Phyllis Zelkowitz

Oxytocin in pregnancy and the postpartum: relations to labor and its management

The purpose of this study was to examine variations in endogenous oxytocin levels in pregnancy and postpartum state. We also explored the associations between delivery variables and oxytocin levels. A final sample of 272 mothers in their first trimester of pregnancy was included for the study. Blood samples were drawn during the first trimester and third trimester of pregnancy and at 8 weeks postpartum. Socio-demographic data were collected at each time point and medical files were consulted for delivery details. In most women, levels of circulating oxytocin increased from the first to third trimester of pregnancy followed by a decrease in the postpartum period. Oxytocin levels varied considerably between individuals, ranging from 50 pg/mL to over 2000 pg/mL. Parity was the main predictor of oxytocin levels in the third trimester of pregnancy and of oxytocin level changes from the first to the third trimester of pregnancy. Oxytocin levels in the third trimester of pregnancy predicted a self-reported negative labor experience and increased the chances of having an epidural. Intrapartum exogenous oxytocin was positively associated with levels of oxytocin during the postpartum period. Our exploratory results suggest that circulating oxytocin levels during the third trimester of pregnancy may predict the type of labor a woman will experience. More importantly, the quantity of intrapartum exogenous oxytocin administered during labor predicted plasma oxytocin levels 2 months postpartum, suggesting a possible long-term effect of this routine intervention, the consequences of which are largely unknown.

Factors associated with depression in pregnant immigrant women

This study examined psychosocial risk factors for depressive symptomatology in a community sample of pregnant immigrant women in Montreal, Canada. One hundred and nineteen participants were recruited through hospitals and responded to questionnaires assessing depression, somatic symptoms, functional status, social support, stressful life events and marital adjustment. Forty-two percent of participants scored above the cut-off for depression. Depressive symptoms were associated with poorer functional status and more somatic symptoms. Depressed women reported a lack of social support, more stressful life events and poorer marital adjustment. Transitions associated with migration may place pregnant immigrant women at high risk for depression.

Persistent maternal anxiety affects the interaction between mothers and their very low birthweight children at 24 months.

BACKGROUND Parental distress following the birth of a premature infant diminishes the parents ability to be sensitive to the infants cues, and this may affect infant developmental outcomes. AIMS The present study examined the effects of maternal anxiety during infant hospitalization in the Neonatal Intensive Care Unit (NICU) on the interactive behavior of mothers with their very low birthweight (VLBW) children in toddlerhood. SUBJECTS A sample of 56 mothers and their VLBW infants were recruited in the NICU. STUDY DESIGN During the infants NICU stay, mothers completed a self-report measure of trait anxiety. These mothers and their infants were followed when the infants were 24 months corrected age, when mothers and their children were videotaped during free play at home. These videotapes were then coded using the Emotional Availability Scales. RESULTS Maternal anxiety was not found to be related to severity of neonatal illness. Maternal anxiety in the NICU was associated with less sensitivity and less structure in interaction with their toddlers at 24 months corrected age, even controlling for maternal education and child birthweight. Children of mothers with higher anxiety scores in the NICU were less likely to involve their mothers in their play at 24 months corrected age. CONCLUSIONS Maternal anxiety in the NICU predicted adverse interactive behaviors when the children were 24 months corrected age. Early identification of anxious mothers in the NICU is needed in order to initiate preventive intervention to support the mother-infant relationship.

Psychopathology in offspring of mothers with borderline personality disorder: a pilot study.

Objective: Children of mothers with borderline personality disorder (BPD) were hypothesized to be at greater risk for psychopathology, particularly impulse spectrum disorders, than children of mothers with other personality disorders. Method: Twenty-one index children were compared with 23 children of mothers with a nonborderline personality disorder. Diagnoses were obtained using the Kiddie Schedule for Affective Disorders and Schizophrenia–Episodic Version (KSADS-E) and the Child Diagnostic Interview for BPD (CDIB), and functioning was rated with the Child Global Assessment Schedule (CGAS). Physical, sexual, and verbal abuse, as well as family violence and placements, were also assessed. Results: The children of the borderline mothers, as compared with controls, had more psychiatric diagnoses, more impulse control disorders, a higher frequency of child BPD, and lower CGAS scores. There were no differences between the groups for trauma. Conclusion: The offspring of borderline mothers are at high risk for psychopathology.

Stability and change in depressive symptoms from pregnancy to two months postpartum in childbearing immigrant women

SummaryThe present study explored changes in mental health and functional status from pregnancy to 2 months postpartum in a sample of 106 childbearing immigrant women. Three sets of variables were examined in relation to postpartum depressive symptomatology: (1) prenatal depression, worries, and somatic symptoms; (2) social relationships (marital quality and social support), and (3) factors related to migration (premigration stress and length of stay in the host country). We found that 37.7% of the women in this community sample scored above the cutpoint of 12 on the Edinburgh Postnatal Depression Scale; prenatal depressive and somatic symptoms, as well as marital quality, were the best predictors of postpartum depressive symptomatology. An examination of differing trajectories from pregnancy to the postpartum period suggests that women with relatively few somatic complaints, low levels of perinatal stress, and satisfactory marital relations were less likely to exhibit mental health problems during pregnancy and postpartum. Women who were not depressed prenatally but reported postpartum depressive symptomatology exhibited several predisposing risk factors during pregnancy: many somatic complaints, high perinatal anxiety, and premigration stress. Women who were depressed during pregnancy but not postpartum reported improved physical function after childbirth. The implications of these findings for screening childbearing immigrant women are discussed.

The course of postpartum psychiatric disorders in women and their partners.

This study examined the course of postpartum psychiatric disorders in a community sample of mothers and their partners to determine whether sociodemographic variables, life stress, and psychiatric history were related to persistence of mental health problems. At 6 months postpartum, 48 index couples where the wife had a psychiatric disorder at 2 months postpartum and 50 control couples with no such diagnosis underwent diagnostic interviews and completed questionnaires on psychological symptoms, life stress, and treatment history. The results indicate that at follow-up, 54% of the index mothers still had a psychiatric diagnosis, as did 60% of their partners who had had a psychiatric diagnosis at 2 months postpartum. Socioeconomic status, country of origin, and life stress were related to persistence, as were diagnosis and timing of onset of the disorder. About a third of the parents were referred for treatment. It is concluded that for many families, postpartum psychiatric disorders are not a transient phenomenon.

Risk Factors for Borderline Pathology in Children

OBJECTIVE To examine risk factors associated with borderline pathology in latency-age children. METHOD The subjects were 98 children assessed for day treatment. Borderline subjects were identified in a chart review using the Child Diagnostic Interview for Borderlines, which divided the sample into borderline (n = 41) and nonborderline (n = 57) groups. Functional levels were assessed by Childrens Global Assessment Scale scores. The risk factors were also rated by chart review; all subjects were given a cumulative abuse score and a cumulative parental dysfunction score. RESULTS Both groups demonstrated severe functional impairment. The risk factors that differentiated the borderline group were sexual abuse, physical abuse, severe neglect, and parental substance abuse or criminality. Sexual abuse and severe neglect were significant in multivariate analysis. Cumulative abuse and cumulative parental dysfunction scores were both higher in the borderline group. CONCLUSIONS The findings indicate that the risk factors in borderline children are similar to those found in adults.

Neuropsychological Factors Associated With Borderline Pathology in Children

OBJECTIVE To determine whether children with borderline pathology have a specific pattern of neuropsychological risk factors. METHOD The subjects were 94 school-age children in day treatment, divided into borderline (n = 41) and nonborderline (n = 53) groups according to results of the Child version of the Diagnostic Interview for Borderlines. All children were assessed with the Child Behavior Checklist, the Schedule for Affective Disorders and Schizophrenia for School-Age Children, and a neuropsychological battery. RESULTS Children with borderline pathology had abnormal scores on the Wisconsin Card Sorting Test and on the Continuous Performance Test, both of which suggested problems with executive function. Although borderline pathology was highly comorbid with conduct disorder, most results were independent of this comorbidity. CONCLUSIONS Borderline pathology in children has a unique pattern of neuropsychological risk factors that may reflect a diathesis for this syndrome.

Postpartum psychiatric disorders : Their relationship to psychological adjustment and marital satisfaction in the spouses

The authors examined mental health and marital quality in an index group of spouses of women with postpartum psychiatric disorders and a control group of men whose wives had recently given birth but had no such disorders. At 6 to 9 weeks postpartum, couples underwent a psychiatric interview and completed self-report measures of psychological symptoms, marital satisfaction, and changes in couple and family functioning since the birth. Index spouses reported more symptoms and had lower Global Assessment of Functioning (R. L. Spitzer, J. B. W. Williams, M. Gibbon, & M. B. First, 1990) scores than controls. Index men reported greater marital dissatisfaction and more change in household routines, recreation, and intimacy with their partners than controls.

Anxiety affects the relationship between parents and their very low birth weight infants

The goal of this study was to examine the medical and sociodemographic factors associated with parental anxiety following the birth of a very low birth weight infant (VLBW, below 1500 g), and to determine the impact of anxiety on the behavior of parents with their VLBW infants in the Neonatal Intensive Care Unit (NICU). The parents of 88 VLBW infants were recruited through the NICU of a tertiary-care hospital, approximately 2 weeks following delivery. Parents completed self-report questionnaires measuring anxiety, marital quality, and social support. Prior to discharge, each parent was observed twice during a feeding interaction with the infant. Maternal anxiety was greater when their infants were smaller in terms of birth weight and younger in gestational age. Maternal education, marital status, and country of origin, as well as social support and marital quality, were also associated with anxiety. Paternal anxiety was not related to socioeconomic status or infant medical risk, but was associated with country of origin, social support, and marital quality. For both mothers and fathers, anxiety was a better predictor of parental behavior than was infant medical risk. These findings suggest the need to intervene with anxious parents in order to promote satisfactory parent-infant relationships.