Social support and maternal depression from pregnancy to postpartum: the association with positive maternal behaviours among Brazilian adolescent mothers

Adolescent motherhood is a risky situation related to poorer quality of infant caregiving. The lack of social support and increased odds for maternal depression are the main concerns. This study aimed to investigate whether maternal–foetal attachment, social support and maternal depression measured during pregnancy and after birth were associated with postpartum maternal behaviours among Brazilian adolescent mothers. Forty-one adolescent mothers participated (M_age?=?16.88 years; SD?=?1.60) in the first two waves of a longitudinal study. Both mother and infant behaviours were assessed during videotaped home observations at three months postpartum. Hierarchical regression analysis indicated that positive postpartum maternal behaviours were strongly related to concurrent, rather than prenatal, measures of social support and maternal depression. Infant birth weight was also associated with positive maternal behaviours. Findings contribute to a better understanding of the personal and contextual factors affecting maternal behaviours shortly after birth in a high-risk sample of adolescent mothers.     

Adolescent motherhood. Comparison of outcome with older mothers

The purpose of this study was to determine whether there were differences in maternal role attainment behaviors for three age groups (15-19, 20-29, 30-42 years) of 294 first-time mothers over a 1-year period. Interviews and questionnaires were completed at early postpartum, 1, 4, 8, and 12 months. Findings are in agreement with more recent research that the health status of adolescent mothers and their infants does not differ greatly from that of older mothers during the first year of motherhood. The adolescent's infant's growth and development were not handicapped. There were no group differences in feelings of love for the infant. The adolescent mother consistently scored lower than older mothers on observed and self-rated maternal competency behaviors. The adolescent mother derived greater gratification in the mothering role than older mothers through 8 months; at 12 months, the 20-29-year-old mother scored higher in gratification. The help received from the adolescent's mother declined at 8 and 12 months suggesting an increased need for social support from other sources at this time.     

Poor adolescent expectant mothers: can we assess their potential for child abuse?

PURPOSE: To explore the correlates of high scores on the Child Abuse Potential Inventory in adolescent expectant mothers. METHODS: Child Abuse Potential scores and data on demographics, pregnancy desire, history of maltreatment, psychological functioning, and perceived social support were obtained by self-report and semi-structured interview. The sample consisted of 50 poor single adolescents recruited from prenatal clinics during the second half of the pregnancy. The relationships among the variables were assessed using Pearson product-moment correlation and multiple regression strategies. RESULTS: Higher Child Abuse Potential scores were associated with higher maternal psychological distress, maternal history of psychiatric diagnosis, and lack of perceived support by the father of the baby. Older pregnant teenagers were more likely to report childhood history of maltreatment, higher psychological distress, and perceived and expected less support by the maternal mother. Expectant mothers who were raised by a single parent were more likely to have a history of childhood maltreatment, less likely to live with the father of the baby during their pregnancy and to expect less support from him. CONCLUSIONS: Child Abuse Potential scores, obtained during pregnancy in a sample of poor single adolescents provide a marker of maternal prenatal functioning and perceived social support. Further studies are warranted to validate prenatal use of the Child Abuse Potential Inventory (CAPI), which may help identify populations at particularly high risk for child abuse during pregnancy and inform strategies for early preventive interventions. Adolescent education on family planning, child rearing, and social support programs should address the importance of the fathers' role.     

Public health nursing care for adolescent mothers: impact on infant health and selected maternal outcomes at 1 year postbirth.

PURPOSE: To compare effects of an early intervention program (EIP) of intense home visitation by public health nurses (PHNs) with effects of traditional public health nursing care (TPHN) on infant health and selected maternal outcomes of adolescent mothers. METHODS: EIP adolescents (N = 102) received preparation-for-motherhood classes and individual home visits (from pregnancy through 1 year postpartum) from PHNs employed in a county health department. Participants were predominantly Latina (64%) and African-American (11%) and from impoverished backgrounds. Infant health outcomes were determined based on medical record data; interviews and standardized questionnaires evaluated other program effects (e.g., maternal educational achievement and psychological status). Data were analyzed using Chi-square and repeated measures ANOVA. RESULTS: Infants of EIP mothers experienced significantly fewer total days (n = 74) and actual episodes (n = 14) of hospitalization during the first year of life than those receiving TPHN (n = 154, n = 24, respectively). Similarly, positive program effects were found for immunization rates. There were no group differences in emergency room visits or repeat pregnancy rates. Alcohol, tobacco, and marijuana use significantly increased from pregnancy through 1 year postpartum in both groups but remained markedly lower than rates prior to pregnancy (lifetime rates). CONCLUSIONS: These findings demonstrate the positive effects of a PHN home visitation program on health outcomes for children of adolescent mothers. Days of infant hospitalization were substantially reduced and immunization rates increased during the first year of life for children of EIP mothers. Greater efforts need to be directed toward preventing repeat pregnancy and return to substance use following childbirth in at-risk adolescent mothers.     

Identification of predictor variables of a postpartum emotional reaction

Clinical observations and research suggest that postpartum emotional reactions (PEREA) are a widespread phenomenon. Prenatal identification of women who are at risk is essential if health professionals are to intervene and prevent long‐term problems for the mother and her family. Health status, previous psychiatric history, locus of control, psychosocial assets, and life change events, as well as maternal adaptation to pregnancy and motherhood were examined in this study as possible predictor variables of a postpartum emotional reaction. Twenty‐seven expectant women were assessed once prenatally and twice in the postpartum period. The data revealed that 59% of the participants, both primiparas and multíparas, experienced an increase in negative affect at some stage of the pregnancy and/or within 4 to 6 weeks postpartum. There were no significant differences between those who developed a PEREA and those who did not on the following variables: planned versus unplanned pregnancy, desired versus undesired pregnancy, attendance at prenatal class, and feeding plans. There was a significant association (p < .01) between breastfeeding and the occurrence of a PEREA at 4 to 6 weeks postpartum among the primiparas. The study demonstrated that there was no single cause but several factors that, if present in combination, were predictive of an emotional reaction postpartum. Locus of control and existing emotional reactions, especially prenatal depression, were the most important predictor variables. The individual's ability to adapt to day‐to‐day life was influenced by the presence or absence of a combination of factors. These included preexisting emotional reactions, perceived locus of control, health status, and/or stress. Trait anxiety, depression, and hostility at 4 to 6 weeks postpartum were best predicted from measures taken in the immediate postpartum period.     

Effects of social supports on attitudes and behaviors of pregnant adolescents

The influence of social support on maternal attitudes and behaviors was assessed in 57 third-trimester adolescent women attending an urban prenatal clinic. Sociodemographic characteristics, social support, self-esteem, and feelings about pregnancy were measured by questionnaire. The support and influence of the adolescent father was emphasized. Social support was measured as a multidimensional construct derived by a priori and empirical procedures. The outcomes measured were the amount of prenatal care, attendance at scheduled postpartum appointments, and pleasure with the pregnancy. Stepwise multiple-regression analyses were used to assess the contributions of the predictor to criterion variables. Pleasure with pregnancy was positively associated with the receipt of assistance from the adolescent's mother, favorable opinions of friends, and satisfaction with living arrangements. Attendance at postpartum visits was associated with high self-esteem. Notably absent as significant contributors were sociodemographic characteristics, receipt of emotional and tangible support from the adolescent father, and expectation of aid from social-assistance programs.     

Maternal cognitions, psychopathologic symptoms, and infant temperament as predictors of early infant feeding problems: a longitudinal study

OBJECTIVE: The current study examined the contribution of prenatal and postnatal maternal core beliefs, self-esteem, psychopathologic symptoms, and postnatal infant temperament to the prediction of infant feeding difficulties. METHOD: Ninety-nine women completed questionnaires assessing their core beliefs, psychopathology, and self-esteem during pregnancy and at 6 months postpartum. At 6 months, mothers also rated their infant's temperament and feeding, and were ob-served feeding their infants. RESULTS: Maternal reports of child feeding difficulties were predicted by higher levels of emotional deprivation and entitlement core beliefs and lower levels of self-sacrifice and enmeshment core beliefs during pregnancy. Postnatal social isolation core beliefs, lower maternal self-esteem, and more difficult infant temperament added significantly to the variance explained by prenatal factors. Maternal core beliefs, self-esteem, psychopathology, and infant temperament failed to significantly predict independent observations of child food refusal. CONCLUSION: Maternal cognitions are implicated in the development of maternal reports of feeding difficulty.     

Predicting postpartum depressive symptoms in new mothers: the role of optimism and stress frequency during pregnancy

During the transition to motherhood, women typically show favorable psychological adjustment after the first child is born, whereas 10 percent to 26 percent of women are at risk of developing clinically significant postpartum depressive symptoms. Little is known about which individuals are especially protected against the emergence of postpartum depressive symptoms during this time. Using a "risk and resilience" theoretical framework, we expected that optimism during pregnancy would be associated with less postpartum depression severity, controlling for antenatal depressive symptoms. We also predicted that optimism would buffer the relations between four dimensions of stress frequency during pregnancy (financial, spousal, physical, and occupational) and the development of postpartum depressive symptoms. Using data from three panels of a longitudinal study of married couples across the transition to first parenthood, we found that optimism of expectant mothers during pregnancy was associated with decreased depression severity at six months and 12 months postpartum. The data also showed that when women experienced high frequencies of financial, spousal, and physical stress during pregnancy, those who were optimistic were much less at risk of developing clinically significant depressive symptoms at six months and 12 months postpartum compared with those who were pessimistic. Implications for enhancing optimism across the transition to motherhood through culturally relevant social work practice are discussed.     

Health Care Utilisation in the First Year of Life Among Infants of Mothers With Perinatal Depression or Anxiety

Background: Limited information is available on associations between maternal depression and anxiety and infant health care utilisation. Methods: We analysed data from 24 263 infants born between 1998 and 2007 who themselves and their mothers were continuously enrolled for the infant's first year in Kaiser Permanente Northwest. We used maternal depression and anxiety diagnoses during pregnancy and postpartum to categorise infants into two depression and anxiety groups and examined effect modification by timing of diagnosis (pregnancy only, postpartum only, pregnancy and postpartum). Using generalised estimating equations in multivariable log‐linear regression, we estimated adjusted risk ratios (RR) between maternal depression and anxiety and well baby visits (<5 and ≥5), up to date immunisations (yes/no), sick/emergency visits (<6 and ≥6) and infant hospitalisation (any/none). Results: Infants of mothers with perinatal depression or anxiety were as likely to attend well baby visits and receive immunisations as their counterparts (RR = 1.0 for all). Compared with no depression or anxiety, infants of mothers with prenatal and postpartum depression or anxiety, or postpartum depression or anxiety only were 1.1 to 1.2 times more likely to have ≥6 sick/emergency visits. Infants of mothers with postpartum depression only had marginally increased risk of hospitalisation (RR = 1.2 [95% confidence interval 1.0, 1.4]); 70% of diagnoses occurred after the infant's hospitalisation. Conclusions: An understanding of the temporality of the associations between maternal depression and anxiety and infant acute care is needed and will guide strategies to decrease maternal mental illness and improve infant care for this population.     

What they tell you to forget: from child sexual abuse to adolescent motherhood

This study explores the relationship between child sexual abuse and adolescent motherhood, using a life story interview method. The sample consists of 27 mothers participating in a home-visitation parenting program for mothers at risk of child maltreatment. The failure to articulate the violation of child sexual abuse and to appropriately construct blame resulted in a range of self-destructive behaviors, some of which placed mothers at greater risk of teen pregnancy. Repressed feelings associated with the trauma often resurfaced with motherhood as victims re-experienced their innocence and vulnerability as children.     

Parenting knowledge among adolescent mothers

The parenting knowledge of first-time adolescent mothers who chose to receive special services from the public school system was measured. These data are thought to be the first reported on the adolescent's awareness that parenting influences the present and future well-being of the infant and mother. Knowledge level was high and no different from that of adult primiparous mothers of comparable socioeconomic status. Correct response to individual items on the infant Caregiving Inventory (ICI) ranged from 84% to 96% for adolescents. These results are contrary to the previous reports of deficient parenting by adolescents. They reflect the need for continuing investigation of adolescent mothers' parenting knowledge in evaluating their effectiveness as parents.     

Adolescent mothers' postpartum contraceptive use: a qualitative study

CONTEXT: Effective contraceptive use among first‐time adolescent mothers can reduce the risk of a rapid repeat pregnancy and associated negative maternal and child health outcomes. Many adolescent mothers begin using a highly effective method after delivery; however, their rates of contraceptive discontinuation are high. Little research has explored the factors that influence adolescents’ postpartum contraceptive use. METHODS: In‐depth interviews were conducted with 21 black, white and Latina adolescent first‐time mothers from rural and urban areas of North Carolina between November 2007 and February 2009. In addition, interviews were conducted with 18 key informants—professionals who work closely with adolescent mothers. Interviews explored adolescent mothers’ health behaviors, including contraceptive use, before and after pregnancy. Content analysis was used to identify key themes and patterns. RESULTS: Teenagers’ use of contraceptives, particularly injectables, IUDs and implants, increased postpartum. Reasons for this improvement included improved clarity of intention to avoid pregnancy and improved contraceptive knowledge, support and access after delivery. However, this increased access often did not continue long after delivery, and levels of method switching were high. Among the barriers to postpartum contraceptive use that key informants cited were lack of information and parental support, as well as the loss of Medicaid and continuity of care. CONCLUSIONS: Ongoing follow‐up may help reduce adolescent mothers’ risk of contraceptive discontinuation postpartum. Increasing use of long‐acting methods also may help reduce their vulnerability to gaps in contraceptive use and discontinuation, which increase the risk of unintended pregnancy.     

The relations between maternal mind-mindedness,parenting stress and obstetric history among Chinese mothers

ABSTRACT

Relations between maternal mind-mindedness, parenting stress and obstetric history were investigated in a Chinese sample of 96 mother-infant dyads (M_{infants' age} = 15.95 months, M_{maternal age} = 30 years). Parenting stress and obstetric history were assessed through questionnaires while mind-mindedness was observed through video recordings of mother-infant interactions. Among mothers who perceived their pregnancy to have been difficult, those who had planned to conceive were more likely to comment appropriately on their infants' mental states. Mothers who displayed a highly emotional reaction of an exclusively positive nature when their babies were first given to them experienced lower total parenting stress scores. Mothers who were more mind-mindedness experienced lower parenting stress. Main carer status and daily time spent with child were related to parenting stress. Results are discussed in relation to socio-cultural factors that might shape antenatal perceptions and influence parenting stress which in turn affect mothers' relationships with their children.     

Correlates of Prenatal Parenting Expectations in new Mothers: Is Better Self-Efficacy a Potential Target for Preventing Postnatal Adjustment Difficulties?

The extent to which a mother’s prenatal expectations are realistic or unrealistic has been associated with postnatal adjustment in first-time mothers. This cross-sectional study investigated the associations with prenatal parenting expectations to determine what makes them more or less realistic. A mediational model was developed to explain the relationships between family and social support, maternal adjustment (i.e., depression, anxiety, worry, stress, and happiness), parenting self-efficacy, and prenatal expectations. We recruited 255 first-time expectant mothers living in Brisbane, Australia. Using structural equation modeling, we found that higher levels of social and family support were associated with lower levels of maternal maladjustment, which in turn was related to higher parental self-efficacy. Finally, self-efficacy was a significant positive predictor of prenatal parenting expectations, implying that the more confident mothers are, the more realistic are their parenting expectations during pregnancy. This was a fully mediated effect. Our findings are of particular relevance for the educational and counseling services offered to pregnant mothers. Specifically, they could assist health professionals in identifying mothers who may be prone to having unrealistic expectations and prepare them for the demands and challenges of having a new baby, which may prevent poor adjustment in the postnatal period.     

Dual Vulnerability of Being Both a Teen and an Immigrant Parent: Illustrations from an Italian Context

Italy has experienced a recent surge in immigration, which has led to an increase in the country’s birth rate. Many immigrant mothers are adolescent parents. 30 adolescent mothers (17 recent immigrants and 13 adolescents of Italian descent) completed measures of adolescent self-development and motherhood, perceived availability and satisfaction with social support, and emotional and behavioral characteristic of their children. Findings suggest that immigrant teen mothers show more difficulties related to parenting than do Italian born teen mothers. In particular, immigrant teen mothers report lower levels of social support satisfaction and availability, higher levels of parent–child dysfunction, and experience motherhood and child behavior as more problematic. The findings highlight and confirm the need for well-designed, specific supportive services for adolescent immigrant mothers.     

Pregnant again? Psychosocial predictors of short-interval repeat pregnancy among adolescent mothers in Mexico City

Which adolescent mothers are most likely to become pregnant soon after their first delivery? This study identifies and explores selected background, pregnancy, and postpartum predictors of short-interval repeat pregnancy among urban Mexican adolescents who were single when they conceived their first pregnancy. Of 137 adolescents followed until their second postpartum year, 26 had short-interval repeat pregnancies. These pregnancies were most likely to occur if the teenager was married or in consensual union by 5 months postpartum, was not using an IUD, and had a mother who had been an adolescent mother. Being married or in consensual union postpartum was, in turn, predicted by positive reactions of the adolescent and her partner during the first pregnancy. Nonuse of IUD was more likely if the adolescent had left school prior to pregnancy, did not receive support from her partner during the first pregnancy, and had not obtained an IUD before hospital discharge after first delivery. Adolescents whose mothers had been teen mothers came from more disadvantaged families.     

Which mothers smoke before, during and after pregnancy?

OBJECTIVE: To investigate the sociodemographic factors associated with cigarette smoking in women before, during and after pregnancy. STUDY DESIGN: A 12-month longitudinal study. METHOD: All eligible mothers at two public maternity hospitals in Perth, Australia were asked to participate in a study of infant feeding. While in hospital, participating mothers completed a self-administered baseline questionnaire. Follow-up telephone interviews were conducted at 4, 10, 16, 22, 32, 40 and 52 weeks. Data collected included sociodemographic, biomedical, hospital-related and psychosocial factors associated with the initiation and duration of breastfeeding. RESULTS: A total of 587 (55%) mothers participated in the study. Thirty-nine percent of mothers reported smoking pre-pregnancy. Mothers who smoked were more likely to have a partner who smoked and to have consumed alcohol prior to pregnancy, and less likely to have attended antenatal classes. They were also less likely to have known how they were going to feed their baby before conception and likely to be more inclined to consider stopping breastfeeding before four months postpartum. CONCLUSIONS: Having a partner (father of the newborn infant) who smoked and maternal alcohol consumption prenatally were factors associated with pre-pregnancy smoking. In addition, if a woman decided how she would feed her infant before the pregnancy occurred and intended to breastfeed for longer than four months she was less likely to smoke in the prenatal period. Having a father (of the newborn infant) who smoked during pregnancy continued to be a factor significantly associated with maternal smoking in the antenatal and postnatal period. Not attending antenatal classes and not intending to breastfeed for longer than four months were also factors associated with maternal smoking. At ten weeks postpartum being of Caucasian origin and having a low Iowa Infant Feeding Attitude Score were factors significantly associated with smoking postnatally.     

Postpartum Depression in Adolescent and Adult Mothers: Comparing Prenatal Risk Factors and Predictive Models

Our objective was to assess whether postpartum depression risk factors differ between adolescent and adult mothers and to evaluate the need for adolescent specific screening instruments. We performed a retrospective cohort study using data from the Rhode Island Pregnancy Risk Assessment Monitoring System, 2004–2008. We identified maternal age specific risk factors using weighted logistic regression and developed predictive models using a forward selected weighted logistic regression. Notable differences in odds ratios were observed for risk factors such as maternal race (OR Hispanic vs. White: 0.99, 95 % CI 0.49–1.99 among adolescents; 3.32, 95 % CI 2.01–5.49 among adults), pre-pregnancy alcohol use (OR use vs. non-use: 2.04, 95 % CI 1.08–3.86 among adolescents; 0.49, 95 % CI 0.33–0.73 among adults), and pregnancy intention (OR unintended vs. intended: 1.05, 95 % CI 0.37–2.97 among adolescents; 2.67, 95 % CI 1.51–4.74 among adults). In predictive models, adolescent postpartum depressive symptoms were most influenced by prior depression and social support while adult postpartum depressive symptoms were associated with risk factors including maternal race, pregnancy intention, SES, prior depression, mental health during pregnancy, stressors, and social support. We were able to identify similarities and dissimilarities in risk factors for postpartum depressive symptoms among adolescents and adults. Predictive models developed in the general population of pregnant women performed poorly among adolescents relative to age specific predictive models, suggesting that current screening tools may not adequately identify high risk adolescents.