Alexandra P. Pacheco

Anxiety and depression during pregnancy in women and men

BACKGROUND High-anxiety and depression rates have been reported in women during pregnancy; however men and parity effects have not been studied as extensively. The purpose of this study was to analyze anxiety and depression in women and their partners during pregnancy, namely differences between the 1st, 2nd and 3rd pregnancy trimesters, between women and men, and between primiparous and multiparous. METHODS A sample of 300 women and their partners (n=560) were recruited during the 1st pregnancy trimester and have completed the STAI-S (State Anxiety Inventory) and the EPDS (Edinburgh Postnatal Depression Scale) in the 1st, 2nd and 3rd pregnancy trimesters. RESULTS Anxiety symptoms follow a U pattern in pregnancy, while depression symptoms decrease throughout pregnancy. Women show higher anxiety and depression values than men, although patterns of time variation are similar. Primiparous women and men display higher anxiety levels in the 1st than in the 3rd trimester, while multiparous register higher values in the 3rd than in the 1st pregnancy trimester. CONCLUSION Different time variation in pregnancy was found for anxiety and depression symptoms; however anxiety and depression symptoms are particularly high during the 1st trimester. Intervention needs will be analyzed according to the results.

Depression during pregnancy and the postpartum period in adolescent and adult Portuguese mothers

SummaryObjective: To study prevalence as well as risk factors for pregnancy and postpartum depression in a sample of adolescent and adult Portuguese mothers.Methods: The Edinburgh Postnatal Depression Scale (EPDS) was administered to 108 (54 adult and 54 adolescent) Portuguese women at 24–36 weeks of pregnancy and at 2–3 months postpartum.Results: Rates for EPDS > 12 are high during the 3rd trimester of pregnancy (18.5%) and at 2–3 months postpartum (17.6%), and not significantly different between these two periods; more than 1/4 of the sample (27.8%) had an EPDS > 12 before or after delivery. Adolescent mothers presented more depressive symptoms as well as more EPDS > 12 than adult mothers, both in pregnancy (25.9% versus 11.1%) and at 2–3 months postpartum (25.9% versus 9.3%); moreover, when considering other socio-demographics, adolescent mothers were still at risk for depressive symptoms during pregnancy as well as for postpartum depression. Women depressed in pregnancy, and ones who are under 18 years old and who live with the partner, were at risk for postpartum EPDS > 12.Conclusion: Adolescent mothers seem particularly at risk for depression during pregnancy and the postpartum period, therefore, just like the women who are depressed during pregnancy, they should be better targeted in preventive and intervention measures.

Teenage pregnancy, attachment style, and depression: A comparison of teenage and adult pregnant women in a Portuguese series

Abstract The aim of this Portuguese study is to compare the experience of pregnancy in teenage years and later adulthood and to examine insecure attachment style as a risk factor for depression during pregnancy. The Attachment Style Interview (ASI; Bifulco, Moran, Ball, & Bernazzani, 2002) and the Edinburgh Postnatal Depression Scale (EPDS; Cox, Holden, & Sagovsky, 1987) were administered to 66 pregnant adolescents and 64 adult women. Pregnant teenagers were found to be nearly three times more likely to have an insecure attachment style of Enmeshed, Angry-Dismissive, or Fearful style than adults, all at high levels of impairment (54% vs.19%, p < .02). Logistic regression showed, when all risk factors were entered, highly Enmeshed style and poor partner support provided the best model for depression with age at pregnancy no longer adding. Insecure attachment style should be addressed in prevention and intervention strategies with teenage mothers.

Mother-to-Infant Emotional Involvement at Birth

Objectives To study mother-to-infant emotional involvement at birth, namely factors (socio-demographics, previous life events, type of delivery, pain at childbirth, support from partner, infant characteristics, early experiences with the newborn, and mother’s mood) that interfere with the mother’s positive, negative and not clear emotions toward the newborn. Methods The Bonding Scale (an extended Portuguese version of the ‘New Mother-to-Infant Bonding Scale’) and the Edinburgh Postnatal Depression Scale were administrated during the first after delivery days to 315 mothers recruited at Júlio Dinis Maternity Hospital (MJD, Porto, Portugal). Results A worse emotional involvement with the newborn was observed when the mother was unemployed, unmarried, had less than grade 9, previous obstetrical/psychological problems or was depressed, as well as when the infant was female, had neonatal problems or was admitted in the intensive care unit. Lower total bonding results were significantly predicted when the mother was depressed and had a lower educational level; being depressed, unemployed and single predicted more negative emotions toward the infant as well. No significant differences in the mother-to-infant emotional involvement were obtained for events related to childbirth, such as type of delivery, pain and partner support, or early experiences with the newborn; these events do not predict mother’s bonding results either. Conclusion The study results support the need for screening and supporting depressed, unemployed and single mothers, in order to prevent bonding difficulties with the newborn at birth.

Mother-to-infant and father-to-infant initial emotional involvement

While infant attachment has been largely studied, parental attachment is still relatively unknown, especially when referred to fathers. However, it is mainly recognised that parents’ emotional involvement with the newborn contributes to the quality of the interaction and the care they provide. The aim of this study was to study mother‐to‐infant and father‐to‐infant initial emotional involvement; namely, differences between mothers and fathers and changes in mother’s emotions toward the neonate within the first days after delivery. The Bonding Scale, an extended Portuguese version of the ‘New Mother‐to‐Infant Bonding Scale’, was administered during the first two days after childbirth to a sample of 315 mothers and 141 fathers (n = 456), at the Júlio Dinis Maternity Hospital (Portugal). Most mothers and fathers show positive emotions and only a few of them showed negative emotions toward the infant. Maternal and paternal emotional involvement toward the newborn tend to be similar; nevertheless, fathers show less fear and better emotional involvement with the neonate, while mothers are sadder and show more emotions not related to bonding. During the first days following delivery, emotions not related to bonding, such as fear, seem to decrease in mothers.

Brazelton Neonatal Behavioral Assessment Scale: a psychometric study in a Portuguese sample.

BACKGROUND The Neonatal Behavioral Assessment Scale (NBAS, Brazelton & Nugent, 1995) is an instrument conceived to observe the neonatal neurobehavior. Data analysis is usually performed by organizing items into groups. The most widely used data reduction for the NBAS was developed by Lester, Als, and Brazelton (1982). OBJECTIVE Examine the psychometric properties of the NBAS items in a sample of 213 Portuguese infants. METHOD The NBAS was performed in the first week of infant life (3 days±2) and in the seventh week of life (52 days±5). RESULTS Principal component analyses yielded a solution of four components explaining 55.13% of total variance. Construct validity was supported by better neurobehavioral performance of 7-week-old infants compared with 1-week-old infants. CONCLUSION Changes in the NBAS structure for the Portuguese sample are suggested compared to Lester factors in order to reach better internal consistency of the scale.

Fetal heart rate variability mediates prenatal depression effects on neonatal neurobehavioral maturity

This study analyzed the mediating role of fetal heart rate variability (FHR) on prenatal depression and neonatal neurobehavioral maturity. A sample of 104 pregnant women was recruited and divided into two groups according to their Edinburgh Postnatal Depression Scale (EPDS) scores (depressed/non-depressed). FHR variability in response to speech stimuli was assessed at term (between 37 and 39 weeks gestation). The neonates were then assessed on the Neonatal Behavioral Assessment Scale (NBAS) during the first 5days after birth. The fetuses of non-depressed pregnant women showed higher HR variability than the fetuses of depressed pregnant women in response to speech stimuli, and later as neonates they performed more optimally on the NBAS (on autonomic stability and total scores). FHR variability mediated the relationship between the mothers prenatal depression and the neonatés NBAS performance. Prenatal depression effects on neonatal behavior may be partially explained by its adverse effects on fetal neurobehavioral maturity.