A prospective study of the parent–baby bond in men and women 15 months after birth

Maternal and paternal postpartum early mood and bonding

BACKGROUND

Whereas the maternal 'blues' has been widely researched, comparatively less is known about the "highs" following childbirth, and the relation between mothers and fathers' mood in this early period. We aimed to investigate the association between maternal 'blues' and 'highs' with paternal postpartum mood (here described as 'lows' and 'highs') in the early postpartum and their associations with the quality of child bonding.

METHODS

Women and their cohabitating male partners, fathers of the index child (N = 98 couples), attending an obstetric hospital unit completed questionnaires on mood, bonding and socio-demographics between the 3rd and the 5th postpartum day. We used generalised estimating equations to analyse the data.

RESULTS

The 'blues' scores were higher in mothers, whereas 'highs' and bonding were higher in fathers. Maternal 'blues' were significantly correlated with paternal 'lows' (rs = .23, p < .05) and maternal 'highs' were also associated with paternal 'highs' (rs = .22, p < .05). Parental 'highs' were significantly associated with better baby bonding (B = .13, p = .02).

CONCLUSIONS

Our study demonstrates moderate associations between both 'blues/lows' and 'highs' in mothers and fathers shortly after the birth of the child. Associations between mood, particularly 'highs', and bonding were similar for mothers and fathers. Greater consideration of 'blues/lows' and 'highs' in both parents is needed to promote adjustment in the postpartum period.

Intergenerational transmission of maternal prenatal anxiety to infant fearfulness: the mediating role of mother-infant bonding

PURPOSE

This study is the first to directly investigate the mechanistic role of maternal bonding toward her infant in the early intergenerational pathway of risk from maternal anxiety to infant fearfulness.

METHODS

Mothers (N = 216; Mage=32.78) reported on their anxiety and bonding at four time-points between pregnancy and ten-months postpartum. At four and ten-months postpartum, infant temperamental precursors of anxiety were assessed through maternal report and observation.

RESULTS

Cross-lagged longitudinal path modeling indicated a significant link between prenatal maternal anxiety and infant temperamental fearful withdrawal at 10-months postpartum (R2 = 0.117), which was fully explained by decreased maternal bonding at one-month postpartum and increased infant temperamental negative reactivity at 4-months postpartum.

CONCLUSION

Results support the need to foster maternal bonding in preventive perinatal care, particularly in the context of maternal anxiety.

Determinants of Psychosocial Health Status in Pregnant and Postpartum Women Experiencing Earthquake in Turkey

OBJECTIVE

It is well known that natural disasters such as earthquakes negatively affect physical and mental health by exposing people to excessive stress. The aim of this study was to investigate determinants of psychosocial health status among the pregnant and postpartum women who experienced earthquake in Türkiye.

METHODS

Pregnant and postpartum women (n = 125) living in tent cities in the Kahramanmaraş region formed the study sample. Data were collected between February 20 and 26, 2023, through face-to-face interviews. The instruments used for data collection were the Introductory Form, the Depression Anxiety Stress Scale, the Traumatic Childbirth Perception Scale, and the Post-Traumatic Stress Disorder-Short Scale.

RESULTS

A moderate positive relationship was found between stress and posttraumatic stress and traumatic childbirth perception in pregnant and postpartum women, and a high positive relationship was found between anxiety and depression. A high level of relationship was found between anxiety and stress and depression.

CONCLUSIONS

It is seen that the psychosocial health of pregnant and postpartum women, who belong to the risk group in the earthquake zone, is at high risk. Psychological support is urgently needed to preserve and improve their psychosocial health.

A Longitudinal Study of Maternal Postnatal Bonding and Psychosocial Factors that Contribute to Social-Emotional Development

In this longitudinal study, we examined how maternal bonding and psycho-social factors are associated with social-emotional problems in two-year-old children. Our data came from a birth cohort from which data were collected at four timepoints: prenatally during the third trimester, and postnatally at 3, 8 and 24 months. The participants were 1,667 mothers, of which 943 (56.6%) returned the questionnaire at each timepoint of the longitudinal study. The Children's social-emotional problems were examined using the Brief Infant-Toddler Social and Emotional Assessment. According to linear regression analysis, maternal bonding difficulties at three and eight months, maternal expectations of the unborn baby during pregnancy, and maternal relationships within and outside the family were related to social-emotional problems in children of two years of age. The results highlight the importance of screening mothers who already prenatally have bonding problems or mothers who have bonding problems postnatally to provide effective and targeted intervention support.

Birth related PTSD and its association with the mother-infant relationship: A meta-analysis

OBJECTIVE

There is a growing body of research showing that birth related posttraumatic stress disorder (PTSD) symptoms may impact the mother-infant relationship. The present study assessed the strength of the association between birth related PTSD symptoms and the mother-infant relationship.

METHOD

A total of twelve studies (5,572 participants) were included based on database searches using PubMed, EBSCO and ProQuest.

RESULTS

The findings showed that greater levels of birth related PTSD symptoms were associated with poorer mother-infant relationship, r = -0.36, 95% CI: [-0.43 - -0.28], random effects model. The outcomes appeared to be heterogeneous (Q(11) = 81.63, p <.001, tau2 = 0.0123, I2 = 80.73%), despite all outcomes being in the same direction as the overall outcome.

CONCLUSIONS

The results indicated that birth related PTSD symptoms are negatively associated with the mother-infant relationship. Further investigation into the prevention of birth related trauma is suggested. Improving birthing experiences for mothers is likely to contribute to improved infant mental health, thereby reducing overall social and economic costs.

First-Time Parents' Bonding with Their Baby: A Longitudinal Study on Finnish Parents during the First Eight Months of Parenthood

Early positive bonding between parents and babies promotes the development of parenting skills and parents' sensitivity to their infant's needs. Positive bonding has been suggested to decrease the risk of maltreatment. There is less research into the differences between primiparae's and their spouses' bonding with their baby and changes in the parent-to-infant bonding during the first year of the baby's life. The aim of this study was to describe bonding with one's baby and related differences and changes within first-time parents. The data were collected from nine maternal health clinics in 2019-2021 in one city in Finland. The Mother-to-Infant Bonding Scale (MIBS) and the Edinburgh Postnatal Depression Scale (EPDS) were used. The data were collected during pregnancy (T1) and when the baby was aged 1-2 months (T2) and 6-8 months (T3). The questionnaire was completed separately by the primiparae (n = 81 at T1) and their spouses (n = 79 at T1). The findings demonstrated that both parents had positive feelings for their baby. The primiparae's and their spouses' MIBS scores were relatively low at T2 and T3. The change between time points or the difference in the parents' bonding was not statistically significant when examining MIBS total scores. The present study identified a positive weak-to-moderate correlation between the MIBS and EPDS. This association was highlighted in the group of primiparae. The results of this study can be used to develop maternity and child health clinic services, and to promote parents' equal growth in parenthood.

Persistent symptoms of maternal post-traumatic stress following childbirth across the first months postpartum: Associations with perturbations in maternal behavior and infant avoidance of social gaze toward mother

Recent literature identifies childbirth as a potentially traumatic event, following which mothers may develop symptoms of Post-Traumatic-Stress-Following-Childbirth (PTS-FC). The current study examines whether stable symptoms of PTS-FC during the early postpartum period may impose risk for perturbations in maternal behavior and infant social-engagement with mother, controlling for comorbid postpartum internalizing symptoms. Mother-infant dyads (N = 192) were recruited from the general population, during the third trimester of pregnancy. 49.5% of the mothers were primipara, and 48.4% of the infants were girls. Maternal PTS-FC was assessed at 3-day, 1-month and 4-month postpartum, via self-report and clinician-administered interview. Latent Profile Analysis generated two profiles of symptomology: "Stable-High-PTS-FC" (17.0%), and "Stable-Low-PTS-FC" (83%). Membership in the "Stable-High-PTS-FC" profile associated with perturbed maternal sensitivity, which was in turn significantly associated with infant avoidance of social gaze toward mother (Indirect effect β = -0.15). Results suggest the need for early screening and inform the planning of early preventive interventions.

Factors associated with father-infant bonding during the COVID-19 pandemic: an internet-based cross-sectional study in Japan

The COVID-19 pandemic has forced lifestyles changes and affected the relationships between fathers and their infants. However, the factors associated with paternal-infant bonding have not been clarified. This study aimed to explore the factors associated with father-infant bonding during the COVID-19 pandemic in Japan. This cross-sectional study used data from a nationwide survey and the Japanese version of the Mother-to-Infant Bonding Scale (MIBS) to measure father-infant bonding. The participants were divided into two groups depending on their partners' parity. A linear regression model (Gauss-Markov-type) was used for both groups. A total of 1055 men were included in the analysis. Of these men, 521 (49.4%) had a primipara partner, and 534 (50.6%) had a multipara partner. No significant differences were found between the two groups' MIBS-J scores. Fathers' mental health, relationship with the partner and family members, abusive behavior towards children, wanted pregnancy, and the youngest child's Neonatal Intensive Care Unit admission history were associated with father-infant bonding. Regarding factors related to COVID-19, caring for the child while the partner is at home has a negative impact on bonding, while fear related to infection with COVID-19 has no negative impact on bonding.

Identifying Core Items of the Japanese Version of the Mother-to-Infant Bonding Scale for Diagnosing Postpartum Bonding Disorder

The Japanese version of the mother-to-infant bonding scale (MIBS-J), a self-report of postpartum bonding disorder, is used in clinical settings for screening postpartum bonding disorder at various time points. However, its psychometric properties, particularly measurement invariance, have rarely been reported, and the validity of comparing scores across time points and sex is unclear. We aimed to select and validate the MIBS-J items suitable for parents at three time points. Postpartum mothers (n = 543) and fathers (n = 350) were surveyed at 5 days, 1 month, and 4 months postpartum. All participants were randomly divided into two subgroups, one for exploratory factor analyses (EFAs) and another for confirmatory factor analyses. Measurement invariance of the best model was tested using the entire sample, between fathers and mothers, and across the three observation periods. A three-item structure (items 1, 6, and 8) extracted through EFAs showed acceptable configural invariance. This model was accepted for scalar invariance between fathers and mothers and for metric invariance across the three time points. Our findings suggest that the three-item MIBS-J is sufficient for diagnosis of postpartum parental bonding disorder through continuous observation for at least 4 postpartum months, in order to detect the priority of parents who need support.

Maternal postnatal bonding disorder and developmental delays in children: the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study

Although there is some evidence regarding an association between maternal bonding disorder and child development, studies have mainly focused on development during the period of infancy. We aimed to examine the associations between maternal postnatal bonding disorder and developmental delays in children beyond 2 years of age. We analyzed data from 8380 mother-child pairs who participated in the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study. Maternal bonding disorder was defined as Mother-to-Infant Bonding Scale score of ≥5 at 1 month after delivery. The Ages & Stages Questionnaires, Third Edition, which consists of five developmental areas, was used to assess developmental delays in children at 2 and 3.5 years of age. Multiple logistic regression analyses were conducted to examine the associations between postnatal bonding disorder and developmental delays after adjustment for age, education, income, parity, feelings toward pregnancy, postnatal depressive symptoms, child's sex, preterm birth, and birth defects. Bonding disorder was associated with developmental delays in children at 2 and 3.5 years of age: the odds ratios (95% confidence intervals) were 1.55 (1.32-1.83) and 1.60 (1.34-1.90), respectively. Bonding disorder was associated with delay in communication only at 3.5 years of age. Bonding disorder was associated with delay in gross motor, fine motor, and problem solving, but not delay in the personal-social domain, at 2 and 3.5 years of age. In conclusion, maternal bonding disorder 1 month after delivery was associated with an increased risk of developmental delays in children beyond 2 years of age.

Stability of maternal postnatal bonding between 3 and 6 months: Associations with maternal mental health and infant temperament

Maternal bonding is key for infant development and well-being. Research to date focused on prenatal bonding experience, with fewer studies looking at the postnatal period. Moreover, evidence suggests significant associations among maternal bonding, maternal mental health, and infant temperament. The joint impact of maternal mental health and infant temperament on maternal postnatal bonding remains unclear, with limited research reporting longitudinal data. Hence, the present study aims (1) to explore the impact of maternal mental health and infant temperament on postnatal bonding at both 3 and 6 months of age, (2) to explore postnatal bonding stability from 3 to 6 months, and (3) to determine which factors are linked with 3-to-6-month changes in bonding. At the infants' 3 months (n = 261) and 6 months of age (n = 217), mothers provided measures of bonding, depressive and anxious symptoms, and infant temperament via validated questionnaires. At 3 months, higher levels of maternal bonding were predicted by lower levels of anxiety and depression in the mothers and by higher infants' regulation scores. At 6 months, lower levels of anxiety and depression predicted higher levels of bonding. Moreover, mothers showing decreases in bonding were characterized by 3-to-6-month increases in depression and anxiety, as well as increased reported difficulties in regulation dimensions of infant temperament. This study highlights the impact of both maternal mental health and infant temperament on maternal postnatal bonding in a longitudinal sample and could offer useful information for early childhood prevention and care.

Childbirth related PTSD and its association with infant outcome: A systematic review

INTRODUCTION

Maternal postnatal mental health problems may negatively impact child development. Postpartum research has mainly focused on the impact of maternal depression and anxiety due to their high prevalence (13-25 % and 10-18 %, respectively). However, maternal childbirth-related PTSD (CB-PTSD) could be another important risk factor in child development (estimated prevalence: 4.7 %).

OBJECTIVE

We investigated whether maternal CB-PTSD (symptoms) are associated with a negative mother-child relationship and/or child developmental outcome for children aged 0-5 years. Furthermore, we examined whether maternal trauma-focused therapy can positively impact mother and child outcomes.

METHODS

We performed a systematic review by searching three databases (Embase, Medline, PsycInfo). Search terms involved: 'birth or delivery modes', 'PTSD psychological trauma', and 'child development or child behavior'. Two independent reviewers evaluated all eligible papers.

RESULTS

Thirty-five papers (30 samples) were included and qualitatively reported. Results suggest a negative association of maternal CB-PTSD (symptoms) with mother-infant attachment and child behavior. However, confounding factors may explain this association. The evidence on associations with breastfeeding, sleeping, socio-emotional development, and weight gain is insufficient. Research investigating the effect of maternal trauma-focused therapy on a child's outcome is scarce, contradictory, and of low quality.

CONCLUSION

This systematic review suggests that maternal CB-PTSD may be associated with an increased number of problems in mother-infant attachment and child behavior, but other domains remain scarcely investigated and methodologic issues are present (cross-sectional study design, influence of confounding variables, sample representativeness, diversity in assessment tools). Our results support a multidisciplinary approach to providing early prevention and screening of the maternal mental health state.

Association of Paternity Leave with Impaired Father–Infant Bonding: Findings from a Nationwide Online Survey in Japan

Although the number of fathers taking childcare leave is increasing, the impact of paternity leave on father–infant bonding remains to be fully investigated. This study aimed to assess the association between paternity leave and father–infant bonding among fathers with children under two years old. A cross-sectional study was performed using data from the Japan COVID-19 and Society Internet Survey study, a nationwide online survey conducted between July and August 2021 (N = 1194). Father–infant bonding was assessed by the Japanese version of the Mother–Infant Bonding Scale (MIBS-J), which comprised two subscales (lack of affection (LA), and anger and rejection (AR)), with a higher score denoting poor bonding. Four hundred (33.5%) fathers self-reported taking childcare leave. Paternity leave was associated with higher total MIBS-J score and AR score after adjusting for covariates (coefficient 0.51; 95% confidence interval (CI) 0.06–0.96, coefficient 0.26; 95% CI 0.03–0.49, respectively), but not with LA score (coefficient 0.10; 95% CI −0.13–0.34). There was no trend in the association between paternity leave and total MIBS-J score by children’s age group (p for trend = 0.98). Paternity leave was associated with impaired bonding, especially with increased anger and rejection, among fathers with children under two years of age.

From adolescence to parenthood: a multi-decade study of preconception mental health problems and postpartum parent-infant bonds

PURPOSE

To examine associations between anxiety and depressive symptoms across adolescence and young adulthood with subsequent maternal- and paternal-infant bonding at 1 year postpartum.

METHODS

The data were from a prospective, intergenerational cohort study. Participants (381 mothers of 648 infants; 277 fathers of 421 infants) self-reported depression and anxiety at three adolescent waves (ages 13, 15 and 17 years) and three young adult waves (ages 19, 23 and 27 years). Subsequent parent-infant bonds with infants were reported at 1 year postpartum (parent age 29-35 years). Generalised estimating equations (GEE) separately assessed associations for mothers and fathers.

RESULTS

Mean postpartum bonding scores were approximately half a standard deviation lower in parents with a history of persistent adolescent and young adult depressive symptoms (maternal β_adj = - 0.45, 95% CI - 0.69, - 0.21; paternal β_adj = - 0.55, 95% CI - 0.90, 0.20) or anxiety (maternal β_adj = - 0.42, 95% CI - 0.66, - 0.18; paternal β_adj = - 0.49, 95% CI - 0.95, 0.03). Associations were still mostly evident, but attenuated after further adjustment for postpartum mental health concurrent with measurement of bonding.

CONCLUSIONS

Persistent symptoms of depression or anxiety spanning adolescence and young adulthood predict poorer emotional bonding with infants 1-year postbirth for both mothers and fathers.

The relationship of prenatal attachment level to traumatic childbirth perception and posttraumatic stress in pregnancy

OBJECTIVE

This study aimed to investigate the relationship between the extent of prenatal attachment and traumatic childbirth perception (TCP) and posttraumatic stress.

METHODS

A total of 308 pregnant women admitted to the Obstetrics and Gynecology Department during a period of 6 months were applied a Personal Information Form, the Prenatal Attachment Inventory, the Traumatic Childbirth Perception Scale, and the Posttraumatic Diagnostic Scale, Self-Report version.

RESULTS

There was a negative correlation between TCP and posttraumatic stress disorder (PTSD). Traumatic stress decreased with increasing prenatal attachment.

CONCLUSION

Consequently, a negative correlation was found between prenatal attachment and PTSD.

Paternal Leave and Father-Infant Bonding: Findings From the Population-Based Cohort Study DREAM

Background: Father-infant bonding is important for child development. Yet, in contrast to mother-infant bonding, little is known about factors that might facilitate father-infant bonding. With new generations of fathers being more involved in childcare, this study aims to examine the impact of paternal leave duration on father-infant bonding, and whether this relation is mediated by the amount of time fathers actively spend on childcare. Methods: Data of n = 637 fathers were derived from the German population-based cohort study "Dresden Study on Parenting, Work, and Mental Health" (DREAM). Mediation analyses were conducted. Duration of paternal leave (predictor), weekly hours spent on childcare (mediator), and father-infant bonding (outcome) were measured at 14 months postpartum. The potential confounders current status of paternal leave, part-time work during paternal leave, duration of solo paternal leave, age, education, and partnership satisfaction were included in a second mediation analysis. Results: Without considering confounders, duration of paternal leave positively predicted father-infant bonding through weekly hours spent on childcare. When adding confounders to the model, this indirect path did not stay significant. Moreover, in the adjusted model and on the direct path duration of paternal leave negatively predicted father-infant bonding. Additionally, partnership satisfaction positively predicted father-infant bonding. Some study variables were significantly associated with the mediator. Longer duration of paternal leave, currently being on paternal leave, younger age, and lower educational level predicted more weekly hours spent on childcare. Conclusions: Duration of paternal leave not being a stable predictor for father-infant bonding suggests that fathers, who do not have the opportunity to take long periods of paternal leave, can still form strong bonds with their infants. Other factors, for example partnership satisfaction, which might represent fathers' underlying capacity to bond, might be more crucial for father-infant bonding. At the same time, results should not be interpreted in a way that father involvement (e.g., paternal leave/time spent) does not matter for children's development. The finding that longer duration of paternal leave increases weekly hours spent on childcare supports the idea that facilitating father involvement can be achieved by paternal leave incentives such as non-transferable father months.

Pre-natal Attachment and Parent-To-Infant Attachment: A Systematic Review

During the perinatal period, the establishment of the attachment relationship with the fetus and subsequently with the real child is crucial for the parents' and the child's well-being. Coherently with the assumption that the attachment relationship starts to develop during pregnancy, this systematic review aims to analyze and systematize studies focused on the association between pre-natal attachment and parent-to-infant attachment, in order to clarify the emerging results and provide useful information for clinical purposes. Nineteen studies were included. Sixteen researches identified a positive relationship between pre-natal attachment and parent-to-infant attachment, and three articles highlighted a negative association between antenatal attachment and post-partum bonding disorders. These results were found both in women and men, in normative and at-risk pregnancies, adopting different assessment approaches (i.e., self-report measures, observations, and projective measures). However, only small or moderate associations were found. Future studies are needed to further confirm these findings across different populations (e.g., male samples, non-normative samples or samples in disadvantaged conditions) and with different methodological approaches (e.g., observational measures). Moreover, studies would be needed in order to clarify mechanisms through which pre-natal attachment influences parent-to-infant attachment, as well as protective and risk factors which intervene between these two variables.

Infant temperament as a predictor of maternal attachment: A Jordanian study

AIM

To investigate the relationship between maternal bonding and infant temperament during the first year of infant's life. Moreover, it also wanted to explore which perinatal factors could influence the quality of maternal attachment.

METHOD

A cross-sectional study design was used to collect data from a sample of 277 mothers during the period of May-October 2018. The participants were asked to complete a three-part survey that was developed to collect data on maternal attachment and infant temperament. Data was collected between March 2019-June 2019.

RESULTS

The analysis of the data revealed that there was a significant relationship between infant temperament and maternal attachment [F(2, 95) = 6.783, p-value = .001]. It also revealed that the factors that most influenced maternal attachment were infant temperament and planned pregnancy, which together explained 54% of the variance in maternal attachment (R2   =  7.5).

CONCLUSION

Maternal attachment in Jordanian mothers can be explained by two significant factors: infant temperament and planning for pregnancy.

Antecedents of fathers' perception of child behavior at child age 12 months

This study investigates whether fathers' adverse childhood experiences (ACE) and attachment style reported during pregnancy predict fathers' perception of child behavior assessed 12 months postpartum, expressed by the Parenting Stress Index (PSI), Child Domain. Prospective fathers (N = 835) were recruited to "The Little in Norway (LiN) study" (Moe & Smith) at nine well-baby clinics in Norway, with data collection composed of five time points during pregnancy and two time points postpartum (6 and 12 months). The main analyses included linear regression, path-analysis modeling, and intraclass correlation based on mixed effects modeling. First, linear regression analyses showed that neither fathers' ACE nor attachment style significantly predicted perceived child behavior postpartum directly. Furthermore, path analyses showed that ACE and less secure attachment style (especially avoidant attachment) measured early in pregnancy strongly predicted negatively perceived child behavior, mediated by fathers' mental health symptoms during pregnancy and partner disharmony postpartum. Second, intraclass correlation analyses showed that fathers' perceived child behavior showed substantial stability between 6 and 12 months postpartum. Family interventions beginning in pregnancy may be most beneficial given that fathers' early experiences and perceptions of attachment in pregnancy were associated with later partner disharmony and stress.

The role of maternal mental health, infant temperament, and couple's relationship quality for mother-infant bonding

BACKGROUND

Mother-infant bonding is the early emotional connection between mother and infant. It is affected by some aspects of maternal mental health, infant temperament, and the quality of a couple's relationship.

OBJECTIVE

This research aimed to determine the associations of the mother's postnatal depression and anxiety symptoms, infant temperament, and the quality of the couple's relationship with mother-infant bonding.

METHODS

This cross-sectional study was conducted on a sample of 241 Croatian mothers of infants aged between one month and one year (M_age = 6.34 months). The psychological instruments used in this study were: Postpartum Bonding Questionnaire, Edinburgh Postnatal Depression Scale, Depression Anxiety Stress Scale, Infant Characteristic Questionnaire, and Perceived Quality of Marital Relationship Scale .

RESULTS

Hierarchical regression analyses showed that previous maternal depression longer than two weeks, postnatal depression and anxiety symptoms, and difficult and unpredictable infant temperament were associated with self-report of poorer mother-infant bonding. Of the examined variables, the quality of the couple's relationship was in the lowest association with mother-infant bonding.

CONCLUSION

Given the importance of, in particular, the maternal depression and infant temperament for poor mother-infant bonding, early intervention and the reduction of risks factors may be necessary to prevent the development of such difficulties.

Parental Birth-Related PTSD Symptoms and Bonding in the Early Postpartum Period: A Prospective Population-Based Cohort Study

The parent-infant bond following childbirth is an important facilitator of optimal infant development. So far, research has mainly focused on mother-infant bonding. Data on fathers are still sparse. Parental mental health, such as posttraumatic stress symptoms (PTSD), may influence mother-infant relations and/or interactions. There is evidence that both parents can experience PTSD symptoms following childbirth (PTSD-CB). The aim of this study is to investigate the prospective relationship between parental PTSD-CB symptoms at 1 month postpartum and perceived parent-infant bonding at 3 months postpartum, while adjusting for antenatal confounders. A subsample was used for this study (n _Totalsample 488, n _mothers = 356, n _fathers = 132) of an ongoing prospective cohort study. Future parents awaiting their third trimester antenatal appointments at a Swiss university hospital were recruited. Self-report questionnaires assessed PTSD-CB symptoms and psychological distress at 1 month postpartum, and parent-infant bonding at 3 months postpartum. Confounders included antenatal PTSD symptoms and social support measured via self-report questionnaires, and gestity and gestational age, extracted from medical records. Using structural equation modeling, the predictive ability of PTSD-CB symptoms at 1 month postpartum on parent-infant bonding at 3 months postpartum was assessed for both parents respectively. Maternal PTSD-CB symptoms at 1 month postpartum were found to be negatively prospectively associated with mother-infant bonding at 3 months postpartum; however, this effect disappeared after adjusting for psychological distress at 1 month postpartum. No such effects were found for fathers. There was no evidence of mediation of the relationship between parental PTSD-CB symptoms at 1 month postpartum and parental-infant bonding at 3 months postpartum via psychological distress at 1 month postpartum. However, such a mediation was found for maternal intrusion and hyperarousal symptom subscales. Results expand the current literature on the impact of PTSD-CB on parent-child relations to also include fathers, and to a community sample. Any adverse effects of mental health symptoms on parent-infant bonding were evidenced by 3 months postpartum only for mothers, not fathers. Our results may inform the development of prevention/intervention strategies.

Predicting infant-father attachment: the role of pre- and postnatal triadic family alliance and paternal testosterone levels

This longitudinal study examined whether prenatal family alliance and prenatal paternal testosterone levels predicted infant-mother and infant-father attachment security and whether this association was mediated by postnatal family alliance and postnatal paternal testosterone levels. In 105 couples expecting their first child, family alliance was assessed in the third trimester of pregnancy with the prenatal version of the Lausanne Trilogue Play (LTP). Family alliance was measured again 6 months postnatally, using the LTP. Fathers provided testosterone samples prenatally and at 6 months postnatally. Infant-parent attachment was assessed with the Attachment Q-Sort (AQS) at 24 months. Results indicated an increase in paternal testosterone levels from the pre- to the postnatal period. A more positive prenatal family alliance predicted higher infant-father attachment security at 24 months, but not infant-mother attachment security. The association between prenatal family alliance and attachment security was not mediated by postnatal family alliance or postnatal paternal testosterone levels. This study highlights the significance of prenatal family relations, and the need to consider in research and practice the divergent effects of prenatal family alliance patterns on the emerging infant-mother and infant-father attachment relationships. The underlying hormonal mechanisms during the transition to fatherhood are important targets for future research.

Is childbirth-induced PTSD associated with low maternal attachment?

Few studies examined maternal attachment in childbirth-related postpartum posttraumatic stress disorder (PP-PTSD). We studied 685 postpartum women, assessing for PP-PTSD, non-childbirth PTSD, maternal attachment, pre-birth, birth, and post-birth factors. Attachment was lower in PP-PTSD than in non-childbirth PTSD and no PP-PTSD. Hierarchical regression showed that PP-PTSD predicted less maternal attachment above and beyond pre-birth psychiatric conditions, acute distress in birth, and lack of breastfeeding. Childbirth-induced posttraumatic stress may interfere with the formation of maternal attachment, warranting screening of at-risk women.

DOES FATHERS' PRENATAL MENTAL HEALTH BEAR A RELATIONSHIP TO PARENTING STRESS AT 6 MONTHS?

This study aimed to explore fathers' mental health and retrospectively reported adverse childhood experiences during pregnancy, as well as various pathways predicting self-reported stress at 6 months' postpartum as assessed by the Parenting Stress Index (PSI; R.R. Abidin, ). A total of 835 fathers contributed data to the study. Data collection comprised five time points during pregnancy and one at 6 months' postpartum. The main analyses were performed using linear regression and path analyses. First, linear regression analyses showed that paternal anxiety symptoms during pregnancy predicted stress scores in the PSI child domain at 6 months (coefficient = 0.36). Second, path analyses showed that depressive symptoms during pregnancy predicted parenting stress in the child domain, mediated by spousal disharmony at 6 months' postpartum (coefficient = 0.77). Third, adverse childhood experiences scores predicted parenting stress in the child domain by two different pathways: one mediated by anxiety symptoms in pregnancy (coefficient = 0.29) and the other by depressive symptoms in pregnancy and experienced spousal disharmony at 6 months' postpartum (coefficient = 0.77). The findings suggest that fathers' symptoms of anxiety and depression during pregnancy as well as adverse childhood experiences predict paternal stress and a negative perception of their children's behavior at 6 months' postpartum.

Mother-infant bonding in the postpartum period: assessment of the impact of pre-delivery factors in a clinical sample

This study aims to examine the extent to which a variety of pre-delivery factors (demographic, reproductive, psychological, psychiatric, and psychopathological) predict disturbances in mother-infant bonding (MIB) in the postpartum period. Two hundred fifty-one pregnant women enrolled at a public perinatal psychiatric service were assessed between the first and second trimester of pregnancy and at 6-7 weeks after delivery. During pregnancy, the psychological risk factors were assessed with the Vulnerable Personality Style Questionnaire, the Marital Adjustment Scale, the Early Trauma Inventory, and the General Health Questionnaire. To detect psychopathology, the Edinburgh Postnatal Depression Scale and the State-Trait Anxiety Inventory were used. At the postpartum evaluation, MIB was measured by the Postpartum Bonding Questionnaire. The results of the final regression model showed that emotional abuse in childhood, family psychiatric history, previous psychiatric hospitalization, and anxiety during pregnancy were significant predictors of MIB disturbances in postpartum, explaining 10.7% of the variance. The evaluation of women's risk factors in pregnancy is important in order to prevent MIB disturbances and thus to ensure the welfare of mothers and their babies.

Maternal posttraumatic stress disorder during the perinatal period and child outcomes: A systematic review

BACKGROUND

Approximately 3.3% of women in pregnancy have posttraumatic stress disorder (PTSD) and 4% of women postpartum PTSD. The impact of maternal PTSD during the perinatal period (from conception until one year postpartum) on child outcomes has not been systematically examined.

METHOD

A systematic review was conducted to synthesize and critically evaluate quantitative research investigating the association between perinatal PTSD and child outcomes. Databases EMBASE, BNI, Medline, PsycInfo and CINAHL were searched using specific inclusion and exclusion criteria.

RESULTS

26 papers reporting 21 studies were identified that examined associations between perinatal PTSD and postpartum birth outcomes, child development, and mother-infant relationship. Studies reviewed were heterogeneous, with poor-to-medium scores of methodological quality. Results showed that maternal postpartum PTSD is associated with low birth weight and lower rates of breastfeeding. Evidence for an association between maternal PTSD and preterm birth, fetal growth, head circumference, mother-infant interaction, the mother-infant relationship or child development is contradictory. Associations between maternal PTSD and infant salivary cortisol levels, and eating/sleeping difficulties are based on single studies, so require replication.

LIMITATIONS

Methodological weaknesses of the studies included insufficient sample size, use of invalidated measures, and limited external validity.

CONCLUSION

Findings suggest that perinatal PTSD is linked with some negative child outcomes. Early screening for PTSD during the perinatal period may be advisable and onward referral for effective treatment, if appropriate. Future research using larger sample sizes, validated and reliable clinical interviews to assess PTSD, and validated measures to assess a range of child outcomes, is needed.

Early Parental Adaptation, Prenatal Distress, and High-Risk Pregnancy

OBJECTIVES

To examine the examined the effects of high risk pregnancy and prenatal distress on parental postnatal adaptation.

METHODS

A sample of 111 expecting parents, consisting of 32 high risk pregnancy (HRP) mothers and 21 spouses and 36 matched low risk pregnancy (LRP) mothers and 22 spouses completed reports of depression symptoms (BDI) and pregnancy related concerns prenatally. At three months postpartum, parent-infant direct observations and reports of parenting alliance (PAI), stress (PSI-SF), satisfaction and efficacy (PSOC) were gathered. Data was analyzed with GLM multivariate analyses and the actor-partner interdependence model.

RESULTS

Parents' prenatal BDI predicted postnatal parental stress. BDI and concerns predicted postnatal satisfaction, but only for mothers. Mother's concerns predicted low maternal and high paternal parenting alliance. Partner effect was found so that high concerns predicted high reports of parenting alliance by spouse. Mean-group differences were found between HRP and LRP during parent-infant observations, so that HRP parents displayed lower sensitivity and reciprocity.

CONCLUSIONS

Prenatal distress, and to some degree high risk pregnancy, are risk factors that may interfere with the early formation of parent-infant relationship. Clinical implications of these findings are presented.