Associations between maternal psychological distress and mother-infant bonding: a systematic review and meta-analysis

Purpose: Maternal psychological distress and mother-infant bonding problems each predict poorer offspring outcomes. They are also related to each other, yet the extensive literature reporting their association has not been meta-analysed. Methods: We searched MEDLINE, PsycINFO, CINAHL, Embase, ProQuest DTG, and OATD for English-language peer-reviewed and grey literature reporting an association between mother-infant bonding, and multiple indicators of maternal psychological distress. Results: We included 133 studies representing 118 samples; 99 samples (110,968 mothers) were eligible for meta-analysis. Results showed concurrent associations across a range of timepoints during the first year postpartum, between bonding problems and depression (r = .27 [95% CI 0.20, 0.35] to r = .47 [95% CI 0.41, 0.53]), anxiety (r = .27 [95% CI 0.24, 0.31] to r = .39 [95% CI 0.15, 0.59]), and stress (r = .46 [95% CI 0.40, 0.52]). Associations between antenatal distress and subsequent postpartum bonding problems were mostly weaker and with wider confidence intervals: depression (r = .20 [95% CI 0.14, 0.50] to r = .25 [95% CI 0.64, 0.85]), anxiety (r = .16 [95% CI 0.10, 0.22]), and stress (r = .15 [95% CI − 0.67, 0.80]). Pre-conception depression and anxiety were associated with postpartum bonding problems (r = − 0.17 [95% CI − 0.22, − 0.11]). Conclusion: Maternal psychological distress is associated with postpartum mother-infant bonding problems. Co-occurrence of psychological distress and bonding problems is common, but should not be assumed. There may be benefit in augmenting existing perinatal screening programs with well-validated mother-infant bonding measures

Initiating the dialogue between infant mental health and family therapy: a qualitative inquiry and recommendations

This qualitative study explores infant-family mental health experts' perspectives and experiences regarding the inclusion of infants in the family therapy setting. Infant socioemotional development is relational in nature and evolves in the context of both dyadic attachment relationships and broader multi-person co-parenting systems. Given this, we sought to understand why family therapy interventions involving families with infants rarely include the infant in a triangular or family systemic approach. Interviews were completed by clinical and/or research experts whose work integrates tenets of both infant mental health (IMH) and family theory and therapy. All interviewees brought at least 5 years of expertise and were actively engaged in the field. Interviewees expressed consistent beliefs that infants have a rightful and helpful place in family therapy approaches. They maintained that infants' innate social drive and communicative capacities position them to make meaningful and clinically significant contributions within family and systemic psychotherapy contexts. Noting that infants have remained on the periphery of these practices, experts advocated expansion and greater integration between IMH and family therapy, while preserving each field's distinctive identity. Experts reported that the interplay between IMH and family therapy fields has been uni-directional as family systems concepts are embedded within IMH approaches, but few IMH premises are incorporated in mainstream family therapy practices. The disconnect was attributed to multiple factors, including graduate and professional training and theoretical, clinical, research, and sociocultural barriers, which were mutually reinforcing. Experts also identified clinical gains for both infants and family members when infants were meaningfully included in family interventions. Common ground was identified between the disciplines, with a belief that relationally distressed young children and parents are best served by clinical engagement with their network of relationships. Results call for greater collaboration between disciplines to challenge existing traditions and to more fully include infants in mainstream family therapy. Recommendations for integration of family therapy and IMH in clinical, theoretical, research, training, and sociocultural domains are offered

Expériences sur le bien-être des femmes enceintes : aides et obstacles

Little research has been done to date to understand, qualitatively, the contributing factors of psychological thriving during pregnancy, birth, and postpartum, particularly from the voices of mothers themselves. In order to better understand what women perceive as contributing to a healthy and positive child-bearing experience, the authors asked postpartum women to report what factors contributed to their well-being. Using the enhanced critical incident technique, women reported what they found was helpful, hindering, or what they would have wished for in their pregnancy, birth, and postpartum experiences. Implications and recommendations for counsellors working with women during pregnancy and the postpartum period are discussed.Bien peu de recherches ont été menées à ce jour pour comprendre, qualitativement, les facteurs qui contribuent à favoriser le bien-être psychologique durant la grossesse, au moment de l’accouchement et durant la période de post-partum, particulièrement en ce qui concerne le point de vue des mères elles-mêmes. Pour mieux comprendre ce que perçoivent les femmes comme étant des facteurs qui contribuent à une expérience de grossesse saine et positive, les auteurs ont demandé à des femmes en période de post-partum de rapporter les facteurs ayant contribué à leur bien-être. Au moyen de la technique améliorée d’analyse d’incident critique, les femmes ont indiqué ce qu’elles avaient trouvé favorable et défavorable, autrement dit ce qu’elles auraient souhaité comme expériences durant leur grossesse, leur accouchement et le post-partum. L’article présente une discussion des implications et recommandations à l’intention des conseillers et conseillères qui travaillent auprès des femmes durant les périodes de grossesse et de post-partum

Prospective predictors of bonding and emotional availability: A longitudinal study of pregnancy and the first year of life

BackgroundMother-infant relationship quality in the first year of life has important implications for offspring development through the life course. The emotional bond that a mother feels towards her baby is critical to offspring social, emotional and cognitive development (Bornstein, 2014). Likewise, the capacity for a mother and her infant to share an emotional connection and enjoy a mutually fulfilling and healthy relationship, otherwise known as emotional availability (EA), is critical to establishing positive parent-child relationships (Biringen & Easterbrooks, 2012). Despite an emerging literature on the importance of bonding and EA, little is known about the predictors of the mother’s felt bond to her offspring across pregnancy and the postnatal period as well as emotional availability at infant age 12-months. Even less is known about the predictors of the relationship between partners and their infants. There are a range of factors theorised to promote bonding and EA in infancy including healthy parent-infant bonding during pregnancy and parent wellbeing (i.e., good mental health and low-risk substance use); yet these factors have not been comprehensively assessed in both mothers and their partners across the first year of life.AimsFour empirical studies sought to examine: (1) maternal bonding to offspring across the pregnancy and postnatal period, and to examine a broad range of sociodemographic and psychosocial predictors of the maternal-offspring bond; (2) the extent to which mother-fetal bonding, substance use and mental health through pregnancy predicted postnatal mother-infant bonding at 8-weeks; (3) the extent to which postnatal bonding, maternal mental ill-health and substance use at infant age 8-weeks predicted mother-infant bonding and mother EA at 12-months of age; and, (4) the role of mother and partner bonding, mental health and substance use at 8-weeks post-birth on mother and partner-infant EA at 12-months infant age, accounting for the correlated dyadic influence. MethodsUsing a sample of pregnant women participating in an Australian pregnancy cohort study of perinatal health and development, participants completed maternal and paternal bonding, mental health and substance use questionnaires at each trimester (one, two and three), 8-weeks and 12-months postnatal. Data was collected on a range of sociodemographic and psychosocial factors. The EA Scales were used to code the quality of interactions between mother-infant and partner-infant dyads during a 20-minute free play observational video recorded at 12-months infant age. ResultsMaternal-fetal bonding increased in quality and intensity across the pregnancy period with a plateauing of bonding representations towards the end of pregnancy. Bonding between late pregnancy and the early postnatal period remained relatively stable. Maternal-fetal bonding was the strongest predictor of maternal bonding in the postnatal period, both at 8-weeks and 12-months. Mental health and substance use also predicted both maternal and paternal relationship quality, as indicated by bonding and EA measures. Tobacco use for both mothers and partners was negatively associated with EA at 12-months. ConclusionThe results of this thesis show that early bonding to the fetus was not only important in laying the foundation for mother-infant bonding in the early postnatal period, but also later in the postnatal period. Moreover, both maternal mental ill-health and substance use appeared to play a small yet significant role in predicting later bonding. However, it was notable that substance use occurred only infrequently in the sample and that substance abuse/dependence were not reported in this sample.These results highlight the importance of supporting the development of a healthy bond between a mother and her fetus during pregnancy and in the early postnatal period. The results also suggest that interventions could be targeted towards parents struggling with symptoms of depression and/or substance use during pregnancy and postnatal. Interventions aimed at emotional regulation and EA promotion for young parents with a history of depression and substance use might also be helpful in strengthening the mother/partner-child relationship. There is a need for further longitudinal research continuing into the toddler and preschool years, including continued assessment of partners and the important role they play. Targeted interventions aimed at enhancing bonding have the potential to strengthen parent-infant relationships through the first year of life

The Role of Antenatal and Postnatal Maternal Bonding in Infant Development: A Systematic Review and Meta-Analysis

The Role of Antenatal and Postnatal Maternal Bonding in Infant Development: A Systematic Review and Meta-Analysi

Timing of the first report and highest level of child protection response in association with early developmental vulnerabilities in an Australian population cohort

Background: Childhood maltreatment is associated with early childhood developmental vulnerabilities. However, the extent to which higher levels of child protection responses confer benefit to developmental competencies, and the impact of earlier timing of first reports in relation to early childhood vulnerability remains unclear. Objective: We examined associations between early developmental vulnerabilities and (1) the highest level of child protection response (where OOHC was deemed the highest response among other types of reports/responses), and (2) the developmental timing of the first child protection report. Participants and Setting: Participants included 67,027 children from the New South Wales Child Development Study, of whom 10,944 were reported to child protection services up to age 5 years. Methods: A series of Multinomial Logistic Regressions were conducted to examine focal associations. Results: Children with substantiated maltreatment reports showed the strongest odds of vulnerability on three or more developmental domains (adjusted OR = 4.90; 95% CI = 4.13–5.80); children placed in OOHC showed slightly better physical, cognitive and communication competencies (adjusted ORs from 1.83 to 2.65) than those with substantiated reports that did not result in OOHC placements (adjusted OR from 2.77 to 3.67), when each group was compared to children with no child protection reports. Children with first maltreatment reports occurring in the first 18 months of life showed the strongest likelihood of developmental vulnerabilities on three or more developmental domains (adjusted OR = 3.56; 95% CI = 3.15–4.01) relative to children with no child protection reports. Conclusion: Earlier reports of maltreatment may signal the need for targeted remediation of early developmental competencies to mitigate early developmental difficulties.</p

Association between maternal perinatal depression and anxiety and child and adolescent development: A meta-analysis

IMPORTANCE: There is widespread interest in associations between maternal perinatal depression and anxiety and offspring development; however, to date, there has been no systematic, meta-analytic review on the long-term developmental outcomes spanning infancy through adolescence. OBJECTIVE: To provide a comprehensive systematic review and meta-analysis of the extant literature on associations between maternal perinatal depression and anxiety and social-emotional, cognitive, language, motor, and adaptability outcomes in offspring during the first 18 years of life. DATA SOURCES: Six databases were searched (CINAHL Complete, Cochrane Library, Embase, Informit, MEDLINE Complete, and PsycInfo) for all extant studies reporting associations between perinatal maternal mental health problems and offspring development to March 1, 2020. STUDY SELECTION: Studies were included if they were published in English; had a human sample, quantitative data, a longitudinal design, and measures of perinatal depression and/or anxiety and social-emotional, cognitive, language, motor, and/or adaptability development in offspring; and investigated an association between perinatal depression or anxiety and childhood development. DATA EXTRACTION AND SYNTHESIS: Of 27 212 articles identified, 191 were eligible for meta-analysis. Data were extracted by multiple independent observers and pooled using a fixed- or a random-effects model. A series of meta-regressions were also conducted. Data were analyzed from January 1, 2019, to March 15, 2020. MAIN OUTCOMES AND MEASURES: Primary outcomes included social-emotional, cognitive, language, motor, and adaptability development in offspring during the first 18 years of life. RESULTS: After screening, 191 unique studies were eligible for meta-analysis, with a combined sample of 195 751 unique mother-child dyads. Maternal perinatal depression and anxiety were associated with poorer offspring social-emotional (antenatal period, r = 0.21 [95% CI, 0.16-0.27]; postnatal period, r = 0.24 [95% CI, 0.19-0.28]), cognitive (antenatal period, r = −0.12 [95% CI, –0.19 to –0.05]; postnatal period, r = −0.25 [95% CI, –0.39 to –0.09]), language (antenatal period, r = −0.11 [95% CI, −0.20 to 0.02]; postnatal period, r = −0.22 [95% CI, −0.40 to 0.03]), motor (antenatal period, r = −0.07 [95% CI, −0.18 to 0.03]; postnatal period, r = −0.07 [95% CI, −0.16 to 0.03]), and adaptive behavior (antenatal period, r = −0.26 [95% CI, −0.39 to −0.12]) development. Findings extended beyond infancy, into childhood and adolescence. Meta-regressions confirmed the robustness of the results. CONCLUSIONS AND RELEVANCE: Evidence suggests that perinatal depression and anxiety in mothers are adversely associated with offspring development and therefore are important targets for prevention and early intervention to support mothers transitioning into parenthood and the health and well-being of next-generation offspring

Maternal bonding, negative affect, and infant social-emotional development: A prospective cohort study

The interrelationships between maternal bonding, negative affect, and infant social-emotional development were examined using multi-wave perinatal data from an Australian cohort study (N = 1,579). Self-reported bonding and negative affect were assessed at each trimester, and 8 weeks and 12 months postpartum. The Bayley-III social-emotional scale was administered at age 12 months. Results revealed strong continuities in bonding and negative affect across pregnancy and postpartum. Small associations (β = -.10 to -.20) existed between maternal negative affect during pregnancy and poor early bonding. Higher postnatal maternal bonding predicted infant social-emotional development (β = .17). Maternal bonding and negative affect are interrelated yet unique constructs, with suggested developmental interplay between mother-to-infant bonding and infant social-affective development