Exploring the psychometric qualities of prenatal attachment inventory in France.

OBJECTIVES: The aim of the study was to explore the structure of the Prenatal Attachment Inventory (PAI) on a French sample of pregnant women. METHODS: Three hundred and nine pregnant women were recruited in gynecology-obstetrics departments and on social networks. To be included, women had to be pregnant, aged between 18 and 45 years old, and not have somatic complications of pregnancy. The women completed a questionnaire including questions on sociodemographic information, and the PAI. The structure of PAI was explored with an exploratory structural equation model (ESEM). RESULTS: Three factorial solutions were explored: two-, three- and four-factor. The 2-factor solution was excluded due to its CFI, TLI and RMSEA indexes, which were lower than the reference values. The choice between the 3- and 4-factor solutions was made according to the clinical meaning of the items included in the factors. The 3-factor solution was retained with the factors: "current and future representations of the baby", "maternal-fetal relationship", and "proprioceptive feeling". The scale had good internal consistency. CONCLUSIONS: The PAI is the first standardized multidimensional assessment tool for maternal-fetal attachment in the French language. In view of the results obtained, this tool can be disseminated and used by professionals in perinatal care.

Psychometric validation of the French version of the PedsQLTM4.0 generic health-related quality of life questionnaire for 2-4-year-old children.

The Pediatric Quality of Life Inventory version 4.0 (PedsQLTM4.0) is an internationally recognized, generic, health-related quality of life (HRQoL) questionnaire, but its proxy 2-4-year-old version has not been validated in France. This study proposes a psychometric validation of this tool for French children aged 2 to 4 years and 11 months. A total of 220 parents of typically developing children participated. Acceptability was explored. Internal consistency was tested using Cronbach's alpha. Factor structure was tested using an exploratory structural equation modeling (ESEM). Risk of bias was assessed regarding gender and age effect on HRQoL using Student's t test. Except for school functioning, compliance was good (< 2.9%). No floor effects were observed, but ceiling effects were found for all scores. The total score had good internal consistency (Cronbach's α = .82). The Cronbach's α of each subscale was between .53 and .71. Factor analysis rejected the original 4-factor structure and revealed an alternative 2-factor structure. The total score and emotional scale score did not appear to be sensitive to gender or child age.  Conclusions: The PedsQLTM4.0 generic HRQoL questionnaire presents good psychometric properties, regarding acceptability and reliability. For use among French children aged 2 to 4 years and 11 months, we recommend retaining the total score and the emotional scale score.

[Meeting your baby and becoming a father]. / Rencontrer son bébé et devenir père.

The birth, the moment when the father physically discovers his baby, is essential in the development of fatherhood. Accompanying this encounter during the stay in the postnatal unit leads to a greater commitment to care on the part of the father over the following three months. It therefore seems essential to support him during these first moments, by offering him skin-to-skin contact, for example, or by showing him in practical terms how to provide nursing care for his newborn. Encouraging the development of the father-baby relationship is beneficial for the family alliance that is being built around the cradle.

[Representations of co-parenthood among primiparous and multiparous fathers-to-be]. / Représentations de la coparentalité des futurs pères primipares et multipares.

From the moment they become pregnant, future parents anticipate how they will coordinate, support and divide the tasks related to their child. This is known as co-parenting. Research carried out in three french gynaecology-obstetrics departments and in social network examined fathers' perceptions of co-parenthood and sought to determine whether these were in line with scientific conceptions of the concept.

[Fatherhood in the mother-baby unit: the experience of the Panda unit]. / La paternité en unité mère-bébé : l'expérience de l'unité Panda.

Mother-baby units offer a care environment that is conducive to better care for fathers. However, these units still need to evolve in terms of organization and attitude to care. The systematic use of pre- and postnatal interviews is an interesting approach to consider.

[Touch during nursing care in daycare]. / Le toucher lors des soins de nursing en crèche.

Based on knowledge of child development, this exploratory study focuses on the quality of touch during the care of babies in early childhood facilities. It also examines the place given to affect in the interaction between professionals and children.

[Representations of skin-to-skin care among parents and caregivers in neonatology]. / Représentations du soin peau à peau chez les parents et les soignants de néonatalogie.

A study looked at the representations of skin-to-skin contact among parents and caregivers in seven neonatal units in France and Belgium. Their ways of understanding skin-to-skin contact have some common elements, without completely overlapping. The work carried out could prove useful for professionals who, thanks to it, would be likely to obtain a better understanding and adhesion of the families to the practice of this relational care.

[Tactile communication within the father-mother-baby triad]. / La communication tactile au sein de la triade père-mère-bébé.

This literature review focuses on tactile interactions between parents and their infants. Research on the dyad has explored both cultural differences in touch and the relationship between touch style and hormonal secretion in both parents. The few studies that have examined this communicative modality within the triad have investigated the frequency and type of parent-infant touch, as well as the effect of skin-to-skin contact on tactile interactions at three months postpartum.

Impact of the Covid-19 pandemic on perinatal mental health (Riseup-PPD-COVID-19): protocol for an international prospective cohort study.

BACKGROUND: Corona Virus Disease 19 (COVID-19) is a new pandemic, declared a public health emergency by the World Health Organization, which could have negative consequences for pregnant and postpartum women. The scarce evidence published to date suggests that perinatal mental health has deteriorated since the COVID-19 outbreak. However, the few studies published so far have some limitations, such as a cross-sectional design and the omission of important factors for the understanding of perinatal mental health, including governmental restriction measures and healthcare practices implemented at the maternity hospitals. Within the Riseup-PPD COST Action, a study is underway to assess the impact of COVID-19 in perinatal mental health. The primary objectives are to (1) evaluate changes in perinatal mental health outcomes; and (2) determine the risk and protective factors for perinatal mental health during the COVID-19 pandemic. Additionally, we will compare the results between the countries participating in the study. METHODS: This is an international prospective cohort study, with a baseline and three follow-up assessments over a six-month period. It is being carried out in 11 European countries (Albania, Bulgaria, Cyprus, France, Greece, Israel, Malta, Portugal, Spain, Turkey, and the United Kingdom), Argentina, Brazil and Chile. The sample consists of adult pregnant and postpartum women (with infants up to 6 months of age). The assessment includes measures on COVID-19 epidemiology and public health measures (Oxford COVID-19 Government Response Tracker dataset), Coronavirus Perinatal Experiences (COPE questionnaires), psychological distress (BSI-18), depression (EPDS), anxiety (GAD-7) and post-traumatic stress symptoms (PTSD checklist for DSM-V). DISCUSSION: This study will provide important information for understanding the impact of the COVID-19 pandemic on perinatal mental health and well-being, including the identification of potential risk and protective factors by implementing predictive models using machine learning techniques. The findings will help policymakers develop suitable guidelines and prevention strategies for perinatal mental health and contribute to designing tailored mental health interventions. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04595123 .

Birth defects in children of men exposed in utero to diethylstilbestrol (DES).

OBJECTIVE: Prenatal exposure to diethylstilbestrol (DES) is associated with adverse effects, including genital anomalies and cancers in men and women. Animal studies showed birth defects and tumors in the offspring of mice prenatally exposed to DES. In humans, birth defects, such as hypospadias were observed in children of prenatally exposed women. The aim of this research was to assess the birth defects in children of prenatally exposed men. METHODS: In a retrospective study conceived by a patients' association (Réseau DES France), the reports of men prenatally exposed to DES on adverse health effects in their children were compared with those of unexposed controls and general population. RESULTS: An increased incidence of two genital anomalies, cryptorchidism (OR=5.72; 95% CI 1.51-21.71), and hypoplasia of the penis (OR=22.92; 95% CI 3.81-137.90), was observed in the 209 sons of prenatally exposed men compared with controls, but hypospadias incidence was not increased in comparison with either the controls or the general population. No increase of genital anomalies was observed in daughters. CONCLUSION: With caution due to the methods and to the small numbers of defects observed, this work suggests an increased incidence of two male genital tract defects in sons of men prenatally exposed to DES. This transgenerational effect, already observed in animals and in the offspring of women prenatally exposed to DES, could be the result of epigenetic changes transmitted to the subsequent generation through men.

[Supporting the encounter of mothers suffering from borderline conditions with their baby]. / Accompagner la rencontre des mères souffrant d'états limites avec leur bébé.

Mothers suffering from borderline conditions are overwhelmed by emotions. Their interactions are tainted with qualitative discontinuities, unpredictable for infants. These high-risk situations must not be trivialised. They are characterised by the importance of providing rapid support to the baby and by the existence of maternal suffering. The infant's basic needs guide the professionals working with these families.

Update on Mental Health of Infants and Children of Parents Affected With Mental Health Issues.

This paper highlights the most recent publications, in the field of psychiatry, on offspring of patients with psychiatric illnesses such as schizophrenia and bipolar disorder, and then summarizes what we know about the progeny of adults with mood disorders, the most prevalent of parental disorders. Studies examining personality disorders and contextual factors such as stress and trauma are examined with a focus on the crucial question of development and attachment status in children. Findings converge to reveal that offspring of parents (generally mothers) with most major psychiatric disorders present a higher risk for all mental disorders, and a wide range of disorders are also found in children, adolescent, and finally adult offspring of mothers with mood and anxiety disorders. Developmental psychopathology and infant and child psychiatry have focused on early relationship formation through social interaction and attachment patterns as pathways affected by vulnerability or resilience factors. First year of life longitudinal studies following mothers and infants has shown that maternal psychopathology is positively correlated with higher risk of attachment issues. It would seem that pathology appears when adaptation to real-life contexts becomes difficult in association with an accumulation of negative individual characteristics and environmental circumstances. We suggest that in order to move forward psychiatry should embrace a developmental cascade model, which posits a cumulative pathway for the emergence of psychopathology in the developing child. We propose that we have sufficient knowledge today to start implementing multilevel approaches to enhance the health and mental health of the next generation.

Impact of prenatal exposure to diethylstilbestrol (DES) on psychological outcome: a national survey of DES daughters and unexposed controls.

To explore whether prenatal exposure to diethylstilbestrol (DES) is associated with increased risk of poor psychological outcome independently of the occurrence of major somatic complications related to DES exposure. Data on health outcome were collected in women prenatally exposed to DES (n = 2566) and unexposed women (n = 2967) recruited in a French national survey. Women prenatally exposed to DES were 1.7 times more likely to have consulted a mental health specialist compared to unexposed women (adjusted odds ratio = 1.69, 95% confidence interval 1.47-1.96), independently of demographic characteristics, poor gynecological or obstetrical outcome, or history of cancer. Frequency of consultation with a mental health specialist in persons with a history of gynecological complications or cancer was comparable in women prenatally exposed to DES and unexposed women. Findings regarding psychological outcome obtained in the high-risk group of women prenatally exposed to DES may contribute to improving identification of psychological needs of all women presenting with gynecological abnormalities.

[An innovative position during skin-to-skin contact in neonatology]. / Une installation innovante lors du peau à peau en néonatologie.

Skin-to-skin is, by its very nature, the only relational care entirely devoted to the parent-baby relationship, from the infant's time in neonatal intensive care. However, current practice is unsuited to visual and tactile exchange. A simple change to the baby's positioning helps to improve the quality of the immediate interaction between the infant and the mother, benefiting the development of the baby and parenthood.

[Supporting the establishment of the parent-child bond in cases of prematurity]. / Soutenir l'élaboration de la relation parent-enfant en cas de prématurité.

The evolution of the care of premature babies is having an effect on a particular difficulty, that of the development of parenthood and the parent-baby relationship hampered by an early birth. The short- and long-term consequences of any disruption to these two dimensions can be considerable and the hospital must take into account the issue when caring for parents and their premature baby.

Adverse health effects in children of women exposed in utero to diethylstilbestrol (DES).

OBJECTIVE: Exposure to diethylstilbestrol (DES) in utero is associated with adverse health effects, including genital anomalies in women and men, and cancers in women. Animal studies showed birth defects and tumors in the offspring of DES exposed mice, revealing transgenerational transmission of DES effects. In humans, birth defects, such as hypospadias were observed in children of prenatally exposed women. The aim of this research was to further assess the health effects in children of prenatally exposed women. METHODS: In a retrospective cohort study, the reports of women exposed to DES in utero on their 4409 children were compared with those of unexposed women on their 6203 children. Comparisons used odd ratios (OR) between children of exposed and unexposed women and standardized incidence rate (SIR) with the general population. These cohorts were recruited on a voluntary basis to answer questionnaires. RESULTS: There was a global increase of defects in children born to exposed women when compared with those born to unexposed (OR 2.29, 95% CI: 1.80-2.79, P<0.001) and with the general population (SIR 2.39, 95% CI: 2.11-2.68). Increased defects were observed in male genital tract, esophagus, lip or palate, musculoskeletal and circulatory systems. For female genital tract anomalies, there was no significant increase. However, this cohort being relatively young, further follow-up is needed. An increase of cerebral palsy was revealed. The incidence of cancers was not increased, in particular for breast, uterus and ovary. CONCLUSION: Our results confirmed a transgenerational transmission of defects in male genital tract. With caution due to possible bias associated with this method, our data suggest an increase of defects for esophagus, lip or palate, musculoskeletal and circulatory system in children of exposed women.

Impact of pregnancy on psychotropic medication prescription: a French cohort study.

OBJECTIVES: To determine if and when prescription of psychotropic medication in women is modified by pregnancy. METHOD: Psychotropic prescription of 87 213 pregnant women affiliated with the French General Health System was examined. Period of analyses lasted 17 months to cover 4 months before and after pregnancy. A comparable cohort of 87 213 non pregnant women constituted the control group. RESULTS: More than half of pregnant women to whom a psychoactive drug was prescribed were novel users during all three trimesters and after delivery. Prevalence of psychotropic medication before pregnancy is comparable to that of non-pregnant women. Rate of psychotropic medication during the peripartum stayed high, even though it decreased by half during the first trimester, showing a "pregnancy impact effect". CONCLUSIONS: Data show a dramatic impact of pregnancy. More information on specific patterns of prescription needs to be gained in order to establish decision-making models for psychotropic prescription during pregnancy.

Cancer Risk in Women Exposed to Diethylstilbestrol in Utero.

OBJECTIVE: To evaluate the overall cancer risk, primarily breast cancer, for women exposed to diethylstilbestrol (DES) in utero in France. METHODS: A cohort of 3 436 prenatally DES exposed women and a comparable cohort of 3256 unexposed women were recruited retrospectively from voluntary responses to questionnaires, and cases were ascertained by medical history at the time of recruitment. RESULTS: One hundred ninety-five cancers were observed in exposed women (136 breast cancers, and 59 in other sites) and 141 cancers in unexposed women (90 breast cancers, and 51 others). A significant increase of breast cancers was found in exposed women, with a multivariate incidence rate ratio of 2.10 (95% CI 1.60-2.76) when compared with unexposed women. When exposed women were compared with the general population in France, the standardized incidence ratio was 2.33 (95% CI 1.93-2.72). CONCLUSION: Our results suggest a significant increase of breast cancer in prenatally DES exposed women when compared with unexposed women and with the general population. For other cancers, except clear cell carcinoma of the cervix or vagina, there was a global non-significant increase.