Paternal and Maternal Transition to Parenthood: The Risk of Postpartum Depression and Parenting Stress

Parenting interventions targeting early parenting difficulty: A scoping review

Parent and child wellbeing are reciprocal. Attentive, responsive parenting, is contingent on parental wellbeing. Insights into mechanisms of early parenting interventions that seek to improve parent and child outcomes are needed. This scoping review aimed to systematically map research reporting on parenting interventions for parents experiencing early parenting difficulty. A secondary aim was to synthesise existing research using a realist lens, to provide context, mechanism and outcome insights into elements of early parenting interventions. A systematic search was conducted across six databases within the publication period of 2010-2020, to identify evidence on interventions targeting early parenting difficulty. Using pre-determined inclusion criteria, fifteen studies were selected for review. Deductive reflexive thematic analysis identified three themes: conceptual disparities in early parenting difficulty, early parenting intervention diversity and an absence of theory to explain interventions or outcomes. Neither early parenting difficulty nor the theoretical basis for early parenting interventions were well defined. Identification of contexts, mechanisms and outcomes of early parenting interventions is a unique contribution of this study. These insights may be used to inform planning, implementation and evaluation activities to promote context-focused, early parenting interventions targeting a critical phase of child development.

Perceptions of family functioning impact smoking during pregnancy

BACKGROUND

Although socio-environmental factors are known to contribute to the maintenance of smoking behavior, few studies have examined the impact of family functioning on smoking during pregnancy.

OBJECTIVE

The current study examined the relationship between perceptions of family functioning and smoking during pregnancy.

METHODS

Pregnant women (N = 345, 59% ethnic/racial minority) completed the Family Assessment Device, a gold-standard assessment examining perceptions of family functioning in seven domains. Multinomial logistic regressions analyzed associations between clinically determined suboptimal levels of family functioning by domain and smoking status during pregnancy (smoking, ≥28 continuous days quit, nonsmoking), with stratified analyses exploring ethnic/racial differences (non-Hispanic/White vs. racial/ethnic minority).

RESULTS

Participants who reported suboptimal levels of family functioning in domains of Affective Involvement, Affective Responsiveness, Behavioral Control, and Roles were significantly more likely to have been smoking than nonsmoking during pregnancy. Stratified analyses revealed differing effects by ethnic/racial identity, with perceptions of Roles remaining the only significant effect on smoking outcomes for both groups. No significant effects were found regarding the impact of family functioning on whether participants were smoking vs. quit during pregnancy.

CONCLUSIONS

Suboptimal family functioning may contribute to smoking during pregnancy, but effects may differ based on domain of family functioning and by ethnic/racial identity.

Comparative impact of exercise-based interventions for postpartum depression: A Bayesian network meta-analysis

OBJECTIVE

The current study aimed to address and rank which exercise-based interventions are preferable to standard care/no therapy or another exercise intervention for postpartum depression (PPD) management and provide estimates for future definitive evidence.

METHODS

The authors systematically searched PubMed, Embase, the Web of Science, PsycInfo, and ClinicalTrails.gov for randomized controlled trials (RCTs) on exercise-based interventions for PPD from their inception to May 9, 2023. Included were RCTs of exercise-based interventions for PPD with at least 4 weeks' duration. The pooled effects of intervention comparisons were generated by the Bayesian random-effects model, and the quality of evidence was evaluated by the Grading of Recommendations, Assessment, Development, and Evaluations framework.

RESULTS

Twelve RCTs (1260 women; mean age, 20-35 years) comparing exercise-based interventions with usual care/no therapy were included. Exercise effectively treats depressive symptoms (standard mean difference [SMD], -0.81 [95% confidence interval (CI), -1.20 to -0.42], P < 0.001). Pram walking was significantly associated with a reduction of depressive symptoms during the postpartum period (SMD, -1.00 [95% CI, -2.60 to -0.10], P = 0.020), as well as yoga (SMD, -0.73 [95% CI, -1.84 to -0.43], P < 0.001) and supervised mixed exercise (SMD, -0.77 [95% CI, -1.67 to -0.01], P = 0.041) compared with usual care/no therapy. In indirect comparisons, pram walking (surface under the cumulative ranking curve, 58.9%) was better than yoga (SMD, -0.28 [95% CI, -1.86 to 1.22], P = 0.322) and supervised mixed exercise (SMD, -0.23 [95% CI, -1.59 to 1.12], P = 0.358). However, the difference was not statistically significant. The confidence in evidence was very low to moderate.

CONCLUSION

In women with PPD, all commonly prescribed physical exercises were effective alternative or complementary treatments. However, pram walking may perform better in improving the symptoms of PPD.

Associations of pelvic floor dysfunction and postnatal mental health: a systematic review

BACKGROUND

Postpartum mental health conditions are common and can have devastating effects for both mother and infant. Adverse birth outcomes increase the risk of postnatal mental health conditions. Pelvic floor dysfunction (PFD) is a common adverse pregnancy outcome that may be a risk factor for postnatal mental health conditions. There are many studies reporting associations between PFD and postnatal mental health conditions, but no reports have synthesised the current literature as it relates to pregnancy and the postpartum period.

METHODS

A research librarian conducted systematic literature searches using terms concerning PFD, postnatal mental health conditions, and pregnancy. Searches were conducted within PubMed, Embase, CINAHL, Cochrane, and Scopus. Two reviewers independently rated each study for inclusion and study quality. No studies were excluded based on quality.

RESULTS

A total of 47 studies were included for review. Articles addressed sexual dysfunction (n = 11), incontinence (n = 21), perineal laceration (n = 13), pelvic organ prolapse (n = 2), and general pelvic floor symptoms (n = 2) and associations with postnatal mental health conditions. Two articles addressed more than one type of PFD. The majority (44 studies) reported associations between PFD and adverse postnatal mental health conditions.

DISCUSSION

Most studies included for review found consistent associations between PFD and adverse mental health conditions. Healthcare providers should screen for PFD and postnatal mental health conditions early in the postpartum period. Future research should investigate whether the treatment of PFD can modify the associations between PFD and postnatal mental health conditions.

Prenatal and Postnatal Maternal Depressive Symptoms Are Associated With White Matter Integrity in 5-Year-Olds in a Sex-Specific Manner

BACKGROUND

Prenatal and postnatal maternal psychological distress predicts various detrimental consequences on social, behavioral, and cognitive development of offspring, especially in girls. Maturation of white matter (WM) continues from prenatal development into adulthood and is thus susceptible to exposures both before and after birth.

METHODS

WM microstructural features of 130 children (mean age, 5.36 years; range, 5.04-5.79 years; 63 girls) and their association with maternal prenatal and postnatal depressive and anxiety symptoms were investigated with diffusion tensor imaging, tract-based spatial statistics, and regression analyses. Maternal questionnaires were collected during first, second, and third trimesters and at 3, 6, and 12 months postpartum with the Edinburgh Postnatal Depression Scale (EPDS) for depressive symptoms and Symptom Checklist-90 for general anxiety. Covariates included child's sex; child's age; maternal prepregnancy body mass index; maternal age; socioeconomic status; and exposures to smoking, selective serotonin reuptake inhibitors, and synthetic glucocorticoids during pregnancy.

RESULTS

Prenatal second-trimester EPDS scores were positively associated with fractional anisotropy in boys (p < .05, 5000 permutations) after controlling for EPDS scores 3 months postpartum. In contrast, postpartum EPDS scores at 3 months correlated negatively with fractional anisotropy (p < .01, 5000 permutations) in widespread areas only in girls after controlling for prenatal second-trimester EPDS scores. Perinatal anxiety was not associated with WM structure.

CONCLUSIONS

These results suggest that prenatal and postnatal maternal psychological distress is associated with brain WM tract developmental alterations in a sex- and timing-dependent manner. Future studies including behavioral data are required to consolidate associative outcomes for these alterations.

Parental stress mediates the effects of parental risk factors on dysfunctional parenting in first-time parents: A dyadic longitudinal study

Both parental psychological well-being (e.g., depressive symptoms) and parental relationship functioning (e.g., negative communication) are common parental risk factors for dysfunctional parenting. The spillover process from these parental characteristics to dysfunctional parenting is assumed to be amplified by parental stress, which is particularly common among mothers and fathers of young children. However, few studies have examined dyadic spillover processes from parental risk factors and parental stress on parenting in early childhood. In the current study, we first examined direct actor and partner effects of parents' depressive symptoms and negative communication at 10 months postpartum on dysfunctional parenting at 48 months postpartum in 168 primiparous mixed-gender couples. Second, we analyzed indirect effects via one's own and the partner's parental stress at 36 months postpartum using Actor-Partner Interdependence Mediation Models (APIMeM). We found direct actor effects for mothers' depressive symptoms and negative communication on their dysfunctional parenting. Additionally, indirect actor effects were found for depressive symptoms and negative communication among mothers and fathers. Specifically, mediating effects of depressive symptoms and negative communication on one's dysfunctional parenting through one's parental stress were found. There were no indirect partner effects through parental stress. These findings highlight the important role of parental stress in early childhood as a mediator between both individual and relationship parental risk factors and dysfunctional parenting. These results further underscore the importance of longitudinal dyadic analyses in providing early and tailored interventions for both mothers and fathers of young children.

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.

Associations between unintended fatherhood and paternal mental health problems: A systematic review and meta-analysis

BACKGROUND

Unintended pregnancies are linked to adverse parental mental health, yet little attention has been given to this relationship in fathers specifically. We aimed to meta-analyse associations between unintended pregnancies and mental health problems in fathers with children aged ≤36 months.

METHODS

We conducted keyword searches of Medline, CINAHL, Academic Search Complete, PsycInfo and Embase to February 2, 2022, and hand searched included reference lists.

RESULTS

Of 2826 records identified, 23 studies (N = 8085 fathers), reporting 29 effects, were eligible for meta-analysis. Included studies assessed depression, anxiety, stress, parenting stress, post-traumatic stress disorder (PTSD), alcohol misuse and psychological distress. Pooled estimates, from random effects meta-analyses, for all mental health outcomes (k = 29; OR = 2.28) and depression only (k = 19; OR = 2.36), showed that the odds of reporting mental health difficulties were >2-fold higher in men reporting unintended births compared with those reporting intended births. However, there was no evidence of association with anxiety (k = 2) or stress (k = 2). Overall, mental health problems were greater in low-income countries. No differences were found across parity, timepoint of mental health assessment, or instruments used to measure mental health symptoms.

LIMITATIONS

Analyses were limited by the use of retrospective assessment of pregnancy intention, and heterogeneity of measures used. Further, assessment of fathers' mental health was restricted to the first year postpartum. This review was limited to English language studies.

CONCLUSIONS

Unintended pregnancies present an identifiable risk for postpartum mental health problems in fathers.

Cognitive processing biases associated with fear of childbirth

Fear of childbirth (FOC) is a phobic-like response concerning the prospect of giving birth. FOC can have negative implications for women during pregnancy and can impact their birthing experience. Cognitive processing biases (e.g., difficulty disengaging from threatening information, interpreting ambiguous information as threatening, and preferentially recalling threatening content) have previously been found to maintain general anxiety and low mood. To date, there has been no research assessing these attention, interpretation, and memory biases and their relationship with FOC in pregnant women. Accordingly, in this cross-sectional study, participants who were at least 12 weeks pregnant (n = 116), recruited through a local hospital trust, completed tasks assessing attention (emotional Stroop task), interpretation (scrambled sentences test), and explicit memory (recognition task) biases with materials including FOC-related content. They also completed three separate measures of FOC and measures of low mood, general anxiety, worry, and rumination. We found that a negative interpretation bias (but not attention or explicit memory biases) was associated with higher levels of FOC. These findings indicate that women presenting with higher FOC are more likely to demonstrate negative interpretation biases for ambiguous information relating to childbirth, which may inform research developing interventions to support women presenting with FOC.

The effect of perceived social support on postpartum stress: the mediating roles of marital satisfaction and maternal postnatal attachment

BACKGROUND

Multiple factors may be responsible for the development of postpartum stress, including perceived social support, marital satisfaction, and maternal postnatal attachment. However, the underlying mediation mechanisms remain unclear. This study examined the complex relationships between perceived social support and postpartum stress among Chinese women.

METHODS

A convenience sample comprising 406 postpartum women was recruited from six hospitals in Nantong, Jiangsu Province, China. The participants completed general survey questionnaires and were evaluated using the Maternal Postpartum Stress Scale, the Perceived Social Support Scale, the Maternal Postnatal Attachment Scale, and the Marital Satisfaction Scale. Furthermore, we evaluated the relationship between postpartum stress and the various influencing factors by performing a multiple linear regression analysis. The potential mediating roles of marital satisfaction and maternal and infant attachment in the association between perceived social support and postpartum stress were explored by performing a mediation analysis.

RESULTS

According to the multivariate regression analysis, perceived social support, marital satisfaction, and maternal postnatal attachment contributed to postpartum stress levels (P < 0.05). The mediation analysis revealed that marital satisfaction and maternal postnatal attachment played parallel mediating roles in the association between perceived social support and postpartum stress, and the mediating effect of marital satisfaction was - 0.1125 (95% confidence interval [CI]: -0.1784 to -0.0520), accounting for 33.20% of the total effect, and the mediating effect of maternal postnatal attachment was - 0.0847 (95% CI: -0.1304 to -0.0438), accounting for 25.00% of the total effect.

CONCLUSION

Our study revealed that perceived social support could influence postpartum stress not only through direct effect (41.80% of the total effect), but also through the indirect effect (mediation effect) of marital satisfaction and maternal postnatal attachment (58.20% of the total effect), suggesting that improving postpartum women's social support, enhancing maternal and infant attachment, and improving their marital satisfaction could help lower postpartum stress.

Exploring the perception of parents on children's screentime: a systematic review and meta-synthesis of qualitative studies

BACKGROUND

Screentime (ST) has been increasingly pervasive in young children. Evidence suggests positive and negative effects of ST on children's development. Parents play a crucial role in influencing their children's ST. There is limited research consolidating the parental perceptions related to children's ST. This review consolidates the evidence on the perception of parents on their children's ST.

METHODS

Six electronic databases (PubMed, Embase, CINAHL, PsycINFO, Scopus, and ProQuest) were searched from their inception to September 2022. Critical appraisal was conducted using the Critical Appraisal Skills Program (CASP) checklist. Data synthesis was performed using Sandelowski and Barroso's approach.

RESULTS

Twenty studies were included in this review, encapsulating the experiences of 1,311 parents. Three main themes with corresponding subthemes were identified: (1) Varied reasons behind ST; (2) Attitudes toward ST; and (3) Strategies and approaches to managing ST.

CONCLUSION

The findings highlighted the varied reasons parents promote ST. Parents reported their concerns and confusion about ST and shared some strategies and approaches for better ST. Future research is needed to develop and evaluate educational programs to ensure that parents understand the risks and benefits of ST and in turn, ensure the appropriate adoption of ST for their children.

IMPACT

In the digital era, parents' attitudes towards screentime (ST) for their children are mixed. This review presents the dilemma parents face and their struggles with using optimal screen time for their children. This review provides up-to-date evidence on the parents' confusion and concerns about ST as well as strategies and approaches used by the parents for better ST. There is an urgent need for evidence-based educational programs to enhance parental knowledge about ST so that they can ensure appropriate ST among children.

CLINICAL TRIAL REGISTRATION

PROSPERO Registration No. CRD42022356083.

Satisfaction, Intimacy and Conflict in Canadian Couples: An Analysis of Change from Adolescence to Adulthood

Romantic relationship qualities are likely to change from adolescence to adulthood. Therefore, we undertook a longitudinal study to examine changes in satisfaction, intimacy, and conflict over this period by simultaneously testing the effects of age, relationship length, and their interaction. These qualities were measured at nine-time points from ages 16 to 30 in a Canadian sample of 337 participants (62.9% women) who reported being in a romantic relationship at least once over this period. The results of multilevel analyses show that satisfaction, intimacy, and conflict decline with age but increase with relationship length. Moreover, age and relationship length were found to have a significant interactive effect on satisfaction and intimacy.

Feasibility of wearable sensors in the NICU: Psychophysiological measures of parental stress

BACKGROUND

Parents report elevated stress during their infant's NICU hospitalization. Real-time measures may improve our understanding of parental stress in the NICU.

AIM

Examine the feasibility of wearable sensors to describe parental stress in the NICU.

STUDY DESIGN

In this prospective feasibility study of 12 parent-infant dyads, parents wore an Empatica E4 wristband to measure psychophysiological stress via electrodermal activity (EDA) during sensory interventions (holding, massage, reading, touch, etc) with their babies. Baseline and intervention periods were delineated during which concurrent monitoring and clinical observations of infant behavior and environmental factors were recorded. Feasibility was assessed by investigating recruitment/enrollment, retention/adherence, acceptability, sensor usability, and changes in EDA waveforms based on potential stressors. For the latter, independent samples t-tests and ANOVA were used to examine differences in EDA from baseline to intervention, and the impact of environmental and infant factors on parent stress were visually analyzed against EDA waveforms.

RESULTS

Wearable sensor use in the NICU appeared feasible as assessed by all methods. Preliminary data analysis indicated that overall parent EDA levels during parent-infant interactions were low, and engagement in sensory intervention(s) led to a non-significant increase in parental EDA, measured by both skin conductance levels and non-specific skin conductance responses. Three main patterns of EDA emerged: a temporary increase in EDA at the beginning of the intervention followed by a decrease and plateau, a plateau in EDA from baseline to intervention, and a gradual rise in EDA throughout intervention. Specific environmental and infant factors, such as infant stress and health care providers entering the room, appeared to impact parent stress levels.

CONCLUSION

Although these preliminary findings provide support for use of EDA in the NICU, future studies are needed.

Postpartum depression screening in mothers and fathers at well-child visits: a feasibility study within the NASCITA cohort

OBJECTIVE

To assess the feasibility of the family paediatrician's (FP) role in identifying the signs of postpartum depression in parents in time to guarantee child well-being.

DESIGN, SETTING AND PARTICIPANTS

Data for this observational prospective study were collected within the NASCITA (NAscere e creSCere in ITAlia) cohort. During the first visit, paediatricians collected sociodemographic data regarding the parents and information about their health status, the pregnancy and the delivery. Whooley questions were administered during the first and second visits (scheduled 60-90 days after childbirth). Moreover, on the third visit (5-7 months after childbirth) the FP was asked to answer 'yes' or 'no' to a question on the parental postpartum depression, based on his knowledge and on the acquired information.

RESULTS

In 2203 couples who completed the assessment, 529 mothers (19.9%), 141 fathers (6.3%) and 110 (5%) couples reported any depressive symptomatology. Of these, 141 mothers (5.3% of the total sample) and 18 fathers (0.8% of the total sample) were classified as 'likely depressed'. An association was found between maternal postnatal depressive symptoms and having a diagnosed psychiatric disorder during pregnancy (OR 9.49, 95% CI: 3.20 to 28.17), not exclusively breastfeeding at hospital discharge (OR 1.76, 95% CI: 1.19 to 2.61) and the presence of child sleeping disorders at 3 (OR 2.46, 95% CI: 1.41 to 4.28) and 6 months (OR 2.18, 95% CI: 1.37 to 3.47). Another significant predictor of postpartum depression was being primiparous (OR 1.99, 95% CI: 1.31 to 3.02). Concerning the fathers, a significant association was reported only between likely depressed fathers and child sleeping disorders at 3 months (OR 7.64, 95% CI: 2.92 to 19.97). Moreover, having a likely depressed partner was strongly associated with depressive symptoms in fathers (OR 85.53, 95% CI 26.83 to 272.69).

CONCLUSIONS

The findings of this study support the feasibility of an active screening programme for parental postnatal depression during well-child visits as an integral part of postpartum care.

TRIAL REGISTRATION NUMBER

NCT03894566; Pre-results.

Stress and resilience during pregnancy: A comparative study between pregnant and non-pregnant women in Ethiopia

BACKGROUND

Stress during pregnancy is associated with perturbances in maternal psychology and physiology, and results in adverse pregnancy and birth outcomes. However, little attention has been given to understand maternal stress and its potential negative consequences in many low- and middle-income countries. We aimed to investigate whether pregnancy is associated with greater stress and lower psychological resilience among women living in Jimma, Southwest Ethiopia.

METHOD

An institution-based comparative cross-sectional study design was implemented in Jimma University Medical Center and Jimma health centers from 15 September to 30 November 2021. Women attending antenatal care and family planning services were invited to participate in the study. Participants were interviewed using the Perceived Stress Scale (PSS-10), Brief Resilience Scale (BRS), distress questionnaire-5, and the Household Food Insecurity Access Scale (HFIAS). Linear regression analysis was used to test associations between pregnancy (exposure) and outcomes of interest (stress and resilience scores), while adjusting for potential confounders. Stress and resilience were mutually adjusted for one another in the final model.

RESULTS

A total of 166 pregnant and 154 non-pregnant women participated, with mean age of 27.0 SD 5.0 and 29.5 SD 5.3 years respectively. Pregnancy was associated with increased stress score by 4.1 points (β = 4.1; 95% CI: 3.0, 5.2), and with reduced resilience by 3.3 points (β = -3.3; 95% CI: -4.5, -2.2) in a fully adjusted model. In mutually-adjusted models, pregnancy was independently associated with greater stress (β = 2.9, 95% CI 1.8, 3.9) and lower resilience (β = -1.3, 95% CI: -2.5, -0.2) compared to non-pregnant women.

CONCLUSION

In this low income setting, pregnancy is associated with greater vulnerability in the mental health of women, characterized by greater perceived stress and diminished resilience. Context-relevant interventions to improve resilience and reduce stress could help improve the health and wellbeing of mothers, with potential benefits for their offspring.

Psychometric evaluation and validation of the Postpartum Specific Anxiety Scale for the Spanish-speaking population: PSAS-ES

OBJECTIVE

The transition to motherhood is a period of risk for the development of mood disorders. Postpartum anxiety has not been as thoroughly studied as other emotional disorders despite its impact on mothers and their babies. The absence of standardized programmes for early detection and specific tools for its diagnosis means postpartum anxiety is often underestimated or overshadowed. This study aimed to translate and validate the Postpartum Specific Anxiety Scale [PSAS] for the Spanish population and to analyse its reliability as an exploratory tool for specific anxiety in mothers.

METHOD

Four stages were followed in this research: translation and back-translation to obtain the Spanish version [PSAS-ES]; preliminary pilot study to explore the comprehensibility and ease of responding the items (n = 53); convergent validity analyses (n = 644); and test-retest reliability (n = 234).

RESULTS

The PSAS-ES has shown to have good acceptability, convergent validity and high internal consistency with a Cronbach's α coefficient of 0.93 for the overall scale of PSAS. The four factors had good reliability. The results of test-retest was 0.86, indicating excellent stability over time in the first 16 weeks.

CONCLUSION

The psychometric results show that the PSAS-ES is a valid tool to explore and detect anxiety in Spanish mothers between 0 and 16 weeks postpartum.

Midwives and child health nurses' support is associated with positive coparenting for fathers of infants: A cross-sectional analysis

AIMS AND OBJECTIVES

To examine if the professional support that fathers received from midwives and child health nurses was associated with improvements in fathers' coparenting. A secondary aim was to investigate if there were any support differences between fathers based on parity.

BACKGROUND

Stronger coparenting is associated with improved maternal, paternal and child health. It is unclear if routine prenatal and postnatal professional support is associated with improved coparenting in fathers of infants.

DESIGN

Cross-sectional online survey.

METHODS

In total, 612 fathers of infants (aged 0-24 months) completed baseline data between November 2018 and March 2020. Socio-demographics, pregnancy control variables, social support, professional support, being invited to attend and attending three specific visits for fathers, respectively, and the fathers' coparenting relationship, using the Brief Coparenting Relationship Scale, were assessed. The STROBE checklist was used as the reporting guideline for this study.

RESULTS

Fathers' attendance at child health visits, support from the prenatal and postnatal midwife, respectively, and total support from the child health nurse, are associated with more positive coparenting. Primiparous fathers reported more received social and professional support, as well as a more positive coparenting relationship than multiparous fathers.

CONCLUSIONS

Receiving clinical support from both midwives and child health nurses is associated with fathers' positive coparenting. All fathers should be invited and encouraged to attend prenatal, postnatal and child health visits to further support their coparenting relationship. Relative to primiparous fathers, multiparous fathers may require targeted and additional clinical support regarding their coparenting relationship.

RELEVANCE TO CLINICAL PRACTICE

With fathers becoming more involved in childrearing, having stronger coparenting skills can help them better adapt to their parental roles. Our findings help understand how routine professional support from midwives and child health nurses are experienced among new fathers and that multiparous fathers are in further need of coparenting support.

Caring for a Child with Congenital Adrenal Hyperplasia Diagnosed by Newborn Screening: Parental Health-Related Quality of Life, Coping Patterns, and Needs

Diagnosing a child by newborn screening with classic congenital adrenal hyperplasia due to 21-hydroxylase deficiency (CAH) causes multiple challenges for the affected parents and the whole family. We aimed to examine the health-related Quality of Life (HrQoL), coping, and needs of parents caring for a child with CAH to develop demand-responsive interventions for improving the psychosocial situation of affected families. In a retrospective cross-sectional design, we assessed HrQoL, coping patterns, and the needs of parents caring for a CAH-diagnosed child using specific questionnaires. Data of 59 families with at least one child diagnosed with CAH were analyzed. The results show that mothers and fathers in this study reached significantly higher HrQoL scores compared to reference cohorts. Decisive for the above-average parental HrQoL were effective coping behaviors and the parental needs being met. These findings verify the importance of helpful coping patterns and rapid fulfillment of parental needs for maintaining a good and stable HrQoL of parents with a child diagnosed with CAH. It is crucial to strengthen the parental HrQoL to build a reasonable basis for a healthy upbringing and improve the medical care of CAH-diagnosed children.

Barriers to perinatal mental health care experiences by midwives and obstetricians and their patients: A rapid review

INTRODUCTION

While perinatal mental health concerns are common, little attention is paid to noticing or addressing these concerns. Midwives and obstetricians are uniquely positioned to universally screen their patients for mental health conditions during the perinatal period, and provide referrals for additional mental health supports if relevant. Previous studies on perinatal mental health care have focused primarily on midwifery care, excluding perinatal healthcare providers such as obstetricians. This rapid review aims to examine the barriers to accessing mental health care during the perinatal period as experienced by obstetricians, midwives, and their patients.

METHODS

A rapid review of literature was conducted on barriers to perinatal mental health care as experienced by patients, midwives, and obstetricians. The search strategy included published literature from PubMed, CINAHL, PsycINFO, and Web of Science published between 2000 and 2020. All documents were screened by two researchers and disagreements were resolved through consensus with a third reviewer. After data from all included articles were extracted, thematic analysis was conducted, and findings were compared with related reviews that focused on mental health access for individuals who accessed midwifery care.

RESULTS

Of the 539 references and documents that were screened, 31 articles met the inclusion criteria. In the extraction phase, country, study objective(s), study design, perspective(s), barriers, and the dimension(s) impacted along the pathway to accessing care were retrieved from the 31 included articles. After all barriers were classified using the Supply-Side Dimensions of Access, we developed a classification framework to further examine stigma at the societal, institutional, and individual levels.

DISCUSSION

While midwives utilize a more holistic approach to care as compared with obstetricians, the barriers identified through this rapid review indicate that obstetricians and their patients face similar struggles to accessing and providing mental health care. Moreover, stigma plays a large role in the barriers experienced by patients, midwives, and obstetricians - at individual and institutional levels.

CONCLUSION

Obstetricians encounter similar stigma-related barriers as midwives in detecting mental health concerns, as well as connecting clients to available mental health resources and supports. Therefore, to effectively eliminate barriers to accessing perinatal mental health care, a systemic change must be enacted throughout all three layers to address the deep-rooted stigma associated with accessing mental health care during the perinatal period.

Exploring the Healthcare Services' Contribution to Reducing Postpartum Depression

Introduction

The postpartum period is accompanied by health risks that impact many women. Postpartum depression (PPD) is a mental health problem that has been neglected in maternal healthcare services.

Objective

The purpose of this study was to explore nurses' perceptions towards health services' contribution to lowering the incidence of PPD.

Methods

An interpretive phenomenological approach was adopted in a tertiary hospital in Saudi Arabia. A convenience sample of 10 postpartum nurses was interviewed face-to-face. The analysis followed Colaizzi's data analysis method.

Results

Seven main themes emerged on how to improve maternal health services to contribute to reducing the incidence of PPD among women: (1) maternal mental health, (2) follow-up of mental health status, (3) screening mental health status, (4) enhancing health education, (5) reducing stigma toward mental health, (6) updating resources, and (7) empowering nurses.

Conclusion

The integration of mental health services into maternal services that are provided to women needs to be considered in the context of Saudi Arabia. This integration will result in high-quality holistic maternal care.

Parents' experiences of the significance of interpersonal interactions for becoming parents and a family during neonatal intensive care

PURPOSE

To describe parents' experiences of the significance of interpersonal interactions for becoming parents and a family during neonatal intensive care.

DESIGN AND METHODS

We employed a qualitative descriptive design with semi-structured family interviews. Ten families were included from four neonatal intensive care units (NICU) in Sweden. Results were evaluated using thematic analysis.

RESULTS

The results were presented as two themes: 1) Interactions within the family, and 2) Interactions between parents and staff. Analyses revealed that interpersonal interactions could both facilitate and hinder development in becoming a parent and a family.

CONCLUSION

Interactions within the family and with the staff have an important function in the process of becoming a parent and a family. This process would benefit from a systemic approach, focusing on the family as a unit, as unique individuals, and as parents with unique needs and experiences.

PRACTICE IMPLICATIONS

Our findings can facilitate changes to reduce the separation between family members (mother-father-newborn-siblings) during their stay in NICU; guiding parents to take care of their child, while being sensitive and balancing their situation as to where they are in their process; supporting the family through joint conversations by listening to the parents and their expectations and experiences both in the NICU and at home; and encouraging parents to do everyday things together outside NICU like an ordinary family.

The parental reflective functioning questionnaire: Infant version in fathers of infants and association with paternal postpartum mental health

The parents' capacity to reflect upon the psychological processes in their child, termed parental reflective functioning (PRF) can be impaired by parental mental health problems. The present study aimed to investigate the factor structure of an infant version of the Parental Reflective Functioning Questionnaire (PRFQ-I) in a low-risk sample of 259 Danish fathers of 1-11-month-old infants to investigate measurement invariance of the PRFQ-I between fathers and mothers; and to examine the association between PRF and paternal depressive symptoms, psychological distress, and parenting stress. Confirmatory factor analysis supported a three-factor model of the PRFQ-I. Multi-group factor analysis indicated partial measurement invariance. Multiple linear regressions showed that paternal depressive symptoms were not associated with PRF. There was an interaction effect of paternal depressive symptoms and general psychological distress on paternal interest and curiosity in their infant's mental state and certainty of infant mental state. Increased parenting stress was associated with impaired PRF on all three subscales of the PRFQ-I. These results provide further evidence for a multidimensional, brief assessment of paternal reflective skills and insight into how variability in paternal psychological functioning relates to impaired PRF in the postpartum period.

Maternal stress in the postpartum period is associated with altered human milk fatty acid composition

BACKGROUND & AIMS

Maternal stress in the postpartum period affects not only the mother, but also her newborn child who is at increased risk for a wide range of disorders later in life. The mechanisms underlying transmission of maternal stress to the child remain elusive. Human milk (HM) is a potential candidate and is an important source of fatty acid (FA), which are crucial for child (neuro)development. This study aims to investigate whether maternal psychological and biological stress influences HM FA composition over the first month postpartum.

METHODS

The Amsterdam Mother's Milk study is a prospective cohort study. We included lactating women who delivered at term with a large range of stress levels: a high stress (HS) group, women whose child was hospitalized for a minimum of 2 days (n=23) and a control (CTL) group, women who gave birth to a healthy child (n=73). HM was collected three times a day at postpartum days 10, 17 and 24. Perceived psychological stress was measured using multiple validated questionnaires, while biological stress measures were based on cortisol in hair, saliva and HM. HM FAs were analyzed by gas-chromatography and compared between groups.

RESULTS

Maternal perceived stress scores were significantly higher in the HS group (p < 0.01), whereas cortisol measurements did not differ between groups. The absolute concentrations of total FA in HM (p=0.023), including the total amount of poly unsaturated fatty acids (PUFAs) (p=0.022) and omega-6 PUFAs (p=0.018), were lower in the HS group compared to the CTL group. Relative values of FAs did not differ between groups.

CONCLUSION

Maternal stress in the first month postpartum was associated with overall lower levels of FA in HM. This possibly indicates a route of transmission of maternal stress signals to the infant. Future research should investigate if these stress-induced changes in HM FAs have consequences for child development.

Resilience and Wellbeing Strategies for Pandemic Fatigue in Times of Covid-19

The COVID-19 pandemic is truly one of the greatest collective health crises in history which have altered our life and living. For years, people have felt fatigued from following public health directives such as social distancing, wearing masks, washing hands frequently, and working or studying remotely without in-person interactions. In this paper, we explore strategies for resilience and wellbeing which can mitigate pandemic-caused stress and behavioural fatigue. We start with individual level strategies including reworking stress appraisals, the importance of psychological flexibility, reducing loneliness through adaptive online platform use, optimizing familial relationships when living in close quarters for a prolonged period, reducing symptoms of burnout and using adaptive distractions, using specific evidence-based resilience strategies. We discuss specific considerations which tap on our shared identities and shared responsibilities which can enhance a sense of community, especially for individuals from marginalized backgrounds and how suicide risks can be minimized.

Instruments to Identify Symptoms of Paternal Depression During Pregnancy and the First Postpartum Year: A Systematic Scoping Review

Men often experience depressive symptoms during the transition to parenthood, but there is a lack of synthesized knowledge of instruments used to identify such symptoms. The aim of this scoping review was to identify instruments used to measure symptoms of depressive symptoms among fathers in pregnancy and the postpartum period, and to describe the instruments' characteristics and measurement properties. We identified studies published since 1990 through searches in databases such as MEDLINE, EMBASE, and PsycINFO and in gray literature. Pairs of reviewers selected relevant studies based on predetermined inclusion criteria. For each included study, we collected information relevant to the review question, guided by the COnsensus based Standards for the selection of health status Measurement INstruments (COSMIN). We included 13 instruments, described in 59 studies with about 29,000 participants across 25 countries. There were 12 validation studies. None of the instruments were uniquely developed for assessing paternal depressive symptoms related to fatherhood. The three most extensively examined instruments were the Edinburgh Postnatal Depression Scale (EPDS), Center for Epidemiologic Studies Depression Scale, and Beck Depression Inventory. For seven of the 13 instruments, there was no information reported about the instruments' properties beyond internal consistency, but for the other six instruments the 12 validation studies reported on both reliability and validity. No studies reported on measurement error or responsiveness. EPDS was both the most extensively assessed instrument and reported to be the most reliable and valid. Further research on instruments for identifying men with depression in pregnancy and the postpartum period is warranted.

Parenting stress in the early years – a survey of the impact of breastfeeding and social support for women in Finland and the UK

Background

Being a new parent can be both joyful and stressful. Parenting stress is associated with poorer health and well-being for parents and infant and increased psychological distress. For new mothers, physical and hormonal changes, expectations of mothering and demands of a new baby may cause additional stress. Breastfeeding is promoted as optimal for maternal and infant health, but can have both positive and negative psychological impacts. Formal and informal social support can offset parenting and breastfeeding stress. Source, content and context of support for new parents are important considerations. This study compares two countries with different parenting and breastfeeding contexts, Finland (more supportive) and the UK (less supportive), investigating the role of breastfeeding stress, self-efficacy and social support as predictors of stress and role strain for new mothers.

Methods

A cross-sectional online survey was completed by 1550 breastfeeding mothers of infants up to 2 years old, recruited via social media platforms in Finland and the UK. Predictors of parenting stress and strain, including demograpic factors, childbirth experiences, breastfeeding and social support were investigated.

Results

We found fewer differences between countries than expected, perhaps due to demographic and contextual differences. Women in Finland reported better childbirth experiences, more positive breastfeeding attitudes, and more self-efficacy than in the UK. Levels of parenting stress were similar in both countries. Women in the UK reported more parental role strain, but fewer breastfeeding stressors. Participants accessed more informal than formal supports, including their partner for parenting and facebook groups and family for breastfeeding. Analysis suggested breastfeeding stress and social support had significant direct effects – respectively increasing and reducing parenting stress and role strain, but no moderating effects of social support suggesting support did not change the relationship between breastfeeding and parenting stress.

Conclusions

Results have important implications for the provision of breastfeeding and parenting support for new mothers. Simple interventions to manage stress for mothers in the postnatal period could be beneficial and are easily delivered by supporters. As shown elsewhere, socio-economic and cultural factors are crucial influences on parenting experiences.

Infant regulation during the pandemic: Associations with maternal response to the COVID-19 pandemic, well-being, and socio-emotional investment

In the transition to parenthood, the COVID-19 pandemic poses an additional strain on parental well-being. Confirmed infections or having to quarantine, as well as public health measures negatively affect parents and infants. Contrary to previous studies mainly focusing on the well-being of school-aged children and their parents during lockdown periods, the present study investigated how mothers of infants respond to the COVID-19 pandemic and whether this is related to maternal well-being, maternal socio-emotional investment, and infant regulation. Between April and June 2021, 206 mothers of infants (M_age  = 7.14 months, SD_age  = 3.75 months) reported on COVID-19 infections, their response to the COVID-19 pandemic, their well-being, socio-emotional investment, and their infant's regulation. Exploratory factor analyses yielded five dimensions of maternal response to the COVID-19 pandemic: social distancing, worrying about the child, birth anxiety, distancing from the child, and information on COVID-19-related parenting behavior and support. These dimensions were related to mother-reported infant regulatory problems. Path analyses revealed paths via reduced maternal well-being and maternal socio-emotional investment. Maternal perceptions of infant regulatory problems are related to how the mothers respond to the COVID-19 pandemic. Better information about COVID-19-related parenting behavior and support might buffer against these effects.

Parenting Stress, Maternal Self-Efficacy and Confidence in Caretaking in a Sample of Mothers with Newborns (0-1 Month)

A mother's responses to her newborn and her confidence in the child's caretaking depend on her attachment security, general parental stress, and perceived self-efficacy. However, few studies have analyzed maternal confidence in caretaking and how it is influenced by some mothers' characteristics. We aimed to examine the association between maternal adult attachment and confidence in a child's caretaking and to understand whether this relationship was mediated by parenting stress and maternal self-efficacy. The sample consisted of 96 mothers with a mean age of 33 years with newborn children aged between 3 and 30 days. The instruments used were the Experiences in Close Relationships-Revised (ECR-R), the Mother and Baby Scale (MABS), the Parenting Stress Index Short Form (PSI-SF), and the Maternal Self-Efficacy Questionnaire (MEQ). The results showed a positive association between attachment avoidance and lack of confidence in caretaking, and this association was mediated by parenting stress. Conversely, attachment anxiety appeared not to influence confidence in caretaking, and maternal self-efficacy did not appear to mediate the relationship between attachment and confidence in the caretaking of infants. Our results could guide new research in studying confidence in caretaking and enable healthcare professionals to recognize at-risk situations early from the first month after childbirth.

Sleep patterns and psychosocial health of parents of preterm and full-born infants: a prospective, comparative, longitudinal feasibility study

Background

The early birth and hospitalization of a preterm infant in neonatal intensive care unit can produce several emotional and behavioural responses including sleep problems for parents. Few studies have explored sleep and its associations with health and HRQoL over time in this vulnerable parent population. This purpose of this study was to evaluate the feasibility of a prospective, comparative, longitudinal study of the sleep patterns and psychosocial health of preterm and full-born infants’ parents during the first postpartum year.

Methods

A prospective, comparative, longitudinal feasibility study was conducted. Parents of preterm infants were compared to parents of full-born infants to identify if there were differences in outcomes between the groups. The parents were instructed to wear actigraphs and complete sleep diaries for two consecutive weeks, and responded to a digital questionnaire covering stress, insomnia, fatigue, depression, social support, self-efficacy, and health-related quality of life. Survey data were collected at infant ages of 2, 6, and 12 months, actigraphy and sleep diary data were collected at infant age of 2 months only. Descriptive analysis was used to describe recruitment and attrition rates. Differences between completers and dropouts were analysed with a chi-square test (categorical data) and Mann–Whitney–Wilcoxon test for two independent samples (continuous variables).

Results

Between June 2019 and March 2020, 25 parents of a preterm infant and 78 parents of a full-born infant were recruited from four neonatal intensive care units and two maternity wards, respectively, in four Norwegian hospitals. Feasibility was predefined as recruiting ≥ 75 parents each of preterm and full-born infants. The target for the full-born group was reached. However, the preterm group recruitment was challenging. Actigraphs, sleep diaries, and questionnaires were evaluated as feasible for use in a future study. Attrition rates were high in both groups at 6 and 12 months. No parent-related characteristics were associated with participation at 6 months. At 12 months, dropouts had a statistically significantly lower age in the full-born group (both parents) and higher age and body mass index in the preterm group (fathers).

Conclusions

A longitudinal study is feasible; however, procedural changes, including using active methods and contacting participants, are necessary to increase the recruitment of preterm infants’ parents.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-04862-1.

Examining Differences in Alcohol and Smoking Behaviors between Parenting and Nonparenting Lesbian Women

BACKGROUND

The transition to parenthood is a significant life event that has implications for health behaviors and health. Few studies have examined alcohol use and smoking by parenthood status (nonparent vs. parent) among women who identify as lesbian.

METHODS

This study used data from two longitudinal studies, the Chicago Health and Life Experiences of Women Study (n = 135) and the U.S. National Longitudinal Lesbian Family Study (n = 116), to compare problem drinking and cigarette smoking trajectories among lesbian-identified women by parenthood status. We used mixed models to investigate differences in problem drinking and cigarette smoking in three waves of data in each study.

RESULTS

Lesbian parents reported significantly less problem drinking, but not cigarette smoking, than nonparent lesbian women. When considering the interaction between parental status and time, problem drinking was significantly higher among nonparents than parents at each time interval.

CONCLUSIONS

Parenthood was associated with positive changes in drinking among lesbian women; however, more research is needed to understand how to support smoking cessation among parenting lesbian women.

Risk for partners’ depression and anxiety during pregnancy and up to one year postpartum: A longitudinal cohort study

INTRODUCTION

Families may benefit from increased focus on partner emotional well-being during pregnancy and the perinatal period. Our aim was to explore the risk for depression and anxiety during pregnancy and one year postpartum in relation to partners’ self-reported health, sense of coherence, social support, and lifestyle factors.

METHODS

This is a longitudinal cohort study using three questionnaires that were answered twice during pregnancy and at one year postpartum. Participants (n=532) were recruited between April 2012 and September 2013, and follow-up was between April 2012 and March 2015, in Sweden.

RESULTS

In late pregnancy, 8.9% of the prospective partners were at high risk for depression and 8.3% one year postpartum. An increased risk for depression was found amongst those reporting ‘fair or very poor’ sexual satisfaction and those reporting ‘fair or very poor’ health during pregnancy and postpartum. High anxiety was reported by 10.8% during late pregnancy and 12.4% one year postpartum. Partners who were unemployed, had financial difficulties, and who scored low on a Sense of Coherence scale, showed significantly higher anxiety in late pregnancy and postpartum. Social support has a significant and positive impact concerning signs of depression and anxiety, both during pregnancy and postpartum.

CONCLUSIONS

More than 10% of partners in this study showed depressive symptoms and anxiety, indicating a problem in need of attention by stakeholders. Strengthening social support is of greatest importance. It is time for the introduction of family-focused care aimed at prevention of depression and anxiety, and maintenance of family well-being.

Understanding links between maternal perinatal posttraumatic stress symptoms and infant socioemotional and physical health

Maternal posttraumatic stress symptoms (PTSS) are associated with adverse consequences for older children, but very few studies have examined links between perinatal maternal PTSS and infant outcomes. Trauma exposure and psychopathology, including PTSS, is often heightened for women during pregnancy through 1 year postpartum. Therefore, the perinatal period may be a critical time for understanding the risk maternal PTSS and other mental health factors pose to the socioemotional and physical health of infants. The present study explored the relation between maternal PTSS and infant socioemotional and physical health problems in a sample of racially and ethnically diverse mother-infant dyads (N = 295) assessed prenatally and at 12 months postpartum. This study also examined whether there are: (1) moderating effects of maternal depressive symptoms and parenting stress on these associations and (2) indirect effects of PTSS on infant outcomes through observed maternal sensitivity. Results indicated that postpartum depressive symptoms and parenting stress, rather than PTSS, were associated with greater infant socioemotional health problems. However, prenatal PTSS were associated with greater infant physical health problems when mothers also reported clinically significant levels of postpartum depressive symptoms. Maternal sensitivity was not associated with maternal PTSS, depressive symptoms, or parenting stress, nor was it related to infant socioemotional and physical health; thus, maternal sensitivity was not tested as an intermediary mechanism linking maternal mental health with infant outcomes. Implications for promoting maternal mental health in the perinatal period to bolster socioemotional and physical health of infants are discussed.

Maternal Self-Efficacy Buffers the Effects of COVID-19-Related Experiences on Postpartum Parenting Stress

OBJECTIVE

To examine the associations of maternal self-efficacy (MSE) and perceived social support with parenting stress during the postpartum period during the COVID-19 pandemic and whether these two psychosocial factors account for variance in parenting stress in addition to the effects of COVID-19-related experiences and sociodemographic factors.

DESIGN

Cross-sectional survey.

SETTING

Online survey, the Perinatal Experiences and COVID-19 Effects (PEACE) study, launched in May 2020.

PARTICIPANTS

Participants included 310 women who gave birth in the past 24 weeks.

METHODS

The survey included self-report quantitative measures of MSE, social support, COVID-19-related experiences, parenting stress, symptoms of depression and anxiety, and a range of sociodemographic factors.

RESULTS

Hierarchical multiple regression analysis indicated that MSE and social support were negatively associated with postpartum parenting stress in addition to the effects of COVID-19-related experiences, maternal symptoms of depression and anxiety, and a range of demographic factors. Furthermore, MSE interacted with COVID-19-related experiences such that higher levels of MSE mitigated the effects of COVID-19-related experiences on parenting stress.

CONCLUSION

Our findings underscore the importance of protective factors at the individual and interpersonal levels and provide insights for prevention and intervention programs aimed at mitigating postpartum parenting stress during a wide-scale disaster such as the COVID-19 pandemic.

Post-traumatic stress disorder following childbirth: prevalence and associated factors-a prospective cohort study

Objective

Traumatic experiences during or after childbirth are subject of intense discussions in mainstream and social media as well as in scientific literature. Aim of this evaluation is to estimate the prevalence of post-traumatic stress disorder (PTSD) following childbirth in postpartum women and to evaluate the influence of maternal, obstetrical and neonatal characteristics on the degree of PTSD symptoms measured by the Impact of Events Scale questionnaire (IES-R).

Methods

In total, 589 women who gave birth in the University Medical Center Mainz, Germany in 2016, participated in a survey within the first days after birth. Of these, 278 also participated 6 months later. All participants received the validated Impact of Events Scale questionnaire (IES-R). The influence of maternal, obstetric and fetal parameters on PTSD score was evaluated.

Results

PTSD overall prevalence was 2.9%. Patients with PTSD had significantly less often personal support during labor (p < 0.001). Maternal age (p < 0.001), parity (p < 0.001), migration background (p < 0.001), mode of delivery (p < 0.001) and assistance during labor (p < 0.001) were parameters significantly influential on the PTSD symptom level measured by the IES-R.

Conclusions

Maternal PTSD prevalence after childbirth seems to be quite rare with 2.9%. Nevertheless, recent findings assume that this prevalence may only represent the “tip of the iceberg”. PTSD after childbirth should not be underestimated. As PTSD depends on personal vulnerability and existing risk factors, patients at risk have to be detected before childbirth, which appears to be challenging especially for obstetric and family care professionals.

Effectiveness of Pediatric Teleconsultation to Prevent Skin Conditions in Infants and Reduce Parenting Stress in Mothers: Randomized Controlled Trial

BACKGROUND

In Japan, eHealth for infants and mothers is currently an important aspect, but its effectiveness has rarely been examined. For infants, skin problems, including atopic dermatitis (AD), which is known to lead to other allergic diseases, are one of the most common conditions. Mothers of infants are prone to experiencing parenting stress, which adversely affects mothers' and children's well-being. Additionally, studies have reported that AD among offspring enhances parenting stress, and postnatal maternal psychological problems can increase the risk of AD in children.

OBJECTIVE

This study evaluated the effectiveness of pediatric teleconsultation for preventing AD in infants and reducing parenting stress in mothers in Japan.

METHODS

The study was an open-label, randomized, parallel-armed controlled trial. In total, 318 pairs of infants and mothers in the Yokohama City Sakae Ward were recruited when they submitted birth cards to the ward, received the explanation about the trial, and provided informed consent on the website for this trial. Eligible pairs of infants and mothers were randomly assigned to the intervention group (n=140) or the control group (n=138). Participants in the intervention and control groups received routine postnatal care from local government services. In addition, participants in the intervention group had the option to combine routine pediatric services with teleconsultation and email newsletters without charge from the date of registration until the infant turned 4 months. Primary outcomes were (1) the prevalence of AD in infants diagnosed based on the United Kingdom Working Party criteria and (2) parenting stress and mental status of mothers assessed using the Parenting Stress Index-Short Form (PSI-SF) and General Health Questionnaire-12 (GHQ-12). Data were collected by the ward office staff and researcher during the 4-month checkup.

RESULTS

The prevalence of AD in infants was significantly lower in the intervention group than in the control group during the 4-month checkup (20% vs 33%, P=.02; relative risk ratio, 0.614 [95% CI 0.519-0.969]). No significant differences were observed in the PSI-SF and GHQ-12 scores between the 2 groups. There was a significant difference in the prevalence of AD between participants who used teleconsultation services and email newsletters, participants who did not use teleconsultation services but received email newsletters, and participants who neither received nor used either service (18% vs 22% vs 33%, P=.048).

CONCLUSIONS

This is the first randomized controlled trial demonstrating that routine pediatric care combined with teleconsultation and email newsletters was effective in reducing the prevalence of AD in infants. The findings highlight the potential of pediatric eHealth to become a useful new strategy for preventing AD.

TRIAL REGISTRATION

University Hospital Medical Information Network Clinical Trials Registry UMIN000029774; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000034022.

Depression and stress in Korean parents: A cohort study

AIM

This study identified the level of depression and stress in couples experiencing pregnancy and childbirth.

BACKGROUND

Married couples who experience pregnancy and delivery, deal with psychological changes during the parenthood transition. If they do not adapt well, they experience negative emotions that negatively affect them and their child. Therefore, the incidence and changing patterns of depression among couples need to be explored.

METHODS

Using a prospective cohort study design, the researchers collected the couples' depression and stress levels 6 times. This study included 219 prenatal pregnant women, 181 spouses during pregnancy in the prenatal period, 178 postpartum mothers, and 125 spouses after childbirth. The levels of depression and stress were investigated using the Edinburgh Postnatal Depression Scale and Perceived Stress Scale.

RESULTS

The incidence rate of prenatal depression was 10.5- 21.5% in pregnant women and 10.5-12.7% in their spouses. After childbirth, the incidence rate of depression was 21.3- 32.0% in postpartum women and 6.4-10.4% in their spouses. The levels of depression and stress varied from the prenatal to the postpartum period, showing different patterns between women and their spouses. Significantly, the emotional patterns in the couples were different as far as parity was concerned.

CONCLUSIONS

The levels of depression and stress in couples continuously changed during the prenatal and postpartum periods and the patterns differed as well. Even couples who experience a healthy pregnancy and childbirth experience negative emotional changes. Therefore, timely nursing management will alleviate stress and depression not first-time by first-time parents.

Parenting stress in mothers with asthma during the postpartum period

OBJECTIVE

Maternal asthma often complicates pregnancy and is linked with poorer quality of life. Additionally, individuals with asthma are at an increased risk of depression and anxiety. We examined whether asthma during pregnancy is related to parenting stress in the first year postpartum and if this relationship varies with level of asthma control.

METHODS

This cohort survey-based study included mothers with (n = 157) and without (n = 79) asthma. Mothers with asthma participated in this study following participation in a randomized controlled trial of a novel asthma management strategy during pregnancy. Mothers completed the Parenting Stress Index - Short Form during the first 12 months postpartum. Mothers with asthma also completed the Asthma Control Questionnaire.

RESULTS

Parenting stress did not differ between mothers with and without asthma. Additionally, for mothers with asthma, there were no differences in levels of parenting stress based on asthma control.

CONCLUSIONS

This study suggests that mothers with asthma are not at an increased risk for excessive parenting stress. However, due to response and sampling bias, levels of parenting stress in asthmatic mothers may be underreported in our sample.

Prenatal Stress Exposure and Post-traumatic Stress Disorder Associated With Risk of Postpartum Alcohol Misuse Among Women Veterans

OBJECTIVES

Maternal alcohol misuse during the postpartum period is associated with negative maternal and infant outcomes. This study examined whether greater stress exposure in the year before the baby's birth and maternal post-traumatic stress disorder (PTSD) were associated with postpartum alcohol misuse among a sample of women veterans. Maternal PTSD was also examined as a moderator of the association between stress exposure and postpartum alcohol misuse.

METHODS

Data were drawn from the Center for Maternal and Infant Outcomes Research in Translation study, a multisite prospective cohort study of pregnant and postpartum women veterans. Interviews were conducted within 12 weeks after birth. At this post-birth interview, women reported whether they experienced stressful events (e.g., loss of job, military deployment, separation/divorce) in the year before birth. PTSD diagnosis and postpartum scores on the Alcohol Use Disorders Identification Test (AUDIT-C) were derived from the Department of Veterans Affairs medical records.

RESULTS

Models testing main and interaction effects showed a statistically significant association of both PTSD (p = .02) and stress exposure (p = .04), as well as significant interaction of PTSD and stress exposure (p = .03) with AUDIT-C scores postpartum, after controlling for marital status, age, and race. Specifically, compared with women without PTSD, those with PTSD had higher overall AUDIT-C scores postpartum, regardless of stress exposure. For women without PTSD, more stress exposure before birth was associated with higher AUDIT-C scores during the postpartum phase.

CONCLUSIONS

PTSD diagnosis and life stressors before infant birth predicted maternal alcohol misuse during the postpartum period. Identifying such risk factors is an initial step in preventing alcohol misuse, with the goal of enhancing postpartum health for the birthing parent and infant.

Effect of parental depressive symptoms on offspring's brain structure and function: A systematic review of neuroimaging studies

Perinatal Depression (PND) is a severe mental disorder that appears during pregnancy or in the post-partum. Although PND has been associated with behavioral problems in the offspring, its effects on brain development are unclear. With this review we aimed at summarizing the existing literature on the effects of perinatal depressive symptoms on children's brains. A search on PubMed and Embase of structural, functional Magnetic Resonance Imaging (MRI) and Diffusion Tensor Imaging (DTI) studies exploring the effect of PND on offspring's brain was conducted. We selected twenty-six studies, ten structural MRI, five DTI, six fMRI and five with combined techniques. Overall, the studies showed: a) gray matter alterations in amygdala and fronto-temporal lobes; b) microstructural alterations in amygdala, frontal lobe, cingulum, longitudinal fasciculus and fornix; and c) functional alterations between limbic and mesocortical networks. The small sample size and the heterogeneity in populations and methodologies limit this review. In conclusion, PND seems to influence structure and function of offspring, that may contribute to the risk of behavioral disturbances later in life.

Factors Influencing Paternal Postpartum Depression: A Systematic Review and Meta-Analysis

BACKGROUND

Postpartum period is a critical time that requires adjustments not only for mothers but also for fathers and may pose risk for depression. Studies show that the prevalence of paternal postpartum depression (PPD) is between 1.2% and 25.5%. PPD is an under-recognized public health issue and its reported influencing factors are still inconclusive.

OBJECTIVE

The purpose of this paper is to extend the literature by examining influencing factors that affect paternal PPD and describe the strength their associations.

METHODS

We conducted keyword search of Web of Science, PubMed, Embase, the Cochrane Library and PsycARTICLES electronic databases up to Jan 17, 2020, without language restrictions, for observational studies investigating the factors influencing paternal PPD and its effects. Fixed or random effect model was used to pool odds ratio (OR) and 95% confidence intervals (CI) with Stata software 12.0. Heterogeneity between studies was evaluated using Cochran's chi-squared test (Cochran's Q) and I² values.

RESULTS

Nineteen cross-sectional studies and eighteen cohort studies published from 1996 to 2019 were included in this review and seventeen studies in the meta-analysis. Factors affecting paternal PPD can be classified into paternal, maternal, infant and family factors. In Meta-analysis, 9 of 17 influencing factors were revealed to be statistically significant: 1) paternal factors: unemployment OR= 2.59 (95%CI:1.42-4.74), low social support OR=1.05 (95%CI:1.03-1.08), negative life events OR=1.45 (95%CI:1.13-1.87), perceived stress OR=1.08 (95%CI:1.03-1.12), financial strain OR=2.07 (95%CI:1.13-3.81), history of mental illness OR=3.48 (95%CI:2.49-4.86); 2) maternal factors: parity OR=1.36 (95%CI:1.13-1.65) and maternal postnatal depression OR=1.17 (95%CI:1.03-1.33); 3) family factors: low marital satisfaction OR=1.40 (95%CI:1.22-1.61). No statistically significant association with infant factors was found in the meta-analysis.

LIMITATIONS

There was publication bias since we only included English studies. Samples were under-represented in low-and middle-income countries. The meta-analysis results are subject to unobserved confounding factors and cannot explain causality.

CONCLUSION

This overview of the evidence suggests a relationship between paternal employment, psychological status, history of maternal mental illness, first pregnancy, marital relationship and paternal PPD. The low number of studies for some infant factors in meta-analysis leaves gaps in knowledge that need to be addressed. The mechanisms underlying the reported associations and their causal relationship still remain unclear. The awareness of the serious long-term consequences of paternal PPD should encourage better identification of those at risk and the development of effective interventions to protect fathers from PPD.

What are the factors affecting parents' postnatal sense of security?

INTRODUCTION

The postpartum period is part of an important process for mothers and fathers. A sense of security is central as it might influence a parent's journey towards becoming a successful parent. The aim was to determine factors affecting parents' postnatal sense of security (PPSS) before postpartum discharge from a hospital in Konya, Turkey.

METHODS

A descriptive study was conducted. From January 2019 to March 2019, a questionnaire was given to a convenience sample of 188 couples discharged from a regional hospital in Turkey. The sense of security was assessed using the PPSS instrument, with low scores defined as those less than the mean.

RESULTS

Low and high sense of security was based on the mean in the population, for mothers 49.36 and for fathers 34.90. It was found that 43.6% of mothers and 69.7 % of fathers had a low score, which was linked to some specific factors in the postpartum period. These were the type of birth, being ready to take responsibility for baby care, being ready to be discharged, being healthy, having any concern about the baby's health, social support presence, having professional support, and presence of a sense of security.

CONCLUSIONS

Many parents, particularly fathers, have a low postnatal sense of security. In the postpartum period, it is very important for midwives, who are always with the family, to identify the risks for a low sense of security during this period and provide effective care. More studies in different settings with larger samples are recommended.

Parenting stress among new parents before and during the COVID-19 pandemic

BACKGROUND

The outbreak of COVID-19 has forced parents to deal with a challenging crisis, which may have increased their stress levels, negatively affecting their parenting and putting their infants at risk of abuse.

OBJECTIVE

To examine the contribution of the pandemic to parenting stress, exploring differences in parenting stress among new parents before and during the crisis, the role of background and personal variables, and the possibility that the study phase moderated the associations of gender and personal resources with parenting stress.

METHOD

Israeli parents (n = 1591) whose first child was 3-12 months old were recruited twice through social media: in 2019, before the spread of COVID-19 (n = 985); and in March 2020, during the pandemic (n = 606).

RESULTS

Sociodemographic variables, perception of the childbirth as traumatic, lower meaning in life, higher search for meaning, less marital satisfaction, and study phase all contributed to greater parenting stress. In addition, the association between gender and stress was moderated by study phase, with fathers reporting a greater increase in stress during the pandemic. Moreover, only during the pandemic did fathers report higher parenting stress than mothers.

CONCLUSIONS

The findings highlight the vulnerability of new parents of young infants to parenting stress during the crisis, and the special attention which should be paid to fathers. They indicate the value of strengthening meaning in life and preserving good marital relationships as resources that help to cope with the heightened parenting stress at this time.

Paternal Postpartum Bonding and Its Predictors in the Early Postpartum Period: Cross-Sectional Study in a Polish Cohort

Introduction: Parental postpartum bonding has been studied by many researchers focusing on maternal bonding. The objective of this study was to examine the psychological and socio-demographic predictors of paternal postpartum bonding in the early postpartum period. Methods: In this cross-sectional study, 131 couples (fathers median age of 32.37 years, SD = 4.59; mothers median age of 30.23 years, SD = 3.90) of newborns from full-term pregnancies were recruited from November 2019 until March 2020. The primary outcome was paternal postpartum bonding as measured by the Postpartum Bonding Questionnaire (PBQ). Secondary outcomes included: maternal and paternal anxiety [with the Generalized Anxiety Disorder (GAD) Assessment]; maternal and paternal stress [with the Parental Stress Scale (PSS)]; maternal depressive symptoms [with the Edinburgh Postpartum Depression Scale (EPDS)]; and maternal and paternal socio-demographic variables as fathers' presence at childbirth, education level, age, and parental experience. Results: Paternal postpartum bonding was significantly correlated with paternal anxiety (moderate strength), maternal stress (strong correlation), and maternal postpartum bonding. No significant correlations between paternal postpartum bonding, maternal depression symptoms, and maternal anxiety were found. The mediating role of paternal stress in paternal postpartum bonding was proven. Paternal anxiety strengthens paternal stress (b = 0.98). Further, a high level of paternal stress disrupts paternal postpartum bonding (b = 0.41). Results of regression analyses have revelated that maternal infant bonding (p < 0.01) and paternal stress (p < 0.01) are the only predictors of parental postpartum bonding across all included variables. None of investigated socio-demographic variables were associated with paternal postpartum bonding. Conclusion: Notwithstanding limitations, the current findings add to a growing body of literature on paternal postpartum bonding. The results have shown that paternal mental health is related to parental postpartum bonding directly after delivery. Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT04118751.

Investigation of Digital Technology Use in the Transition to Parenting: Qualitative Study

BACKGROUND

The transition to parenting-that is, the journey from preconception through pregnancy and postpartum periods-is one of the most emotionally charged and information-intense times for individuals and families. While there is a developing body of literature on the use and impact of digital technology on the information behaviors of children, adolescents, and young adults, personal use of digital technology during the transition to parenting and in support of infants to 2 years of age is relatively understudied.

OBJECTIVE

The purpose of this study was to enhance our understanding of the ways digital technologies contribute to the experience of the transition to parenting, particularly the role these technologies play in organizing and structuring emerging pregnancy and early parenting practices.

METHODS

A qualitative descriptive study was conducted to understand new parents' experiences with and uses of digital technology during 4 stages-prenatal, pregnancy, labor, and postpartum-of their transition to becoming a new parent. A purposive sampling strategy was implemented using snowball sampling techniques to recruit participants who had become a parent within the previous 24 months. Focus groups and follow-up interviews were conducted using semistructured interview guides that inquired about parents' type and use of technologies for self and family health. Transcribed audio recordings were thematically analyzed.

RESULTS

A total of 10 focus groups and 3 individual interviews were completed with 26 participants. While recruitment efforts targeted parents of all genders and sexual orientations, all participants identified as heterosexual women. Participants reported prolific use of digital technologies to direct fertility (eg, ovulation timing), for information seeking regarding development of their fetus, to prepare for labor and delivery, and in searching for a sense of community during postpartum. Participants expressed their need for these technologies to assist them in the day-to-day demands of preparing for and undertaking parenting, yet expressed concerns about their personal patterns of use and the potential negative impacts of their use. The 3 themes generated from the data included: "Is this normal; is this happening to you?!", "Am I having a heart attack; what is this?", and "Anyone can put anything on Wikipedia": Managing the Negative Impacts of Digital Information.

CONCLUSIONS

Digital technologies were used by mothers to track menstrual cycles during preconception; monitor, document, and announce a pregnancy during the prenatal stage; prepare for delivery during labor/birth stage; and to help babies sleep, document/announce their birth, and connect to parenting resources during the postpartum stage. Mothers used digital technologies to reassure themselves that their experiences were normal or to seek help when they were abnormal. Digital technologies provided mothers with convenient means to access health information from a range of sources, yet mothers were apprehensive about the credibility and trustworthiness of the information they retrieved. Further research should seek to understand how men and fathers use digital technologies during their transition to parenting. Additionally, further research should critically examine how constant access to information affects mothers' perceived need to self-monitor and further understand the unintended health consequences of constant surveillance on new parents.

Fertility Problems and Parenting Daily Hassles in Childhood: A 7-year Longitudinal Study of Adoptive Parents

Fertility problems are known to exert a negative impact on psychological health. Meanwhile, individuals with fertility challenges often view adoption as a positive healing experience. Yet, a dearth of work has examined the long-term impact that fertility problems have on adoptive parents and their childrearing stress. Here, we investigated how fertility problems related to parenting daily hassle (PDH) trajectories among adoptive mothers and fathers in the Early Growth and Development Study (N = 333). When adopted children were 9 months old, adoptive parents reported whether they had fertility problems prior to their decision to adopt and rated their PDH frequency and intensity on six occasions over the next 7 years. Multilevel models revealed inverse U-shaped curves for PDH among both fertile and infertile parents, such that PDH increased from child age 9 months until about 5 to 6 years and decreased thereafter. Mothers with fertility problems exhibited a steeper PDH incline from 9 months to the peak at child age 5 to 6, but also incurred a swifter subsequent decline. There were no significant differences in fathers' PDH trajectories based on fertility problems. We discuss why fertility problems appear to impact PDH trajectories for mothers rather than fathers.

Screening for Early Signs of Paternal Perinatal Affective Disorder in Expectant Fathers: A Cluster Analysis Approach

Previous studies documented gender-related differences in the expression of Perinatal Affective Disorders. However, little attention has been paid to screening the male population during the perinatal period. This study was based on three aims: (1) to investigate the mental health of expectant fathers based on their levels of depression, anxiety, addiction, anger attacks/hostility, and somatization, identifying psychological profiles; (2) to analyze the association between these profiles and the individual variable of perceived stress; (3) and to examine the association between these profiles and the couple’s variable of marital adjustment. A total of 350 Italian expectant fathers in the last trimester of pregnancy were asked to fill in questionnaires concerning perceived stress, dyadic adjustment, psychiatric symptomatology, and depression. Three different clusters were found: “psychologically healthy men” (68%) with low levels of symptoms on all the scales; “men at risk of externalized behavioral problems” (17.1%), characterized by one or more addictive or risky behaviors and moderate levels of scales scores; and “men experiencing psychological distress” (14.9%), with the highest scores on all the scales. A significant association emerged among the perceived stress, marital adjustment, and cluster membership. These results highlight the importance of screening fathers in perinatal health services, which are still predominantly mother-centered, and underscore the necessity to create tailored and personalized interventions.

The effect of psychoeducation on fear of childbirth and birth type: systematic review and meta-analysis

OBJECTIVE

Psychoeducation is an evidence-based therapeutic intervention for women that provide information, support for a better understanding and coping with fear of childbirth (FOC). Although there have been some studies examining the effects of psychoeducation on FOC and cesarean section (CS), there is no high quality evidence. This systematic review and meta-analysis study aimed to investigate the effects of psychoeducation on FOC and CS rate.

METHODS

Literature research was performed in CINAHL, PubMed, Science Direct, OVID, Medline, Science Citation Index (Web of Science) and Cochrane Central Register of Controlled Trials until April 2018. This study is based on the recommendations of the Cochrane guidelines. The analysis was conducted using the Comprehensive Meta-Analysis Program Version 3.

RESULTS

Four randomized controlled studies and three non-randomized controlled studies were selected; six studies were combined for FOC and four studies were combined for CS rate. Meta-analysis revealed that psychoeducation is effective in reducing pregnant women's FOC (hedges' g 0.59, 95% Confidence Interval (CI) 0.46-0.72, p = .000; 931 women) and the CS rate (Odds Ratio 1.730, 95% CI 1.285-2.330, p = .000; 682 women).

CONCLUSION

This study provides sufficient evidence that psychoeducation is an effective to reduce FOC and CS rate.

The Relationship Between Paternal and Maternal Depression During the Perinatal Period: A Systematic Review and Meta-Analysis

Background: Meta-analyses suggest an increased prevalence of paternal depression during the perinatal period of around 10%. The relationship between paternal and maternal symptoms, however, has received little attention. Objective: To determine pooled estimates pertaining to the relationship between paternal and maternal depression during the perinatal period according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Data sources: Studies reporting on the relationship between depression in fathers and mothers between the first trimester and the first year following childbirth were identified using PubMed, PsycINFO, and EMBASE for the period between November 2009 and February 2020. Study selection: A total of 28 primary, empirical studies published in English or German, reporting effect estimates for the relationship of depression in mother-father/partner dyads, involving 11,593 couples, were included. Ten studies included multiple assessments, resulting in 64 extracted effects. Analysis: Information on correlations and odds ratios were extracted. Four random-effects analyses were conducted for the pooled association between paternal and maternal depression: (a) during the prenatal and (b) during the postnatal period, as well as for the prospective relationships between (c) paternal depression and maternal depression at a later timepoint, and (d) vice versa. Models were specified as restricted maximum-likelihood estimation. Heterogeneity was assessed using H 2 and I 2. Funnel plots, the Egger method, and the trim-and-fill test were used to assess publication bias. Sensitivity analyses with and without studies for which we approximated r were conducted. Data synthesis: With substantial heterogeneity, positive associations were found between paternal and maternal depression (a) during pregnancy (r = 0.238), (b) in the postnatal period (r = 0.279), as well as for the prospective relationship between (c) paternal and later maternal depression (r = 0.192), and (d) maternal and later paternal depression (r = 0.208). Conclusion: Paternal depression showed positive correlations with maternal depression across the perinatal period. Given notable methodological and cultural heterogeneity and limitations of individual studies, it was not possible to further identify determining or moderating factors. Increasing evidence for implications of parental depression for child development warrants further scientific attention.

An Illustration of Interpersonal Psychotherapy for Perinatal Depression

This is a case of a 38-year-old married woman presenting with major depressive disorder one month after the birth of her third child. The depressive episode began in the context of interpersonal difficulties with her husband. In addition, she was also battling an internal conflict of continuing to pursue her career dream as an obstetrician and fulfilling her responsibility as a wife and a mother. Interpersonal psychotherapy (IPT) was selected as the treatment choice as an evidence-based peripartum treatment that could specifically address the two presenting problem areas, i.e., marital interpersonal dispute and role transition. This paper provides an illustration of IPT sessions conducted with verbatim selections of the sessions.