Postpartum Depressive Symptoms as a Mediator Between Intimate Partner Violence During Pregnancy and Maternal-Infant Bonding in Japan

Perinatal Intimate Partner Violence and Maternal-Infant Bonding in Women With Anxiety Symptoms in Pakistan: The Moderating Role of Breastfeeding

Intimate partner violence (IPV) during the perinatal period can negatively affect both a woman's health and the bonding with her infant. Research on IPV among pregnant women experiencing psychological distress in South Asia is limited. We examined associations between perinatal exposure to IPV and postnatal maternal-infant bonding in Pakistani women with symptoms of anxiety and assessed if breastfeeding practices moderated these associations. Postnatal data were collected from 720 Pakistani women who reported at least mild levels of anxiety symptoms in pregnancy. We performed Poisson regression with robust variance analyses to examine the associations between IPV during pregnancy or within 6 weeks after delivery (i.e., the perinatal period) and maternal-infant bonding. Interaction terms between IPV and breastfeeding practices were included in the analytic models to examine the moderating effects. About 27% of women were exposed to at least one type of perinatal IPV. Women who were exposed to IPV were more likely to have moderate to severe postpartum anxiety (n = 57, 28.9% of IPV-exposed women), compared to those without IPV (n = 65, 12.4% of unexposed women; p value < .001). Compared to women not reporting IPV, women exposed to any IPV showed a 38% increase in Postpartum Bonding Questionnaire scores, suggesting higher likelihood of impaired bonding (risk ratio [RR] = 1.38, 95% confidence interval [CI] [1.21, 1.56]). Among women who initiated breastfeeding later than 1 hr post-delivery, IPV was associated with impaired bonding (RR = 1.09, 95% CI [1.06, 1.20]), whereas no association was present for women who initiated breastfeeding within 1 hr (RR = 1.03, 95% CI [0.98, 1.08]). In addition to the efforts to reduce IPV, encouraging IPV-exposed women to adhere to the breastfeeding guidelines (e.g., early breastfeeding) may enhance maternal-infant bonding.

Comparison of Maternal-Fetal Attachment and Fertility Motivation in Pregnant Women With and Without Experience of Violence: Descriptive and Analytic Study

Background and Aims

Domestic violence during pregnancy harms the mother-child bond and can affect fertility decisions. The study aims to Comparison of Maternal-Fetal Attachment and Fertility Motivation in Pregnant Women with and without Experience of Violence.

Materials and Methods

This descriptive and analytical study was conducted was conducted in 2024. A total of 292 pregnant women were selected through stratified random cluster sampling from primary healthcare of zanjan, Iran, and divided in non-violent (147) and violent (145) groups. Data collection tools were Demographic, the Conflict Tactics Scale (CTS2), the mother's attachment to Cranley's fetus, and Miller's fertility preferences questionnaire. To analyze the data by SPSS 17, we used Chi-square test, Pearson's test, correlation coefficient, and logistic regression, with a significance level set at p-value < 0.05.

Results

Most of the women who experienced violence had a second pregnancy or more (116 out of 145). Unwanted pregnancy was almost twice as common in women who had experienced violence as in women who had not (16.1% vs 8.2%). Women who experienced violence were significantly more likely to have fewer children (χ2 = 4.693, p = 0.33). As a result of the Binary logistics regression analyses, it was determined that the variables of young age of husband (OR: 1.325; CI:1.379-3.352), law education level of the husbands (OR:1.313; CI:1.090-2.093), gravida ≥ 5 (OR:5.750; CI:1.018-32.464), low desire to have children (OR:1.882; CI: 1.035-3.420), and low Fetal Attachment (OR: 5.423; CI: 1.965-14.966) were statistically significant with violent women.

Conclusion

Domestic violence during pregnancy affects the bond between mother and fetus, as well as fertility choices. Reducing domestic violence can enhance maternal-fetal attachment and improve fertility rates.

The Association of Spousal Relationship Quality and Social Support With Maternal-Infant Bonding: Moderating Roles of Maternal Age and Paternal Occupation

This study examined associations between spousal relationship quality and social support with mother-infant bonding among women in Rawalpindi, Pakistan (Intervention Arm: n = 352, Mage = 25.1, SD = 4.7; Control Arm: n = 358, Mage = 25.3, SD = 4.5). We used cross-sectional data from the Happy Mother-Healthy Baby intervention study, a randomized controlled trial conducted between 2019 and 2022. Women were enrolled at their first prenatal visit (at or before 22 weeks of gestation) and followed until 6-week postpartum. Spousal relationship quality, social support, and bonding were assessed at 6-week postpartum. Linear regression analyses found relationship quality (b = 3.85) and social support (b = 1.99) were positively associated with bonding. Analyses were adjusted for mother's education, treatment group, exposure to perinatal intimate partner violence, postpartum depressive symptoms, husband's education, husband's occupation, infant birthweight, and preterm birth. Husband's occupation (unskilled/unemployed vs. professional/skilled) significantly moderated the relationship between social support (b = 3.27 vs. b = 1.37) and relationship quality (b = 5.36 vs. b = 2.95) with bonding. Maternal age (≤ 25 years old vs. > 25 years old) significantly moderated the association between relationship quality and bonding (b = 4.96 vs. b = 2.49). Results suggest that interventions focused on improving social support and relationship quality among anxious women and their spouses could improve maternal-infant bonding. Trial Registration: ClinicalTrials.gov NCT03880032; https://clinicaltrials.gov/ct2/show/NCT03880032.

The status of intimate partner violence against pregnant women in contemporary China: a scoping review

PURPOSE

This review explored the status of publications on intimate partner violence (IPV) against pregnant women in contemporary China.

METHODS

The PubMed, Cochrane Library, Embase, CINAHL, and PsycInfo databases were searched using the terms "IPV," "pregnant woman," "Chinese," and synonyms in English, along with related keywords for Chinese publications. All literature pertaining to IPV during pregnancy, conducted in China, and published between 1987 and September 2023 was included.

RESULTS

A total of 37 articles from 30 studies were selected. The prevalence of IPV during pregnancy ranged from 2.5% to 31.3%, with psychological violence being the most common form. Frequently identified risk factors included unintended pregnancy, poor family economic conditions, male partners engaging in health risk behaviors, poor employment status of women or their partners, low education levels among women, physical or mental health issues, strained couple relationships, and in-law conflicts. IPV during pregnancy primarily led to mental health problems for the victims and could result in adverse obstetric outcomes, as well as negative effects on the temperament and development of the offspring. Victims in China demonstrated a low willingness to seek help from professionals. Furthermore, relevant research in mainland China is scarce, with a limited number of studies and non-standardized research methodologies.

CONCLUSION

Future research should investigate IPV in pregnancy from various perspectives, identify factors unique to IPV during pregnancy, and focus on high-risk groups. Considering the conditions in China, there is a pressing need to increase public awareness of IPV and to investigate interventions aimed at addressing this issue.

Longitudinal Patterns of Multidimensional Violence Exposure and Adolescent Early Sexual Initiation

Early sexual intercourse is associated with sexually transmitted infections, pregnancy, and depressive symptoms, and delay of intercourse allows adolescents opportunities to practice relationship skills (Coker et al., 1994; Harden, 2012; Kugler et al., 2017; Spriggs & Halpern, 2008). Thus, understanding predictors of early sexual intercourse is crucial. Prior research has suggested that violence exposure is associated with early initiation of sexual intercourse in adolescence (Abajobir et al., 2018; Orihuela et al., 2020). However, most studies have looked only at a single type of violence exposure. In addition, little research has examined longitudinal patterns of violence exposure in order to determine whether there are particular periods when the violence exposure may have the strongest impact on sexual behavior. Guided by life history and cumulative disadvantage theories, we use longitudinal latent class analysis and data from the Future of Families and Child Well-being Study (N = 3,396; 51.1% female, 48.9% male) to examine how longitudinal patterns of multiple types of violence exposures across ages 3 to 15 are associated with early sexual initiation in adolescence. Findings suggest that experiencing persistent physical and emotional abuse across childhood was associated with the greatest prevalence of early sexual initiation. Early exposure to violence was not consistently associated with greater likelihood of sexual initiation; instead, early abuse was more strongly associated with sexual initiation for boys, while late childhood abuse was more strongly associated for girls. These findings suggest that gender-sensitive programs are highly needed to address unique risk factors for boys' and girls' sexual behaviors.

Impact of parental perinatal depressive and anxiety symptoms trajectories on early parent-infant impaired bonding: a cohort study in east and west coasts of Malaysia

The association between maternal depressive and anxiety symptoms and impaired bonding with infants were widely studied, but not in fathers and none in Malaysia. We investigated the impact of different trajectories of perinatal depressive and anxiety symptoms on parent-infant impaired bonding during 2-3 months postpartum in both mothers and fathers in two areas of Malaysia. This study originated from a psychiatric morbidity cohort study carried out in health clinics in east and west Malaysia. Edinburgh Postnatal Depression Scale and anxiety subscale of Depression, Anxiety, and Stress Scale at late pregnancy and 2-3 months postpartum and Postpartum Bonding Questionnaire were completed by 566 mothers and 457 fathers. About 11.7% mothers and 16.1% fathers reported depressive symptoms during pregnancy, 6.5% mothers and 10.5% fathers during 2-3 months postpartum, and 3-4% mothers and fathers both depressive and anxiety symptoms 2-3 months postpartum. The mean impaired bonding score was highest in mothers and fathers who had both depressive and anxiety symptoms 2-3 months postpartum. Impaired bonding is associated with higher EPDS and DASS (anxiety subscale) scores 2-3 months postpartum in both parents. Physical partner violence and deteriorated marital relationship were associated with increased risk of impaired bonding in mothers. The association between depressive, anxiety, and comorbidity of depressive and anxiety symptoms in both mothers and fathers and parent-infant impaired bonding during 2-3 months postpartum urges for screening and treatment of depressive and anxiety symptoms in both parents during early parenthood.

Effects of Stress and Nativity on Maternal Antenatal Substance Use and Postnatal Mental Disorders

Background: Maternal substance use and common mental disorders (CMDs) during or after pregnancy can lead to negative health outcomes among mothers and infants. We examined whether nativity (US-born versus foreign-born) and stress levels during pregnancy were associated with antenatal substance use and postnatal CMDs. Methods: We analyzed the Boston Birth Cohort, a racially diverse cohort recruited at birth with rolling enrollment since 1998. Information on antenatal substance use (tobacco and/or alcohol use) was obtained using an in-person postpartum questionnaire (n = 6,514). Information on postnatal CMDs (depression and/or anxiety) was obtained from medical records (n = 2,052). Nativity and stress during pregnancy were self-reported. We performed multivariate logistic regression to examine how nativity and stress levels were jointly associated with antenatal substance use and postnatal CMDs. We further investigated if blacks, Hispanics, and whites were differentially at risk. Results: We found that US-born mothers were at higher risk of substance use and CMDs than their foreign-born counterparts. In analyses combining nativity and stress, being US-born with high stress was associated with increased odds of antenatal substance use (adjusted odds ratio [aOR] = 14.91, 95% confidence interval [CI]: 12.09-18.39) and postnatal CMDs (aOR = 4.09, 95% CI: 2.72-6.15) compared with foreign-born mothers with low stress. The results of the subanalyses limited to black and Hispanic women separately were similar; high stress alone was associated with fourfold increased odds of CMDs among foreign-born Hispanic mothers (aOR = 4.27, 95% CI: 1.96-9.33). Conclusions: Findings suggest that identifying and alleviating high stress among pregnant women may reduce their risk of antenatal substance use and postnatal CMDs.

Depressive symptoms in men immediately after birth

OBJECTIVE

Depression is the second leading cause of morbidity worldwide. This study aimed to assess the prevalence and associated risk factors of paternal postpartum depressive symptoms (PPD).

METHODS

In a cross-sectional study, via a stratified random and convenience sampling method 591 couples who were referred to Mazandaran primary health centers between 2 and 8 weeks postpartum were recruited from March to October 2017. Couples were screened for depressive symptoms using Edinburgh Postnatal Depression Scale (EPDS). Fathers provided information on socio-demographic characteristics, life events, neonatal stressor, perceived stress (Perceived Stress Scale), social support (Multidimensional Scale of Perceived Social Support), and general health status using General Health Questionnaire (GHQ-12) as well. Data was analyzed using multiple logistic regression.

RESULTS

Overall, 93 fathers (15.7%) and 188 mothers (31.8%) reported depressive symptoms above the cut-off EPDS score of 12. In the multiple logistic regression model, older age, maternal depressive symptoms, higher GHQ-12 scores and increased recent life events were related to paternal PPD. A significant inverse association was found between number of children and paternal PPD.

CONCLUSION

Depressive symptoms especially in first-time fathers following the birth of a child are not uncommon. Creating opportunities for men to access special health care services, parental education to help adapting to parenthood, screening programs, and psychiatric/psychosocial interventions to decrease suffering of depression for both depressed parents are recommended.