Nieto Lourdes, Lara Ma Asunción, Navarrete Laura
Ramón de la Fuente Muñiz National Institute of Psychiatry, Calzada México-Xochimilco 101, San Lorenzo Huipulco, 14370, Tlalpan, D.F., Mexico.
Matern Child Health J. 2017 Jun;21(6):1250-1259. doi: 10.1007/s10995-016-2223-6.
Objectives Although maternal attachment is an important predictor of infant developmental outcomes, little is known about its pre- and postnatal predictors. The purpose of this secondary data analysis is to assess several risk factors for maternal attachment at 6 months postpartum in a sample of Mexican women at risk of depression. The predictors included were prenatal depressive symptoms, pregnancy intendedness, partner relationship, social support, maternal history of childhood sexual abuse, and postpartum depressive symptoms. Methods A total of 156 pregnant women seeking antenatal care at three health centers were selected because they displayed depressive symptoms (CES-D ≥ 16) or had previously suffered depression. Women were interviewed during pregnancy and at 6 months postpartum. A step-wise multivariate logistic regression was conducted to evaluate the pre- and postpartum risk factors for postpartum depression related to low maternal attachment. Results Pre- and postpartum depressive symptoms increased the risk of low maternal attachment by factors of 3.00 and 3.97, respectively, compared with women who did not present these symptoms; low level of adjustment with the partner increased the risk by a factor of 3.11, low social support by a factor of 2.90, and CSA by a factor of 2.77. Conclusions for practice Prevention programs during pregnancy to reduce depressive symptoms should strengthen strategies to promote maternal attachment by improving partner relations and increasing social support. However, evidence shows that such programs alone are insufficient, so direct interventions should also be implemented. Women with a history of childhood sexual abuse should be given additional attention during prenatal care.
目标 尽管母婴依恋是婴儿发育结果的重要预测指标，但对其产前和产后的预测因素却知之甚少。这项二次数据分析的目的是评估一组有抑郁风险的墨西哥女性产后6个月时母婴依恋的几个风险因素。纳入的预测因素包括产前抑郁症状、妊娠意愿、伴侣关系、社会支持、童年期性虐待的母亲病史以及产后抑郁症状。方法 选取了在三个健康中心寻求产前护理的156名孕妇，因为她们表现出抑郁症状（CES-D≥16）或曾患抑郁症。在孕期和产后6个月对这些女性进行访谈。进行逐步多因素逻辑回归分析，以评估与母婴低依恋相关的产后抑郁的产前和产后风险因素。结果 与未出现这些症状的女性相比，产前和产后抑郁症状使母婴低依恋风险分别增加3.00倍和3.97倍；与伴侣关系的低调适水平使风险增加3.11倍，社会支持水平低使风险增加2.90倍，童年期性虐待使风险增加2.77倍。实践结论 孕期预防抑郁症状的项目应通过改善伴侣关系和增加社会支持来加强促进母婴依恋的策略。然而，有证据表明仅靠此类项目是不够的，因此还应实施直接干预措施。有童年期性虐待史的女性在产前护理期间应给予额外关注。
