The Role of Maternal Perceived Social Support on the Relation Between Prenatal Depressive Symptoms and Labor Experience

Background: Depression during pregnancy is a severe risk factor for negative outcomes in women and children. In particular, prenatal symptoms of depression are linked to a more complicated labor experience, characterized by more painful labor and more frequent recourse to epidural analgesia and/or oxytocin. Although this link is evident, less is known about possible mediators of this relationship. Aims: This study investigated the mediating role of perceived maternal social support on the relationship between prenatal maternal depression and labor experience. Methods: Participants were 152 Italian nulliparous women ( Mage = 31.68 years, SD = 4.94). Data were collected at two different times: T1 (at week 30–33 of gestation) women completed the Beck Depression Inventory and the Maternal Social Support Scale; T2 (at childbirth) clinical data regarding labor was registered from hospital records (duration of labor in hours and administration of oxytocin and epidural analgesia in hours). Results: The Structural Equation Modeling showed that prenatal symptoms of depression are linked to a more complicated labor experience (β = .31, p < .001). However, the quality of the maternal social support can mediate this relationship (indirect effect: β = .17, p < .000). Limitations: The complexity of the proposed model, the characteristics of the sample, the variables investigated, and the questionnaires used are discussed. Conclusion: The perception of having a good social network is an important predictor of women’s health in the transition to motherhood, decreasing the negative effect of maternal prenatal depressive symptoms on the quality of women’s labor experience.

Maternal childhood trauma and prenatal stressors are associated with child behavioral health

Maternal adversity and prenatal stress confer risk for child behavioral health problems. Few studies have examined this intergenerational process across multiple dimensions of stress; fewer have explored potential protective factors. Using a large, diverse sample of mother–child dyads, we examined associations between maternal childhood trauma, prenatal stressors, and offspring socioemotional-behavioral development, while also examining potential resilience-promoting factors. The Conditions Affecting Neurocognitive Development and Learning and Early Childhood (CANDLE) study prospectively followed 1503 mother–child dyads (65% Black, 32% White) from pregnancy. Exposures included maternal childhood trauma, socioeconomic risk, intimate partner violence, and geocode-linked neighborhood violent crime during pregnancy. Child socioemotional-behavioral functioning was measured via the Brief Infant Toddler Social Emotional Assessment (mean age = 1.1 years). Maternal social support and parenting knowledge during pregnancy were tested as potential moderators. Multiple linear regressions (N = 1127) revealed that maternal childhood trauma, socioeconomic risk, and intimate partner violence were independently, positively associated with child socioemotional-behavioral problems at age one in fully adjusted models. Maternal parenting knowledge moderated associations between both maternal childhood trauma and prenatal socioeconomic risk on child problems: greater knowledge was protective against the effects of socioeconomic risk and was promotive in the context of low maternal history of childhood trauma. Findings indicate that multiple dimensions of maternal stress and adversity are independently associated with child socioemotional-behavioral problems. Further, modifiable environmental factors, including knowledge regarding child development, can mitigate these risks. Both findings support the importance of parental screening and early intervention to promote child socioemotional-behavioral health.

Social Support, Maternal Agency, Postnatal Depression, and Domestic Violence Influence the Formal Employment-Exclusive Breastfeeding Relationship: Evidence From Kenya

Objectives We previously demonstrated that formal employment among mothers in Kenya is associated with a lower prevalence and odds of exclusive breastfeeding (EBF). This study evaluated the influence of maternal social support, agency, postnatal depression, and domestic violence on the association between formal employment and EBF in Naivasha, Kenya, where many women work in agricultural labor. Methods Using cross-sectional data (n = 1,186), we examined validated scales of social support, agency, domestic violence, and postnatal depression as effect modifiers in adjusted, stratified models of the association between employment and EBF. We hypothesized that higher social support and agency would attenuate the odds ratios that evaluated employment and EBF, and domestic violence and depression would further decrease the odds of EBF based on employment. Results Comparing formally employed to non-formally employed mothers, women with higher social support were more likely to practice EBF at 14 weeks: OR high (95%CI) = 0.22 (0.09, 0.51) and OR low = 0.12 (0.05, 0.29). The same trend was observed at 24 weeks. Among mothers with higher maternal agency compared to those with lower agency, the negative association between formal and EBF was decreased at both 14 weeks [OR high = 0.21 (0.09, 0.47) versus OR low = 0.16 (0.06, 0.44)] and 24 weeks. Comparing mothers who reported experiencing domestic violence to those who had not, the negative association between formal and EBF was increased at both 14 weeks [OR = 0.06 (0.01, 0.31) versus OR No violence = 0.18 (0.09, 0.36)] and 24 weeks. At 14 weeks, mothers with depression decreased the association between employment and EBF: [OR dep = 0.11 (0.03,0.45) versus OR no depression = 0.16 (0.08, 0.33). At 24 weeks, the employment-EBF relationship was non-significant among mothers with depression: [OR dep = 0.31 (0.08, 1.30) but remained significant among mothers without depression: OR no dep = 0.22 (0.12, 0.40). Conclusions Among formally employed mothers, maternal social support and agency improve the employment-breastfeeding relationship, while women exposed to domestic violence or postnatal depression experienced a further decrease in the likelihood of EBF. Supportive interventions to improve EBF and other maternal health factors are needed in the postpartum period for employed mothers. Funding Sources NIH Fogarty International Center

Maternal Social Support Is Associated with Knowledge and Attitudes on Fruit and Vegetable Consumption Among Refugee Mothers in Post- Emergency Settlements in Uganda

Objectives Research on the effectiveness of maternal social support to improve knowledge, attitudes, and practices about the consumption of healthy diets is limited in Uganda. Our study examined the association between maternal social support and knowledge, attitudes, and practices of fruit and vegetable consumption among South Sudanese refugee mothers in post-emergency settlements in the West Nile region, in Uganda. Methods This cross-sectional study included 379 refugee mothers (15–49 years). Principal component analysis was used to determine scores for maternal knowledge, attitudes, and practices of fruit and vegetable consumption. The Medical Outcomes Study (MOS) Social Support Index was used to determine maternal social support scores. A mean score &gt; 4 was considered optimal social support. Associations between maternal social support and knowledge, attitudes, and practices of fruit and vegetable consumption were determined by logistic regression, adjusted for confounders. Statistical significance was set at p &lt; 0.05. Results The mean maternal age was 27.8 ± 5.0. Although 62.3% of mothers had optimal social support scores, 37.7% did not have anyone to rely on for day-to-day support. Even though mothers with optimal social support were more likely to have more knowledge about fruit and vegetable consumption (AOR = 2.05 [1.32 – 3.19], p = 0.003), there was not a significant association between maternal social support and fruit and vegetable consumption (AOR = 0.75 [0.46 – 1.23], p = 0.242). Furthermore, mothers with optimal social support were less likely to be positive towards fruit and vegetable consumption (AOR = 0.13 [0.02 – 0.73], p = 0.023). Conclusions Social support interventions have the potential to improve maternal knowledge on fruit and vegetable consumption among mothers in post-emergency areas. A mixed-methods longitudinal study may further determine why social support is associated with increased knowledge but not with more positive attitudes about fruit and vegetable consumption. Funding Sources Esther Winterfeldt Summer Research Fellowship; The Nestlé Foundation.

Maternal Distress and Social Support Are Linked to Human Milk Immune Properties

Possible alterations of maternal immune function due to psychological stress may reflect immunoactive factor levels in breast milk. This study aimed to assess the association between maternal distress and breast milk levels of secretory IgA (SIgA), IgM, IgG, and lactoferrin (LF). We hypothesized that this association is moderated by maternal social support achieved from others during lactation. The study group included 103 lactating mothers and their healthy five-month-old infants. Maternal distress was determined based on the State Anxiety Inventory and the level of salivary cortisol. Social support was assessed using the Berlin Social Support Scales. Breast milk samples were collected to test for SIgA, IgM, IgG, and LF using the ELISA method. Milk immunoactive factors were regressed against maternal anxiety, social support, salivary cortisol, and infant gestational age using the general regression model. Maternal anxiety was negatively associated with milk levels of LF (β = −0.23, p = 0.028) and SIgA (β = −0.30, p = 0.004), while social support was positively associated with milk IgG (β = 0.25, p = 0.017). Neither anxiety nor social support were related to milk IgM. No association was found between the level of maternal salivary cortisol and immunoactive factors in milk. Our results suggest that maternal psychological wellbeing and social support may affect milk immune properties.

Maternal Distress and Social Support are Linked to Human Milk Immune Properties

Possible alterations of maternal immune function due to psychological stress may reflect immunoactive factor levels in breast milk. This study aimed to assess the association between maternal distress and breast milk levels of secretory IgA (SIgA), IgM, IgG, and lactoferrin (LF). We hypothesized this association is moderated by maternal social support achieved from others during lactation. The study group included 103 lactating mothers and their healthy 5-months-old infants. Maternal distress was determined based on the State Anxiety Inventory and the level of salivary cortisol. Social support was assessed using Berlin Social Support Scales. Breast milk samples were collected to test for SIgA, IgM, IgG, and LF using the ELISA method. Milk immunoactive factors were regressed against maternal anxiety, social support, salivary cortisol, and infant gestational age using the general regression model. Maternal anxiety was negatively associated with milk levels of LF (&beta;=-0.22, p&lt;0.05) and SIgA (&beta;=-0.29, p&lt;0.01), while social support was positively associated with milk IgG (&beta;=0.25, p&lt;0.05). Neither anxiety nor social support was related to milk IgM. No association was found between the level of maternal salivary cortisol and immunoactive factors in milk. Our results suggest that maternal psychological well-being and social support may affect milk immune properties.

Longitudinal effects of perinatal social support on maternal depression: a marginal structural modelling approach

BackgroundDepression in the perinatal period, during pregnancy or within 1 year of childbirth, imposes a high burden on women with rippling effects through her and her child’s life course. Social support may be an important protective factor, but the complex bidirectional relationship with depression, alongside a paucity of longitudinal explorations, leaves much unknown about critical windows of social support exposure across the perinatal period and causal impacts on future depressive episodes.MethodsThis study leverages marginal structural models to evaluate associations between longitudinal patterns of perinatal social support and subsequent maternal depression at 6 and 12 months postpartum. In a cohort of women in rural Pakistan (n=780), recruited in the third trimester of pregnancy and followed up at 3, 6 and 12 months postpartum, we assessed social support using two well-validated measures: the Multidimensional Scale of Perceived Social Support (MSPSS) and the Maternal Social Support Index (MSSI). Major depressive disorder was assessed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (DSM IV).ResultsHigh and sustained scores on the MSPSS through the perinatal period were associated with a decreased risk of depression at 12 months postpartum (0.35, 95% CI: 0.19 to 0.63). Evidence suggests the recency of support also matters, but estimates are imprecise. We did not find evidence of a protective effect for support based on the MSSI.ConclusionsThis study highlights the protective effect of sustained social support, particularly emotional support, on perinatal depression. Interventions targeting, leveraging and maintaining this type of support may be particularly important for reducing postpartum depression.

The effect of maternal depressive symptoms on infant feeding practices in rural Ethiopia: Community based birth cohort study

Background: Infant feeding is a multidimensional and multi-risk factor practice with a vital role in ensuring optimal child health, growth and development. Maternal depression and other psychosocial factors have been shown to have adverse consequences on feeding practices. However, most of these findings were based on single infant feeding practice (IFP) dimension; for instance, early initiation of breastfeeding, exclusive breastfeeding or introduction of complementary foods. This study aims to explore the longitudinal relationship of maternal depressive symptoms and other selected psychosocial factors with IFPs in rural Ethiopia using summary IFP index.Methods: This study uses existing data from the ENGINE birth cohort study. The study had an open cohort design, with “rolling recruitment” procedure and follow up of pregnant women for a period of two years. It was conducted from March 2014 to March 2016 in three districts in the southwest of Ethiopia. A total of 4680 pregnant women were recruited between 12 and 32 weeks of gestation. Data were collected once during pregnancy for all women (twice for those in the first trimester), at birth, and then every three months until the child was 12 months old. Standardized questionnaire were used to collect data on IFPs, maternal depressive symptoms, household food insecurity, intimate partner violence (IPV), maternal social support, active social participation, and other socio-demographic variables. A composite measure of IFP index was computed using 14 WHO recommended infant and young child feeding (IYCF) practice indicators. High IFP index indicated best practice. Prenatal and postnatal maternal depressive symptoms were assessed using the patient health questionnaire (PHQ-9). Linear multilevel mixed effects model was fitted to assess longitudinal relationship of IFPs with maternal depression and other psychosocial factors.Results: Reports of higher postnatal depressive symptoms (ß= -1.03, P=0.001) and IPV (ß= -0.21, P=0.001) were associated with lower scores on the IFP index. Whereas, reports of better maternal social support (ß= 0.11, P=0.002) and active social participation (ß= 0.55, P<0.001) were associated with higher scores on the IFP index. Contrary to expected, moderate household food insecurity (ß= 0.84, P=0.003), severe household food insecurity (ß= 1.03, P=0.01) and infant morbidity episodes (ß= 0.63, P=0.013) were associated with higher scores on the IFP index.Conclusion: Early postnatal depressive symptoms and intimate partner violence were negative predictors of IFPs. On the other hand, maternal social support, social participation, maternal education and gestational age at birth were positive predictors of IFPs. Overall, we can conclude that multitude of factors are related to IFPs and hence coordinated, multi-sectoral and multi-stakeholder interventions including maternal depressive symptoms screening and management are needed to improve IFPs.