjunto de dados, obtidos através de diálogos cotidianos videografados na relação mãe-bebê, disponíveis no Laboratório de Aquisição da Fala e da Escrita (LAFE) da Universidade Federal da Paraíba. Com base na análise desenvolvida, pudemos perceber que desde as primeiras relações mãe-bebê já é possível verificar o uso de metáforas conceptuais, que revelam valores culturais, morais, éticos, ideológicos transmitidos pelas mães ao interagirem com os filhos.

Countertransference with mother-baby dyads in a context of multiple traumas

The encounter of mother-baby dyads in a context of a traumatic narrative renders the areas of transference and countertransference more complex, with multiple identification processes. What are the implications regarding the transmission of trauma to the child and how does it occur? The clinical case of a mother, with a past fraught with challenges and traumas, illustrates a way of accessing a child's experience of trauma via the clinician's countertransference.

Cognitive Breastfeeding Counseling: A Single Session Helps Improve LATCH Score.

Antenatal counseling improves the rate of exclusive breastfeeding. But routine antenatal counseling may not be effective in achieving this. Cognitive behavioral therapy derived techniques may be more useful in improving breastfeeding outcomes. We did this study to test the effectiveness of a single session of cognitive counseling compared to routine counseling in the third trimester for improving LATCH score. Fifty mother-baby dyads were enrolled. Twenty-six mothers underwent cognitive counseling and 24 mothers underwent routine counseling. After birth, the LATCH scores were assessed within the first 24 hours in the newborn. A single session of cognitive breastfeeding counseling in the third trimester is effective in significantly improving the LATCH scores in the immediate newborn period.

Lactation Education Program at an Academic Medical Center

Purpose: Despite the well-known benefits of breastfeeding, US rates of exclusive breastfeeding lag behind other developed nations. Without early and sustained primary care support, many mothers are likely to stop breastfeeding prematurely. Lactation Consultants (IBCLCs) can be very helpful in providing support for breastfeeding mother-baby dyads, however they are not always conveniently located for patients. Therefore, our objective was to develop and implement a pilot lactation training program for General Pediatrics faculty at an academic medical institution to enhance breastfeeding. As part of the program, we sought to assess changes in …

Skin to Skin Contact: Newborn Temperature Stability in the Operating Room.

The purpose of this project was to assess temperature stability in newborns undergoing early intraoperative skin-to-skin contact (SSC) after elective cesarean birth. This feasibility study examined electronic medical record data of 91 mother-baby dyads who participated in early intraoperative SSC after an elective cesarean birth. Infant axillary temperatures were obtained just before initiation and upon completion of intraoperative SSC. The mean age of women in this sample was 35 (SD, 4.2) years. They were an average of 39 4/7 weeks gestation, and largely Caucasian 55% (n = 50) and Asian 30 (33%). Fifty-eight percent (n = 53) of infants were male, weighing an average of 3,566 g (SD, 401.83). Nineteen (21%) of infants demonstrated no temperature change pre to post SSC, with an increase noted in 32 (35%) infants, and a decrease in 40 (44%). Findings provide support for continued intraoperative SSC. Areas for improvement were also identified, for example, missing medical record data.

Breastfeeding Determinants in Healthy Term Newborns.

Breastfeeding is the normative standard for infant feeding. Despite its established benefits, different factors can affect breastfeeding rates over time. The purpose of this study was to evaluate breastfeeding determinants in healthy term newborns during the first three months of life. A prospective, observational, single-center study was conducted in the nursery of Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico in Milan, Italy. The mother-baby dyads that were admitted to the Clinic in January and February 2017 were enrolled. Only healthy term babies with birth weight ≥10th percentile for gestational age were included. Data were collected through medical records and questionnaires administered during the follow-up period. Then, we fitted univariate and multivariate logistic models and calculated odds ratios. 746 dyads were included but 640 completed the study. The factors found to be favoring breastfeeding were a previous successful breastfeeding experience, a higher level of education of the mother, attending prenatal classes, no use of pacifier, rooming in practice, and breastfeeding on demand. Factors acting negatively on breastfeeding were advanced maternal age, non-spontaneous delivery, perception of low milk supply, mastitis, and nipple fissures. This study highlights the need to individualize the assistance provide to breastfeeding mothers, paying special attention to personal experiences.

Maternal obesity and excessive maternal weight gain during pregnancy: effects on outcomes after neonatal cardiac surgical procedures.

A retrospective review of neonates who underwent cardiopulmonary bypass within the first 30 days of life at our institution between 2011 and 2013 was conducted. Postoperative variables investigated included the duration of length of mechanical ventilation, length of stay in the ICU, peak vasoactive inotrope scores, and peak lactate level. Maternal obesity was defined as 1st trimester body mass index ⩾30 kg/m2. Excessive weight gain was defined as ⩾12 kg gained during pregnancy. In order to determine the association between maternal obesity or excessive weight gain and postoperative variables, we used multiple linear regression, adjusting for birth weight and risk adjustment for congenital heart surgery score. Records from 58 mother-baby dyads were examined. After controlling for birth weight and risk adjustment for congenital heart surgery score, there were no significant associations between maternal obesity and excessive weight gain during pregnancy versus all postoperative outcomes measured. Despite the known negative impact of maternal obesity on perinatal outcomes, we were unable to find associations between maternal obesity and excessive weight gain during pregnancy versus postoperative outcomes.

Maternal magnesium therapy, neonatal serum magnesium concentration and immediate neonatal outcomes.

The fetus is exposed to magnesium administered to the pregnant mother. However, there is controversy regarding magnesium-related neonatal adverse outcomes, largely driven by a limited understanding of the factors that influence neonatal serum magnesium concentrations and associated outcomes. The objective of this study was to examine the relationship between antenatal maternal magnesium dose and serum concentrations, neonatal serum magnesium concentration and immediate neonatal outcomes. A retrospective study was conducted at a community-based teaching hospital. Neonatal serum magnesium concentrations within 48 h of birth were used to stratify magnesium-exposed neonates into three groups: group 1: <2.5 mg dl-1, group 2: ⩾2.5 to <4.5 mg dl-1, and group 3:⩾4.5 mg dl-1. Immediate neonatal outcomes were compared between the three groups. Total maternal magnesium dose and serum magnesium concentrations before the delivery were correlated with neonatal serum magnesium concentrations and outcomes. Of the 304 mother-baby dyads between 24 and 34 weeks gestation, 237 received antenatal magnesium. Neonatal serum magnesium concentration was 3.14±0.83 mg dl-1 in exposed and 1.96±0.42 mg dl-1 in unexposed neonates (P<0.001). Compared with group 2, neonates had higher odds of grade 3 or 4 intraventricular hemorrhage in group 1 (adjusted odds ratio (AOR) 5.95 (95% confidence interval (CI) 1.05 to 33.66)) and group 3 (AOR 8.42 (95% CI 1.35 to 52.54)). Group 3 neonates also had increased odds of periventricular leukomalacia (AOR: 5.37 (95% CI 1.02 to 28.28) compared with group 2 neonates. Predictors of neonatal serum magnesium concentrations included maternal magnesium dose (r=0.66, P<0.0001), duration of therapy (r=0.70, P<0.0001) and serum concentration (r=0.72, P<0.001). The between-group differences highlight that there is a therapeutic range of neonatal serum magnesium concentrations for neuroprotective effects of antenatal magnesium sulfate, while concentrations outside of this range may be associated with adverse neonatal outcomes. Further studies are needed to determine the optimal dose and duration of maternal magnesium to minimize adverse neonatal outcomes.

Gestational, perinatal, and postnatal factors that interfere with practice of exclusive breastfeeding by six months after birth

BackgroundDespite evidences indicating the superiority of breastfeeding and recent advances in the indicators of breastfeeding in Brazil, exclusive breastfeeding (EBF) during the first six months after birth continues to be an infrequent practice in the country. The objective of the present study was to determine which gestational, perinatal, and postnatal factors of the mother-baby dyad might be associated with the cessation of EBF by six months after birth.MethodsData were collected at the rooming-in facility of the Reference Center of Women’s Health of Ribeirão Preto-Mater (CRSM-Mater) during the postpartum period (24 to 72 h after birth) from December 2012 to April 2013 and by telephone contact between the researcher and participating mothers by six months after birth.Questionnaires were applied to collect data, such as the practice of EBF in the last 24 h in the sixth month after birth. The hierarchical theoretical model was proposed and data were analyzed statistically by log-binomial regression models using SAS 9.3.ResultsThe study involved 283 mother-baby dyads in which the mother evaluated did not present pregnancy-puerperal complications that could impede breastfeeding and confirmed the interest in breastfeeding her child. After the telephone contact in the exact sixth month after the birth of each participating baby, 84.8% of the participating mothers reported that they were no longer exclusively breastfeeding their babies. After statistical analysis, we found that there was a significant association between cessation of EBF and maternal report of previous experience with EBF for one month (0.91, 95% CI 0.81, 0.99) and six months (0.81; 95% CI 0.68, 0.94). These practices were associated with the maintenance of EBF and, even after adjustment for maternal socio-demographic variables, this association was maintained (0.85; 95% CI 0.73, 0.99). Thus, there is a greater chance of practicing and maintaining EBF by six months after birth when mother had previous experience with it.ConclusionThe identification of the risk variables associated with cessation of EBF by six months postpartum, such as previous experience with exclusive breastfeeding, may contribute to the effectiveness of EBF intervention and support measures during the first six months after birth.

Health education intervention promoting infant safe sleep in paediatric primary care: randomised controlled trial

BackgroundFew randomised controlled trials (RCTs) have been conducted to improve infant sleep practices. There is limited research on how best to integrate safe sleep information into routine paediatric anticipatory guidance...

Mindful with Your Baby: Feasibility, Acceptability, and Effects of a Mindful Parenting Group Training for Mothers and Their Babies in a Mental Health Context

Many mothers experience difficulties after the birth of a baby. Mindful parenting may have benefits for mothers and babies, because it can help mothers regulate stress, and be more attentive towards themselves and their babies, which may have positive effects on their responsivity. This study examined the effectiveness of Mindful with your baby, an 8-week mindful parenting group training for mothers with their babies. The presence of the babies provides on-the-spot practicing opportunities and facilitates generalization of what is learned. Forty-four mothers with their babies (0–18 months), who were referred to a mental health clinic because of elevated stress or mental health problems of the mother, infant (regulation) problems, or mother-infant interaction problems, participated in 10 groups, each comprising of three to six mother-baby dyads. Questionnaires were administered at pretest, posttest, 8-week follow-up, and 1-year follow-up. Dropout rate was 7%. At posttest, 8-week follow-up, and 1-year follow-up, a significant improvement was seen in mindfulness, self-compassion, mindful parenting, (medium to large effects), as well as in well-being, psychopathology, parental confidence, responsivity, and hostility (small to large effects). Parental stress and parental affection only improved at the first and second follow-ups, respectively (small to medium effects), and maternal attention and rejection did not change. The infants improved in their positive affectivity (medium effect) but not in other aspects of their temperament. Mindful with your baby is a promising intervention for mothers with babies who are referred to mental health care because of elevated stress or mental health problems, infant (regulation) problems, or mother-infant interaction problems.

Measuring Maternal Behaviors in the Neonatal Intensive Care Unit.

One of the most important considerations in designing clinical infant research studies is the selection of reliable and valid measurement procedures. Few measures of caregiver-child interactions have been studied with newborns, particularly premature infants. The main objective of this study was to examine psychometric properties of the NICHD Mother-Child Interaction Qualitative Ratings in a sample of premature infants and their mothers to evaluate its use in the Neonatal Intensive Care Unit (NICU). Mother-baby dyads (N=24) were videotaped in a 10-minute interaction in the NICU. Nine raters independently assessed dyadic interactions using the NICHD Mother-Child Interaction Qualitative Ratings in a fully-crossed research design. Rater reliability was strong for mother and infant ratings, (.76 to .94). Scores yielded normal distributions for maternal sensitivity, positive regard, and flatness of affect and skewed distributions for maternal intrusiveness, detachment, negative regard, and all child ratings. Positive maternal behaviors correlated positively with one another and negatively with negative maternal behaviors. Thus, preliminary analyses suggest that scores obtained using the NICHD Mother-Child Interaction Qualitative Ratings with premature babies and their mothers in the NICU demonstrate adequate inter-rater reliability, and distributional properties provide preliminary evidence of face validity.

Antibiotic treatment at delivery shapes the initial oral microbiome in neonates

Oral microorganisms are important determinants of health and disease. The source of the initial neonatal microbiome and the factors dictating initial human oral microbiota development are unknown. This study aimed to investigate this in placental, oral and gut microbiome profiles from 36 overweight or obese mother-baby dyads as determined by 16S rRNA sequencing. Expression of five antibiotic resistance genes of the β-lactamase class was analysed in the infant oral microbiota samples by QPCR. The neonatal oral microbiota was 65.35% of maternal oral, 3.09% of placental, 31.56% of unknown and 0% of maternal gut origin. Two distinct neonatal oral microbiota profiles were observed: one strongly resembling the maternal oral microbiota and one with less similarity. Maternal exposure to intrapartum antibiotics explained the segregation of the profiles. Families belonging to Proteobacteria were abundant after antibiotics exposure while the families Streptococcaceae, Gemellaceae and Lactobacillales dominated in unexposed neonates. 26% of exposed neonates expressed the Vim-1 antibiotic resistance gene. These findings indicate that maternal intrapartum antibiotic treatment is a key regulator of the initial neonatal oral microbiome.

Interculturality and Early Attachment: A Comparison of Urban/ Non-Mapuche and Rural/Mapuche Mother-Baby Dyads in Chile

It is well known in the field that culture and context play an important role in child rearing and parenting practices. However, many studies do not address the cultural dimension of attachment, although evidence indicates that aspects of early attachment differ across cultures. With the goal of comparing the quality of mother–baby interactions, this study analyzed attachment behaviors and maternal sensitivity in two settings: urban/non-Mapuche and rural/Mapuche in Chile. The sample was composed of 34 mother-baby dyads (17 urban/non-Mapuche and 17 rural/Mapuche) with 12-month-old children. During a feeding episode, the attachment style of the interaction was assessed with the Attachment during Stress scale, and maternal sensitivity was evaluated with the Child-Adult Relationship Experimental Index-Toddlers (CARE-Index). The groups differed in their interaction attachment style and in affective and proximity modalities: Urban/non-Mapuche mothers tended to have secure and ambivalent attachment styles, and rural/Mapuche mothers tended to have avoidant styles. When educational level is controlled, ethnicity group can explain the differences in mothers’ attachment styles. The findings of the study and their implications are discussed.

Differences in the Protective Effect of Exclusive Breastfeeding on Child Overweight and Obesity by Mother's Race.

Objectives To examine the relationship between infant feeding and risk of child overweight and obesity across race and ethnicity in a diverse community-based cohort. Methods 2172 mother baby dyads were drawn from a prospective cohort constructed using data from electronic medical records linked to birth records. The primary exposure was exclusive breastfeeding at 2months of age; outcome was BMI Z-score and BMI≥85th percentile (overweight and obese) at 4years of age. Regression models were adjusted for confounding using covariance balanced propensity score and inverse probability weighting. Results At age 4, exclusively breast fed children had lower BMI Z-score (-0.109, SE=0.048) and a decreased odds of a BMI≥85th percentile (0.832; 95% CI 0.792, 0.994), when compared to those exclusively formula-fed or had mixed feeding. Race and ethnicity significantly moderated these associations. Sub-population analysis showed the effect was significant for BMI Z-score (p=0.0002) and BMI≥85th percentile (p<0.0001) only for children of NH white mothers. For children of NH black mothers exclusive breastfeeding was not associated with a significant difference in BMI Z-score, however there was an increased odds of overweight or obesity (p=0.0145). Conclusions The protective effect of breastfeeding against early childhood overweight and obesity may differ by race and ethnicity. This suggests that programs aiming to reduce obesity by increasing rates of breastfeeding may have limited impact for some groups and should be coupled with other racially and ethnically focused efforts to encourage healthy feeding practices in infancy and early childhood.

Prenatal maternal distress affects atopic dermatitis in offspring mediated by oxidative stress

Recent evidence suggests that prenatal maternal distress increases the risk of allergic diseases in offspring. However, the effect of prenatal maternal depression and anxiety on atopic dermatitis (AD) risk remains poorly understood. We investigated whether prenatal maternal distress is associated with AD risk in offspring and whether the mechanism is mediated by reactive oxygen species. Two general population-based birth cohorts formed the study. One cohort (Cohort for Childhood Origin of Asthma and Allergic Diseases [COCOA]) consisted of 973 mother-baby dyads, and the other (Panel Study on Korean Children [PSKC]) consisted of 1531 mother-baby dyads. The association between prenatal distress and AD was assessed by using Cox proportional hazards and logistic regression models. In COCOA placental 11β-hydroxysteroid dehydrogenase type 2 and glutathione levels and serum IgE levels in 1-year-old children were measured. In COCOA and PSKC AD occurred in 30.6% (lifetime prevalence) and 11.6% (1year prevalence) of offspring, respectively. Prenatal maternal distress increased the risk of AD in offspring, both in COCOA (hazard ratio for depression, 1.31 [95% CI, 1.02-1.69]; hazard ratio for anxiety, 1.41 [95% CI, 1.06-1.89]) and PSKC (odds ratio for distress, 1.85 [95% CI, 1.06-3.25]). In COCOA both prenatal maternal depression and anxiety scores were positively related to the predicted probability of AD (P<.001 in both). Prenatal distress decreased placental glutathione to glutathione disulfideratios (P=.037) and, especially in those who later had AD, decreased placental 11β-hydroxysteroid dehydrogenase type 2 levels (P=.010) and increased IgE levels at 1year of age (P=.005). Prenatal maternal depression and anxiety promote risk of AD in offspring. Maternal distress increases the predicted probability of AD. The mechanism might involve chronic stress, abnormal steroid levels, and reactive oxygen species.