Experience of early motherhood during the first wave of the COVID-19 pandemic in Northern Germany: a single-centre before and after comparison.

PURPOSE: To assess maternal mental health during the first weeks after birth including birth experience, postpartum adjustment to early motherhood and the perception of newborn behaviour, and how this may be influenced by the first wave of the COVID-19 pandemic. METHODS: Ninety women who gave birth after the first enforcement of nation-wide disease control restrictions in Germany between 16 March and 10 May 2020 were surveyed and compared with 101 women who had given birth before the pandemic. Information on maternal mental health and maternal perception of early motherhood and neonatal behaviour were assessed at 3-8 weeks postpartum. RESULTS: Mothers who gave birth under the COVID-19-associated disease control restrictions did not show significant differences in depression, anxiety and social support scales compared to mothers before the pandemic. Birth experience was similar, while support during birth was perceived to be higher under the COVID-19 restrictions. Confidence in caretaking of the newborn and perception of neonatal behaviour were comparable between the two groups. Mothers expressed significantly higher dissatisfaction with the maternal role during the pandemic. CONCLUSIONS: Overall, maternal mental health and the perception of the newborn and early caretaking during the first COVID-19 wave did not substantially differ from the perceptions of mothers before the pandemic. A potential influence of the pandemic on higher dissatisfaction with the maternal role may be associated with the pandemic conditions affecting everyday life and should be addressed in postpartum care and in future qualitative and longitudinal studies.

[Parental Mentalization and Early Parent-Child Interaction in Mothers with Affective Disorders or Borderline Personality Disorder: A Systematic Review]. / Elterliche Mentalisierung und frühe Eltern-Kind-Interaktion bei Müttern mit affektiven Störungen oder Borderline- Persönlichkeitsstörung: Ein systematisches Review.

The ability to mentalize is central in the context of the parent-child relationship.The parental competence to see the child'smental state as an independent individual is an essential prerequisite for perceiving and interpreting child signals appropriately.These abilities are crucial but not always available under elevated stress levels when confronted with a child's affects and parenting challenges. Despite the clinical and conceptual relevance of mentalization with borderline personality disorder (BPD) and affective disorders, the subject has rarely been systematically addressed in parents.This review provides a systematic overview of parental mentalization in mothers with affective disorders or BPD and its impact on the quality of maternal interactive behaviour. The findings generally revealed a negative association between mothers' parental mentalization and depression or BPD, which varied greatly depending on the mentalization constructs. Both psychiatric diagnosis and current severity of symptoms were found to be relevant. However, some positive aspects of mentalization were not markedly impaired. Further, a lowermentalizing abilitywas associatedwith reduced sensitive behaviour in depressedmothers. The results contribute to a better understanding of the association between mentalization and maternal psychopathology and help refine early interventions in parent-child settings.

[Effect of light therapy on the night sleep of children with sleep problems]. / Wirkung von Lichttherapie auf den Nachtschlaf von Kindern mit Schlafproblemen.

Effect of light therapy on the night sleep of children with sleep problems Abstract. Studies on the effect of light therapy on the nighttime sleep of adolescents revealed earlier sleep onset and longer sleep periods. The present study examines the corresponding effects in children. A group of 28 children (M = 10.0; SD = 1.65 years) with difficulties falling asleep and sleeping through the night received a light therapy device for home application. The effect was investigated by an A-B-A-B design with four measurement points. We detected significant, small- to medium-sized effects on the children's sleep-onset problems and ability to sleep through the night as well as mood. Sleep onset was reduced by approximately 10 minutes. The representativeness of the sample is limited, but the results largely correspond to the findings in adolescents. Because of the weekly switch between application and nonapplication, the true circadian effects might be underestimated. In principle, however, the effects found in adolescents appear to be transferable to children, though further research is necessary.

Parental Reflective Functioning and Its Association With Parenting Behaviors in Infancy and Early Childhood: A Systematic Review.

Background: Parental reflective functioning (PRF) refers to parents' mental capacity to understand their own and their children's behaviors in terms of envisioned mental states. As part of a broader concept of parental mentalization, PRF has been identified as one of the central predictors for sensitive parenting. However, the unique contribution of PRF to the quality of various parenting behaviors has not yet been addressed systematically. Thus, the present article provides a systematic overview of current research on the associations between PRF or its sub-dimensions and observed parenting behaviors in infancy and early childhood, while considering the influence of contextual factors. Methods: The review was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Systematic searches were carried out in five electronic databases. The eligibility and methodological quality of the identified studies were assessed using pre-defined criteria and a standardized checklist. Results: Sixteen studies with moderate to high quality on a total of 15 parenting behaviors were included, the majority of which examined positive parenting behaviors, while negative parenting behaviors were rarely investigated. Most of the associations indicated a positive effect of PRF on parenting behavior, with mostly small-sized effects. The strength and direction of the associations varied depending on the dimensionality of PRF, observation settings, sample types, socioeconomic factors, and cultural background. Moreover, five assessment instruments for PRF and 10 observation instruments for parenting behaviors were identified. Conclusion: In summary, PRF has shown a positive association with parenting quality. However, its complex interaction with further contextual factors emphasizes the need for differentiation of PRF dimensions and the consideration of the observation settings, assessment time points, psychosocial risks, and sample types in observational as well as intervention studies. Further high-quality studies with multivariate analyses and diverse study settings are required.

Behavioral Inhibition in the Second Year of Life Is Predicted by Prenatal Maternal Anxiety, Overprotective Parenting and Infant Temperament in Early Infancy.

Background: Behavioral inhibition, characterized by shyness, fear and avoidance of novel stimuli, has been linked with internalizing personality traits in childhood, adolescence and early adulthood, and particularly later social anxiety disorder. Little is known about the relevance of potential prenatal precursors and early predictors for the development of inhibited behavior, such as infant vulnerability and family risk factors like parental anxiety and overprotection. Pregnancy-related anxiety has been associated with both infant temperament and maternal overprotective parenting. Thus, the aim of this study was investigating the predictive relevance of prenatal pregnancy-related anxiety for behavioral inhibition in toddlerhood, by considering the mediating role of maternal overprotection and infant distress to novelty. Materials and Methods: As part of a longitudinal pregnancy cohort, behavioral inhibition at 24 months postpartum was assessed in N = 170 mother-child pairs. Maternal pregnancy-related anxiety was examined in the third trimester of pregnancy, and maternal overprotection and infant distress to novelty at 12 months postpartum. Results: Mediation analysis with two parallel mediators showed that the significant direct effect of pregnancy-related anxiety on child behavioral inhibition was fully mediated by infant distress to novelty p < 0.001 and maternal overprotection (p < 0.05). The included variables explained 26% of variance in behavioral inhibition. A subsequent explorative mediation analysis with serial mediators further showed a significant positive association between distress to novelty and maternal overprotective parenting (p < 0.05). Conclusion: Results indicate a predictive relevance of both infant and maternal factors for the development of behavioral inhibition in toddlerhood. Mothers who perceived more pregnancy-related anxiety showed more overprotective parenting and had infants with more distress to novelty. Further, mothers being more overprotective reported their child to be more inhibited in toddlerhood. Our findings also indicate the stability of reported infant distress to novelty as one aspect of later behavioral inhibition. Addressing specific forms of parental anxiety from pregnancy on and in interaction with child-related variables seems to be a promising approach for future studies and clinical interventions.

Born Under COVID-19 Pandemic Conditions: Infant Regulatory Problems and Maternal Mental Health at 7 Months Postpartum.

BACKGROUND: The SARS-COVID-19 pandemic and its associated disease control restrictions have in multiple ways affected families with young children, who may be especially vulnerable to mental health problems. Studies report an increase in perinatal parental distress as well as symptoms of anxiety or depression in children during the pandemic. Currently, little is known about the impact of the pandemic on infants and their development. Infant regulatory problems (RPs) have been identified as early indicators of child socio-emotional development, strongly associated with maternal mental health and the early parent-infant interaction. Our study investigates whether early parenthood under COVID-19 is associated with more maternal depressive symptoms and with a perception of their infants as having more RPs regarding crying/fussing, sleeping, or eating, compared to mothers assessed before the pandemic. METHODS: As part of a longitudinal study, 65 women who had given birth during the first nationwide disease control restrictions in Northern Germany, were surveyed at 7 months postpartum and compared to 97 women assessed before the pandemic. RPs and on maternal depressive symptoms were assessed by maternal report. Number of previous children, infant negative emotionality, and perceived social support were assessed as control variables. RESULTS: Compared to the control cohort, infants born during the COVID-19 pandemic and those of mothers with higher depressive symptoms were perceived as having more sleeping and crying, but not more eating problems. Regression-based analyses showed no additional moderating effect of parenthood under COVID-19 on the association of depressive symptoms with RPs. Infant negative emotionality was positively, and number of previous children was negatively associated with RPs. LIMITATIONS: Due to the small sample size and cross-sectional assessment, the possibility for more complex multivariate analysis was limited. The use of parent-report questionnaires to assess infant RPs can support but not replace clinical diagnosis. CONCLUSIONS: The pandemic conditions affecting everyday life may have a long-term influence on impaired infant self- and maternal co-regulation and on maternal mental health. This should be addressed in peripartum and pediatric care. Qualitative and longitudinal studies focusing on long-term parental and infant outcomes under ongoing pandemic conditions are encouraged.

Becoming a mother: Predicting early dissatisfaction with motherhood at three weeks postpartum.

OBJECTIVE: The peripartum period can go along with increased insecurity, strain or frustration, potentially leading to a dissatisfying experience of motherhood, which itself is associated with poorer postnatal adjustment. Identifying prenatal influencing factors on the early postnatal dissatisfaction with motherhood is crucial to enable specific support for parents from pregnancy on. The aim of this study was to investigate the predictive relevance of prenatal levels of anxiety and hostility as manifestations of prenatal strain, and further maternal-fetal bonding, adult attachment style and recalled parenting by the own mother on the dissatisfaction with motherhood. DESIGN: Data was assessed longitudinally. SETTING: The study took place at the University Medical Center Hamburg-Eppendorf, Hamburg, Germany. PARTICIPANTS: N=100 pregnant women from the general population. MEASUREMENTS AND FINDINGS: Pregnancy-related anxiety, hostility, maternal-fetal bonding and adult attachment style were assessed in the last trimester of pregnancy, and recalled parenting by the own mother and current dissatisfaction with motherhood at three weeks postpartum. Hierarchical regression analysis showed that lower recalled care by the own mother predicted higher dissatisfaction with overall motherhood, from the perspective as an adult and related to their child. Higher pregnancy-related anxiety predicted higher overall and child-related dissatisfaction. Higher hostility predicted higher child-related dissatisfaction. KEY CONCLUSION: Prenatal negative emotional states and lower recalled care by the own mother can serve as indicators for maternal dissatisfaction. IMPLICATION FOR PRACTICE: Shaping professional support around negative emotional states and addressing experiences of own upbringing already prenatally might prevent an early dissatisfaction with motherhood and negative consequences for mother and child.

The association between maternal-fetal bonding and prenatal anxiety: An explanatory analysis and systematic review.

BACKGROUND: The prenatal period can be associated with an increase in distress and anxiety. Research indicates that impaired mental well-being influences the development of prenatal maternal-fetal bonding, which manifests in representations, emotions and behaviors. However, the impact of prenatal anxieties on maternal-fetal bonding is still not fully understood, partly due to heterogeneity in the conceptualization and the measurement of both constructs. The aims of this review were to identify studies assessing the relation between both constructs and to investigate direction and size of effects for different types of prenatal anxiety and conceptualizations of maternal-fetal bonding. METHODS: A systematic search was carried out on January 7, 2017, and updated on October 23, 2017, based on four electronic databases and a targeted reference search. Of the 3845 identified publications, K = 31 studies fit the eligibility criteria. RESULTS: While components of maternal-fetal bonding centering around pregnancy or maternal role were not affected, the quality of perceived emotional proximity to the child, as assessed by the Maternal Antenatal Attachment Scale, was impaired by anxieties across studies. Associations were overall negative and of low to moderate size. LIMITATIONS: Studies focusing on high-risk subpopulations were excluded. Included studies mostly assessed samples from Western societies, which limits the generalizability of results to non-Western cultures. CONCLUSION: The quality of perceived emotional proximity to the fetus was consistently impaired by anxiety. Nevertheless, varying effect sizes indicate a more complex association that is influenced by underlying confounders. Multivariate analyses are needed to improve the understanding of the interacting factors that influence maternal-fetal bonding.