Advanced Maternal Age: A Scoping Review about the Psychological Impact on Mothers, Infants, and Their Relationship.

The mean age at childbirth in Europe has gradually increased, and it is now around 29 years of age. It has been shown that older maternal age is associated with problems of fertility; in fact, with increasing age, the chance of conceiving diminishes, and fetal and obstetric complications grow. Research has focused particularly on the biological risks associated with late pregnancy, both for the child and the woman. Less space has been dedicated to the potential psychological and relational benefits of motherhood at an advanced age. The aim of this review was to summarize the existing literature on this issue. Qualitative and quantitative studies were sourced from Pubmed, Science Direct, PsycINFO, and SciELO. The selected works highlight that advanced maternal age can be associated with some advantages for both mothers and their offspring in terms of physical healthcare, parenting styles, and child developmental outcomes. Specifically, the review suggests that older mothers have greater emotional maturity and feel more prepared for motherhood; also, advanced maternal age appears to exert a protective influence on children's behavioral, social, and emotional functioning, compensating for the biological risks.

Maternidade distante do país de origem: "aqui a gente não tem uma aldeia" / Maternity far from the country of origin: "here we do not have a village" / Maternidad lejos del país de origen: "aquí no tenemos pueblo"

O presente estudo é um recorte de uma pesquisa mais ampla sobre a experiência da maternidade de mulheres brasileiras migrantes. Ele tem como objetivo investigar o apoio recebido por elas no processo de tornar-se mãe. Trata-se de uma pesquisa qualitativa na qual foram realizadas, em 2022, sete entrevistas com mulheres brasileiras que vivenciaram gestação, parto e primeiro ano de vida do filho (a) em Portugal, Reino Unido, Itália, Espanha e França. Os resultados apontam para a relevância da presença de pessoas que compartilham da mesma cultura de origem na construção da maternidade e na rede de apoio durante a perinatalidade. Conclui-se que o distanciamento da rede familiar, de amigos e de referenciais da cultura de origem da mulher migrante gerou o aumento das sobrecargas psíquica e física inerentes à maternidade. Ao mesmo tempo, de acordo com as participantes, o distanciamento da família e da cultura de origem proporcionou maior liberdade e abertura para a construção da maternidade, provendo novas representações culturais que contribuíram para a construção de sua forma de ser mãe.(AU)

This study is a segment of a broader research project on the maternity experience of Brazilian migrant women. It aims to investigate the support received by these women in the process of becoming mothers. It encompasses a qualitative research study involving seven interviews conducted in 2022 with Brazilian women who experienced pregnancy, childbirth, and the first year of their child's life in Portugal, the United Kingdom, Italy, Spain, and France. The findings highlight the importance of having individuals sharing the same cultural background in the construction of motherhood and in the support network during the perinatal period. The distance from the family network, friends, and references of the migrant woman's culture of origin generated an increase in the psychic and physical burdens inherent to motherhood. Simultaneously, according to the participants, distancing from family and their cultural origins provided greater freedom and openness in constructing motherhood, offering new cultural representations that contributed to shaping their way of being mothers. (AU)

El presente estudio es parte de una investigación más amplia acerca de la experiencia de la maternidad de las mujeres migrantes brasileñas. Tiene como objetivo investigar el soporte recibido por ellas en el proceso de convertirse en madre. Se trata de una investigación cualitativa en la que, en 2022, se realizaron siete entrevistas con mujeres brasileñas que vivieron el embarazo, el parto y el primer año de vida de su hijo en Portugal, Reino Unido, Italia, España y Francia. Los resultados apuntan para la relevancia de la presencia de personas que comparten la misma cultura de origen en la construcción de la maternidad y en la red de apoyo durante la perinatalidad. Se concluye que el alejamiento de la red familiar, amigos y puntos de referencia de su cultura de origen de la mujer migrante ha generado un aumento de las sobrecargas psíquicas y físicas inherentes a la maternidad. Al mismo tiempo, según las participantes, el alejamiento de la familia y de la cultura de origen les ha proporcionado una mayor libertad y apertura para la construcción de la maternidad, brindando nuevas representaciones culturales que contribuyeron para la construcción de su forma de ser madre. (AU)

The genesis of perinatal clinical psychology and its contemporary issues.

The main aim of French clinical psychology is to explain the psychic processes of transformation, to which the subject is central. In this context, transformations in the perinatal period open an innovating field in perinatal clinical psychology focused on the conscious/subconscious, subjective/inter-subjective psychic reality of a subject who is in the process of becoming (or becoming once again) a parent and being born a human.

A 5 years' experience of a parent-baby day unit: impact on baby's development.

Introduction: Psychiatric Mother-Baby Units are well established in France, United Kingdom, and Australia, mostly in full-time hospitalization. Inpatient units are considered as best practice for improving outcomes for mothers and babies when the mother is experiencing severe mental illness and many studies have showed the effectiveness of care for the mother or the mother-infant relationship. Only a limited number of studies have focused on the day care setting or on the development of the baby. Our parent-baby day unit is the first day care unit in child psychiatry in Belgium. It offers specialized evaluation and therapeutic interventions focused on the baby and involves parents with mild or moderate psychiatric symptoms. The advantages of day care unit is to reduce the rupture with social and family living. Aims: The objective of this study is to evaluate the effectiveness of parent-baby day unit in prevention of babies' developmental problems. First, we present the clinical characteristics of the population treated in the day-unit in comparison to the features presented in the literature review about mother-baby units, which usually receive full-time treatment. Then, we will identify the factors that might contribute to a positive evolution of the baby's development. Materials and methods: In this study, we retrospectively analyze data of patients admitted between 2015 and 2020 in the day unit. Upon admission, the 3 pillars of perinatal care - babies, parents, and dyadic relationships - have systematically been investigated. All the families have received a standard perinatal medico-psycho-social anamnesis, including data on the pregnancy period. In this unit, all the babies are assessed at entry and at discharge using the diagnostic 0 to 5 scale, a clinical withdrawal risk, and a developmental assessment (Bayley). Parental psychopathology is assessed with the DSM5 diagnostic scale and the Edinburgh scale for depression. Parent-child interactions are categorized according to Axis II of the 0 to 5 scale. We have evaluated the improvement of children symptomatology, the child development and the mother-child relation between the entrance (T1) and the discharge (T2) and we have compared two groups of clinical situations: a group of patients with a successful evolution (considering baby's development and the alliance with the parents) and a group of unsuccessful evolution during hospitalization. Statistical analysis: We use descriptive statistics to characterize our population. To compare the different groups of our cohort, we use the T-test and non-parametric tests for continue variables. For discrete variables, we used the Chi2 test of Pearson. Discussion: The clinical population of the day unit is comparable to the mother-baby units in terms of psychosocial fragility but the psychopathological profile of the parents entering the day unit shows more anxiety disorder and less post-partum psychosis. The babies' development quotient is in the average range at T1 and is maintained at T2. In the day unit, the number of symptoms as well as the relational withdrawal of the babies is reduced between T1 and T2. The quality of parent-child relationship is improved between T1 and T2. The children of the group of pejorative evolution had a lower developmental quotient at the T1 and an overrepresentation of traumatic life events. Conclusion: These results indicate that parent-baby day unit lead to positive outcomes in clinical situations with anxio-depressive parents, relational withdrawal of the babies, functional problems of the babies but not when a significant impact on the development of the baby already exists. The results of this study can guide therapeutic approaches for the benefit of care in parent-baby day units, and improve the development of the child and of the dyadic relationships.

Management of pheochromocytoma during pregnancy. A multidisciplinary challenge: A case reports.

INTRODUCTION: Identification of pheochromocytoma during pregnancy is unusual. Lack of appropriate management may be responsible of high risk for both mother and fetus. The guarantee of a successful management of a pheochromocytoma during pregnancy is the establishment of an early diagnosis as well as the prevention of a hypertensive crisis during delivery and surgical treatment and without compromising the maternal-fetal prognosis. CASE PRESENTATION: A 31-year-old female patient, without any notable pathological history, pregnant at 20 weeks of amenorrhea was diagnosed for a Menard's triad. The medical investigations had allowed to confirm the diagnosis of left secretory pheochromocytoma. The surgical indication was taken in concertation between surgeons, endocrinologists, gynecologists and anesthesiologists. The parturient had undergone an uneventful laparoscopic left adrenalectomy without incidents. CASE DISCUSSION: Our case well illustrates that when the operative indication is posed, laparoscopic surgery can be performed safely during any trimester. However, it is legitimate to modulate the incisions according to gestational age and the height of the fundus. The involvement of all disciplines intervening in the management of the pregnant woman with pheochromocytoma is the guarantor of a favorable maternal-fetal prognosis. CONCLUSION: A well-established diagnosis for pregnant women with severe secondary hypertension, multidisciplinary management, and safe laparoscopic approach are crucial to prevent perinatal morbidity and mortality.

[Consequences of domestic violence on toddler development and parenting]. / Conséquences des violences conjugales sur le développement du tout-petit et la parentalité.

The climate of domestic violence is a major risk factor for the health and development of children from an early age, as well as for parenthood. The role of health professionals is essential in addressing this issue. Training on this subject is necessary because it allows them to feel more comfortable in dealing with these issues and to work in an interdisciplinary manner.

[The psychomotrician, mediator during the carrying process between a mother and her baby]. / Le psychomotricien, médiateur lors du portage entre une mère et son bébé.

The carrying in the arms of the young child by his mother is necessary during breastfeeding, for example. But it also occurs during moments of cuddling. These times of bodily proximity, with no other end than the relationship and tenderness, encourage the weaving of emotional bonds between the adult and his baby. If the adjustment between the two partners goes relatively well in most cases, certain dyads present interactive difficulties and the cuddles seem less fluid, less natural. Psychomotricians can then intervene to support the partners in the interaction by playing a mediating role.

Neonatal Programming of Microbiota Composition: A Plausible Idea That Is Not Supported by the Evidence.

Underpinning the theory "developmental origins of health and disease" (DOHaD), evidence is accumulating to suggest that the risks of adult disease are in part programmed by exposure to environmental factors during the highly plastic "first 1,000 days of life" period. An elucidation of the mechanisms involved in this programming is challenging as it would help developing new strategies to promote adult health. The intestinal microbiome is proposed as a long-lasting memory of the neonatal environment. This proposal is supported by indisputable findings such as the concomitance of microbiota assembly and the first 1,000-day period, the influence of perinatal conditions on microbiota composition, and the impact of microbiota composition on host physiology, and is based on the widely held but unconfirmed view that the microbiota is long-lastingly shaped early in life. In this review, we examine the plausibility of the gut microbiota being programmed by the neonatal environment and evaluate the evidence for its validity. We highlight that the capacity of the pioneer bacteria to control the implantation of subsequent bacteria is supported by both theoretical principles and statistical associations, but remains to be demonstrated experimentally. In addition, our critical review of the literature on the long-term repercussions of selected neonatal modulations of the gut microbiota indicates that sustained programming of the microbiota composition by neonatal events is unlikely. This does not exclude the microbiota having a role in DOHaD due to a possible interaction with tissue and organ development during the critical windows of neonatal life.

[Screening and healthcare for pregnant women with psycho-social vulnerability : A French national study]. / Dépistage et parcours de soins en cas de vulnérabilités psycho-sociales maternelles : une enquête nationale française.

INTRODUCTION: Psycho-social vulnerabilities are a medical risk factor for both fetus and mother. Association between socioeconomic status and prenatal follow-up has been well established and inadequate follow-up is associated with higher morbidity and mortality in women in unfavorable situations. OBJECTIVE: The objective is to identify screening strategies and to describe existing systems for pregnant women in psycho-social vulnerability in French maternity hospitals. MATERIAL AND METHODES: This is a national survey conducted by questionnaire in all French maternities. RESULTS: Screening by means of targeted questions is carried out by 96.7% of maternity units. Early prenatal interviews are offered systematically by 64% of maternity units and access to them is still difficult for women in vulnerable situations. In order to organize care pathways, 28.7% of maternities have a structured unit within their establishment and 81% state that they have mobilizable caregivers. Multidisciplinary meetings for the coordination of the various stakeholders are held by 85.8% of maternity units. Collaboration with networks and associations is emphasized. CONCLUSION: A large proportion of maternities seek to identify women in situation of psycho-social vulnerabilities and to organize care paths. However, the resources implemented still appear insufficient for many maternity units. Each maternity hospital has resources and is developing initiatives to deal with the difficulties of care.

Does Parental Reflective Functioning Mediate the Associations between the Maternal Antenatal and Postnatal Bond with the Child in a Community Sample?

Although establishing an affective tie with a child during perinatality is considered one of the most important maternal tasks, little is still known about the mediators of the association between maternal antenatal and postnatal bonding with the infant. This prospective study addresses this gap by evaluating a community sample of 110 Italian women to assess whether maternal pre- and postnatal bonds with the infant are mediated by parental reflective functioning (PRF), as assessed at the third trimester of pregnancy and three months postpartum. Controlling for confounding variables, the hierarchical regression analyses show the maternal prenatal quality of attachment to the fetus as the main predictor of maternal postnatal attachment to the child (ß = 0.315; t = 0.2.86; p = 0.005). The mediation analyses show that mothers' PRF (b = 0.245; SE = 0.119; 95% CI = 0.071, 0.531) explains 39% of the relationship between maternal pre- and postnatal bonding with the child. The findings of this study contribute to research on the association between prenatal and mother-to-infant bonding by additionally investigating the importance of taking into account maternal PRF as a mediating variable. This provides support for the clinical utility of interventions focused on maternal PRF.

Les soignants de périnatalité face à la COVID-19 : stress, qualité de vie et préoccupations Perinatal caregivers coping with covid-19 : stress, quality of life and concerns.

AIMS: The first wave of the COVID-19 pandemic generated "risks" and uncertainties as well as organizational changes among French perinatal caregivers. Our study aimed to investigate the psychosocial impact of the first wave on this population. METHOD: Our participants (N=565) were invited to answer an online questionnaire that included questions on various indices of health and quality of life at work (e.g., ProQoL, perceived stress) and other questions on the impact of the pandemic on work organization. An open-ended question was designed to identify the participants' three most frequently perceived preoccupations with regard to the health situation. RESULTS: In addition to highlighting the multifactorial nature of participants' preoccupations, our results illustrated the effect of professional status and type of motherhood on the different indices of health and quality of life at work. When it was found that the pandemic had an impact on work organization and on teams, lower health and quality of work life scores were recorded. On the other hand, when positive impacts on organization were reported, mainly in terms of reduced work intensity, they were associated with higher health and quality of work life scores. CONCLUSION: We explain this last result as either one actual effect of the pandemic on work organization, or as a phenomenon of cognitive rationalization.

[Perinatal beliefs: Neurocognitive mechanisms and cultural specificities]. / Croyances périnatales : mécanismes neurocognitifs et spécificités culturelles.

Perinatal beliefs contribute to the experience of pregnancy and the process of parenthood. Many of these perinatal beliefs have been perpetuated and evolved over time and throughout the world, exerting their influence on the behavior of pregnant women in interaction with medical recommendations. These beliefs generally offer explanations for gravidic and puerperal phenomena, helping to reduce the uncertainty of parents faced with the biological, psychological and social transitions of pregnancy. But certain beliefs can also be harmful, and alter the maternal experience of pregnancy and postpartum. In this paper, we provide an overview of the beliefs associated with the perinatal period. We successively detail the beliefs concerning fertility, pregnancy, childbirth, and postpartum, specifying the cultural beliefs from other cultures interacting with medical recommendations. Finally, we propose a neurocognitive model of perinatal beliefs generation, and we show the need to know these beliefs to improve care in midwifery, obstetrics, and fetal medicine.

[Meeting between a mother in exile and her child in a mother-baby unit]. / Rencontre entre une mère en exil et son enfant en unité mère-bébé.

Asylum-seeking mothers face numerous traumatic reactivations during the perinatal period due to the psychological vulnerability specific to this period. These situations of cumulative vulnerability between exile and perinatal care present professionals with new challenges in the socio-sanitary field. Births are precious for the constitution of tomorrow's generations. Thus, it is necessary to provide appropriate assistance to these parents and babies.

[Suicidality in the perinatal period: Descriptive study on factors associated with suicidal ideation among women hospitalized in the perinatal period at the specialized hospital center]. / Suicidalité en période périnatale : quels sont les facteurs associés ?

OBJECTIVES: Suicide is the leading cause of maternal mortality in high-resource countries. The onset of suicidal ideation is a major risk factor for suicide attempts. Suicidality has a major impact on the mother-baby relationship and on child development. The main objective of the study was to identify factors associated with the occurrence of perinatal suicidal ideation in women requiring hospitalization. The secondary objectives of the study were to describe the socio-demographic and clinical characteristics of this specific population, to specify the follow-up procedures at hospital discharge and to develop a semi-directed interview framework for psychiatric evaluation of perinatal patients admitted to a psychiatric hospital in order to better identify those at risk of suicide and improve overall management, particularly in terms of referral to existing perinatal care services. METHODS: Descriptive and retrospective study carried out at the Specialized Hospital Center of women hospitalized in the perinatal period between 2014 and 2019. The inclusion criteria were: inpatient pregnant or postpartum within one year of delivery, 16 to 43 years. A keyword search was performed to retrieve the computerized records. All records matching the inclusion criteria were included. We studied the occurrence of suicidal ideation according to the main known clinical and socio-demographic risk factors. RESULTS: The sample included 25 pregnant patients and 57 post-partum patients. The presence of a psychiatric history increased the risk of suicidal ideation by 4.38 (P<0.03). The association between the occurrence of a stressful life event and the risk of suicidal ideation onset was close to significant (P<0.10). One third of the patients had been admitted for a reason related to suicidality. Less than one-third of the patients had been referred to existing perinatal services. CONCLUSIONS: Suicidality in the perinatal period has a major impact on the dyad as well as on the whole family. The search for suicidal ideas must be systematic during psychiatric interviews, a fortiori when a psychiatric history has been authenticated. Every patient hospitalized in adult psychiatry should be referred to specialized outpatient perinatal psychiatry services. Prevention involves raising awareness and training of all health professionals, networking, but also informing the general public.

[Complementarity of body/psyche care in case of postpartum depression]. / Complémentarité des soins corps/psyché en cas de dépression du post-partum.

The perinatal period is suffused with profound upheaval and physical and psychological changes, and is accompanied by frequent psychopathological and psychiatric disorders. The early management of mother-child relationships during this period is therefore a major and complex issue, both for professionals and for patients. Two main pitfalls would be to distinguish the taking into account of the subject's suffering from the risk of early alteration of the parent-baby relationship, and to separate the psychological and physical dimensions at stake. A clinical situation illustrates the way in which the body and the psyche can be engaged and envisaged in a joint care.

The Psychological Impact of COVID-19 Pandemic on Women's Mental Health during Pregnancy: A Rapid Evidence Review.

BACKGROUND: The perinatal period is a particularly vulnerable period in women's lives that implies significant physiological and psychological changes that can place women at higher risk for depression and anxiety symptoms. In addition, the ongoing pandemic of coronavirus disease 2019 (COVID-19) is likely to increase this vulnerability and the prevalence of mental health problems. This review aimed to investigate the existing literature on the psychological impact of the COVID-19 pandemic on women during pregnancy and the first year postpartum. METHOD: The literature search was conducted using the following databases: Pubmed, Scopus, WOS-web of science, PsycInfo and Google Scholar. Out of the total of 116 initially selected papers, 17 have been included in the final work, according to the inclusion criteria. RESULTS: The reviewed contributions report a moderate to severe impact of the COVID-19 outbreak on the mental health of pregnant women, mainly in the form of a significant increase in depression-up to 58% in Spain-and anxiety symptoms-up to 72% in Canada. In addition to the common psychological symptoms, COVID-19-specific worries emerged with respect to its potential effects on pregnancy and the well-being of the unborn child. Social support and being engaged in regular physical activities appear to be protective factors able to buffer against the effects of the pandemic on maternal mental health. CONCLUSIONS: Despite the limitations of the study design, the evidence suggests that it is essential to provide appropriate psychological support to pregnant women during the emergency in order to protect their mental health and to minimize the risks of long-term effects on child development.

Propuesta de un modelo ecosistémico para la atención integral a la salud mental perinatal / An ecosystemic model for comprehensive perinatal mental health care

La atención a la salud mental tradicionalmente ha prestado poca atención a las madres. Son muy escasos en nuestro medio los programas de atención integral a la salud mental perinatal. Proponemos un modelo de encuadre que sirva para la atención integral a la perinatalidad, incluyendo los cuidados a los procesos psíquicos de la reproducción, embarazo, parto y posparto desde una visión ecosistémica inspirada en las propuestas de Urie Bronfenbrenner y John Bowlby, entre otros, integrando las aportaciones de la neurobiología, la epigenética, los modelos de transmisión intergeneracional del apego y el trauma, la sistémica, y añadiendo una perspectiva de género y ecológica que permita visibilizar las necesidades de la díada madre-bebé en el centro como punto de partida para la prevención y la atención en perinatalidad. Proponemos una mirada perinatal como modelo para continuar profundizando en la atención a madres y familias en el inicio de la vida, así como para cuidar también a las profesionales que los atienden. Apostamos por la escucha, el acompañamiento y la psicoterapia como herramientas básicas en la atención comunitaria e individual a madres, bebés y familias. (AU)

Mental health care has traditionally paid little attention to mothers. Comprehensive perinatal mental health care programs are very scarce in our environment. We propose a framing model that serves for comprehensive perinatal care, including care for the mental processes of reproduction, pregnancy, childbirth, and postpartum from an ecosystemic vision inspired by the proposals of Urie Bronfenbrenner and John Bowlby, among others. The model integrates data from neurobiology and epigenetics and theories from systemic and intergenerational transmission of attachment and trauma. It is embedded in a gender and ecological perspective that allows making visible the mother-baby dyad's needs in the center as a starting point for prevention and attention during the perinatal period. We propose a perinatal view as a model to continue deepening care for mothers and families at the beginning of life, as well as to care for the professionals who care for them. We bet on listening, support and psychotherapy as basic tools in community and individual care for mothers, babies, and families. (AU)

Becoming a Mother During COVID-19 Pandemic: How to Protect Maternal Mental Health Against Stress Factors.

During the COVID-19 pandemic, there were an increasing prevalence of perinatal psychiatric symptoms, such as perinatal anxiety, depression, and post-traumatic stress disorders. This growth could be caused by a range of direct and indirect stress factors related to the virus and changes in health, social and economic organization. In this review, we explore the impact of COVID-19 pandemic on perinatal mental health, and propose a range of hypothesis about their etiological mechanisms. We suggest first that the fear of being infected or infected others (intrauterine transmission, passage of the virus from mother to baby during childbirth, infection through breast milk), and the uncertainty about the effect of the virus on the fetuses and infants may have played a key-role to weakening the mental health of mothers. We also highlight that public health policies such as lockdown, limiting prenatal visits, social distancing measures, and their many associated socio-economic consequences (unemployment, loss of income, and domestic violence) may have been an additional challenge for perinatal mental health. Ground on these hypotheses, we finally purpose some recommendations to protect perinatal mental health during a pandemic, including a range of specific support based on digital technologies (video consultations, phone applications) during pregnancy and the postpartum period.

[Obstetrical follow-up and perinatal prognosis in drug addict pregnant women]. / Suivi obstétrical et pronostic périnatal chez les femmes enceintes toxicomanes.

OBJECTIVE: To identify the factors associated with a good obstetric follow-up and a good perinatal prognosis, in order to adapt the management of pregnant women with addiction to opiates. METHODS: A retrospective study was carried out in our maternity between January 2012 and December 2014, including 104 women who were addicted to opiates, whether or not they were substituted, with or without associated consumptions, regardless of the term of delivery beyond 22 weeks of amenorrhea. RESULTS: A good obstetrical follow-up was observed by 32.7% of women. The father's presence (OR=3.9; P=0.0113) and investment in pregnancy (OR=4.4; P=0.0029), as well as the desired character of the pregnancy (OR=4.5; P=0.0008) appeared to be associated with the quality of the observed follow-up. Preterm deliveries (11.8 versus 35.8%; P=0.0103), and social measures taken at the discharge of the newborn from the maternity (2.9 versus 24.3%, P=0.0057) were less frequent. A good perinatal prognosis was found for 29.8% of the cases. Associated consumptions <3 (OR=2.6 [1.1-6.2]; P=0.0281) confirmed by negative urine drug screening (OR=2.9 [1.1-7.8]; P=0.0307) were more numerous. CONCLUSION: Although the follow-up and the perinatal prognosis of these pregnancies have improved considerably in recent years, it seems necessary to further optimize their management.