Postnatal Psychological Distress Research Articles

Biological and social cascades of prenatal contextual risk and maternal psychological distress to early-childhood adjustment.

In the peripartum, putative mechanisms in the transmission of prenatal contextual risk and maternal psychological distress include biological and social processes. In this study, path analyses were used to test unique, cascading pathways of prenatal contextual risk and pre- and postnatal maternal psychological distress through social mediators (parenting) and biological mediators (infant stress physiology) on infant temperament and toddler adjustment. The sample is comprised of racially and ethnically diverse first-time mothers (N = 200) living in low-income contexts (< 200% poverty) who were followed from pregnancy to 18-36 months postpartum. In pregnancy, mothers reported contextual risk and psychological distress (anxiety, depression). In the postpartum, mothers reported their psychological distress. At 2-4 months postpartum, observed mother-infant interactions were coded for sensitive responsiveness. Infant cortisol baseline and reactivity to a lab stressor were collected when infants were 4-6 months old. Mothers reported on infant's temperament (negative affect, effortful control) at 10-12 months and on child adjustment (internalizing, externalizing symptoms) at 18-36 months. Prenatal contextual risk predicted infant cortisol reactivity. Prenatal psychological distress predicted postnatal distress but, when accounting for postnatal distress, did not predict putative mediators or indicators of child adjustment. In contrast, maternal postnatal depression predicted subsequent maternal sensitive responsiveness, which in turn predicted later infant baseline cortisol and cortisol reactivity. Baseline cortisol predicted infant negative affectivity, which predicted toddler internalizing and externalizing symptoms. There was no evidence of mediated effects of prenatal variables on child adjustment outcomes, whereas contextual risk, postnatal psychological distress, and parenting were more salient predictors of child adjustment. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Mother-Infant Interaction and Maternal Postnatal Psychological Distress Associate with Child's Social-Emotional Development During Early Childhood: A FinnBrain Birth Cohort Study.

We studied the effects of mother-infant interaction and maternal pre- and postnatal psychological distress on children's social-emotional problems and competences, as well as whether interaction quality moderates the association between distress and children's outcomes. Maternal pre- and postnatal psychological distress were measured using the SCL and EPDS questionnaires, whereas mother-infant interaction was measured when the child was 8months old using the EA Scales. Children's social-emotional development was measured using the BITSEA questionnaire at 2years old and using the SDQ questionnaire at 4years old, where higher maternal structuring was associated with fewer social-emotional problems in children and higher maternal sensitivity was associated with greater social-emotional competence in children at 2years old. Further, higher postnatal distress was found associated with greater social-emotional problems at 2years old, though neither these effects nor moderating effects at 4years old were observed after multiple-comparison corrections. Our findings support direct associations of both mother-infant interaction and maternal postnatal psychological distress with children's social-emotional development during toddlerhood.

Mother-Father Differences in Risk Factors for Postnatal Psychological Distress: Results from the German SKKIPPI Cohort Study

The postnatal period is a potentially vulnerable time for families and can be associated with psychological distress in mothers and fathers. The aim of this analysis was to identify mother-father differences in symptoms of postnatal psychological distress and their risk factors. Cross-sectional screening data for postnatal psychological distress included postnatal depressive (PDS), anxiety (PAS), and obsessive-compulsive symptoms (POCS). Using baseline data of 4984 mothers and 962 fathers from the German SKKIPPI cohort study, we conducted an explorative multilevel logistic regression. Mothers were more likely than fathers to report PAS (OR 1.55, 95% CI: 1.00–2.41, p = 0.051) and POCS (1.38, 1.03–1.83, p = 0.029) but not PDS (1.15, 0.76–1.74, p = 0.509). Risk factors associated with psychological symptoms in mothers and fathers were life stressors, history of mental illness, and unsuitable pregnancy timing. Most risk factors were similar in mothers and fathers. However, relationship problems, having a child with a serious illness or disability, and the receipt of state payments seemed to have greater impact on fathers for some outcomes. These associations require further attention by researchers and should be considered by practitioners in the management of postnatal mental health. The SKKIPPI study has been registered in the German Clinical Trial Registry on February 8th, 2019 (DRKS-ID: DRKS00016653).

Maternal prenatal and postnatal psychological distress trajectories and impact on cognitive development in 4-year-old children: the Japan Environment and Children's Study.

Maternal prenatal and postnatal psychological distress, including depression and anxiety, may affect children's cognitive development. However, the findings have been inconsistent. We aimed to use the dataset from the Japan Environment and Children's Study, a nationwide prospective birth cohort study, to examine this association. We evaluated the relationship between the maternal six-item version of the Kessler Psychological Distress Scale (K6) scores and cognitive development among children aged 4 years. K6 was administered twice during pregnancy (M-T1; first half of pregnancy, M-T2; second half of pregnancy) and 1 year postpartum (C-1y). Cognitive development was assessed by trained testers, using the Kyoto Scale of Psychological Development 2001. Multiple regression analysis was performed with the group with a K6 score ≤ 4 for both M-T1 and M-T2 and C-1y as a reference. Records from 1,630 boys and 1,657 girls were analyzed. In the group with K6 scores ≥ 5 in both M-T1 and M-T2 and C-1Y groups, boys had significantly lower developmental quotients (DQ) in the language-social developmental (L-S) area (partial regression coefficient: -4.09, 95% confidence interval: -6.88 - -1.31), while girls did not differ significantly in DQ for the L-S area. Among boys and girls, those with K6 scores ≤ 4 at any one or two periods during M-T1, M-T2, or C-1y did not have significantly lower DQ for the L-S area. Persistent maternal psychological distress from the first half of pregnancy to 1 year postpartum had a disadvantageous association with verbal cognitive development in boys, but not in girls aged 4 years.

Mother–infant interaction and maternal postnatal psychological distress are associated with negative emotional reactivity among infants and toddlers— A FinnBrain Birth Cohort study

Studies have reported mixed findings regarding the effects of mother-infant interaction and maternal distress on children’s negative emotional reactivity. In the current study (N = 134 and 107), we examined the effects of maternal Emotional Availability (sensitivity, structuring, non-intrusiveness and non-hostility) and maternal psychological distress on negative reactivity among children in the FinnBrain birth cohort study. In addition, the possible moderating effect of mother-infant interaction on the associations between maternal psychological distress and children's negative reactivity was examined. We used questionnaires to asses maternal psychological distress, observations of mother-infant interaction and observations as well maternal reports of child temperament to overcome the key limitations of many studies relying on single-method assessments. Our results showed that higher maternal sensitivity and structuring at 8 months of child’s age were associated with lower mother-reported negative reactivity among children at 24 months. Higher maternal postnatal distress associated with higher parent-reported negative reactivity in children at 12 and 24 months of age when the effects of prenatal distress and the quality of mother-infant interaction were controlled for. Mother-infant interaction and maternal psychological distress did not associate with observations of child negative reactivity. We found no moderation effects of mother-infant interaction regarding the associations between maternal distress and children’s negative emotional reactivity. Our findings reflect the importance of developing interventions to reduce the maternal distress symptoms while enhancing maternal sensitivity and structuring to prevent the possible harmful effects of these on child negative reactivity.

Exploring the prospective role of relationships and psychological distress in postpartum risk of intergenerational continuity of child maltreatment

Objectives: This prospective longitudinal study aimed to explore the role of family relationships (romantic satisfaction and mother-infant bonding) and psychological distress in the associations between four child maltreatment (CM) subtypes (sexual, physical, and emotional abuse, neglect) and early child abuse potential in young mothers.Methods: A sample of 85 pregnant mothers (18-29 years old) was recruited to complete an online survey at Time 1 (T1); 57 mothers participated at T2 (3 months postpartum). The survey documented experiences of CM, prenatal romantic satisfaction, postnatal psychological distress, mother-infant bonding, and child abuse potential using validated questionnaires.Results: Four sequential mediation models were tested, one for each CM subtype. Results show that a maternal history of CM (all subtypes) was indirectly associated with heightened child abuse potential three months postpartum. All CM subtypes were negatively related to prenatal romantic satisfaction, which was in turn negatively associated with postnatal psychological distress. Postnatal psychological distress was related to lower mother-infant bonding which, in turn, was related to increased child abuse potential. The complete sequential model was significant for physical, sexual, and emotional abuse, while a partial sequence was identified with neglect.Implications: Our results are consistent with theoretical models and empirical findings demonstrating the importance of relational factors and mental health in the intergenerational continuity of CM. While our findings await replication, they emphasize the need to intervene early - during the perinatal period - on mental health and family relationships to interrupt intergenerational cycles of CM in at-risk families.

The association between caesarean and postnatal psychological distress: Effect modification by mental health history.

The association between mode of delivery and postnatal depression is uncertain. Mental health history may modify the association. The objective of this study was to determine whether the association between caesarean and postnatal psychological distress (PPD) differs according to long-standing depression/anxiety. Analysis of the UK-based Millennium Cohort Study of women who gave birth 2000-2002 was carried out. The outcomes were PPD at 9months by Rutter Malaise Inventory and actively treated physician-diagnosed depression/severe anxiety at 3years. The exposure was mode of delivery. Adjusted relative risks were estimated using Poisson regression. Effect modification according to long-standing depression/anxiety was investigated multiplicatively and additively. We included 15,936 women, of whom 2346 (13.4%, weighted) reported PPD. Women with long-standing depression/anxiety were at 34% lower risk of PPD following elective caesarean, compared with vaginal birth: relative risk (RR) 4.36 (95% confidence interval [CI] 3.76, 5.05), RR 3.25 (95% CI 2.23, 4.75) and RR 4.92 (95% CI 3.67, 6.59) for vaginal, elective and emergency caesarean births, respectively, with relative excess risk due to interaction (RERI) -1.28 (95% CI -2.73, 0.16), ratio of RRs 0.66 (95% CI 0.42, 1.05). Women with long-standing depression/anxiety were at greatest risk of later treatment following emergency caesarean, with RR 4.95 (95% CI 3.86, 6.34), RR 4.09 (95% CI 2.51, 6.65) and RR 6.74 (95% CI 4.87, 9.32), for vaginal, elective and emergency caesarean births, respectively; RERI 1.79 (95% CI -0.13, 3.71), ratio of RRs 1.36 (95% CI 0.94, 1.99); all RRs with reference to vaginal birth in the absence of long-standing depression/anxiety. There was no evidence of a similar association between emergency caesarean and PPD nor elective caesarean and later treatment. Women with long-standing depression or anxiety who had elective caesarean had a lower risk of postnatal distress. When this group had emergency caesarean, there was greater risk of actively treated depression/anxiety at 3years. These associations were not observed in women without long-standing depression/anxiety.

Interparental Conflict Across the Early Parenting Period: Evidence From Fathers Participating in an Australian Population-Based Study

Current evidence about the prevalence of interparental conflict (IPC) during early parenthood is primarily based on mothers’ reports. Drawing upon Australian longitudinal data from 4136 fathers, the aims of the study were to: (a) report on the extent to which fathers report IPC across six biennial time intervals when their children were aged 6–12 months to 10–11 years, (b) identify trajectories of IPC over time and (c) identify postnatal factors (at the initial time point) associated with high risk trajectories of IPC. One in 10 fathers reported high IPC at each time interval. A high and increasing pattern of IPC was observed for 6% of fathers. Factors associated with this trajectory were fathers being from a non-English speaking background and high postnatal psychological distress reported by mothers and fathers. These findings underscore the importance of early intervention for some families experiencing IPC in the early years of their children’s lives.

Maternal post-natal depressive symptoms at 2 months: Effects of French antenatal preventive measures in the E.L.F.E. cohort

BackgroundGiven the high incidence of perinatal maternal depression, implementation of preventive actions is crucial. In France, two prenatal preventive measures are available to the general population: early prenatal interview (EPI) and antenatal classes (ANC). ObjectiveTo explore the independent associations between EPI and / or ANC and maternal depressive symptoms at 2 months postpartum. MethodWe used data from the Etude Longitudinale Française depuis l'Enfance (ELFE), a French national representative cohort of children and their parents, followed-up from birth to early adulthood. Data concerning characteristics were collected from the mothers during the maternity stay and between 6/8 weeks’ post-partum. The level of depressive symptoms was scored by the French version of the Edinburgh Postnatal Depression Scale (EPDS) between 6/8 weeks’ post-partum. We considered EPDS score ≥10 indicative of postnatal psychological distress (PPD) and EPDS ≥12 for postnatal depressive symptoms (PNDS). After data imputation, multivariate logistic regression analysis was performed. ResultsAmong the 16,411 mothers included in our sample, 26% benefited both from EPI and ANC, 31.1 % of ANC, 7.7% of an EPI and 35% of neither; 20,1% presented PPD and 12,1% PNDS. The likelihood of presenting PPD was significantly higher in mothers who had neither had EPI nor ANC (OR = 1.15 (95% CI : 1.01–1.30). There was no association between receiving or not an EPI and/or ANC and presenting PNDS. ConclusionsAntenatal preventive measures may be helpful to prevent PPD at 2 months’ post- partum, while PNDS do not seem to be influenced by these actions.

Links between perinatal risk factors and maternal psychological distress: A network analysis.

This paper explores a range of perinatal risk factors that may increase maternal vulnerability to postnatal psychological distress in a sample of 17531 women participating in the Millennium Cohort Study, a diverse British, longitudinal birth cohort study. Using a graphical network modeling framework, this study models the links between postnatal psychological distress and perinatal risk factors, while controlling for sociodemographic factors and history of depression and anxiety. Postnatal psychological distress was assessed at 9months postpartum using the Rutter Malaise Inventory. Results of the graphical network models indicate that lower levels of happiness about the pregnancy (Edge weight [w]=0.084, 95% CI=0.069-0.100, b=0.095), smoking during pregnancy (w=0.026, 95% CI=-0.009-0.060, b=0.029), infection during pregnancy (w=0.071, 95% CI=0.024-0.118, b=0.090), hyperemesis gravidarum (w=0.068, 95% CI=0.013-0.123, b=0.083), baby in special care (w=0.048, 95% CI=-0.004-0.099, b=0.062), not being white (w=0.101, 95% CI=0.062-0.140, b=0.118), being from a more deprived area (w=-0.028, 95% CI=-0.051 to -0.005, b=-0.039), lower income (w=-0.025, 95% CI=-0.055-0.005, b=-0.036), and history of depression or anxiety (w=0.574, 95% CI=0.545-0.603, b=0.764) were associated with increased psychological distress. Some perinatal risk factors may be directly associated with postnatal psychological distress, but many risk factors appear to be primarily associated with demographic factors. This emphasizes the importance of taking a holistic approach when evaluating an individual's risk of developing postnatal psychological distress.

Psychosocial factors associated with postpartum psychological distress during the Covid-19 pandemic: a cross-sectional study

BackgroundTrauma, natural and man-made catastrophic events can be predictors of postpartum psychological distress. In a public health response due to coronavirus disease 2019 outbreak, the Italian government imposed a lockdown from March 9 to May 3. This extraordinary situation may have been challenging for maternal psychological health. The aim of this study was to investigate the prevalence of depressive and post-traumatic stress symptoms in women giving birth during the Covid-19 pandemic and its associations with quarantine measures, obstetrical factors, and relational attachment style.MethodsWomen who gave birth in a high-volume obstetric/gynaecological medical centre located in an epidemic area during the Covid-19 pandemic (March 8 to June 15) were asked to complete an online survey about their childbirth experience and the perceived effect of the pandemic. The Edinburgh Postnatal Depression Scale (EPDS), the Impact of Event Scale-Revised (IES-R), and the Relationship Questionnaire (RQ) were administered to assess levels of postpartum depressive and post-traumatic stress symptoms (PTSS) and relational style of attachment, respectively. Multivariate analysis was applied to identify associations between quarantine measures, childbirth experience, attachment style, and EPDS and IES-R scores.ResultsThe survey was completed by 163 women (response rate 60.8%). The prevalence of depressive symptoms was 44.2% (EPDS cut-off score ≥ 11) and the PTSS rate was 42.9% (IES-R cut-off score ≥ 24). Dismissive and fearful avoidant attachment styles were significantly associated with the risk of depression and PTSS, respectively. Perceived pain during birth was a risk factor for postpartum depression. Perceived support provided by healthcare staff was a protective factor against depression and PTSS. Another protective factor against PTSS was quiet on the ward due to the absence of hospital visitors.ConclusionThis study reports a high prevalence of postpartum depressive and PTSS in women who gave birth during the Covid-19 pandemic. Postnatal psychological distress seemed to be associated more with the prenatal experience and other individual factors than with the pandemic hospital restrictions. Early detection during pregnancy of an insecure attachment style is fundamental to provide targeted preventive and therapeutic psychological interventions.

SUPPORTING INFANT MENTAL HEALTH THROUGH EARLY INTERVENTIONS WITH CAREGIVERS WHO EXPERIENCED TOXIC STRESS AND EARLY ADVERSITY

Parents who experienced toxic stress and early adversity are at high risk of presenting pre- and postnatal psychological distress, mother-infant bonding impairments, and parenting difficulties. Early in development, their offspring are correspondingly more likely to present biological, developmental, and affective risk indicators than offspring of parents without histories of trauma. Therefore, there is a critical need for timely detection of the most vulnerable parents to provide effective preventive interventions. This Symposium will introduce participants to 4 programs aiming to support infant mental health through early interventions with caregivers who experienced trauma and toxic stress and/or who are currently facing extreme challenges.

Association between gender disadvantage factors and postnatal psychological distress among young women: A community-based study in rural India

ABSTRACT Common mental health disorders are studied extensively among adult women globally. However, they remain under-researched among young women. This study aims to determine whether gender disadvantage factors are associated with psychological distress among young women in rural India, where the child sex ratio is lower than the national average. A cross-sectional survey was conducted in rural Pune, India. A total of 229 young married women who had a live birth in the last 12 months were screened for psychological distress. The predictors of psychological distress were estimated using multivariable logistic regression analyses. Psychological distress was found among 50 respondents (21.9%). Young women who were married before 18 years had 2.19 times higher odds of distress than women who were married after 18 years. Young women who gave birth to a female infant had 2.43 times higher odds of distress than those who gave birth to a male infant. Lack of partner support and experience of postnatal health complications were other predictors. Study findings ascertain the role of gender disadvantage factors in causing psychological distress. From a public health perspective, early identification and treatment of psychological distress, is imperative, along with addressing gender inequitable practices.

Maternal psychological distress during and after pregnancy and atopic dermatitis in children

Abstract Background Previous studies reported the association between maternal psychological distress (PD) during or after pregnancy and atopic dermatitis in children. However, studies examining the association from both pre- and post-natal aspects are limited. Methods We analysed data from 6,366 mother-child pairs who participated in the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study in Japan. Mothers were categorised into four groups of PD (K6 scores ≥5) during early pregnancy and one year after delivery; no PD in both periods, prenatal PD only, postnatal PD only, and PD in both periods. Mothers reported on their children's atopic dermatitis at age two using the International Study of Asthma and Allergies in Childhood (ISAAC). Multivariate logistic regression analysis was conducted to examine the association between maternal PD and atopic dermatitis in children adjusting for maternal age at delivery, maternal education, maternal smoking during early pregnancy, maternal history of atopic diseases, paternal history of atopic diseases, preterm birth, parity, and child's sex. Results The study population included 51.9% without PD in both periods, 14.6% with prenatal PD only, 14.0% with postnatal PD only, and 19.4% with PD in both periods. The prevalence of atopic dermatitis in children at age two was 18.8%. Mothers with postnatal PD only and mothers with PD in both periods had higher risks of children's atopic dermatitis compared with mothers without PD in both periods; the adjusted odds ratios (95% confidence intervals) were 1.37 (1.14-1.65) and 1.38 (1.17-1.63), respectively. The corresponding odds ratio (95% confidence interval) of mothers with prenatal PD only was 1.08 (0.89-1.31). Conclusions Postnatal PD was associated with an increased risk of atopic dermatitis in children. This finding suggests the importance for monitoring mental health among postpartum women. Key messages Postnatal PD has significant effects on atopic dermatitis in children. This study is a first study to examine the association between maternal PD and children’s atopic dermatitis in Japan. Improvements of postnatal care including social support might be effective in preventing atopic dermatitis in children.

Psychological distress in pregnancy and postpartum

PurposeDepression, stress, and anxiety, termed ‘psychological distress,’ are common in pregnancy and postpartum periods. However, it is unclear whether prenatal psychological distress predicts postpartum psychological distress. We studied the prevalence, comorbidity and associations of maternal depression, stress, and anxiety in the prenatal period in relation to the occurrence of these same measures in the postpartum period. MethodsData originated from the MotherToBaby study of pregnant women residing in the U.S or Canada (2016–2018). Risk ratios and 95% Confidence Intervals using modified-Poisson regression models were used to investigate associations between prenatal psychological distress and postpartum psychological distress. ResultsOf the 288 women in the analysis, 21.2% and 26.7% of women had evidence of prenatal and postnatal psychological distress, respectively. Among those with prenatal psychological distress, 43 (70.5%) also had postpartum psychological distress. Twenty-five (41%) of those with prenatal and 46 (60%) of those with postpartum psychological distress had comorbidity of at least two of the measures. Prenatal measures independently predicted the same postnatal measures; prenatal anxiety also independently predicted postpartum stress. Participants who experienced more types of prenatal psychological distress were at higher risk for postpartum depression, stress, and anxiety. ConclusionDepression, stress, and anxiety are common in pregnant women and often occur together. Prenatal psychological distress measures are associated with postnatal psychological distress measures, with stronger associations among women with more than one type of psychological distress in pregnancy. Interventions during pregnancy may reduce the risk of postpartum psychological distress.

3.31 THE UNIQUE CONTRIBUTION OF MATERNAL DEPRESSIVE SYMPTOMS DURING PREGNANCY TO OFFSPRING’S SOCIOEMOTIONAL DEVELOPMENT BETWEEN 12 AND 36 MONTHS

Prenatal maternal psychological symptoms are associated with several aspects of offspring’s socioemotional development that are themselves predictive of mental health difficulties in later childhood or adolescence. This study aimed to evaluate whether maternal depressive symptoms during pregnancy were prospectively associated with offspring socioemotional development over and beyond the effect of other risk factors, namely maternal age, maternal history of childhood maltreatment, and postnatal psychological distress.

How maternal pre- and postnatal symptoms of depression and anxiety affect early mother-infant interaction?

BackgroundMaternal pre- and postnatal psychological distress, such as anxiety and depression, may negatively affect mother-infant interaction quality. However, more information is needed on the role of specific types and timings of pre- and postnatal distress symptoms on mother-infant interaction. Research on the role of maternal anxiety is especially scarce. MethodsWe examined whether maternal pregnancy- related anxiety (gestational weeks 24 and 34), general anxiety or depressive symptoms (gw 14, 24 and 34 and at the infant age of 3 and 6 months) associate with the quality of mother-infant interaction when the child is eight months old. Maternal symptoms (N = 190) were measured with EPDS, SCL-90 anxiety subscale and PRAQ-R2. Mother-infant interaction was measured with the Emotional Availability Scales (EAS). ResultsAfter controlling for background factors, general anxiety at the 3rd pregnancy trimester was associated with higher maternal intrusiveness in EAS. Depressive symptoms at 6 months postpartum associated with lower maternal structuring behavior and with the child's lower involvement of the mother. LimitationsA very small number of mothers with severe symptoms of depression and anxiety. ConclusionsPrenatal anxiety and postnatal depressive symptoms may each have unique effects on the different areas of mother-infant interaction, suggesting the need to develop more targeted interventions for mothers with different symptom profiles and timings. Prenatally anxious mothers could potentially benefit from early interventions decreasing stress and anxiety symptoms and specifically promoting their ability to read infant cues appropriately. Infants of postnatally depressed mothers may need interventions where both members of the dyad receive help.

Predicting Postnatal Psychological Distress in a Zambian Cohort: Relationship between the EPDS and the GHQ-12

Postnatal mental distress is a public health problem and women screening positive of psychological distress who do not meet the diagnostic criteria for psychiatric disorder may be experiencing significant distress for which they might require assistance from mental health personnel. The risk of a woman experiencing psychological distress during the postnatal period can be predicted before it occurs. The study included 300 pregnant women who were selected systematically and on whom two assessments were conducted at two different points. The first assessment was conducted at 32-week gestation while the second one at six weeks following childbirth. The participants were assessed using the Edinburgh Postnatal Depression Scale (EPDS) and the General Health Questionnaire (GHQ-12). Analysis of Variance (ANOVA) was used to test the association between the EPDS and the GHQ-12 while logistic regression analysis was carried out in order to predict postnatal psychological distress. The results showed no significant difference between the socio-demographic characteristics and the EPDS score. A significant association was found between the GHQ-12 and EPDS scores (r = 0.545; p = 0.001). Logistic regression revealed that a single predictor, antenatal EPDS individual score, alone provided a highly adequate model and was statistically reliable in distinguishing between presence and absence of psychological distress in the postnatal period (−2 log likelihood = 225.634; CI (1.035 - 1.173); X2 (1) 9.633, p = 0.002). The study revealed a correlation between EPDS score and GHQ-12 and that the EPDS can predict postnatal psychological distress using the data from the antenatal period. Therefore, patients who are found with antenatal psychological distress should be consistently evaluated throughout pregnancy and during the postnatal period to allow for early detection and intervention of postnatal psychological distress.

Associations between maternal mental health and early child wheezing in a South African birth cohort.

BackgroundWheezing in early childhood is common and has been identified in high‐income countries (HIC) as associated with maternal antenatal or postnatal psychosocial risk factors. However, the association between maternal mental health and childhood wheezing has not been well studied in low and middle‐income countries (LMIC), such as South Africa.MethodsA total of 1137 pregnant women over 18 year old, between 20 and 28 weeks’ gestation, and attending either of two catchment area clinics were enrolled in a South African parent study, the Drakenstein Child Health Study (DCHS). Psychosocial risk factors including maternal depression, psychological distress, early adversity, and intimate partner violence (IPV), were measured antenatally and postnatally by validated questionnaires. Two outcomes were evaluated: Presence of wheeze (at least one episode of child wheeze during the first 2 years of life); and recurrent wheeze (two or more episodes of wheezing in a 12‐month period). Logistic regression was used to investigate the association between antenatal or postnatal psychosocial risk factors and child wheeze, adjusting for clinical and socio‐demographic covariates.ResultsPostnatal psychological distress and IPV were associated with both presence of wheeze (adjusted OR = 2.09, 95%CI: 1.16‐3.77 and 1.63, 95%CI: 1.13‐2.34, respectively), and recurrent child wheeze (adjusted OR = 2.26, 95%CI: 1.06‐4.81 and 2.20, 95%CI: 1.35‐3.61, respectively).ConclusionMaternal postnatal psychological distress and IPV were associated with wheezing in early childhood. Thus, screening and treatment programs to address maternal psychosocial risk factors may be potential strategies to reduce the burden of childhood wheeze in LMICs.

Does body image influence the relationship between body weight and breastfeeding maintenance in new mothers?

Obese women have lower breastfeeding initiation and maintenance rates than healthy weight women. Research generally focuses on biomedical explanations for this. Psychosocial factors including body image and well-being after childbirth are less well understood as predictors of breastfeeding. In obese and healthy weight women, we investigated changes in body image between 72hrs post-delivery and 6-8weeks post-natal, studying how women's body image related to breastfeeding initiation and maintenance. We also investigated how psychological distress was related to body image. Longitudinal semi-structured questionnaire survey. Body image and psychological distress were assessed within 72hrs of birth and by postal questionnaire at 6-8weeks, for 70 obese and 70 healthy weight women initiating exclusive (breastmilk only) breastfeeding or mixed feeding (with formula milk) in hospital. Breastfeeding was re-assessed at 6-8weeks. Obese women were less likely to exclusively breastfeed in hospital and maintain breastfeeding to 6-8weeks. Better body image was related to maintaining breastfeeding and to lower post-natal psychological distress for all women, but education level was the most significant predictor of maintenance in multivariate regression including body image and weight status. Body image mediated, but did not moderate the relationship between weight and breastfeeding maintenance. Body image was lower overall in obese women, but all women had low body image satisfaction around childbirth, reducing further at 6-8weeks. Health professionals should consider women's body image when discussing breastfeeding. A focus on breast function over form may support breastfeeding for all women. Statement of contribution What is already known on this subject? Obesity can negatively affect breastfeeding initiation and maintenance, but there is little information about how psychosocial factors affect this relationship. Body image may be an important factor, but has not been studied in relation to breastfeeding maintenance. What does this study add This article examines the influence of body image on obese and healthy-weight women's breastfeeding maintenance at 6-8weeks. Different aspects of body image mediated but did not moderate the relationship between weight status and breastfeeding maintenance, but in multivariate regression, maternal education level was the most significant predictor. Obese women had poorer body image and were less likely to maintain breastfeeding; however, for all women, body image became more negative in this postpartum period. Interventions should normalize positive aspects of women's postnatal bodies, including function rather than form. Addressing body concerns could encourage new mothers to maintain breastfeeding, irrespective of weight status.