Disruption to the development of maternal responsiveness? The impact of prenatal depression on mother–infant interactions

doi:10.1016/j.infbeh.2012.07.020

Infant Behavior and Development

Volume 35, Issue 4, December 2012, Pages 613-626

https://doi.org/10.1016/j.infbeh.2012.07.020 Get rights and content

Abstract

Both prenatal and postnatal maternal depression are independently associated with an increased risk of adverse infant development. The impact of postnatal depression on infants may be mediated through the effect of depression in reducing maternal responsiveness. However, the mechanisms underlying the effect of prenatal depression are unclear. Using longitudinal data from over 900 mother–infant pairs in a UK birth cohort (ALSPAC), we found that women with high depressive symptom scores during mid pregnancy, but NOT when their infants were 8 months, had a 30% increased risk of low maternal responsiveness when the infant was 12 months compared to women with consistently low depression. This may provide a mechanism to explain the independent association between prenatal depression and poorer infant development.

Highlights

► Antenatal depression is associated with poor infant outcomes. ► Disruption to the development of maternal responsiveness may explain this association. ► We investigated the impact of depression during pregnancy on maternal responses 12 months after birth. ► Women who were depressed during pregnancy but not after birth showed disrupted maternal responsiveness. ► The findings highlight the importance of pregnancy for the mother–infant relationship.

Section snippets

Mother–infant interactions and maternal depression

Maternal sensitivity, which is a mother's ability to engage with and respond to her infant's emotions and communications, is fundamental to positive mother–infant relationships (Ainsworth, 1979). Observations of a mother showing positive behavioural responses towards her infant provide a core index of maternal sensitivity. Increased positive responsiveness observed during mother–infant interactions is positively associated with mother–infant attachment and the later emotional, cognitive and

The development of maternal responsiveness during pregnancy

Although previous research has established that postnatal depression has an important impact on the mother–infant dyad the development of precursors for maternal responsiveness may occur even earlier. Indeed, for a mother to be responsive towards her infant from the moment of birth it would be of evolutionary advantage for precursors for maternal responsiveness to develop by the end of pregnancy rather than after the infant is born. In support of this women who report stronger prenatal infant

Disruption to the development of maternal responsiveness by prenatal depression

Symptoms of depression are at least as common during pregnancy as following birth (Bennett et al., 2004, Evans et al., 2001). Depression or stress during pregnancy is also associated with later emotional and cognitive development in offspring, including lower IQ, increased risk of clinical depression during childhood and adolescence and behavioural problems (Bergman et al., 2007, Deave et al., 2008; Evans et al., 2012; Hay, Pawlby, Waters, Perra, & Sharp, 2010). Postnatal depression was

Hypotheses

We, therefore, hypothesised that:

1)
Depression during mid pregnancy would be associated with reduced maternal responsiveness during mother–infant interactions after birth, independently of recent maternal depression. By independent of recent maternal depression we meant that women who experienced high depression during mid pregnancy but NOT close to the time of maternal responsiveness measurement would show reduced maternal responsiveness.
2)
The association between depression during mid pregnancy and

Method

To test these hypotheses we used data from a large UK population based study (ALSPAC). The study included regular measurements of depression both during pregnancy and after birth, measures of infant development and temperament as well as an observed measurement of maternal responsiveness at 12 months after birth.

Sample demographics

There were 964 women who completed both the mother–infant interaction at 12 months and the depression questionnaires during mid pregnancy and after birth (see Fig. 2). However, only 872 of these mother–infant pairs also had complete case data for confounding variables. Sample characteristics are given in Table 1. Mothers in the complete case sample were on average older, delivered later, had a higher level of educational attainment, were more likely to have breastfed their infant and were less

Discussion

To our knowledge this is the first study to report an effect of prenatal depression on later maternal responsiveness. This effect did not change substantially following adjustment for maternal, perinatal or infant variables. Furthermore, as this association was found for women who were not depressed after birth there was evidence that the effects of prenatal depression were independent of depression that occurred close to the time maternal responsiveness was measured (recent maternal

Conclusion

We therefore conclude that there may be a disruptive effect of prenatal depression on the development of important preparations for maternal responsiveness as well as the previously reported effect of concurrent maternal depression on the expression of maternal responsiveness. The measure of maternal responsiveness used here has previously been shown to be associated with later child development (Pearson et al., 2011). Therefore, our results may provide another mechanism to explain the negative

Conflicts of interest

None.

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Citation Excerpt :
In fact, observational studies confirm that antenatal depression is associated with observed disruptions in the mother-infant relationship in the postpartum, regardless of presence of postnatal depression (Bind et al., 2021). In one study, mother-infant interaction was assessed in the context of both antenatal and postnatal depression, in an effort to elucidate whether there was a difference in dyadic interaction based on timing of maternal symptoms (Pearson et al., 2012). The authors found that women who exhibited high levels of depression during mid pregnancy, but not postnatally, were less responsive toward their infants, when observed using the Thorpe Interaction Measure, than women with no antenatal depression.
Antenatal depression affects up to 20% of pregnancies, yet research has historically focused on postnatal depression and its effects on mothers and their offspring. Studies are now emerging highlighting the impact that depression in pregnancy can also carry on both members of the dyad, including difficulties with psychological, physical, and social functioning. More specifically, researchers have begun to examine whether antenatal depression may lead to difficulties in the developing mother-infant relationship and subsequent infant attachment. While much of the research on this has explored psychosocial mechanisms behind the pathway from antenatal depression to a disrupted relationship in the postpartum, few studies have looked at biological underpinnings of this process. Of the literature that exists, it has been found that mothers with depression in pregnancy have lower levels of oxytocin and increased levels of inflammatory markers, plausibly creating difficulties in the mother-infant bonding process, leading to impaired mother-infant interactions and non-secure infant attachment. Furthermore, infants with non-secure attachments are at risk of entering a proinflammatory state due to a dysregulated stress response system. Overall, the literature on the neurobiology of mother-infant interactions and infant attachment in the context of antenatal depression is sparse, thus warranting future research.
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Disruption to the development of maternal responsiveness? The impact of prenatal depression on mother–infant interactions

Abstract

Highlights

Section snippets

Mother–infant interactions and maternal depression

The development of maternal responsiveness during pregnancy

Disruption to the development of maternal responsiveness by prenatal depression

Hypotheses

Method

Sample demographics

Discussion

Conclusion

Conflicts of interest

Neuroimage

Physiology and Behavior

Journal of the American Academy of Child and Adolescent Psychiatry

Infant Behavior and Development

Physiology and Behavior

Current Opinion in Neurobiology

Infant Behavior and Development

Journal of Pediatrics

Infant Behavior and Development

Hormones and Behavior

Biological Psychiatry

Clinical Psychology Review

Progress in Neuro-psychopharmacology and Biological Psychiatry

Biological Psychiatry

Neuroimage

Biological Psychiatry

Infant Behavior and Development

Infant Behaviour and Development

Hormones and Behavior

Neuroscience

Appetite

Biological Psychiatry

Early Human Development

Hormones and Behavior

Infant–mother attachment

American Psychologist

Prevalence of depression during pregnancy: Systematic review

Obstetrics and Gynecology

Trajectories of maternal depressive symptoms, maternal sensitivity, and children's functioning at school entry

Developmental Psychology

Revision of the infant temperament questionnaire

Pediatrics

Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale

British Journal of Psychiatry

The impact of maternal depression in pregnancy on early child development

BJOG: An International Journal of Obstetrics and Gynaecology