Maternal depression and atopic dermatitis in children linked

January 21, 2020

Science Daily/George Washington University

A recent study suggests that maternal depression in the postpartum period, and even beyond, is associated with the development of atopic dermatitis throughout childhood and adolescence.

Maternal depression in the postpartum period, and even beyond, is associated with the development of atopic dermatitis (AD) throughout childhood and adolescence, according to a recent study published in the journal Dermatitis.

AD is a chronic, inflammatory skin disease typically characterized by itch, pain, and sleep disturbance. It has also been strongly linked to a number of mental health disorders, such as depression, anxiety, and suicidal ideation.

The study, led by Jonathan Silverberg, MD, PhD, MPH, associate professor of dermatology at the George Washington University School of Medicine and Health Sciences, examined the association of maternal depression in the postpartum period, and maternal and paternal depression in later childhood with AD in U.S. children and adolescents.

Silverberg conducted the data acquisition, analysis, and interpretation at Northwestern University Feinberg School of Medicine, in collaboration with first author Costner McKenzie, a medical student at Northwestern.

"We know that emotional factors can exacerbate AD flares and influence the course of the disease," said Silverberg, the senior author of the study. "Previous studies have shown that family environment and other environmental factors can have an impact on AD."

The researchers analyzed data from the Fragile Families and Child Wellbeing Study. They found that postpartum depression was associated with higher odds of AD developing later in childhood, more persistent AD, and increased sleep disturbance among children with AD.

"Our results further suggest that postpartum depression is associated with AD even in older children and adolescents, with more persistent disease and greater sleep disturbance," Silverberg said. "This could potentially suggest more severe AD."

Continued research is needed, according to the researchers, to confirm the associations found, determine underlying mechanisms, and identify appropriate interventions. The authors of the study suggest that pediatricians should consider screening and early intervention for postpartum depression to identify infants at higher risk for AD.

Children born to mothers with depression in the postpartum period and beyond may warrant increased screening for AD and atopic disease, as well as use of gentle skin care and other strategies to mitigate AD.

https://www.sciencedaily.com/releases/2020/01/200121133312.htm

Mothers of fussy babies at higher risk of depressive symptoms

March 25, 2019

Science Daily/Michigan Medicine - University of Michigan

As FDA approval of the first postpartum depression drug hits the news, study looks at how infant fussiness and a baby's level of prematurity may influence the severity of maternal depressive symptoms.

It's no secret that fussy newborns can be especially challenging for parents already facing physical and mental exhaustion from caring for a new baby.

But now science backs up the impact on parents: The less soothable the infant, the more distressed the mother.

Mothers of highly irritable infants experience greater depressive symptoms, according to new University of Michigan-led research. The nationally representative study, which included data from more than 8,200 children and their parents, appears in Academic Pediatrics.

The study is also believed to be the first to explore whether the degree of a baby's prematurity in combination with infant fussiness may influence the severity of maternal depressive symptoms.

Researchers found that mothers of very preterm, fussy infants (born at 24-31 weeks) had about twice the odds of experiencing mild depressive symptoms compared to moms of very preterm infants without fussiness.

However, mothers of fussy babies born moderate-late preterm (32-36 weeks gestation) as well as mothers of full-term infants were about twice as likely to report moderate to severe depressive symptoms as moms of less irritable babies born at the same gestational age.

"We found that maternal depression risk varied by gestational age and infant fussiness," says senior author Prachi Shah, M.D., a developmental and behavioral pediatrician at U-M C.S. Mott Children's Hospital and an associate research scientist at U-M's Center for Human Growth and Development. "Mothers of fussy infants born late preterm and full term are more likely to experience more severe levels of maternal depression, than mothers of fussy infants who were born more preterm."

"These findings reinforce that all mothers caring for babies with more difficult temperaments may need extra help managing the emotional toll," she adds. "Early screening for infant fussiness may help identify mothers with depressive symptoms in need of support, but may be especially important for mothers of infants born mildly preterm, in whom the symptoms of depression are more severe."

Shah notes that while very preterm infants have higher morbidity than babies born later, the perinatal care of infants born very preterm may actually help buffer against more severe maternal depression.

Very preterm infants are often cared for in a neonatal ICU setting where part of the specialized care includes guidance focused on the vulnerabilities associated with preterm birth. As parents transition home they often receive an enhanced level of postnatal support and developmental follow up, including referrals to early intervention programs, home visiting and subsequent care in neonatal clinics.

"The additional support and services provided to families of very premature children help prepare parents for the potential challenges associated with caring for a preterm infant and may help mitigate the risk for maternal depressive symptoms," Shah says.

However, she notes that mild depressive symptoms may progress into more severe depressive symptoms, and should also be addressed as early as possible.

Additionally, researchers found that maternal characteristics associated with prenatal stress and socioeconomic disadvantages -- such as lower income, unmarried status and smoking -were associated with greater odds of both mild and moderate-severe maternal depressive symptoms.

Asian and black race were also associated with greater odds of moderate-severe depressive symptoms whereas Hispanic ethnicity was associated with lower odds of maternal depression. Authors say this raises questions regarding the role of culture as a potential risk or protective factor in the development of maternal depression.

The study included data from the Early Childhood Longitudinal Study, Birth Cohort. Maternal depressive symptoms were assessed through self-reported questionnaires at the baby's nine-month visit.

The study adds to previous research suggesting that mothers of more irritable infants report significantly less confidence and more stress than mothers of less fussy infants.

"Pediatricians and providers should pay close attention to mothers who describe difficulty soothing their babies," Shah says. "Early interventions may help reduce the risk of maternal depression that negatively impacts a child-parent relationship and that may be harmful to both the health of a mother and child."

https://www.sciencedaily.com/releases/2019/03/190325110321.htm

Infant sleep duration associated with mother's level of education and prenatal depression

Findings show greater support for mothers who experience prenatal depression or cesarean delivery may be warranted

February 27, 2019

Science Daily/University of Alberta Faculty of Medicine & Dentistry

A new study analyzing data from Canadian parents has found that babies sleep less at three months of age if their mothers do not have a university degree, experienced depression during pregnancy or had an emergency cesarean-section delivery.

The study, which examined associations between a mother's level of education, prenatal depression, method of delivery and her infant's sleep duration, was published this month in Sleep Medicine. It found that infants born to mothers without a university degree slept an average of 13.94 hours per day -- 23 minutes less than infants born to mothers with a university degree, and just short of the National Sleep Foundation guidelines of an average of 14-17 hours of sleep per day at three months of age.

The researchers analyzed data from 619 infants and their mothers participating in AllerGen's CHILD Cohort Study -- a national birth cohort study collecting a wide range of health, lifestyle, genetic and environmental exposure information from nearly 3,500 children and their families from pregnancy to adolescence.

"Sleep affects a baby's growth, learning and emotional development, and is one of the most common concerns of new parents," said Piush Mandhane, an associate professor of pediatrics at the University of Alberta and one of the study's lead authors.

"While earlier research has linked a mother's socioeconomic status, including level of education, to shorter infant sleep duration, we have not really understood the factors at play. Our study revealed that 30 per cent of the effect of maternal education on infant sleep duration is actually mediated by a mother's prenatal depression, as well as the type of delivery."

Specifically, the researchers found mothers without a university degree to be at significantly higher risk of having symptoms of depression during both the prenatal and postnatal periods, or the prenatal period alone, compared to women with a university degree.

There are several possible explanations for the association between maternal depression and infant sleep, according to co-lead author Anita Kozyrskyj, also a professor of pediatrics at the U of A. "Mothers in distress tend to have sleep problems during pregnancy, which can be 'transmitted' to the fetus via the mother's circadian clock and melatonin levels," she said. "Maternal depression and emergency cesarean section also both lead to elevated free cortisol levels, which, in turn, may cause an exaggerated stress response in infants that negatively impacts their sleep."

Further, the researchers found that the method of delivery independently predicted infant sleep duration, with infants delivered by emergency cesarean section sleeping approximately one hour less per day than infants born by vaginal delivery.

"This was an interesting finding, as we did not observe an association between shorter infant sleep and scheduled cesarean sections or vaginal deliveries," commented first author Brittany Matenchuk, an AllerGen trainee and a former Master's student at the U of A.

"While we are still at an early stage of unravelling the underlying biologic mechanisms, our study suggests that prenatal depression and birth mode are potential targets for health-care professionals and policy makers to improve infant sleep duration. Mothers who experience prenatal depression or an emergency cesarean delivery may benefit from support so that infant sleep problems do not persist into childhood."

According to the team, previous studies have shown that sleep has a large impact on infant emotional and behavioural development. It may also affect how they perform cognitively later in life.

"We need to support moms before the child is born," added Mandhane. "And if we can start to promote healthy sleep early on, three months of age onward, I think that just is better for families in general."

https://www.sciencedaily.com/releases/2019/02/190227140010.htm

Maternal depression and natural disaster-related stress may affect infants' temperament

February 6, 2019

Science Daily/Wiley

A new study demonstrates that prenatal maternal depression has important consequences for infant temperament. Furthermore, the negative impact of prenatal maternal depression appeared to be magnified when pregnant women lived through Superstorm Sandy.

The study analyzed data on 310 mother-child dyads, with 64 percent of women being pregnant prior to Sandy and 36 percent being pregnant during Sandy. Compared with other infants, infants born to women with prenatal depression were more likely to experience greater distress, greater fear, lower smiling and laughter, lower high- and low-pleasure seeking, lower soothability, slower falling reactivity, lower cuddliness, and greater sadness at six months of age. These effects were amplified when women were pregnant during Superstorm Sandy.

"The fetal period is one of the most critical periods for neurodevelopment. Prenatal stress, especially during this critical period of fetal development, may render the developing brain more vulnerable to additional stressors such as maternal depression," said lead author Dr. Yoko Nomura, of Queens College, the Advanced Research Science Center at The Graduate Center, CUNY and Icahn School of Medicine at Mount Sinai. "Natural disasters may increase in frequency and magnitude, but we can attempt to alleviate the negative impacts on offspring if we identify high risk pregnant mothers with depression and offer them interventions to make them more resilient."

https://www.sciencedaily.com/releases/2019/02/190206091409.htm

Mommy and me: Study shows how affectionate mothering can combat the effects of maternal depression

February 11, 2016

Science Daily/University of Utah

Certain parenting strategies can combat the negative impacts of maternal depression on an infant, suggests the first study of its kind. The work sought to investigate how a depressed mother's neuroendocrine response to stress can program the infant's hypothalamic-pituitary-adrenal axis, a set of signals and relationships between the hypothalamus, the pituitary gland and the adrenals. The hypothalamic-pituitary-adrenal axis is responsible for creating cortisol, a hormone released in response to stress.

Poverty, lack of education and exposure to violence can undeniably impact a child's life trajectory significantly. But how can a mother's exposure and potentially depressive reactions to these stressors impact a child before his/her life even begins? A depressed mother's response to stress can pass through the placenta to negatively impact the fetus in ways that manifest after birth such as birth weight, brain development and increased susceptibility to various ailments.

The first study of its kind, "The contributions of maternal sensitivity and maternal depressive symptoms to epigenetic processes and neuroendocrine functioning," led by University of Utah assistant professor Elisabeth Conradt in the Department of Psychology, found that certain parenting strategies can combat the negative impacts of maternal depression on an infant. The findings were published in Child Development.

The mechanics of stress relief

Conradt's study sought to investigate how a depressed mother's neuroendocrine response to stress can program the infant's hypothalamic-pituitary-adrenal axis, a set of signals and relationships between the hypothalamus, the pituitary gland and the adrenals. The hypothalamic-pituitary-adrenal axis is responsible for creating cortisol, a hormone released in response to stress.

Existing research with animal models suggest that this programming can occur after birth through epigenetic mechanisms, or changes in gene expression that do not change the genes themselves and can be passed between generations, through the quality of the mother's caregiving.

"We were curious about whether maternal behavior could "buffer" the child against the effects of maternal depression, and if this buffering could be observed at the level of the infant's epigenome," said Conradt.

Inspired by these animal studies, Conradt's team sought to determine whether, and how, the quality of the postnatal environment, specifically maternal sensitivity, is related to DNA methylation of genes involved in hypothalamic-pituitary-adrenal axis functioning and infants' neuroendocrine functioning in humans.

DNA methylation is when a methyl group is added to an individual cytosine (one of the four main building blocks of DNA and RNA). When the methyl group is added to a gene promoter, the region of DNA that initiates gene expression, this leads to reduced gene activity.

Prior research indicates that being depressed while pregnant and exposure to childhood abuse is related to increased DNA methylation, and subsequently reduced gene activity, of key stress-related genes including the glucoroticoid receptor gene (NR3C1) and 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD2).

Increased methylation of 11β-HSD2 leads to greater exposure of the fetus to maternal cortisol while increased methylation of NR3C1 results in fewer glucocorticoid receptors to which cortisol can bind and therefore greater levels of cortisol in the blood.

Conscious detachment: Ignoring babies to induce stress

To investigate whether DNA methylation of NR3C1 and 11β-HSD2 was related to maternal depressive symptoms and/or maternal sensitivity, Conradt and her team worked with 128 infants of women with self-reported symptoms of depression and obtained DNA (to test for methylation) from the infants through cheek swabs and cortisol levels from their saliva.

The infants each participated in three two-minute face-to-face play episodes with their mothers. The first play episode required normal play between mother and infant, the second episode required that the mothers be unresponsive to their infants and the third episode was a reunion episode where mothers were allowed to interact again.

Maternal sensitivity, recorded every 30 seconds, was assessed using four scales. First, maternal acceptance: Willingness and ability of the mother to follow her infant's lead. Second, demandingness: the degree to which the mother required her infant to behave a certain way. Third, responsiveness: Both the mother's awareness of her infant's signals and her response to them, regardless of the appropriateness of response. Fourth, appropriate touch: The mother's ability to touch her infant in a gentle and affectionate manner as opposed to a more intrusive manner.

The researchers took a pre-stress cortisol sample from each infant prior to entering the lab and two post-stress samples after the unresponsive play episode and after the reunion play episode. A cheek swab for DNA was taken after the second play episode.

When put to the test, sensitivity beat stress

The research team found that greater levels of maternal sensitivity were related to lower levels of cortisol. While there were no differences in DNA methylation among infants whose mothers scored high on sensitivity, infants whose mothers were both less sensitive and had high depressive symptoms had higher levels of methylation and more cortisol.

Furthermore, mothers with depressive symptoms who were more responsive and engaged in more appropriate touch during face-to-face play had infants with less DNA methylation compared to mothers with depressive symptoms who were also insensitive.

Having a sensitive caregiver, therefore, appears to buffer infants from the exposure of the mother's depressive symptoms. Infants aren't aware of whether their caregivers are depressed or not; they are only aware of how they're treated. This study is the first to demonstrate that certain forms of maternal caregiving can have such an effect.

"Many mothers struggle with depression but interact quite sensitively with their infants. In these instances, the mother may be "turning on" certain genes that we think allow infants to manage stress in adaptive ways," Conradt summarized.

Conradt and her team are currently replicating and extending this study with first-time pregnant women in Utah to better understand whether parenting can buffer the infant to the effects of prenatal exposure to stress and depression.

"We are excited about the possibility that this research may lead to specific ways one can effectively intervene with pregnant women at risk for postpartum depression."

https://www.sciencedaily.com/releases/2016/02/160211185003.htm

Positive father-child relationship can moderate negative effects of maternal depression Crucial role for partners of depressed mothers

Crucial role for partners of depressed mothers

May 11, 2017
Science Daily/Bar-Ilan University
A new study has examined for the first time whether fathering can moderate the negative effects of maternal depression on family-level functioning. The results of the study are the first to describe the family process by using direct observations of mothering, fathering, and family patterns in homes where mothers suffer clinical depression during the child's first years of life.

Maternal depression negatively impacts children's emotional and cognitive development and family life. Studies have shown that a home in which the mother suffers from depression exhibits lower cohesion, warmth, and expressiveness and higher conflict, rigidity, and affectionless control. Since 15-18% of women in industrial societies and up to 30% in developing countries suffer from maternal depression, it is of clinical and public health concern to understand the effects of maternal depression on children's development.

A family affair

A new study, published in Development and Psychopathology, by Prof. Ruth Feldman and colleagues at the Department of Psychology and Leslie and Susan Gonda (Goldschmied) Multidisciplinary Brain Research Center at Bar-Ilan University has, for the first time, examined whether fathering can moderate the negative effects of maternal depression on family-level functioning. The results of this study are the first to describe the family process by using direct observations of mothering, fathering, and family patterns in homes where mothers suffer clinical depression during the child's first years of life.

Feldman conducted a longitudinal study of a carefully selected sample of married or cohabiting chronically depressed women with no comorbid contextual risk, who were repeatedly assessed for maternal depression across the first year after childbirth and when the child reached age six. The families were home-visited when the child reached preschool age in order to observe and videotape mother-child, father-child, and both-parent-child interactions.

Sense and sensitivity

During the first years of life, sensitivity marks the most critical component of the parental style that affects the child's emotional and social development. Sensitive parents are attuned to their child's needs and attend to them in a responsive and nonintrusive manner. Parents who act intrusively tend to take over tasks that children are, or could be, performing independently, imposing their own agenda without regard for the child.

In Feldman's study depressed mothers exhibited low sensitivity and high intrusiveness, and children displayed lower social engagement during interactions with them. Partners of depressed mothers also showed low sensitivity, high intrusiveness, and provided little opportunities for child social engagement, so that the family unit was less cohesive, harmonious, warm, and collaborative. However, when fathers were sensitive, nonintrusive, and engaged children socially, maternal depression no longer predicted low family cohesion.

Feldman: "When fathers rise to the challenge of co-parenting with a chronically depressed mother, become invested in the father-child relationship despite little modeling from their wives, and form a sensitive, nonintrusive, and reciprocal relationship with the child that fosters his/her social involvement and participation, fathering can buffer the spillover from maternal depression to the family atmosphere."

According to Feldman, because rates of maternal depression appear to increase each decade, and paternal involvement in child care is constantly increasing in industrial societies, it is critical to address the fathers' potential contribution to family welfare by providing interventions for the development of a sensitive parenting style and other compensatory mechanisms, in order to enhance their role as buffers of the negative effects of maternal depression.

https://www.sciencedaily.com/releases/2017/05/170511095154.htm