Mother-to-infant bonding: determinants and impact on child development:Challenges for maternal health care

The aim of this dissertation was to further explore mechanisms of mother-to-infant bonding and to evaluate associations between mother-to-infant bonding and socio-emotional child development. The results may support maternal health care providers in addressing the transition to motherhood and mother-to-infant bonding in daily practice. This dissertation contributed to the knowledge about mother-to-infant bonding. Our findings support the theory that mother-to-infant bonding is a process that starts during pregnancy and continues postnatally. We strengthened the evidence that mother-to-infant bonding contributes to prevention of child behavioral and emotional problems. According to our review of the literature, depressive symptoms are negatively associated with postnatal mother-to-infant bonding quality. We demonstrated that intrapartum synthetic oxytocin is not associated with child behavioral and emotional problems, mother-to-infant bonding and postnatal anxiety. Nevertheless, it is associated to a slightly negligible extent with postnatal depressive symptoms in the general population. We demonstrated that open ended questions are not used frequently to address transition to motherhood early in pregnancy. And the topics mother-to-infant bonding and support were not addressed frequently at the first prenatal booking visit. These results emphasize that maternal health care providers should ask more open questions early in pregnancy. We recommend maternal health care providers to consider addressing mother-to-infant bonding already early during pregnancy. However there are no appropriate prenatal interventions yet to optimize mother-to-infant bonding or for women with psychological complaints like depression

Development of a risk classification model in early pregnancy to screen for suboptimal postnatal mother-to-infant bonding:A prospective cohort study

BACKGROUND: Previous studies identified demographic, reproduction-related and psychosocial correlates of suboptimal mother-to-infant bonding. Their joint informative value was still unknown. This study aimed to develop a multivariable model to screen early in pregnancy for suboptimal postnatal mother-to-infant bonding and to transform it into a risk classification model. METHODS: Prospective cohort study conducted at 116 midwifery centers between 2010-2014. 634 women reported on the Mother-to-Infant Bonding questionnaire in 2015-2016. A broad range of determinants before 13 weeks of gestation were considered. Missing data were described, analyzed and imputed by multiple imputation. Multivariable logistic regression with backward elimination was used to develop a screening model. The explained variance, the Area Under the Curve of the final model were calculated and a Hosmer and Lemeshow test performed. Finally, we designed a risk classification model. RESULTS: The prevalence of suboptimal mother-to-infant bonding was 11%. The estimated probability of suboptimal mother-to-infant can be calculated: P(MIBS≥4) = 1/(1+exp(-(-4.391+(parity× 0.519)+(Adult attachment avoidance score× 0.040))). The explained variance was 14% and the Area Under the Curve was 0.750 (95%CI 0.690-0.809). The Hosmer and Lemeshow test had a p-value of 0.21. This resulted in a risk classification model. CONCLUSION: Parity and adult attachment avoidance were the strongest independent determinants. Higher parity and higher levels of adult attachment avoidance are associated with an increased risk of suboptimal mother-to-infant bonding. The model and risk classification model should be externally validated and optimized before use in daily practice. Future research should include an external validation study, a study into the additional value of non-included determinants and finally a study on the impact and feasibility of the screening model

eCorrelates of prenatal and postnatal mother-to-infant bonding quality:A systematic review

Background Mother-to-infant bonding is defined as the emotional tie experienced by a mother towards her child, which is considered to be important for the socio-emotional development of the child. Numerous studies on the correlates of both prenatal and postnatal mother-to-infant bonding quality have been published over the last decades. An up-to-date systematic review of these correlates is lacking, however. Objective To systematically review correlates of prenatal and postnatal mother-to-infant bonding quality in the general population, in order to enable targeted interventions. Methods MEDLINE, Embase, CINAHL, and PsychINFO were searched through May 2018. Reference checks were performed. Case-control, cross-sectional or longitudinal cohort studies written in English, German, Swedish, Spanish, Norwegian, French or Dutch defining mother-to-infant bonding quality as stipulated in the protocol (PROSPERO CRD42016040183) were included. Two investigators independently reviewed abstracts, full-text articles and extracted data. Methodological quality was assessed using the National Institute of Health Quality Assessment Tool for Observational Cohort and Cross-sectional studies and was rated accordingly as poor, fair or good. Clinical and methodological heterogeneity were examined. Main results 131 studies were included. Quality was fair for 20 studies, and poor for 111 studies. Among 123 correlates identified, 3 were consistently associated with mother-to-infant bonding quality: 1) duration of gestation at assessment was positively associated with prenatal bonding quality, 2) depressive symptoms were negatively associated with postnatal mother-to-infant bonding quality, and 3) mother-to-infant bonding quality earlier in pregnancy or postpartum was positively associated with mother-to-infant bonding quality later in time. Conclusion Our review suggests that professionals involved in maternal health care should consider monitoring mother-to-infant bonding already during pregnancy. Future research should evaluate whether interventions aimed at depressive symptoms help to promote mother-toinfant bonding quality. More high-quality research on correlates for which inconsistent results were found is needed