Mother-To-Infant Bonding Disorder, but not Depression, 5 days After Delivery is a Risk Factor For Neonate Emotional Abuse: A Study in Japanese Mothers of 1-Month Olds

Background:Despite its clinical and public policy-making importance, neonatal abuse has been only minimally studied.Purpose:To identify predictors of mothers’ emotional abuse towards their infants at 1 month after childbirth.Methods:We studied a cohort of 252 women at three time points: late pregnancy and 5 days and 1 month after childbirth. At each time point, the women were administered a set of questionnaires about their depression (Edinburgh Postnatal Depression Scale), bonding towards the foetus or neonate (Maternal Antenatal Attachment Scale and Postnatal Bonding Questionnaire, respectively), and, at 1 month after childbirth, emotional abuse (Conflict Tactic Scale).Results:Structural equation modeling (SEM) analysis revealed that neonatal emotional abuse was predicted by bonding difficulties at 5 days after childbirth but not by depression at that time point.Conclusion:Assessment for maternal bonding problems in the early post-natal period should be routinely performed by perinatal health professionals.

O CONTRIBUTO DOS FATORES PSICOLÓGICOS NA OCORRÊNCIA DO PARTO PRÉ-TERMO

Some psychological variables of women seem to be in close relationship with the clinical course of pregnancy and delivery outcome. However, about risk factors for preterm birth, it is necessary to deepen the knowledge of the psychological risk area to enable more effective prevention. Aim: To relate the result of delivery, with regard to gestational age, mode of delivery and infant characteristics with psychological variables assessed during pregnancy, prenatal maternal attachment, psychopathological symptomatology and coping. Methodology: A prospective, descriptive correlational study; participants were 395 women at the second trimester of pregnancy and at postpartum, who attended antenatal clinics at the center of Portugal. The following instruments were used: Clinical Questionnaire about the Result of Delivery; Sociodemographic and Clinical Questionnaire in Pregnancy; Maternal Antenatal Attachment Scale; Brief Symptoms Inventory (BSI); Problems’ Resolution Inventory (PRI). Results: Gestational age and birth weight of the baby, on one side, and variables of prenatal attachment, BSI and PRI, on the other side, did not correlate significantly. The quality of prenatal maternal attachment was higher in women who came to have a delivery by forceps or vacuum extraction, compared with those that had caesarean birth (p = .05). The majority of women had a healthy pregnancy (75.7%). Coping strategies like Interpersonal Sensitivity and Help-seeking seem to influence the occurrence of obstetrical pathology. Women with higher scores on Total Prenatal Attachment and Intensity of Preocupation are more likely to have newborns with health problems. There is an association between clinical variables, the newborn´s health at birth and obstetric pathology of the II and III trimesters. Conclusion: Prenatal psychological factors such as prenatal attachment do not seem to influence the obstetric condition or the result of delivery but appear to play an important role about how pregnant women experience pregnancy and labor.Keywords: Prenatal psychological factors; evolution during pregnancy, delivery outcome.Resumo.Algumas variáveis psicológicas da mulher parecem estar em estreita relação com a evolução clínica da gravidez e o resultado do parto. No entanto, acerca dos fatores de risco para o parto prétermo, é necessário aprofundar conhecimentos na área do risco psicológico que permitam uma prevenção mais eficaz. Objetivos: relacionar o resultado do parto, no que se refere à idade gestacional, tipo de parto e características do bebé, com as variáveis psicológicas avaliadas durante a gravidez, vinculação materna pré-natal, sintomatologia psicopatológica e coping. Metodologia: estudo prospetivo, descritivo-correlacional; amostra constituída por 395 mulheres no segundo trimestre de gravidez e no pós-parto que frequentaram consultas pré-natais na zona centro do país. Instrumentos de pesquisa: Questionário Clínico relativo ao Resultado do Parto; Questionário Sociodemográfico e Clínico na Gravidez; Maternal Antenatal Attachment Scale; Brief Symptoms Inventory (BSI); Inventário de Resolução de Problemas (IRP). Resultados: a idade gestacional e o peso do bebé ao nascer, por um lado, e as variáveis da vinculação pré-natal, BSI e IRP, por outro lado, não se correlacionam significativamente. A qualidade da vinculação pré-natal materna era mais elevada nas mulheres que vieram a ter um parto por fórceps ou ventosa, em comparação com as que fizeram cesariana (p = .05). A maior parte das mulheres teve uma gravidez saudável (75.7%). A diferença entre estas e as que sofreram alguma patologia obstétrica situa-se na Sensibilidade Interpessoal e Pedido de Ajuda, favoráveis às primeiras. Mulheres com pontuações mais elevadas na Vinculação Materna Total e Intensidade da Preocupação têm mais probabilidade de ter bebés com problemas de saúde. Existe uma associação entre as variáveis clínicas, a saúde do bebé no momento do nascimento e a patologia obstétrica do II e do III trimestre. Conclusão: Fatores psicológicos pré-natais como a vinculação pré-natal não parecem exercer influência na patologia obstétrica nem no resultado do parto mas parecem desempenhar um papel importante na forma como a grávida vive a gestação e o trabalho de parto.Palavras-chave: Fatores psicológicos pré-natais; evolução da gravidez; resultado do parto.