[Parenthood put to the test by average prematurity]. / La parentalité à l'épreuve de la moyenne prématurité.

Any premature birth can be traumatic, and a risk factor for the parenting process and the quality of parent-baby interactions. Average prematurity is no exception. It can undermine essential parenting functions, such as availability and sensitivity to the child, and generate interactive dysfunctions within parent-baby dyads. In some cases, it can lead to genuine psychopathological states.

Prenatal attachment, anxiety and grief during subsequent pregnancy after medical termination of pregnancy. Attachment to which child?

PURPOSE: To evaluate emotional distress and prenatal attachment throughout a subsequent pregnancy after Termination of Pregnancy (TOP) for fetal abnormality. METHODS: Observational study, in a French Tertiary Maternity. POPULATION: 25 women in a subsequent pregnancy after a medical termination of pregnancy for foetal abnormality, 18-year-old and older. Prenatal Interviews at 20 Gestationnal weeks (GW), 27 GW and 35 GW and Postnatal at 3 months and at each time self-administered questionnaires of anxiety, post-traumatic stress syndrome (PCLS) depressive symptoms (EPDS), prenatal attachment (PAI) and Perinatal Grief Scale (PGS). RESULTS: Pregnancy onset, i.e. before 20 GW, showed increased prevalence of anxiety (16/23, 66.7%), depression (7/23, 30.4%) and post-traumatic stress symptoms (4/16, 25%). Total score on PGS is higher in onset of pregnancy than in the third trimester (p = 0.005). Prenatal attachment was lower during early pregnancy (p = 0.003) and correlated inversely with grief intensity (p = 0.022). During late pregnancy, emotional symptoms decrease, and prenatal attachment stopped increase positively, specifically among women whose foetal abnormality in previous pregnancies were diagnosed late, at an average of 25 GW. CONCLUSION: This research shows the specific dynamics of pregnancies following TOP and highlights the necessity for early prenatal psychological support. One should also pay special attention to prenatal attachment during late pregnancy even after knowing that the fetus is healthy.

Impact of Monochorionicity and Twin to Twin Transfusion Syndrome on Prenatal Attachment, Post Traumatic Stress Disorder, Anxiety and Depressive Symptoms.

Monochronioric (MC) twin pregnancies are considered as high-risk pregnancies with potential complications requiring in-utero interventions. We aimed to assess prenatal attachment, anxiety, post-traumatic stress disorder (PTSD) and depressive symptoms in MC pregnancies complicated with Twin-To-Twin-transfusion syndrome (TTTS) in comparison to uncomplicated monochorionic (UMC) and dichorionic pregnancies (DC). Auto-questionnaires were filled out at diagnosis of TTTS and at successive milestones. Prenatal attachment, PTSD, anxiety and perinatal depression were evaluated respectively by the Prenatal Attachment Inventory (PAI) completed for each twin, the Post-traumatic Checklist Scale (PCLS), the State-Trait Anxiety Inventory (STAI) and the Edinburgh Perinatal Depression Scale (EPDS). There was no significant difference in the PAI scores between the two twins. In the DC and UMC groups, PAI scores increased throughout pregnancy, whilst it didn't for TTTS group. TTTS and DC had a similar prenatal attachment while MC mothers expressed a significantly higher attachment to their fetuses and expressed it earlier. At the announcement of TTTS, 72% of the patients present a score over the threshold at the EPDS Scale, with a higher score for TTTS than for DC (p = 0.005), and UMC (p = 0.007) at the same GA. 30% of mothers in TTTS group have PTSD during pregnancy. 50% of TTTS- patients present an anxiety score over the threshold (STAI-Scale), with a score significantly higher in TTTS than in UMC (p<0.001) or DC (p<0.001). The proportion of subject with a STAI-State over the threshold is also significantly higher in TTTS than in DC at 20 GW (p = 0.01) and at 26 GW (p<0.05). The STAI-state scores in UMC and DC increase progressively during pregnancy while they decrease significantly in TTTS. TTTS announcement constitutes a traumatic event during a pregnancy with an important risk of PTSD, high level of anxiety and an alteration of the prenatal attachment. These results should guide the psychological support provided to these patients.

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...

Posttraumatic stress disorder in children affected by sickle-cell disease and their parents.

Children affected with sickle-cell disease experience painful crises that may be life threatening, or felt as if they were. We evaluated by semistructured interviews and questionnaires the presence of posttraumatic stress disorder in 11 children affected by sickle-cell disease and having suffered at least one hospitalization for a painful crisis, and in their parents (10 mothers, 1 father). Three children (27%) and four parents (40%) were diagnosed with the disorder. It was not correlated to the disease severity but, in parents, to a feeling of powerlessness over the child's illness (P = 0.04).