Perinatal influences on infant development
While we often ask about pregnancy and delivery in social histories, these studies suggest important elements of maternal-infant relationships that can have long-term impacts. Ruyak, Boursaw & Carcari Stone (2022) published “The Social Determinants of Perinatal Maternal Distress” in Journal of Rural Mental Health. Here’s an edited abstract:
Symptoms of perinatal maternal distress are prevalent across general populations, yet more significant for low-income rural populations. Social determinants of health (SDOH) have been proposed as a framework to explain these disparities. This pilot study examined associations between prenatal individual and socioenvironmental determinants of health and symptoms of perinatal maternal distress (PMD) in women enrolled in midwifery practice and living in a rural state. Having experienced emotional abuse in one’s lifetime, total number of past-year stressors, and everyday discrimination score were all statistically significant predictors of PMD at study enrollment and follow-up. Results suggest shifting to a multisymptom, life-course assessment, and intervention paradigm, tailored to the context of specific populations, may improve perinatal care and reduce disparities. Results of this study provide compelling evidence that having experienced emotional abuse in one’s lifetime and experiences of everyday discrimination may be significant predictors of perinatal emotional health, suggesting that a SDOH framework is an appropriate paradigm for development of assessment and intervention strategies to reduce disparities and improve perinatal mental health.
I love this study because it highlights the social experiences that can impact perinatal experience. The next study similarly emphasizes social experience. Astor et al. (2022) published “Maternal Postpartum Depression Impacts Infants’ Joint Attention Differentially Across Cultures” in Developmental Psychology. Here’s the abstract:
We assessed whether the negative association between maternal postpartum depression (PPD) and infants’ development of joint attention (gaze following) generalizes from WEIRD (Western, Educated, Industrialized, Rich, and Democratic) to Majority World contexts. The study was conducted in Bhutan (N = 105, M = 278 days, 52% males) but also draws from publicly available Swedish data (N = 113, M = 302 days, 49% males). We demonstrate that Bhutanese and Swedish infants’ development follows the same trajectory. However, Bhutanese infants’ gaze following were not related to maternal PPD, which the Swedish infants’ were. The results support the notion that there are protecting factors built into the interdependent family model. Despite all the benefits of being raised in a modern welfare state, it seems like Swedish infants, to an extent, are more vulnerable to maternal mental health than Bhutanese infants.
The third article shifts to postpartum anxiety. Collier (2021) published “Postpartum Anxiety is Invisible, but Common and Treatable” in Harvard Gazette. Here’s an edited summary:
Many symptoms overlap between postpartum depression and postpartum anxiety (such as poor sleep, trouble relaxing, and irritability). Mothers experiencing postpartum depression commonly experience symptoms of anxiety, although not all mothers suffering from anxiety are depressed. Establishing the correct diagnosis is important, as women with postpartum anxiety may not respond as well to certain treatments for depression, such as interpersonal psychotherapy or medications such as bupropion (Wellbutrin).
Similar to postpartum depression, postpartum anxiety may spike due to hormonal changes in the postpartum period. It may also increase as a response to real stressors — whether it’s the health of the baby, finances, or in response to navigating new roles in your relationships. A history of pregnancy loss (miscarriage or stillbirth) also increases your risk for developing postpartum anxiety. If you have a history of anxiety before or during pregnancy, postpartum anxiety symptoms may also return after delivery. Anxiety and sadness may also appear after weaning from breastfeeding due to hormonal changes.
It is estimated that at least one in five women has postpartum anxiety. We do know that therapies such as cognitive behavioral therapy (CBT) are excellent treatments for anxiety disorders, including OCD. For some women, medications can be helpful and are more effective when combined with therapy. Selective serotonin reuptake inhibitors (SSRIs) are generally the first-line medications (and the best studied medication class) for anxiety disorders, whereas benzodiazepines are rapidly acting anti-anxiety medications that are often used while waiting for an SSRI to take effect. Breastfeeding provides many benefits to the baby: it’s the perfect nutrition, it helps build a baby’s immune system, it may help prevent adulthood obesity, and it provides comfort and security. Breastfeeding also provides benefits for the mother: it releases prolactin and oxytocin (the love and cuddle hormones), which help a mother bond with her baby and provide a sense of relaxation. When considering whether to start a medication, it is important to be aware that all psychiatric medications are excreted into the breast milk. What non-medication strategies are helpful in decreasing postpartum anxiety?
Cuddle your baby (a lot). This releases oxytocin, which can lower anxiety levels.
Try to maximize sleep. Although the baby may wake you every three hours (or 45 minutes) to feed, your partner should not. Sleeping in separate rooms or taking shifts caring for the baby may be necessary during the first few months. Aim for at least one uninterrupted four-hour stretch of sleep, and be mindful about caffeine intake.
Spend time with other mothers. Although you may feel like you don’t have the time, connecting with other mothers (even online) can do wonders in lowering your fears and validating your emotions. Chances are you are not the only one worrying up a storm.
Increase your physical activity. In spite of the physical toll that pregnancy, delivery, and milk production take on your body, physical activity is one of the most powerful anti-anxiety strategies. Activities that incorporate breathing exercises, such as yoga, may be particularly helpful.
Wean gradually. If you are breastfeeding and make the decision to wean, try to do so gently (when possible) to minimize sudden hormonal changes.
Ask for help. Caring for a baby often requires a village. If you are feeding the baby, ask someone else to help with household chores. There is an old saying "sleep when the baby sleeps."
I like this piece because, like the first two, it emphasizes social support as essential. The final study extends beyond the perinatal period but fits well with the others. Vallorani et al. (2022) published “Assessing Bidirectional Relations Between Infant Temperamental Negative Affect, Maternal Anxiety Symptoms and Infant Affect-Biased Attention Across the first 24-months of life” in Developmental Psychology. Here’s the edited impact statement and abstract:
Developmental theories suggest affect-biased attention, preferential attention to emotionally salient stimuli, emerges during infancy through coordinating individual differences. Here we examined bidirectional relations between infant affect-biased attention, temperamental negative affect, and maternal anxiety symptoms. Infant–mother pairs from Central Pennsylvania and Northern New Jersey (N = 342; 52% White; 50% reported as assigned female at birth) participated when infants were 4, 8, 12, 18 and 24 months of age. Infants completed the overlap task while eye-tracking data were collected. Mothers reported their infant’s negative affect and their own anxiety symptoms. At the between-person level, mothers with greater anxiety symptoms had infants with greater affect-biased attention. However, at the within-person level, greater fluctuation in maternal anxiety symptoms at 12- and 18 months prospectively related to greater stability in attention to angry facial configurations. Additionally, greater fluctuation in maternal anxiety symptoms at 18 months prospectively related to greater stability in attention to happy facial configurations. Finally, greater fluctuation in maternal anxiety symptoms at 4- and 12 months prospectively related to greater stability in infant negative affect. These results suggest that environmental uncertainty, linked to fluctuating maternal anxiety, may shape early socioemotional development. We found that although overall mothers with higher levels of anxiety symptoms have infants that exhibit greater affect-biased attention, over time, infants with mothers who fluctuate more in maternal anxiety symptoms exhibit more stable affect-biased attention. Environmental uncertainty, linked to fluctuating maternal anxiety, may shape early socioemotional development.
This is an important study in that it illustrates that moms with high anxiety symptoms have babies who attend more to affect, with fluctuation in mom’s anxiety correlated with more stable affect-based attention.