Does interactive ultrasound intervention relieve minor depressive symptoms and increase maternal attachment in pregnancy? A protocol for a randomized controlled trial

Background: Perinatal depression, especially minor depression, is common during pregnancy and is likely to continue into the postpartum period. It may impair the mother's health, the infant's neurodevelopment, and the mother-infant relationship. Screening for perinatal depression is recommended; however, there is no consensus on how to treat depressive symptoms while simultaneously supporting the mother-infant relationship. Ultrasound examination has been shown to improve maternal-fetal attachment among pregnant women. Our aim is to develop a four-dimensional (4D) based interactive ultrasound intervention and test whether it relieves minor depressive symptoms and improves maternal-fetal attachment. Previous studies show that supporting the mother-infant relationship aids in relieving maternal depression. Until now, few studies have combined pregnancy ultrasound and psychological support.Methods: A controlled randomized setting was designed to assess whether interactive 4D-ultrasound intervention would decrease maternal depressive symptoms, strengthen maternal-fetal attachment and mother-infant relationship. An obstetrician and a psychologist specialized in infant mental health conduct the interventions. The focus is to jointly observe the behavior of the fetus according to the mothers' wishes. Altogether, 100 women scoring 10-15 on Edinburgh Pre-/Postnatal Depression Scale (EPDS) and with singleton pregnancy are recruited using a web-based questionnaire. Half of the participants will be randomized to the intervention group and will undergo three interactive ultrasound examinations. The primary outcomes are a decrease in perinatal depressive symptoms assessed with EPDS and an increase in maternal attachment. The maternal attachment was assessed using the Working Model of the Child Interview (WMCI), the Maternal Antenatal Attachment Scale (MAAS), and the Maternal Postnatal Attachment Scale (MPAS). Secondly, we hypothesize that if the intervention decreases prenatal depressive symptoms and improves prenatal attachment the decrease in depressive symptoms and improvement in mother-infant relationship is seen postnatally.Discussion: Ultrasound is widely used during pregnancy. The interactive approach is unique and may be feasible as part of routine screenings and maternity clinic visits. Intervention that decreases depression and simultaneously supports maternal-fetal attachment would be a valuable addition to the treatment of minor depression among pregnant women.</p

Vanhempien osallistamisesta hyötyä vastasyntyneen sairaalahoitoon

Vauvat ovat saamassa oikeuden vanhemman läsnäoloon

Fewer maternal depression symptoms after the Close Collaboration with Parents intervention : Two-year follow-up

Aim To test whether the implementation of the Close Collaboration with Parents intervention at a neonatal intensive care unit (NICU) decreases depression symptoms of mothers up to two years after the delivery of preterm infants. Methods We used a non-equivalent two-group design, comparing mothers of very low birthweight infants in the same NICU before (2001–2006) and after (2011–215) the intervention. The unit carried out the educational intervention (2009–2012) that was targeted at its healthcare team and aimed to improve their skills to collaborate with parents. Maternal depression symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS) six months and two years after the expected birth date of the infant. Results We found a median difference of 2.56 (95% CI from 1.64 to 3.48) in EPDS at the two-year follow-up between the pre-intervention and post-intervention groups, p < 0.001. Furthermore, we found no interaction between measurement time-points and group, implying that the intervention effect on maternal depression symptoms was similar at the six-month and two-year time-points. Conclusion The intervention seems to have long-term preventive effects on maternal depressive symptoms. This effect is of clinical significance as prolonged maternal depression associates with adverse child outcomes.© 2022 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.fi=vertaisarvioitu|en=peerReviewed

Close Collaboration with Parents intervention improves family-centered care in different neonatal unit contexts: a pre-post study

Background The quality of family-centered care and parental participation in care in neonatal units differ widely across the world. Appropriate education might be an effective way to support medical staff in neonatal units to collaborate with parents and implement family-centered care. The aim of this study was to evaluate the effects of the educational intervention on the quality of family-centered care in eight Finnish neonatal intensive care units from both the staff and parent perspectives. Methods A mixed-method pre-post intervention study was conducted in eight neonatal intensive care units in Finland. Data were collected from staff and parents using the Bliss Baby Charter audit tool and semi-structured interviews. Results The quality of family-centered care, as assessed by staff and parents, increased significantly after the intervention in all eight units. The intervention was able to help staff define and apply elements of family-centered care, such as shared decision making and collaboration between parents and staff. In interviews, staff described that they learned to support and trust the parents' ability to take care of their infant.Conclusions The educational intervention increased the quality of family-centered care and enabled mutual partnership between parents and staff. ImpactThis study shows that the educational intervention for the whole multi-professional staff of the neonatal unit improved the quality of family-centered care. The Close Collaboration with Parents intervention enabled mutual partnership between parents and staff. It also provides evidence that during The Close Collaboration with Parents intervention staff learned to trust the parents' ability to take care of their infant.</div

The validity of the Language Environment Analysis system in two neonatal intensive care units

Aim To evaluate the validity of the Language Environment Analysis (LENA) system's automatic measures in two neonatal intensive care units supporting parent-infant closeness, and in two Finno-Ugric languages: Finnish and Estonian. Methods The sound environment of 70 very preterm infants was recorded for 16 h in the neonatal intensive care units with the LENA system roughly at the gestational age of 32 (+2) weeks. Of these, the recordings of 14 infants (20%, two 5-min samples with a high percentage of speech, totally 140 min) were analysed in detail and in two different ways. Parental closeness diaries were used to document the presence of the parents. Agreements between LENA system and human coder estimates were analysed. Results Findings showed a high variation in agreements. The highest agreements were found in female and adult word counts (r = 0.91 and 0.95). The agreements for child vocalisation count, conversational turns and silence were modest or low (r = -0.03 to 0.64). Conclusion Our study provides novel information on the validity of the LENA system in the neonatal intensive care unit. Findings show that the LENA system provides valid information on adult words, but LENA estimates for child vocalisations were less valid at this early age.Peer reviewe

Fewer maternal depression symptoms after the Close Collaboration with Parents intervention: Two-year follow-up

Aim: To test whether the implementation of the Close Collaboration with Parents intervention at a neonatal intensive care unit (NICU) decreases depression symptoms of mothers up to two years after the delivery of preterm infants.Methods: We used a non-equivalent two-group design, comparing mothers of very low birthweight infants in the same NICU before (2001-2006) and after (2011-215) the intervention. The unit carried out the educational intervention (2009-2012) that was targeted at its healthcare team and aimed to improve their skills to collaborate with parents. Maternal depression symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS) six months and two years after the expected birth date of the infant.Results: We found a median difference of 2.56 (95% CI from 1.64 to 3.48) in EPDS at the two-year follow-up between the pre-intervention and post-intervention groups, p Conclusion: The intervention seems to have long-term preventive effects on maternal depressive symptoms. This effect is of clinical significance as prolonged maternal depression associates with adverse child outcomes.</p

The Paternal Brain in Action: A Review of Human Fathers' fMRI Brain Responses to Child-Related Stimuli

As fathers are increasingly involved in childcare, understanding the neurological underpinnings of fathering has become a key research issue in developmental psychobiology research. This systematic review specifically focused on (1) highlighting methodological issues of paternal brain research using functional magnetic resonance imaging (fMRI) and (2) summarizing findings related to paternal brain responses to auditory and visual infant stimuli. Sixteen papers were included from 157 retrieved records. Sample characteristics (e.g., fathers' and infant's age, number of kids, and time spent caregiving), neuroimaging information (e.g., technique, task, stimuli, and processing), and main findings were synthesized by two independent authors. Most of the reviewed works used different stimuli and tasks to test fathers' responses to child visual and/or auditory stimuli. Pre-processing and first-level analyses were performed with standard pipelines. Greater heterogeneity emerged in second-level analyses. Three main cortical networks (mentalization, embodied simulation, and emotion regulation) and a subcortical network emerged linked with fathers' responses to infants' stimuli, but additional areas (e.g., frontal gyrus, posterior cingulate cortex) were also responsive to infants' visual or auditory stimuli. This review suggests that a distributed and complex brain network may be involved in facilitating fathers' sensitivity and responses to infant-related stimuli. Nonetheless, specific methodological caveats, the exploratory nature of large parts of the literature to date, and the presence of heterogeneous tasks and measures also demonstrate that systematic improvements in study designs are needed to further advance the field

The validity of the Language Environment Analysis system in two neonatal intensive care units

Aim To evaluate the validity of the Language Environment Analysis (LENA) system's automatic measures in two neonatal intensive care units supporting parent-infant closeness, and in two Finno-Ugric languages: Finnish and Estonian.MethodsThe sound environment of 70 very preterm infants was recorded for 16 h in the neonatal intensive care units with the LENA system roughly at the gestational age of 32 (+2) weeks. Of these, the recordings of 14 infants (20%, two 5-min samples with a high percentage of speech, totally 140 min) were analysed in detail and in two different ways. Parental closeness diaries were used to document the presence of the parents. Agreements between LENA system and human coder estimates were analysed.ResultsFindings showed a high variation in agreements. The highest agreements were found in female and adult word counts (r = 0.91 and 0.95). The agreements for child vocalisation count, conversational turns and silence were modest or low (r = -0.03 to 0.64).ConclusionOur study provides novel information on the validity of the LENA system in the neonatal intensive care unit. Findings show that the LENA system provides valid information on adult words, but LENA estimates for child vocalisations were less valid at this early age.</p

Challenges for transition into early parenthood : Prenatal depressive symptoms, marital distress, and premature birth of an infant

Depression and marital distress are identified risks for parenting problems during the postnatal period, but less is known about how they impact parenting during the transition from the prenatal to postnatal period. Preterm birth of an infant has shown to be an independent risk factor for maternal postnatal depression. The aims of this thesis were 1) to explore the effects of prenatal and postnatal depressive symptoms and marital distress on both parents’ parental representations and on postnatal breastfeeding (Study I and II) and 2) to develop a comprehensive intervention to support parenting after preterm birth and evaluate the effect of the intervention on maternal postnatal depressive symptoms (Study III and IV). The results showed that prenatal maternal depressive symptoms were associated with suboptimal quality of mothers’ prenatal representation of their unborn infant and their relationship with the infant. The mothers’ prenatal depressive symptoms predicted postnatal depressive symptoms, which were associated with shorter duration of exclusive breastfeeding. Fathers’ marital distress increased their likelihood of having suboptimal prenatal representations. A new intervention, the “Close Collaboration with Parents,” was developed and successfully implemented. The intervention decreased the level of postnatal depressive symptoms among mothers of preterm infants. In conclusion, prenatal and postnatal depressive symptoms of mothers were found to be risk factors for the developing mother-infant relationship in the transition to parenthood, whereas only the marital distress had a negative impact on the fathers’ prenatal representations. In addition, postnatal depression symptoms among mothers of preterm infants were found to be decreased by the new comprehensive intervention.Varhaisen vanhemmuuden haasteet : Raskaudenaikaiset masennusoireet, parisuhdetyytymättömyys ja lapsen ennenaikainen syntymä Vanhempien masennusoireiden ja parisuhdetyytymättömyyden tiedetään lisäävän vanhemmuudessa havaittujen ongelmien riskiä lapsen syntymän jälkeen. Huomattavasti vähemmän on tutkittu sitä, miten nämä tekijät vaikuttavat varhaiseen vanhemmuuteen siirtymävaiheessa, raskausajasta synnytyksen jälkeiseen aikaan. Toisaalta on näyttöä siitä, että lapsen ennenaikainen syntymä on itsenäinen riskitekijä äitien synnytyksenjälkeiselle masennukselle. Tämän väitöskirjan tavoitteena oli: 1) Tutkia raskausaikaisten ja synnytyksen jälkeisten masennusoireiden ja parisuhdetyytymättömyyden vaikutusta molempien vanhempien raskaudenaikaisiin mielikuviin lapsesta ja suhteestaan lapseen sekä synnytyksen jälkeiseen täysimetykseen (tutkimukset I ja II). 2) Kehittää laaja-alainen interventio, joka tukee varhaista vanhemmuutta sairaalahoidon aikana vauvan ennenaikaisen syntymän jälkeen ja tutkia tämän intervention vaikuttavuutta äitien synnytyksen jälkeiseen masennukseen (tutkimukset III ja IV). Tulokset osoittivat, että äitien kohonneet raskaudenaikaiset masennusoireet olivat yhteydessä heidän mielikuviensa heikompaan laatuun niin, että mielikuvat vauvasta ja omasta vanhemmuudesta olivat todennäköisemmin vääristyneitä. Äitien raskaudenaikaiset masennusoireet ennustivat heidän synnytyksen jälkeisiä masennusoireitaan ja nämä puolestaan olivat yhteydessä täysimetyksen lyhyempään kestoon. Isien raskausaikainen parisuhdetyytymättömyys lisäsi todennäköisyyttä siihen, että heillä oli heikompilaatuisia mielikuvia vauvasta ja itsestä vanhempana. Tutkimuksessa kehitettiin ja toteutettiin myös uusi varhaista vanhemmuutta tukeva interventio ”Vanhemmat Vahvasti Mukaan” vastasyntyneiden tehohoitoon. Intervention osoitettiin vähentävän masennusoireita ennenaikaisena syntyneiden vauvojen äideillä. Yhteenvetona voi todeta sekä raskaudenaikaiset että synnytyksen jälkeiset masennusoireet olivat riskitekijöitä kehittyvälle äiti-lapsi-suhteelle ja äitiydelle. Isä-lapsi-suhde sen sijaan näytti olevan altis parisuhdevaikeuksien negatiiviselle vaikutukselle. Lisäksi uusi interventio osoittautui tehokkaaksi vähentämään ennenaikaisesti syntyneiden lasten äitien synnytyksen jälkeisiä masennusoireita.Siirretty Doriast