Examining the role of mother-child interactions and DNA methylation of the oxytocin receptor gene in understanding child controlling attachment behaviors.

This study examined mother-child interactions and DNA methylation of the oxytocin receptor (OXTR) gene in the child, in relation with controlling-attachment behaviors at early preschool age. Maternal interactive behaviors were coded using the Emotional Availability Scales, and child attachment behaviors were assessed with the Separation-Reunion procedure and coded with the Preschool Attachment Rating Scales. DNA methylation data were captured from exon 3 of the OXTR. Results indicated that lower maternal sensitivity was associated with more controlling-caregiving behaviors, and that less maternal structuring was associated with more controlling-punitive behaviors. Hypomethylation of the OXTR gene was associated with greater maternal structuring behaviors, and with more child controlling-caregiving behaviors. The moderating role of the OXTR gene was examined in the association between interactive behaviors and child controlling behaviors, but no interaction effect was found. These results suggest that maternal interactive behaviors and OXTR methylation are independently associated with child controlling attachment.

Sleep quality is associated with vasopressin methylation in pregnant and postpartum women with a history of psychosocial stress.

BACKGROUND: The relationship between disturbed sleep and stress is well-documented. Sleep disorders and stress are highly prevalent during the perinatal period, and both are known to contribute to a number of adverse maternal and foetal outcomes. Arginine vasopressin (AVP) is a hormone and a neuropeptide that is involved in stress response, social bonding and circadian regulation of the sleep-wake cycle. Whether the AVP system is involved in regulation of stress response and sleep quality in the context of the perinatal mental health is currently unknown. The objective of the present study was to assess the relationship between levels of cumulative and ongoing psychosocial risk, levels of disordered sleep and AVP methylation in a community sample of pregnant and postpartum women. METHODS: A sample of 316 participants completed a battery of questionnaires during the second trimester of pregnancy (PN2, 12-14 weeks gestation), third trimester (PN3, 32-34 weeks gestation), and at 7-9 weeks postpartum (PP). Disordered sleep was measured using the Sleep Symptom Checklist at PN2, PN3 and PP; cumulative psychosocial risk was assessed with the Antenatal Risk Questionnaire (ANRQ) at PN2; salivary DNA was collected at the follow-up (FU, 2.9 years postpartum); and % methylation were calculated for AVP and for two of the three AVP receptor genes (AVPR1a and AVPR1b). Women were separated into high (HighPR) and low (LowPR) psychosocial risk groups, based on their scores on the ANRQ. RESULTS: Women in the HighPR group had significantly worse sleep disturbances during PN2 (p < .001) and PN3 (p < .001), but not at PP (p = .146) than women in the LowPR group. In HighPR participants only, methylation of AVP at intron 1 negatively correlated with sleep disturbances at PN2 (rs=-.390, p = .001), PN3 (rs=-.384, p = .002) and at PP (rs= -.269, p = .032). There was no association between sleep disturbances and AVPR1a or AVPR1b methylation, or between sleep disturbances and any of the AVP methylation for the LowPR group. Lastly, cumulative psychosocial stress was a moderator for the relationship between AVP intron 1 methylation and disordered sleep at PN2 (p < .001, adjusted R2 = .105), PN2 (p < .001, adjusted R2 = .088) and PP (p = .003, adjusted R2 = .064). CONCLUSIONS: Our results suggest that cumulative psychosocial stress exacerbates sleep disorders in pregnant women, and that salivary DNA methylation patterns of the AVP gene may be seen as a marker of biological predisposition to stress and sleep reactivity during the perinatal period. Further research is needed to establish causal links between AVP methylation, sleep and stress.

Men's knowledge of their own fertility: a population-based survey examining the awareness of factors that are associated with male infertility.

STUDY QUESTION: How knowledgeable are men about the medical, environmental and psychological factors that are associated with male infertility? SUMMARY ANSWER: Men, across most demographic groups, have limited knowledge of the various factors that are associated with male infertility. WHAT IS KNOWN ALREADY: Few surveys have focused on men's knowledge of their own fertility. Studies of both men and women have found that men are comparatively less knowledgeable about issues of fertility and reproductive health. STUDY DESIGN, SIZE, DURATION: A regionally representative sample of Canadian men completed a web-based survey of male fertility and reproductive health, over a 2-month period in 2015. PARTICIPANTS/MATERIALS, SETTING, METHODS: Men, aged 18-50 years, were recruited for the study. There were 701 male participants, with a mean age of 34.1 years. Each participant was asked to identify factors associated with male infertility; fertility knowledge was assessed through two open-ended questions and a comprehensive list of risk factors and attendant health issues. MAIN RESULTS AND THE ROLE OF CHANCE: Men were only able to identify 51% of the risk factors and 45% of the health issues associated with male infertility. Men were most aware of the modifiable risk factors for infertility (e.g. sexually transmitted infections, smoking cigarettes), relative to their knowledge of fixed risk factors (e.g. delayed puberty, size of testicles) and the attendant health issues (e.g. cardiovascular disease, diabetes). The overall level of fertility knowledge did not vary by most demographic characteristics (e.g. age, education, employment, income), though men from ethnic minority groups displayed moderately greater awareness. Additionally, younger men, those with lower incomes and those who had no desire to have future biological children were more likely to identify themselves as unaware of associations with infertility in the open-ended questions. Self-reported knowledge was significantly associated with higher overall knowledge scores. More than half of the sample expressed an interest in obtaining information about male fertility and reproductive health, with the majority of these men indicating that medical professionals and online sources were their preferred methods for receiving information. LIMITATIONS, REASONS FOR CAUTION: Participants were self-selected and required to have Internet access in order to participate. This may affect the generalizability of results. WIDER IMPLICATIONS OF THE FINDINGS: Previous studies of fertility knowledge have either omitted men from their samples or when men have been included, they were asked about general fertility or women's fertility. This is the first large-scale survey that focuses solely on men's knowledge of male fertility. Insight into the areas where men's knowledge may be lacking can inform strategies for disseminating fertility-related information and improving men's fertility awareness. Public health initiatives should tailor campaigns to educate men about the lesser known associations with male infertility, particularly those that are most prevalent and preventable through lifestyle modification. STUDY FUNDING/COMPETING INTERESTS: The study was funded by a grant from CIHR TE1-138296. No competing interests.

What's the message? A content analysis of newspaper articles about assisted reproductive technology from 2005 to 2011.

Infertility and its treatment is the subject of considerable media coverage. In order to evaluate the representation of assisted reproductive technology (ART) in the popular media, we conducted a content analysis of North American newspaper articles. We also explored whether different themes emerged in relation to the implementation of public funding for ART in Quebec, Canada. Print and online newspaper articles from 2005 to 2011 were retrieved using the terms "in-vitro fertilization", "infertility treatment", "assisted reproductive technology", and "IVF treatment". Totally, 719 newspaper articles met inclusion criteria and were coded according to predetermined categories. Risks (63%) and ethical issues (61%) related to ART were most commonly featured. Quebec-based articles were mostly concerned with the politics and financial issues governing ART, and were less likely to report the risks and emotional impact of ART than other North American press. Newspapers tended to emphasize extreme scenarios as well as controversial cases that may not represent the everyday realities of ART. Changes in public policy may also engender shifts in the tone and content of media reports. It is important to establish resources that can inform the public as well as prospective infertility patients about their condition and potential treatment options.

Parenting disability, parenting stress and child behaviour in early inflammatory arthritis.

INTRODUCTION: Our study examines the association between the disease characteristics of inflammatory arthritis and patients' self-perception of mental health, parenting disability, parenting stress and child behaviour in early inflammatory arthritis (EIA). METHODS: Patients in the early phase (more than 6 weeks, less than 18 months) of inflammatory arthritis were recruited from a larger EIA registry that recorded sociodemographic data and measures of pain, physical functioning and disease activity. Patient-perceived parenting disability, parenting stress, depression and children's behaviour problems were assessed using the Parenting Disability Index, Parenting Stress Index, Center for Epidemiologic Studies--Depression Mood Scale and Child Behavior Checklist, respectively. RESULTS: Pain, physical dysfunction, number of tender joints and physician global assessment of disease activity were associated with parenting disability. Self-report measures of parenting disability were associated with those of depression and parenting stress. Parenting stress was associated with children internalizing and externalizing behaviour problems while parenting disability was associated with children externalizing behaviour problems. CONCLUSION: This study suggests a possible reciprocal relationship among physical aspects of disease activity, parenting disability and parent and child distress in EIA.

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

The 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.

Diatheses and stressors in borderline pathology of childhood: the role of neuropsychological risk and trauma.

OBJECTIVE: To determine the relative contributions of neuropsychological deficits and psychosocial stressors to the presence of borderline pathology in children. METHOD: The subjects were 86 school-age children (75 males, 11 females) referred for psychiatric day treatment. Thirty-five of the children met criteria for borderline pathology. Data on psychosocial risk factors were obtained for each child from a questionnaire completed by members of the child's clinical team and were based on interviews with parents and children, as well as reports from schools and social agencies. Neuropsychological measures included computerized versions of the Wisconsin Card Sorting Test and the Continuous Performance Test. RESULTS: Both deficits in executive function and psychological trauma made significant and independent contributions to the variance in borderline pathology. Inclusion of both sets of risk factors produced a model that explained 48% of the variance in borderline diagnosis. CONCLUSIONS: Both environmental risks and neurobiological vulnerability should be taken into account to understand the etiology of borderline pathology in children.

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.

Psychological risk factors for borderline pathology in school-age children.

OBJECTIVE: To determine whether children with borderline pathology have a specific pattern of psychological risk factors. METHOD: The subjects were 94 school-age children in day treatment, divided into borderline (n = 41) and nonborderline (n = 53) groups using the child version of the Retrospective Diagnostic Interview for Borderlines. All children were assessed using the Child Behavior Checklist, the Schedule for Affective Disorders and Schizophrenia for School-Age Children, and the Psychosocial Questionnaire. Parental pathology was assessed by a computerized version of the Structured Clinical Interview for DSM-III-R. RESULTS: Children with borderline pathology had higher rates of physical abuse, sexual abuse, severe neglect, as well as family breakdown and parental criminality. In multivariate analyses, the discriminating factors were sexual abuse and parental criminality. Borderline pathology was highly comorbid with conduct disorder, but most of these results remained significant in reanalyses comparing children with and without conduct disorder. CONCLUSIONS: Borderline pathology in children has a unique pattern of risk factors not accounted for by conduct disorder alone.

Outcome of small-for-gestational age and appropriate-for-gestational age infants born before 27 weeks of gestation.

OBJECTIVE: To evaluate the consequences of being small-for-gestational age at extremely low gestational age. METHODOLOGY: Comparison of two historical cohorts of small-for-gestational age (SGA) and appropriate-for-gestational age (AGA) infants born between 24 and 26 6/7 weeks of gestation (gestational age estimated by early ultrasound at 16 to 18 weeks). Data were collected retrospectively on 191 successive admissions to the neonatal intensive care unit between January 1, 1983, and December 31, 1992. These included: demographic and maternal information, delivery mode and condition at birth, mortality, neonatal intensive care unit morbidities (respiratory distress syndrome, intraventricular hemorrhage, patent ductus arteriosis [PDA], chronic lung disease [CLD], retinopathy of prematurity [ROP], necrotizing enterocolitis, infection), nutrition, and length of hospitalization. RESULTS: Forty-one (21%) of the 191 infants were classified as SGA. Those with congenital anomalies (10% in the SGA and 2% in the AGA group) were excluded from further analysis. Despite a similar rate of respiratory distress syndrome (50%), the SGA infants had a greater rate of failure of indomethacin treatment for PDA closure (54% vs 32% for AGA), a higher risk for CLD defined as a need for supplementary oxygen at 36 weeks (65% vs 32% for AGA), a more prolonged need for oxygen supplementation and ventilatory support (94 days vs 68 days for AGA and 58 days vs 40 days for AGA, respectively). SGA infants were also at greater risk for developing severe ROP (stage >/=III) (65% vs 12% for AGA). CONCLUSIONS: For infants born before 27 weeks, being small-for-gestational age confers additional risks for severe morbidity, ie, PDA ligation, CLD, and ROP.

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.

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.

Childrearing attitudes among parents of very low birth weight and normal birth weight children.

The childrearing attitudes of parents of school-age children born at weights under 1500 g (VLBW) were compared with those of parents of age- and gender-matched children born at full term (NBW) to determine whether there were systematic differences between the two groups and whether parental attitudes were associated with child outcomes. Parents completed a self-report measure of childrearing attitudes and provided information on the child's health since birth. The children were given measures of IQ and self-concept, and their teachers rated their social and academic competence. Neonatal morbidity and subsequent need for hospitalization were unrelated to parental attitudes. Parents of VLBW children reported less use of guilt as a control strategy. They were also less child-centered, particularly if their children had chronic respiratory or ear-nose-throat problems. Greater parental warmth, less control through guilt, and less parental detachment were associated with more socially competent behavior and more positive self-concept in 9-year-old VLBW children.

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 Children's 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.

A comparison of the families of mothers with borderline and nonborderline personality disorders.

The purpose of this study was to evaluate the families of procreation of mothers with borderline personality disorder (BPD) on measures of family stability, family satisfaction, and family environment. Families of nine BPD mothers were compared with families of 14 mothers with other personality disorders using a semi-structured interview to evaluate family history, the Family Environment Scale (FES), and the Family Satisfaction Scale (FSS). Families of procreation of BPD mothers were more unstable than comparison group families. FES scores of BPD mothers were significantly lower than controls in cohesion and organization, but not in conflict. Instability and low family cohesion are common in families of BPD mothers, and may place their children at increased risk for development of psychopathology.

Screening for post-partum depression in a community sample.

OBJECTIVE: This study undertook to estimate the prevalence of post-partum depression in the community by means of telephone screening. Demographic correlates of post-partum depression were also investigated. METHOD: The sample was identified through two community health centres. Over a period of 17 months, 1559 childbearing women were screened at six weeks post-partum, using the ten-item Edinburgh Postnatal Depression Scale (EPDS). RESULTS: The prevalence of post-partum depression was estimated to be 6.2%, using a cut point of 10 on the EPDS, and 3.4% using the more stringent cut point of 12. Women who were not working or those with lower occupational status, were at greater risk for depression. Recent immigrants, particularly those who were not working or who had given birth to a second child, were also at higher risk. CONCLUSION: Telephone screening for post-partum depression is feasible, and can aid in the identification of women at risk.

Zinc dependency as a cause of chronic diarrhea in variant acrodermatitis enteropathica.

Two siblings with chronic diarrhea, growth failure, mood changes, and occasional cheilosis responded repeatedly to treatment with either pharmacologic doses of zinc or pancreatin (Viokase), and their symptoms were exacerbated after withdrawal of therapy. Pancreatic exocrine deficiency was ruled out in both cases. Proteolytic activity was 20% of normal in one infant tested. Plasma zinc concentration was normal. Plasma picolinic acid concentration was low in these two patients and in one previously reported patient (mean 3.6, normal 12.4 +/- 3.3 mumoles/liter). This is a characteristic shared with acrodermatitis enteropathica. The response to Viokase may be due to its content of picolinic acid and/or zinc or the correction of a deficiency of carboxypeptidase, a zinc-requiring enzyme.