Efectividad audiovisual del monitoreo independiente del bienestar fetal sobre el apego materno-fetal y los resultados del parto / Audiovisual Effectiveness of Independent Fetal Well-being Monitoring on Mother-Fetus Attachment and Birth Outcomes

Introducción: El vínculo madre-feto juega un papel importante en la atención del embarazo, impactando los resultados del nacimiento. El monitoreo del movimiento fetal es una competencia fundamental para que las mujeres embarazadas lo hagan de manera independiente. Objetivo: Producir monitoreo audiovisual del movimiento fetal independiente y probar su efectividad en el apego materno-fetal y los resultados del parto. Métodos: La etapa I, desarrollo de Monitoreo de Bienestar Fetal Audiovisual, con estudio de literatura, etapas, desarrollo de escenarios, creación de audiovisuales, prueba de validez de expertos. La etapa 2 probó la efectividad de los medios audiovisuales sobre el apego materno-fetal con el instrumento Inventario de Apego Prenatal y los resultados del nacimiento a partir del peso del bebé al nacer. Diseño de un verdadero enfoque experimental de grupo de control pretest-postest. Muestras de mujeres embarazadas con antecedentes de atención prenatal en el Centro de Salud Kasihan II, Bantul, Yogyakarta, Indonesia con los siguientes criterios: embarazo único, normal, edad gestacional de 28 a 36 semanas. Los encuestados de 60 sujetos se dividieron en grupos experimentales y de control. Los datos normales se probaron mediante la prueba t pareada, la prueba t independiente y MANOVA. Resultados: Puntaje de prueba de validez de experto en contenido 81% muy válido, puntaje de validez de experto en medios 80.33%, válido. La aplicación audiovisual mostró los resultados de la prueba t pareada, tanto en el grupo experimental como en el control hubo diferencias en el pretest y postest, P<0.05. La prueba t de muestra independiente P < 0,05 y los resultados MANOVA simultáneos mostraron una puntuación de apego materno-fetal y un resultado del nacimiento P < 0,05 (AU)

Introduction: The mother-fetus bond plays an important role in pregnancy care, impacting birth outcomes. Monitoring fetal movement is a fundamental competence for pregnant women to do independently. Objective: to produce audiovisual monitoring of independent fetal movement and prove its effectiveness on maternal-fetal attachment and birth outcomes. Methods: Phase I, developing Audiovisual Fetal Well-being Monitoring, with literature study steps, developing scenarios, creating audiovisuals, testing the validity of experts. Stage 2 tested the effectiveness of audiovisual media on maternal-fetal attachment with the Prenatal Attachment Inventory instrument and birth outcomes from infant birth weight. Design of true experimental pretest-posttest control group approach. Samples of pregnant women with a history of antenatal care at the Kasihan II Health Center, Bantul, Yogyakarta, Indonesia with the following criteria: single pregnancy, normal, gestational age 28-36 weeks. Respondents of 60 subjects were divided into experimental and control groups. Normal data were tested by paired t test, independent t-test and MANOVA. Results: Content expert validity test score 81% very valid, media expert validity score 80.33%, valid. The audiovisual application showed the results of the paired t-test, both in the experimental and control groups there were differences in pretest and posttest, P <0.05. Independent sample t-test P < 0.05 and simultaneous MANOVA results showed maternal-fetal attachment score and birth outcome P < 0.05. Conclusion: Independent monitoring of fetal well-being using audiovisual media simultaneously affects the increase in maternal-fetal attachment scores and birth outcomes so it is recommended that second trimester pregnant women be taught techniques for counting fetal movements and practicing them routinely (AU)

Una psicoterapia centrada en la parentalidad para tratar la psicopatología perinatal, sostener el vínculo madre-bebé y prevenir los trastornos en el niño / A psychotherapy focused on parenting to treat perinatal psychopathology, to support the mother-baby bond and to prevent disorders in the child

El embarazo y el año que sigue al parto son los períodos de la vida más propiciospara la emergencia de trastornos psicológicos en la mujer. Las consecuencias pueden convertirse en dramáticas paraella, para el vínculo con su hijo y para el desarrollo somático, social y psíquico de este último. Este artículo muestrapor qué es importante cuidar la dimensión psíquica de la parentalidad para un tratamiento eficaz de estos trastornos,a fin de que los efectos terapéuticos beneficien a la vez a la mujer, al vínculo madre-bebé y al niño. Se propone unmodelo de psicoterapia breve centrada en la parentalidad que permite intervenir desde el embarazo y luego incluir elniño en el posparto.(AU)

The pregnancy and first year following childbirth are the most conduciveperiods of life for the emergence of psychological disorders in women. The consequences can be dramatic forthem, for the bond with their child and for the child’s somatic, social and psychological development. This articleshows why it is important to take care of the psychic dimension of parenthood for an effective treatment ofthese disorders, so that the therapeutic effects benefit at the same time the woman, the mother-baby bondand the child. A model of brief psychotherapy focused on parentality is proposed, which allows to intervenefrom pregnancy and then to include the child in the postpartum period.(AU)

L’embaràs i l’any que segueix al part són els períodes de la vida més propicisper a l’emergència de trastorns psicològics en la dona. Les conseqüències poden esdevenir dramàtiques per aella, per al vincle amb el seu fill i per al desenvolupament somàtic, social i psíquic d’aquest. Aquest article mostraper què és important tenir cura de la dimensió psíquica de la parentalitat per a un tractament eficaç d’aqueststrastorns, per tal que els efectes terapèutics beneficiïn al mateix temps la dona, el vincle mare-nadó i el nen. Esproposa un model de psicoteràpia breu centrada en la parentalitat que permet intervenir des de l’embaràs idesprés incloure el nen al postpart.(AU)

El abordaje perinatal interdisciplinar desde Atención Primaria de Salud (APS): el desarrollo de una atención bio-psico-social integrada / The interdisciplinary perinatal approach from Primary Health Care (PHC): the development of an integrated bio-psycho-social care

El Equipo de Atención Primaria (EAP) Roquetes-Canteres de Barcelona se plantea, en el marcode investigación impulsada por Bruc Salut (equipo psicoterapéutico), una intervención bio-psico-social integrada. Eneste artículo se describe la investigación desde su inicio y los diferentes programas que se están llevando a cabo desde2014 con un recorrido por todos los programas desarrollados. Se explica detenidamente cómo se han creado, llevadoa cabo, evaluado y su funcionamiento actual, gracias al trabajo coordinado del equipo interdisciplinar para atenderlos aspectos emocionales de la parentalidad, el establecimiento del vínculo y el buen desarrollo del bebé, así como lasensibilización y contención de los profesionales del equipo. Finalmente, se define la figura del profesional sanitariode enlace del EAP, que se ha creado para coordinar y guiar el equipo y fomentar la mirada bio-psico-social entre losprofesionales, vital para evitar una visión fragmentada de las familias.(AU)

The Primary Health Care Team (EAP) Roquetes-Canteres in Barcelona is considering, within theresearch framework promoted by Bruc Salut (a psychotherapeutic team), an integrated bio-psycho-social intervention.This article describes the research since its beginning and the different programmes that are being carried out since2014 with a tour of all the developed programmes. It explains thoroughly how they have been created, carried out,evaluated and their current operation, thanks to the coordinated work of the interdisciplinary team to address theemotional aspects of parenthood, the establishment of the bond and the good development of the baby, as well asthe awareness and self-restraint of the team professionals. Finally, the figure of the EAP liaison health professional isdefined, which has been created to coordinate and guide the team and to promote the bio-psycho-social view amongthe professionals, vital to avoid a fragmented view of the families.(AU)

L’Equip d’Atenció Primària (EAP) Roquetes-Canteres de Barcelona es planteja,en el marc de la investigació impulsada per Bruc Salut (equip psicoterapèutic), una intervenció biopsicosocialintegrada. En aquest article es descriuen la investigació des de l’inici i els diferents programes que s’estan duenta terme des de 2014 amb un recorregut per tots els programes desenvolupats. S’explica detingudament coms’han creat, dut a terme, avaluat i el funcionament actual, gràcies al treball coordinat de l’equip interdisciplinariper atendre els aspectes emocionals de la parentalitat, l’establiment del vincle, el bon desenvolupament del nadói també la sensibilització i contenció dels professionals de l’equip. Finalment, es defineix la figura del professionalsanitari d’enllaç de l’EAP, que s’ha creat per coordinar i guiar l’equip i fomentar la mirada biopsicosocial entreels professionals, vital per evitar una visió fragmentada de les famílies.(AU)

Trastornos del vínculo con origen en la etapa perinatal. Contribuciones del psicoanálisis y la neurociencia / Bonding disorders starting in the perinatal stage. Contributions of psychoanalysis and neuroscience

Sepresentan en este artículo dos casos atendidos en un centro de salud mental infanto-juvenil (CSMIJ) en los cuales elvínculo materno filial está gravemente comprometido desde etapas prenatales. Tanto desde aportes psicoanalíticoscomo de estudios neurocientíficos actuales, se expone cómo el periodo perinatal es clave para que el bebé puedaconstruir una base emocional sana que repercutirá en su desarrollo posterior. Se subraya la importancia de destinarrecursos a la intervención precoz en mujeres gestantes o en periodo de puerperio que puedan presentar dificultadesemocionales, para fortalecer el vínculo con sus hijos e hijas y prevenir una mayor tendencia a problemas de saludmental en estos.(AU)

Thisarticle presents two cases attended in a child and adolescent mental health center (CSMIJ) in which thematernal-filial bond is severely compromised since prenatal stages. Both psychoanalytical contributions andcurrent neuroscientific studies show how the perinatal period is key for the baby to build a healthy emotionalbase that will have repercussions on its later development. The importance of allocating resources to earlyintervention in pregnant or postpartum women who may present emotional difficulties is emphasized, in orderto strengthen the bond with their children and prevent a greater tendency to mental health problems in them.(AU)

Espresenten en aquest article dos casos atesos en un centre de salut mental infantil i juvenil (CSMIJ) en què el vinclematernofilial està greument compromès des d’etapes prenatals. Tant des d’aportacions psicoanalítiques comd’estudis neurocientífics actuals, s’exposa com el període perinatal és clau perquè el nadó pugui construir unabase emocional sana que repercutirà en el desenvolupament posterior. Se subratlla la importància de destinarrecursos a la intervenció precoç en dones gestants o en període de puerperi que puguin presentar dificultatsemocionals, per enfortir el vincle amb els seus fills i filles i prevenir una tendència més gran a problemes de salutmental en aquests.(AU)

Spatial multiomics map of trophoblast development in early pregnancy.

The relationship between the human placenta-the extraembryonic organ made by the fetus, and the decidua-the mucosal layer of the uterus, is essential to nurture and protect the fetus during pregnancy. Extravillous trophoblast cells (EVTs) derived from placental villi infiltrate the decidua, transforming the maternal arteries into high-conductance vessels1. Defects in trophoblast invasion and arterial transformation established during early pregnancy underlie common pregnancy disorders such as pre-eclampsia2. Here we have generated a spatially resolved multiomics single-cell atlas of the entire human maternal-fetal interface including the myometrium, which enables us to resolve the full trajectory of trophoblast differentiation. We have used this cellular map to infer the possible transcription factors mediating EVT invasion and show that they are preserved in in vitro models of EVT differentiation from primary trophoblast organoids3,4 and trophoblast stem cells5. We define the transcriptomes of the final cell states of trophoblast invasion: placental bed giant cells (fused multinucleated EVTs) and endovascular EVTs (which form plugs inside the maternal arteries). We predict the cell-cell communication events contributing to trophoblast invasion and placental bed giant cell formation, and model the dual role of interstitial EVTs and endovascular EVTs in mediating arterial transformation during early pregnancy. Together, our data provide a comprehensive analysis of postimplantation trophoblast differentiation that can be used to inform the design of experimental models of the human placenta in early pregnancy.

Avaliação do crescimento e desenvolvimento infantil e fatores de risco de um município que integra uma universidade brasileira de cunho internacional / Evaluation of childhood growth and development and risk factors of a municipality that is part of an international brazilian university / Evaluación de los factores de crecimiento y desarrollo infantil y de riesgo de un municipio que forma parte de una universidad brasileña internacional

Fatores de risco, incluindo os de cunho materno, interferem no crescimento e desenvolvimento infantil. Nesse sentido, o conhecimento desses fatores e avaliação ade- quada desses processos são necessários para articulação de estratégias preventivas de transtornos futuros. Assim, o estudo visou investigar o crescimento e desenvolvimento de crianças atendidas em consulta de puericultura em unidades básicas de saúde de um mu- nicípio cearense, que integra uma universidade brasileira de cunho internacional, e seus fatores de risco. Trata-se de estudo observacional, analítico, transversal e de abordagem quantitativa, conduzido com crianças e suas mães no Centro de Saúde de Acarape e Posto de Saúde São Benedito (Acarape ­ CE), no período de fevereiro a julho de 2021. Após consentimento, as mães preencheram um questionário, seguido de avaliação do cresci- mento e desenvolvimento das crianças. Os dados obtidos foram analisados. Das 70 crian- ças, 50,00% (n = 17) e 51,43% (n = 18) dos meninos e meninas tinham baixa estatura para idade, respectivamente. Para o desenvolvimento psicossocial, dos 284 testes condu- zidos, 86,27% (n = 245) foram realizados em plenitude pelas crianças. Observou-se as- sociação significativa entre a gestante ter concebido o filho com, no mínimo, 9 meses de período gestacional e esse apresentar relação Peso/Idade adequada e Estatura/Idade ina- dequada. Houve associação significativa entre a criança não ingerir refresco em pó e apre- sentar relação Peso/Idade adequada. Conclui-se que as crianças tinham idade gestacional adequada e apresentavam estado nutricional apropriado, apesar da baixa estatura para idade. Manifestavam desenvolvimento psicossocial, de linguagem e físico normais. Sobre os fatores de risco, esses envolveram os de cunho materno e o consumo de alimentos cariogênicos.

Risk factors, including maternal ones, interfere with child growth and de- velopment. In this sense, knowledge of these factors and adequate evaluation of these processes are necessary to articulate preventive strategies for future disorders. Thus, the study aimed to investigate the growth and development of children seen in childcare con- sultations in primary health units in Ceará, part of a Brazilian university of international character, and their risk factors. This is an observational, analytical, cross-sectional study with a quantitative approach, conducted with children and their mothers at the Acarape Health Center and São Benedito Health Center (Acarape ­ CE), from February to July 2021. After consent, the mothers completed a questionnaire, followed by an assessment of the children's growth and development. The data obtained were analyzed. Of the 70 children, 50.00% (n = 17) and 51.43% (n = 18) of the boys and girls were short for their age, respectively. Of the 284 tests conducted for psychosocial development, 86.27% (n = 245) were entirely performed by the children. A significant association was observed between the pregnant woman having conceived her child at least nine months of gestation and having an adequate Weight/Age and Height/Age ratio. There was a significant asso- ciation between the child not ingesting powdered soft drinks and having an appropriate Weight/Age ratio. It was concluded that the children had an adequate gestational age and had an appropriate nutritional status, despite their low height for their age. They showed normal psychosocial, language, and physical development. The risk factors involved those of mother nature and the consumption of cariogenic foods.

Los factores de riesgo, incluidos los maternos, interfieren en el crecimiento y desarrollo infantil. En este sentido, el conocimiento de estos factores y la evaluación adecuada de estos procesos son necesarios para articular estrategias preventivas de futu- ros trastornos. Así, el estudio tuvo como objetivo investigar el crecimiento y desarrollo de niños atendidos en consultas de puericultura en unidades básicas de salud de un muni- cipio de Ceará, que forma parte de una universidad brasileña de carácter internacional, y sus factores de riesgo. Se trata de un estudio observacional, analítico, transversal, con enfoque cuantitativo, realizado con niños y sus madres en el Centro de Salud de Acarape y el Centro de Salud São Benedito (Acarape ­ CE), de febrero a julio de 2021. Después del consentimiento, las madres completaron un cuestionario, seguido de una evaluación del crecimiento y desarrollo de los niños. Los datos obtenidos fueron analizados. De los 70 niños, el 50,00% (n = 17) y el 51,43% (n = 18) de los niños y niñas eran bajos para su edad, respectivamente. Para el desarrollo psicosocial, de las 284 pruebas realizadas, el 86,27% (n = 245) fueron realizadas íntegramente por los niños. Se observó una asociación significativa entre la gestante haber concebido a su hijo con al menos 9 meses de gesta- ción y tener una adecuada relación Peso/Edad y Talla/Edad. Hubo asociación significativa entre el niño que no ingiere gaseosas en polvo y presentar una adecuada relación Peso/Edad. Se concluyó que los niños tenían una edad gestacional adecuada y un estado nutricional adecuado, a pesar de su baja talla para su edad. Presentaron un desarrollo psi- cosocial, lingüístico y físico normal. En cuanto a los factores de riesgo, estos involucraron los de naturaleza materna y el consumo de alimentos cariogénicos.

Which social, gestational and mental health aspects are associated to maternal-fetal attachment? / Quais aspectos sociais, gestacionais e de saúde mental materna estão associados ao apego materno-fetal?

Abstract Objectives: this study aimed to explore a set of factors associated with lower maternal-fetal attachment (MFA) in pregnant women. Methods: this is a cross-sectional study corresponding to the second wave of a cohort study with a population-based sample of pregnant women in the South of Brazil. The maternal-fetal attachment scale (MFAS) was used to measure MFA. Bivariate analysis was performed using the t-test and ANOVA. The variables that presented p<0.20 were taken for multivariate analysis, through linear regression, in order to control possible confounding factors. Results: a total of 840 pregnant women were included. Pregnant women who had lower MFA means were those who did not live with a partner (B=-3.8 [CI95%=-6.0; -1.7]), those between the first and second trimester of pregnancy (B=-4.3 [CI95%=-5.9; -2.6]), those who did not have support from their mother during pregnancy (B=-2.4 [CI95%=-4.6; -0.2]), and those with depressive symptoms (B=-4.9 [CI95%=-7.4; -2.5]). Conclusions: the results showed that a higher MFA it is associated with an adequate support network during pregnancy, better maternal mental health, and with an advanced pregnancy. Early evaluation of MFA and effort to promote an adequate prenatal bond, focusing on maternal psychological and emotional aspects are strongly suggested.

Resumo Objetivos: explorar um conjunto de fatores associados ao menor apego materno-fetal (AMF) em gestantes. Métodos: trata-se de um estudo transversal, correspondente à segunda fase de um estudo de coorte com uma amostra de base populacional de gestantes no sul do Brasil. Foi utilizada a Escala de Apego Materno-Fetal (EAMF) para medir o AMF. A análise bivariada foi realizada através do teste t e ANOVA. As variáveis que apresentaram p<0,20 foram levadas para análise multivariada, por meio de regressão linear, a fim de controlar possíveis fatores de confusão. Resultados: foram incluídas 840 gestantes. As gestantes que apresentaram menores médias de AMF foram aquelas que não moravam com um companheiro (B=-3,8 [IC95%=-6,0; -1,7]), que estavam entre o primeiro e o segundo trimestre de gestação (B=-4,3 [IC95%=-5,9; -2,6]), que não tiveram o apoio da mãe durante a gestação (B=-2,4 [IC95%=-4,6; -0,2]) e que apresentaram sintomas depressivos (B=-4,9 [IC95%=-7,4; -2,5]). Conclusões: os resultados mostraram que um maior AMF está associado a presença de uma rede de apoio adequada na gravidez, melhor saúde mental materna e a uma gestação avançada. A avaliação precoce do AMF e a promoção de um vínculo pré-natal adequado, com foco nos aspectos psicológicos e emocionais maternos são fortemente sugeridos.

The structure and correlates of the 20-item Maternal-Fetal Attachment Scale in a population-based sample of Hungarian expectant women.

OBJECTIVE: This study aimed at analysing the structure and reliability of the modified, 20-item Hungarian version of the Maternal-Fetal Attachment Scale (MFAS-HU-20), and to investigate its associations with certain demographic, pregnancy-related and psychosocial characteristics. DESIGN: A socio-demographically diverse sample of Hungarian women completed interviews in middle or late pregnancy, as part of the countrywide Cohort '18 Growing Up in Hungary study. SETTING: Data collection was carried out by local health visitors either at the family home or at the health visitor's office. PARTICIPANTS: In total, 7,315 pregnant women were included in the study; they were aged between 13 and 49, and had a mean gestational age of 30 weeks. MEASUREMENTS: In addition to the MFAS-HU-20, other paper-and-pencil scales were applied to measure perceived social support, partnership interactions, depressive and generalized anxiety symptoms, and pregnancy-related anxiety. Socio-demographic and pregnancy-related data were collected through personal interviews. FINDINGS: Exploratory and confirmatory factor analyses supported an oblique two-factor model, consisting of factors that were renamed 'Attunement' and 'Interaction'. Cronbach's alphas for these two subscales confirmed their adequate internal consistency. The age of the expectant women, their partnership status, level of education, equivalized household income and parity all had a small effect on their bonding, while gestational age and multiple pregnancy had no meaningful impact on prenatal attachment in the present study. The psychosocial characteristics of the pregnant women were weakly associated with their attachment to the fetus, regardless of the mother's level of education. CONCLUSIONS: This study suggests a two-factor structure of maternal-fetal attachment that reflects the distinction between the mental and behavioural aspects of this relationship. Socio-demographic background and psychosocial characteristics have a small impact on women's attachment to their fetus. IMPLICATIONS FOR PRACTICE: The MFAS-HU-20 seems to be a reliable and valid scale that could be utilized in prenatal research and pregnancy care. Its correlates highlight the importance of interventions aimed at providing social support for pregnant women.

Apego materno-fetal e transtornos psiquiátricos em gestantes com fetos malformados / Maternal-fetal attachment and psychiatric disorders in pregnant women with malformed fetuses

OBJETIVO: Determinar a prevalência e os fatores associados aos sintomas de ansiedade e depressão e ao apego materno-fetal em gestantes com diagnóstico de malformações congênitas. MÉTODOS: Estudo prospectivo de corte transversal realizado durante o período de dezembro/2019 a março/2020. Foram incluídas 77 gestantes com diagnóstico de malformação fetal atendidas no Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) e excluídas aquelas < 18 anos e as que sabiam o diagnóstico da malformação há menos de três semanas. Aplicou-se um questionário com variáveis sociodemográficas e clínicas, além da Escala Hospitalar de Ansiedade e Depressão e da Escala de Apego Materno-Fetal. Para análise estatística, foi aplicado o modelo de regressão logística multivariado com nível de significância de 5%. RESULTADOS: Entre as gestantes, 46,8% possuíam sintomas ansiosos e 39%, depressivos, sendo o apego materno-fetal médio em 54,5% e alto em 45,5%. Antecedentes de ansiedade e depressão e não possuir religião foram associados a maior risco de sintomas de ansiedade e depressão, e saber da malformação há ≥ 10 semanas associou-se apenas ao risco de ansiedade e ter gestação múltipla associou-se apenas ao risco de depressão. O apego materno-fetal não foi associado a ansiedade ou depressão. CONCLUSÃO: Observou-se alta prevalência de sintomas ansiosos e depressivos em gestantes com fetos malformados, além da presença de apego materno-fetal médio/alto em todas pacientes, porém sem associação com os transtornos psiquiátricos estudados. Diante disso, urge a necessidade da criação de novas linhas de cuidado voltadas à saúde mental dessas mulheres.

OBJECTIVE: To determine the prevalence and factors associated with anxiety and depression symptoms and maternal-fetal attachment in pregnant women diagnosed with congenital malformations. METHODS: Prospective cross-sectional study conducted from December/2019 to March/2020. Seventy-seven managers with a diagnosis of fetal malformation attended at the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) and those under 18 years of age who did not know the diagnosis of malformation in less than 3 weeks were excluded. Applicable to a questionnaire with clinical and sociodemographic variables, in addition to the Hospital Anxiety and Depression Scale and Maternal- -Fetal Attachment Scale. For statistical analysis, the multivariate logistic regression model was applied with a 5% significance level. RESULTS: Among pregnant women, 46.8% had anxiety symptoms and 39% depressive symptoms, with average maternal-fetal attachment at 54.5% and high at 45.5%. History of anxiety and depression and cannot use religion have been associated with an increased risk of anxiety and depression, whereas malformation saber for ≥ 10 weeks, associated only with risk of anxiety and multiple pregnancy only in depression. Maternal-fetal attachment was not associated with anxiety or depression. CONCLUSION: If there is a high prevalence of anxious and depressive symptoms in pregnant women with malformed fetuses, in addition to the presence of medium maternal-fetal/high attachment in all patients, with no association with the studied psychiatric disorders. Therefore, request the creation of new lines of care aimed at the mental health of these 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 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.

Abbreviated Version of the Maternal-Fetal Attachment Scale: Evidence of Validity and Reliability / Versão Abreviada da Escala de Apego Materno-Fetal: Evidências de Validade e Confiabilidade / Versión Corta de la Maternal Fetal Attachment Scale: Evidencia de Validez y Fiabilidad

Abstract The Maternal-Fetal Attachment Scale has been widely applied in research on the subject. There are no known studies that have validated a shortened version of this instrument in Brazil. This study aimed to propose a shortened version of the Maternal-Fetal Attachment Scale and examine its evidence of validity and reliability. This methodological study was carried out on a sample of 937 pregnant women in the Primary Health Care of Montes Claros, Minas Gerais - Brazil. Construct validity and reliability were measured. A trifactor version with 15 items was obtained, which presented satisfactory adjustment indexes. Convergent and discriminant validities were close to the recommended ones. The scale differentiated attachment scores according to different sample characteristics. Internal consistency (Cronbach's α = 0.878) and composite reliability (> 0.70) were appropriate. The abbreviated Brazilian version of the Maternal-Fetal Attachment Scale presented satisfactory psychometric attributes for application to pregnant women in Primary Health Care.

Resumo A Escala de Apego Materno-Fetal tem sido amplamente aplicada em pesquisas sobre a temática. Desconhecem-se investigações sobre a validade de uma versão reduzida desse instrumento no Brasil. Este estudo teve por objetivo propor uma versão abreviada da Escala de Apego Materno-Fetal e examinar suas evidências de validade e confiabilidade. Trata-se de um estudo metodológico, realizado com uma amostra de 937 gestantes no âmbito da Atenção Primária à Saúde de Montes Claros, Minas Gerais - Brasil. Obteve-se uma versão trifatorial com 15 itens, que apresentou índices satisfatórios de ajuste. As validades convergente e discriminante foram próximas do recomendado. A escala diferenciou os escores de apego segundo diferentes características da amostra. A consistência interna (α de Cronbach = 0,878) e a confiabilidade composta (> 0,70) foram apropriadas. A versão brasileira abreviada da Escala de Apego Materno-Fetal apresentou atributos psicométricos satisfatórios para aplicação a gestantes na Atenção Primária à Saúde.

Resumen La Maternal Fetal Attachment Scale es ampliamente aplicada en estudios sobre la temática. No existen investigaciones sobre la validez de una versión corta de este instrumento en Brasil. Se pretende proponer una versión corta de esta escala y examinar su validez y fiabilidad. Estudio metodológico, realizado en la Atención Primaria de Salud de Montes Claros, Minas Gerais - Brasil en una muestra de 937 mujeres embarazadas. Se midieron la validez y la fiabilidad del constructo. Se obtuvo una versión de tres factores, con 15 ítems, e índices de ajuste satisfactorios. La validez convergente y discriminante se acercó a lo recomendado. La escala diferenció las puntuaciones de vinculación según las distintas características de la muestra. La consistencia interna (α de Cronbach = 0,878) y la fiabilidad compuesta (> 0,70) fueron adecuadas. La versión corta de Maternal Fetal Attachment Scale para Brasil presentó atributos psicométricos satisfactorios para aplicarse a gestantes en Atención Primaria de Salud.

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.

Estrogens Regulate Placental Angiogenesis in Horses.

A sufficient vascular network within the feto-maternal interface is necessary for placental function. Several pregnancy abnormalities have been associated with abnormal vascular formations in the placenta. We hypothesized that growth and expansion of the placental vascular network in the equine (Equus caballus) placenta is regulated by estrogens (estrogen family hormones), a hormone with a high circulating concentration during equine gestation. Administration of letrozole, a potent and specific inhibitor of aromatase, during the first trimester (D30 to D118), decreased circulatory estrone sulfate concentrations, increased circulatory testosterone and androstenedione concentrations, and tended to reduce the weight of the fetus (p < 0.1). Moreover, the gene expression of CYP17A1 was increased, and the expression of androgen receptor was decreased in the D120 chorioallantois (CA) of letrozole-treated mares in comparison to that of the control mares. We also found that at D120, the number of vessels tended to decrease in the CAs with letrozole treatment (p = 0.07). In addition, expression of a subset of angiogenic genes, such as ANGPT1, VEGF, and NOS2, were altered in the CAs of letrozole-treated mares. We further demonstrated that 17ß-estradiol increases the expression of ANGPT1 and VEGF and increases the angiogenic activity of equine endothelial cells in vitro. Our results from the estrogen-suppressed group demonstrated an impaired placental vascular network, suggesting an estrogen-dependent vasculogenesis in the equine CA during the first trimester.

The composition of human vaginal microbiota transferred at birth affects offspring health in a mouse model.

Newborns are colonized by maternal microbiota that is essential for offspring health and development. The composition of these pioneer communities exhibits individual differences, but the importance of this early-life heterogeneity to health outcomes is not understood. Here we validate a human microbiota-associated model in which fetal mice are cesarean delivered and gavaged with defined human vaginal microbial communities. This model replicates the inoculation that occurs during vaginal birth and reveals lasting effects on offspring metabolism, immunity, and the brain in a community-specific manner. This microbial effect is amplified by prior gestation in a maternal obesogenic or vaginal dysbiotic environment where placental and fetal ileum development are altered, and an augmented immune response increases rates of offspring mortality. Collectively, we describe a translationally relevant model to examine the defined role of specific human microbial communities on offspring health outcomes, and demonstrate that the prenatal environment dramatically shapes the postnatal response to inoculation.

Pandemic stress and SARS-CoV-2 infection are associated with pathological changes at the maternal-fetal interface.

INTRODUCTION: The reported effects of SARS-CoV-2 on pregnancy outcomes are conflicting; studies frequently overlook the placenta, which is critical for the health of the mother and infant(s). This study aimed to determine the effect of pandemic stress ± SARS CoV-2 infection on placental histopathology. METHODS: Women were recruited in Canada (n = 69); France (n = 21) or in the UK (n = 25), between March and October 2020. Historic controls (N = 20) were also included. Placenta and fetal membrane samples were collected rapidly after delivery and were fixed and stained for histopathological analysis. Maternal demographical data and obstetric outcomes were recorded. RESULTS: Over 80% of the placentas from SARS-CoV-2+ pregnancies had histopathological abnormalities: predominantly structural (71-86%) or inflammatory (9-22%), depending on geographical location. Excessive fibrin was seen in all sites, whereas deciduitis (Canada), calcifications (UK), agglutinations and chorangiosis (France) predominated in different locations. The frequency of abnormalities was significantly higher than in SARS-CoV-2 negative women (50%, p < 0.05). Demographic and obstetric data were similar in the SARS-CoV-2+ women across all sites - characterised by predominantly Black/Middle Eastern women, and women with elevated body mass index. DISCUSSION: Overall, the frequency of placental abnormalities is increased in SARS-CoV-2+ women, but the incidence of placental abnormalities is also higher in SARS-CoV-2- women that gave birth during the pandemic, which highlights the importance of appropriate control groups to ascertain the roles of pandemic stress and SARS-CoV-2 infection on the placenta and pregnancy outcomes.

Relationship of health practices with depression and maternal-fetal attachment in adolescent pregnant women: A prospective study.

AIM: To determine the relationship of health practices with depression and maternal-fetal attachment in adolescent pregnant women. METHODS: This prospective study was conducted on 316 adolescent pregnant women with medical records at the health centers in Tehran, Iran. The participants were selected through the complete enumeration. Data were collected using the socio-demographic and obstetrics questionnaire, the Health Practices Questionnaire-II (HPQ-II), the Edinburgh Postnatal Depression Scale (EPDS), and the Cranley's Maternal-Fetal Attachment Scale (MFAS). The data were analyzed with the Pearson correlation test, the independent t-test, one-way ANOVA, and the general linear model. RESULTS: The mean scores of health practices, depression, and maternal-fetal attachment were 135.3 (SD 9.1, range 34-170), 10.1 (SD 5.4, range 0-30), and 91.6 (SD 8.6, range 24-120), respectively. The results of Pearson correlation test showed that health practices had a significant relationship with depression (r = -0.29) and maternal-fetal attachment (r = 0.37). Results of general linear model showed that an increase in the health practices score led to a significant decrease in depression score during pregnancy [ß = -0.10; 95% CI: -0.17 to -0.04] and a significant increase in maternal-fetal attachment score [ß = 0.30; 95% CI: 0.19 to 0.40]. CONCLUSION: There is significant relationship between health practices and depression, as well as maternal-fetal attachment in adolescent pregnant women. Therefore, intervention to improve one of them may improve the other one(s).

Convertirse en madre durante la gestación: validación de un nuevo instrumento para su medición / Becoming a mother during pregnancy: validation of a new instrument for its measurement

Objetivo: Diseñar y validar un nuevo instrumento para la evaluación del compromiso con la maternidad, el apego maternofetal y la preparación para la maternidad durante el periodo de la gestación a partir de la teoría de Ramona Mercer. Metodología: Estudio metodológico psicométrico realizado con 200 mujeres gestantes de la ciudad de Medellín, Colombia, durante los años 2018 y 2019, en 3 fases: revisión de la literatura, diseño y validación de un instrumento. Se diseñó un instrumento a partir de los atributos identificados en la fase de revisión de la literatura, y se realizaron la validación de contenido con expertos, la validación facial a través de una prueba piloto, y para la validez de constructo se utilizó el análisis factorial exploratorio (AFE). Adicionalmente, se calculó la consistencia interna del instrumento. Resultados: La mediana de la edad y de las semanas de gestación de las mujeres participantes fue de 26 años y 26 semanas, respectivamente. En la validación de contenido, el 100% de los ítems obtuvieron una V de Aiken >0,7 y un intervalo de confianza del 95% >0,7. El modelo final del AFE obtuvo un índice de Kaiser-Meyer-Olkin (KMO) de 0,88 y mostró 3 factores que explicaron el 68,1% de la varianza y un total de 21 ítems: apoyo y presencia del compañero (11), preparación altruista (6) y apego cognitivo (4). La consistencia interna global obtenida a través del índice alfa de Cronbach fue de 0,90. Conclusiones: El instrumento «Convertirse en Madre» durante la gestación mostró ser válido y confiable, y permitió que emergiera la dimensión «apoyo y presencia del compañero», no contemplada por Mercer en su teoría, y que desapareciera la dimensión «compromiso con la maternidad». (AU)

Objective: To design and validate a new instrument to assess the commitment with the motherhood, the maternal-fetal bonding and the preparation for motherhood during pregnancy from Ramona Mercer’s theory. Methodology: Methodological psychometric study carried out with 200 pregnant women from the city of Medellín (Colombia) during the years 2018 and 2019 in three phases: literature review, design and validation of an instrument. An instrument was designed based on the attributes identified in the literature review phase and content validation was carried out with experts, facial validation through a pilot test and exploratory factor analysis (EFA) was used for the construct validity. Additionally, the calculation of the internal consistency of the instrument. Results: The median age and gestation weeks of the participating women was 26 years and 26 weeks respectively. In the content validation, 100% of the items obtained an Aiken V greater than 0.7 and a CI95% above 0.7. The final model of EFA obtained a Kaiser Meyer-Olkin of 0.88 and showed three factors that explained 68.1% of the variance and a total of 21 items: support and presence of the partner (11), altruistic preparation (6) and cognitive bondin (4). The overall internal consistency obtained through Cronbach’s alpha was 0.90. Conclusions: The instrument becoming a mother during pregnancy proved to be valid and reliable and allowed the dimension of support and presence of the partner not contemplated by Mercer to emerge in her theory and the commitment to motherhood to disappear. (AU)

Madres adolescentes de Valparaíso: Riesgo relacional, apego y síntomas depresivos en comparación a madres adultas / Teenage mothers of Valparaiso: relational risk, attachment and depressive symptoms compared to adult others

El embarazo adolescente es considerado un factor de riesgo tanto para la salud de la madre como para la de su futuro hijo por significar una doble crisis del ciclo vital, poniendo en riesgo el proceso de vinculación. Objetivos. El presente estudio busca analizar el riesgo relacional, tipo de apego y comparar la aparición de síntomas depresivos en madres adolescentes y adultas durante la gestación y en el período postparto. Métodos. Estudio prospectivo de dos cohortes de primigestas adolescentes y adultas, pertenecientes a centros de atención primaria de Valparaíso durante el año 2013. Resultados. Las madres adolescentes presentaron una mayor prevalencia de apego no seguro, mayores tasas de alto riesgo relacional materno-fetal y madre-bebé y mayor prevalencia de síntomas depresivos en comparación a madres adultas. Sin embargo, sólo la diferencia en la prevalencia de apego no seguro entre ambas cohortes fue estadísticamente significativa.

Teenage pregnancy is considered a risk factor for both the mother and her child's health and wellbeing. It can be hypothesized that going through a double psychological crisis might be harmful to the development of a secure relationship of attachment in the dyad. Objectives. This investigation seeks to analyze relational risks, attachment styles, and to compare the prevalence of depressive symptoms between teenage mothers and adult mothers during pregnancy and postpartum. Methods. An observational prospective cohort study was carried out, considering primiparous mothers, both teenage and adults, who attended primary public healthcare centers in Valparaíso during 2013. Results: In comparison to adult mothers, teenage mothers were more likely to exhibit insecure attachment styles, depressive symptoms in pregnancy and postpartum, and scored higher in the relational risk assessment scale. However, only the difference on the rate of insecure attachment styles between teenage and adult mothers was statistically significant.

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.