Miller A R, Barr R G, Eaton W O
Department of Pediatrics, McGill University, Montreal, Quebec, Canada.
Pediatrics. 1993 Oct;92(4):551-8.
To determine whether prepartum and postpartum emotional distress in first-time mothers is associated with crying and fussing behavior and activity level in 6-week-old infants, after eliminating potential biases.
Observational study examining predictive and concurrent associations between maternal emotions and infant behaviors.
General community.
Expectant primiparas attending obstetricians' offices for routine prenatal care were recruited in the third trimester. Mothers and babies were required to be free of medical complications to complete the study. Of 113 mothers who enrolled, complete crying/fussing data were obtained in 88 dyads. Activity data were obtained in a designated subgroup of 50 infants.
Mothers completed a self-report scale of emotional distress, the 28-item General Health Questionnaire, at 34 weeks of gestation and at 6 weeks postpartum. Crying/fussing data were obtained using a previously validated parent diary of infant behavior during the sixth week of life. Motor activity was measured objectively in the home setting with actometers.
Third-trimester distress was not related to either infant crying/fussing or activity. Postpartum distress was significantly related to crying/fussing duration and bout frequency (r[88] = .45 and .28, respectively; both P < .01). These relations were not diminished after controlling statistically for background and/or potential mediating variables, nor could they be accounted for by different diary-recording styles in the mothers. Postpartum distress was not, however, related to activity level (r[50] = -.09; not significant). Furthermore, the pattern of maternal distress was associated differentially with crying levels. Distress levels increased from prepartum to postpartum among mothers of infants who met predefined clinical criteria for "colic," while decreasing in the others ("colic" status x period interaction: F(1,86) = 8.2; P < .01). Also, infant crying varied among four groups of mothers who differed according to presence and timing of clinically significant emotional disturbance (one-way analysis of variance, F (3,86) = 9.4; P < .001). Infants of mothers who became significantly distressed postpartum ("reactive") cried more than those in the other groups, even mothers who had been distressed both prepartum and postpartum ("depressed") (3.7 vs 2.7 h/d; P = .05, post hoc Tukey).
Maternal emotional distress and infant crying behavior are associated in the postpartum period independent of reporting or referral biases. Clinically significant levels of crying (or "colic") are differentially associated with different patterns of clinically significant maternal distress. Reported concern about either maternal mood or infant crying behavior should be taken seriously as a possible indicator of a stressed mother-infant relationship.
在消除潜在偏倚后，确定初产妇产前和产后的情绪困扰是否与6周龄婴儿的哭闹行为及活动水平相关。
一项观察性研究，旨在检验母亲情绪与婴儿行为之间的预测性和同期相关性。
普通社区。
在孕晚期招募了到产科医生办公室接受常规产前护理的初产妇。母亲和婴儿需无医学并发症才能完成研究。在113名登记的母亲中，88对母婴获得了完整的哭闹数据。50名婴儿的指定亚组获得了活动数据。
母亲在妊娠34周和产后6周完成一份自我报告的情绪困扰量表，即28项一般健康问卷。使用先前验证过的婴儿出生后第六周行为的家长日记获取哭闹数据。在家中使用活动监测仪客观测量运动活动。
孕晚期的困扰与婴儿哭闹或活动均无关。产后困扰与哭闹持续时间和发作频率显著相关（r[88]分别为0.45和0.28；P均<0.01）。在对背景和/或潜在中介变量进行统计学控制后，这些关系并未减弱，母亲不同的日记记录方式也无法解释这些关系。然而，产后困扰与活动水平无关（r[50]=-0.09；无显著性）。此外，母亲困扰模式与哭闹水平存在差异关联。符合“腹绞痛”预定义临床标准的婴儿的母亲，其困扰水平从产前到产后有所增加，而其他婴儿的母亲则下降（“腹绞痛”状态×时期交互作用：F(1,86)=8.2；P<0.01）。此外，根据临床显著情绪障碍的存在和时间不同，四组母亲的婴儿哭闹情况也有所不同（单因素方差分析，F(3,86)=9.4；P<0.001）。产后出现显著困扰的母亲（“反应性”）的婴儿比其他组的婴儿哭得更多，甚至比产前和产后都困扰的母亲（“抑郁性”）的婴儿哭得更多（3.7小时/天对2.7小时/天；P=0.05，事后检验Tukey法）。
产后母亲情绪困扰与婴儿哭闹行为相关，与报告或转诊偏倚无关。临床上显著的哭闹水平（或“腹绞痛”）与临床上显著的母亲困扰的不同模式存在差异关联。对母亲情绪或婴儿哭闹行为的报告担忧应作为母婴关系紧张的可能指标予以认真对待。
