Can mothers' representations of their infants be improved in primary care? A randomized controlled trial of a parenting intervention using video feedback in a predominantly low- to moderate-risk sample.

Introduction: Mothers' representations of their infants are important intervention targets because they predict the observed quality of infant-mother interactions. The current study investigated the influence of a video-feedback infant-parent intervention on mothers' representations of their infants beyond the effect of standard treatment. Methods: Data from a naturalistic, randomized controlled trial of 152 predominantly low- to moderate-risk mothers (mean age = 29.7 years) with infants (mean age = 7.3 months) were used. At Well Baby Centers, all families followed the universal program, which was treatment as usual (TAU), whereas half of the families also received the intervention. The Working Model of the Child Interview categories and scales as well as three latent factors generated from a factor analysis were used to assess maternal representations at baseline and follow-up (9-13 months after baseline). A linear mixed model analysis was used to analyze the data. Results: There were no differences in representation changes from baseline to follow-up between the control group (TAU) and intervention group. When both groups were combined, there were minor improvements in the mothers' representations at the follow-up. Discussion: Aspects of the intervention, the quality of TAU, and the homogeneity scores of the predominantly low-risk sample may explain the intervention's lack of effect on mothers' representations beyond TAU. The supportive services at Norwegian Well Baby Centers as well as the infants' increasing age putatively contributed to the improved features of the mothers' representations in the total sample. That standard community care may affect maternal representations has not been shown before. Future research should identify the core components in interventions targeting maternal representations and examine whether those components can be incorporated in primary care. Including measures of mothers' reflective functioning could broaden our knowledge of representations and their changeability. Clinical trial registration: This study is registered in the International Standard Randomized Controlled Trial Number registry under the reference number ISRCTN 99793905.

Validity of the Maternal Antenatal Attachment Scale-Spanish Version for Mexican Pregnant Women / Validez de la Escala de Apego Prenatal Materno: versión en español para mujeres mexicanas embarazadas

During pregnancy, parents experiment emotions, thoughts, and behaviors related to their unborn child as precursors of attachment in the caretaker-infant dyad. The Maternal Antenatal Attachment Scale (MAAS) is an instrument that has shown adequate psychometric properties to evaluate this construct in developed countries. The aim of this study was to assess the reliability and concurrent validity of the Maternal Antenatal Attachment Scale-Spanish version for Mexican women (MAAS-Spanish version). A sample of 142 women in their third trimester of pregnancy who received care in a tertiary hospital was selected. The full scale of the MAAS-Spanish version obtained a Cronbach alpha of .79. A significant negative correlation was found between the global MAAS-Spanish version score (r = -.23, p ≤ .01) and the Postpartum Depression Predictors Inventory-Revised and depressive symptoms (r = -.36 , p ≤ .01). The translated and adapted scale has adequate internal consistency and concurrent validity to measure this construct in this population. ()AU)

Durante el embarazo, los padres experimentan emociones, pensamientos e ideas sobre su nonato relevantes en el estudio de precursores del apego en la díada cuidador-infante. La Escala de Apego Prenatal Materno (MAAS) es un instrumento que ha mostrado adecuadas propiedades psicométricas para evaluar este constructo en países desarrollados. El propósito de este estudio fue evaluar la confiabilidad y validez concurrente de dicha escala—versión en español para mujeres mexicanas (MAAS—versión en español). Se seleccionó a una muestra de 142 mujeres en tercer trimestre gestacional, que recibían atención en un hospital de tercer nivel. La escala total obtuvo un alfa de Cronbach de .79. Se evidenció una correlación negativa significativa de la puntuación global de la MAAS de r = -.23, (p ≤ .01) con la PDPI-R y de r = -.36, (p ≤ .01) con la sintomatología depresiva (EPDS). La escala traducida cuenta con una consistencia interna y validez concurrente adecuadas para medir este constructo en esta población. (AU)

Prenatal Mental Representations in Italian First-Time Mothers Before and During the COVID-19 Pandemic: A Study with Interviews on Maternal Representations During Pregnancy.

INTRODUCTION: Psychosocial risks increase the levels of not-integrated/ambivalent and restricted/disengaged representations during pregnancy, but no study has specifically analysed the impact of the COVID-19 pandemic on maternal representation styles. OBJECTIVES: (1) to compare maternal representation styles in primiparous women who became pregnant before and during the COVID-19 pandemic and (2) to analyse the content of representation styles during the COVID-19 pandemic. METHODS: A total of 37 Italian pregnant women were recruited from 2019 to 2021. The sample was divided into two groups: the pre-COVID-19 group (22 women, mean age = 33.14 years; SD = 3.78) and the COVID-19 group (15 women, mean age = 35.9 years; SD = 4.6). Interviews on maternal representations during pregnancy were administered and analysed for style and content. RESULTS: Women during the COVID-19 pandemic reported more restricted/disengaged and less integrated/balanced representation styles than women pre-COVID-19. Content analysis showed that the COVID-19 pandemic led women to focus more on concrete aspects of pregnancy in lieu of emotional aspects, thus leading them to develop more restricted/disengaged representation styles. CONCLUSIONS FOR PRACTICE: In future pandemics pregnant women should be supported in focusing their attention to emotions, sensations and fantasies about themselves as mothers and their children.

When the Good Object is also a Thief: A Memoir of Adoption.

This contemporary Kleinian memoir explores the possible existence of an intrapsychic, adoption-specific preoedipal triad including child, birth mother, and adoptive mother that can shape the emerging mind. As an intrapsychic construct, the adoption triad comes to exist in the infantile mind, requiring that adoptees contend with four additional part-object maternal representations: a villain (bad birth mother), a victim (good birth mother), a rescuer (good adoptive other), and a thief (bad adoptive mother). The psychic complexities of this possible adoption triad are explored, with an eye to how it might illuminate the psychosocial challenges experienced by some adoptees, including dysregulated behavior, rage, dissociation, and shame. To this end, Bion's ideas regarding presymbolic, nondefensive communication and Winnicott's understanding of use of the object are invoked. Expanding the preoedipal paradigm of adoption to include the possibility of an intrapsychic, adoption-specific maternal triad can enhance our understanding of the psychology of adoption, as well as highlight the need to consider the ways in which internal objects can exist simultaneously in both dyadic and triadic paradigms.

Children's Maternal Representations Moderate the Efficacy of Parent-Child Interaction Therapy-Emotion Development (PCIT-ED) Treatment For Preschool Depression.

A randomized controlled trial (RCT) demonstrated that a novel psychotherapy, Parent-Child Interaction Therapy-Emotion Development (PCIT-ED), effectively treats preschool-onset depression. However, little is known about which children benefit most from PCIT-ED. As positive parent-level factors are associated with lesser depressive symptoms, this study explored the potential moderating role of positive parenting relationships on PCIT-ED efficacy. This study examined mothers and their children aged 3-6 (N = 185) who participated in the PCIT-ED RCT. Children were randomized to immediate PCIT-ED treatment (n = 94) or a waitlist control condition (n = 91) that received treatment after 18 weeks. Prior to treatment, children completed a narrative story completion task that was videotaped and coded for children's positive and negative representations of their mothers. Parent-child interaction tasks were also completed pre-treatment and videotaped and coded to measure observed parenting. Odds of MDD diagnosis post-treatment were predicted by the interaction of children's negative maternal representations and treatment group (Estimate = -.68; SE = .27; [Formula: see text] = 6.45; p = .01) and the interaction of children's relatively more positive than negative maternal representations and treatment group (Estimate = .30; SE = .13; [Formula: see text] = 5.27; p = .02). Observed parenting measures did not significantly predict odds of MDD diagnosis. Thus, PCIT-ED predicted loss of MDD diagnosis for children who displayed maternal representations that were less negative, and relatively more positive than negative. Results suggest that children with relatively more positive maternal representations may be more likely to benefit from PCIT-ED, whereas children with more negative maternal representations may need targeted work to decrease negative maternal perceptions before initiating PCIT-ED in order for treatment to be most effective.

Intergenerational transmission of trauma from mother to infant: the mediating role of disrupted prenatal maternal representations of the child.

Data from a multi-method, longitudinal study involving a community sample (N = 120) of pregnant women aged 18-42 were used to examine disrupted maternal representations of the child as a mechanism of the transmission of trauma from mother to infant. Using structural equation modeling, the best fitting model indicated that severity of mothers' childhood interpersonal trauma was associated with severity of disruption in prenatal representations of the child, which in turn was associated with less secure infant-mother attachment at 1 year of age. There was a significant indirect effect of maternal childhood interpersonal trauma on infant-mother attachment insecurity via disrupted prenatal maternal representations. Findings highlight an important mechanism of trauma transmission that could be targeted in interventions with mother-infant dyads.

Measuring mothers' representations of their infants: Psychometric properties of the clinical scales of the working model of the child interview in a low- to moderate-risk sample.

The Working Model of the Child Interview (WMCI) is frequently used to measure parents' representations. Beyond the global categories (balanced, disengaged, distorted), the reliability, factor structure, and validity of all the 15 clinical scales have not previously been studied. The WMCI was administered to 152 Norwegian mothers of infants (mean age = 7.3 months) recruited from community well-baby clinics. Interrater reliability was adequate for the global categories and moderate for the clinical scales. Exploratory factor analysis and confirmatory factor analysis yielded three factors with evidence of factorial validity: Factor 1 balanced; factor 2 resentful; factor 3 apprehensive. Factor 1 corresponded with the original category balanced, while factor 2 and factor 3 corresponded with the original category distorted. Concurrent validity was supported as mothers with balanced representation (factor 1) were less stressed and the mother-infant interaction was more positive than that of mothers with resentful representation. Mothers with resentful or apprehensive representations (factor 2 and factor 3) reported more stress. The extracted factors and demographic variables correlated weakly or not at all, confirming discriminant validity. Our findings show that the clinical scales of the WMCI can be used in research with low- to moderate-risk samples.

El Modelo de Trabajo de la Entrevista del Niño (WMCI) se usa frecuentemente para medir las representaciones de los progenitores. Más allá de las categorías globales (equilibradas, desconectadas, distorsionadas), la confiabilidad, la estructura de factores y la validez de todas las 15 escalas clínicas no han sido previamente estudiadas. Se les administró el WMCI a 152 madres noruegas de infantes (edad media = 7.3 meses) reclutadas de clínicas comunitarias para el bienestar del bebé. La confiabilidad entre los evaluadores fue adecuada para las categorías globales y moderada para las escalas clínicas. Los análisis exploratorios de factores (EFA) y los análisis confirmatorios de factores (CFA) produjeron tres factores con evidencia de validez factorial: Factor 1) equilibradas; factor 2) resentidas; factor 3) aprensivas. El factor 1 se correspondió con la categoría original de equilibradas, mientras que el factor 2 y el factor 3 se correspondieron con la categoría original de distorsionadas. La validez concurrente encontró apoyo en que las madres con una representación equilibrada (factor 1) estaban menos estresadas y la interacción madre-infante fue más positiva que la de las madres con representaciones resentidas. Las madres con representaciones resentidas o aprensivas (factor 2 y factor 3) reportaron más estrés. Los factores extraídos y las variables demográficas se correlacionaron débilmente o no se correlacionaron del todo, lo cual confirma la validez discriminante. Nuestros resultados muestran que las escalas clínicas del WMCI pueden usarse en la investigación con grupos muestras de bajo a moderado riesgo.

Le Modèle Fonctionnel de l'Entretien de l'Enfant (WMCI en anglais) est fréquemment utilisé pour mesurer les représentations des parents. Au-delà des catégories globales (équilibré, désengagé, déformé), la fiabilité, la structure de facteur et la validité de toutes les 15 échelles cliniques n'ont pas été étudiées jusqu'à présent. Le WMCI a été donné à 152 mères de nourrissons norvégiennes (âge moyen = 7,3 mois) recrutées dans des cliniques de bien-être du bébé communautaires. La fiabilité entre les évaluateurs était adéquate pour les catégories globales et modérée pour les échelles cliniques. L'Analyse Factorielle Exploratoire (AFE) et l'Analyse Factorielle de Confirmation (AFC) ont produit trois facteurs avec une preuve de validité factorielle: Facteur 1) équilibré; facteur 2) rancunier; facteur 3) appréhensif. Le facteur 1 correspondait à la catégorie originale balancé, alors que le facteur 2 et le facteur 3 correspondaient à la catégorie originale déformé. La validité simultanée a été confirmée puisque les mères avec une représentation équilibrée (facteur 1) étaient moins stressées et l'interaction mère-bébé était plus positive que celle des mères avec une représentation rancunière. Les mères avec des représentations rancunières ou appréhensives (facteur 2 et facteur 3) ont fait état de plus de stress. Les facteurs extraits et les variables démographiques se sont faiblement corrélés ou pas du tout, confirmant une validité discriminante. Nos résultats montrent que les échelles cliniques du WMCI peut être utilisée dans les recherches avec des échantillons à risque faible à modéré.

Hostile/Helpless maternal representations in pregnancy and later child removal: A pilot study.

This article presents the results of a small pilot study examining links between Hostile/Helpless (HH) representations of caregiving in pregnancy and later child removal by child protective services. The sample was drawn from a replication study of the Minding the Baby® attachment-based home-visiting intervention conducted in the United Kingdom, serving young first-time mothers in under resourced communities. The HH classification system (Lyons-Ruth et al.) was adapted for use with the Pregnancy Interview (PI) (Slade); 26 PIs were assessed (coders blinded) in a sample that included 13 mothers whose infants were removed from custody due to anticipated or documented maltreatment within 2 years of childbirth, and 13 mothers who did not have their infants removed. Mothers whose infants were removed from their custody had significantly higher HH scores than mothers of infants who were not removed from their care (F(1, 24) = 14.500, p < .001), and the relation between overall HH classification and infant removal status was also significant (χ2 (1, N = 26) = 12.462, p < .001). Results suggest that prenatal maternal caregiving representations may predict postnatal relationship disruptions, and indicate the need for larger studies further testing this prenatal approach to maltreatment risk assessment in at-risk populations.

Este artículo presenta los resultados de un pequeño estudio piloto que examina las conexiones entre las representaciones Hostiles/Indefensas de la prestación de cuidado durante el embarazo y más tarde cuando los servicios de protección a la niñez han separado al niño. El grupo muestra fue seleccionado de un estudio de replicación de la intervención Cuidando al Bebé (Minding the Baby® -MTB) de visita a casa con base en la afectividad, llevada a cabo en el Reino Unido para servirles a madres jóvenes en comunidades de pocos recursos. El sistema de clasificación Hostil/Indefensa (HH) (Lyons-Ruth et al., 1995-2005) se adaptó para el uso con la Entrevista del Embarazo (PI) (Slade, 2011); se evaluaron 26 entrevistas PI (los codificadores lo hicieron de manera ciega), de un grupo muestra que incluía 13 madres cuyos infantes fueron separados de su custodia debido al anticipado o documentado maltrato dentro de los 2 años anteriores al parto, y 13 madre cuyos infantes no habían sido separados. Las madres cuyos infantes habían sido separado de su custodia presentaron significativamente más altos puntajes HH que las madres de infantes no separados del cuidado materno (F(1, 24) = 14.500, p < .001), y la relación entre la clasificación general HH y la condición de separación del infante fue también significativa (c2(1, N = 26) = 12.462, p < .001). Los resultados sugieren que las representaciones prenatales del cuidado materno pudieran predecir las interrupciones de la relación postnatal, y apuntan a la necesidad de estudios más comprensivos que continúen examinando este acercamiento prenatal a la evaluación del riesgo de maltrato en grupos bajo riesgo.

Cet article présente les résultats d'une petite étude pilote examinant les liens entre les représentations Hostile/Impuissant du mode de soin durant la grossesse et plus tard durant le retrait de l'enfant par les services de protection de l'enfance. Cet échantillon a été retiré d'une étude de réplication de l'intervention sur l'attachement et faite à domicile Minding the Baby (MTB), faite au Royaume Unis, servant de jeunes mères n'ayant pas eu d'enfant auparavant dans des communautés n'ayant pas beaucoup de ressources. Le système de classification HI suivant les initiales en français Hostile/Impuissant (Lyons-Ruth et al., 1995-2005) a été adapté pour une utilisation durant l'Entretien de Grossesse (abrégé selon le français EG ici, Slade, 2011). 26 EG ont été évalués (codage à l'aveugle) dans un échantillon qui a inclus 13 mères dont les bébés avaient été retirés de leur garde pour maltraitance documentée ou anticipée dans les deux ans après la naissance, et 13 mères dont les bébés n'avaient pas été retirés. Les mères dont les bébés avaient été retirés de leur garde avaient des scores HI bien plus élevés que les mères de bébés n'avaient pas été retirés de leur garde (F(1, 24) = 14,500, p <,001), et la relation entre la classification générale HI et le statut de retrait du bébé était aussi importante (c2(1, N = 26) = 12,462, p <,001). Les résultats suggèrent que les représentations de mode de soin maternel prénatal peuvent prédire des perturbations de la relation postnatale, et indiquent le besoin d'études plus grandes testant plus profondément cette approche prétanale de l'évaluation de risque de maltraitance chez des populations à risque.

Evaluation of early relational disturbance in high-risk populations: Borderline personality disorder features, maternal mental state, and observed interaction.

Despite the longstanding theoretical association in the attachment literature between maternal trauma history and disturbances in the mother-infant interaction, few studies have investigated mechanisms of transmission of traumatogenic relational patterns in high-risk mother-infant dyads. This study investigated interrelationships among maternal trauma history, distorted maternal representations (DMRs, i.e. disturbed thoughts and feelings about the infant and self-as-parent), maternal mentalisation (i.e. capacity to conceive of self and other's intentions in terms of mental states including thoughts, feelings, and desires), and quality of interaction in a clinical sample of mothers with Borderline Personality Disorder (BPD) features and their infants (N = 61). Measures used included the Childhood Trauma Questionnaire, Parent Development Interview, Mother-Infant Relationship Scale, Borderline Symptom Checklist-23, and the Emotional Availability Scales. The results indicated BPD features mediated the relationship between maternal trauma history and DMRs predicting disturbance in interaction. In addition, analyses showed that maternal mentalisation had a buffering effect between DMRs and maternal non-hostility and yet the severity of BPD features moderated the relationship between mentalisation and DMRs. The findings suggest postpartum borderline pathology may adversely impact the experience of being a parent for women with a relational trauma history including deficits in mentalisation (i.e. hypermentalising) and disturbances in the mother-infant interaction. Implications for research and clinical practice are discussed.

A pesar de la larga asociación teorética en la literatura de la afectividad entre el historial de trauma materno y perturbaciones en la interacción madre-infante, pocos estudios han investigado mecanismos de transmisión de patrones de relación traumatogénicos en díadas madre-infante de alto riesgo. Este estudio investigó interrelaciones entre el historial de trauma materno, las distorsionadas representaciones maternas (DMR, v.g. pensamientos y sentimientos perturbados acerca del infante y de sí misma como madre), la mentalización materna (v.g. capacidad para concebir las intenciones propias y de otros en términos de estados mentales), y la calidad de interacción en un grupo muestra clínico de madres con características de Trastornos de Personalidad Limítrofe (BPD) y sus infantes (N = 61). Entre las medidas usadas están el Cuestionario de Trauma de Niñez, la Entrevista de Desarrollo de la Progenitora, la Escala de Relación Madre-Infante, la Lista de Verificación de Síntomas de Personalidad Limítrofe - 23, y las Escalas de Disponibilidad Emocional. Los resultados indicaron que las características BPD mediaron la relación entre el historial de trauma materno y las DMR prediciendo perturbaciones en la interacción. Es más, los análisis mostraron que la mentalización materna tenía un efecto amortiguador entre las DMR y la no hostilidad materna y aun así la severidad de las características BPD moderaron la relación entre la mentalización y las DMR. Los resultados sugieren que la patología limítrofe posterior al parto pudiera impactar adversamente la experiencia de ser madre para mujeres con historial de trauma, incluyendo déficits en la mentalización (v.g. la hipermentalización) y las perturbaciones en la interacción madre-infante. Se discuten las implicaciones para la investigación y la práctica clínica.

En dépit de la longue association théorique dans les recherches sur l'attachement entre le passé de trauma de la mère et les perturbations dans l'interaction mère-bébé, il existe peu d'études portant sur les mécanismes de transmission de patterns relationnels traumagénétiques chez les dyades mère-bébé à haut risque. Cette étude s'est penchée sur les interrelations entre le passé de trauma de la mère, des représentations maternelles déformées (des DMR, c'est-à-dire des pensées déformées ainsi que des sentiments déformés sur le bébé et soi-même en tant que parent), la mentalisation maternelle (c'est-à-dire la capacité de concevoir ses propres intentions ainsi que celles des autres en termes d'états mentaux), et la qualité de l'interaction chez un échantillon clinique de mères ayant les caractéristiques du trouble de la personnalité limite et leurs bébé (N = 61). Les mesures utilisées ont inclus le Questionnaire de Trauma de l'Enfance, l'Entretien du Développement du Parent, l'Echelle de Relation Mère-Bébé, la Checklist de Symptômes de la Personnalité Limite-23, ainsi que les Echelles de Disponibilité Emotionnelle. Les résultats ont indiqué que les traits de TPL affectaient la relation entre l'histoire de trauma de la mère et les DMS = R prédisant une perturbation dans l'interaction. De plus les analyses ont montré que la mentalisation maternelle faisait effet de tampon entre les DMR et la non-hostilité maternelle et pourtant la sévérité des traits TPL modérait la relation entre la mentalisation et les DMR. Les résultats suggèrent qu'une pathologie limite postpartum pourrait avoir un impact adverse sur l'expérience de parentage pour les femmes ayant un passé de trauma, y compris des déficits dans la mentalisation (par exemple, une hyper-mentalisation) et des perturbations dans l'interaction mère-bébé. Les implications pour les recherches et la pratique clinique sont discutées.

The prenatal maternal representations of mothers at risk of recurrent care proceedings in the Family Drug and Alcohol Court: A thematic analysis.

BACKGROUND: A substantial number of birth mothers experience repeat removals of their infants and children due to child protection concerns. The perspectives of mothers going through repeat removals and their experiences of pregnancy are insufficiently researched. AIMS AND METHODS: The current qualitative study aimed to explore the maternal representations of five pregnant mothers at risk of recurrent care proceedings. A thematic analysis of these mothers' responses to the Pregnancy Interview focused on their representations of themselves as mothers, of their babies, and of the mother-baby relationship. RESULTS: Seven key themes were identified: (1a) "Uncertainty and fear of losing the baby," (1b) "Uncertainty but hope of becoming a mother," (2) "Not wanting to be like their own mother," (3) "Experiencing recovery and pregnancy as two interdependent processes," (4) "Struggling to imagine the baby," (5) "The omnipresence of previous children," (6) "Pleasure at starting to have a connection with the baby," and (7) "Noting the baby's dependency." CONCLUSION: The results are clinically relevant as they highlight grief, maternal self-identity, recovery from substance abuse, and ability to manage uncertainty as critical areas of intervention for these mothers.

Trasfondo: Un número considerable de madres que dan a luz experimentan la repetida separación de sus infantes y niños debido a las preocupaciones de protección infantil. Las perspectivas de las madres que pasan repetidamente por el proceso de separación y las experiencias de su embarazo no están suficientemente investigadas. Metas y Métodos: El presente estudio cualitativo se propuso explorar las representaciones maternas de cinco madres embarazadas bajo riesgo de un proceso recurrente relacionado con el cuidado. Un Análisis Temático de las respuestas de estas madres a la Entrevista del Embarazo (Slade, 2007) se enfocó en las representaciones sobre ellas mismas como madres, de sus bebés, así como de la relación madre-bebé. Resultados: Se identificaron siete temas claves: (1a) 'Incertidumbre y temor de perder el bebé,' (1b) 'Incertidumbre, pero con la esperanza de llegar a ser madre,' (2) 'No querer ser como su propia madre,' (3) 'Experimentar el recobro y el embarazo como dos procesos interdependientes,' (4) 'Dificultad en imaginarse al bebé,' (5) 'La omnipresencia de niños anteriores,' (6) 'Comenzar a tener una conexión con el bebé que trae alegría,' y (7) 'Notar la dependencia del bebé.' Conclusión: Los resultados son clínicamente relevantes ya que ellos subrayan el hecho de que la aflicción de estas madres, la auto-identidad materna, el recobro del abuso de sustancias, así como la habilidad para arreglárselas con la incertidumbre constituyen áreas críticas de intervención. Palabras claves: procedimientos relacionados con el cuidado, madres biológicas, relación madre-bebé, Entrevista de Embarazo, representaciones maternas prenatales.

Contexte: Un nombre important de mères ayant donné naissance font l'expérience du retrait répété de leurs nourrissons et de leurs enfants à cause d'inquiétudes liées à la protection de l'enfant. Les perspectives de ces mères faisant face à des retraits répétés et leurs expériences de leur grossesse n'ont pas fait l'objet d'assez de recherches. Buts et Méthodes: Cette étude qualitative s'est donné pour but d'explorer les représentations maternelles de cinq mères enceintes à risques de procédures de soins récurrents. Une Analyse Thématique des réponses de ces mères durant l'Entretien de Grossesse (Slade, 2007) a porté sur leurs représentations d'elles-mêmes en tant que mères, et de leurs bébés, et de la relation mère-bébé. Résultats: Sept thèmes clés ont été identifiés: (1a) 'L'incertitude et la peur de perdre le bébé', (1b) 'L'incertitude mais l'espoir de devenir mère', (2) 'Ne pas vouloir être comme leur propre mère', (3) 'Faire l'expérience du rétablissement de la toxicomanie et de la grossesse comme deux processus interdépendants', (4) 'Le fait d'avoir des difficultés à imaginer le bébé', (5) 'L'omniprésence des enfants précédents', (6) 'Commencer à avoir une connexion avec le bébé qui apporte une joie', et (7) 'Le fait de notre la dépendance du bébé'. Conclusion: Les résultats sont cliniquement importants dans la mesure où ils mettent en évidence que le deuil de ces mères, leur auto-identité maternelle, leur rétablissement de toxicomanie, et leur capacité à gérer l'incertitude constituent des domaines critiques d'intervention. Mots clés: procédure de prise en charge, mère biologique, relation mère-bébé, Entretien de Grossesse, représentations maternelles avant la naissance.

Maternal pre and perinatal experiences with their full-term, preterm and very preterm newborns.

BACKGROUND: Mothers' reports about pregnancy, maternity and their experiences during the perinatal period have been associated with infants' later quality of attachment and development. Yet, there has been little research with mothers of very preterm newborns. This study aimed to explore mothers' experiences related to pregnancy, premature birth, relationship with the newborn, and future perspectives, and to compare them in the context of distinct infants' at-birth-risk conditions. METHODS: A semi-structured interview was conducted with women after birth, within the first 72 h of the newborn's life. A total of 150 women participated and were divided in three groups: (1) 50 mothers of full-term newborns (Gestational Age (GA) ≥ 37 weeks; FT), (2) 50 mothers of preterm newborns (GA 32-36 weeks; PT) and (3) 50 mothers of very preterm newborns (GA < 32 weeks; VPT). RESULTS: Mothers of full-term infants responded more often that their children were calm and that they did not expect difficulties in taking care of and providing for the baby. Mothers of preterm newborns although having planned and accepted well the pregnancy (with no mixed or ambivalent feelings about it) and while being optimistic about their competence to take care of the baby, mentioned feeling frightened because of the unexpected occurrence of a premature birth and its associated risks. Mothers of very preterm newborns reported more negative and distressful feelings while showing more difficulties in anticipating the experience of caring for their babies. CONCLUSION: The results indicate that Health Care Systems and Neonatal Care Policy should provide differentiated psychological support and responses to mothers, babies and families, taking into account the newborns' GA and neonatal risk factors.

Development and initial reliability and validity of a new measure of distorted maternal representations: The Mother-Infant Relationship Scale.

Distorted maternal representations (DMRs)-mother's ideas, understanding, and feelings about the infant-shape early interaction and the emerging relationship. Distorted interactions reportedly affect infant attachment and socioemotional development and may be associated with maternal early adversity and trauma. Limited measures are available that could be used as screening tools of DMRs. The aims of this study were to (a) describe the development of the Mother-Infant Relationship Scale (MIRS) and (b) to evaluate its psychometric properties. The development and validation of the MIRS closely followed standard guidelines for the development of psychometric tests. Psychometric properties were examined across two samples: 78 adult psychiatric patients with features of borderline personality and 86 individuals from a nonclinical sample (N = 164). The scale demonstrated excellent internal consistency (Cronbach's α = .91) for the clinical sample and adequate internal consistency (.78) for the nonclinical sample, excellent test-retest reliability (intraclass correlation coefficient = .81), and good concurrent validity with an observational (Pearson's correlation coefficients = -.35 to -.54) and a representational measure (.53). Factor analysis revealed three components: DMRs specific to (a) maternal hostility/rejection of the infant, (b) issues about parenting/attachment, and (c) anxiety/helplessness about infant care. Findings suggest that the MIRS is a reliable and valid screening tool of DMRs. Potential uses in clinical and research settings are discussed.

Las Representaciones Maternas Distorsionadas (DMR) - ideas, comprensión y sentimientos de la madre sobre el infante - le dan forma a la temprana interacción y la naciente relación. Las interacciones distorsionadas, según se dice, afectan la unión afectiva y el desarrollo socio-emocional del infante y pudieran estar asociadas con la temprana adversidad y trauma maternos. Limitadas medidas están disponibles para ser usadas como herramientas de detección de DMR. Las metas de este estudio fueron (1) describir el desarrollo de la Escala de la Relación Madre-Infante (MIRS) y (2) evaluar sus propiedades sicométricas. El desarrollo y validación de MIRS siguió muy de cerca los parámetros estándares para el desarrollo de pruebas sicométricas. Las propiedades sicométricas fueron examinadas en 2 grupos muestras: 78 pacientes siquiátricos adultos con características de personalidad limítrofe y 86 individuos de un grupo muestra no clínico (N=164). La escala demostró una consistencia interna excelente (alfa de Cronbach .91) para el grupo muestra clínico y adecuada (.78) para el no clínico, una excelente confiabilidad de prueba y re-prueba (ICC .81), y una buena validez simultánea con una medida de observación (coeficientes de correlación de Pearson entre -.35 y -.54) y una de representación (.53). Los análisis de factores revelaron 3 componentes: específicas DMR para (1) hostilidad materna/rechazo del infante, (2) asuntos sobre crianza/afectividad, (3) ansiedad/sentirse sin ayuda acerca del cuidado del infante. Los resultados sugieren que MIRS es una herramienta de detección de DMR confiable y válida. Se discuten los posibles usos en escenarios clínicos y la investigación.

Les Représentations Maternelles Déformées (RMD en français) - les idées des mères, leur compréhension, leurs sentiments sur le nourrisson - donnent forme à l'interaction et à la relation qui émerge. Il semblerait que les interactions déformées affectent l'attachement du nourrisson et le développement socio-émotionnel et qu'elles pourraient être liées à l'adversité maternelle précoce et au trauma. Des mesures limitées sont disponibles qui pourraient être utilisées comme outils de dépistages des RMD. Dans ce contexte, les buts de cette étude étaient de (1) décrire le développement de l'Echelle de la Relation Mère-Nourrisson (MIRS en anglais) et (2) évaluer ses propriétés psychométriques. Le développement et la validation de la MIRS ont suivi attentivement les lignes directrices standard pour le développement de tests psychométriques. Les propriétés psychométriques ont été examinées au travers de 2 échantillons: 78 patients psychiatriques adultes avec des traits de la personnalité limite, et 86 individus d'un échantillon non-clinique (N=164). L'échelle a fait preuve d'une cohérence interne excellente (alpha de Cronbach ,91) pour l'échantillon clinique et adéquate (,78) pour l'échantillon non-clinique, ainsi que d'une fiabilité test-re-test excellente (ICC s81), tout comme d'une bonne validité simultanée avec une mesure d'observation (coefficients de corrélation de Pearson allant de -,35 à -,54) et une mesure de représentation (,53). L'analyse de facteurs a révélé 3 composantes spécifiques aux RMD (1) de l'hostilité/la rejection du nourrisson, (2) des problèmes de parentage/attachement, (3) de l'anxiété / du désarroi à propos du soin du nourrisson. Les résultats suggèrent que la MIRS est un outil fiable et valide de détection des RMD. Des utilisations possibles dans des milieux cliniques et des milieux de recherche sont discutés.

Representações maternas de gestantes sobre o bebê concebido por ovodoação / Pregnant women's maternal representations about the baby conceived by egg donation / Representaciones maternas de gestantes sobre el bebé concebido por donación de óvulos

Este estudo tem como objetivo investigar as representações maternas de gestantes sobre o bebê concebido por ovodoação. Realizou-se uma pesquisa qualitativo-exploratória, com delineamento de estudo de casos múltiplos. Participaram três gestantes com idades entre 44 e 45 anos, que preencheram uma ficha de dados sociodemográficos e clínicos, responderam à entrevista IRMAG e a uma entrevista sobre reprodução assistida; também foram utilizadas anotações de campo. Os dados foram analisados a partir de dois eixos temáticos, um apoiado em elementos da realidade objetiva e outro em elementos da realidade subjetiva, abordando a ovodoação de forma transversal. Os resultados destacaram as expectativas em torno das características físicas da criança ao nascer, evidenciando a genética, e expectativas sobre a saúde física do bebê vinculadas à doadora. Revelar à criança sua origem genética não é considerado relevante nesse momento pelas gestantes. As representações são comuns às de gestações naturais e a doadora se fez presente nas representações sobre o bebê.

This study had the goal of investigating pregnant women's maternal representations about the baby conceived by egg donation. A qualitative-exploratory research was conducted, with a multicase study design. Three pregnant women aged between 44 and 45 years took part, who filled a sociodemographic and clinical data sheet, answered the IRMAG interview and were interviewed about assisted reproduction; field notes were also used. The data was analyzed along two thematic axes, one based on elements of objective reality, and the other on elements of subjective reality, approaching egg donation transversely. The results highlight the expectations around the physical characteristics of the child to be born, pointing out genetics, and the expectations about the baby's physical health related to the donor. Revealing to the children their genetic origin was not considered relevant by the pregnant women at this moment. The representations are common to natural pregnancies and the donor was present in the representations about the baby.

Este estudio investigó las representaciones maternas de gestantes sobre el bebé concebido por donación de óvulos. Se realizó una pesquisa cualitativo-exploratoria, con delineamiento de estudio de casos múltiples. Participaron tres gestantes entre 44 y 45 años, que llenaron una ficha de datos sociodemográficos y clínicos, respondieron a la entrevista IRMAG y a una entrevista sobre la reproducción asistida; además se utilizaron anotaciones de campo. Los datos fueron analizados a partir de dos ejes temáticos, uno apoyado en elementos de la realidad objetiva y otro apoyado en elementos de la realidad subjetiva, abordando la donación de forma transversal. Los resultados destacaron expectativas en torno a las características físicas del bebé, evidencia de la genética, y las expectativas sobre su salud física, vinculadas a la donadora. La revelación sobre el origen genético para el niño no es considerada relevante en este momento por las gestantes. Las representaciones son comunes a las de gestaciones naturales y la donadora se hizo presente en las representaciones sobre el bebé.

A Pilot Study of the Relationship Between Pregnancy and Autoimmune Disease: Exploring the Mother's Psychological Process.

Autoimmune disease mainly affects women in their reproductive years and has a significant impact on childbearing. Pregnancy can induce an improvement of the mother's symptomatology in some diseases such as rheumatoid arthritis while exacerbating or having no effect on other autoimmune diseases as multiple sclerosis (Borchers et al., 2010). This uncertainty can affect the process of psychological reorganization, which leads to the achievement of a maternal identity. The quality of the mother-fetus emotional bond is considered particularly relevant for the subsequent attachment relationship and the psychological development of the infant (Ammaniti et al., 2013). In the last trimester of pregnancy, 15 women with different autoimmune diseases were interviewed using the IRMAG-R (Ammaniti and Tambelli, 2010). They also completed a battery comprising: PAI (Della Vedova et al., 2008); MAAS (Busonera et al., 2016); DAS (Gentili et al., 2002); PBI (Scinto et al., 1999); MSPSS (Prezza and Principato, 2002); DERS, (Giromini et al., 2012); CES-D (Fava, 1983); HCR-TS (Bova et al., 2012). All interviews were audiotaped, transcribed verbatim, and analyzed by Atlas.ti. The results show that women with autoimmune disease were ambivalent toward pregnancy, had high levels of depression, had difficulties in recognizing physical and psychological changes, and had difficulties in imagining the child. These are considered risk factors that could negatively affect the postnatal mother-infant relationship. These results focus on the importance of early multidisciplinary interventions that can support expectant women when they show signs of relationship difficulties with their infants prior to his/her birth.

Mothers' Depression, Anxiety, and Mental Representations After Preterm Birth: A Study During the Infant's Hospitalization in a Neonatal Intensive Care Unit.

Aim: This paper aimed to explore psychological functioning and mental representations in mothers of preterm infants during the child's hospitalization in a Neonatal intensive care unit (NICU). Methods: A sample including 62 mothers of premature infants (gestational age < 37 weeks) was recruited in a NICU. According to the gestational age at the time of delivery, we considered two groups: Group A included mothers whose children were born before 32 weeks of pregnancy; Group B included mothers whose children were born at or after 32 weeks of pregnancy. Within one week of childbirth, mothers were administered two self-report questionnaires: the Edinburgh Postnatal Depression Scale (EPDS) and the State-Trait Anxiety Inventory (STAI). When their infants' medical conditions became stable, the Clinical Interview for Parents of High-Risk Infants (CLIP) was administered to mothers. Results: The results showed high levels of depression and anxiety in both groups of mothers, with higher state anxiety scores in Group A than Group B. Besides, a series of hierarchical regression analyses were conducted with STAI, EPDS, and gestational age as predictors on the CLIP scores. Results indicated that EPDS scores predicted CLIP scores on parental self-image, support system, and readiness for discharge (p < 0.001); moreover, the interaction among depression, anxiety, and gestational age predicted the CLIP dimension of feeling of mutual recognition (p < 0.005). Conclusions: These findings suggested that a premature birth and the child's hospitalization might exert a negative effect on the mothers' emotional state, their perception of parental self-image and, consequently, the early bond with the child-independent from the infants' gestational age at the time of the preterm delivery. The data underlined the importance of involving NICU nurses and clinicians in order to optimize the care for mothers immediately after the preterm birth and during the infant's hospitalization, taking into account psychological needs of mothers of both very preterm and moderately preterm infants.

Improving Maternal Representations in High-Risk Mothers: A Randomized, Controlled Trial of the Mom Power Parenting Intervention.

A key mechanism of risk transmission between maternal risk and child outcomes are the mother's representations. The current study examined the effects of an attachment-based, trauma-informed parenting intervention, the Mom Power (MP) program, in optimizing maternal representations of high-risk mothers utilizing a randomized, controlled trial design (NCT01554215). High-risk mothers were recruited from low-income community locations and randomized to either the MP Intervention (n = 42) or a control condition (n = 33) in a parallel design. Maternal representations were assessed before and after the intervention using the Working Model of the Child Interview. The proportion of women with balanced (secure) representations increased in the MP group but not in the control group. Parenting Reflectivity for mothers in the treatment group significantly increased, with no change in the control condition. Participation in the MP program was associated with improvements in a key indicator of the security of the parent-child relationship: mothers' representations of their children.

Maternal representations of their children in relation to feeding beliefs and practices among low-income mothers of young children.

Identifying maternal characteristics in relation to child feeding is important for addressing the current childhood obesity epidemic. The present study examines whether maternal representations of their children are associated with feeding beliefs and practices. Maternal representations refer to mothers' affective and cognitive perspectives regarding their children and their subjective experiences of their relationships with their children. This key maternal characteristic has not been examined in association with maternal feeding. Thus the purpose of the current study was to examine whether maternal representations of their children, reflected by Working Model of the Child Interview typologies (Balanced, Disengaged, or Distorted), were associated with maternal feeding beliefs (Authority, Confidence, and Investment) and practices (Pressure to Eat, Restriction, and Monitoring) among low-income mothers of young children, with maternal education examined as a covariate. Results showed that Balanced mothers were most likely to demonstrate high authority, Distorted mothers were least likely to demonstrate confidence, and Disengaged mothers were least likely to demonstrate investment in child feeding. Moreover, Balanced mothers were least likely to pressure their children to eat. Findings are discussed with regard to implications for the study of childhood obesity and for applied preventions.

NARRATIVE AND META-ANALYTIC REVIEW OF INTERVENTIONS AIMING TO IMPROVE MATERNAL-CHILD ATTACHMENT SECURITY.

Early secure maternal-child attachment relationships lay the foundation for children's healthy social and mental development. Interventions targeting maternal sensitivity and maternal reflective function during the first year of infant life may be the key to promoting secure attachment. We conducted a narrative systematic review and meta-analysis to examine the effectiveness of interventions aimed at promoting maternal sensitivity and reflective function on maternal-child attachment security, as measured by the gold standard Strange Situation (M. Ainsworth, M. Blehar, B. Waters, & S. Wall, 1978) and Q-set (E. Waters & K. Deane, 1985). Studies were identified from electronic database searches and included randomized or quasi-randomized controlled parallel-group designs. Participants were mothers and their infants who were followed up to 36 months' postpartum. Ten trials, involving 1,628 mother-infant pairs, were included. Examination of the trials that provided sufficient data for combination in meta-analysis revealed that interventions of both types increased the odds of secure maternal-child attachment, as compared with no intervention or standard intervention (n = 7 trials; odds ratio: 2.77; 95% confidence interval: 1.69, 4.53, n = 965). Of the three trials not included in the meta-analyses, two improved the likelihood of secure attachment. We conclude that interventions aimed at improving maternal sensitivity alone or in combination with maternal reflection, implemented in the first year of infants' lives, are effective in promoting secure maternal-child attachments. Intervention aimed at the highest risk families produced the most beneficial effects.

Representações maternas durante uma gravidez patólogica: o caso da anemia falciforme / Maternal representations during a pathological pregnancy: the case of sickle cell disease / Representaciones maternas durante el embarazo con anemia de células falciformes

As representações maternas são um conjunto de expectativas, fantasias, anseios, medos e percepções da mãe de sua gravidez, de sua futura função parental e de seu bebê. O presente artigo trata destas representações durante a gravidez patológica de mulheres com anemia falciforme. Para isto, uma pesquisa qualitativa foi realizada com cinco gestantes a fim de analisar suas representações, seguindo uma perspectiva psicanalítica. Salienta-se que a observação das representações maternas constitui uma importante ferramenta para a prevenção de distúrbios da relação mãe-bebê. No decorrer do estudo, observamos que as representações maternas podem ser afetadas pela doença materna.(AU)

Maternal representations include the expectations, fantasies, desires, fears and perceptions of a mother about her pregnancy, her motherhood and her future baby. This study is an introduction to maternal representations during pathological pregnancies of women with sickle cell disease. For this, a qualitative research was conducted with five women to analyze their representations, following a psychoanalytic perspective. The observation of maternal representations is an important tool in the prevention of disorders in mother-infant relationships. Finally, we observed that maternal representations can be affected by the mother's disease.(AU)

Representaciones maternas son un conjunto de expectativas, fantasías, deseos, miedos y percepciones de las madres durante el embarazo, con su futuro rol parental y con su bebé. Este artículo trata de las representaciones de las madres durante el embarazo con anemia de células falciformes. Para ello, un estudio cualitativo se llevó a cabo con cinco mujeres embarazadas para examinar sus representaciones, a raíz de una perspectiva psicoanalítica. Téngase en cuenta que la observación de las representaciones maternas es una herramienta importante para la prevención de los trastornos de la relación madre-hijo. Durante el estudio, se observó que las representaciones maternas pueden ser afectadas por la enfermedad materna.(AU)

Representações maternas durante uma gravidez patólogica: o caso da anemia falciforme / Maternal representations during a pathological pregnancy: the case of sickle cell disease / Representaciones maternas durante el embarazo con anemia de células falciformes

As representações maternas são um conjunto de expectativas, fantasias, anseios, medos e percepções da mãe de sua gravidez, de sua futura função parental e de seu bebê. O presente artigo trata destas representações durante a gravidez patológica de mulheres com anemia falciforme. Para isto, uma pesquisa qualitativa foi realizada com cinco gestantes a fim de analisar suas representações, seguindo uma perspectiva psicanalítica. Salienta-se que a observação das representações maternas constitui uma importante ferramenta para a prevenção de distúrbios da relação mãe-bebê. No decorrer do estudo, observamos que as representações maternas podem ser afetadas pela doença materna...

Maternal representations include the expectations, fantasies, desires, fears and perceptions of a mother about her pregnancy, her motherhood and her future baby. This study is an introduction to maternal representations during pathological pregnancies of women with sickle cell disease. For this, a qualitative research was conducted with five women to analyze their representations, following a psychoanalytic perspective. The observation of maternal representations is an important tool in the prevention of disorders in mother-infant relationships. Finally, we observed that maternal representations can be affected by the mother's disease...

Representaciones maternas son un conjunto de expectativas, fantasías, deseos, miedos y percepciones de las madres durante el embarazo, con su futuro rol parental y con su bebé. Este artículo trata de las representaciones de las madres durante el embarazo con anemia de células falciformes. Para ello, un estudio cualitativo se llevó a cabo con cinco mujeres embarazadas para examinar sus representaciones, a raíz de una perspectiva psicoanalítica. Téngase en cuenta que la observación de las representaciones maternas es una herramienta importante para la prevención de los trastornos de la relación madre-hijo. Durante el estudio, se observó que las representaciones maternas pueden ser afectadas por la enfermedad materna...