Human placental lactogen (human chorionic somatomammotropin) and oxytocin during pregnancy: Individual patterns and associations with maternal-fetal attachment, anxiety, and depression.

Previous studies support links among maternal-fetal attachment, psychological symptoms, and hormones during pregnancy and the post-partum period. Other studies connect maternal feelings and behaviors to oxytocin and suggest that an increase in oxytocin during pregnancy may prime maternal-fetal attachment. To date, researchers have not examined a possible association between maternal-fetal attachment with human placental lactogen although animal models are suggestive. In the current study, we sought to describe oxytocin and human placental lactogen levels as related to psychological constructs across pregnancy. Seventy women participated in the study. At each of three time-points (early, mid, and late pregnancy), the women had their blood drawn to assess oxytocin and human placental lactogen levels, and they completed psychological assessments measuring maternal-fetal attachment, anxiety, and depression. Our results indicate that oxytocin levels were statistically similar across pregnancy, but that human placental lactogen significantly increased across pregnancy. Results did not indicate significant associations of within-person (comparing individuals to themselves) oxytocin or human placental lactogen levels with maternal-fetal attachment. Additionally, results did not show between-person (comparing individuals to other individuals) oxytocin or human placental lactogen levels with maternal-fetal attachment. Oxytocin levels were not associated with anxiety; rather the stage of pregnancy moderated the effect of the within-person OT level on depression. Notably, increasing levels of human placental lactogen were significantly associated with increasing levels of both anxiety and depression in between subject analyses. The current study is important because it describes typical hormonal and maternal fetal attachment levels during each stage of pregnancy, and because it suggests an association between human placental lactogen and psychological symptoms during pregnancy. Future research should further elucidate these relationships.

The mental health crisis of expectant women in the UK: effects of the COVID-19 pandemic on prenatal mental health, antenatal attachment and social support.

BACKGROUND: Pregnancy has been shown to be times in a woman's life particularly prone to mental health issues, however a substantial percentage of mothers report subclinical perinatal mental health symptoms that go undetected. Experiences of prenatal trauma, such as the COVID-19 pandemic, may exacerbate vulnerability to negative health outcomes for pregnant women and their infants. We aimed to examine the role of: 1) anxiety, depression, and stress related to COVID-19 in predicting the quality of antenatal attachment; 2) perceived social support and COVID-19 appraisal in predicting maternal anxiety and depression. METHODS: A sample of 150 UK expectant women were surveyed during the COVID-19 pandemic. Questions included demographics, pregnancy details, and COVID-19 appraisal. Validated measures were used to collect self-reported maternal antenatal attachment (MAAS), symptoms of anxiety (STAI), depression (BDI-II), and stress related to the psychological impact of COVID-19 (IES-r). RESULTS: We found that the pandemic has affected UK expectant mothers' mental health by increasing prevalence of depression (47%), anxiety (60%) and stress related to the psychological impact of COVID-19 (40%). Women for whom COVID-19 had a higher psychological impact were more likely to suffer from depressive (95% HDPI = [0.04, 0.39]) and anxiety symptoms (95% HPDI = [0.40, 0.69]). High depressive symptoms were associated with reduced attachment to the unborn baby (95% HPDI [-0.46, -0.1]). Whilst women who appraised the impact of COVID-19 to be more negative showed higher levels of anxiety (HPDI = [0.15, 0.46]), higher social support acted as a protective factor and was associated with lower anxiety (95% HPDI = [-0.52, -0.21]). CONCLUSIONS: The current findings demonstrate that direct experience of prenatal trauma, such as the one experienced during the COVID-19 pandemic, significantly amplifies mothers' vulnerability to mental health symptoms and impairs the formation of a positive relationship with their unborn baby. Health services should prioritise interventions strategies aimed at fostering support for pregnant women.

Postpartum bonding and association with depressive symptoms and prenatal attachment in women with fear of birth.

BACKGROUND: Co-morbidity is prevalent in women with fear of birth. Depressive symptoms and lack of prenatal attachment might influence the postpartum bonding between the mother and the new-born. AIM: To examine the underlying dimensions of the Postpartum Bonding Questionnaire and to investigate associations between depressive symptoms, prenatal attachment and postpartum bonding in women with fear of birth. METHODS: A longitudinal study comprising 172 women with fear of birth. Data were collected by questionnaires in mid- and late pregnancy and two months after birth. The Edinburgh Postnatal Depressive Scale, Prenatal Attachment Inventory and Postpartum Bonding Questionnaire were investigated. RESULTS: Two factors of the Postpartum Bonding Questionnaire were identified: Factor 1 mirrored caring activities and the women's perceptions of motherhood, whereas Factor 2 reflected negative feelings towards the baby. The Postpartum Bonding Questionnaire was negatively correlated with the Prenatal Attachment Inventory and positively with The Edinburgh Postnatal Depressive Scale. Women with fear of birth and depressive symptoms both during pregnancy and postpartum showed the highest risk of impaired bonding after birth. Primiparity and being single were also associated with impaired bonding. CONCLUSION: A focus on women's mental health during pregnancy is necessary in order to avoid the negative effects of impaired bonding on the infant. Depressive symptoms could be concurrent with fear of birth and, therefore, it is important to determine both fear of birth and depressive symptoms in screening procedures during pregnancy. Caregivers who meet women during pregnancy need to acknowledge prenatal attachment and thereby influence adaptation to motherhood.

The mediating role of prenatal depression in adult attachment and maternal-fetal attachment in primigravida in the third trimester.

BACKGROUND: Prenatal depression and adult attachment are factors that affect the establishment of an intimate relationship between a mother and fetus. The study explored differences in prenatal depression and maternal-fetal attachment (MFA) scores between different types of adult attachment and the effects of maternal depression scores and attachment dimensions on maternal intimacy with the fetus. METHODS: The Edinburgh Postnatal Depression Scale (EPDS), Experience of Close Relationship (ECR) scale, Maternal Antenatal Attachment Scale (MAAS) and a general data scale were used to investigate 260 primigravida. An exploratory analysis was performed to analyze the effects of the depression score and adult attachment on MFA. RESULTS: The results showed that pregnant women with insecure attachment exhibited an increased prevalence of prenatal depression, lower total MFA scores, and lower MFA quality compared with those women with secure adult attachment. The explorative analysis showed that the depression scores mediated the relationship between adult attachment avoidance and MFA quality. CONCLUSIONS: Primigravida who had insecure adult attachment exhibited an increased prevalence of prenatal depression and lower MFA. Maternal depression and adult attachment may affect the emotional bond between a mother and fetus. This finding should be seriously considered, and timely intervention needs to take personality traits into consideration.

Maternal-fetal attachment in pregnant Italian women: multidimensional influences and the association with maternal caregiving in the infant's first year of life.

BACKGROUND: Maternal-Fetal Attachment (MFA) describes the cognitive-representational, emotional, and behavioral aspects of the mother-fetus relationship that develops during pregnancy. We present two studies conducted on pregnant Italian women. In Study I, we aimed to explore multifaceted associations of MFA with variables important for a healthy pregnancy (e.g., maternal mental health, the couple's relationship). In Study II, we investigated the predictive role of MFA on observed maternal caregiving during the first months of the infant's life. METHODS: In Study I, 113 pregnant Italian women were assessed on MFA (Maternal Antenatal Attachment Scale, MAAS), maternal depression (Beck Depression Inventory-II, BDI-II), maternal anxiety (State Trait Anxiety Inventory - State version, STAI), adjustment of the couple (Dyadic Adjustment Scale, DAS), and perceived parental care (The Parental Bonding Instrument, PBI). In Study II, 29 mother-infant pairs were followed up at 4 months to assess observational variables of maternal caregiving through the Emotional Availability Scale (EAS) and to test for an association with MFA in pregnancy. RESULTS: Study I showed a significant association between MFA and the quality of the couple relationship (ß = .49, P < .001) and between MFA and the recall of memories of care received in childhood (ß = .22, P = .025). Study II showed a predictive effect of MFA on maternal structuring observed during mother-infant interactions at 4 months of age (ß = 0.36, P = .046). CONCLUSION: The study points out relevant relationship contexts that might receive care and support throughout pregnancy to protect MFA. The findings also provide thoughtful insights on the role of MFA in early maternal caregiving, suggesting that MFA might be a candidate as one putative antecedent of mother-infant interaction processes.

Maternal-fetal bonding during the COVID-19 pandemic.

BACKGROUND: The pregnant population experienced unique COVID-19 physical and psychosocial stressors such as direct health concerns related to the virus and loss of access to resources since the COVID-19 emerged as a global pandemic in early 2020. Despite these COVID-19-related stress and concerns, the maternal experience of bonding with their unborn children has not been well studied. This work aimed to study the association between mental health history, current mental health symptoms, psychological factors, COVID-19-related worries, and self-reported maternal-fetal bonding of pregnant women. METHODS: This online, survey-based cross-sectional study focused on women pregnant during the pandemic and assessed 686 women using data collected from May 19, 2020 to October 3, 2020. Enrolled respondents completed assessments in which they self-reported maternal-fetal bonding, mental health symptomatology, psychological factors, and COVID-19-related worries regarding health, pregnancy, and resources. RESULTS: Depressive symptoms in pregnant women were associated with lower quality maternal-fetal bonding, while a higher level of anxiety was positively associated with bonding; however, past history of depression or generalized anxiety diagnosis did not appear to be as relevant as active symptomatology. Maternal resilience, but not distress tolerance, appeared to be a protective factor resulting in improved bonding. Higher levels of worry regarding impact of COVID-19 on health were significantly associated with improved bonding, while worries regarding the impact of COVID-19 on the pregnancy or resources were not significantly associated with bonding. The study also found associations between different sociodemographic variables and bonding, including a strong positive association between first time motherhood and bonding and a negative association between higher education and income and bonding. CONCLUSIONS: This study was the first to report potential protective and risk factors to the maternal-fetal bonding process in women pregnant during the COVID-19 pandemic. Unique COVID-19 concerns exist; however, anxiety and COVID-19 concerns do not appear to undermine maternal-fetal bonding while active depressive symptomatology may negatively influence bonding; interventions increasing maternal resilience may be particularly valuable.

The association of maternal-fetal attachment with smoking and smoking cessation during pregnancy in The FinnBrain Birth Cohort Study.

BACKGROUND: Smoking in pregnancy constitutes a preventable risk factor for fetal/child development and maternal-fetal attachment (MFA) seems to contain a momentum that can break the chain of adverse outcomes by promoting maternal prenatal health practices. This study aimed to explore the association of MFA with smoking at any time during pregnancy and smoking cessation in early pregnancy, and the modifying role of MFA on the expected effects of education and prenatal psychological distress (PPD) on prenatal smoking behavior. METHODS: The pregnant women (n = 3766) participated in the The FinnBrain Birth Cohort Study in Finland between December 2011 and April 2015. The binary outcomes, smoking at any time during pregnancy and smoking cessation in early pregnancy, were obtained from self-reports at gestational weeks (gwks) 14 and 34 and The Finnish Medical Birth Register. MFA was assessed with the Maternal-Fetal Attachment Scale (MFAS) at gwks 24 and 34. Logistic regression analyses were used to determine the association between MFA and maternal prenatal smoking behavior. FINDINGS: The prevalence of smoking was 16.5%, and 58.1% of the smokers quit smoking during pregnancy. The independent associations of total MFA scores with prenatal smoking behavior were not established (aOR = 1.00-1.02, multiplicity adjusted p > 0.05). A higher score in the altruistic subscale of MFA, Giving of self, associated with a higher probability of smoking cessation (24 gwks: aOR = 1.13, 95% CI [1.04, 1.24], p = 0.007, multiplicity adjusted p = 0.062; 34 gwks: aOR = 1.17, 95% CI [1.07, 1.29], p < 0.001, multiplicity adjusted p = 0.008). The modifying effect of MFA on the observed associations between PPD and smoking in pregnancy and between maternal education and smoking in pregnancy / smoking cessation in early pregnancy was not demonstrated. CONCLUSIONS: The altruistic dimension of maternal-fetal attachment associates with an increased probability of smoking cessation during pregnancy and therefore strengthening altruistic maternal-fetal attachment may constitute a promising novel approach for interventions aiming at promoting smoking cessation during pregnancy.

Posttraumatic stress symptoms following childbirth: associations with prenatal attachment in subsequent pregnancies.

This longitudinal population-based study aimed to investigate the prospective relationship between PTSD symptoms following childbirth and prenatal attachment in the subsequent pregnancy. Data were derived from the Norwegian Akershus Birth Cohort (ABC), a large population-based prospective cohort study. Data from 1473 women who had given birth at least once before and who had completed questionnaires at 17 and 32 weeks of gestation were included. Confirmatory factor analysis of the short version of the Prenatal Attachment Inventory was conducted to validate the scale. Further, structural equation modeling techniques were used to estimate prospective associations of PTSD symptoms following childbirth with prenatal attachment. Finally, to explore potential mechanisms of the association, mediation and moderation analyses were conducted. PTSD symptoms following previous childbirth were found to be prospectively related to higher levels of prenatal attachment in the subsequent pregnancy, while controlling for important confounding factors, such as symptoms of maternal depression and anxiety, previous pregnancy loss, and sociodemographic factors (maternal age, educational level, marital status, and number of children). When fear of childbirth was included as a potential mediating variable, the prospective relationship between PTSD symptoms following childbirth and prenatal attachment in the subsequent pregnancy increased, thereby indicating a suppressor effect. Fear of childbirth did not act as a significant moderator. Our findings suggest that a subsequent pregnancy following a traumatic childbirth may for some women represent an opportunity for a higher level of prenatal attachment, whereas high levels of fear of childbirth may be detrimental for prenatal attachment.

Motherhood during or after breast cancer diagnosis: A qualitative study.

OBJECTIVE: Little is known about the process of becoming a mother in women who experienced a breast cancer diagnosis (BC). In this qualitative study, we investigated maternal representations in pregnant women with experience of BC and those with no oncological history. METHODS: A total of 38 women were recruited, 19 women who experienced a BC diagnosis and 19 who had not. To explore maternal representations, semi-structured interviews were conducted and analysed through thematic analysis. RESULTS: Four main themes were identified: fears and worries, meaning of motherhood, mother-foetus relationship and partner support. Across themes, differences between primiparous and multiparous are reported. Women with gestational breast cancer (GBC) described fear for their own and their child's survival. Women with previous BC recall contrasting emotions. All women with experience of BC perceived breastfeeding as fundamental and inability to do so provoked worry. Relationship with the partner was considered central, while healthy women were projected towards the future triadic relationship. CONCLUSIONS: Finding a mental space during pregnancy for the representation of the future child could be hard for women with GBC. Dissimilarities in the experience of motherhood in cancer patients provide insight into psychological aspects that should be taken into account in clinical practice.

Exposure to unpredictable maternal sensory signals influences cognitive development across species.

Maternal care is a critical determinant of child development. However, our understanding of processes and mechanisms by which maternal behavior influences the developing human brain remains limited. Animal research has illustrated that patterns of sensory information is important in shaping neural circuits during development. Here we examined the relation between degree of predictability of maternal sensory signals early in life and subsequent cognitive function in both humans (n = 128 mother/infant dyads) and rats (n = 12 dams; 28 adolescents). Behaviors of mothers interacting with their offspring were observed in both species, and an entropy rate was calculated as a quantitative measure of degree of predictability of transitions among maternal sensory signals (visual, auditory, and tactile). Human cognitive function was assessed at age 2 y with the Bayley Scales of Infant Development and at age 6.5 y with a hippocampus-dependent delayed-recall task. Rat hippocampus-dependent spatial memory was evaluated on postnatal days 49-60. Early life exposure to unpredictable sensory signals portended poor cognitive performance in both species. The present study provides evidence that predictability of maternal sensory signals early in life impacts cognitive function in both rats and humans. The parallel between experimental animal and observational human data lends support to the argument that predictability of maternal sensory signals causally influences cognitive development.

Experiences of pregnant women with a third trimester routine ultrasound - a qualitative study.

BACKGROUND: Studies showed that pregnant women generally value routine ultrasounds in the first two trimesters because these provide reassurance and a chance to see their unborn baby. This, in turn, might help to decrease maternal anxiety levels and increase the bond with the baby. However, it is unclear whether pregnant women hold the same positive views about a third trimester routine ultrasound, which is increasingly being used in the Netherlands as a screening tool to monitor fetal growth. The aim of this study was to explore pregnant women's experiences with a third trimester routine ultrasound. METHODS: We held semi-structured interviews with fifteen low-risk pregnant women who received a third trimester routine ultrasound in the context of the Dutch IUGR RIsk Selection (IRIS) study. The IRIS study is a nationwide cluster randomized controlled trial carried out among more than 13,000 women to examine the effectiveness of a third trimester routine ultrasound to monitor fetal growth. For the interviews, participants were purposively selected based on parity, age, ethnicity, and educational level. We performed thematic content analysis using MAXQDA. RESULTS: Most pregnant women appreciated a third trimester routine ultrasound because it provided them confirmation that their baby was fine and an extra opportunity to see their baby. At the same time they expressed that they already felt confident about the health of their baby, and did not feel that their bond with their baby had increased after the third trimester ultrasound. Women also reported that they were getting used to routine ultrasounds throughout their pregnancy, and that this increased their need for another one. CONCLUSIONS: Pregnant women seem to appreciate a third trimester routine ultrasound, but it does not seem to reduce anxiety or to improve bonding with their baby. Women's appreciation of a third trimester routine ultrasound might arise from getting used to routine ultrasounds throughout pregnancy. We recommend to examine the psychological impact of third trimester routine ultrasounds in future studies. Results should be taken into consideration when balancing the gains, which are as yet not clear, of introducing a third trimester routine ultrasound against unwanted side effects and costs.

Intimate Partner Violence, Negative Attitudes Toward Pregnancy, and Mother-to-Fetus Bonding Failure Among Japanese Pregnant Women.

We examined the associations between intimate partner violence (IPV) before and during pregnancy, negative attitudes toward pregnancy, and mother-to-fetus bonding. Participants were 636 pregnant women in the third trimester, who completed the Mother-to-Infant Bonding Scale, Violence Against Women Screen, and ad hoc questions (for IPV before pregnancy, negative attitudes, and demographics). We found association between IPV during pregnancy and mother-to-fetus bonding failure was mediated by negative attitudes toward pregnancy in the third trimester. IPV before pregnancy was associated with negative attitudes at the beginning of pregnancy, which predicted negative attitudes in the third trimester and mother-to-fetus bonding failure. Careful assessments and psychological interventions are needed to reduce negative attitudes toward pregnancy among abused women in antenatal health settings to prevent mother-to-fetus bonding failure.

Body experience and the mother-child relationship in pregnancy: a cross-sectional study of pregnant Portuguese women.

Objective: In spite of the huge physical transformations that occur during pregnancy, there is little research on the role of body experience in the establishment of the mother-child relationship in pregnancy. The aim of the present study was to address this gap. Method: A sample of 330 pregnant women completed questionnaires assessing mother-child relationship (the Maternal-Fetal Attachment Scale), body experience, and other demographic and pregnancy variables. Results: Pearson's correlations revealed a number of variables were related to mother-child relationship in pregnancy, and t-tests and ANOVAs showed some between-subjects differences based on demographic variables. After controlling for these variables, regression analyses revealed that body experience was a significant predictor of both subscales of the Maternal-Fetal Attachment Scale: emotional investment in the baby and maternal role-taking. Conclusion: These findings highlight the connection between body experience and the psychological tasks of pregnancy and draw attention to new ways of assessing and improving mother-child relationships as early as in pregnancy. Results are discussed in terms of their clinical implications.

Macrophage Exosomes Induce Placental Inflammatory Cytokines: A Novel Mode of Maternal-Placental Messaging.

During pregnancy, the placenta forms the interface between mother and fetus. Highly controlled regulation of trans-placental trafficking is therefore essential for the healthy development of the growing fetus. Extracellular vesicle-mediated transfer of protein and nucleic acids from the human placenta into the maternal circulation is well documented; the possibility that this trafficking is bi-directional has not yet been explored but could affect placental function and impact on the fetus.We hypothesized that the ability of the placenta to respond to maternal inflammatory signals is mediated by the interaction of maternal immune cell exosomes with placental trophoblast. Utilizing the BeWo cell line and whole placental explants, we demonstrated that the human placenta internalizes macrophage-derived exosomes in a time- and dose-dependent manner. This uptake was via clathrin-dependent endocytosis. Furthermore, macrophage exosomes induced release of proinflammatory cytokines by the placenta. Taken together, our data demonstrates that exosomes are actively transported into the human placenta and that exosomes from activated immune cells modulate placental cytokine production. This represents a novel mechanism by which immune cells can signal to the placental unit, potentially facilitating responses to maternal inflammation and infection, and thereby preventing harm to the fetus.

The Relationship of Maternal-Fetal Attachment and Postpartum Depression: A Longitudinal Study.

AIM: To determine the relationship between maternal-fetal attachment and postpartum depression. METHODS: This longitudinal study was done on 242 primiparous women in 2016. The data collection tools used included a socio-demographic characteristics questionnaire and Cranley's Maternal-Fetal Attachment Scale - which was completed at 32-37weeks of pregnancy - and obstetrics information questionnaire and the Edinburgh Postnatal Depression Scale -which was completed at 6-8weeks after birth. A multivariate linear regression was used to estimate the extent to which maternal-fetal attachment affected postpartum depression. RESULTS: The mean Maternal-Fetal Attachment score was 90.0 (SD: 10.3) from the attainable score of 23 to 115. The mean depression score was 8.0 (SD: 3.8) from the attainable score of 0 to 30. Pearson's correlation test showed a significant inverse relationship between maternal-fetal attachment and postpartum depression (r=-0.196, p<0.001). The multivariate linear regression model showed that postpartum depression correlated significantly with the mother's age and two dimensions of attachment including differentiation of self from fetus and attributing characteristics to the fetus. CONCLUSION: According to the findings, maternal-fetal attachment is one of the factors contributing to postpartum depression. Greater emphasis should be placed on the preparation of pregnant women for accepting their maternal role, so that the maternal-neonatal relationship can be enhanced and postpartum depression thus reduced.

Maternal attachment style during pregnancy and becoming a mother in Poland.

OBJECTIVE: This paper investigates the connections in pregnant women between their mother attachment style and their self-image as a mother, the image of their mother as a mother, and their bond with the unborn child. BACKGROUND: The relationship with one's mother plays a crucial role in the process of becoming a mother. It influences what a pregnant woman thinks about herself as a mother. This relationship is a predictor of the bond with the child during the pregnancy. METHODS: This research was participated in by 165 pregnant women. They completed the following: a modified version of the Experiences in Close Relationships (ECR) questionnaire, investigating a mother's attachment to her own mother; the Adjective Check List (ACL), developed by Gough and Heilbrun; the Maternal-Fetal Attachment Scale (MFAS); and a sociodemographic survey. RESULTS: A mother's attachment style is connected with the need for autonomy, as measured by the ACL, and with 'assuming a parental role' in the MFAS questionnaire. The strongest connection was found between a mother's attachment style and the image of one's own mother as a mother. Statistically-significant correlations were found for 32 of 37 scales on the ACL. CONCLUSION: Attachment style exerts influence upon a mother's self-image, the image of one's own mother as a mother and the bond with the unborn child.

The relationship between maternal-fetal attachment and maternal self-efficacy in Iranian women: a prospective study.

INTRODUCTION: This prospective study was conducted to determine the relationship between maternal-fetal attachment and maternal self-efficacy. Maternal self-efficacy contributes significantly to the mental health of the mother and infant. Maternal-fetal attachment facilitates maternal role attainment and might improve maternal self-efficacy. METHODS: This study was conducted on 242 women. The data collection tools used included a socio-demographic and obstetric questionnaire, Cranley's Maternal-Fetal Attachment Scale, the Edinburgh Postnatal Depression Scale and the Maternal Self-Efficacy Scale. A multivariate linear regression was used to estimate the extent to which maternal-fetal attachment affects maternal self-efficacy. RESULTS: Pearson's correlation test showed a moderate but significant positive correlation between maternal-fetal attachment and self-efficacy (r = 0.48, P < 0.001). The highest correlation with self-efficacy was observed in the domain of 'differentiation of self from fetus' (r = 0.43) and the lowest in the domain of 'giving of self' (r = 0.25). According to the multivariate linear regression, the domain of 'Interaction with fetus' had a significant relationship with maternal self-efficacy (P = 0.009). CONCLUSION: Maternal-fetal attachment would appear to be a factor related to postpartum maternal self-efficacy which suggests identifying and supporting women with low self-efficacy may increase maternal-fetal attachment and thereby maternal self-efficacy.

Daughters of Mothers Who Smoke: A Population-based Cohort Study of Maternal Prenatal Tobacco use and Subsequent Prenatal Smoking in Offspring.

BACKGROUND: Prenatal exposure to tobacco is associated with adverse health outcomes for the mother and child, and has been associated with an increased risk of tobacco smoking and nicotine dependence in offspring. The objective of this study was to examine the risk of prenatal smoking, among daughters, associated with maternal prenatal smoking. METHODS: We used a population-based cohort study design, with linked vital records data of mothers and daughters delivering 1984-96 and 1996-2013, respectively, in Washington State. The exposure of interest was mothers' prenatal smoking (any vs. no smoking at any time during pregnancy), while the outcome was daughters' prenatal smoking (similarly assessed). We used multivariable log-binomial regression to obtain estimates of the relative risk (RR) and 95% confidence interval (CI). RESULTS: Daughters exposed to maternal prenatal smoking were more likely to smoke during their pregnancy, compared to unexposed daughters (RR 1.78, 95% CI 1.72, 1.84, adjusted for the year the daughter delivered, her marital status and educational attainment, and the mothers' race/ethnicity). CONCLUSIONS: In this relatively young population, we found that daughters exposed to maternal prenatal smoking have an increased risk of smoking later on during their own pregnancy, emphasizing the importance of exposures during the prenatal period. The mechanisms leading to prenatal smoking are multifactorial and likely include behavioural, genetic, epigenetic and environmental factors. An understanding of this risk factor for prenatal smoking may guide health care providers to better target smoking cessation interventions to at-risk populations.

Maternal Bonding through Pregnancy and Postnatal: Findings from an Australian Longitudinal Study.

Background Mother-infant bonding provides the foundation for secure attachment through the lifespan and organizes many facets of infant social-emotional development, including later parenting. Aims To describe maternal bonding to offspring across the pregnancy and postnatal periods, and to examine a broad range of sociodemographic and psychosocial predictors of the maternal-offspring bond. Methods Data were drawn from a sample of 372 pregnant women participating in an Australian population-based longitudinal study of postnatal health and development. Participants completed maternal bonding questionnaires at each trimester and 8 weeks postnatal. Data were collected on a range of sociodemographic and psychosocial factors. Results Bonding increased significantly through pregnancy, in quality and intensity. Regression analyses indicated that stronger antenatal bonding at all time points (trimesters 1 through 3) predicted stronger postnatal bonding. Older maternal age, birth mother being born in a non-English speaking country, mother not working full time, being a first-time mother, breast-feeding problems, and baby's crying behavior all predicted poorer bonding at 8 weeks postpartum. Conclusion These novel findings have important implications for pregnant women and their infant offspring, and for health care professionals working in perinatal services. Importantly, interventions to strengthen maternal-fetal bonding would be beneficial during pregnancy to enhance postnatal bonding and infant health outcomes.

The Effect of Relaxation on Mother's Anxiety and Maternal-Fetal Attachment in Primiparous IVF Mothers.

OBJECTIVES: Infertility is one of the main stressful events of life and a crisis affecting various dimensions of infertile couples' lives. Relaxation, as a strategy, can be effective in the individuals' resistance to stress and anxiety. Therefore, the present study aimed to assess the effect of relaxation on mother's anxiety and maternal-fetal attachment in primiparous women who used In Vitro Fertilization (IVF) to get pregnant. METHODS: In this clinical trial, 80 primiparous women who had used IVF to get pregnant were randomly divided into a control and an intervention group. The intervention group took part in four 90-min relaxation classes in addition to receiving the routine pregnancy care. Anxiety and maternal-fetal attachment were evaluated before and one month after the intervention. Also, maternal-infantile attachment score was computed after delivery. The statistical analyses were performed using the SPSS statistical software. Chi-square and independent t-test was used to analyze the data. RESULTS: The results revealed no significant difference between the two groups regarding the mean scores of anxiety and attachment before the intervention. However, a significant difference was observed in this regard after the intervention (41.4 ± 4.1 vs. 51.0 ± 10.4, P < 0.01). CONCLUSION: The study results showed that relaxation training was effective in reduction of anxiety and increase of maternal-fetal attachment in the women who had used IVF to get pregnant. Although there are other methods for reducing anxiety, relaxing can be used for IVF women due to its ease of use and its wide acceptance.