Infant colic and maternal depression

Diagnostic strategy of metagenomic next-generation sequencing for gram negative bacteria in respiratory infections

OBJECTIVE

This study aims to identify the most effective diagnostic method for distinguishing pathogenic and non-pathogenic Gram-negative bacteria (GNB) in suspected pneumonia cases using metagenomic next-generation sequencing (mNGS) on bronchoalveolar lavage fluid (BALF) samples.

METHODS

The effectiveness of mNGS was assessed on BALF samples collected from 583 patients, and the results were compared with those from microbiological culture and final clinical diagnosis. Three interpretational approaches were evaluated for diagnostic accuracy.

RESULTS

mNGS outperformed culture significantly. Among the interpretational approaches, Clinical Interpretation (CI) demonstrated the best diagnostic performance with a sensitivity of 87.3%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 98.3%. CI's specificity was significantly higher than Simple Interpretation (SI) at 37.9%. Additionally, CI excluded some microorganisms identified as putative pathogens by SI, including Haemophilus parainfluenzae, Haemophilus parahaemolyticus, and Klebsiella aerogenes.

CONCLUSION

Proper interpretation of mNGS data is crucial for accurately diagnosing respiratory infections caused by GNB. CI is recommended for this purpose.

Maternal capital predicts investment in infant growth and development through lactation

Introduction

Maternal capital (MC) is a broad term from evolutionary biology, referring to any aspects of maternal phenotype that represent resources available for investment in offspring. We investigated MC in breastfeeding mothers of late preterm and early term infants, examining its relationship with infant and breastfeeding outcomes. We also determined whether MC modified the effect of the relaxation intervention on these outcomes.

Methods

The data was collected as part of a randomized controlled trial investigating breastfeeding relaxation in 72 mothers of late preterm and early term infants. Indicators of MC (socioeconomic, social, somatic, reproductive, psychological, and cognitive) were collected at baseline at 2-3 weeks post-delivery. Principal Component Analysis was conducted for the MC measures and two components were identified: 1."Subjective" maternal capital which included stress and depression scores, and 2."Objective" maternal capital which included height, infant birth weight, and verbal memory. Univariate linear regression was conducted to assess the relationship between objective and subjective MC (predictors) and infant growth, infant behavior, maternal behavior, and infant feeding variables (outcomes) at 6-8 weeks. The interaction of MC and intervention assignment with outcomes was assessed.

Results

Higher objective MC was significantly associated with higher infant weight (0.43; 95%CI 0.21,0.66) and length z-scores (0.47; 95%CI 0.19,0.76), shorter duration of crying (-17.5; 95%CI -33.2,-1.9), and lower food (-0.28; 95%CI -0.48,-0.08) and satiety responsiveness (-0.17; 95%CI -0.31,-0.02) at 6-8 weeks. It was also associated with greater maternal responsiveness to infant cues (-0.05, 95%CI -0.09,-0.02 for non-responsiveness). Greater subjective maternal capital was significantly associated with higher breastfeeding frequency (2.3; 95%CI 0.8,3.8) and infant appetite (0.30; 95%CI 0.07,0.54). There was a significant interaction between the intervention assignment and objective MC for infant length, with trends for infant weight and crying, which indicated that the intervention had greater effects among mothers with lower capital.

Conclusion

Higher MC was associated with better infant growth and shorter crying duration. This was possibly mediated through more frequent breastfeeding and prompt responsiveness to infant cues, reflecting greater maternal investment. The findings also suggest that a relaxation intervention was most effective among those with low MC, suggesting some reduction in social inequalities in health.

Neonatal Antibiotics and Food Allergy Are Associated With FGIDs at 4-6 Years of Age

OBJECTIVES

Antibiotics may contribute to the development of functional gastrointestinal disorders (FGIDs). This study aimed to determine whether antibiotics during the first week of life, infantile colic in the first year of life, gut-associated immune markers at 1 year of age, and allergies at 4-6 years of age in term-born children were associated with a higher prevalence of FGIDs at 4-6 years of age.

METHODS

A prospective observational cohort of 436 term-born infants was followed up at the age of 4-6 years; 151 received broad-spectrum antibiotics (AB+), and 285 healthy controls (AB-). Validated Questionnaire On Pediatric Gastrointestinal Symptoms-Rome III and International Study of Asthma and Allergy in Childhood questionnaires were sent to parents of 418 available children. The independent t-test, chi-squared test or non-parametric test and logistic multivariate regression analyses were used.

RESULTS

In total, 340 of 418 (81%) questionnaires were completed. Only the presence of functional abdominal pain was significantly higher in AB+ than AB- (4% vs 0.4%, respectively, P  = 0.045). Children with food allergy fulfilled significantly more often the criteria for irritable bowel syndrome (IBS) and abdominal migraine (26% vs 9%, P  = 0.002 and 7% vs 1%, P  = 0.043, respectively) compared to non-allergic children. No differences in FGIDs existed at the age of 4-6 years between children with and without a history of infantile colic. There were significant differences in gut-associated immune markers between children with and without FGIDs.

CONCLUSION

Antibiotics during the first week of life resulted in a higher risk for functional abdominal pain at 4-6 years. Furthermore, food allergy was associated with IBS and abdominal migraine at 4-6years.

Stress in Egyptian parents of children with developmental disabilities. The moderating effect of social support

BACKGROUND

Research shows that parents of children with developmental disabilities (DDs) are at increased risk for elevated stress. Child adaptive functioning as well as social supports are key factors influencing stress in parents. However, few studies have examined the interaction between these variables and their contribution to perceived stress especially in Egyptian parents.

AIMS

The present study investigated the relationship between parenting stress, child adaptive functioning, and social supports. It also examined the moderating role of social support in the relationship between child adaptive functioning and stress in Egyptian parents of children with DDs.

METHOD

Sixty-four Egyptian parents of children with DDs completed assessment measures of parenting stress, child adaptive functioning, and social supports.

RESULTS

Parenting stress was negatively associated with child adaptive functioning and informal social supports. However, there was no association between parenting stress and formal social supports. In addition, level of informal social support had a moderating effect on the relationship between child adaptive functioning and level of parenting stress.

CONCLUSIONS

The findings highlight the importance of interventions that reduce child-related stressors, particularly low adaptive functioning. Programs that address parenting stress and promote effective informal and formal social supports are crucial to help parents cope with stress.

Development and validation of the infant crying and parent well-being screening tool

This article describes the development and validation of the infant crying and parent well-being (ICPW) screening tool, developed to provide an effective and efficient way of identifying families struggling with infant crying and soothing. Construct validity for the ICPW was assessed using survey data from 290 parents of infants. Scores on the ICPW were associated with parental depression, parenting stress, and low co-parent confidence. Parents with positive ICPW screens-indicating additional support is needed-were more likely to have high or clinical levels of parenting stress than parents with negative screens. Inconsolable and excessive infant crying negatively impacts the well-being of parents, and most importantly, is the primary trigger for infant abuse. The ICPW is a unique, efficient tool that allows providers to screen for families who may need additional support around infant crying and soothing.

Defining and distinguishing infant behavioral states using acoustic cry analysis: is colic painful?

BACKGROUND

To characterize acoustic features of an infant's cry and use machine learning to provide an objective measurement of behavioral state in a cry-translator. To apply the cry-translation algorithm to colic hypothesizing that these cries sound painful.

METHODS

Assessment of 1000 cries in a mobile app (ChatterBaby^TM). Training a cry-translation algorithm by evaluating >6000 acoustic features to predict whether infant cry was due to a pain (vaccinations, ear-piercings), fussy, or hunger states. Using the algorithm to predict the behavioral state of infants with reported colic.

RESULTS

The cry-translation algorithm was 90.7% accurate for identifying pain cries, and achieved 71.5% accuracy in discriminating cries from fussiness, hunger, or pain. The ChatterBaby cry-translation algorithm overwhelmingly predicted that colic cries were most likely from pain, compared to fussy and hungry states. Colic cries had average pain ratings of 73%, significantly greater than the pain measurements found in fussiness and hunger (p < 0.001, 2-sample t test). Colic cries outranked pain cries by measures of acoustic intensity, including energy, length of voiced periods, and fundamental frequency/pitch, while fussy and hungry cries showed reduced intensity measures compared to pain and colic.

CONCLUSIONS

Acoustic features of cries are consistent across a diverse infant population and can be utilized as objective markers of pain, hunger, and fussiness. The ChatterBaby algorithm detected significant acoustic similarities between colic and painful cries, suggesting that they may share a neuronal pathway.

Temporal Patterns of Infant Regulatory Behaviors in Relation to Maternal Mood and Soothing Strategies

This study investigates the temporal patterning of infant self-regulatory behaviors (crying/fussing, sleeping) in relation to both infant (age, sex, regulatory problems) and maternal variables (soothing behaviors, mood). Self-regulatory and soothing behaviors were assessed in 121 mother-infant dyads (4-44 weeks) by the Baby's Day Diary at 5 min intervals over 3 days. Further infant characteristics and maternal mood were assessed by questionnaires (DASS, CES-D, STAI) and the Diagnostic Interview for the Assessment of Regulatory Problems in Infancy and Toddlerhood. Data were analyzed using generalized additive mixed models. Negative maternal mood was associated with a deviant course of crying/fussing during the day. Body contact was associated with reduced variability in the 24 h course of sleep. Mother-infant transactional processes-above and beyond known relationships with overall levels of crying/fussing and sleeping-might play out on the temporal dimension of infant regulatory behaviors.

Infant crying problems and symptoms of sleeping problems predict attachment disorganization at 18 months

This longitudinal study examined the associations among infant crying, symptoms of sleeping problems, and attachment while considering the influence of maternal sensitivity and depressive symptoms. One hundred and five healthy full-term infants (42.9% female) were assessed for crying and symptoms of sleeping problems at 3 and 18 months via parental interview. Maternal sensitivity was measured through researcher observation, and attachment was measured at 18 months using the Strange Situation procedure. It was found that infant crying and symptoms of sleeping problems were not linked to the organized patterns of secure or insecure (avoidant versus resistant) attachment. However, when the disorganized attachment was considered, there were direct links found from infant crying and symptoms of sleeping problems at 3 months (β= .22, p< .05) and 18 months (β= .21, p< .05). Thus, crying and symptoms of sleeping problems as early as 3 months may indicate a disruption in the coherence of infants' relationship to their caretakers.

Systematic review on maternal depression versus anxiety in relation to excessive infant crying: it is all about the timing

Different types of studies suggest a link between maternal depression/anxiety and excessive infant crying (EC). However, comparability is hampered due to different designs, definitions and measurements. This systematic review investigates the specific role of maternal depression and anxiety considering them as preceding, concurrent and subsequent conditions of EC. A computerised literature search was conducted in January 2017 using Medline, PubMed, PsycINFO and Web of Science. After screening n = 399 records for inclusion/exclusion criteria, n = 33 records based on n = 30 projects were eligible for systematic qualitative data synthesis. All studies on maternal depression/anxiety and EC within the first 3 years of life were included. Included studies investigated predominantly maternal depression (25/30) and secondly maternal anxiety (17/30). Significant positive results were found in the majority of studies for maternal depression (21/25) as well as for maternal anxiety (12/17) in relation to EC. In-depth analyses further revealed that concurrent and subsequent maternal depression was robustly related with EC, whilst preceding maternal depression was not. In contrast, preceding and concurrent (but not subsequent) maternal anxiety was consistently related to subsequent EC. Maternal depression is more likely a correlate or even a consequence of EC, whereas anxiety is rather a temporally preceding condition and thus a potential risk factor or risk marker for both subsequent EC and associated maternal depression. Interventions for EC should address concurrent maternal depression, whilst preventive approaches might target preceding maternal anxiety as early as prior to or during pregnancy.

Regulatory Problems in Very Preterm and Full-Term Infants Over the First 18 Months

OBJECTIVE

This study is an investigation of differences in regulatory problems (RPs; crying, sleeping, feeding) expressed by infants born very preterm (VP; <32 wk gestation) or with very low birth weight (VLBW; <1500 g) and infants born at full term (FT) during the first 18 months of life. It investigates the prevalence of single and multiple RPs, their persistence and how early in infancy RPs still found at 18 months of age can be predicted.

METHOD

This prospective longitudinal study of 73 VP/VLBW and 105 FT infants utilized a standard interview of mothers to assess regulatory problems among the infants at term, 3, 6, and 18 months of age.

RESULTS

Few differences were found between VP/VLBW and FT infants in the first 6 months. At 18 months, VP/VLBW infants had more single sleeping (RR = 2.2, CI = 1.3-3.7), feeding (RR = 1.4, CI = 1.03-1.8), and multiple RPs (RR = 1.7, CI = 1.02-2.8) than FT infants. In VP/VLBW infants, RPs as early as 3 months and in FT infants RPs as early as 6 months predicted RPs at 18 months. Those infants who had persistent RPs in the first 6 months of life were more likely to still have RPs at 18 months.

CONCLUSION

VP/VLBW children are at slightly increased risk for RPs at term and in the second year of life. Clinicians should be aware that RPs that persist across the first 6 months point to increased risk of continuing RPs into toddlerhood in both VP/VLBW and FT infants.

PREPP: postpartum depression prevention through the mother-infant dyad

Most interventions to prevent postpartum depression (PPD) focus on the mother rather than the mother-infant dyad. As strong relationships between infant sleep and cry behavior and maternal postpartum mood have been demonstrated by previous research, interventions targeted at the dyad may reduce symptoms of PPD. The goal of the current study was to examine the effectiveness of Practical Resources for Effective Postpartum Parenting (PREPP). PREPP is a new PPD prevention protocol that aims to treat women at risk for PPD by promoting maternally mediated behavioral changes in their infants, while also including mother-focused skills. Results of this randomized control trial (RCT) (n = 54) indicate that this novel, brief intervention was well tolerated and effective in reducing maternal symptoms of anxiety and depression, particularly at 6 weeks postpartum. Additionally, this study found that infants of mothers enrolled in PREPP had fewer bouts of fussing and crying at 6 weeks postpartum than those infants whose mothers were in the Enhanced TAU group. These preliminary results indicate that PREPP has the potential to reduce the incidence of PPD in women at risk and to directly impact the developing mother-child relationship, the mother's view of her child, and child outcomes.

Preventing postpartum depression: review and recommendations

Nearly 20 % of mothers will experience an episode of major or minor depression within the first 3 months postpartum, making it the most common complication of childbearing. Postpartum depression (PPD) is significantly undertreated, and because prospective mothers are especially motivated for self-care, a focus on the prevention of PPD holds promise of clinical efficacy. This study is a qualitative review of existing approaches to prevent PPD. A PubMed search identified studies of methods of PPD prevention. The search was limited to peer-reviewed, published, English-language, randomized controlled trials (RCTs) of biological, psychological, and psychosocial interventions. Eighty articles were initially identified, and 45 were found to meet inclusion criteria. Eight RCTs of biological interventions were identified and 37 RCTs of psychological or psychosocial interventions. Results were mixed, with 20 studies showing clear positive effects of an intervention and 25 showing no effect. Studies differed widely in screening, population, measurement, and intervention. Among biological studies, anti-depressants and nutrients provided the most evidence of successful intervention. Among psychological and psychosocial studies, 13/17 successful trials targeted an at-risk population, and 4/7 trials using interpersonal therapy demonstrated success of the intervention versus control, with a further two small studies showing trends toward statistical significance. Existing approaches to the prevention of PPD vary widely, and given the current literature, it is not possible to identify one approach that is superior to others. Interpersonal therapy trials and trials that targeted an at-risk population appear to hold the most promise for further study.

Paternal postnatal depressive symptoms, infant sleeping and feeding behaviors, and rigid parental regulation: a correlational study

Paternal postnatal depression (PND) is now recognized as a serious and prevalent problem, associated with poorer well-being and functioning of all family members. Aspects of infant temperament, sleeping and feeding perceived by parents as problematic are associated with maternal PND, however, less is known about paternal PND. This study investigated depressive symptoms (Edinburgh postnatal depression scale (EPDS)) in 219 fathers of infants aged from 1 to 24 weeks (median 7.0 weeks). Infant predictor variables were sleeping problems, feeding problems and both mother and father reported temperament. Control variables were partner's support, other support and life events. Rigidity of parenting beliefs regarding infant regulation was also measured as a potential moderating factor. Infant feeding difficulties were associated with paternal depressive symptoms, subsuming the variance associated with both sleep problems and temperament. This relationship was not moderated by regulation beliefs. It was concluded that infant feeding is important to fathers. Fathers of infants with feeding difficulties may not be able to fulfill their idealized construction of involved fatherhood. Role incongruence may have an etiological role in paternal PND.

Maternal anxiety disorders predict excessive infant crying: a prospective longitudinal study

PURPOSE

To prospectively examine relations between maternal DSM-IV-TR anxiety and depressive disorders and excessive infant crying.

METHODS

Based on the prospective longitudinal Maternal Anxiety in Relation to Infant Development Study, n=306 expectant mothers were enrolled during early pregnancy and repeatedly interviewed until 16 months post partum. Lifetime and prospective information on maternal anxiety and depressive disorders was assessed via standardised diagnostic interviews (Composite International Diagnostic Interview for Women). Excessive crying (crying for ≥3 h per day on ≥3 days per week for ≥3 weeks) was assessed via Baby-DIPS. During the first 16 months after delivery, n=286 mother-infant dyads were available and included in the analyses.

RESULTS

Excessive crying was reported by n=29 mothers (10.1%). Infants of mothers with anxiety disorders prior to pregnancy were at higher risk for excessive crying than infants of mothers without any anxiety disorder prior to pregnancy (OR=2.54, 95% CI 1.11 to 5.78, p=0.027). Risk was even increased when considering additionally incident anxiety disorders until delivery (OR=3.02, 95% CI 1.25 to 7.32, p=0.014) and until 16 months post partum (OR=2.87, 95% CI 1.13 to 7.28, p=0.027). Associations remained stable when adjusting for sociodemographic and perinatal covariates. Maternal depressive disorders prior to pregnancy were not significantly associated with excessive crying in this sample.

IMPLICATIONS

Maternal lifetime and incident anxiety disorders revealed to be a robust predictor for excessive crying. Thus, early identification and monitoring of women with anxiety disorders is important to identify mother-infant dyads at risk for excessive crying.

Reducing maternal depressive symptoms through promotion of parenting in pediatric primary care

We studied associations between 2 pediatric primary care interventions promoting parental responsiveness and maternal depressive symptoms among low-income mothers. This randomized controlled trial included 2 interventions (Video Interaction Project [VIP], Building Blocks [BB]) and a control group. VIP is a relationship-based intervention, using video-recordings of mother-child dyads to reinforce interactional strengths. BB communicates with parents via parenting newsletters, learning materials, and questionnaires. At mean (SD) child age 6.9 (1.2) months, depressive symptoms were assessed with the Patient Health Questionnaire-9 (PHQ-9), parental responsiveness was assessed with StimQ-I. A total of 407 dyads were assessed. Rates of mild depressive symptoms were lower for VIP (20.6%) and BB (21.1%) than Controls (32.1%, P = .04). Moderate depressive symptoms were lower for VIP (4.0%) compared to Controls (9.7%, P = .031). Mean PHQ-9 scores differed across 3 groups (F = 3.8, P = .02): VIP mothers scored lower than controls (P = .02 by Tukey HSD). Parent-child interactions partially mediated VIP-associated reductions in depressive symptoms (indirect effect -.17, 95% confidence interval -.36, -.03).

Postnatal depression mediates the relationship between infant and maternal sleep disruption and family dysfunction

BACKGROUND

Previous research has linked family sleep disruption and dysfunction in children; however, the mechanism is unknown.

AIMS

This study examined whether maternal sleep and postnatal depression (PND) mediate the relationship between infant sleep disruption and family dysfunction.

STUDY DESIGN AND PARTICIPANTS

Mothers of infants aged 12 months old (N=111; 48% male) completed infant and parent sleep surveys, the Edinburgh Postnatal Depression Scale and the Family Assessment Device.

RESULTS

Poor infant sleep was related to poor maternal sleep, which was associated with higher PND and higher level of family dysfunction.

CONCLUSIONS

Results are consistent with the proposition that identification of both infant and maternal sleep problems during infancy can be relevant to reduction of PND and improved family functioning.

Das exzessive Schreien bei 5 Monate alten Säuglingen und prä-, peri- und postnatale Belastungen ihrer Mütter in einer Hoch-Risiko-Stichprobe

Fragestellung: Zusammenhänge zwischen persistierendem, exzessivem Schreien des Säuglings im fünften Lebensmonat und den prä- und perinatalen Belastungen sowie der postnatalen Befindlichkeit ihrer Mütter zu untersuchen. Methodik: Alle Daten wurden erhoben, als die Kinder im Durchschnitt 18.5 Wochen alt waren. Die Stichprobe von 300 Mutter-Kind-Dyaden war durch psychosoziale Risiken wie Armut, Mangel an sozialer Unterstützung, Minderjährigkeit der Mütter, Substanzmissbrauch oder psychische Störungen der Mutter belastet. Das exzessive Schreien wurde nach der Wessel-Regel erfasst, für die Erhebung von prä-, peri- und postnatalen Belastungen wurden Fragebögen vorgelegt. Ergebnisse: Multivariate Analysen zeigten ein erhöhtes Risiko für soziale Belastung in der Schwangerschaft (OR = 17.66) und für eine unerwünschte Schwangerschaft (OR = 13.77). Postnatal war das persistierende exzessive Schreien mit höheren Ausprägungen einer postpartalen depressiven Symptomatik der Mutter, mütterlicher Stressbelastung, Dysfunktionalität der Mutter-Kind-Interaktion, dem Wahrnehmen des Säuglings als «schwierig» sowie mit Schwierigkeiten bei der emotionalen Beziehungsaufnahme assoziiert. Schlussfolgerungen: Die Ergebnisse unterstreichen den Einfluss erhöhter pränataler Stressbelastung der Mütter und einer unerwünschten Schwangerschaft auf das persistierende exzessive Schreien der Säuglinge. Ein herabgesetztes Wohlbefinden der Mütter sowie ihre Schwierigkeiten bei der emotionalen Beziehungsaufnahme implizieren einen erhöhten Bedarf an Unterstützungsangeboten. Das Zusammenwirken von pränatalen und Beziehungsvariablen spielt eine Rolle für das Auftreten und die Aufrechterhaltung von frühen Regulationsproblemen.

Quick, simple measures of family relationships for use in clinical practice and research. A systematic review

BACKGROUND

Family functioning has been implicated in the onset of child and adult psychopathology. Various measures exist for assessing constructs in the areas of parent-child relationships, parental practices and discipline, parental beliefs, marital quality, global family functioning and situation-specific measures.

OBJECTIVES

To identify systematically all questionnaire measures of family functioning appropriate for use in primary care and research.

METHODS

A systematic literature review was conducted, following PRISMA guidelines and searching 14 bibliographic databases using pre-determined filters, to identify family functioning measures suitable for use in families with children from 0 to 3 years old.

RESULTS

One hundred and seven measures of family functioning were reported and tabulated and the most commonly used measures were identified.

CONCLUSIONS

There are numerous measures available demonstrating characteristics, which make them suitable for continued use. Future research is needed to examine the more holistic measurement of family functioning using integration of multi-informant data.

Parenting stress in mothers and fathers of toddlers with autism spectrum disorders: associations with child characteristics

Elevated parenting stress is observed among mothers of older children with autism spectrum disorders (ASD), but little is known about parents of young newly-diagnosed children. Associations between child behavior and parenting stress were examined in mothers and fathers of 54 toddlers with ASD (mean age = 26.9 months). Parents reported elevated parenting stress. Deficits/delays in children's social relatedness were associated with overall parenting stress, parent-child relationship problems, and distress for mothers and fathers. Regulatory problems were associated with maternal stress, whereas externalizing behaviors were associated with paternal stress. Cognitive functioning, communication deficits, and atypical behaviors were not uniquely associated with parenting stress. Clinical assessment of parental stress, acknowledging differences in parenting experiences for mothers and fathers of young children with ASD, is needed.

Postpartum mood disorders and maternal perceptions of infant patterns in well-child follow-up visits

AIMS

The aims of this study were to evaluate the associations between postpartum depressive symptoms and maternal perceptions of infant patterns with 1-year follow-up examinations, and to assess the impacts of treatment on these perceptions.

METHODS

One hundred three mother-infant pairs were evaluated. Data on maternal reports of infant feeding, sleeping and temperament patterns were collected at each well-child visit. The Edinburgh Postpartum Depression Scale was used to assess depressive symptoms. A psychiatrist interviewed the mothers with depressive symptoms, and psychiatric treatments were administered accordingly. The associations between depressive symptoms and maternal perceptions at each visit were analyzed by taking into account the entire follow-up period.

RESULTS

Thirty-five mothers (34%) scored within the clinical range of the EPDS during the follow-up period. Mothers with elevated depressive symptoms were more inclined to report infant cry-fuss, sleeping and temperamental problems through the follow-up. Such complains on infant cry-fuss and temperament problems and maternal sleeping problems improved after treatment in compliant mothers. The dropout rate was high (58.3%) in noncompliant mothers.

CONCLUSION

Postpartum depressive symptoms may lead to negative maternal perceptions of infant patterns. Earlier management of these disorders and maternal compliance to psychiatric suggestions may provide a better care for the mother-infant pairs.

Prenatal and parenting stress on adolescent maternal adjustment: identifying a high-risk subgroup

OBJECTIVES

Identifying adolescents who are at increased risk for a particularly difficult pregnancy and adjustment into parenthood is important, as the physical and psychological development of their infants rest in the well-being of these new mothers. This study aims to examine the effects of prenatal stress and parenting stress and the association with: (1) adolescent maternal adjustment; and (2) postpartum emotional distress.

METHODS

In a prospective longitudinal cohort study, 154 pregnant adolescents (age 14-19) from 10 public clinics were interviewed four times from the third trimester of pregnancy to 16 months postpartum. Planned comparisons of four stress groups were used to compare mean scores for measures of feelings about motherhood, infant care, parenting competency, and emotional distress.

RESULTS

Adolescent mothers who experienced high prenatal stress and high parenting stress had lower maternal adjustment (i.e., fewer positive feelings about motherhood, less infant care, and low parenting competency) and high postpartum emotional distress. Even when compared to adolescent mothers who experienced prenatal or parenting stress only, these adolescents were still at a greater disadvantage.

CONCLUSIONS

Results suggest that adolescents who experience high stress during and after pregnancy are at increased risk for difficult maternal adjustment and high postpartum emotional distress. Findings support the need for health services targeting this subgroup of adolescent mothers, including both prenatal and parenting support. Early intervention to increase maternal adjustment and decrease emotional distress should remain a priority in facilitating the most optimal maternal and child health outcomes.