Impact of the COVID-19 pandemic on maternal anxiety during pregnancy: A prevalence study / Impacto de la pandemia por COVID-19 en la ansiedad materna durante el embarazo: Un estudio de prevalencia

Aim: To assess the impact of the coronavirus SARS-CoV-2 pandemic on the level of anxiety in low-risk pregnant women. Material and method: Epidemiological, descriptive, prevalence study. A total of 74 patients who underwent low risk antenatal controls during the state of alarm because of COVID-19, were included. They filled in the Hamilton Anxiety Rating Scale and a specific document about the pandemic. Clinical histories and different variables of clinical interest were reviewed and compiled, respectively. Results: Mean age was 34.05 years with average amenorrhoea of 28.17 weeks. A total of 77% of the sample presented symptoms and signs compatible with anxiety. Of these, 44.6% and 32.4% presented minor and major anxiety, respectively. Concern over the time of the birth and postpartum and fear of being at greater risk because of possible infection was present in 95.9% and 94.6% of the sample, respectively. A total of 93.2% of the sample was afraid of intrauterine virus transmission; 94.5% admitted fear over the neonatal consequences of infection. Conclusions: The pregnant women assessed had three times more anxiety during the COVID-19 pandemic. This incidence is independent of most study variables.(AU)

Objetivo: Evaluar el impacto de la pandemia del coronavirus SARS-CoV-2 en el nivel de ansiedad en mujeres embarazadas de bajo riesgo. Material y método: Estudio epidemiológico, descriptivo, de prevalencia. Se incluyeron un total de 74 pacientes que se sometieron a controles prenatales de bajo riesgo durante el estado de alarma por COVID-19. Completaron la escala de calificación de ansiedad de Hamilton y un documento específico sobre la pandemia. Se revisaron y recopilaron historias clínicas y diferentes variables de interés clínico, respectivamente. Resultados: La edad promedio fue de 34,05 años con amenorrea promedio de 28,17 semanas. El 77% de la muestra presentó síntomas y signos compatibles con la ansiedad. De estos, el 44,6 y el 32,4% presentaron ansiedad menor y mayor, respectivamente. La preocupación por el momento del parto y el puerperio y el temor de presentar mayor riesgo por una posible infección estuvieron presentes en el 95,9 y 94,6% de la muestra, respectivamente. El 93,2% de la muestra temía una posible transmisión del virus intrauterino; el 94,5% admitió tener miedo a las consecuencias neonatales tras una posible infección. Conclusiones: Las embarazadas evaluadas tenían tres veces más ansiedad durante la pandemia de COVID-19. Esta incidencia es independiente de la mayoría de las variables de estudio.(AU)

Ansiedade materna e relação mãe-bebê: um estudo qualitativo / Maternal anxiety and mother-child relationship: a qualitative study / La ansiedad materna y la relación madre-hijo: un estudio cualitativo

A ansiedade materna é um tema relevante de pesquisa no âmbito da relação mãe-bebê, pois esse sentimento pode trazer repercussões para mãe e o desenvolvimento do bebê. Este estudo de casos múltiplos, de caráter qualitativo, teve como objetivo investigar a ansiedade materna em mães de bebês de seis a 10 meses, buscando identificar sua repercussão na díade mãe-bebê. Os achados demonstraram a presença de complicações na gravidez e no pós-parto e de eventos estressantes durante esses períodos. Em todos os casos analisados, observou-se ansiedade materna na gravidez e nos primeiros cuidados com o bebê. Sentimentos como medo, angústia, dúvidas e preocupações, relatados pelas mães, desencadearam comportamentos ansiosos, refletindo na relação mãe-bebê. A partir dos relatos deste estudo, observa-se a importância do apoio para o empoderamento das mães, para que elas assumam o papel materno com mais confiança. Salienta-se a necessidade de intervenções desde a gestação para o manejo da ansiedade materna, bem como práticas de educação em saúde visando à promoção da saúde mental materno-infantil

Maternal anxiety is an important topic of research regarding the mother-child relationship because this feeling can impact the mother and the baby's development. This qualitative study, of a multiple-case design, aimed to investigate maternal anxiety in mothers of babies aged between six and 10 months, trying to identify its impact on the mother-child dyad. The findings showed the occurrence of complications in pregnancy and the postpartum period and stressful events during these periods. In all analyzed cases, the presence of maternal anxiety during pregnancy and the newborn early care was verified. Feelings such as fear, anguish, doubts, and concerns, reported by mothers, triggered anxious behaviors, reflecting on the mother-baby relationship. From the reports of this study, the importance of support for the empowerment of mothers was observed, so that they can assume the maternal role with more confidence. It points out the need for intervention programs since pregnancy for the management of maternal anxiety, as well as health education practices aiming to promote maternal and child mental health.

La ansiedad materna es un tema relevante de investigación en el ámbito de la relación madre-hijo, ya que este sentimiento puede tener repercusiones en la madre y en el desarrollo del bebé. Este estudio cualitativo, de casos múltiples, investigó la ansiedad materna en madres de niños de seis a 10meses, buscando identificar su impacto en la díada madre-hijo. Los resultados revelaron la presencia de complicaciones en el embarazo y en el posparto, y de eventos estresantes durante estos momentos. En los casos analizados, se observó ansiedad materna durante el embarazo y en el cuidado temprano del bebé. Sentimientos como el miedo, la angustia, las dudas y las preocupaciones, relatados por las madres, desencadenaron comportamientos ansiosos, reflejándose en la relación madre-bebé. A partir de los informes de este estudio se observa la importancia del apoyo para el empoderamiento de las madres, para que asuman ese rol con más confianza. Son necesarias intervenciones desde el embarazo para el tratamiento de la ansiedad materna, así como prácticas de educación con la finalidad de promoción de la salud mental materna y infantil.

Longitudinal changes in attachment patterns of preterm infants born in a non-Western country.

Unexpected early birth of an infant may affect the attachment formation of mother-child dyads. This longitudinal study aimed to explore mother-infant attachment patterns of very preterm (VPT) and preterm (PT) infants compared to their term-born peers in a non-Western country. Neurodevelopmental outcomes of infants, maternal anxiety and depressive symptoms, and sociodemographic features were evaluated to explore their effects on attachment. Eighteen VPT, 11 PT, 11 term infants and their mothers participated. Observations of attachment patterns and neurodevelopmental assessments were performed at 18 and 24 months of corrected age. This study identified a change in attachment patterns of VPT infants over time such that VPT infants tended to have less insecure attachment patterns with their mothers at the end of the infancy period. While motor and language development scores were associated with attachment patterns at 18 months, models predicting attachment patterns were no longer significant at 24 months. Therefore, change in VPT infants' developmental outcomes and attachment patterns over time suggests that preterm birth itself is not necessarily a risk factor for developing insecure attachment patterns; yet, developmental delays may account for insecure attachment patterns. It is suggested that efforts to promote developmental outcomes of preterm infants may improve mother-child attachment.

El inesperado nacimiento prematuro de un infante pudiera afectar la formación de la afectividad de las díadas madre-niño. Este estudio longitudinal se propuso explorar los patrones de afectividad madre-infante de infantes nacidos muy prematuramente (VPT) e infantes prematuros (PT) comparados con sus compañeros nacidos dentro del término regular en un país no occidental. Se evaluaron los resultados de desarrollo neurológico de los infantes, la ansiedad y síntomas depresivos maternos, así como las características socio-demográficas, con el fin de explorar sus efectos sobre la afectividad. Dieciocho VPT 11 PT, 11 infantes nacidos dentro del término regular y sus madres participaron. Las observaciones de patrones de afectividad y evaluaciones de desarrollo neurológico se llevaron a cabo a los 18 y 24 meses de la edad corregida. Este estudio identificó un cambio en los patrones de afectividad de los infantes VPT a lo largo del tiempo, de tal manera que los infantes VPT tendieron a tener menos patrones de afectividad insegura con sus madres al final del período de infancia. Mientras que los puntajes de desarrollo motor y de lenguaje se asociaron con patrones de afectividad a los 18 meses, los modelos que predijeron los patrones de afectividad ya no eran significativos a los 24 meses. Por tanto, el cambio en los resultados de desarrollo de los infantes VPT y los patrones de afectividad a lo largo del tiempo sugieren que el nacimiento prematuro en sí no es necesariamente un factor de riesgo para desarrollar patrones de afectividad insegura, pero los retardos en el desarrollo pudieran ser responsables de patrones de afectividad insegura. Se sugiere que los esfuerzos para promover los resultados de desarrollo de infantes prematuros pudieran mejorar la afectividad madre-niño.

Unexpected early birth of an infant may affect the attachment formation of mother-child dyads. This longitudinal study aimed to explore mother-infant attachment patterns of very preterm (VPT) and preterm (PT) infants compared to their term-born peers in a non-Western country. Neurodevelopmental outcomes of infants, maternal anxiety and depressive symptoms, and socio-demographic features were evaluated to explore their effects on attachment. Eighteen VPT, 11 PT, 11 term infants and their mothers participated. Observations of attachment patterns and neurodevelopmental assessments were performed at 18 and 24 months of corrected age. This study identified a change in attachment patterns of VPT infants over time such that VPT infants tended to have less insecure attachment patterns with their mothers at the end of the infancy period. While motor and language development scores were associated with attachment patterns at 18 months, models predicting attachment patterns were no longer significant at 24 months. Therefore, change in VPT infants' developmental outcomes and attachment patterns over time suggests that preterm birth itself is not necessarily a risk factor for developing insecure attachment patterns; yet, developmental delays may account for insecure attachment patterns. It is suggested that efforts to promote developmental outcomes of preterm infants may improve mother-child attachment.

Ansiedade Materna e Problemas Comportamentais de Crianças com Fissura Labiopalatina / Maternal Anxiety and Behavioral Problems of Children with Cleft Lip and Palate / Ansiedad Materna y Problemas Conductuales de Niños con Fisura Labiopalatina

Resumo Indicadores emocionais maternos como a ansiedade têm sido considerados como condições de adversidade ao desenvolvimento infantil. São observadas peculiaridades e uma diversidade de achados em relação a problemas de comportamento e a outros distúrbios debilitantes em crianças ao longo do ciclo vital. O presente estudo objetivou identificar e associar indicadores clínicos para a ansiedade materna com os indicadores de problemas de comportamento (internalizantes e externalizantes) de 83 crianças com fissura labiopalatina, com idade entre três e cinco anos. Os instrumentos utilizados foram: protocolo de entrevista, Idate e CBCL. Os resultados apontaram que as crianças que convivem com mães com indicadores clínicos para ansiedade apresentaram prevalência de comportamentos internalizantes (p < 0,001) e externalizantes (p < 0,001). Para os meninos (37,5%) seriam identificados mais problemas de comportamento externalizantes enquanto que para as meninas (60,0%), mais problemas de comportamento internalizantes. Das mães identificadas com ansiedade avaliaram suas crianças como clínicas em problemas externalizantes (p = 0,020 e < 0,001). Considera-se que tais dados podem contribuir para o planejamento de ações preventivas e interventivas, de modo a favorecer o suporte psicológico para as mães que apresentam indicadores clínicos para ansiedade, assim como propor medidas para os problemas comportamentais das crianças que convivem com mães ansiosas....(AU)

Abstract Maternal emotional indicators such as anxiety have been considered as conditions of adversity to child development, and peculiarities and diversity of findings have been observed in relation to behavioral problems and other debilitating disorders in children across the life cycle. The present study aimed to identify and associate clinical indicators for maternal anxiety along with indicators of behavioral problems (internalizing and externalizing) of 83 children with cleft lip and palate, aged between three and five years old. The instruments used were: Interview Protocol, IDATE and CBCL. The results indicated that children who live with mothers with clinical indicators for anxiety showed prevalence of internalizing (p < 0.001) and externalizing (p < 0.001) behaviors; in boys (37.5%) were identified more externalizing behavioral problems while in girls (60.0%) were identified more internalizing behavioral problems. Children with mothers identified with anxiety were evaluated as clinical in externalizing problems (p = 0.020 e < 0.001). It is considered that such data can contribute to the planning of preventive and interventional actions, in order to promote psychological support for mothers who have clinical indicators for anxiety, and to propose measures for the behavioral problems of children living with anxious mothers....(AU)

Resumen Indicadores emocionales maternos como la ansiedad han sido considerados como condiciones adversas al desarrollo infantil, observándose peculiaridades y resultados con relación a problemas de conducta y a otros disturbios debilitantes en niños a lo largo del ciclo vital. El presente estudio tuvo como objetivo identificar y asociar indicadores clínicos de ansiedad materna con los indicadores de problemas de comportamiento (internalizantes y externalizantes) de 83 niños con fisura labio-palatina, con edades entre tres y cinco años. Los instrumentos utilizados fueron: protocolo de entrevista, Idate y CBCL. Los resultados señalaron que los niños que conviven con madres con indicadores clínicos de ansiedad presentaron prevalencia de conductas internalizantes (p < 0,001) y externalizantes (p < 0,001), siendo que para los varones (37,5%) serían identificados más problemas de comportamientos externalizantes y para las niñas (60,0%) más problemas de comportamientos internalizantes. Las madres identificadas con ansiedad evaluaron a sus niños como clínicos en problemas externalizantes (p = 0,020 e < 0,001). Consideramos que estos datos pueden contribuir para el planeamiento de acciones de prevención e intervención con la finalidad de favorecer el apoyo psicológico a las madres que presentaron indicadores clínicos de ansiedad, así como para proponer medidas para los problemas de conducta de los niños que viven con madres ansiosas....(AU)

ANXIETY AND DEPRESSION DURING PREGNANCY AND TEMPERAMENT IN EARLY INFANCY: FINDINGS FROM A MULTI-ETHNIC, ASIAN, PROSPECTIVE BIRTH COHORT STUDY.

Maternal antenatal mood is associated with negative infant temperament. This link has not been substantiated in Asian populations. We evaluated the association between antenatal maternal mood and infant temperament among Asian mother-infant pairs. Antenatal maternal depression and anxiety were assessed using the Edinburgh Postnatal Depression Scale (J. Cox, J. Holden, & R. Sagovsky, 1987) and the State-Trait Anxiety Inventory (C. Spielberger, R. Gorsuch, R. Lushene, P. Vagg, & G. Jacobs, 1983), respectively, at 26 weeks of pregnancy and 3 months' postnatally. Infant temperament was evaluated with the Early Infant Temperament Questionnaire (B. Medoff-Cooper, W.B. Carey, & S.C. McDevitt, 1993) at 3 months. Factor analysis was performed to extract culturally relevant categories of temperamental traits. Linear regression was performed to examine the influences of antenatal maternal mood on the factor-model-derived infant temperament. Of the 609 mothers, 11% met risk criteria for depression, 17% for state-anxiety, and 19% for trait-anxiety during pregnancy. Factor analysis yielded three infant temperament factors: Emotionality and Attentional Regulation, Sensory Reactivity, and Regularity and Motor Expression, Cronbach's αs = 0.613, 0.712, and 0.752, respectively. Maternal antenatal state-anxiety, p < .001, and trait anxiety, p = .005, were associated with negative emotionality and poor attentional regulation, especially among Chinese, whereas depression was not, p = .090. There was an association between maternal antenatal anxiety and negative infant temperamental traits in this Asian sample.

PREDICTORS OF EMOTIONAL AND BEHAVIORAL PROBLEMS IN 1-YEAR-OLD CHILDREN: A LONGITUDINAL PERSPECTIVE.

Emotional and behavioral problems at an early age can reasonably be considered a high-risk factor for later mental health disorders. The aim of the article is to reveal predictive factors of 1½-year-old children's emotional and behavioral problems. The study was a part of a prospective birth-cohort study. The study sample consisted of 172 full-term infants (born during Gestational Weeks 37-42) and their mothers. Emotional and behavioral problems at the age of 1½ years were measured using the Child Behavior Checklist for Ages 1½-5 (T. Achenbach & L. Rescorla, 2000), which was completed by mothers. Emotional and behavioral problems at age of 1½ years were more prevalent in infants born via cesarean section, as compared to infants born vaginally without administration of medication. Newborns' suboptimal functioning after birth, complicated emotional acceptance of pregnancy, a couple's nonsatisfactory relationship during pregnancy, maternal distress during pregnancy and in the first months after childbirth, and inflexible and parent-oriented attitudes toward infant-rearing also predicted children's emotional and behavioral problems independent of sociodemographic factors. Results suggest that biomedical and psychosocial factors which manifest themselves in the prenatal and perinatal periods can have associations with later infant and child mental health.