Interventions with depressed mothers and their infants: modifying interactive behaviours

BACKGROUND: Postpartum depression (PPD) has a prevalence ranging from 3% to 30% and is associated with serious infant growth and developmental problems. Interventions directed at improving maternal mood have been unsuccessful in producing changes in observed face-to-face interactions between mother and infant. The Keys to Caregiving (KTC) is an intervention program that helps parents to understand and respond to infant behaviours, with a goal of increasing positive affective expressions in infants. In this pilot study, KTC was used with mothers suffering from mild to moderate PPD and their infants. METHODS: PPD was confirmed by scores on the Edinburgh Postnatal Depression Scale and the Beck Depression Inventory. Eleven dyads completed the study. KTC was carried out in 5 weekly group sessions, beginning at infant age of 3 months. Dyads were videotaped prior to and after KTC, using the Face-to-Face Still-Face paradigm, which assesses infants' responses during normal play and the effects of the Still-Face perturbation. The tapes were scored for infant facial emotion expressions. RESULTS: After intervention, infants displayed a marked increase in Interest and Joy when interacting face-to-face with their mothers, even though mothers' depression ratings did not change. LIMITATIONS: This pilot study is limited by lack of control dyads, however, it provides the foundation necessary for a full trial. CONCLUSIONS: This study suggests that intervention that focuses on what mothers do with their infants instead of how they feel can be effective in increasing infants' positive responsiveness and improving infant outcomes. Such interventions can be an essential component of treatment when mothers present with postpartum depression.     

Depression, partnership, social support, and parenting: interaction of maternal factors with behavioral problems of the child

Background: Children of depressed mothers are at elevated risk to develop behavioral problems. Besides maternal depression, other risk factors like interpersonal functioning, are discussed. The object of this study was to investigate the predictive value of the maternal variables depression, partnership, social support, and parenting for internal and external behavioral problems of the children. Methods: A total of 100 mothers and their children who participated in a German mother–child rehabilitation program were interviewed by questionnaire. Structural equation modeling was conducted in order to determine the predictive value of the mentioned maternal variables on behavioral problems of the children. Results: Behavioral problems of the children can be predicted by the parenting and the partnership of the mothers. Mothers with more parenting difficulties and with less containment with partnership report more behavioral problems of their children. Depression and social support do indirectly predict the child’s problems. Limitations: The data is from a cross-sectional sample. Therefore, path models do not demonstrate causation. All information is based upon maternal report. Conclusions: These findings suggest the need for intervention programs which focus on the parenting and the partnership of the mothers. More research with independent assessment is needed.     

Attachment quality is related to the synchrony of mother and infant monitoring patterns

We investigated whether attachment quality is related to infant–mother dyadic patterns in monitoring animated social situations. Sixty 12-month-old infants and their mothers participated in an eye-tracking study in which they watched abstractly depicted distress interactions involving the separation of a “baby” and a “parent” character followed by reunion or further separation of the two characters. We measured infants’ and their mothers’ relative fixation duration to the two characters in the animations. We found that infant attachment disorganization moderated the correspondence between the monitoring patterns of infant–mother dyads during the final part of the animations resulting in reunion or separation. Organized infants and their mothers showed complementary monitoring patterns: the more the mothers focused their attention on the “baby” character, the more the infants focused their attention on the “parent” character, and vice versa. Disorganized infant–mother dyads showed the opposite pattern although the correlation was nonsignificant: mothers and their infants focused on the same character. The attachment-related differences in the nature of the synchrony in the attentional processes of infants and their mothers suggest that by 12 months the dyads’ representations of social situations reflect their shared social–emotional experiences.     

The effect of percutaneous oestrogen replacement therapy on Lp(a) and other lipoproteins

Objectives: To determine the effect of percutaneous oestrogen replacement therapy on lipoprotein (a) and other plasma lipoproteins. Methods: Open longitudinal prospective study conducted at the hormone replacement clinic of the Prince of Wales Hospital, New Territories, Hong Kong. Thirty women who had undergone a total abdominal hysterectomy and bilateral salpingo-oophorectomy for benign gynaecological conditions were treated with 1.5 mg of percutaneous 17β-oestradiol gel applied daily for a period of 12 consecutive months. Measurements of plasma lipoproteins were made before the commencement of treatment and repeated at 6- and 12-month intervals. Results: There was a significant reduction in the concentrations of Lp(a) during the first 6 months of treatment, with median values falling from 7.87 mg dL⁻¹ to 6.16 mg dL⁻¹ (P = 0.004, 0–6 months). During the second 6 months, the median concentration increased to 9.38 mg dL⁻¹, (P = 0.072, 66-12 months), which did not significantly differ from the baseline level (P = 0.545, 0–12 months). Significant reductions in the concentrations of apoprotein A-I (apo A-I), apoprotein B (apo B), high density lipoprotein cholesterol (HDL-C), and HDL₃-C were also present after 6 months (P = 0.043, 0.049, 0.028, 0.013, respectively), but there were no differences between the baseline values of these lipoproteins and those at the completion of the study (P = 0.948, 0.244, 0.839, 0.117 respectively). Drug compliance was maintained throughout the study, with similar mean oestradiol concentrations at 6 and 12 months. Conclusions: The percutaneous administration of 17β-oestradiol has variable short term effects on plasma lipoproteins which are not maintained over a longer duration of treatment. By avoiding the ‘first pass’ effect on the liver, this method of delivery does not appear to produce the sustained changes in lipoproteins seen with oral treatment.     

Reflective functioning,maternal attachment,mind-mindedness,and emotional availability in adolescent and adult mothers at infant 3 months

The study evaluated reflective functioning (RF), maternal attachment, mind-mindedness, and emotional availability among 44 adolescent mother–infant dyads and 41 adult mother–infant dyads. At infant age 3 months, mother–infant interaction was coded with the mind-mindedness coding system and Emotional Availability Scales; mother attachment and RF were evaluated with the Adult Attachment Interview (AAI). Adolescent mothers (vs. adult mothers) were more insecure and had lower RF; they were also less sensitive, more intrusive and hostile, and less structuring of their infant’s activity; they used fewer attuned mind-related comments and fewer mind-related comments appropriate to infant development. In adult mothers, the Mother Idealizing and Lack of Memory AAI scales were correlated to non-attuned mind-related comments and the Father Anger scale to negative mind-related comments. In adult mothers, RF was associated with sensitivity. This was not the case with adolescent mothers. In both groups of mothers, there were no associations between sensitivity and mind-mindedness.     

The dynamic changes of gangliosides in breast milk and the intake of gangliosides in maternal and infant diet in three cities of China

Objective: To study the ganglioside intake of lactating mothers and its effect on the breast milk and infants. Methods: The related information of mothers and infants was obtained by questionnaire survey, including the recipe, family information, and so on. The content of gangliosides in the mothers’ food and breast milk was tested by HPLC-MS. The intake of gangliosides for infants was recorded and calculated. Then the dynamic changes of the content of gangliosides in breast milk and the impact on the development of infants were evaluated. Results: GD3 was rich in milk and dairy products. The average intake of gangliosides for lactating mothers was 6.33 mg/day, of which GM3 was 3.02 mg/day and GD3 was 1.51 mg/day. The main food sources of gangliosides were meat (46.6%), eggs (26.6%), and dairy products (18.9%). The average content of gangliosides in breast milk was 9.58 mg/L. The content in 0-7 days after delivery (15.95 mg/L) was the highest, and then gradually decreased with time, getting the lowest in 6 months after delivery (6.47 mg/L). GM3 and GD3 were the two main types in breast milk. The average milk intake of infants under 6 months gradually increased from 570 mL to 1367 mL, and the daily intake of gangliosides was relatively stable, with a median of 6.4 mg. There was no significant relationship between the intake of gangliosides and physical development in infants. Conclusion: This study is the first to report the dietary ganglioside intake of Chinese city mothers. This study is also the first to indirectly infer the demand of infant ganglioside by detecting the components of breast milk. It will accumulate basic data for improving the diet of Chinese mothers and the recommended amount of infant nutrients.     

Personal relatedness and attachment in infants of mothers with borderline personality disorder

The principal aim of this study was to assess personal relatedness and attachment patterns in 12-month-old infants of mothers with borderline personality disorder (BPD). We also evaluated maternal intrusive insensitivity toward the infants in semistructured play. We videotaped 10 mother-infant dyads with borderline mothers and 22 dyads where the mothers were free from psychopathology, in three different settings: a modification of Winnicott's Set Situation in which infants faced an initially unresponsive ("still-face") stranger, who subsequently tried to engage the infant in a game of give and take; the Strange Situation of Ainsworth and Wittig; and a situation in which mothers were requested to teach their infants to play with miniature figures and a toy train. In relation to a set of a priori predictions, the results revealed significant group differences as follows: (a) compared with control infants, toward the stranger the infants of mothers with BPD showed lower levels of "availability for positive engagement," lower ratings of "behavior organization and mood state," and a lower proportion of interpersonally directed looks that were positive; (b) in the Strange Situation, a higher proportion (8 out of 10) of infants of borderline mothers were categorized as Disorganized; and (c) in play, mothers with BPD were rated as more "intrusively insensitive" toward their infants. The results are discussed in relation to hypotheses concerning the interpersonal relations of women with BPD, and possible implications for their infants' development.     

Intergenerational effects of mother's early rearing experience on offspring treatment and socioemotional development

This longitudinal study spans two generations of rhesus monkeys. First, the study investigates the effects of early rearing experiences on the maternal behavior of first-generation mothers (rates of premature infant rejection) and, second, the study investigates the effects of maternal rejection on the behavior of second-generation infants. Rhesus macaque mother–infant dyads (Macaca mulatta—N = 176) were observed twice weekly, with each session lasting 300 s. First-generation mothers were raised in one of three conditions: as mother-reared controls (MR; [n = 95]), in peer groups (PR; raised without adults but with constant access to three same-aged peers [n = 49]), or with an inanimate surrogate (SPR; raised with an inanimate fleece-covered, surrogate mother and limited daily peer-group interactions [n = 32]). Second-generation infants were all raised by their differentially reared mothers and statistically grouped into one of two groups: those that were rejected by their mothers beginning at a more-typical weaning age (controls), starting in the third month of life (n = 108), and those that were prematurely rejected, with mothers showing rejections before the third month of infant life (n = 68). Overall, PR mothers exhibited the highest rates of premature infant rejection, except for month 1 of infant life, when SPR mothers exhibited the highest rates of rejection. Intriguingly, after month 1, SPR mothers showed high rates of infant cradling and seldom rejected their infants. Independent of their mothers’ early rearing environment, prematurely rejected infants displayed more aggression and passive vigilance, and were cradled and groomed less by their mothers, and there was evidence that the overall rates of rejection after the first 2 months of life had a cumulative negative effect on the developing infant. Post hoc analyses of plasma cortisol levels showed that the prematurely rejected infants had higher cortisol concentrations, suggesting a high level of stress in the prematurely rejected infants. These results suggest that maternal presence during infancy has long-term effects on a female's future maternal skills which, in turn, have intergenerational consequences for the socioemotional development of second-generation infants.     

The budding yeast, Saccharomyces cerevisiae, as a model for aging research: a critical review

In this review we discuss the yeast as a paradigm for the study of aging. The budding yeast Saccharomyces cerevisiae, which can proliferate in both haploid and diploid states, has been used extensively in aging research. The budding yeast divides asymmetrically to form a ‘mother’ cell and a bud. Two major approaches, ‘budding life span’ and ‘stationary phase’ have been used to determine ‘senescence’ and ‘life span’ in yeast. Discrepancies observed in metabolic behavior and longevity between cells studied by these two systems raise questions of how ‘life span’ in yeast is defined and measured. Added to this variability in experimental approach and results is the variety of yeast strains with different genetic make up used as ‘wild type’ and experimental organisms. Another problematic genetic point in the published studies on yeast is the use of both diploid and haploid strains. We discuss the inherent, advantageous attributes that make the yeast an attractive choice for modern biological research as well as certain pitfalls in the choice of this model for the study of aging. The significance of the purported roles of the Sir2 gene, histone deacetylases, gene silencing, rDNA circles and stress genes in determination of yeast ‘life span’ and aging is evaluated. The relationship between cultivation conditions and longevity are assessed. Discrepancies between the yeast and mammalian systems with regard to aging are pointed out. We discuss unresolved problems concerning the suitability of the budding yeast for the study of basic aging phenomena.     

Altered stress patterns and increased risk for postpartum depression among low-income pregnant women

Postpartum depression (PPD) has been associated with a number of negative maternal and infant health outcomes. Despite these adverse health effects, few studies have prospectively examined patterns of pre- and postnatal stress that may increase a woman’s risk for PPD. The current study examined whether the timing of altered salivary cortisol patterns and perceived stress levels during pregnancy and at 3 months postpartum was associated with PPD symptoms among 100 low-income mothers. Higher levels of PPD were found among women with a lower cortisol awakening response (first and second trimester), lower average daily cortisol (second trimester), a flatter diurnal cortisol pattern (second and third trimester and at 3 months postpartum), and a less abrupt drop in both cortisol and perceived stress from the third trimester to 3 months postpartum. These results support the need for early screening and regulation of stress levels to promote depression prevention efforts in at-risk populations.     

Emotional reactivity in infants with congenital heart defects and maternal symptoms of postnatal depression

The object of this study was to examine the role of emotional reactivity in infants with congenital heart defects (CHD) in relation to their mothers' symptoms of postnatal depression. The study population was drawn from the Norwegian country-wide CHD registry from the Department of Pediatric Cardiology at Oslo University Hospital and the Norwegian Mother and Child Cohort Study. Mother–infant dyads with mild/moderate or severe CHD (n = 242) were assessed with a 6-item short version (EPDS-6) of the Edinburgh Postnatal Depression Scale and the Infant Characteristic Questionnaire's fussy/difficult subscale (ICQ-D/F-7) at 6 months postpartum. When adjusting for infant emotional reactivity, mothers of infants with severe CHD showed significantly elevated symptoms of postnatal depression 6 months postpartum (odds ratio = 2.22) compared to the mothers of infants with mild/moderate CHD. The results identify severe CHD in infants as a predictor of heightened symptoms of postnatal depression in mothers, independent of the infant's emotional reactivity. Although a causal direction underlying the association could not be determined, the possible, negative reciprocal relationships between severe CHD in infants, high levels of emotional reactivity in infants, and symptoms of maternal postnatal depression are considered.     

Outcomes of Late-Preterm and Term Infants Born to SARS-CoV-2-Positive Mothers

With the spread of coronavirus disease 2019 (COVID-19) in Korea, the number of pregnant women infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is rapidly increasing. A shortage of negative-pressure isolation rooms for newborns makes hospital assignment more difficult for late-pregnant women with COVID-19. Among 34 infants born to SARS-CoV-2-positive mothers, 5 (14.7%) presented with respiratory distress and 1 (2.9%) presented with feeding intolerance that required specialized care. Aerosol-generating procedures were performed in one infant. Overall outcomes of 34 infants were favorable, and no infant tested positive for SARS-CoV-2. Most infants born to SARS-CoV-2-positive mothers did not need to be quarantined in a negative-pressure isolation room, and 17 (50%) mother–infant dyads were eligible for rooming-in. If negative-pressure isolation rooms are selectively used for newborns requiring aerosol-generating procedures or newborns in respiratory distress, resource availability for lower-risk cases may improve.     

Maternal mind-mindedness and its association with attachment: the case of Arab infants and mothers in Israel

ABSTRACT

We examined the association between maternal Mind-Mindedness (MM) and secure attachment in an Arab sample in Israel. Seventy-six infant–mother dyads were observed during free play to assess maternal MM and in the Strange Situation Procedure to assess attachment. Mothers of secure infants were hypothesized to use more appropriate and fewer non-attuned mind-related comments than mothers of insecure infants. The results showed that mothers of secure infants used more appropriate mind-related comments than mothers of disorganized infants, with no significant differences compared to mothers of ambivalent infants. Also, mothers of secure infants used less non-attuned mind-related comments than both mothers of disorganized infants and mothers of ambivalent infants. In addition, the findings showed that: (1) mothers of secure infants were most likely to show the combination of high appropriate and low non-attuned mind-related comments; (2) mothers of disorganized infants were most likely to show the combination of high non-attuned and low appropriate mind-related comments; and (3) a nonsignificant trend indicated that mothers of ambivalent infants were most likely to show a combination of high appropriate and high non-attuned mind-related comments.The findings support the relevance of MM in an Arab sample.     

A National Directory of Four Year Colleges,Two Year Colleges,and Post High School Training Programs for Young People With Learning Disabilities (Book)

Studied child- and parent-focused parenting stress in 71 clinically depressed and 53 nondepressed mothers of infants 3 to 13 months old. Depressed mothers reported more parenting stress and daily hassles, less marital harmony, and less social support than nondepressed mothers, and they were rated as less competent with their infant. Mothers of temperamentally difficult infants reported greater stress, and depressed women with difficult infants were highest in child-focused stress. In hierarchical multiple-regression analyses predicting child-focused stress, infant difficulty was the only significant predictor for depressed women, but nondepressed women's child-focused stress was predicted by both the demographic composite and infant difficulty. The depressed group's parent-related stress was predicted by depression level, infant temperament, and marital discord, but for nondepressed mothers, only the demographic factors and infant temperament were significant predictors. Depressed women reporting greater child- and parent-focused stress were independently rated as less competent parents than those under less stress.     

PREPP: postpartum depression prevention through the mother–infant dyad

Most interventions to prevent postpartum depression (PPD) focus on the mother rather than the mother–infant dyad. As strong relationships between infant sleep and cry behavior and maternal postpartum mood have been demonstrated by previous research, interventions targeted at the dyad may reduce symptoms of PPD. The goal of the current study was to examine the effectiveness of Practical Resources for Effective Postpartum Parenting (PREPP). PREPP is a new PPD prevention protocol that aims to treat women at risk for PPD by promoting maternally mediated behavioral changes in their infants, while also including mother-focused skills. Results of this randomized control trial (RCT) (n?=?54) indicate that this novel, brief intervention was well tolerated and effective in reducing maternal symptoms of anxiety and depression, particularly at 6 weeks postpartum. Additionally, this study found that infants of mothers enrolled in PREPP had fewer bouts of fussing and crying at 6 weeks postpartum than those infants whose mothers were in the Enhanced TAU group. These preliminary results indicate that PREPP has the potential to reduce the incidence of PPD in women at risk and to directly impact the developing mother–child relationship, the mother’s view of her child, and child outcomes.     

Behavioral and hormonal responses to separation in infant rhesus monkeys and mothers

Effects of social stimuli on behavioral and physiological responses were examined in infant rhesus monkeys at 4 and 9 months of age. Infants and mothers were removed from the social group and housed as dyads. Following this period, infants were removed and separated under four counterbalanced conditions: (a) totally isolated--placed in a holding cage for 24 hr; (b) mother present, no contact--housed in a single cage in view of their mother, no contact; (c) mother present, contact--similar to above, with mother in proximity to the infant; and (d) peer present--separated but in proximity to a peer. In the first experiment, the infants rarely vocalized when totally isolated but showed high rates of vocalization in the presence of the mother, both with and without contact. In the mother-present conditions, they failed to show a plasma cortisol response. In contrast, totally isolated infants showed a significant elevation in plasma cortisol. At 9 months of age, these infants were separated for 3 days under two different conditions: mother present and totally isolated. Once again, the infants that were totally isolated showed little vocalization but significant elevations in plasma cortisol. In contrast, infants separated in the presence of their mothers showed high vocalization rates but no cortisol response. The concepts of protest and despair are discussed as they relate to behavioral and physiological differences observed following different separation paradigms.     

The correlation between ubiquitin in the brainstem and sleep apnea in SIDS victims

Background: The sudden infant death syndrome (SIDS) is still the main cause of postneonatal infant death and its etiology has stimulated many competing theories, among which is the role of hypoxia and brainstem abnormalities. One report claims an increased in ubiquitin in the liver of SIDS victims, ubiquitin being one of the heat-shock proteins. The correlation between ubiquitin in the brainstem and sleep apnea in SIDS was investigated here. Materials and methods: Among 27,000 infants studied prospectively to characterize their sleep–wake behavior, 38 infants died under 6 months of age, including 26 cases of SIDS. All the infants had been recorded during one night in a pediatric sleep laboratory some 3–12 weeks before death. The frequency and duration of sleep apnea were analyzed. Brainstem material was collected at autopsy and examined immunohistochemically for ubiquitin. The density of ubiquitin-positive elements was measured semiquantitatively. Correlation analyses were carried out between the density of ubiquitin-positive elements and the data on sleep apnea. Results: In the victims of SIDS, a statistically significant positive correlation was found between the density of ubiquitin-positive neuronal factors in the pons and the frequency of obstructive apnea (P=0.001) and statistically significant negative correlations were seen between the density of ubiquitin-positive cells in the ependyma in the pons and the duration of obstructive apnea (P=0.044) and between the density of ubiquitin-positive cells in the subependyma in the medulla and the frequency of central apnea (P=0.024). Conclusions: It was found that three significant associations existed between the pathological data referring to ubiquitin and physiological data in SIDS victims. These facts are in agreements with he association of sleep apnea in SIDS.     

Influence of the MTHFR genotype on the rate of malformations following exposure to antiepileptic drugs in utero

Folate deficiency and the presence of the 677C > T (CT) polymorphism in the methylenetetrahydrofolate reductase (MTHFR) gene have been implicated in the causation of malformations in the fetus (particularly cleft lip and palate and neural tube defects). These birth defects are also recognised complications of exposure to antiepileptic drugs (AEDs). In pregnant women with epilepsy, the use of AEDs has an added effect on the physiological reduction in folate levels, which may be enhanced further by the presence of the 677C > T polymorphism in the mother.

We studied the MTHFR genotype and rate of major malformations (MM) in 187 mother-child pairs where the mothers had epilepsy and in 236 matched control pairs. Sodium valproate (VPA) was the most commonly used drug and was associated with the highest rate of malformations (9.6%). 49% of mothers, both in the cases and controls were heterozygotes for the 677C > T polymorphism. The rate of MM was increased in offspring of mothers who were heterozygous or homozygous for 677C > T genotype amongst AED-exposed cases, but more so in those exposed to VPA. The effect of the VPA on the rate of MM was much higher [OR 7.79, 95% CI (1.45–41.9)] than the effect of the maternal 677C > T genotype [OR 2.57, 95% CI (0.28–23.7)]. There was no association between the child's MTHFR genotype and the rate of MM. Conclusion: This study indicates that although the maternal MTHFR genotype may confer susceptibility to the teratogenic effect of AEDs, particularly VPA, it is likely that the main teratogenic effects are mediated through other mechanisms.     

Prevalence of disability and associated social and health-related factors among the elderly in Spain: a population-based study

Objectives: To estimate the prevalence of disability and its association with morbidity and other social and health-related factors among Spain’s non-institutionalized elderly population. Methods: Cross-sectional survey, by home-based personal interview, covering a sample of 4000 subjects representative of the non-institutionalized Spanish population aged 60 years and over. The relationship between disability and social and health-related study variables was studied using logistic regression. Results: A total of 72.9% of subjects reported some type of disability: 59.1% in agility, 51.6% in mobility, 40.1% in instrumental activities and 19.1% in activities of daily living. After adjusting for all relevant variables, disability showed to be significantly more frequent for: female gender (OR=1.83; 1.53–2.19); more advanced age (OR=4.54; 3.27–6.32); low/no educational level (OR=2.01; 1.67–2.42); deteriorated cognitive status (OR=1.67; 1.24–2.23); at least two chronic diseases (OR=2.54; 2.01–3.20); poor perceived health status (OR=3.02; 2.48–3.69); little physical activity (OR=2.57; 1.94–3.42); and greater use of hospital care (OR=1.34; 1.10–1.64). Conclusions: Prevalence of disability among Spain’s non-institutionalized elderly population is very high. This might be explained by a greater number of chronic diseases, a higher percentage of subjects with low educational level and a higher proportion of community-dwelling elderly persons than in Anglo-Saxon countries.     

Emerging self-regulation in toddlers born preterm or low birth weight: differential susceptibility to parenting?

The differential susceptibility to parenting model was examined in relation to toddler self-regulation in a prospective longitudinal study of infants born preterm or low birth weight. We followed 153 mother-infant dyads across five time points between the infant's Neonatal Intensive Care Unit stay and 24 months postterm. Assessments of infant temperament, quality of early parenting interactions, contextual variables, and toddler effortful control and behavior problems were conducted. Results supported differential susceptibility and dual risk models in addition to documenting main effects of early parenting on children's emerging self-regulation. Our data suggested that preterm or low birth weight infants who were prone to distress or rated by mothers as more difficult were particularly susceptible to the effects of early negative parenting.