Mother-infant interaction is influenced by the amount of holding in preterm infants

OBJECTIVES: The aim of this study was to evaluate associations between infant crying, holding and mother-infant interaction. METHODS: The study groups included 30 firstborn Finnish preterm infants (<1501 g or <32 weeks), and their 36 full-term controls. Caregiver's holding and infant's crying behavior was assessed using Baby Day Diary at 5 months of corrected age. The quality of mother-infant interaction was assessed using PC-ERA at 6 and 12 months of corrected age. RESULTS: The results showed that longer duration of holding in home environment was associated with better quality of mother-infant interaction at 6 and 12 months of corrected age in preterm infants. Preterm infants cried more often and were held more than full-term infants. The frequency of crying was associated with the duration of holding in preterm infants. Mother-infant interaction was comparable between the groups of preterm and full-term infants. CONCLUSIONS: Our results underline the importance of caregiver's physical closeness for the quality of the mother-infant interaction in preterm infants. Prematurity itself does not necessary affect the quality of mother-infants interaction in a non-risk population.     

Failure to thrive in the term and preterm infants of mothers depressed in the postnatal period: a population-based birth cohort study

AIMS: To examine the relationship between failure to thrive in preterm and term infants and postnatal depression in their mothers. METHOD: In a whole population birth cohort of 12,391 infants (excluding those born after term or with major congenital abnormalities) failure to thrive over the first nine months was identified using a conditional weight gain criterion which identified the slowest-gaining 5%. Depression symptoms were recorded using the Edinburgh Postnatal Depression Scale (EPDS) at 18 and 32 weeks of pregnancy and at 8 weeks and 8 months after delivery. RESULTS: After the birth, high depression scores were significantly more common in the mothers of infants born preterm, and controlling for depression scores in pregnancy did not eliminate this association after the birth. Failure to thrive was identified in 4.5% of the children born at term (531/11718) and in 8.3% of those born preterm (56/673). The difference was highly significant (chi2 = 20.25 with 1 df, p < .0001). Using a conventional cut-off on the EPDS (score > 12) to identify mothers as 'depressed', the prevalence of failure to thrive in the term infants of mothers depressed at 8 weeks postpartum was 5.0%; in the remainder of the population (controls) it was 4.3%. In mothers depressed at 8 months the prevalence was 4.3% in both groups. The prevalence of failure to thrive in the preterm infants of mothers depressed at 8 weeks was 8.8% (7.0% in controls) and in those depressed at 8 months it was 12.3% (6.7% in controls). None of these differences in prevalence was statistically significant, and significant differences did not emerge from further analyses using more stringent criteria for depression. CONCLUSIONS: Preterm births are specifically associated with high maternal depression scores in the postpartum period, and with a higher prevalence of failure to thrive. High depression scores in the postpartum period are not themselves associated with a higher prevalence of failure to thrive, however, either in infants born at term or in those born preterm.     

Mothers' postpartum psychological adjustment and infantile colic.

BACKGROUND: Infantile colic is a common problem of early infancy. There is limited data on the relation between postpartum maternal psychological problems and colic. AIM: : To investigate whether infantile colic is associated with postpartum mood disorders or insecure adult attachment style of the mother. METHODS: Seventy eight mothers and newborns were enrolled in this prospective, longitudinal study. Maternal depressive symptoms were screened with Edinburgh Postpartum Depression Score (EPDS) and maternal anxiety was assessed with State-Trait Anxiety Inventory (STAI). The Adult Attachment Scale was used to determine the attachment style of the mother. Infantile colic was defined according to Wessel criteria. RESULTS: Infantile colic was present in 17 infants (21.7%); 12.9% of the mothers had an EPDS > or =13. The mean EPDS of the mothers whose infants had infantile colic (10.2+/-6.0) was significantly higher than that of the mothers of infants without colic (6.3+/-4.0). Among infants with infantile colic, 62.5% had mothers who had insecure attachment style, whereas only 31.1% of mothers had insecure attachment when the infant did not have infantile colic. CONCLUSION: Postpartum maternal depressive symptoms and insecure attachment style are associated with infantile colic. Screening and early intervention of postpartum depression might promote the health of both the mother and infant.     

The impact of very premature birth on the psychological health of mothers

BACKGROUND: The birth of a very premature infant is a critical event in the life of a family and studies have shown that mothers of these infants are at greater risk of psychological distress than mothers of full-term infants. STUDY DESIGN: A total population study of mothers of preterm infants born at less than 32-week gestation at a tertiary referral hospital. SUBJECTS AND METHODS: Sixty-two mothers of very preterm infants (<32 weeks) participated in the present study which examines correlates of maternal depressive symptomatology at 1 month following very premature birth. Information was obtained from structured questionnaires completed by mothers at 1 month after infant admission to neonatal intensive care. RESULTS: Forty percent of the mothers reported significant depressive symptoms on the Edinburgh Postpartum Depression Scale (EPDS). Logistic regression analysis indicated that high maternal stress resulted in an increased likelihood of depressive symptoms (OR 1.15, CI 1.04-1.26, p<0.01). Higher levels of maternal education (p<0.05), and increased perception of support from nursing staff (OR 1.06, CI 0.88-1.00, p<0.05) resulted in decreased likelihood of depressive symptoms. CONCLUSIONS: The birth and subsequent hospitalisation of a very premature infant evokes considerable psychological distress in mothers. These results have implications for policy development in order to enhance family centred care in the neonatal intensive care.     

A controlled trial of skin-to-skin contact in extremely preterm infants

BACKGROUND: Extremely preterm birth, even in the absence of significant neurological impairment, is associated with altered pain responses and impaired memory and behaviour. Preterm birth increases the risk of maternal depression and may impede the development of the mother-infant relationship, factors that in turn are also associated with impaired infant outcome. Mother-infant skin-to-skin contact has been recommended as a simple means of ameliorating these effects. METHODS: We conducted a pragmatic, prospective, controlled, intention-to-treat trial in two neonatal intensive care units. Infants born below 32 weeks gestation were recruited within the first week after birth and assigned to a control group receiving standard care, or an intervention group in which mothers were encouraged to provide a session of skin-to-skin contact once daily for 4 weeks. We assessed infant behaviour at time of discharge from hospital, responses to immunisation at 4 and 12 months of age, and memory, behaviour and development at 1 year corrected (postmenstrual) age. Indices of maternal depression, stress, anxiety, lactation performance and infant interaction were assessed at time of infant discharge, 4 months and 1 year. RESULTS: No significant difference was identified in any infant or maternal measure at any time point. CONCLUSIONS: Mother-infant skin-to-skin contact after extremely preterm birth results in neither benefit nor adverse consequences. Although there is no reason to dissuade mothers who wish to provide STS contact, we are unable to recommend resource allocation for the implementation of STS programmes for extremely preterm infants in a neonatal intensive care unit setting.     

The effectiveness of early intervention and the factors related to child behavioural problems at age 2: a randomized controlled trial

BACKGROUND: The aim of this study was to assess the effectiveness of early home-based intervention as a community health service and evaluate the influence of both early maternal depression and mother-infant relationships on child behavioral problems at age 2 in a longitudinal setting. METHODS: A randomized controlled trial was conducted in this study. A total of 95 mother-infant pairs were assigned randomly to intervention (48) or control (47) groups. The intervention group received monthly specific home visits between the infant ages of 5 and 9 months while the control group received only routine center-based services. Maternal depression and the mother-infant relationship were assessed by medical checkups at the ages of 4 and 10 months. Child behavioral problems were assessed at age 2. RESULTS: The intervention had no significant impact on child behavioral problems. However, for mothers who had a disturbed relationship with their infants, the rate of improvement in the quality of the relationship was higher in the intervention group. Disturbed mother-infant relationships at 10 months and early maternal depression significantly increased the risk of high scores on the Child Behavior Checklist (CBCL). CONCLUSIONS: These findings indicate that intervention is most likely to have a positive impact on the quality of mother-infant relationships in cases where the relationship is disturbed and that a disturbed mother-infant relationship and maternal depression during infancy are relevant to the future mental health of the child. To prevent difficulties in child functioning, more prolonged interventions focusing on disturbed mother-infant relationships may be required.     

Interaction between mothers and infants born at risk during the first six months of corrected age

Abstract The effects of preterm birth and the perinatal infant health condition on mother-infant interactions were analysed in 278 mother-infant pairs, divided into four groups according to infants' gestational age at birth: group 1. 23–31 weeks; group 2,32–36 weeks; group 3, 37–42 weeks; and group 4, a control group of healthy full-term infants. The methodological approach was based on observation of the pairs at 2,4 and 6 months of infants" corrected age (± 1 week) during undressing of the infant and face-to-face interaction. It was found that mother-infant pairs with preterm infants (groups 1 and 2) did not differ in interactional variables from those of the control group. On the other hand, the birth of a full-term infant in need of neonatal intensive care (group 3) affected maternal and infant interactive behaviour. Additionally, infants from group 3 did not show stability in their interactive behaviour between any ages of measurement. This result suggests that interactive behaviour of full-term infants in need of neonatal intensive care are rather unpredictable during their first 6 months of life, which might have contributed to the less optimal interactive pattern observed for their mothers compared with mothers of the control group.     

Postpartum mood disorders and maternal perceptions of infant patterns in well-child follow-up visits

AIMS: The aims of this study were to evaluate the associations between postpartum depressive symptoms and maternal perceptions of infant patterns with 1-year follow-up examinations, and to assess the impacts of treatment on these perceptions. METHODS: One hundred three mother-infant pairs were evaluated. Data on maternal reports of infant feeding, sleeping and temperament patterns were collected at each well-child visit. The Edinburgh Postpartum Depression Scale was used to assess depressive symptoms. A psychiatrist interviewed the mothers with depressive symptoms, and psychiatric treatments were administered accordingly. The associations between depressive symptoms and maternal perceptions at each visit were analyzed by taking into account the entire follow-up period. RESULTS: Thirty-five mothers (34%) scored within the clinical range of the EPDS during the follow-up period. Mothers with elevated depressive symptoms were more inclined to report infant cry-fuss, sleeping and temperamental problems through the follow-up. Such complains on infant cry-fuss and temperament problems and maternal sleeping problems improved after treatment in compliant mothers. The dropout rate was high (58.3%) in noncompliant mothers. CONCLUSION: Postpartum depressive symptoms may lead to negative maternal perceptions of infant patterns. Earlier management of these disorders and maternal compliance to psychiatric suggestions may provide a better care for the mother-infant pairs.     

Interactive Effects of Infant Gestational Age and Infant Fussiness on the Risk of Maternal Depressive Symptoms in a Nationally Representative Sample

ObjectiveTo examine the interactive effects of gestational age and infant fussiness on the risk of maternal depressive symptoms in a nationally representative sample.MethodsOur sample included 8200 children from the Early Childhood Longitudinal Study, Birth Cohort. Gestational age categories were very preterm (VPT, 24–31 weeks), moderate/late preterm (MLPT, 32–36 weeks) and full term (FT, 37–41 weeks). Maternal depressive symptoms (categorized as nondepressed/mild/moderate-severe), from the modified Center for Epidemiological Studies Depression Questionnaire, and infant fussiness (categorized as fussy/not fussy) were assessed at 9 months from parent-report questionnaires. We examined the interactive effects of infant fussiness and gestational age categories and estimated adjusted odds ratios (aOR) and 95% confidence intervals (CI) of maternal depressive symptoms using multinomial logistic regression.ResultsInfant fussiness interacted with gestational age categories in predicting maternal depressive symptoms (P = .04), with severity varying by gestational age and infant fussiness. Compared with mothers of VPT infants without fussiness, mothers of VPT infants with fussiness had greater odds of mild depressive symptoms (aOR, 2.32; 95% CI, 1.19–4.53). Similarly, compared with mothers of MLPT and FT infants without fussiness, mothers of fussy MLPT and FT infants had greater odds of moderate-severe symptoms (aOR, 2.30; 95% CI, 1.40–3.80, and aOR, 1.74; 95% CI, 1.40–2.16, respectively).ConclusionsMothers of MLPT and FT infants with fussiness had increased odds of moderate-severe depressive symptoms, and mothers of VPT infants with fussiness had increased risk of mild symptoms. Early screening for infant fussiness in preterm and FT may help identify mothers with depressive symptoms in need of support.     

Mothers' postpartum psychological adjustment and infantile colic

Background

Infantile colic is a common problem of early infancy. There is limited data on the relation between postpartum maternal psychological problems and colic.

Aim:

To investigate whether infantile colic is associated with postpartum mood disorders or insecure adult attachment style of the mother.

Methods

Seventy eight mothers and newborns were enrolled in this prospective, longitudinal study. Maternal depressive symptoms were screened with Edinburgh Postpartum Depression Score (EPDS) and maternal anxiety was assessed with State‐Trait Anxiety Inventory (STAI). The Adult Attachment Scale was used to determine the attachment style of the mother. Infantile colic was defined according to Wessel criteria.

Results

Infantile colic was present in 17 infants (21.7%); 12.9% of the mothers had an EPDS ⩾13. The mean EPDS of the mothers whose infants had infantile colic (10.2±6.0) was significantly higher than that of the mothers of infants without colic (6.3±4.0). Among infants with infantile colic, 62.5% had mothers who had insecure attachment style, whereas only 31.1% of mothers had insecure attachment when the infant did not have infantile colic.

Conclusion

Postpartum maternal depressive symptoms and insecure attachment style are associated with infantile colic. Screening and early intervention of postpartum depression might promote the health of both the mother and infant.     

Évaluer les difficultés interactives entre une mère déprimée et son bébé de 3 mois au moyen de l’échelle GRMII de Fiori-Cowley et Murray

Background and aim

Early detection of postnatal depression and mother–infant interactive difficulties are major issues not only for the emotional and cognitive development of the infant, but also for the implementation of early prevention of interactive disorders. This study examined the characteristics of mother–infant interactions in a free play situation, when infants were 3 months old, in case of maternal postnatal depression, and in a control group. The quality of interactions was assessed using the Global Ratings of Mother–Infant Interactions by Fiori–Cowley and Murray (GRMII).

Methods

The sample was composed of 90 mothers with their infants, including 39 mothers with postnatal depression and 51 without mood disorders. Affective disorder was assessed by the Montgomery and Asberg Depression Rating Scale (MADRS). Mothers and their 3-month-old infants were invited to play freely, in a room dedicated to parent–infant observation in the laboratory. Free play sequences were video recorded and a posteriori coded by two trained clinicians blind to maternal affective status, with the GRMII.

Results and conclusion

Analyses show that for all items of the GRMII, non-depressed mothers and their infant obtained higher scores i.e. better scores than depressed mothers and their infant. However, significance was evidenced only for 8 items of the grid: 3 on the maternal sensitivity scale, 2 on signs of depression, and 3 on the interactive dimension. Results thus show that at 3 months postpartum, depression appeared to have already affected interaction with the infant. Main differences were observed in mother's active engagement, acceptation, sensitivity and ability to provide adjusted responses to her infant. Analysis of maternal intrusiveness and remoteness did not yield significant findings, but conversely maternal sensitivity was negatively impacted. The GRMII appeared as an easy-to-use and objective tool to detect specificities of early depressed mother–infant interactions, adapted to a clinical setting. Early detection of interactive distortion gives a window of opportunity for a clinical intervention focused not only on maternal depressive symptoms, but also on the dyad itself.     

Can pediatricians accurately identify maternal depression at well‐child visits?

Background: The feasibility of a two‐item screening tool for maternal depression in a pediatric setting was recently reported. We assessed whether the accuracy of pediatrician recognition of maternal depression during the one‐month well‐child visit could be improved by an educational intervention using the two‐item screening tool. Methods: We conducted an educational intervention for pediatric residents in a suburban hospital in Tokyo, Japan, with outcome measurement before and after. Resident education included knowledge about postpartum depression and its impact on children, use of the two‐item screening tool and available management strategies. Sixteen pediatric residents examined 267 mother–infant dyads during well‐child visits. Residents documented the presence or absence of postpartum depressive symptoms on medical records. Depressive symptoms were also determined using the Edinburgh Postnatal Depression Scale (EPDS) survey; residents were not aware of the results. Using the EPDS as a “gold standard,” improvement in sensitivity and specificity of resident recognition of maternal depressive symptoms was determined. Results: The overall prevalence of postpartum depressive symptoms based on the EPDS was 15.4%. The sensitivity of resident recognition was 8% and specificity 98% before intervention, and 12% and 96% afterwards, respectively. The difference was not statistically significant. Residents indicated fear of maternal stigmatization and mothers' receptiveness to discussing depressive symptoms, as well as lack of time and skills, as major barriers to the identification of maternal depression. Conclusions: A simple educational intervention using a two‐item screening tool did not improve the pediatrician's accuracy in detecting depressive symptoms in mothers. Additional strategies to address perceived barriers may be needed.     

Parenting stress in mothers of very preterm infants — Influence of development,temperament and maternal depression

Objective

To measure levels of parenting stress and postnatal depression in mothers of very preterm infants in comparison with mothers of infants born at term is the objective of this study. The study also aimed to explore factors associated with parenting stress in the mothers of the preterm infants.

Methods

One hundred and five mothers who delivered 124 babies at ≤ 30 weeks gestation were enrolled together with 105 term mothers who delivered 120 babies. At one year of age (corrected for prematurity for the preterm cohort), the mothers completed the Parenting Stress Index Short Form (PSI), the Edinburgh Postnatal Depression Scale (EPDS) and the Short Temperament Scale for Toddlers. The infants had neurodevelopmental assessment. The preterm and term groups were compared.

Results

Questionnaires were completed by 101 of the preterm mothers and 98 of the term mothers. The mean PSI Total Stress score was significantly higher for the preterm mothers (70.28 vs 64.52, p = 0.022), with 19% of the preterm group and 9% of the term group having high scores (p = 0.038).There was no group difference on the EPDS or measures of temperament, with disability being greater in the preterm infants. For the preterm group, maternal depression and infant temperament were independent predictors of Total Stress scores on multivariate analysis.

Conclusions

Parenting stress in mothers of preterm infants at one year of age is significantly greater than that found in mothers of term infants. For preterm mothers, symptoms of depression and infant temperament are independent risk factors for higher levels of parenting stress.     

Infantile colic, prolonged crying and maternal postnatal depression

Aim:  To study if infant crying is associated with maternal postnatal depression.
Methods:  Data from 1015 mothers and their children participating in a prospective European multicentre study were analysed. Infantile colic and prolonged crying were defined as excessive crying as reported by the mothers 2 and 6 months after delivery, and at the same time the mothers completed the Edinburgh Postnatal Depression Scale (EPDS).
Results:  In cross-sectional analyses, infant crying was associated with high EPDS scores both 2 (OR: 4.4; 95% CI: 2.4–8.2) and 6 months postpartum (OR: 10.8; 95% CI: 4.3–26.9). More than one-third of the others of infants with prolonged crying had high EPDS scores 6 months postpartum. Longitudinal analyses showed that mothers of infants with colic had increased odds of having high EPDS scores 6 months after delivery even if crying had resolved (OR: 3.7; 95% CI: 1.4–10.1).
Conclusion: Both infantile colic and prolonged crying were associated with high maternal depression scores. Most noteworthy, infantile colic at 2 months of age was associated with high maternal depression scores
4 months later.     

Breastfeeding duration and postpartum psychological adjustment: role of maternal attachment styles

Aim:   Depressive and anxiety symptoms are common in new mothers. The aim of this study is to explore the link between postpartum psychological adjustment and feeding preferences of the mothers.
Methods:   Sixty mothers and newborns were enrolled in this prospective, longitudinal study. Maternal depressive symptoms were screened by the Edinburgh Postpartum Depression Scale (EPDS), and maternal anxiety level was assessed by the State-Trait Anxiety Inventory at 1 month postpartum. The Multidimensional Scale of Perceived Social Support was used for the assessment of maternal social support. The Adult Attachment Scale was used to determine the attachment style of the mother. Infants were examined and evaluated at 1 and 4 months of life.
Results:   All mothers started breastfeeding their infants postpartum; 91% and 68.1% continued exclusive breastfeeding at 1 and 4 months, respectively. The first-month median EPDS score of mothers who breastfeed at the fourth month was statistically significantly lower than those who were not breastfeeding (6 and 12, respectively) ( P  = 0001). The first-month median EPDS score of mothers with secure attachment was lower than the median score of mothers with insecure attachment (5 and 9, respectively) ( P  < 0001). Exclusive breastfeeding rate was not statistically different among mothers with secure and insecure attachment styles. The median state and trait anxiety scores and social support scores of mothers were not different between groups according to breastfeeding status.
Conclusions:   This study has shown an association between higher EPDS scores and breastfeeding cessation by 4 months after delivery.     

Preterm infants' early developmental status is associated with later developmental outcome

Aim: To assess the development of preterm infants from 40 weeks gestational age to 18 months corrected age to identify early predictors of later development. Methods: Fifty‐one infants were involved. Infant development was assessed at 40 and 44 weeks gestational age with the Brazelton neonatal behavioral assessment scale and a self‐regulation scale and at 3, 6, 10, 18 months corrected age with the Bayley Scales of Infant Development. The quality of general movements was assessed at 1 and 3 months corrected age and maternal attachment style at infant’s age of 6 months corrected age with the Relation Scale Questionnaire. Results: At term age and 1‐month corrected age, preterm infants were less mature and had lower levels of self‐regulation than full‐term infants. At 3 months corrected age, a higher proportion of preterm infants (43%) had mildly abnormal motor quality compared to the general population (25%). At all follow‐ups, preterm infants had delayed mental, motor and behavioural development, which was associated with the level of self‐regulation, motor quality and maternal attachment style. Maternal education level was the most predominant background factor related to infant development. Conclusion: Preterm infants show early‐in‐life deviations in self‐regulation, motor quality and development. These deviations are risk factors for later optimal functioning.     

Maternal depressive symptoms during pregnancy, and newborn irritability

Maternal depression is associated with a wide range of adverse outcomes for children, including poor mother-infant interactions at 3 months post-partum. The aim of this study is to determine whether maternal depressive symptoms during pregnancy are associated with neonatal neurobehavioral functioning, as measured by the Neurologic and Adaptive Capacity Scale. The study population consists of 1,123 mothers and their term infants who were participants in a larger study of maternal health and infant outcomes. Women were administered the Center for Epidemiologic Studies-Depression (CES-D) questionnaire for depressive symptoms during their pregnancy. Their infants were subsequently assessed by a pediatrician blind to their CES-D scores. The CES-D score was associated with unconsolability and excessive crying (p less than 0.01). The higher the mother's CES-D score, the more likely it was that the infant would be unconsolable or cry excessively. Mothers with CES-D scores at the 90th percentile were 2.6 times more likely to have unconsolable newborns, compared with women with CES-D scores at the 10th percentile (95% C.I. = 1.54, 4.23). When potentially confounding variables, such as cigarette smoking, alcohol, marijuana, and cocaine use, poor weight gain, income, birth weight, and other drug use, were controlled, the relationship between CES-D score and newborn unconsolability and excessive crying remain unchanged. The results of this study suggest that the relationship between early childhood problems and maternal depressive symptoms may be part of a sequence that starts with depressive symptoms during pregnancy.     

Parenting stress in mothers of preterm infants during early infancy

Objective

Mothers of preterm infants during the first year of life may experience stresses greater that those found in mothers of term infants. The aim of the study was to determine the levels of parenting stress and psychological well-being in mothers of very preterm babies in comparison to a control group of term mothers.

Methods

One hundred and five mothers who delivered 124 babies at ≤ 30 weeks gestation were recruited together with 105 mothers who delivered 120 babies at term. At 4 months of age (corrected for prematurity for the preterm babies), the mothers completed the Parenting Stress Index Short Form, the Edinburgh Postnatal Depression Scale (EPDS), the Dyadic Adjustment Scale (DAS) and the Short Temperament Scale for Infants (STSI). The preterm and term groups were compared.

Results

Questionnaires were returned from 86 of the preterm mothers and 97 of the term mothers. The mean Total Stress score for the preterm and term groups was 67.0 and 63.79 respectively (P = 0.32) with 17% of the preterm and 9% of the term group having high scores (P = 0.135). There were no differences of the EPDS and the DAS between the groups. The temperament of the preterm infants was similar to the term infants. For both groups, scores on the EPDS, DAS and the STSI were independent predictors of Total Stress scores on multiple regression analysis.

Conclusion

Parenting stress in mothers of preterm infants during early infancy does not appear to be greater than that in mothers of infants born at term. For both groups of mothers, depression symptoms, marital satisfaction and infant temperament were independent risk factors for high levels of parenting stress.     

Depressive symptoms among rural Bangladeshi mothers: implications for infant development

OBJECTIVE: To examine how maternal depressive symptoms are related to infant development among low-income infants in rural Bangladesh and to examine how the relationship is affected by maternal perceptions of infant irritability and observations of caregiving practices. METHODS: Development was measured among 221 infants at 6 and 12 months with the Bayley Scales II. Mothers reported on their depressive symptoms and on perceptions of their infant's temperament, and a home visit was made to complete the HOME Inventory. RESULTS: Half (52%) the mothers reported depressive symptoms. In bivariate analyses, maternal depressive symptoms were related to low scores on the Bayley Scales. Infants whose mothers reported depressive symptoms and perceived their infants to be irritable acquired fewer cognitive, motor, and Orientation/Engagement skills between 6-12 months than infants whose mothers reported neither or only one condition. The relationship linking maternal depressive symptoms and perceived infant irritability with infant cognitive skills was partially mediated by parental responsiveness and opportunities for play in the home. CONCLUSIONS: The intergenerational risks of maternal depressive symptoms on infant development extend to rural Bangladesh and are accentuated when mothers perceive their infants as irritable. Mothers who report depressive symptoms and infant irritability may lack the capacity to provide responsive, developmentally-oriented caregiving environments.