Maternal Bonding in Early Infancy Predicts Childrens' Social Competences in Preschool Age

Longitudinal Influences on Maternal-Infant Bonding at 18 Months Postpartum: The Predictive Role of Perinatal and Postpartum Depression and Childbirth Trauma

Background: This study investigated the pathways through which various psychological problems occurring across the perinatal period influence mother-child bonding within the first 18 months postpartum, with a particular focus on the relationship between perinatal and postpartum depression and childbirth-related posttraumatic stress symptomatology. Methods: A multi-stage longitudinal design included three assessment points: recruitment and initial assessment in the third trimester of pregnancy (T1), a second assessment at 8 months postpartum (T2), and a final assessment at 18 months postpartum (T3). A total of N = 51 mothers completed all three waves (total follow-up period per participant: approximately 21 months). Sociodemographic data were collected, and all assessments were completed online. Results: Our findings revealed significant indirect effects, linking higher levels of perinatal depressive symptoms in the third trimester with mother-child bonding difficulties at 18 months postpartum. This association was mediated by both greater childbirth-related posttraumatic stress symptoms and elevated postpartum depressive symptoms at 8 months. Conclusions: These preliminary results highlight how complex perinatal factors at different stages (i.e., during pregnancy and early postpartum) influence mother-child bonding at 18 months postpartum. Understanding these pathways is essential in order to inform targeted interventions and to promote optimal maternal mental health and bonding outcomes.

Postpartum maternal bonding scale: Development and validation in a low- and middle- income country setting

INTRODUCTION

The World Health Organization's Nurturing Care Framework recommends promoting secure postpartum maternal-infant bonding practices through responsive caregiving for healthy child development. Various instruments exist to assess maternal-infant bonding, but they differ in theoretical foundations and constructs, limiting their broad application and comparability. Notably, there is a lack of bonding instruments developed for low- and middle-income countries (LMICs), where children under five are most at risk of not reaching their developmental potential. This paper describes the development and psychometric validation of a conceptually grounded postpartum maternal bonding scale in an LMIC context and highlights its potential applications in similar settings.

METHODS

Based on a literature review of bonding concepts and measurement processes, we developed a postpartum maternal bonding scale using a cultural adaptation model for psychometric instruments for children and adolescents. This involved identifying and reviewing existing bonding-related tools, generating items, iterative rounds of expert reviews, and pretesting with postpartum women. We then conducted a final survey with a large sample of women at 42 days postpartum to establish the scale's psychometric properties. The study was conducted in the Thatta and Sujawal districts of Sindh, Pakistan.

RESULTS

An initial pool of 44 items was developed following a literature review and interviews with postpartum women. After multiple rounds of expert review and cognitive pretesting, a 30-item tool was selected for field testing. Using data from 310 postpartum women, we examined the tool's structure through exploratory (EFA) and confirmatory factor analysis (CFA), leading to a refined 12-item tool. The EFA revealed three factors related to Emotional, Cognitive, and Behavioural bonding. Taking the four highest loading items from each domain, we performed CFA using three models: a first-order model with the three domains, a second-order model, and a bifactor model, which included an overall bonding construct. The bifactor model showed the best fit (comparative fit index =  0.951; root mean square error of approximation =  0.066; standardized root mean square residual =  0.045). This indicates that both an overall bonding construct and specific domains can be measured separately. Pairwise domain correlations were all below 0.67, and internal reliability statistics ranged from 0.63-0.72 (Cronbach's Alpha) and 0.64-0.77 (global omega). Regression analysis showed associations between bonding scores and factors such as cesarean delivery (reduced behavioural bonding score for mothers having caesarean: -0.94, 95% Confidence Interval -1.86 to -0.01, p-value 0.047), maternal disability (reduced overall bonding score for mothers with severe disability -1.54, 95% CI -3.12 to 0.03, p-value 0.054), and probable postpartum depression (reduced overall bonding score in mothers with probable PPD -1.57, 95% CI -2.70 to -0.45, p-value 0.006).

CONCLUSION

The 12-item postpartum maternal bonding scale (PMBS) is a conceptually grounded instrument. It is a brief, easy-to-administer tool with potential cross-cultural use in low- and middle-income settings after cultural adaptation.

Postpartum maternal depression, mother-to-infant bonding, and their association with child difficulties in sixth grade

PURPOSE

Postpartum maternal mental health plays a crucial role in the development of children's social and emotional competencies. This study aimed to investigate the influence of postpartum maternal depression and mother-to-infant bonding on children's emotional and behavioral difficulties in sixth grade.

METHODS

Data from the maternal Edinburgh Postnatal Depression Scale (EPDS) and the Mother-to-Infant Bonding Scale-Japanese version (MIBS-J), administered to mothers approximately 2 weeks to 1 month postpartum during postnatal health checkups in Okaya, Japan, were analyzed alongside Strengths and Difficulties Questionnaire (SDQ) data collected from their sixth-grade children and their caregivers. The study included 245 mother-child pairs of children born between April 2, 2009, and April 1, 2012.

RESULTS

Postpartum maternal depressive symptoms, as assessed by the EPDS, were significantly associated with mother-to-infant bonding difficulties, as assessed by the MIBS-J. Structural equation modeling revealed that EPDS, MIBS-J, and sex significantly predicted psychosocial difficulties of children. Bonding difficulties mediated 34.6% of the total effect of EPDS on child difficulties. The models explained 26.1% of the variance in psychosocial difficulties, with 43.0% of the variance explained for parent-rated SDQ scores and 36.4% for self-rated SDQ scores.

CONCLUSIONS

The negative impact of maternal depressive symptoms on mother-to-infant bonding may have contributed to increased difficulties for the child, highlighting the critical role of bonding in moderating the effects of maternal mental health on child development. These findings underscore the importance of early postpartum interventions targeting both maternal depression and bonding difficulties to mitigate long-term effects on child development.

Characterizing Social Communication Difficulties in Young Children within a Longitudinal Ecological Systems Framework

Social communication difficulties are a transdiagnostic risk factor for psychopathology. However, few studies have examined prospective risk for social communication difficulties in young children within an ecological systems framework. Our sample was 251 parent-child dyads assessed during pregnancy, postpartum, and toddlerhood (child ages 1 and 2). We leveraged observer ratings of child behavior, parent-reported questionnaires, and geocoded data. We examined prospective risk factors for social communication difficulties at ages 1 and 2, including at the level of the child (gestational age), family (household income, maternal mental health, maternal-child bonding), and neighborhood (neighborhood resources). Fewer neighborhood resources were associated with more social communication difficulties at age 1, but only among dyads with impaired maternal bonding. Lower gestational age, lower household income, and impaired maternal bonding were associated with more child social communication difficulties at age 2. Fewer neighborhood resources were also related to more social communication difficulties at age 2, specifically among families with low household incomes. Findings provide insight into families who may benefit from early intervention to reduce transdiagnostic risk for child psychopathology across ecological systems, including efforts to target maternal bonding and poverty.

The Effect of Maternal Attitudes and Depression on Bonding During the Postpartum Period

Purpose

Bonding refers to the development of an emotional relationship between a mother and her baby, which forms a strong and continuous bond that provides the baby with a sense of security and plays an important role in its mental well-being throughout life. The objective of this study was to assess the relationship between cognitive distortions, attitudes towards motherhood and postpartum depression, which have not been studied before, as well as to elucidate their impact on the mother-infant bonding process.

Patients and Methods

The sample of the study was created between November 2018- June 2019 using the non-discriminatory multiplicity snowball sampling technique through social media. Women with infants aged 0-1 year residing in Turkey were asked to participate in the online survey. A sociodemographic data form, the Edinburgh Postpartum Depression Scale, Attitudes Towards Motherhood Scale (AToM), Postpartum Bonding Questionnaire (PBQ), and Cognitive Distortions Scale (CDS) were applied to the sample via social media.

Results

The study sample consisted of 387 women with infants aged 0-1 years, and the rate of impairment bonding was found to be 11.4%. CDS, ATOM and depression scores were significantly higher in the impaired attached group (p < 0.05). The findings indicated that an individual with a psychiatric diagnosis was 2.653 times more likely to exhibit impaired bonding (OR: 2.653, 95% CI: [1.08-6.517]; p = 0.033), and those with a higher AToM score were 1.044 times more likely to display impaired bonding (OR: 1.044, 95% CI: [1.013-1.075]; p = 0.004).

Conclusion

The cognitive structure of the mother is associated with impaired mother-baby bonding. Eliminating the mentioned cognitive elements with psychotherapy interventions will be protective in terms of impaired bonding related to psychopathologies and/or interpersonal relationship problems.

Dance with me? Analyzing interpersonal synchrony and quality of interaction during joint dance

This methodological paper examines the assessment of interpersonal synchrony during a joint dancing task between mothers and their children (aged 4 to 5 years) using OpenPose. This pose estimation tool captures movement in naturalistic settings. The study analyzes 45 mother-child dyads, comparing two analytical methods for assessing synchrony, and examines their correlation with the Coding Interactive Behavior (CIB) measure of interaction quality. The first method employs cross-wavelet transform (CWT) coherence to assess synchrony based on vertical head movement. This straightforward and computationally efficient approach reveals a significant correlation between interpersonal synchrony and CIB scores, thus implying its potential as a reliable indicator of interaction quality and suggesting its potential as a measure of interaction quality. The second method, the generalized cross-wavelet transform (GCWT), analyzes synchrony across multiple body parts, offering a more complex and detailed analysis of interpersonal dynamics. However, it did not significantly correlate with the CIB scores. Our findings suggest that focusing on head movement using CWT can effectively capture critical elements of interpersonal synchrony linked to interaction quality. In contrast, despite its richness, the more complex GCWT approach may not align as closely with observed interactive behaviors as the CIB scores indicate. This study underscores the need to balance methodological complexity and ecological validity in research, offering insights into selecting analytical techniques based on research objectives and the nuances of interpersonal dynamics. Our results contribute to the field of interpersonal synchrony research, emphasizing the benefits of efficient methods in understanding mother-child interactions and interaction relationships in general.

Critical assessment of infants born to mothers with drug resistant tuberculosis

Background

There have been no detailed descriptions of infants born to mothers treated for drug resistant TB in pregnancy. Critical case history assessment is important to identify risks and guide clinical practice.

Methods

In a cohort of pregnant women with multidrug or rifampicin resistant (MDR/RR)-TB enrolled between 1 January 2013 and 31 December 2022, we followed mother-infant pairs until the infant was 12 months old. We performed critical case history assessments to explore potential mechanisms of Mycobacterium tuberculosis transmission to the infant, and to describe the clinical presentation and disease trajectories observed in infants diagnosed with TB.

Findings

Among 101 mother-infant pairs, 23 (23%) included infants diagnosed with TB disease; 16 were clinically diagnosed and seven had microbiological confirmation (five MDR/RR-TB, two drug-susceptible TB). A positive maternal sputum culture at the time of delivery was significantly associated with infant TB risk (p = 0.023). Of the 12 infants diagnosed with TB in the first three months of life, seven (58%) of the mothers were culture positive at delivery; of whom four reported poor TB treatment adherence. However, health system failures, including failing to diagnose and treat maternal MDR/RR-TB, inadequate screening of newborns at birth, not providing appropriate TB preventive therapy (TPT), and M. tuberculosis transmission from non-maternal sources also contributed to TB development in infants.

Interpretation

Infants born to mothers with MDR/RR-TB are at greatest risk if maternal adherence to MDR/RR-TB treatment or antiretroviral therapy (ART) is sub-optimal. In a high TB incidence setting, infants are also at risk of non-maternal household and community transmission. Ensuring maternal TB diagnosis and appropriate treatment, together with adequate TB screening and prevention in all babies born to mothers or households with TB will minimise the risk of infant TB disease development.

Funding

South African Medical Research Council.

Child-related factors associated with depressive symptoms among mothers of school-going children in urban Bangladesh: A cross-sectional study

OBJECTIVE

This study aimed to identify the child-related factors associated with depressive symptoms among mothers of school-going children in Dhaka city of Bangladesh.

METHODS

The study followed a cross-sectional design and was conducted between June and December 2019 among mothers of school-going children from Dhaka City, Bangladesh. A multistage sampling technique was adopted, and a total of 324 mothers of school-going children studying in the same school for at least six months were selected. Depressive symptoms of mothers were measured using a 20-item Self-Rating Depression Scale weighted to 100 percent, with 25-49 categorized as no depression and ≥ 50 as having depression. A binary logistic regression model was executed to identify the child-related factors associated with depressive symptoms among mothers. All statistical analyses were performed using the statistical software, Stata (Version 14.0).

RESULTS

More than half of the participants (54.3%) were aged 40 years or above and had up to HSC level education (52.5%). The majority of the participants were homemakers (67.0%), mothers of a girl child (53.1%), and had a family income of 50,000 BDT or more (52.8%). Adjusted analyses revealed that the mother's depressive symptoms were associated with their child's frequent complaints of headaches or stomach aches (aOR = 13.19, 95% CI 3.03-57.37), having an injury (aOR = 4.05, 95% CI 1.44-11.41), and unfriendly relationship with mothers (aOR = 21.46, 95% CI 5.04-91.28).

CONCLUSION

The present study highlighted several child-related factors that are associated with depressive symptoms among mothers that need to be considered while designing any intervention to address depressive symptoms among mothers of school-going children. It is also important to counsel mothers and fathers of the children about the importance of having a sound mother-child relationship while addressing depressive symptoms among mothers.

Prevalence and Factors Associated with Impaired Maternal-Infant Bonding among Mothers Attending Young Child Clinic in Kampala, Uganda

Impaired maternal-infant bonding can have a negative impact on the mother-infant relationship, affecting the social, emotional, and cognitive development of a child. In Uganda, there is a paucity of literature on impaired maternal-infant bonding. This quantitative, cross-sectional study aimed to determine the prevalence and factors associated with impaired maternal-infant bonding. Postnatal mothers (n = 422) attending the Young Child Clinic at Kawempe National Referral Hospital participated in the study. Maternal-infant bonding was measured using the Postpartum Bonding Questionnaire (PBQ). Participants with a score ≥ 13 on the PBQ were considered to have impaired maternal-infant bonding. The prevalence of impaired maternal-infant bonding among mothers was 45% (190/422). Logistic regression was used to determine factors associated with impaired maternal-infant bonding. Unmarried mothers (AOR = 2.05, 95% [CI = 1.03-4.09], p = 0.041), unplanned pregnancy (AOR = 5.19, 95% [CI = 3.07-8.82], p < 0.001), first-time mothers (AOR = 2.46, 95% [CI = 1.37-4.43], p = 0.003), female infant (AOR = 1.80, 95% [CI = 1.13-2.86], p = 0.013), mothers with no/low education levels (AOR = 2.29, 95% [CI = 1.05-4.50], p = 0.036), and those who delivered post term (AOR = 2.49, 95% [CI = 1.10-5.67], p = 0.028) were more likely to have impaired maternal-infant bonding. Nurses and midwives in postnatal care should include maternal-infant bonding within their client's assessment and provide supportive mother-centered care. Interventions to improve maternal-infant bonding should be created and implemented in clinical practice.

Infant carrying: Associations with parental reflective functioning, parental bonding and parental responses to infant crying

Infant carrying may have beneficial effects on the parent-infant relationship but only limited research has been conducted in this area. Therefore, the main aim of the current study was to investigate whether infant carrying is associated with parental reflective functioning, parental bonding, and parental (emotional) and behavioral responses to infant crying, key elements within the parent-infant relationship, promoting infant development. Parents reporting high levels (N = 389) of infant carrying (six times a week or daily) and parents reporting low levels (N = 128) of infant carrying (less than once a week or not at all) who participated in an online survey about the developing parent-infant relationship in Germany were included in the present study. Standardized questionnaires were used to assess parental reflective functioning, parental bonding impairments, and emotional responses to infant crying. Further insensitive (non-responsive and hostile) behaviors in response to infant crying were assessed. Parents with high levels of infant carrying showed better parental reflective functioning, lower parental bonding problems, less negative emotions, and less insensitive behaviors in response to infant crying.

Two babies, two bonds: Frequency and correlates of differential maternal-infant bonding in mothers of twins

We assessed prevalence and correlates of differential maternal-infant bonding (i.e., experiencing a stronger bond with one baby vs. the other) in mothers of twins, focusing on aspects of maternal mental health, well-being, and pregnancy/birth that have been previously linked with maternal-infant bonding. Participants (N = 108 American women, 88.89% White, 82.41% non-Hispanic, aged 18-45, who gave birth to twins in the past 6-24 weeks) were recruited from postpartum support websites. Participants completed a Qualtrics survey assessing pregnancy/birth history, symptoms of depression and anxiety, sleep, stress, romantic relationship satisfaction, and postpartum bonding. Twenty-six participants (24.07%) reported a bonding discrepancy. These participants endorsed higher symptoms of depression and anxiety, lower relationship satisfaction, lower average postpartum bonding, higher general and parenting stress, and longer pregnancy (all ps > .05). Greater degree of bonding discrepancy correlated with more depression, higher parenting stress, longer pregnancy, and lower relationship satisfaction (all ps > .05). Mothers of twins may benefit from postpartum mental health support, stress management strategies, and interventions to improve bonding. Future work should assess the role of breastfeeding difficulties, delivery method, birth-related trauma, infant regulatory capacity, and temperament. Longitudinal studies will help test cause and effect and potential long-term repercussions of maternal-infant bonding discrepancies.

A longitudinal study on the association between trait mindfulness and maternal bonding across the perinatal period

AIMS/BACKGROUND

The mother-to-infant is important for healthy child development. The current study focused on the association between maternal trait mindfulness and the course of maternal bonding from pregnancy to one year postpartum.

DESIGN/METHODS

Women participating in a prospective perinatal cohort study (n = 1003) completed online questionnaires on maternal bonding (Pre- and Post-natal Bonding Scale) at 28 weeks of pregnancy, and at 8 weeks, 6 months and 12 months postpartum. At 20 weeks of pregnancy, women completed the Three Facet Mindfulness Questionnaire - Short Form. Multilevel analyses were used to analyse 1) changes in maternal bonding over time and 2) the relationship of these changes with different facets of trait mindfulness measured once during pregnancy. Demographics, obstetrics, and depressive symptoms were controlled for.

RESULTS

Results showed that maternal bonding first increased from pregnancy to 8 weeks postpartum and then remained relatively stable throughout the first-year postpartum. On average, women with high scores on acting with awareness and non-judging also scored higher on maternal bonding, but demonstrated a smaller increase in maternal bonding scores over time when compared to women with medium and low scores on these mindfulness facets. Furthermore, non-reacting was also positively associated with the level of maternal bonding but was not related to the course of bonding over time. The main effects of non-reacting and non-judging were not significant after adjusting for covariates. Depressive symptoms and a high educational level were negatively associated with bonding.

CONCLUSION

Mindfulness-based interventions may be helpful in supporting expectant mothers who are at risk for suboptimal bonding.

Transferring an extremely premature infant to an extra-uterine life support system: a prospective view on the obstetric procedure

To improve care for extremely premature infants, the development of an extrauterine environment for newborn development is being researched, known as Artificial Placenta and Artificial Womb (APAW) technology. APAW facilitates extended development in a liquid-filled incubator with oxygen and nutrient supply through an oxygenator connected to the umbilical vessels. This setup is intended to provide the optimal environment for further development, allowing further lung maturation by delaying gas exposure to oxygen. This innovative treatment necessitates interventions in obstetric procedures to transfer an infant from the native to an artificial womb, while preventing fetal-to-neonatal transition. In this narrative review we analyze relevant fetal physiology literature, provide an overview of insights from APAW studies, and identify considerations for the obstetric procedure from the native uterus to an APAW system. Lastly, this review provides suggestions to improve sterility, fetal and maternal well-being, and the prevention of neonatal transition.

The relationship between postpartum pain and mother-infant bonding: A prospective observational study

INTRODUCTION

Postpartum pain is associated with impaired maternal recovery and may influence mother-infant bonding.

METHODS

Participants who underwent a vaginal or cesarean delivery were assessed 24 h postpartum. Postpartum pain intensity was measured using the Verbal Numeric Score (VNS) (0-10) and classified as non-severe (<8) or severe pain (≥8). Maternal-infant bonding was evaluated using the Post-Partum Bonding Questionnaire (PBQ; 0-125), with a score > 5 defining impaired bonding. Demographic data included age, BMI, parity, education level, economic status, partnership, prior history of depression, familial history of depression, desire to breastfeed, epidural analgesia during labor, rooming in, and Edinburgh Postnatal Depression Scale (EPDS). Data were analyzed using 2 separate multivariable logistic regression models for vaginal and cesarean deliveries, where maximum postpartum pain was the independent variable and impaired postpartum bonding was the dependent variable and controlled for the other factors collected.

RESULTS

Severe postpartum pain (VNS ≥ 8) showed no significant relationship with impaired bonding when controlling for confounding variables. In vaginal deliveries, there was an association between a history of depression and impaired bonding (Odds Ratio 2.2 [1.07-4.65], p = 0.04) and EPDS > 10 and impaired bonding (OR 11.5 [3.2-73.6], p < 0.001). For cesarean deliveries, rooming in with the baby had a protective effect (OR 11.5 [3.2-73.6], p < 0.001).

CONCLUSIONS

Contrary to expectations, severe postpartum pain did not influence maternal-infant binding in the cohort of patients with vaginal and cesarean deliveries. Instead, factors such as maternal mental health and rooming-in practices appeared to exert more significant influence.

CLINICAL TRIAL REGISTRATION

NCT05206552.

Gestational diabetes mellitus and its impact on the mother-infant relationship: A cohort study in the postnatal period

Women with gestational diabetes mellitus (GDM) are at increased risk of poor perinatal mental health outcomes. However, the association between GDM and the mother-infant relationship is unclear. This study aimed to examine whether GDM itself impacts the mother-infant relationship and maternal mental health using a cohort study design. We used data from the Cohort of Newborns in Emilia-Romagna (CoNER) study, which included 642 women recruited in Bologna, Italy. Psychological data were collected at 6 and 15 months postnatally using a purpose designed measure to examine the mother-infant relationship. We used linear fixed effects and mixed-effects models to assess the effect of GDM on relationship scores at 6 and 15 months postpartum. Women with GDM had significantly lower relationship scores at 15 months postpartum [β - 1.75 95% CrI (-3.31; -0.21)] but not at 6 months [β - 0.27 95% CrI (-1.37; 0.81)]. Mother-infant relationship scores were significantly lower overall at 15 months compared to 6 months postpartum [β - 0.29 95% CrI (-0.56; -0.02)]. Our findings suggest that there may be a delayed effect on the mother-infant relationship in response to the experience of GDM. Future research using large birth cohorts should investigate this further to confirm these findings, and whether women with GDM would benefit from early interventions to improve relationships taking into account length of time postpartum.

Associations of stress, anxiety, and partner satisfaction with maternal-fetal attachment in women pregnant during the COVID-19 pandemic: an online study

BACKGROUND

The COVID-19 pandemic has led to exceptional stress in pregnant women. The aim of the present study was to investigate associations of maternal stress (pandemic-related and -unrelated), anxiety, and relationship satisfaction experienced during the COVID-19 pandemic with prenatal mother-infant attachment.

METHODS

An online study was conducted evaluating pandemic-related stress, pregnancy-specific stress (unrelated to the pandemic), anxiety, partnership satisfaction, and maternal-fetal attachment in German-speaking women during the second COVID-19 lockdown between January and March 2021. In total, 431 pregnant women (349 lived in Germany and 82 in Switzerland) filled in the questionnaires and gave information on demographic and pregnancy-related variables (i.e. age, gestational age, parity). Bivariate correlations were calculated in order to investigate associations between the different variables and additionally, a hierarchical regression model was conducted in order to evaluate the influence of the independent variables on prenatal attachment.

RESULTS

The hierarchical regression analysis revealed that after controlling for age, gestational age, and parity higher pandemic-related stress, namely stress associated with feeling unprepared for birth, higher partnership satisfaction as well as higher positive appraisal (considered as a way of coping with pandemic-related stress) was associated with stronger maternal-fetal attachment, whereas associations of anxiety and other forms of stress were non-significant.

CONCLUSIONS

The study highlights interesting associations between maternal pandemic-related preparedness stress and positive appraisal of the pregnancy as well as partnership satisfaction and prenatal attachment in women pregnant during the COVID-19 pandemic.

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.

Maternal postnatal bonding disorder and emotional/behavioral problems in preschool children: The Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study

BACKGROUND

Although there is evidence that maternal perinatal mental disorders are associated with emotional/behavioral problems in children, the long-term impacts of postnatal bonding disorder remain unclear. We aimed to examine the associations between maternal postnatal bonding disorder and emotional/behavioral problems in preschool children.

METHODS

We analyzed data from 7220 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 ≥5 at 1 month after delivery. The Child Behavior Checklist for Ages 1½-5 was used to assess emotional/behavioral problems, and its subscales were used to assess internalizing and externalizing problems in children at 4 years of age. Multiple logistic regression analyses were conducted to examine the associations of postnatal bonding disorder with emotional/behavioral, internalizing, and externalizing problems after adjustment for age, education, income, parity, prenatal psychological distress, postnatal depressive symptoms, child's sex, preterm birth, and birth defects.

RESULTS

The prevalence of postnatal bonding disorder was 14.8 %. Postnatal bonding disorder was associated with an increased risk of emotional/behavioral problems in children: the odds ratio (OR) was 2.06 (95 % confidence interval [CI], 1.72-2.46). Postnatal bonding disorder was also associated with increased risks of internalizing problems and externalizing problems in children: the ORs were 1.69 (95 % CI, 1.42-2.02) and 1.90 (95 % CI, 1.59-2.26), respectively.

LIMITATIONS

Bonding and problems were self-reported.

CONCLUSIONS

Bonding disorder at 1 month after delivery was associated with an increased risk of emotional/behavioral problems in children at 4 years of age.

Traumatic childbirth during COVID-19 triggers maternal psychological growth and in turn better mother-infant bonding

BACKGROUND

Although posttraumatic psychological growth (PTG) occurs following stressful events, knowledge of maternal psychological growth as a result of giving birth during the novel coronavirus (COVID-19) pandemic is lacking.

METHODS

We assessed PTG associated with recent childbirth (Posttraumatic Growth Inventory) in a sample of 2205 women who gave birth during the pandemic and 540 who gave birth before. They also provided information about birth-related traumatic stress (Peritraumatic Distress Inventory; PTSD Checklist), mother-infant bonding (Maternal Attachment Inventory), and breastfeeding.

RESULTS

Close to two thirds (60.45 %) of participants reported childbirth-related PTG with greater appreciation of life endorsed most frequently. No group differences in PTG prevalence were noted between deliveries during or before COVID-19 (χ² = 0.35, p = 0.84). A multigroup mediation model revealed that in deliveries during the pandemic, childbirth-related acute stress was linked with elevated PTG (β = 0.07, p < 0.01); in turn, PTG was associated with lower posttraumatic stress symptoms (β = -0.06, p < 0.05) and better mother-infant bonding (β = 0.22, p < 0.001). These indirect paths via PTG were not significant in deliveries before the pandemic.

LIMITATIONS

Reliance on a convenient sample, self-reports, and cross-sectional design may introduce bias.

CONCLUSIONS

Perceived positive maternal psychological changes as a result of childbirth are endorsed by a significant portion of women during the pandemic and can ensue in response to traumatic childbirth. Maternal growth is further implicated in successful postpartum adjustment and positive mother-infant interactions during an important period. Hence, directing clinical attention to opportunities of maternal psychological growth may have benefits especially for women at risk for the adverse outcomes of exposure to traumatic experiences of childbirth.

Depressive symptoms as a transdiagnostic mediator of mother-to-infant bonding: Results from a psychiatric mother-baby unit

Maternal symptoms of depression can interfere with the establishment of healthy mother-infant-bonding, which negatively affects developmental trajectories of the child and maternal wellbeing. However, current evidence about the effects of treatment in severely affected women is still lacking and the transdiagnostic prognostic value of depressive symptoms is not fully clear. Therefore, a naturalistic clinical sample of 140 mother-infant-dyads in inpatient treatment at a mother-baby-unit was analyzed with instruments being administered at admission and before dismissal. Linear mixed effects models were calculated in order to assess the longitudinal influence of scores on the Edingburgh Postpartum Depression Scale (EPDS) on post-partum-bonding measured with the postpartum bonding questionnaire (PBQ). Furthermore, interaction-effects with psychiatric diagnosis of the mothers (depression vs. psychosis) and their partners were assessed. Successful treatment of depressive symptoms was paralleled by a significant decrease of impaired bonding, with only 6.4% of the women having PBQ total scores above cut-off at discharge. Overall, higher scores on the EPDS were associated with a significantly poorer outcome on the PBQ (p = < 0.001), irrespective of diagnosis (p = 0.93). Importantly, there was an interaction effect of EPDS and a psychiatric diagnosis of the partner on the PBQ (p = 0.017). Thus, our results further emphasize the significance of postpartum symptoms of depression for mother-child bonding, which can be effectively improved by comprehensive treatment even in severely affected women. Optimizing treatment and diagnostics as early as possible and enabling access for all women must become a priority.

Mother-Infant Bonding and Its Associated Factors Among Mothers in the Postpartum Period, Northwest Ethiopia, 2021

BACKGROUND

The emotional bond that a mother senses to her infant is essential to their social, emotional, and cognitive development. Understanding the level of mother-infant bonding plays an imperative role in the excellence of care. However, in Ethiopia, there is a paucity of information about mother-infant bonding in the postpartum period.

OBJECTIVE

This study aimed to assess the level of mother-infant bonding and its associated factors among mothers in the postpartum period, Debre Tabor Town Northwest Ethiopia, 2021.

METHODS

A community-based cross-sectional study was conducted with 422 postpartum mothers. The postpartum Bonding Questionnaire was used to assess mother-infant bonding. The Edinburgh Postnatal Depression Scale was used to assess postnatal depression. The level of marital satisfaction was assessed by using Kansas marital satisfaction scale. Social support was assessed by Oslo social support scale. A simple random sampling technique was applied to select study participants. Simple and multiple linear regression were used to identify potential factors associated with the mother-infant bonding scale. A P-value of <0.05 was considered to declare statistical significance.

RESULTS

In this study, out of 420 postpartum mothers,53 (12.6%) had a risk for the quality of mother-infant bond difficulties between mother and an infant; 8.1% of mothers had a risk for rejection and pathological anger; 3.6% of mothers had a risk for infant-focused anxiety and 1.9% of mothers had risk for incipient abuse of an infant. Maternal depression status [adjusted β coefficient (β) = 2.31, 95% CI: (1.98, 2.64)], non-union marital status [β = 15.58, 95% CI: (9.88, 21.27)], being government employee [β = -5.68, 95% CI: (-9.71, -1.64)], having current pregnancy complication [β = -7.28, 95% CI: (-12.27, -2.29)], being non-breastfeeding mother [β = 7.66, 95% CI: (2.94, 12.38)], substance use history [β = -6.55, 95% CI: (-12.80, -0.30)], and social support [β = -2, 95% CI: (-2.49, -1.50)] were statistically significant factors for mother-infant bonding.

CONCLUSION

Generally, a significant number of mothers had mother-infant bonding difficulties in the postpartum period. Preventing strategies for bonding difficulties focus on social support during pregnancy, screening postpartum mothers for postpartum depression, and special attention to substance users, non-union maternal status, and non-breastfeeding mothers.