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