The Interplay Between Maternal and Paternal Senses of Efficacy Moderates the Link Between Perinatal Parental Stress and Family Alliance at 3 Months.

Objective. Both parents may report high levels of stress during the perinatal period with possible negative consequences for parental well-being and child development. Parental sense of efficacy moderates the effect of stress. To date, no studies have assessed links between parental stress and mother-father-infant interactions in terms of family alliance and the extent to which each parent's sense of efficacy moderates these links. Design. In this study, 65 dual-parent families answered a questionnaire about parental stress between 36 and 38 weeks of pregnancy and at 3 months after birth. Families were also observed while playing with their 3-month-old infant in the Lausanne Trilogue Play, and they completed a questionnaire about parental efficacy. Results. Structural equation modeling analyses showed that higher maternal or paternal postnatal stress has a direct link with higher family alliance and the links between stress and family alliance are moderated by complex interaction effects between maternal and paternal senses of efficacy. Conclusions. This study shows the necessity of considering the interaction between the senses of self-efficacy of both parents as moderators of parenting stress.

Parental sensitivity, family alliance and infants' vagal tone: Influences of early family interactions on physiological emotion regulation.

In this study, we investigated the influence of parental sensitivity and family alliance on infants' vagal tone, considered as a physiological indicator of emotion regulation. Studies on mother-infant interactions have shown that vagal tone can be influenced by the quality of the interaction, such as interacting with a sensitive mother. To date, no study has investigated the influence of paternal sensitivity or family alliance on infants' vagal tone. We hypothesized that maternal sensitivity, paternal sensitivity, and family alliance would be associated with infants' vagal tone during dyadic and triadic interactions. We also explored if family alliance would act as a moderator on the association between parental sensitivity and vagal tone and if the sensitivity of both parents would act as a moderator on the association between family alliance and vagal tone. This study took place in Switzerland and included 82 families with their 3-4-month-old infants. Results showed that maternal sensitivity and family alliance were associated with infants' vagal tone, but paternal sensitivity was not. We found no significant moderation effect. However, result tendencies suggested that the contribution of paternal sensitivity to infants' emotion regulation could be influenced by family alliance, whereas maternal sensitivity and family alliance have a unique contribution.

En este estudio, investigamos la influencia de la sensibilidad del progenitor y la alianza de familia sobre el tono vagal del infante, considerado como un indicador fisiológico de regulación de la emoción. Los estudios acerca de las interacciones madre-infante han demostrado que el tono vagal puede ser influido por la calidad de la interacción, tal como el interactuar con una mamá sensible. Hasta hoy, ningún estudio ha investigado la influencia de la sensibilidad paterna o la alianza de familia sobre el tono vagal del infante. Nuestra hipótesis es que la sensibilidad materna, la sensibilidad paterna y la alianza de familia estaban asociadas con el tono vagal del infante durante las interacciones diádicas y triádicas. También exploramos si la alianza de familia actuaba como moderadora en la asociación entre la sensibilidad paterna y el tono vagal y si la sensibilidad de ambos progenitores actuaba como moderadora en la asociación entre la alianza de familia y el tono vagal. Este estudio se llevó a cabo en Suiza e incluyó a 82 familias con sus infantes de 3-4 meses de edad. Los resultados muestran que la sensibilidad materna y la alianza de familia estaban asociadas con el tono vagal del infante, pero que la sensibilidad paterna no lo estaba. No encontramos ningún efecto de moderación significativo. Sin embargo, las tendencias del resultado sugieren que la contribución de la sensibilidad paterna a la regulación de la emoción puede ser influida por la alianza de familia, mientras que la sensibilidad materna y la alianza de familia tienen una contribución particularmente única.

Dans cette étude nous nous sommes penchés sur l'influence de la sensibilité paternelle et de l'alliance de la famille sur le tonus vagal des nourrissons, considéré comme étant un indicateur physiologique de la régulation de l'émotion. Les études sur les interactions mère-nourrisson ont montré que le tonus vagal peut être influencé par la qualité de l'interaction, comme l'interaction avec une mère sensible. Jusqu'à présent aucune étude n'a porté sur l'influence de la sensibilité paternelle ou l'alliance familiale sur le tonus vagal des nourrissons. Nous avons fait l'hypothèse que la sensibilité maternelle, la sensibilité paternelle, et l'alliance familiale peuvent être liées au tonus vagal des nourrissons durant les interactions dyadiques et triadiques. Nous avons également exploré si l'alliance familiale pourrait agir comme modératrice sur le lien entre la sensibilité parentale et le tonus vagal et si la sensibilité des deux parents pourrait agir comme modérateur du lien entre l'alliance familiale et le tonus vagal. Cette étude s'est faite en Suisse et a inclus 82 familles avec des bébés de 3-4 mois. Les résultats ont montré que la sensibilité maternelle et l'alliance familiale étaient liées au tonus vagal des bébés mais la sensibilité de l'était pas. Nous n'avons trouvé aucun effet de modération important. Cependant les tendances des résultats ont suggéré que la contribution de la sensibilité paternelle à la régulation de l'émotion des nourrissons pourrait être influencée par l'alliance familiale alors que la sensibilité maternelle et l'alliance familiale a une contribution unique.

The influence of the COVID-19 lockdown on infants' physiological regulation during mother-father-infant interactions in Switzerland.

In this study, we investigated the physiological regulation of vagal tone during dyadic and triadic parent-infant interactions in infants born before or around the COVID-19 lockdown in Switzerland. We hypothesized that there would be a decrease in vagal tone in triadic interactions compared with dyadic interactions, as triadic interactions are more complex and therefore more resource demanding. However, we expected this difference to be smaller for infants who experienced the period of confinement, as the lockdown led parents to spend more time at home. We also hypothesized that parents would have less stressful interactional events in the triadic interaction because they would be used to interacting with the child together. This study included 36 parents with their 3 month-old infants. Eighteen families met the study authors before the onset of the pandemic (pre-COVID) and 18 met them after its onset, having experienced a period of confinement during the infants' first 3 months of life (COVID). Results showed that the COVID group had no decrease in vagal tone during triadic interactions, whereas the pre-COVID group did. This difference could not, however, be explained by less stressful interactional events in triadic interactions, as the COVID group showed more stressful interactional events in mother-father-infant interactions.

Interactive synchrony and infants' vagal tone as an index of emotion regulation: associations within each mother- and father-infant dyad and across dyads.

Introduction: Studies have shown that infants' emotion regulation capacities are closely linked to the quality of parent-infant interactions. However, these links have been mostly studied in mother-infant dyads and less is known about how the quality of father-infant interactions contributes to the development of emotion regulation during infancy. In this study, we aimed to investigate the links between interactive synchrony (i.e., an index of the quality of parent-infant coordination of interactive behaviors) and infants' vagal tone (i.e., a physiological index of emotion regulation). To understand the respective contributions of both parents, as well as the interrelations between the functioning of both dyads within a family, we observed mothers and fathers from 84 families interacting with their infants. Methods: Synchrony was assessed by using the CARE-Index; infants' vagal tone was derived from the analysis of infants' electrocardiograms recorded during the interactions. Moreover, to take the play's order into account, we counterbalanced the procedure, so that approximately half of the mothers played first. We specified a first structural equation modeling (SEM) model to investigate the associations between interactive synchrony and the infants' root mean square of successive differences (RMSSD), an index of vagal regulation, in the two successive parts of the play. We conducted a multigroup analysis in a second SEM model to investigate the associations of the first SEM model in two groups based on the order of interaction. Results: The results of the SEM models showed that greater synchrony was related to greater infant RMSSD within mother-infant dyads and across one dyad to the other dyad in the full sample and in the group of fathers who interacted first with the infants. The associations between synchrony and infant vagal tone within father-infant dyads never appeared to be significant, nor did any associations within each dyad and across dyads when mothers interacted first. Discussion: This study highlights that the links between interactions and infants' vagal tone are sensitive to family members' interdependencies and some conditions (the order of interaction).

Pregnancy, Mental Well-Being and Lockdown: A Nationwide Online Survey in France.

The objective of this study was to compare the mental well-being of French women who were and were not pregnant during the first COVID-19 pandemic lockdown. We performed a nationwide online quantitative survey including all women between 18 and 45 years of age during the second and third weeks of global lockdown (25 March-7 April 2020). The main outcome measure was mental well-being measured by the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS). This study analysed 275 responses from pregnant women and compared them with those from a propensity score-matched sample of 825 non-pregnant women. In this French sample, the median WEMWBS score was 49.0 and did not differ by pregnancy status. Women living in urban areas reported better well-being, while those with sleep disorders or who spent more than an hour a day watching the news reported poorer well-being. During the first lockdown in France, women had relatively low mental well-being scores, with no significant difference between pregnant and non-pregnant women. More than ever, health-care workers need to find a way to maintain their support for women's well-being. Minor daily annoyances of pregnancy, such as insomnia, should not be trivialised because they are a potential sign of poor well-being.

The impact of pre- and post-natal psycho-educational intervention on the construction of parenthood.

A pilot study was conducted to assess the merits and feasibility of a standardized postnatal psycho-educational interview on mothers' mental wellbeing, self-efficacy, and mother-child and couple relationships. A comparison of prenatal psycho-educational interview (n = 23) vs. pre- and post-natal psycho-educational interviews (n = 26) was carried out. Parental self-efficacy and the mother-child relationship were significantly improved for the group who received a post-natal interview at 2 and 3 months postpartum in addition to a prenatal interview. Pre- and post-natal interviews improve the construction of parenthood.

Relationship between perceived perinatal stress and depressive symptoms, anxiety, and parental self-efficacy in primiparous mothers and the role of social support.

The aim of the authors in this study was to evaluate the relationships between perceived perinatal stress and social support to psychological health outcomes in mothers. A longitudinal, quantitative study was conducted in Geneva, Switzerland on 235 primiparous mothers from September 2010 to January 2012. Data were collected between gestational weeks 37 and 41 (T1), 2 days post-delivery (T2), and at 6 weeks postpartum (T3). Perinatal stress was associated with depressive symptoms (R2 = 0.223), anxiety (R2 = 0.242), and a low sense of parental self-efficacy (R2 = 0.21). However, satisfaction with social support moderated the relationship of stress to the health of mothers. In particular, the authors noted that the more women were provided with support from their partners, the less depressive symptoms and elevated levels of anxiety they reported, even under stressful conditions, while the satisfaction of support from their mothers boosted their sense of competency. Furthermore, satisfaction with emotional support from professionals tempered the stress during the post-partum period (∆R2 = 0.032; p < .05). The results revealed that perinatal stress was related to the psychological health of mothers, but social support may modulate these effects. A number of approaches could be implemented to manage this stress.

Determinants of Health Behaviors After Gestational Diabetes Mellitus: A Prospective Cohort Study in Geneva.

INTRODUCTION: Gestational diabetes mellitus (GDM) is one of the most common complications in pregnancy. The objective of this study was to specify the determinants of postpartum physical activity and dietary habits after a pregnancy complicated by GDM in a population of Swiss women. This information will be used to improve health promotion and diabetes prevention interventions for women with a history of GDM. METHODS: A prospective cohort study of 173 pregnant women with a diagnosis of GDM was carried out. Quantitative data were collected at the end of pregnancy (T1) and at 6 months postpartum (T3). Bivariate and multivariate logistic regression analysis was conducted to assess associations between the level of healthy lifestyle at 6 months postpartum, clinical and sociodemographic characteristics, motivation to adopt a healthy lifestyle after birth at the end of pregnancy, and postulated psychosocial correlates of health behaviors. RESULTS: Multivariate regression analysis showed that only 2 variables were determinants in a low adherence to healthy lifestyle in the postpartum period after GDM: a lower level of social support (odds ratio [OR], 1.5; P < .001) and more perceived barriers to a healthy lifestyle (OR, 1.2; P = .002). DISCUSSION: This study shows that, for women who had GDM, the problem of low adherence to a healthy lifestyle to prevent the onset of type 2 diabetes may be secondary to the lack of resources available for the promotion and development of healthy eating habits and regular physical activity. The findings of this study suggest that some women with a history of GDM do not have the means and resources in the postpartum period to apply the advice given during antenatal monitoring.

The role of satisfaction with social support on the psychological health of primiparous mothers in the perinatal period.

The aim of this study was to develop a satisfaction scale for social support and to investigate the relation of satisfaction with social support to the psychological health of primiparous mothers in terms of depressive symptoms, anxiety, and parental self-efficacy. We carried out a quantitative study during the last month of pregnancy (T1) and 6 weeks after birth (T2) including 235 mothers who were expecting their first child in Geneva (Switzerland) from September 2010 to April 2012. The satisfaction scale for social support revealed five sources of support (from the spouse, young woman's mother, family, friends, professionals), each associated with different types of support (i.e., emotional, esteem, material, and informative). This scale showed good internal consistency for each factor. Moreover, the results revealed a relationship between satisfaction with social support and the mental health of mothers, in particular in the postnatal period for depressive symptoms, anxiety, and self-efficacy. This study highlights the important role of social support and the scale specifically developed during this period is a useful tool to investigate this aspect.

Validation of the post-delivery perceived stress inventory.

This article presents the post-delivery perceived stress inventory (PDPSI) and its psychometric properties. This inventory is unique in that it links the measurement of perceived stress to events experienced during and after delivery. A total of 235 French-speaking, primiparous mothers completed the PDPSI two days after their delivery. To evaluate the predictive validity of the PDPSI on anxiety and depression, participants also completed the EPDS and the STAI two days and six weeks postpartum. The exploratory analysis revealed a 16-item structure divided into five factors: F1: relationship with the child; F2: delivery; F3: fatigue after delivery; F4: breastfeeding; and F5: relationship with the caregivers. The PDPSI demonstrated good internal consistency. Moreover, confirmatory factor analysis produced excellent indices, indicating that the complexity of the PDPSI was taken into account and its fit to the sample. The discriminant analysis showed that the PDPSI was not sensitive to specific changes in the sample making the inventory generalizable to other populations. Predictive validity showed that the scale significantly predicted depression and anxiety in the early postpartum period as well as anxiety six weeks postpartum. Overall, the PDPSI showed excellent psychometric qualities, making it a useful tool for future research-evaluating interventions related to perceived stress during the postpartum period.

Validation of the Antenatal Perceived Stress Inventory.

This article presents the Antenatal Perceived Stress Inventory. The originality of this scale is to assess the impact of events experienced during pregnancy on the stress perceived by mothers. Scale validation was performed using data from 150 French-speaking nulliparous mothers and collected between 36 and 39 weeks of gestation (T1), and between 2 days (T2) and 6 weeks postpartum (T3). Factor analysis revealed a hierarchical three-factor structure that closely fit the data, including medical and obstetric risks/fetal health (F1), psychosocial changes (F2), and the prospect of childbirth (F3). The Antenatal Perceived Stress Inventory is a valid French prenatal stress scale with good psychometric properties.

Validation of the postnatal perceived stress inventory in a French speaking population of primiparous women.

OBJECTIVE: To develop a Postnatal Perceived Stress Inventory (PNPSI) and assess its psychometric properties. DESIGN: Cross-sectional quantitative study. SETTING: One nurse-managed labor and delivery unit in a university hospital in a major metropolitan area. PARTICIPANTS: One hundred seventy-nine (179) primiparous French speaking women who gave birth at term. METHODS: The PNPSI was validated at 6 weeks postpartum. Its predictive validity for depression and anxiety was assessed at the same time. RESULTS: The exploratory analysis revealed a 19-item structure divided into six factors. This inventory has good internal consistency (Cronbach's alpha = .815). The predictive validity shows that the PNPSI significantly predicts depression and anxiety at 6 weeks postpartum, and that certain factors are particularly prominent. CONCLUSION: The PNPSI's psychometric properties make it a useful tool for future research to evaluate interventions for perceived stress during the postnatal period. Its predictive power for depression indicates that it is also a promising tool for clinical settings.

Impact of health beliefs, social support and self-efficacy on physical activity and dietary habits during the post-partum period after gestational diabetes mellitus: study protocol.

BACKGROUND: Gestational diabetes mellitus (GDM) is defined as a glucose intolerance of variable severity occurring or diagnosed for the first time during pregnancy. Numerous epidemiological studies show that this disorder affects between 1 and 18% of pregnancies, depending on the ethnicity of the populations studied, the diagnostic criteria, or the body mass index (BMI). Its incidence is constantly rising worldwide. Patients with GDM have a high risk of developing type 2 diabetes in the months after delivery. For this reason, GDM patients are encouraged to practice specific health behaviors (dietary habits, physical activity) during the postpartum period. It is important to identify the factors that may impact adherence to these behaviors. METHODS/DESIGN: A targeted sample size of 200 eligible pregnant women with a diagnosis of GDM will be enrolled in this prospective, cohort study. They will be recruited from 30-36 weeks of gestation as part of their diabetes consultation in Geneva University Hospital (GUH) maternity unit. Psychosocial variables that could impact adherence to health behaviors in the postpartum period (behavioral intentions, risk perceptions, general knowledge about diabetes, health beliefs, social support, self-efficacy) will be evaluated using specific tools at the end of pregnancy, at 6 weeks postpartum and at 6 months postpartum. Multiple regression analyses will be performed on SPSS. DISCUSSION: For the first time in Europe, the objective of this research is to study in women with very recent GDM the link between dietary habits, physical activity levels, and psychosocial and cognitive factors possibly involved in the adoption of health behaviors in the postpartum period. These factors have been identified in the literature, but to date have never been combined in a single study. The study will allow a predictive theoretical model of health behavior to be established and used as a basis for reflection to optimize interventions carried out on women who have had GDM.

Relation between perceived stress, social support, and coping strategies and maternal well-being: a review of the literature.

The objective of this work was to review published articles on the impact of perinatal stress on mothers' medium- or long-term psychological health and the efficacy of coping strategies, to determine if social support plays a role in the interaction between birth events and mothers' psychological experiences, and to identify the tools used for these measurements. MEDLINE, PsycINFO, and CINAHL databases were searched for English and French language articles from 2000 through 2010 inclusive. Thirty-seven articles fulfilled the selection criteria. The results of this review highlight an association between perceived stress and postpartum depressive symptoms. However, because perceived stress has been evaluated in a general manner, it was not possible to identify events having more or less relation to postpartum depressive symptoms in mothers. Social support also appeared to be related to mothers' psychological health. Coping strategies were difficult to analyze because of the lack of homogeneity in their definition across studies. The comparison among studies of social support and coping strategies was also difficult due to the diversity of tools used and their lack of specificity. New tools should be specifically developed for the perinatal period, and further research should be performed to understand better the events and adequacy of social support.

Determinants of postpartum physical activity, dietary habits and weight loss after gestational diabetes mellitus.

AIM: To describe the most significant findings of the studies that examined the prevalence and determinants of postpartum health behaviours (physical activity, dietary habits and/or weight loss) in patients with gestational diabetes mellitus (GDM). BACKGROUND: Patients with gestational diabetes have a high risk of developing type 2 diabetes in the months after delivery. For this reason, GDM patients are encouraged to practice specific health behaviours during the postpartum period. It is important to identify the factors that may impact the adherence to these behaviours. EVALUATION: Eighteen published research articles that examined postpartum health behaviours and/or their potential determinants in women diagnosed with GDM were selected from electronic databases. KEY ISSUES: Physical activity and diet rarely meet the recommendations. Risk perception, health beliefs, social support and self-efficacy are the main factors identified as having an impact on the adoption of health behaviours. However, the cross-sectional nature of the studies and the lack of social, geographical and/or ethnic variety in the populations studied do not allow us to generalize the conclusions. IMPLICATIONS FOR NURSING MANAGEMENT: This literature review reports all the information currently available that can enable nurses and midwives to engage in the evaluation and optimization of their interventions in GDM patients. Motivational interventions based on Social Cognitive Theory are proposed.

[Stress, social support and coping strategies: what influence on perceived parental self-efficacy of primiparous mothers?]. / Stress, soutien social et stratégies de coping: quelle influence sur le sentiment de compétence parental des mères primipares?

Following comprehensive and semistructured interviews, (N = 30) this article questions the life changes arising in mothers six weeks after the birth of the first child. The birth of a child reflects emotional, behavioral and cognitive changes, requiring consideration and adjustments bythe mothers. We believe there are a number of factors that could impact the perceived self-efficacy and the emotional health of the mothers, and the relationship between mother and child. The research indicates areas of stress encountered by mothers and the strategies put in place by mothers to cope and overcome the stress problem. This article also questions the action taken to reduce stress by the medical team and in particularly the midwife during the birth process. The results show that all stressful events have not the same impacts on the perceived self-efficacy. Breast feeding and the crying of the babies appear to have the most impact. We believe, professional social support has a strong influence on the mothers perceived self-efficacy. As well, it is important to consider the value given to people in charge of support. Thus, the research indicates the complex link between stress, social support and coping strategies and leads to a complex transactional pattern.

[Representations of breastfeeding in the patient/nurse midwife relation]. / Les représentations de l'allaitement dans la relation patientes/sages-femmes.

At the crossroads of medical, cultural and psychological fields, breastfeeding can often provoke intense reactions. In the course of my profession as a midwife, I have observed difficulties in the encounters between patients and midwives. In the context of social representations, I wished to explore and compare the representations of breastfeeding of both patients and midwives, which will test the hypothesis that the incongruity in patient/midwife relationships derives from a difference in their respective representations of breastfeeding. In order to demonstrate this, I conducted partially structured interviews with five hospitalized patients three days post natal, and five midwives from the Geneva maternity ward. The qualitative thematic analysis of the discussions has shown large differences in comprehension between the patients and the midwives, notably in the subject of experience, the influence of contextual factors, emotions, and normative ideas. We can concur that, from the beginning, this hypothesis has in large part been validated. Propositions were formulated, and are the road to improvement. Even after childbirth, breastfeeding, apart from nourishing a child, not only serves as a catalyst for emotions, but also for tensions, conflicts, as well as cultural paradoxes, both domestic and cognitive.