Ouriel Rosenblum

Prenatal Ultrasound Screening: False Positive Soft Markers May Alter Maternal Representations and Mother-Infant Interaction

Background In up to 5% of pregnancies, ultrasound screening detects a “soft marker” (SM) that places the foetus at risk for a severe abnormality. In most cases, prenatal diagnostic work-up rules out a severe defect. We aimed to study the effects of false positive SM on maternal emotional status, maternal representations of the infant, and mother-infant interaction. Methodology and Principal Findings Utilizing an extreme-case prospective case control design, we selected from a group of 244 women undergoing ultrasound, 19 pregnant women whose foetus had a positive SM screening and a reassuring diagnostic work up, and 19 controls without SM matched for age and education. In the third trimester of pregnancy, within one week after delivery, and 2 months postpartum, we assessed anxiety, depression, and maternal representations. Mother-infant interactions were videotaped during feeding within one week after delivery and again at 2 months postpartum and coded blindly using the Coding Interactive Behavior (CIB) scales. Anxiety and depression scores were significantly higher at all assessment points in the SM group. Maternal representations were also different between SM and control groups at all study time. Perturbations to early mother-infant interactions were observed in the SM group. These dyads showed greater dysregulation, lower maternal sensitivity, higher maternal intrusive behaviour and higher infant avoidance. Multivariate analysis showed that maternal representation and depression at third trimester predicted mother-infant interaction. Conclusion False positive ultrasound screenings for SM are not benign and negatively affect the developing maternal-infant attachment. Medical efforts should be directed to minimize as much as possible such false diagnoses, and to limit their psychological adverse consequences.

L’homme transsexuel, sa femme et leur enfant: Une première esquisse

L’auteur aborde l’acces a la parentalite d’un couple compose d’un homme, ancienne femme, et de sa compagne dans le cadre legal d’un centre de biologie de la reproduction. Une personne transsexuelle feminin vers masculin (Female to Male, FtM) est une personne qui, ayant un corps de femme, se sent une identite d’homme et demande une reassignation de son sexe, par une transformation hormono-chirurgicale et un changement d’etat-civil. Ensuite, cette personne peut jouir de toutes les prerogatives liees a son nouveau sexe. Ainsi, la loi francaise lui reconnait la possibilite de se marier avec une femme. Le couple etant sterile par absence de spermatozoides chez cet homme, il a le droit de demander une Aide Medicale a la Procreation pour infertilite, comme pour tout autre couple heterosexuel. L’auteur tente de saisir la specificite de ces couples, tant dans leur choix amoureux que dans leur parcours qui les amene a devenir de futurs parents. Pour les therapeutes de couple et de famille dans une perspective psychanalytique, il apparait fondamental d’accompagner ces sujets desireux de fonder une famille, dans un souci leur permettant d’etre des acteurs a part entiere des processus de transmission.

Dyssynchrony and perinatal psychopathology impact of child disease on parents-child interactions, the paradigm of Prader Willi syndrom

BACKGROUND Infant-mother interaction is a set of bidirectional processes, where the baby is not only affected by the influences of his caregiver, but is also at the origin of considerable modifications. The recent discovery of biological correlates of synchrony during interaction validated its crucial value during child development. Here, we focus on the paradigmatic case of Prader-Willi Syndrome (PWS) where early endocrinal dysfunction is associated with severe hypotonia and early feeding disorder. As a consequence, parent-infant interaction is impaired. In a recent study (Tauber et al., 2017), OXT intranasal infusion was able to partially reverse the feeding phenotype, infants behavior and brain connectivity. This article details the interaction profile found during feeding in these dyads and their improvement after OXT treatment. METHODS Eighteen infants (≤6months) with PWS were recruited and hospitalized 9days in a French reference center for PWS where they were treated with a short course of intranasal OXT. Social withdrawal behavior and mother-infant interaction were assessed on videos of feeding before and after treatment using the Alarm Distress Baby (ADBB) Scale and the Coding Interactive Behavior (CIB) Scale. Raters were blind to treatment status. RESULTS At baseline, infants with PWS showed hypotonia, low expressiveness of affects, fatigability and poor involvement in the relationship with severe withdrawal. Parents tended to adapt to their child difficulties, but the interaction was perturbed, tense, restricted and frequently intrusive with a forcing component during the feeding situation. After OXT treatment, infants were more alert, less fatigable, more expressive, and had less social withdrawal. They initiated mutual activities and were more engaged in relationships through gaze, behavior, and vocalizations. They had a better global tonicity with better handling. These modifications helped the parents to be more sensitive and the synchrony of the dyad was in a positive transactional spiral. CONCLUSION Dys-synchrony can be induced by childrens pathology as well as parental pathology with emotional and developmental impact in the both cases. The PWS paradigm shows us the necessity to sustain early parents-child relationship to avoid establishment of a negative transactional pattern of interaction that can impact childs development.

La sexualité, entre parole et parcours, des sujets infectés par le VIH

AIDS, that union between death and sexuality, makes the latter non-representable and has deeply modified the world of sexual imagination. The article seeks to show how the emergence of HIV has re-defined the current norm within individuals’ sexuality and then goes on to analyse the different stages HIV positive subjects have to confront as they go through life, with the need to re-organise their sexuality ; it then evokes the transgressive aspect of sexuality for some sectors of the population and, finally, gives HIV positive women the opportunity to speak out on how they come to grips with their bodies in relation to partners – soiled bodies henceforth disentitled, deprived of pleasure. HIV infection has the effect of sowing confusion between the different registers such as death, life and sex, and causes in the subject feelings of shame and guilt : so many effects that the therapist has to take on board to render the feeling that they exist in full to the subject.