Introduction: Maternal antenatal depression is associated with increased risk of adverse offspring outcomes, which manifest in approximately 20% of infants. However, the mechanisms by which risk is transferred from mother to infant, and the factors determining susceptibility to antenatal mood disturbance, remain poorly understood. Objectives: The primary objectives of this thesis are to investigate whether: (i) Antenatal depression is associated with alterations of the maternal and infant Hypothalamic-Pituitary-Adrenal (HPA) axis. (ii) The infant serotonin transporter genotype (5-HTTLPR) confers susceptibility to antenatal mood disturbance. Methods: This thesis is an analysis of two different cohorts. First, 103 pregnant women were recruited in Oxford, UK. Participants’ self-reported antenatal mood, and salivary cortisol was assessed in response to a stressor and diurnally. 88 participants were visited two months post-birth. Mothers reported postnatal mood and infant temperament. Infant cortisol responses to inoculation were assessed, as was infant DNA methylation. Analysis of this cohort addresses the first objective of this thesis. Next, data from the ALSPAC cohort was analysed to address the second objective. Maternal-reported antenatal mood and infant behaviour up to 7 years was available, as was 5-HTTLPR genotype data for over 4,000 infants. Results: Antenatal depression was not associated with increased maternal cortisol during pregnancy. Neither antenatal depression nor cortisol was associated with infant cortisol reactivity or temperament. Antenatal depression predicted increased NR3C1 DNA methylation in males, and decreased BDNF DNA methylation in male and female infants. Infant 5-HTTLPR genotype did not moderate associations between antenatal mood disturbance and behavioural difficulties. Conclusions: This thesis does not support the theory that antenatal depression exerts influence on infant development via increased activity of the maternal and infant HPA axis; however, changes in infant DNA methylation may be a mediating mechanism. Further, susceptibility to antenatal mood may be more complex than previously thought.

<p>Många kvinnor lider av nedstämdhet och depression under graviditeten. Det uppmärksammas inte alltid av personalen på mödravårdscentralen. Prenatal depression påverkar sannolikt både den gravida kvinnan och barnet negativt. Screening med självskattningsformuläret EPDS på mödravårdscentralen och erbjudande om stödjande samtal är ett sätt att fånga upp och hjälpa blivande mödrar. Syftet med studien var att beskriva några kvinnors upplevelser av sin livssituation, moderskapet och de stödjande samtal de blivit erbjudna under graviditeten. Syftet var också att ta reda på om och hur samtalen hade påverkat kvinnornas upplevda hälsa. Studien var kvalitativ och byggde på sex intervjuer. Resultatet visade att flera kvinnor saknade stöd i parförhållandet både innan och efter samtalen, men att de flesta var nöjda med samtalen och kände sig hjälpta och stärkta. Preventivt arbete med deprimerade gravida minskar sannolikt lidande både kortsiktigt och långsiktigt. Vikten av att screena mammor och stödja dem bör således uppmärksammas mer inom primärvården.</p>

Många kvinnor lider av nedstämdhet och depression under graviditeten. Det uppmärksammas inte alltid av personalen på mödravårdscentralen. Prenatal depression påverkar sannolikt både den gravida kvinnan och barnet negativt. Screening med självskattningsformuläret EPDS på mödravårdscentralen och erbjudande om stödjande samtal är ett sätt att fånga upp och hjälpa blivande mödrar. Syftet med studien var att beskriva några kvinnors upplevelser av sin livssituation, moderskapet och de stödjande samtal de blivit erbjudna under graviditeten. Syftet var också att ta reda på om och hur samtalen hade påverkat kvinnornas upplevda hälsa. Studien var kvalitativ och byggde på sex intervjuer. Resultatet visade att flera kvinnor saknade stöd i parförhållandet både innan och efter samtalen, men att de flesta var nöjda med samtalen och kände sig hjälpta och stärkta. Preventivt arbete med deprimerade gravida minskar sannolikt lidande både kortsiktigt och långsiktigt. Vikten av att screena mammor och stödja dem bör således uppmärksammas mer inom primärvården.

Prenatal depression is a significant problem because of the myriad psychosocial, somatic and obstetrical complications it poses. Numerous studies have confirmed that religiosity is related to positive health consequences, such as decreased levels of depression, but few have looked at religiosity’s relation to prenatal depression. Evidence is accumulating that Surrender to God, a specific measure of religiosity, is a possible mechanism by which religiosity positively impacts health, and this study is an investigation of Surrender’s relationship to prenatal depression. The 3-item Religious Surrender and Attendance Scale (RSAS-3) is a brief religiosity measurement that incorporates Surrender and church attendance. RSAS-3 was previously found to better predict stress levels during pregnancy than church attendance alone, and it was theorized that it would also be useful in predicting depression levels. Participants in the current study included 330 pregnant women who were enrolled in the state funded project, Tennessee Intervention for Pregnant Smokers, which enrolled smokers and nonsmokers. Participants met with a case manager at their prenatal care provider and completed two packets of questionnaires: one in the first trimester and one in the third trimester. Measures used in this study included the RSAS-3, and the Centers for Epidemiologic Studies Depression Scale (CESD-10). Participants were paid $20 for each research meeting. Zero order correlations revealed that Education level and RSAS-3 were significantly negatively related to depression levels in the first trimester and approaching significance in the third trimester. Education was therefore included in the hierarchical regression model in step 1 and RSAS-3 in step 2. Hierarchical multiple regression revealed that the full model explained 4% of the variance in 1st trimester depression scores (F 2, 325) = 11.5, p <.001., with RSAS-3 explaining an additional 2.6% of the variance in depression after controlling for education, R squared change = .026, F change (1, 325) p = .003 The full model for 3rd trimester depression explained 6.7% of the variance in 1st trimester depression scores (F 2, 197) = 9.00, p <.001. RSAS-3 explained an additional 1.7% of the variance in depression after controlling for education, R squared change = .017, F change (1, 197) p = .058. RSAS-3 was found to predict depression levels throughout pregnancy, with those scoring higher on RSAS-3 having significantly lower depression scores. A noteworthy strength of the current study is the prospective design. While being religious does not guarantee depression will not occur, early treatment of depression symptoms can assuage negative health consequences for the mother and child. If further research verifies a causal mechanism between Surrender and depression, non-pharmacologic treatments utilizing religious coping may be useful for prenatal depression.

Introduction: Close emotional bands develop between mother and child and begin already during pregnancy, several factors affect how this band develops. Fetal life and the first few hours after childbirth are important for the infant's emotional development. Purpose: The purpose of this study is to investigate how midwives in post-natal care pay attention to emotional reactions in the mother, which these reactions are and how the midwives consider themselves to promote the relationship between mother and child. Issues: How do midwives describe that they pay attention to emotional reactions in the mother after childbirth, and what reactions are described? And how do midwives describe that they are working to promote the relationship between mother and child during the aftercare? Method: Five midwives working in the aftercare were interviewed based on a qualitative approach. The data collection method that has been used for this study is a semi-structured interview. The study material has been processed using an inductive thematic analysis. Result: What appears in the study is that midwives find it central to identify the woman's way of thinking about the child's needs and her ability to interpret the child's signals. The participants pay particular attention to those women where the emotional stress has been great after giving birth and can be assumed to need support. Discussion: Most studies and literature support what emerged from this study on the midwives' knowledge and experience about emotional reactions and its influence on the relationship between mother children. The mother's care for the child's needs and the midwife's work in promoting the relationship between these two can be interpreted as the concept of mentalization. / Inledning: Nära känslomässiga band utvecklas mellan mor och barn och påbörjas redan under graviditeten, flertalet faktorer påverkar hur detta band utvecklas. Fosterlivet och de första timmarna efter förlossningen är av betydelse för spädbarnets känslomässiga utveckling. Syfte: Syftet med denna studie är att undersöka hur barnmorskor inom eftervården uppmärksammar känslomässiga reaktioner hos modern, vilka dessa reaktioner är och hur barnmorskorna anser sig främja relationen mellan mor och barn. Frågeställningar: Hur beskriver barnmorskorna att de uppmärksammar känslomässiga reaktioner hos modern efter förlossningen, och vilka reaktioner beskrivs? Samt hur beskriver barnmorskorna att de arbetar för att främja relationen mellan mor och barn under eftervården? Metod: Fem barnmorskor verksamma inom eftervården intervjuades utifrån en kvalitativ ansats. Datainsamlingsmetod som har används för denna studie är en semistrukturerad intervju. Studiens material har bearbetas med hjälp av en induktiv tematisk analys. Resultat: Det som framkommer i studien är att barnmorskorna finner centralt att identifiera är kvinnans sätt att tänka om barnets behov och hennes förmåga att tolka barnets signaler. Deltagarna uppmärksammar särskilt de kvinnor där den känslomässiga påfrestningen har varit stor efter förlossningen och kan antas behöva stöd. Diskussion: Flertalet studier samt litteratur stödjer det som framkom i denna studie om barnmorskornas kunskap och erfarenhet om känslomässiga reaktioner och dess påverkan på relationen mellan mor barn. Moderns omsorg om barnets behov samt barnmorskans arbete i att främja relationen mellan dessa två kan tolkas till begreppet mentalisering.

Thesis (M. A. (Clinical Psychology)) University of Limpopo, 2017 / The study investigated the prevalence of Obsessive-Compulsive Disorder (OCD) symptoms and their relationship with pregnancy-related anxiety, prenatal depression and clinical anger among African pregnant women. The sample consisted of 206 pregnant women attending their antenatal check-ups at the Mankweng, Nobody and Rethabile clinics, and Mankweng hospital in the Capricorn District, Limpopo Province. When correlational analysis was conducted, the patient characteristics of age, having undergone a medical check-up, and having previously delivered a live baby generally did not correlate with any of the main scales measuring OCD, namely, perinatal depression, pregnancy-related anxiety and clinical anger (p > 0.05). Findings from the study indicated that almost 81% of the pregnant women could be classified as obsessive-compulsive disordered, when using the Foa et al. (2002) cut-off score of 21. Furthermore, findings from the regression analyses indicated that higher age, the number of gestation weeks, having previously experienced pregnancy-related complications, perinatal depression, pregnancy-related anxiety and clinical anger were variably positive predictors of OCI-R measured OCD symptoms. The predictors are specific to each of the symptoms. It can be concluded from the study that there is a relationship between OCD symptoms and all the independent variables used. / National Research Foundation

Introduction: Prenatal maternal depression is associated with an increased risk of psychopathology in childhood. The understanding of the mechanisms underlying this association is limited. Further, despite high rates of prenatal depression in the developing world, no research investigating this issue exists from these settings. Objectives: The primary objectives of this thesis are to study the association between prenatal maternal depression and the following early offspring outcomes in a non-smoking, non-alcohol consuming prenatal sample from rural, South India: Foetal stress responsivity, measured through foetal heart rate (FHR). Infant stress responsivity, measured through infant cortisol response to immunisation. Infant temperament. Methods: 194 pregnant women from Solur, India were assessed for depression. The first 67 mothers with elevated symptoms of prenatal depression and the first 66 controls underwent FHR monitoring to study foetal stress responsivity. 58 mother-infant dyads returned at 1.5-3 months post birth. Infant salivary cortisol was measured before and after immunisation. Information on infant temperament and maternal postnatal depression (PND) was also collected. Results: Twenty nine mothers (14.9%) met a diagnosis of major depression during pregnancy while 67 (34.5%) had elevated symptoms of prenatal depression. Whilst there were no linear association between prenatal depression and foetal responsivity, a curvilinear (U shaped) association existed with the foetuses of mothers with very high and very low levels of prenatal depression having elevated stress responses compared to those with moderate levels of prenatal depression. Prenatal depression predicted infant cortisol responsivity independent of PND (B=13.08, p=0.02).The relationship between infant cortisol responsivity and prenatal depression was also U shaped. There was no association between prenatal depression and infant temperament. Conclusions: This is the first study from the developing world investigating the relationship between prenatal depression and offspring outcomes. It provides evidence suggestive of the programming influence of prenatal depression on the developing offspring.

Over the past two decades, India has become an international hub of cross-border surrogacy. The extreme economic and cultural differences between international couples seeking surrogacy and the surrogates themselves, clinics compromising health of surrogates for profit, the stigmatisation of surrogacy in India, and the constant surveillance of these women living in a ‘surrogate house’, have raised concerns regarding the potentially negative psychological impact of surrogacy on Indian surrogates. The primary aims of the thesis were (i) to conduct a longitudinal assessment of surrogates’ psychological problems (anxiety, depression and stress) from pregnancy until several months after relinquishing the baby to the intended parents, (ii) to examine the nature of the bond formed between surrogates and the unborn baby and establish whether this prenatal bond contributes to their psychological problems, and (iii) to explore the experiences of surrogates during and post-surrogacy. Fifty surrogates were compared with a matched group of 69 expectant mothers during pregnancy. Of these, 45 surrogates and 49 compairson group of mothers were followed up 4-6 months after the birth. All surrogates were hosting pregnancies for international intended parents and had at least one child of their own. Data were obtained using standardised questionnaires and in-depth interviews and were analysed using quantitative and qualitative methods. Indian surrogates were found to be more depressed than the comparison group of mothers, both during pregnancy and after the birth. However, giving up the newborn did not appear to add to surrogates’ levels of depression. There were no differences between the surrogates and the expectant mothers in anxiety or stress during either phase of the study. The examination of risk factors for psychological problems among the surrogates showed that anticipation of stigma, experiences of social humiliation and receiving insufficient support during pregnancy were associated with higher levels of depression following the birth. With respect to bonding with the unborn child, surrogates experienced lower levels of emotional bonding (e.g. they interacted less, and wondered less about, the foetus), but exhibited higher levels of instrumental bonding (e.g. they adopted better eating habits and avoided unhealthy practices during pregnancy), than women who were carrying their own babies. Contrary to concerns, greater bonding with the unborn child was not associated with increased psychological problems post-relinquishment. All surrogates were able to give up the child. Meeting the intended parents after the birth positively contributed towards surrogates’ satisfaction with relinquishment whereas meeting the baby did not. The qualitative findings on surrogates’ experiences showed that the majority lacked basic medical information regarding surrogacy pregnancy; hid surrogacy from most people; felt positive and supported at the surrogate house; lived in uncertainty regarding whether or not they would be allowed to meet the intended parents and the baby; and did not actually get to meet them. These findings have important implications for policy and practice on surrogacy in the Global South.