The transition to motherhood during COVID-19: The mediating role of postpartum depression in the association between self-compassion and mindful parenting among Portuguese postpartum women

Background The COVID-19 pandemic can have a significant negative impact on postpartum women's mental health and, consequently, on their parenting. Self-compassion can help mothers navigate the transition to motherhood more adaptively during this pandemic. Aims and Objectives This study aims to: 1) compare depressed and non-depressed mothers and those who experienced and did not experience a negative emotional impact of COVID-19 on mindful parenting;2) explore whether self-compassion is associated with mindful parenting and whether this association can be mediated by lower levels of postpartum depression (PPD);and 3) explore the moderating role of the perceived emotional impact of COVID-19 on these associations. Methods During December 2020, 997 Portuguese mothers of infants with an average age of 2.5 months (SD = 1.28, range:0-6) completed an online survey that included a sociodemographic and obstetric form, questions about the perceived negative emotional impact of the pandemic, the Self-Compassion Scale, the Edinburgh Postnatal Depression Scale, and the Interpersonal Mindfulness in Parenting Scale. Results Women scoring above the EPDS cut-off (38.5%) presented lower levels of self-compassion and of all mindful parenting dimensions. In addition, mothers who reported having felt that the pandemic had a negative emotional impact during pregnancy (76.6%) and postpartum (79.5%) presented lower levels of self-regulation and non-judgemental acceptance of parental functioning. A moderated mediation analysis showed that higher levels of self-compassion were associated with higher levels of mindful parenting and that this association was mediated by lower levels of PPD, particularly among mothers who experienced a negative emotional impact of the pandemic. Interpretation/Discussion COVID-19 has a negative impact on postpartum women's mental health and parenting. Self-compassion seems to help mothers feel less depressed and be more mindful in parenting. Conclusions Postpartum women should be offered the possibility of receiving mental health support, especially during the pandemic. Compassion-based interventions may be particularly important in reducing PPD and promoting mindful parenting.

Becoming a mother during COVID-19: A national study on the experiences of pregnancy and childbirth in Portugal

Background Having a baby during the COVID-19 pandemic poses a number of challenges for mothers, which can seriously compromise their mental health. Aims and Objectives This study aims to describe the birth and postpartum experiences of a national sample of Portuguese postpartum mothers. It also aims to investigate the role of the negative emotional impact of the pandemic on mothers' mental health. Methods During December 2020, 1413 Portuguese mothers (70.8% primiparous) of infants with an average age of 2.5 months (SD = 1.32, range: 0-6) completed an online survey that included a sociodemographic and obstetric form, questions about the perceived emotional impact of the pandemic, the Edinburgh Postnatal Depression Scale, and the Postpartum-Specific Anxiety Scale. Results Most mothers (75.5%) were on pregnancy leave due to an obstetrical complication (45.2%), to avoid COVID-19 infection (44.8%), or both (10%). 95.9% of mothers did a COVID test before labour, but only 1.1% tested positive. Women who did not have the delivery they desired (45.2%), who were unable to be with their baby shortly after birth (14.6%), and who did not perform skin-to-skin contact (33.4%) were significantly more anxious and depressed in the postpartum than those who had the delivery they desired, contacted with their baby after birth and performed skin-to-skin contact. Women who scored above the cut-off on EPDS (37.9%) and who reported that COVID-19 had a negative emotional impact during pregnancy (77.5%) and postpartum (80.1%) presented higher levels of postpartum anxiety and depression. Interpretation/Discussion Having a baby during COVID-19 seems to have a significant impact on postpartum mothers' mental health. In addition, a positive birth experience seems to be a key factor in women's psychological adjustment. Conclusions Despite the limitations imposed by the pandemic, it is essential to promote a positive birth experience and to ensure that women in the perinatal period can obtain psychological support whenever they need it.

The role of mothers' self-compassion on mother-infant bonding during the COVID-19 pandemic: A longitudinal study exploring the mediating role of mindful parenting and parenting stress in the postpartum period

Background The current COVID-19 pandemic is a challenging time for postpartum mothers, and associated challenges may have a negative impact on their parenting and, consequently, on mother-infant bonding. Aims and Objectives This study aimed to longitudinally explore whether mothers' self-compassion was associated with mother-infant bonding and whether this relationship was mediated by mindful parenting and parenting stress. Methods A total of 125 Portuguese mothers of infants aged between zero and 12 months completed an online survey at two assessment points during the first wave of the COVID-19 pandemic (T1: April-May 2020;T2: June-July 2020). The survey included several questionnaires assessing sociodemographic, clinical and COVID-19 information;self-compassion;mindful parenting;parenting stress;and mother-infant bonding. Results Mothers presented significantly higher levels of self-compassion, less impaired mother-infant bonding and lower levels of depressive symptoms at T2 than T1. Higher levels of self-compassion at T1 predicted less impaired mother-infant bonding at T2, and this relationship was mediated by higher levels of mindful parenting and lower levels of parenting stress (both assessed at T1). Interpretation/Discussion Self-compassion seems to be an important predictor of mother-infant bonding. This relationship is explained by a mindful approach to parenting and by mothers' levels of parenting stress. Conclusions These results highlight the relevance of mothers' self-compassion to establishing mother-infant bonding in the postpartum period, particularly during the COVID-19 pandemic, and the important role of mindful parenting and parenting stress in determining this relationship.

Protective factors of postpartum depression and anxiety during COVID-19: A longitudinal study with postpartum mothers before and during a national lockdown

Background In the beginning of 2021, Portugal faced the most difficult phase of the pandemic, being for several weeks at the top of the world ranking of infection and mortality. The transition to motherhood can be particularly difficult in this context and lead mothers to experience high levels of depression and anxiety. Therefore, it is essential to examine the role of modifiable psychological factors than can help women better adjust to this phase, such as self-compassion and psychological flexibility. Aims and Objectives 1) examine the evolution of postpartum depression and anxiety over two distinct phases of the COVID-19 pandemic;and 2) investigate whether self-compassion and psychological flexibility can reduce the likelihood of later postpartum depression and anxiety. Methods 383 Portuguese postpartum mothers completed an online survey during a pandemic phase with few restrictions (December 2020;T1) and during the third wave of the pandemic and national lockdown (March 2021;T2). The survey included a sociodemographic and obstetric form, and questionnaires assessing postpartum depression (EPDS), postpartum anxiety (PSAS-PT), self-compassion (SCS), and psychological flexibility (CompACT). Results Postpartum anxiety and depression levels significantly increased from T1 to T2 (e.g. the number of women scoring above the EPDS cut-off increased from 35.5% to 42.8%). Higher levels of self-compassion and psychological flexibility at T1 predicted lower levels of postpartum depression and anxiety at T2. Interpretation/Discussion COVID-19 control measures, including a general lockdown, have a substantial impact on postpartum women's mental health. Self-compassion and psychological flexibility are two psychological resources that seem to protect women from developing depression and anxiety during postpartum and in a particularly challenging phase of the pandemic. Conclusions Compassion-and acceptance-based interventions can help postpartum women to better adapt to postpartum challenges and to particularly demanding periods such as a lockdown.

ANÁLISE DE CITOCINAS E QUIMIOCINAS NO PLASMA DE PACIENTES COM COVID-19 E DOADORES DE SANGUE ASSINTOMÁTICOS INFECTADOS COM SARS-COV-2

Objetivos: Comparar níveis de citocinas e quimiocinas entre indivíduos infectados com SARS-CoV-2 com COVID-19 grave ou com a forma assintomática da infecção, a fim de avaliar quais destes marcadores biológicos de resposta inflamatória são indicadores de gravidade da infecção viral. Métodos: Foram analisados dados clínicos de 48 pacientes com COVID-19 hospitalizados no Hospital Eduardo de Menezes (FHEMIG, MG) no período de 07 de julho a 21 de novembro de 2020, que necessitaram ou não de assistência em terapia intensiva (grupos UTI e sem UTI, respectivamente). Foi feita a quantificação dos níveis de citocinas (IL-2, IL-4, IL-6, IL-10, TNF, IFN-, IL-17A) e quimiocinas (CCL2, CCL5, CXCL8, CXCL9 e CXCL10) do plasma de 14 pacientes UTI e 17 pacientes sem UTI que tinham COVID-19 grave no momento da coleta da amostra, além de 24 doadores de sangue da Fundação Hemominas com infecção ativa pelo SARS-CoV-2 (RT-PCR positiva) que eram assintomáticos no momento da coleta da amostra. Resultados: A análise clínica dos pacientes UTI (n = 19) em comparação àqueles que não usaram UTI (n = 29) não mostrou diferença estatística quanto à frequência de comorbidades e de sinais e sintomas para COVID-19 na admissão hospitalar. A comorbidade mais comum foi hipertensão (62,5%), seguida por diabetes (37,5%) e obesidade (22,9%). Tosse, dispneia, febre, fatiga e mialgia foram os sinais e sintomas mais prevalentes de COVID-19 em ambos os grupos. Entretanto, os pacientes UTI desenvolveram doença grave ou crítica que requereu um período de hospitalização em média duas vezes mais longo que o grupo sem UTI (p < 0,001). O conjunto dos pacientes com COVID-19 mostrou níveis significativamente mais altos de IL6, IL10 e CCL5 que os doadores assintomáticos. Na comparação dos grupos dos pacientes houve diferença significativa apenas para IFN, com níveis mais elevados nos pacientes UTI. Discussão: Apesar do grupo de pacientes UTI apresentarem quadro de COVID-19 mais grave que os pacientes sem UTI, a frequência de sinais e sintomas da doença e de comorbidades não foi significativamente diferente entre os grupos. A evolução da COVID-19 de assintomática para grave e crítica tem sido associada com intensa resposta inflamatória, o que está de acordo com maiores níveis de IL6, IL10 e CCL5 observados nos pacientes em comparação aos doadores assintomáticos. Nível de IFN pode ser especial indicador de gravidade da doença. Conclusão: Marcadores biológicos, como citocinas e quimiocinas, podem ser melhores preditores de evolução da COVID-19 que sinais clínicos e sintomas. Suporte financeiro: Fundação Hemominas e SES/MG.