Postpartum bonding: the role of perinatal depression, anxiety and maternal-fetal bonding during pregnancy.

Adverse effects of perinatal depression on the mother-child interaction are well documented; however, the influence of maternal-fetal bonding during pregnancy on postpartum bonding has not been clearly identified. The subject of this study was to investigate prospectively the influence of maternal-fetal bonding and perinatal symptoms of anxiety and depression on postpartum mother-infant bonding. Data from 80 women were analyzed for associations of symptoms of depression and anxiety as well as maternal bonding during pregnancy to maternal bonding in the postpartum period using the Edinburgh Postnatal Depression Scale (EPDS), the State-Trait Anxiety Inventory (STAI), the Pregnancy Related Anxiety Questionnaire (PRAQ-R), the Maternal-Fetal Attachment Scale (MFAS) and the Postpartum Bonding Questionnaire (PBQ-16). Maternal education, MFAS, PRAQ-R, EPDS and STAI-T significantly correlated with the PBQ-16. In the final regression model, MFAS and EPDS postpartum remained significant predictors of postpartum bonding and explained 20.8 % of the variance. The results support the hypothesized negative relationship between maternal-fetal bonding and postpartum maternal bonding impairment as well as the role of postpartum depressive symptoms. Early identification of bonding impairment during pregnancy and postpartum depression in mothers plays an important role for the prevention of potential bonding impairment in the early postpartum period.

Timing of elective repeat caesarean does matter: Importance of avoiding early-term delivery especially in diabetic patients.

Five hundred and three elective repeat caesarean sections were analysed to examine the impact of timing of delivery between 37 and 40 weeks' gestation on foetal and maternal short-term outcome. Gestational age, Apgar scores and admission to the neonatal intensive care unit (NICU)-based foetal outcome. Maternal complications were comparatively evaluated. Due to the increasing incidence of gestational diabetes a subgroup analysis on this issue was performed. Neonates born by elective repeat caesarean in early term had a 3.2 times increased risk of being admitted to the NICU due to foetal adaption disorders in the early post-natal phase. Overall maternal peri-operative risks were low and did not differ significantly between 37 and 41 weeks' gestation. Maternal gestational diabetes constituted an additional independent risk factor in early term. In summary, elective early-term caesarean delivery appears to negatively impact immediate neonatal outcome. Waiting at least until 38 completed weeks' gestation improves foetal outcome, especially in diabetic patients.

Prevalence of paternal perinatal depressiveness and its link to partnership satisfaction and birth concerns.

Depressive disorders have shown an increasing prevalence over the past decades. Growing evidence suggests that pregnancy and childbirth trigger depressive symptoms not only in women but likewise in men. This study estimates the prevalence of paternal perinatal depressiveness in a German community sample and explores its link to partnership satisfaction as well as birth-related concerns and concerns about the future. Data was gathered in a longitudinal study over the second and third trimester of their partner's pregnancy up to 6 weeks postpartum. In a two-stage screening procedure, 102 expectant fathers were assessed for symptoms of depression, anxiety, and partnership satisfaction using the Edinburgh Postnatal depression Scale (EPDS), the State/Trait Anxiety Inventory, a self-constructed questionnaire for birth concerns and the Questionnaire of Partnership. The prevalence of elevated depressive symptoms among expectant fathers was 9.8 % prenatally and 7.8 % postnatally. Prenatal relationship quality, prenatal EPDS scores, and birth concerns were significantly associated with and explained 47 % of the variance in paternal postnatal depressive symptoms. The prevalence of paternal depressive symptoms is a significant concern. Our findings point out the need for implementing awareness and screening for depressiveness in fathers in clinical routine in Germany as well as the necessity of developing a screening instrument for paternal birth-related anxiety.

The influence of general anxiety and childbirth-specific anxiety on birth outcome.

In the present study, we examined a German sample to determine whether anxiety symptoms during pregnancy had an impact on the duration and method of childbirth. Data of N = 88 women recruited at the Heidelberg University Hospital were used in the analyses. Prepartum anxiety symptoms were assessed with the State-Trait Anxiety Inventory (STAI, general anxiety) and the Pregnancy Related Anxiety Questionnaire (PRAQ-R, pregnancy-specific anxiety). Obstetric outcome was taken from birth records and operationalized by two parameters: the total duration of birth (dilation and fetal expulsion) and the incidence of pregnancy or birth-related interventions (ventouse, planned, and unplanned Cesarean section). The data show that childbirth-specific anxiety assessed by the PRAQ-R is an important predictor of total birth duration. In contrast, general anxiety measured by the STAI had no effect. The incidence of birth intervention was explained by parity. Anxiety, however, had no predictive value. In addition to medical factors, childbirth-specific anxiety during pregnancy plays an important role in the process of childbirth. The findings of the present study point to the need of implementing psychological interventions to reduce childbirth-specific anxiety and thereby positively influencing birth outcome.

Subclinical depressive symptoms during pregnancy and birth outcome--a pilot study in a healthy German sample.

There is a high prevalence of depression in Germany and all over the world. Maternal depressive symptoms during pregnancy have been shown in some studies to be associated with an increased risk of preterm birth and low birth weight. The influence of maternal depressive symptoms during pregnancy on preterm delivery and fetal birth weight was investigated in a prospective single-centre study. A sample of 273 healthy pregnant women was assessed for symptoms of antepartum depression. Symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS) and the Patient Health Questionnaire (PHQ). Symptoms of anxiety were assessed using the State/Trait Anxiety Inventory. Patients who scored above the cutoff were contacted by phone for a Structured Clinical Diagnostic interview. Neonatal measurements were obtained from the birth registry of the Department of Obstetrics. Baseline data were assessed with a self-styled data sheet. Prevalence of elevated depressive symptoms was 13.2% when measured with the EPDS and 8.4% with the PHQ. According to DSM-IV criteria, only four (EPDS) respective two (PHQ-D) of these patients could be diagnosed with a depressive disorder and ten (EPDS) respective seven (PHQ) with an anxiety disorder. There was no significant influence on preterm birth or birth weight. Maternal depressive symptoms are self-reported. Elevated subclinical symptoms of depression and anxiety during pregnancy are common. However, this study showed no evidence that these symptoms are associated with adverse pregnancy outcome.

Effects of Indoleacetic Acid on the Quantity of Mitochondria, Microbodies, and Plastids in the Apical and Expanding Cells of Dark-grown Oat Coleoptiles.

We determined the number of mitochondria, microbodies, and plastids in dark-grown oat (Avena sativa) coleoptiles following incubation in indoleacetic acid (IAA) for a period of 60 minutes at 6-minute intervals. In the apical outer epidermis of coleoptiles, the mitochondria increased from 31.4 to 35 per cell section with a 6-minute incubation in IAA, and this trend persisted over the 60-minute incubation. Neither the microbodies, plastids, nor the dicytosomes (Gawlik and Miller 1974 Plant Physiol 54:217-221) responded to the hormone. The apical parenchyma showed no change in quantity of any of the organelles including the dictyosomes during IAA incubation. The quick response of mitochondria in the coleoptile tip could be interpreted as an association of this organelle with hormone transport, growth, or perhaps with gravity perception. In the subapical expansion region, IAA caused significant reductions of mitochondria, microbodies, and dictyosomes in the outer epidermis compared to the control, the timing of which preceded the IAA-induced elongation and of geotropism. The fast response of organelles in the various cells is probably a change in organelle volume rather than number. That microbodies show a response to the plant hormone in the permanently achlorophyllous epidermis indicates that these organelles, in addition to their peroxisomal functions in green leaves, also may have a growth regulation function. IAA treatment was without effect on the quantity of the various types of plastids (including the amyloplasts) in the different oat coleoptile cells.

Effects of indoleacetic Acid on dictyosomes of apical and expanding cells of oat coleoptiles.

We found that the auxin-induced growth is mediated through the activation of the dictyosomes (collectively, the Golgi apparatus). Incubation of oat (Avena sativa) coleoptile segments in indoleacetic acid-sucrose-phosphate buffer changes significantly the number of dictyosomes in the expanding cells. A further indication of auxin enhancement of dictyosome activity is a decrease in dictyosomal cisternae (flattened membranous sacs) number. This decrease occurred after 6 minutes of incubation in auxin, and then was followed by a reduction in the organelle number per se. These times are in keeping with the rapid action of auxin-induced cell elongaton, and the latent period of geotropism. In the apical cells, the effect of indoleacetic acid is more subtle and complex. The periods of increased dictyosome utilization and of increased dictyosome synthesis in auxin-treated segments alter with those of the control. These observations indicate that dictyosomes not only have a function in cell elongation, but also may participate in processes such as auxin transport and stimuli perception. The expanding cells have five times as many dictyosomes as the cells in the apex. Dictyosome number within a cell appears to be directly proportional to the length of the cell. The fluctuation of dictyosome number and the effect of auxin on the rate of elongation of individual outer epidermis are discussed.