Transition to motherhood and the self: Measurement, stability, and change

Body Image Assessment Tools in Pregnant Women: A Systematic Review

Pregnancy is a remarkable time and generates several changes in women in a short period. Body image is understood as the mental representation of the body itself, and, although bodily changes are considered healthy, they can impact pregnant women's body image. Problems related to body image during pregnancy can affect the health of the mother and fetus; thus, it is essential for health professionals to detect potential disorders as soon as possible. The objective of this systematic review was to identify instruments for assessing body image in pregnant women, highlighting their main characteristics. To this end, we applied the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses to searches in the EMBASE, PubMed, and American Psychological Association databases from 5 January to 10 August 2021. We included studies on adult pregnant women without comorbidities in the validation and adaptation of (sub)scales that analyze components of body image. We excluded studies that considered nonpregnant, adolescent, postpartum, and/or clinical populations, as well as smoking/drug use studies that were not validation studies or did not assess any aspect of body image. We investigated the quality of the studies using the Quality Assessment Tool for Studies with Diverse Designs. In all, we examined 13 studies. The results point to a growing concern over body image during pregnancy, as there has been an increase in the number of validation and adaptation studies involving scales for different cultures that scrutinize different constructs. The findings suggest that the listed instruments be used in future research.

I Am a Mother Because I Wanted to-I Am a Grandmother Because Others See Me That Way-Motherhood as a Critical Life Event for Ageing Women

The purpose of this study was to analyse women's perceptions of their transition to motherhood in the late decades of their female adulthood. The research problem was whether and to what extent the meaning of the transition to motherhood changes for women from different birth cohorts. Our sample included mothers from two generational cohorts: 50 women in middle adulthood (M = 47.66), and 52 women in late adulthood (M = 69.35). The results were analysed using qualitative data analysis methods, including frequency analysis and qualitative narrative analysis. Based on the analyses, the category of transition to motherhood was found to be a standard feature for all the women studied in middle and late adulthood. In both older generations, some women recalled the birth of their first child as a coping with change. Indicators of criticality were extracted from their narratives: potential bivalence, the unpredictability of consequences, and longevity of life changes. The results showed that the generation of women in late adulthood exhibited significantly fewer difficulties related to their own motherhood. The semantic dominant of the narratives studied is motherhood as taking responsibility for another person.

Predicting the change in perinatal disordered eating symptoms: An examination of psychosocial factors

Disordered eating symptoms remain a largely unidentified and unsupported area in perinatal healthcare, particularly as they pertain to women without diagnosed eating disorders. In an Australian prospective cohort study, women aged 18-48, completed questionnaires between: 18-24 weeks gestation (n = 249, T1), 30-32 weeks gestation (n = 151, T2) and 8-10 weeks postpartum (n = 124, T3), measuring disordered eating symptoms, psychosocial factors (attitudes to pregnancy or motherhood, self-compassion, relationship satisfaction and perinatal social support) and mental health factors (depressive or anxiety symptoms). Multilevel linear models examined predictive associations between psychosocial factors at T1 and the change in disordered eating symptoms from T1 to T2 and from T1 to T3, in addition to the moderating effects of pre-pregnancy BMI and pregnancy depressive or anxiety symptoms. Whilst restraint and shape concerns decreased from T1 to T2, restraint, shape and weight concerns increased from T1 to T3. Psychosocial factors at T1 were able to predict the change in some disordered eating symptoms. Moreover, when pre-pregnancy BMI or pregnancy depressive or anxiety symptoms were elevated, the impact of psychosocial factors on disordered eating increased. The findings of this study provide a more complex understanding of disordered eating across the perinatal period, with implications for future interventions and research design.

Interventions to Empower Adults with Eating Disorders and Their Partners around the Transition to Parenthood

The transition to parenthood is perceived as a stressful life event, when parents experience an immense change of their psychological focus and a reorientation of roles and responsibilities in the family system. This process may be even more challenging in the presence of a parental eating disorder history. This paper reviews the impact of parental eating disorders on the parents, the couple relationship, and their child during the perinatal period. A parental eating disorder is associated with more negative expectations of parental efficacy as well as specific difficulties in couple communication over the child's feeding, shape, and weight. Providers who better understand the effects of an eating disorder on parental functioning can more effectively intervene early on. We also present couple- or parent-based, empirically supported interventions for adults with eating disorders and their partners in the prenatal and postnatal periods: Uniting Couples in the treatment of Anorexia Nervosa (UCAN) and Uniting couples In the Treatment of Eating disorders (UNITE) both enhance recovery from the eating disorder through a couple-based intervention; the Maudsley Model of Treatment for Adults with Anorexia Nervosa (MANTRA) incorporates the support of partners, when appropriate; Parent-Based Prevention (PBP) focuses on improving parental functioning and reducing risk of negative parental and child outcomes. Finally, we discuss the clinical implications of addressing parental eating disorders and encourage more research on these families.

Psychosocial factors, mental health symptoms, and disordered eating during pregnancy

OBJECTIVE

The impact of disordered eating extends beyond women with a diagnosed eating disorder. Scarce research to date has investigated disordered eating in a general perinatal population, including the complex interplay between psychosocial factors, mental health symptoms, and disordered eating at numerous pregnancy periods. Specifically, maternal attitudes and relationship satisfaction are psychosocial factors that have been identified as a gap in the literature.

METHOD

Pregnant women completed an online questionnaire between 18 and 24 weeks gestation (T1, n = 258) and again between 30 and 32 weeks gestation (T2, n = 159). Structural equation modeling was used to test an interrelated model of psychosocial factors-attitudes to pregnancy, attitudes to motherhood, and relationship satisfaction-and disordered eating, mediated by either depressive or anxiety symptoms. Invariance testing examined whether model weights differed between primiparous and multiparous women at each time point.

RESULTS

While at T1 and T2, there were significant direct associations between psychosocial factors and disordered eating, only at T2 were the associations between psychosocial factors and disordered eating mediated by depressive and anxiety symptoms. Furthermore, at T2, multiparous women were at greater risk of an association between maladaptive attitudes to pregnancy and motherhood, depressive symptoms, and disordered eating.

DISCUSSION

The present study highlights the need to investigate the relationships between psychosocial factors and disordered eating, while accounting for the unique antenatal needs of women during different pregnancy periods and across differing parity. The mediating effect of depressive and anxiety symptoms have implications for future research and clinical care.

Once and Again : History of Rearing Experiences and Psychosocial Parenting Resources at Six Months in Primiparous Mothers

Animal and human studies suggest that parenting style is transmitted from one generation to the next. The hypotheses of this study were that (1) a mother's rearing experiences (G1) would predict her own parenting resources (G2) and (2) current maternal mood, motivation to care for her offspring, and relationship with her parents would underlie this association. In a subsample of 201 first-time mothers participating in the longitudinal Maternal Adversity, Vulnerability and Neurodevelopment project, we assessed a mother's own childhood maltreatment and rearing experiences (G1) using the Childhood Trauma Questionnaire and the Parental Bonding Instrument. At 6 months postpartum, mothers completed questionnaires on parenting stress (G2), symptoms of depression, maternal motivation, and current relationship with their own parents. The sample consisted of mostly high socioeconomic status mothers recruited from Montréal (n = 135) or Hamilton (n = 66), Canada, with an age range from 18 to 43 years (M = 29.41, SD = 4.85 years). More severe maltreatment and less supportive rearing by the mother's parents (G1) predicted increased parenting stress at 6 months (G2). These associations were mediated through distinct psychosocial pathways: maltreatment (G1) on parenting stress (G2) through symptoms of depression (Z = 2.297; p = .022); maternal rearing (G1) on parenting stress (G2) through maternal motivation (Z = -2.155; p = .031) and symptoms of depression (Z = -1.842; p = .065); and paternal rearing (G1) on parenting stress (G2) through current relationship with the father (Z = -2.617; p = .009). Maternal rearing experiences predict a mother's own parenting resources though distinct psychosocial pathways, including depressed mood, maternal motivation, and social support.

Dissecting maternal care: Patterns of maternal parenting in a prospective cohort study

Parental care has a strong impact on neurodevelopment and mental health in the offspring. Although numerous animal studies have revealed that the parental brain is a highly complex system involving many brain structures and neuroendocrine systems, human maternal parenting as a multidimensional construct with cognitive, emotional, and behavioural components has not been characterised comprehensively. This unique multi-method analysis aimed to examine patterns of self-reported and observed parenting from 6 to 60 months postpartum in a cohort of 496 mothers (mean maternal age = 32 years). Self-report questionnaires assessed motivational components of mothering, parenting stress, parenting-related mood, maternal investment, maternal parenting style, mother-child relationship satisfaction, and mother-child bonding at multiple time points. Observed parenting variables included the Ainsworth Sensitivity Scales at 6 and 18 months, the Behavioral Evaluation Strategies Taxonomies at 6 months, an Etch-A-Sketch cooperation task at 48 months, and the Parent-Child Early Relationship Assessment at 60 months. To examine whether different latent constructs underlie these measures of maternal parenting, we conducted an exploratory factor analysis. Self-report measures of parenting correlated only weakly with behavioural observations. Factor analysis on a subsample (n = 197) revealed four latent factors that each explained from 7% to 11% of the variance in the data (32% total variance explained). Based on the loadings of the instruments, the factors were interpreted as: Supportive Parenting, Self-Enjoyment Parenting, Overwhelmed Parenting, and Affectionate Parenting. These factor scores showed specific associations with maternal education and depressive symptoms, as well as with child outcomes, including maternally reported internalising and externalising behavioural problems, school readiness, and child-reported symptoms of mental health. These findings parallel the complexity of the parental brain, suggesting that maternal parenting consists of multiple components, each of which is associated with different maternal characteristics and child outcomes.

Haptotherapy as a new intervention for treating fear of childbirth: a randomized controlled trial

OBJECTIVE

To evaluate the effect of haptotherapy on severe fear of childbirth in pregnant women.

DESIGN

Randomized controlled trial.

SETTING

Community midwifery practices and a teaching hospital in the Netherlands.

POPULATION OR SAMPLE

Primi- and multigravida, suffering from severe fear of childbirth (N = 134).

METHODS

Haptotherapy, psycho-education via Internet and care as usual were randomly assigned at 20-24 weeks of gestation and the effects were compared at 36 weeks of gestation and 6 weeks and 6 months postpartum. Repeated measurements ANOVA were carried out on the basis of intention to treat. Since there were crossovers from psycho-education via Internet and care as usual to haptotherapy, the analysis was repeated according to the as treated principle.

MAIN OUTCOME MEASURES

Fear of childbirth score at the Wijma Delivery Expectancy/Experience Questionnaire.

RESULTS

In the intention to treat analysis, only the haptotherapy group showed a significant decrease of fear of childbirth, F(2,99) = 3.321, p = .040. In the as treated analysis, the haptotherapy group showed a greater reduction in fear of childbirth than the other two groups, F(3,83) = 6.717, p < .001.

CONCLUSION

Haptotherapy appears to be more effective in reducing fear of childbirth than psycho-education via Internet and care as usual.

Infant massage improves attitudes toward childbearing, maternal satisfaction and pleasure in parenting

The first year of motherhood is a period of growth and adaptation in women's lives with several challenges such as identifying the baby's needs and giving appropriate answers, so that mother and baby get to know each other and form a strong bond. Infant massage is one of the approaches that make an important contribution to the psychological and physiological wellbeing of both baby and mother, helping to form a harmonious relationship. This longitudinal study assessed the benefits of infant massage in the relationship between mother and baby, from birth to 12 months old. Comprising 194 dyads of mothers and their babies the subjects were divided into two groups of 97 dyads each. The Experimental group (EG) comprised mothers who undertook infant massage in a postnatal program with a physical therapist once a week. The Control group (CG) comprised mothers who did not attend any postnatal program and did not perform infant massage. Self-reported measures of attitudes concerning motherhood (CAQ-P), experience associated to motherhood (WBPB), parental satisfaction (PSS) and maternal separation anxiety (MSAS) were evaluated. Results showed that mothers in the experimental group were better adapted to motherhood, had greater confidence in their abilities and received more support from their mothers and husbands than mothers in the control group and were therefore more confident in their abilities. The EG group experienced a stronger relationship with their babies and described it as more positive than mothers in the control group. This longitudinal study suggests that mothers who learned how to perform infant massage had more positive attitudes towards the experience of motherhood in helping to increase the level of knowledge, regulation and proximity in the dyad. These findings can in turn help mothers to develop strategies that enable them to better cope with motherhood.

The more things change, the more things stay the same: maternal attitudes 3 to 18 months postpartum

AIM

Becoming a parent precipitates changes in new mothers' psychological and social domains. Previous literature has focused exclusively on pregnancy and the early postpartum, but parenting is an evolving process, necessitating adaption to changing circumstances. We extended previous literature and investigate the changes in the postpartum from 3 to 18 months that occur in maternal attitudes.

METHODS

Using the Childbearing Attitudes Questionnaire, we collected data on mothers' ratings of maternal worries, self-efficacy, mother-infant bonding, relationship with the partner and interest in sex (n = 171 women). Data were analysed with a latent growth curve.

RESULTS

Results demonstrated stability in all maternal attitudes after 3 months postpartum. Further, different maternal attitudes are affected by different variables. Maternal worries and self-efficacy are associated with parity, postpartum depression and child temperament. Interestingly, a negative evaluation of the relationship with the partner was only associated with breastfeeding status, while interest in sex was associated with parity, socio-economic status (SES) and depressive symptoms.

CONCLUSION

Despite general stability, different maternal attitudes related to different sets of variables. These patterns of attitudes in relation to relevant variables are discussed in terms of the literature on self-efficacy and gender roles, with important implications for clinical interventions.

Matrix Of Tensions: A Model of Mothering

Questions about how women integrate maternity into their sense of self have generated a quest for an heuristic model. We suggest that mothers struggle to balance themselves amid a set of polarities/tensions and that mothering can be situated within a phenomenological matrix of such tensions. We propose a model that includes the following developmental issues: loss of self/expansion of self; omnipotence/liability; life-destroying/life-promoting behavior; maternal isolation/maternal community; cognitive strategies/intuitive responses; maternal desexualization/ maternal sexualization. Investigation and understanding of how mothers cope with these tensions could yield insights into both universal and particular aspects of mothering.

I held him so and rocked him. I cradled him. I closed my eyes and leaned on his dark head. But the sun in its course emerged from among the water towers of down-town office buildings and suddenly shone white and bright on me. Then through the short fat fingers of my son, interred forever, like a black and white barred king in Alcatraz, my heart lit up in stripes.

— Grace Paley, The Little Disturbances of Man

Breastfeeding and maternal sensitivity predict early infant temperament

AIM

Research findings are inconclusive when it comes to whether breastfeeding is associated with the mother-infant relationship or infant temperament. We examined the association between breastfeeding at three months postpartum and infant temperament at 18 months postpartum and whether this link was affected by the mothers' anxiety and mediated by her sensitivity.

METHODS

We assessed 170 mothers for breastfeeding and anxiety using the Spielberger State-Trait Anxiety Inventory (STAI) at three months postpartum, maternal sensitivity using the Ainsworth Sensitivity Scale at six months postpartum and infant temperament using the Early Childhood Behaviour Questionnaire at 18 months postpartum.

RESULTS

Mothers who breastfed at three months postpartum were more sensitive in their interactions with their infants at six months postpartum, and elevated sensitivity, in turn, predicted reduced levels of negative affectivity in infant temperament at 18 months postpartum. This indirect mediation persisted after controlling for confounders (effect ab = -0.0312 [0.0208], 95% CI = -0.0884 to -0.0031). A subsequent analysis showed that the mediation through sensitivity only occurred in women experiencing higher anxiety, with a STAI score ≥33.56 at three months (ab = -0.0250 [0.0179], 95% CI = -0.0759 to -0.0013).

CONCLUSION

Our results suggest that breastfeeding and maternal sensitivity may have a positive impact on the early development of infant temperament.

Common and divergent psychobiological mechanisms underlying maternal behaviors in non-human and human mammals

Maternal interactions with young occupy most of the reproductive period for female mammals and are absolutely essential for offspring survival and development. The hormonal, sensory, reward-related, emotional, cognitive and neurobiological regulators of maternal caregiving behaviors have been well studied in numerous subprimate mammalian species, and some of the importance of this body of work is thought to be its relevance for understanding similar controls in humans. We here review many of the important biopsychological influences on maternal behaviors in the two best studied non-human animals, laboratory rats and sheep, and directly examine how the conceptual framework established by some of the major discoveries in these animal "models" do or do not hold for our understanding of human mothering. We also explore some of the limits for extrapolating from non-human animals to humans. We conclude that there are many similarities between non-human and human mothers in the biological and psychological factors influencing their early maternal behavior and that many of the differences are due to species-characteristic features related to the role of hormones, the relative importance of each sensory system, flexibility in what behaviors are exhibited, the presence or absence of language, and the complexity of cortical function influencing caregiving behaviors.

The association of breastfeeding initiation with sensitivity, cognitive stimulation, and efficacy among young mothers: a propensity score matching approach

OBJECTIVE

This study examined the association between breastfeeding initiation and maternal sensitivity, efficacy, and cognitive stimulation among young, low-income, African American mothers.

SUBJECTS AND METHODS

Two hundred twenty-one mothers were interviewed during pregnancy, at birth, and at 4 months postpartum regarding breastfeeding and parenting. Medical records were collected after birth, and mother-infant interactions were videotaped at 4 months. Propensity score matching was used to address selection bias by matching breastfeeding and nonbreastfeeding mothers on characteristics measured prior to breastfeeding.

RESULTS

One hundred twenty-four (56%) mothers initiated breastfeeding. After matching, mothers who initiated breastfeeding reported greater parenting efficacy (effect size, d=0.44) and were observed to be more sensitive with their 4-month-old infants (effect size, d=0.42) than nonbreastfeeding mothers. Breastfeeding was marginally associated with less maternal intrusiveness (effect size, d=0.28) but was not related to parenting attitudes or cognitive stimulation.

CONCLUSIONS

This study presents evidence supporting the claim that breastfeeding may enhance maternal efficacy and sensitivity. Providing breastfeeding support to young mothers may have effects that extend beyond maternal and child health outcomes to parenting and mother-child interactions.

The maternal adversity, vulnerability and neurodevelopment project: theory and methodology

OBJECTIVE

To describe the theory and methodology of the multi-wave, prospective Maternal Adversity, Vulnerability and Neurodevelopment (MAVAN) study. The goal of MAVAN is to examine the pre- and postnatal influences, and their interaction, in determining individual differences in mental health.

METHOD

MAVAN is a community-based, birth cohort study of pregnant Canadian mothers and their offspring. Dyads are assessed longitudinally, with multiple assessments of both mother and child in home and laboratory across the child's development. Study measures, including assessments of cognitive and emotional function, are described. The study uses a candidate gene approach to examine gene-environment interdependence in specific developmental outcomes. Finally, the study includes measures of both brain-based phenotypes and metabolism to explore comorbidities associated with child obesity. One of the unique features of the MAVAN protocol is the extensive measures of the mother-child interaction. The relation between these measures will be discussed.

RESULTS

Evidence from the MAVAN project shows interesting results about maternal care, families, and child outcomes. In our review, preliminary analyses showing the correlations between measures of maternal care are reported. As predicted, early evidence suggests that maternal care measures are positively correlated, over time.

CONCLUSIONS

This review provides evidence for the feasibility and value of laboratory-based measures embedded within a longitudinal birth cohort study. Though retention of the samples has been a challenge of MAVAN, they are within a comparable range to other studies of this nature. Indeed, the trade-off of somewhat greater participant burden has allowed for a rich database. The results yielded from the MAVAN project will not only describe typical development but also possible targets for intervention. Understanding certain endophenotypes will shed light on the pathogenesis of various mental and physical disorders, as well as their interrelation.

Physical child abuse potential in adolescent girls: associations with psychopathology, maltreatment, and attitudes toward child-bearing

OBJECTIVE

Adolescent mothers are at increased risk of mistreating their children. Intervening before they become pregnant would be an ideal primary prevention strategy. Our goal was to determine whether psychopathology, exposure to maltreatment, preparedness for child-bearing, substance use disorders (SUDs), IQ, race, and socioeconomic status were associated with the potential for child abuse in nonpregnant adolescent girls.

METHOD

The Child Abuse Potential Inventory (CAPI) was administered to 195 nonpregnant girls (aged 15 to 16 years; 54% African American) recruited from the community. Psychiatric diagnoses from a structured interview were used to form 4 groups: conduct disorder (CD), internalizing disorders (INTs; that is, depressive disorder, anxiety disorder, or both), CD + INTs, or no disorder. Exposure to maltreatment was assessed with the Childhood Trauma Questionnaire, and the Childbearing Attitudes Questionnaire measured maternal readiness.

RESULTS

CAPI scores were positively correlated with all types of psychopathology, previous exposure to maltreatment, and negative attitudes toward child-bearing. IQ, SUDs, and demographic factors were not associated. Factors associated with child abuse potential interacted in complex ways, but the abuse potential of CD girls was high, regardless of other potentially protective factors.

CONCLUSIONS

Our study demonstrates that adolescent girls who have CD or INT are at higher risk of perpetrating physical child abuse when they have children. However, the core features of CD may put this group at a particularly high risk, even in the context of possible protective factors. Treatment providers should consider pre-pregnant counselling about healthy mothering behaviours to girls with CD.

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

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Serotonin transporter allelic variation in mothers predicts maternal sensitivity, behavior and attitudes toward 6-month-old infants

Maternal behavior in the new mother is a multidimensional set of responses to infant cues that are influenced by the mother's early life experiences. In this study, we wanted to test if mothers' early life experiences and mothers' genotype have interactive effects on maternal behaviors and attitudes, something which has not been previously explored. In a sample of 204 mothers, we assessed maternal genotype at the serotonin transporter-linked polymorphic region (5-HTTLPR) and an adjacent upstream polymorphism (rs25531), together giving rise to three alleles: short (S), L(G) and L(A). Controlling for maternal age and parity, we showed that this genotype can predict differences in maternal sensitivity at 6 months postpartum: mothers with an S (or the functionally similar L(G)) allele were more sensitive than mothers who lacked the allele during a 30-min recorded mother-infant interaction (F (4,140) = 3.43; P = 0.01). Furthermore, we found highly significant gene-environment interactions in association with maternal behavior, such that mothers with no S or L(G) alleles oriented away more frequently from their babies if they also reported more negative early care quality (F (5,138) = 3.28; P = 0.008). Finally, we found significant gene-environment associations with maternal attitudes; mothers with the S allele and with greater early care quality scored higher on ratings of their perceived attachment to their baby (F (5,125) = 3.27; P = 0.008). The regression results show significant interactions between the reported quality of care mothers received from their own parents and genotype on both their frequency of orienting away from the infant during the interaction (F(5, 138) = 3.28; P = 0.008, Fig. 1a) and their perceived attachment feelings to the infant (F(5, 125) = 3.27; P = 0.008, Fig. 1b); however the direction of the effects for these two outcome measures were different from one another. With increasing care quality, mothers with the L(A)L(A) genotype (no S or L(G) allele) oriented away less frequently, while S or L(G) allele carriers showed no significant change. In contrast, with increasing early care quality. L(A)L(A) (no S or L(G) allele) mothers scored lower on perceived attachment to their infants, whereas S or L(G) allele carrying mothers scored higher. [corrected].

Rapid metastasis of breast cancer cells from primary tumour to liver

The aim of this study was to establish an animal model of mammary carcinoma metastasis to discern the in vivo effects of growth and spread of breast cancer. Six-week-old female BALB/c mice were inoculated with 4T1 murine breast cancer cells. Mice weight and primary tumour mass volume were regularly recorded to study the physical effects of a vigorously growing and spreading of cancer cell line. Gross and histological studies were carried out to determine the approximate day of metastatic onset. Production of IFN-gamma was assessed by ELISA to understand its role in tumour growth and metastasis. Lymphocyte markers such as CD8+, CD25 and CD49b were analysed to elucidate its role in tumour growth and progression. Present study showed that the metastatic onset occurs approximately 11 days after the mice were inoculated with the 4T1 murine breast cancer cells. Gross studies showed hepatosplenomegaly. The breast cancer cells from primary tumour were found to spread rapidly to the liver on day 11. IFN-gamma production was higher in inoculated mice serum compared to control mice serum. Higher numbers of CD8+, CD25 and CD49b cells were observed in the peripheral blood of inoculated mice, compared to control mice. In conclusion, the 4T1 murine breast cancer cells can migrate and metastasise rapidly to the liver, eliciting various immune responses.

Maternal health after the birth of a medically complex infant: setting the context for evaluation of co-occupational performance

OBJECTIVE

Physical and psychological health indicators of mothers who gave birth to medically complex infants were examined to explore potential risk factors for the development of chronic conditions and to develop a scholarly base that supports the inclusion of maternal health in the scope of early intervention practice.

METHOD

Ten mothers completed the Perinatal Posttraumatic Stress Disorder Questionnaire and the State Trait Anxiety Form Y-1. Nine women completed 24-h Holter recording. Frequency of symptoms of posttraumatic stress disorder (PTSD) and anxiety were determined. High frequency heart rate variability was examined for indicators of autonomic dysregulation.

RESULTS

Nine of 10 women reported symptoms associated with PTSD, and 2 of these women reported more severe symptoms. Two women demonstrated indicators of autonomic dysregulation.

CONCLUSION

Further research examining psychological and physical characteristics in mothers of infants at high risk is important to determine whether these women are at greater risk for chronic health conditions.

Reliability and validity of the Dutch version of the maternal antenatal attachment scale

In this study, we investigated the psychometric qualities of the Dutch version of the Maternal Antenatal Attachment Scale (MAAS). In a monocentric prospective observational cohort study, 403 expectant mothers completed a booklet with questionnaires in the first (T1), second (T2), and third (T3) pregnancy trimesters. In addition to the MAAS (T1-T3), the following measures were used: the Marlowe-Crowne Social Desirability Scale (T1), the Parental Bonding Inventory (T1), the Relationship Questionnaire (T1) the Facilitator scale and the Regulator scale (T3), the Edinburgh Postnatal Depression Scale (T1-T3) and the Pregnancy Related Anxiety Questionnaire (T1-T3). In this study, the mean of the MAAS scales increased as the pregnancy progressed. Good internal reliabilities were found for the Total MAAS scale, the Quality subscale and the Preoccupation subscale. Small-to-moderate correlations were found with social desirability, maternal orientation, parental care and adult attachment. Maternal mood was weakly associated with the quality but not with the intensity of the maternal attachment feelings. Overall, our findings suggest that the Dutch version of the Maternal Antenatal Attachment Scale is a reliable and valid measure of the early emotional tie between a pregnant woman and her unborn child.

The Impact of Having a Baby on the Level and Content of Women's Well-Being

The primary objective of this study was to more fully understand the impact of having a baby on women's well-being by attending to both the level and the content of well-being. To cover the judgemental and affective aspects of well-being we included global measures of life satisfaction and well-being and affective experience measures derived from the day reconstruction method. In a sample of 19 first-time mothers no differences between pre and postnatal reports of general life satisfaction, depression, anxiety, and experienced positive and negative affect were found, suggesting that the arrival of the newborn baby does not universally impact on women's level of well-being. Changes in the content of well-being were studied by examining changes in the way women experience specific activities and interactions with various social partners. There appeared to be an upward shift in experienced positive affect during active leisure and a slight decrease in negative affect during time spent with relatives. The results are discussed in light of previously documented changes across the transition to motherhood in negative mood states, time use, women's evaluation of various aspects of daily life, and relational satisfaction.

On becoming a first-time mother after an emergency Caesarean section: a journey from alienation to symbolic adoption

This qualitative research focused on the significance of subjective experience of mothers who gave birth in an emergency Caesarean section. Ten first-time mothers experiencing emergency Caesarean section were interviewed, and their narrative accounts were analyzed using Giorgi's phenomenological method. Mothers described alienation from the infant on encountering her/him; primal difficulties in holding; a 'mechanistic' pattern of childcare at home; over-apprehension and fear of a cradle-death. A few of the women seemed to cope with these experiences by performing 'a symbolic adoption' of their infants. In the context of object-relations theory, the findings, will potentially inform psychological care in obstetrics and gynaecology.

Depressive symptomatology in pregnant and postpartum women. An exploratory study of the role of maternal antenatal orientations

Little is known about how an expecting woman's view of pregnancy, the child, and motherhood relates to antenatal and postpartum depressive symptomatology. In this study, we investigated the influence of the maternal orientations, as described by Raphael-Leff (Psychological processes of childbearing. The Anna Freud Centre, London, 2005), on the prevalence of depressive symptoms in pregnant and postpartum women. Four hundred three pregnant women participated in a longitudinal study and completed the EPDS and the HADS-D in each pregnancy trimester and between 8 to 12 and 20 to 25 weeks postpartum. In addition, measures of maternal orientation (PPQ), personality (NEO-FFI), coping styles (UCL), adult attachment (RQ), and parental bonding (PBI) were completed antenatally. Bivariate and multivariate analyses revealed that Neuroticism and the Regulator orientation are positively associated with the EPDS and HADS-D in both pregnant and postpartum women. These associations decreased in strength but remained significant after controlling for previous responses on the EPDS and HADS-D. Small negative associations were found between the Facilitator orientation and the HADS-D scores during pregnancy and the early postpartum period. However, this association did not hold its statistical significance within the hierarchical multiple regression models. The maternal orientations have a small but significant and independent contribution in the variance of depressive symptomatology in pregnant and postpartum women.

Transitions familiales et brouilles conjugales : cumulation ou compensation des problèmes d’intimité à travers les phases du parcours de vie familial?1

Cette étude esquisse, sur la base d’un grand échantillon représentatif et longitudinal de couples vivant en Suisse et du point de vue des femmes ayant répondu à l’enquête, un tableau de l’évolution des problèmes conjugaux rencontrés au cours des différentes phases de la vie familiale. Le processus de dégradation de la relation est reconstitué à partir de deux mesures faites dans un intervalle de 5 ans. La genèse des difficultés conjugales est considérée à travers le prisme des transitions familiales, en particulier la naissance des enfants, leur entrée à l’école et leur départ du domicile parental. L’analyse révèle le potentiel déstabilisateur de ces transitions pour le couple. Les bouleversements de l’équilibre relationnel évoluent, dans certains cas, vers un cumul de difficultés qui envahissent l’espace conjugal pour déboucher sur une situation inextricable.

Anxiety in pregnant and postpartum women. An exploratory study of the role of maternal orientations

BACKGROUND

Little is known about why some women are anxious during pregnancy but not in the postpartum period, or vice versa. We aimed to determine the influence of maternal antenatal orientations (Raphael-Leff, J. (2005) Psychological Processes of Childbearing, London, The Anna Freud Centre.) on the prevalence of general anxiety symptoms and specific anxiety in pregnant and postpartum women.

METHODS

Four hundred and three pregnant women participated in a longitudinal study and completed general (HADS-A) and specific (PRAQ, MSAS) anxiety questionnaires and measures of maternal antenatal orientations, personality traits, cognitive and behavioural coping styles and attachment.

RESULTS

Higher scores on the neuroticism and regulator orientation scale consistently predicted higher scores on the general and pregnancy related anxiety measures. Also, an interaction effect was found between the regulator scale and the neuroticism scale on the general anxiety symptoms and pregnancy related anxiety. Finally, the facilitator orientation scale and the neuroticism scale, predicted maternal separation anxiety in the postpartum period.

CONCLUSION

Women differ in the risk factors, the nature and timing of heightened anxiety during the transition to motherhood. The anxieties of women tending to the regulator orientation are pregnancy related, whereas women tending to the facilitator orientation fear the separation from their child in the postpartum period.

Course and correlates of postpartum depression during the transition to parenthood

The transition to parenthood marks a major milestone in family development that is especially difficult for roughly 10% of postpartum women who develop clinical depressions serious enough to interfere with daily functioning. Relatively little is known about the course of postpartum depression, the factors associated with its onset or severity, or its impact on the quality of mother-infant interaction. We studied 70 depressed women and 59 demographically matched nondepressed women delivering their first child and then followed them longitudinally through 24 months. Although the majority of depressions had remitted by 6 months postpartum, some women were depressed throughout the follow-up period, and others continued to evidence subclinical symptoms, indicating that depression in postpartum women can be relatively chronic. Depressed women differed from comparison women on measures of personal and family history, their adaptation to pregnancy, and minor pregnancy and delivery complications. They also perceived their infants as more difficult to care for and their husbands as less supportive. A combination of these variables accounted for 49% of the variance in depression severity scores at 2 months. Depressed women also showed less positive engagement and more negative affect when observed with their infants at 2 months. Spouse support and maternal positive engagement with the baby at 2 months differentiated between those with more chronic versus short-lived depressions. The implications of these findings for the woman's and her infant's development are discussed.

Antenatal mood and fetal attachment after assisted conception

OBJECTIVE

Australian women conceiving with ART are at fourfold risk of admission to early parenting treatment programs compared with those conceiving spontaneously. This study aimed to identify prevalence and determinants of antenatal mood disturbance and other risks for early parenting difficulties after assisted conception.

DESIGN

A prospective longitudinal investigation from conception to 18 months postpartum using telephone interviews and self-report questionnaires.

SETTING

Melbourne IVF and Royal Women's Hospital Reproductive Services, Victoria, Australia.

PATIENT(S)

A consecutive cohort of English-speaking women with ultrasound-confirmed ART-conceived pregnancies.

MAIN OUTCOME MEASURE(S)

Standardized psychometric measures of mood, quality of marital relationship, mother-to-fetus emotional attachment, and personality.

INTERVENTION(S)

None.

RESULT(S)

Of the 288 women with confirmed pregnancies, 239 were contactable, and 183 (77%) were recruited, 95% of whom completed both early and late pregnancy assessments. Participants were socioeconomically advantaged, had very good pregnancy health, exceptional marital relationships, normal personality styles, and intense affectionate attachment to the fetus. Very few (<5%) had clinically significant mood disturbance in late pregnancy.

CONCLUSION(S)

There were low rates of antenatal mood disturbance and other risk factors for postpartum depression. Pregnancy and motherhood might be idealized after ART conception, and preparation for the realities of infant care might then be insufficient.

Effects of motherhood on physiological and subjective responses to infant cries in teenage mothers: a comparison with non-mothers and adult mothers

The present study was designed to determine whether becoming a mother during the adolescent period changes maternal responsiveness or maternal motivation, assessed through hormonal, autonomic, and hedonic responses to recorded infant cries and interactions with their babies. Fifty-six teen mothers were compared to 58 teen non-mothers and 49 adult mothers. Teen mothers reported more sympathy and alertness in response to recorded infant cries compared to non -mother teens; however, among the teen women there were no differences between mothers and non-mothers in heart rate and cortisol responses to infant cries. In contrast, in comparison to adult mothers, teen mothers reported the same levels of sympathy and alertness to infant cries; however, adult mothers showed an 'alerted' pattern of heart rate and cortisol response to infant cries not seen in the teen mother group. Inclusion of the covariate, fathers' employment classification as an index of SES or time of testing and cortisol sampling did not affect this pattern of results. Taken together, these results show that where self-report is used as a measure of maternal responsiveness, teen mothers are no different in responsiveness than adult mothers; however, where physiological and interactional measures of responsiveness are considered, teen mothers are less likely to show heightened or selective responses to infant cries or respond 'attentively' to the infant.

Maternal concerns during early parenthood

BACKGROUND

Most research on maternal concerns has focused on their assessment during pregnancy and the early post-partum period. The aim of this study was to identify primary concerns of mothers later in the first post-partum year, changes over time, and factors that were associated with relatively intense concerns, including infant (difficult) temperament, hours employed out of the home and obstetrical complications during pregnancy or childbirth.

METHOD

Data were obtained from 366 first-time (Israeli) mothers at 3 and 6 months post-partum by employing a new tool, the Mothers' Concern Questionnaire, along with standardized questionnaires, administered by phone.

RESULTS

Analyses revealed six dimensions of concerns (Family Health, Return to Work, Mother's Well-being, Relationships/Support, Infant Care, and Spouse). Of these, issues related to returning to work and family health were of most concern, and ratings were higher at 3 months than at 6 months post-partum. Women with higher-than-average total concern scores perceived their infant as more difficult, were more likely to have experienced an obstetric complication, and worked more hours out of the house than women with lower-than-average scores.

CONCLUSIONS

The findings afford a first look at the profile of normative maternal concerns outside of the immediate post-partum period and identify factors that predict more intense concerns. These findings extend what we know about the issues of new mothers and can guide birth educators and help couples prepare themselves for parenthood.

Psychosocial adjustment during pregnancy for older couples conceiving through assisted reproductive technology

BACKGROUND

The trend to older maternal age at first birth is well established in Western countries and biological risk factors, particularly declining fertility, are well documented. Less is known, however, about the psychosocial well-being of older first time parents. This study explores differences in psychosocial adjustment during pregnancy in older (maternal age >or= 38 years) and younger (maternal age < 35 years) couples after assisted reproductive technology (ART) conception.

METHODS

Questionnaire data were collected from a consecutive cohort of pregnant nulliparous women and their partners recruited over a 12-month period from ART clinics in Sydney, Australia.

RESULTS

There were more similarities than differences when comparing older and younger couples. Older couples took longer to conceive and were more likely to use donor eggs. Older pregnant women scored higher on a measure of psychological hardiness/resilience and reported a lower identification with motherhood compared with younger pregnant women. Older men differed only in reporting a less satisfying social orientation during pregnancy (lower satisfaction with sex life, relationship with partner and social life).

CONCLUSIONS

Findings do not indicate problematic adjustment during pregnancy in older couples, but differences found need further investigation using larger samples and prospective designs.

Postnatal psychiatric morbidity: a validation study of the GHQ-12 and the EPDS as screening tools

OBJECTIVE

To assess the validity of the 12-Item General Health Questionnaire (GHQ-12) and the Edinburgh Postnatal Depression Scale (EPDS) in screening for the most common postnatal psychiatric morbidities (mood, anxiety and adjustment disorders).

METHOD

A two-phase cross-sectional study was designed. First, a sample of 1453 women visiting at 6 weeks postpartum completed the GHQ-12 and the EPDS questionnaires. Second, based upon EPDS outcomes, participants were stratified and randomly selected within each stratum for clinical evaluation [Structured Clinical Interview for DSM-IV (SCID)]. Receiver operating characteristic (ROC) analysis was used.

RESULTS

The concurrent validity was satisfactory (0.80). At optimum cut-off scores, both GHQ-12 and EPDS yielded very good sensitivity (80; 85.5) and specificity (80.4; 85.3), respectively. ROC curves showed that the performance of the EPDS (AUC=0.933) is slightly superior to that of GHQ-12 (AUC=0.904).

CONCLUSION

Both GHQ-12 and EPDS are valid instruments to detect postnatal depression as well as postnatal anxiety and adjustment disorders.

Mood state and psychological adjustment to pregnancy

The aim of this study was to investigate whether there is an association between antenatal mood state (depression and anxiety) and psychological adjustment to pregnancy. Participants were first-time, low obstetric risk mothers at a Sydney teaching hospital who completed self-report questionnaires measuring depression, anxiety, thoughts about motherhood and self as mother and relationship with the fetus. Higher symptom levels of antenatal anxiety were related to less optimal maternal-fetal quality of attachment, more negative attitudes towards motherhood and the self as mother. Similar trends were found for symptoms of depression, however depression was not significantly related to psychological adjustment to pregnancy variables. The significance of anxiety in the current study highlights the importance of considering anxiety in the psychological adjustment to pregnancy, as well as the in the context of perinatal mental health more generally. Implications of these findings for intervention are also briefly discussed.

Perceived parental efficacy: concept analysis

AIMS

This paper describes a concept analysis carried out to remove some of the ambiguity surrounding the conceptual meaning of perceived parental efficacy and to distinguish it from related concepts such as parental confidence and parental competence.

BACKGROUND

Constructing parental efficacy is a crucial step for family members after the birth of their first child. For some authors, perceived parental efficacy is a motor for adequate parental practices. Confusion about the definition and measurement of this concept has hindered both psychology and nursing practice and research. Concept delineation and concept clarification are required in order to further the development of the concept of perceived parental efficacy.

METHODS

A literature search using a variety of online databases yielded 113 articles between the years 1980 and 2000. The final sample (n=60) consisted of 30 articles from two disciplines: nursing and psychology. A content analysis of the literature was done using Rodger's evolutionary concept analysis method.

FINDINGS

Content analysis of the literature yielded four contributors to perceived parental efficacy: positive enactive mastery experiences, vicarious experiences, verbal persuasion and an appropriate physiological and affective state. Perceived parental efficacy can thus be defined as 'beliefs or judgements a parent holds of their capabilities to organize and execute a set of tasks related to parenting a child'.

CONCLUSION

This conceptual analysis has allowed perceived parental efficacy to be distinguished from parental confidence and parental competence. Both nursing and psychology research, practice and education will benefit from a more precise and delineated concept.

Psychological adjustment to twins after infertility

The birth of twins and other multiples is physically and emotionally stressful. The increase in the use of the assisted reproductive technologies has lead to an exponential increase in the rates of twins and triplets in the US. Whereas the medical complications of twins and other multiples has been well studied, the psychological and social implications of these events has not. Very little empirical research has been conducted to assess the differential impact of twins, as compared to singletons, on maternal adjustment, postpartum depression and marital functioning. In addition, assessment of infant health, disposition and behavior and its relation to maternal adjustment is lacking. The birth of twins after a period of infertility complicates the clinical picture and the impact of infertility on subsequent parental adjustment is only beginning to be understood. Although research suggests that infertile couples often desire multiples, the experience of parenting multiples after infertility has not been studied. Research on fertile couples indicate that: (i) approximately 10% of women develop postpartum depression and; (ii) marital adjustment declines after the birth of the first child. Because of the unique demands of parenting multiples, it is hypothesized that mothers of twins who have a history of infertility would be at increased risk for depression and marital decline. Descriptive studies of these families support this view, although additional studies are needed to determine the degree and extent of the problem. Additionally, variables such as, prepregnancy adjustment, equitable division of child-care tasks and perceived social support should be studied to determine if they buffer against the expected effects.

Prenatal and Postpartum Depression among Low-Income Dominican and Puerto Rican Women

This longitudinal study examined depression symptoms among pregnant, low-income, urban Latinas, primarily Puerto Ricans and Dominicans, receiving obstetrical services in community health centers. In all, 106 women were interviewed in late pregnancy, 47 were interviewed again 2 to 3 weeks postpartum, and 42 three months postpartum. Elevated levels of depressive symptoms were evident in 53% of the original sample. Across time, depressive symptoms decreased significantly; however, a decreased score was strongly related to number of negative life events. Social support scores were minimally related to depressive symptomatology. Service recommendations based on these findings include conducting third-trimester assessments of life events experienced during the past year and screening for depression to better identify women at risk of late pregnancy to postpartum–persistent depressive symptoms. More research and clinical attention on dysphoric states in pregnant Latinas and understanding the consequences of impaired perinatal mental health on maternal well-being and infant outcomes are needed.