Salivary alpha‐amylase during pregnancy: Diurnal course and associations with obstetric history,maternal demographics,and mood

Diurnal patterns of salivary alpha amylase (sAA) in pregnant women have not previously been described. The current study employed ecological momentary assessment to examine the association between the diurnal sAA, obstetric history, maternal demographics, and mood during pregnancy. Saliva was self‐collected by 83 pregnant women (89% White, age 25.3–43.0 years; mean gestational age 21.9 weeks, range 6–37 weeks; gravida 1–6) at home over three days. Results indicated that current pregnancy (gestational age and fetal sex) and maternal demographics were not related to diurnal sAA. In contrast, a history of previous miscarriage (Parameter = ?.17; SE = .05; p < .05) was associated with an atypical diurnal pattern. Even after accounting for obstetric history, trait anxiety (Parameter = .16; SE = .04; p < .001) was associated with increased sAA over the day while chronic levels of fatigue (Parameter = ?.06; SE = .03; p < .05) were associated with decreased sAA. In a separate model, we also tested the time varying covariation of sAA and mood. The effects of momentary mood were in contrast to those for trait mood. Both momentary depression (Parameter = .22; SE = .09; p < .01) and vigour/positive mood (Parameter = .12; SE = .04; p < .001) were associated with momentary increases in sAA while momentary anxiety and fatigue were not related to sAA. The findings suggest that basal sAA during pregnancy is sensitive to emotional arousal. Evaluating diurnal patterns of sAA holds promise for advancing understanding of how emotional arousal during pregnancy may affect fetal development. © 2012 Wiley Periodicals, Inc. Dev Psychobiol 55: 156–167, 2013     

Mother-child attachment in later middle childhood: assessment approaches and associations with mood and emotion regulation

This study examined the overlap and validity of several measures of mother - child attachment developed for preadolescents. Validity was assessed in part by examining how attachment is related to children's mood and emotion regulation. Mother - child attachment was assessed in a sample of 9 to 11 year-old children using a story stem interview technique and questionnaires. Positive and negative mood were scored from daily logs completed by children. Emotion regulation was assessed with mothers' reports of constructive coping and teacher reports of children's ability to tolerate frustration. Interview and questionnaire measures of attachment were not consistently related to one another, although both were related to mood and emotion regulation. As expected, secure attachment and maternal secure base support were related to higher levels of positive mood, more constructive coping, and better regulation of emotion in the classroom, with effects stronger for emotion regulation than for mood. Children classified Disorganized or Ambivalent displayed the most negative mood. All effects remained significant after controlling for child temperament.     

Hair cortisol in the perinatal period mediates associations between maternal adversity and disrupted maternal interaction in early infancy

Existing literature points to the possibility that cortisol could be one link between maternal adversity and poorer parenting quality, but most studies have examined salivary cortisol concentrations rather than hair cortisol concentrations. The current study examined hair cortisol concentration (HCC) during the third trimester of pregnancy as a mediator between maternal adversity indicators (childhood abuse, severe mental illness, symptomatic functioning) and maternal caregiving behavior at 4 months postpartum. Forty-four women participated in the study: 30 with severe mental disorders, and 14 nonclinical controls. HCC was assessed during the third trimester of pregnancy (HCC-P) and at 4 months postpartum (HCC-4M). Sexual, physical, and emotional abuse were assessed by the Adverse Childhood Experiences Study Questionnaire. Maternal disrupted interaction was reliably coded from mother–infant video interactions during a Still-Face Procedure. Mediation models indicated that maternal HCC-P and HCC-4M mediated associations between maternal psychopathology (severe mental illness, symptomatic functioning) and maternal disrupted interaction at 4 months. Maternal HCC at 4 months also mediated associations between experienced childhood abuse and overall disrupted interaction. Our findings indicate that HCC may be a potential early biomarker for future caregiving challenges among mothers with severe mental illness and histories of childhood abuse.     

The link between maternal sleep and permissive parenting during late adolescence

Utilizing a multi‐method design, the present study examined the association between maternal sleep, assessed via actigraphy and self‐reports, and permissive parenting (e.g. lax, inconsistent discipline) during adolescence, as well as the extent to which this association differed by mothers’ race/ethnicity and socioeconomic status. The sample was comprised of 234 mothers (M age = 41.76 years, SD = 6.25; 67% European‐American, 31% African‐American, 2% other race/ethnicities) and 237 adolescents (113 boys, 124 girls; M age = 15.80 years, SD = 0.80; 66% European‐American, 34% African‐American). Mothers’ sleep duration (actual sleep minutes) and quality (sleep efficiency, latency, long wake episodes) were assessed using actigraphy. Mothers also reported on their sleep problems and adolescents reported on mothers’ permissive parenting behaviours. Results revealed that actigraphy‐based longer sleep duration and shorter sleep latency were associated with lower levels of permissive parenting. Further, mothers’ race/ethnicity and socioeconomic status moderated the association between actigraphy‐based sleep quality (i.e. sleep efficiency, long wake episodes) and permissive parenting. Specifically, a negative association between sleep efficiency and permissive parenting was evident only for African‐American mothers. In addition, a positive association between more frequent night wakings and permissive parenting was evident only for mothers from lower socioeconomic status households. The findings highlight the benefits of longer and higher‐quality sleep for reducing the risk of permissive parenting, especially among ethnic minority mothers and mothers from lower socioeconomic status households.     

Paternal and maternal depressed mood during the transition to parenthood

BACKGROUND: The course of postnatal depression was examined in first-time mothers and fathers with emphasis on the role of personality and parental relationships as risk factors. METHOD: 157 couples were assessed at four points: antenatally and at 6, 12 and 52 weeks postnatally. Various measures of mood and personality were administered at each of these assessment points. RESULTS: Examination of the factors associated with depressed mood suggested that a woman's relationship with her own mother was important in the early postpartum stage, and also her level of interpersonal sensitivity and neuroticism. For the father, his relationship with either his mother or father and his level of neuroticism were associated with his mood level early on. By the end of the first year couple morbidity increased, with rates of distress being at their highest for both parents, and factors associated with depressed mood being linked to partner relationship variables, at least for mothers. At most time points, antenatal mood and partner relationship were significant predictor variables for the postnatal mood of both mothers and fathers. Limitations: The sample had a relatively high level of education and this should be taken into account when considering the generalisation of findings to less educated populations. At the time of conducting this study, the Edinburgh Postnatal Depression Scale (EPDS) had only been validated for use in the first few months postpartum, and thus we used another scale to measure the mother's mood at the other assessment points (the Beck Depression Inventory). Current research would suggest that the EPDS is valid both antenatally and at other times in the first year postpartum. CONCLUSION: Whilst there was some consistency for mothers and fathers in the variables that predict their postpartum adjustment, these being antenatal mood and partner relationship, there is also evidence that adjustment to parenthood was related to different variables at different times. Early adjustment was related to the couple's relationship with their own parents, as well as their own personality. Later adjustment was related to the couple's functioning and relationship.     

Patient centred care in infertility health care: Direct and indirect associations with wellbeing during treatment

Objective

To investigate whether different dimensions of patient centred care (PCC) were directly associated with wellbeing or indirectly, via lower concerns about medical procedures and/or increased tolerability of treatment.

Methods

Cross-sectional study with 322 women and 111 men undergoing fertility diagnosis or treatment recruited online and in clinical setting. Participants completed questionnaires that assess PCC (PCQ-Infertility), individual (BSI Anxiety and Depression subscales) and relational wellbeing (FertiQoL Relational Domain), treatment concerns (CART Procedural Concerns scale) and tolerability (FertiQoL Tolerability Domain) and they filled a socio-demographic and fertility data file.

Results

All dimensions of PCC were positively associated with better wellbeing except for organization of care. Information provision and continuity of care were indirectly associated with better individual wellbeing, the first via lower treatment concerns and the second via higher treatment tolerability. Competence, accessibility, continuity and communication were indirectly associated with better relational wellbeing via higher treatment tolerability.

Conclusions

Patient centred care promotes wellbeing during treatment. PCC is directly associated to wellbeing but also indirectly. The mode of action of the different PCC dimensions on wellbeing varies.

Practical implications

To promote patients’ wellbeing during treatment clinics should provide treatment related information and allow patients to establish a stable clinical relationship with a trustworthy and competent physician.     

Patient centred care in infertility health care: Direct and indirect associations with wellbeing during treatment

ObjectiveTo investigate whether different dimensions of patient centred care (PCC) were directly associated with wellbeing or indirectly, via lower concerns about medical procedures and/or increased tolerability of treatment.MethodsCross-sectional study with 322 women and 111 men undergoing fertility diagnosis or treatment recruited online and in clinical setting. Participants completed questionnaires that assess PCC (PCQ-Infertility), individual (BSI Anxiety and Depression subscales) and relational wellbeing (FertiQoL Relational Domain), treatment concerns (CART Procedural Concerns scale) and tolerability (FertiQoL Tolerability Domain) and they filled a socio-demographic and fertility data file.ResultsAll dimensions of PCC were positively associated with better wellbeing except for organization of care. Information provision and continuity of care were indirectly associated with better individual wellbeing, the first via lower treatment concerns and the second via higher treatment tolerability. Competence, accessibility, continuity and communication were indirectly associated with better relational wellbeing via higher treatment tolerability.ConclusionsPatient centred care promotes wellbeing during treatment. PCC is directly associated to wellbeing but also indirectly. The mode of action of the different PCC dimensions on wellbeing varies.Practical implicationsTo promote patients’ wellbeing during treatment clinics should provide treatment related information and allow patients to establish a stable clinical relationship with a trustworthy and competent physician.     

Multivariate analyses of molecular genetic associations between childhood psychopathology and adult mood disorders and related traits

Ubiquitous associations have been detected between different types of childhood psychopathology and polygenic risk scores based on adult psychiatric disorders and related adult outcomes, indicating that genetic factors partly explain the association between childhood psychopathology and adult outcomes. However, these analyses in general do not take into account the correlations between the adult trait and disorder polygenic risk scores. This study aimed to further clarify the influence of genetic factors on associations between childhood psychopathology and adult outcomes by accounting for these correlations. Using a multivariate multivariable regression, we analyzed associations of childhood attention-deficit/hyperactivity disorder (ADHD), internalizing, and social problems, with polygenic scores (PGS) of adult disorders and traits including major depression, bipolar disorder, subjective well-being, neuroticism, insomnia, educational attainment, and body mass index (BMI), derived for 20,539 children aged 8.5–10.5 years. After correcting for correlations between the adult phenotypes, major depression PGS were associated with all three childhood traits, that is, ADHD, internalizing, and social problems. In addition, BMI PGS were associated with ADHD symptoms and social problems, while neuroticism PGS were only associated with internalizing problems and educational attainment PGS were only associated with ADHD symptoms. PGS of bipolar disorder, subjective well-being, and insomnia were not associated with any childhood traits. Our findings suggest that associations between childhood psychopathology and adult traits like insomnia and subjective well-being may be primarily driven by genetic factors that influence adult major depression. Additionally, specific childhood phenotypes are genetically associated with educational attainment, BMI and neuroticism.     

Treatment of maternal mood disorder and infant behaviour disturbance in an Australian private mothercraft unit: a follow-up study

Summary Australia has a system of residential parentcraft services which offer brief admissions to mothers experiencing difficulties with infant care and postnatal mood disturbance. Most of these are state-funded public access services. In 1996 a comparable but differentiated service was opened in the private sector. Masada Private Hospital Mother Baby Unit accommodates five mother-infant pairs who are admitted to a five-night structured residential program. Care is provided by a multidisciplinary team comprising a paediatrician, general practitioner, clinical psychologist and specialist nurses. Complex maternal mood disorders as measured on standardised psychometric instruments include depression, anxiety and severe occupational fatigue. Their babies are unsettled, cry for prolonged periods, wake frequently at night and do not sleep well during the day. Many have feeding difficulties. The treatment program comprises both individualised training in infant care and settling strategies and psycho-educational groups offered in a supportive non-judgemental setting. One month post-discharge maternal mood is significantly improved and infant behaviour more manageable compared with functioning on admission.The material was presented at the Marcé Society International Biennial Scientific Meeting in Sydney (Australia) in 2002 (25–27 September 2002).     

Identity disturbance in adolescence: associations with borderline personality disorder

Although establishing a coherent identity is often viewed as a normative developmental task of adolescence, an important question is whether forms of identity disturbance seen in adult personality disorders can also be distinguished in adolescents. If so, such disturbances would constitute an essential target for research and clinical interventions. The goal of this study is to investigate the nature of identity disturbance in an adolescent clinical sample and to explore its links with personality pathology, particularly borderline personality disorder. A national random sample of 139 psychiatrists and clinical psychologists completed a battery of instruments on a randomly selected adolescent patient in their care, including measures of Axis II symptoms and the Identity Disturbance Questionnaire-Adolescent Version, an instrument designed for clinically experienced observers that assesses a wide range of manifestations of potential identity disturbance among adolescents. Factor analysis of the Identity Disturbance Questionnaire--Adolescent Version yielded four clinically and conceptually coherent factors that resembled dimensions previously identified in adults: lack of normative commitment, role absorption, painful incoherence, and lack of consistency. As in adults, identity disturbance in adolescents is a clinically meaningful, multidimensional construct exhibiting significant relationships with different forms of severe personality pathology, most notably borderline personality disorder. As such, identity disturbance can be a manifestation of psychopathology above and beyond the typical Sturm und Drang (storm and stress) of adolescence.     

Heroin abuse during pregnancy: Effects on perinatal outcome and early childhood growth

Heroin abuse during pregnancy is associated with 1) fetal growth retardation and neonatal withdrawal syndrome in infants and 2) an increased frequency of abruptio placentae, sexually transmitted diseases, and other complications in mothers. Based on the findings of several small cohort studies, postnatal growth and development of infants whose mothers were addicted to heroin during pregnancy appears to fall within normal variation. In the present study, information about use of heroin and other substances during pregnancy in relation to neonatal outcome was analyzed in 47 heroin-abusing mothers and 80 control women and their respective infants. In addition medical record information was available for postnatal growth follow-up of 28 (58%) of heroin-exposed children and 22 (27.5%) of control infants. Infants born to heroin addicts in this study were significantly (P<.01) smaller at birth but exhibited no increase in the frequency of congenital anomalies compared with controls. Similar to findings of previous investigators, postnatal development of infants born to addicts was not delayed.     

Effect of maternal asthma and asthma control on pregnancy and perinatal outcomes

BACKGROUND: Asthma is a common condition during pregnancy. OBJECTIVE: We sought to determine the effect of asthma on the rates of adverse pregnancy and fetal outcomes. METHODS: We identified pregnancies among black and white women age 15 to 44 with singleton gestations enrolled in the Tennessee Medicaid program over a period of 9 consecutive years, from 1995to 2003, and used claims data to determine the relationship of maternal asthma and asthma exacerbations on pregnancy and infant outcomes. RESULTS: Among the 140,299 pregnancies, 6.5% were in women with asthma. Among women with asthma, 23% had a hospital or emergency department visit (exacerbated asthma); 40% of black and 23% of white women received hospital or emergency department care for asthma during pregnancy. After controlling for race and other covariates, birth weights among infants of women with asthma were, on average, 38 g lower, and among infants of women with exacerbated asthma they were, on average, 56 g lower. There were moderate, dose-dependent relationships between asthma alone and exacerbated asthma with hypertensive disorders of pregnancy, membrane-related disorders, preterm labor, antepartum hemorrhage, and cesarean delivery. Maternal asthma was not associated with preterm birth or birth defects. CONCLUSION: Asthma is a risk factor for several common adverse outcomes of pregnancy, and poorly controlled asthma during pregnancy increases these risks. CLINICAL IMPLICATIONS: It is possible that both maternal and infant outcomes could be improved in this population with appropriate asthma care, especially among black women.     

Symptoms of anxiety and mood disturbance alter cardiac and peripheral autonomic control in patients with metabolic syndrome

Previous investigations show that metabolic syndrome (MetSyn) causes sympathetic hyperactivation. Symptoms of anxiety and mood disturbance (AMd) provoke sympatho-vagal imbalance. We hypothesized that AMd would alter even further the autonomic function in patients with MetSyn. Twenty-six never-treated patients with MetSyn (ATP-III) were allocated to two groups, according to the levels of anxiety and mood disturbance: (1) with AMd (MetSyn + AMd, n = 15), and (2) without AMd (MetSyn, n = 11). Ten healthy control subjects were also studied (C, n = 10). AMd was determined using quantitative questionnaires. Muscle sympathetic nerve activity (MSNA, microneurography), blood pressure (oscillometric beat-to-beat basis), and heart rate (ECG) were measured during a baseline 10-min period. Spectral analysis of RR interval and systolic arterial pressure were analyzed, and the power of low (LF) and high (HF) frequency bands were determined. Sympatho-vagal balance was obtained by LF/HF ratio. Spontaneous baroreflex sensitivity (BRS) was evaluated by calculation of α-index. MSNA was greater in patients with MetSyn + AMd compared with MetSyn and C. Patients with MetSyn + AMd showed higher LF and lower HF power compared with MetSyn and C. In addition, LF/HF balance was higher in MetSyn + AMd than in MetSyn and C groups. BRS was decreased in MetSyn + AMd compared with MetSyn and C groups. Anxiety and mood disturbance alter autonomic function in patients with MetSyn. This autonomic dysfunction may contribute to the increased cardiovascular risk observed in patients with mood alterations.     

The HELLP syndrome: maternal and perinatal outcome

The HELLP syndrome is a rare condition with a variable presentation, and in general, the outlook for mother and baby is felt to be poor. The aims of this study were to determine the maternal and perinatal outcome in cases of the HELLP syndrome at the Rotunda hospital over a five-year period. A retrospective review of all cases of confirmed HELLP syndrome from 1/1/95 to 1/9/99 was undertaken. Antenatal, intrapartum and neonatal data and in particular, maternal and neonatal complications were recorded. There were 20 cases of HELLP syndrome over the 5-year period. Mean maternal age was 29.8 (19-43) years. 70% were nulliparous. 80% delivered within 24 hours of diagnosis. 85% were delivered by caesarean section. Mean gestation at delivery was 33.5 (24-41) weeks, 65% of which were preterm. 70% of the babies were admitted to the neonatal intensive care unit (NICU). Mean birth weight was 1923g (440-4640g). Mean length of stay was 23.8 (1-68) days. 40% developed respiratory distress syndrome (RDS) with a mean duration of ventilation for these infants of 2.4 (0.5-7) days. There were 2 perinatal deaths both of whom weighed <500g. 95% of women were admitted to the High Dependency Unit. There were no maternal deaths. The mean interval to resolution of laboratory indices to within normal reference ranges was 11 (2-30) days. Maternal morbidity was high, but short-term, with full resolution in all cases. Once the diagnosis was made, delivery was immediate. The neonatal morbidity was also high and was most closely related to the gestation at delivery.     

Infant emotion regulation and cortisol response during the first 2 years of life: Association with maternal parenting profiles

This study investigated the prospective associations among emotion expression, behavioral regulation, and cortisol responses in relation to different maternal parenting behaviors during the first 2 years of the infant's life, among a sample of low-income families. Participants included 1,141 mother–child pairs, assessed when the infants were 6, 15, and 24 months old. Maternal parenting behaviors were observed at the 6-month assessment, whereas infant emotion expression, orienting toward mothers, and cortisol responses were measured using a series of emotion-eliciting tasks at all time points. A latent profile analysis revealed four maternal parenting profiles: Detached, Intrusive, Average, and Engaged. Furthermore, a multiple-group path model revealed distinct patterns of emotion development for infants within different maternal parenting groups. Among children with Engaged and Average mothers, orienting behaviors tended to predict less negative emotion and cortisol responses, which was associated with more future orienting behaviors. Conversely, among children with Intrusive and Detached mothers, orienting behaviors tended to predict more negative emotion and cortisol responses, which predicted less future orienting behaviors. Findings of this study enhance current understanding of how different profiles of maternal parenting behaviors impact infant emotional development in poverty, with significant implications for intervention programs targeting early mother–infant interactions.     

Perceived parenting stress in the course of postpartum depression: the buffering effect of maternal bonding

Research investigating maternal bonding and parenting stress in the course of postpartum depression is lacking. Aim of the study was to investigate the development and potential mediation of both constructs in the course of postpartum depression. n?=?31 mothers with postpartum depression according to DSM-IV and n?=?32 healthy controls completed the German version of the Postpartum Bonding Questionnaire and the Parenting Stress Index at two measuring times: acute depression (T1) and remission (T2). At T1, the clinical group reported lower bonding and higher parenting stress. Bonding was found to partially mediate the link between maternal diagnosis and parenting stress. Furthermore, the clinical group reported lower bonding and higher parenting stress averaged over both measurement times. However, at T2, the clinical group still differed from the controls even though they improved in bonding and reported less parenting stress. A significant increase of bonding was also observed in the control group. Maternal bonding seems to buffer the negative impact of postpartum depression on parenting stress. The results emphasize the need for interventions focusing on maternal bonding and mother-infant interaction in order to prevent impairment of the mother-child relationship.     

A new Mother-to-Infant Bonding Scale: links with early maternal mood

Summary Some mothers find it hard to relate to their new baby, and such failure may have long-term effects on the infant. This has been a neglected area of research. A new simple 8 item self-rating mother-to-infant bonding questionnaire has been designed to assess the feelings of a mother towards her new baby. A principal components and reliability analysis demonstrated an alpha score of 0.71. One hundred and sixty two women filled in the Kennerley Blues Scale, the Edinburgh Postnatal Depression Scale (EPDS) the Highs Scale and the new Mother to Infant Bonding Scale on day 3 postpartum. Twelve weeks later they were sent the EPDS and the Bonding scales again. One hundred and forty four returned all questionnaires. There was a strong correlation between the Bonding scores at 3 days and at 12 weeks (r_s=0.54 p<0.001). Multiple regression analysis showed that those with raised Blues scores had worse, and those with raised Highs scores had better bonding at 3 days. Those with raised EPDS scores at 3 days (13 and over) had worse bonding scores in the first few weeks (median 4 versus 1, p = 0.028), as recalled at 12 weeks. This simple questionnaire is acceptable for use with mothers and gives significant correlations with their early mood.