Warnock Fay F, Craig Kenneth D, Bakeman Roger, Castral Thaila, Mirlashari Jila
Developmental Neurosciences, Child and Family Research Institute, L408, 4480 Oak Street, Vancouver, BC, Canada.
University of British Columbia (BC), School of Nursing, Vancouver, BC, Canada.
BMC Pregnancy Childbirth. 2016 Sep 7;16:264. doi: 10.1186/s12884-016-1050-5.
Sensitive and responsive maternal caregiving behavior strengthens infant self-regulatory capacities (HL), but this regulatory role may be diminished in some mothers with second-trimester prenatal exposure to depression and/ or anxiety (MDA). This study examined maternal and infant behavior during infant heel lance (HL) when mothers had or did not have MDA. Ethological methods and micro-analytic approaches capable of distinguishing and comparing time-based patterning in maternal and infant behavior were used to clarify biological mechanisms, such as MDA, that may underlie observed behavior. Aims were to examine group differences in caregiving behavior between mothers with and without MDA 5 min Pre-HL and 5 min Post-H, and relationships between MDA, maternal caregiving behavior and infant pain behavior self-regulation, concurrently.
At second trimester, mothers were assessed for symptoms of mild-severe depression or anxiety. Mothers whose scores exceeded predetermined cut-off scores on one or more of the mental health measures were allocated to the MDA-exposure group, those below to the non-MDA-exposure group. Reliable observers, blinded to MDA status and study phases, coded video records of the caregiving behavior of each study mother for the full duration of the 5 min Pre-HL and 5 min Post-HL study phases. Group differences and associations between mean measures of maternal mental health scores, time-based measures of maternal behavior, and time-based measures of infant pain behavior regulation (previously coded) were concurrently analyzed using comparative and correlational statistics.
MDA-exposed mothers spent significantly more time not embracing, engaging or responding to infant cues than maternal controls Pre-HL and Post-HL. MDA was associated with atypical maternal caregiving behavior, which in turn was related to atypical infant pain behavior self-regulation during and after the HL.
Our findings have implication for practice. We recommend inclusion of mothers with MDA and their infants in interventions that strengthen the early mother-infant interaction and mother's regulatory caregiving role. MDA and maternal caregiving behavior must be considered in future infant pain studies to examine if they confound effectiveness of mother driven caregiving interventions for neonatal pain. We highlight the importance of examining maternal mental health throughout the perinatal and postnatal trajectory, and particularly the newborn period.
敏感且反应灵敏的母性照料行为能增强婴儿的自我调节能力（足跟采血），但对于一些在孕中期暴露于抑郁和/或焦虑的母亲而言，这种调节作用可能会减弱（母亲抑郁和/或焦虑）。本研究考察了母亲有或没有母亲抑郁和/或焦虑时，婴儿足跟采血期间的母婴行为。采用能够区分和比较母婴行为中基于时间模式的行为学方法和微观分析方法，以阐明可能是观察到的行为基础的生物学机制，如母亲抑郁和/或焦虑。目的是考察在足跟采血前5分钟和采血后5分钟，有和没有母亲抑郁和/或焦虑的母亲在照料行为上的组间差异，以及母亲抑郁和/或焦虑、母性照料行为与婴儿疼痛行为自我调节之间的关系。
在孕中期，对母亲进行轻至重度抑郁或焦虑症状评估。在一项或多项心理健康测量中得分超过预定临界值的母亲被分配到暴露于母亲抑郁和/或焦虑组，得分低于临界值的母亲被分配到未暴露于母亲抑郁和/或焦虑组。对母亲抑郁和/或焦虑状态以及研究阶段不知情的可靠观察者，对每位参与研究的母亲在足跟采血前5分钟和采血后5分钟整个研究阶段的照料行为视频记录进行编码。使用比较和相关统计方法，同时分析母亲心理健康评分的平均测量值、基于时间的母性行为测量值以及基于时间的婴儿疼痛行为调节测量值（先前已编码）之间的组间差异和关联。
与未暴露于母亲抑郁和/或焦虑的母亲相比，暴露于母亲抑郁和/或焦虑的母亲在足跟采血前和采血后不拥抱、不回应婴儿提示的时间明显更长。母亲抑郁和/或焦虑与非典型的母性照料行为有关，而非典型的母性照料行为又与足跟采血期间及之后婴儿疼痛行为的非典型自我调节有关。
我们的研究结果对实践具有启示意义。我们建议将有母亲抑郁和/或焦虑的母亲及其婴儿纳入旨在加强早期母婴互动和母亲调节性照料角色的干预措施中。在未来的婴儿疼痛研究中，必须考虑母亲抑郁和/或焦虑以及母性照料行为，以检验它们是否会混淆母亲主导的新生儿疼痛照料干预措施的有效性。我们强调在围产期和产后轨迹，尤其是新生儿期检查母亲心理健康的重要性。
