Ruth Harriet Brown1, Manuel Eisner2, Susan Walker3, Mark Tomlinson4, Pasco Fearon5, Michael P Dunne6, Sara Valdebenito7, Claire Hughes8, Catherine L Ward9, Siham Sikander10, Joseph Osafo11, Bernadette Madrid12, Adriana Baban13, Vo Van Thang14, Asvini D Fernando15, Aja L Murray16. 1. Psychology Department, The University of Edinburgh, Edinburgh, United Kingdom. Electronic address: rbrown11@exseed.ed.ac.uk. 2. Institute of Criminology, University of Cambridge, Cambridge, United Kingdom; Jacobs Centre for Productive Youth Development, University of Zurich, Switzerland. 3. Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica. 4. Institute of Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa; School of Nursing and Midwifery, Queens University, Belfast, United Kingdom. 5. Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom. 6. Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Australia. 7. Institute of Criminology, University of Cambridge, Cambridge, United Kingdom. 8. Department of Psychology, University of Cambridge, United Kingdom. 9. Department of Psychology, University of Cape Town, Cape Town, South Africa. 10. Global Health Department, Health Services Academy, Islamabad, Pakistan. 11. Department of Psychology, University of Ghana, Accra, Ghana. 12. Child Protection Unit, University of the Philippines, Manila, Philippines. 13. Department of Psychology, Babes-Bolyai University, Cluj-Napoca, Romania. 14. Institute for Community Health Research, University of Medicine and Pharmacy, Hue University, Hue, Viet-Nam. 15. Department of Paediatrics, Faculty of Medicine, University of Kelaniya, Sri Lanka. 16. Psychology Department, The University of Edinburgh, Edinburgh, United Kingdom.
Abstract
BACKGROUND: Mothers from middle-income countries (MIC) are estimated to have higher rates of adverse childhood experiences (ACEs) and depression during pregnancy compared to mothers from high income countries. Prenatal depression can adversely impact on a mother's feelings towards her foetus and thus may be partially responsible for intergenerational transmission of risk associated with maternal ACEs. However, the extent to which prenatal depressive symptoms mediate the association between maternal ACEs and foetal attachment is unknown. METHODS: Data on foetal attachment, ACEs, and prenatal depression came from mothers in their third trimester of pregnancy (n = 1,185) located across eight MICs, participating in the prospective birth cohort Evidence for Better Lives Study - Foundational Research (EBLS-FR). Data were from the baseline measurement. RESULTS: Full-sample path mediation analyses, adjusting for relevant covariates, suggested a full mediating effect of prenatal depression. However, at the individual-country level, both positive and negative effects of ACEs on foetal attachment were observed after the inclusion of depressive symptoms as a mediator, suggesting cultural and geographical factors may influence a mother's empathic development after ACE exposure. LIMITATIONS: As no follow-up measurements of depressive symptoms or postnatal attachment were included in the analyses, the findings cannot be extrapolated to the postnatal period and beyond. Further, causality cannot be inferred as the study was observational. CONCLUSIONS: The findings reinforce the importance of screening for prenatal depression during antenatal care in MICs. Addressing prenatal depression within maternal health care may support foetal attachment and contribute to reducing the intergenerational transmission of disadvantage.
BACKGROUND: Mothers from middle-income countries (MIC) are estimated to have higher rates of adverse childhood experiences (ACEs) and depression during pregnancy compared to mothers from high income countries. Prenatal depression can adversely impact on a mother's feelings towards her foetus and thus may be partially responsible for intergenerational transmission of risk associated with maternal ACEs. However, the extent to which prenatal depressive symptoms mediate the association between maternal ACEs and foetal attachment is unknown. METHODS: Data on foetal attachment, ACEs, and prenatal depression came from mothers in their third trimester of pregnancy (n = 1,185) located across eight MICs, participating in the prospective birth cohort Evidence for Better Lives Study - Foundational Research (EBLS-FR). Data were from the baseline measurement. RESULTS: Full-sample path mediation analyses, adjusting for relevant covariates, suggested a full mediating effect of prenatal depression. However, at the individual-country level, both positive and negative effects of ACEs on foetal attachment were observed after the inclusion of depressive symptoms as a mediator, suggesting cultural and geographical factors may influence a mother's empathic development after ACE exposure. LIMITATIONS: As no follow-up measurements of depressive symptoms or postnatal attachment were included in the analyses, the findings cannot be extrapolated to the postnatal period and beyond. Further, causality cannot be inferred as the study was observational. CONCLUSIONS: The findings reinforce the importance of screening for prenatal depression during antenatal care in MICs. Addressing prenatal depression within maternal health care may support foetal attachment and contribute to reducing the intergenerational transmission of disadvantage.
Authors: Chad Lance Hemady; Lydia Gabriela Speyer; Aja Louise Murray; Ruth Harriet Brown; Franziska Meinck; Deborah Fry; Huyen Do; Siham Sikander; Bernadette Madrid; Asvini Fernando; Susan Walker; Michael Dunne; Sarah Foley; Claire Hughes; Joseph Osafo; Adriana Baban; Diana Taut; Catherine L Ward; Vo Van Thang; Pasco Fearon; Mark Tomlinson; Sara Valdebenito; Manuel Eisner Journal: BMC Pregnancy Childbirth Date: 2022-06-22 Impact factor: 3.105
Authors: Irena Stepanikova; Sanjeev Acharya; Alejandra Colón-López; Safa Abdalla; Jana Klanova; Gary L Darmstadt Journal: EClinicalMedicine Date: 2022-08-27