Maternal Psychological Factors and Onset of Functional Gastrointestinal Disorders in Offspring: A Prospective Study.

BACKGROUND/OBJECTIVES: Functional gastrointestinal disorders (FGIDs) are a heterogeneous group of conditions of unclear etiology. The biopsychosocial model approach to FGIDs posits that early-life stressors may trigger a cascade of complex interactions between genetic predisposition and risk factors eventually leading to the occurrence of FGIDs. The relationship between the psychological disposition of the mother and FGIDs occurrence is poorly understood. We conducted a study to investigate if parental psychological factors may contribute to the onset of FGIDs in offspring. METHODS: We performed a prospective cohort study of parent-infant pairs who completed a battery of self-reported psychological questionnaires and a validated Rome III questionnaire for the diagnosis of infant and toddler FGIDs. The Edinburgh Postpartum Depression Scale (EPDS) was used to examine postpartum depression (PPD) symptoms; the Maternity Blues Questionnaire (MBQ) was applied to measure maternity blues severity; the Symptoms Checklist-Revised (SCL90-R) was used to assess the presence of relevant psychiatric symptoms; adult attachment style in mothers was assessed in a continuous way through the five dimensions of the Attachment Style Questionnaire (ASQ). RESULTS: Out of the 360 eligible mothers, 200 were enrolled, 113 completed the 3-month follow-up and were included in the final analysis. PPD symptoms prevalence was 20.4%, 20%, 13.2%, and 13.1% respectively at 3 days, 1 week, 1 month, and 3 months after delivery. 40.4% of mothers suffered from severe blues according to the MBQ. Relevant psychiatric symptoms (SCL90-R) were present in 7.8% and 10.9% of mothers, respectively at 1 week and 3 months after delivery. 48.7% of mothers showed a secure attachment pattern measured through the RQ. At 1-month follow-up, infant regurgitation was diagnosed in 26 (23%) of infants, infantile colic in 31 (27.4%), dyschezia in 17 (15%), and functional constipation in 9 (8%). At 3-month follow-up, FGIDs prevalence was respectively 16 (19.3%), 11 (13.3%), 4 (4.8%), and 11 (13.3%). A significant positive association between PPD symptoms starting 3 days after delivery and the presence of infantile colic on setting 1 month after birth was found (P = 0.028), as well as between PPD symptoms occurrence 7 days after delivery and infantile regurgitation beginning 1 month after birth (P = 0.042). A higher prevalence of infantile colic was found in the offspring of mothers suffering from PPD symptoms from 3 days after delivery (54.5 vs 19.8; P = 0.001). No significant association was found between FGIDs and psychiatric symptoms and maternity blues at any timepoint. On the other hand, mothers of infants with regurgitation with an onset 1 month after birth have higher insecurity score in avoidant and fearful ASQ-related attachment dimensions (respectively, P = 0.03, P = 0.042, P = 0.03). CONCLUSIONS: Maternal psychological factors might contribute to the onset of infant FGIDs in offspring. Early screening of postpartum depression symptoms and early implementation of psychological interventions within the postpartum period might promote the health of the mother-infant dyad.

Enhancing maternal sensitivity and infant attachment security with video feedback: an exploratory study in Italy.

This study aims to explore whether a short-term and attachment-based video-feedback intervention, the Video-Feedback Intervention to Promote Positive Parenting With Discussions on the Representational Level (VIPP-R; F. Juffer, M.J. Bakermans-Kranenburg, & M.H. van IJzendoorn, 2008), might be effective in enhancing maternal sensitivity and in promoting infants' attachment security in an Italian sample of dyads with primiparous mothers. Moreover, we explore whether the effectiveness of VIPP-R might be different for parents with insecure attachment representations who might be most in need of preventive intervention, as compared to parents who already have a more balanced and secure state of mind. Thirty-two infants (40% female) and their mothers participated in the study. The sample was divided into an intervention group (n = 16) and a comparison group (n = 16). At 6 and 13 months of age, the Adult Attachment Interview (AAI; M. Main, N. Kaplan, & J. Cassidy, 1985) was administered. Moreover, a 30-min mother-infant play situation was videotaped and coded for maternal sensitivity with the Emotional Availability Scales (Z. Biringen, J. Robinson, & R.N. Emde, 2000). At 13 months of age, the Strange Situation Procedure (M.D.S. Ainsworth, M.D. Blehar, E. Waters, & S. Wall, 1978) was used to assess the security of mother-infant attachment. Results revealed a significant interaction effect between intervention and AAI security for infant attachment security; moreover, main effects of AAI security and intervention for maternal sensitivity were found. The VIPP-R appears effective in enhancing maternal sensitivity and infant attachment security, although only mothers with an insecure attachment representation may benefit from the intervention.