Search

Parent-child coregulation, the active dyadic adaptation of biological states, behaviors, and emotions, is an important developmental process. Especially in challenging situations, children need coregulatory support from their parents, which supports the formation of their self-regulation skills. While research has established that coregulation occurs in various contexts across the developmental period, less is known about what constitutes coregulation in terms of child adjustment and the contextual factors that affect coregulation. This systematic review examined what constitutes parent-child coregulation in response to an experimentally induced challenge and in association with child socioemotional outcomes. Systematic searches were conducted in Web of Science, APA PsycInfo, and PubMed, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Fourteen full-text, peer-reviewed, empirical journal articles that were available in English were included. Children were between the ages of 3 and 12 ( M age = 5.37 years, 44%-100% male, 6.3%-90% White). Findings indicate that behavioral and emotional coregulation in response to challenge is positively associated with better child self-regulation. Coregulation associated with positive child outcomes seems to be characterized by high flexibility and dyadic synchrony in mutually responsive and engaged states. Findings regarding physiological coregulation suggest that high levels of physiological synchrony can be maladaptive for child outcomes in the presence of risk (e.g., poverty, maltreatment). In addition, this review highlighted the current ambiguity surrounding the diverse terminologies and concepts used to measure coregulation. The findings of this review reveal a significant link between parent-child coregulation and child socioemotional outcomes, while supporting the idea that contextual factors need to be considered to understand its significance. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Maternal love and caregiving are pillars for optimal child development and may affect infant outcomes from pregnancy onwards. The present study aimed to examine whether maternal trait mindfulness during pregnancy and pre- and postnatal maternal-infant bonding were associated with maternal perceptions of infant temperament and social-emotional development. In total, 408 Dutch women (M age  = 31.33, SD = 3.59) participated in a prospective perinatal cohort study and completed questionnaires on trait mindfulness, prenatal bonding, postnatal bonding, infant temperament, and infant social-emotional development at 20 and 28 weeks of gestation, and 10 weeks, 6 and 12 months postpartum, respectively. Path analyses demonstrated that higher levels of the trait mindfulness facet non-judging (i.e., refraining from judgments about own feelings and thoughts) were associated with more pre- and postnatal maternal bonding and fewer social-emotional problems as perceived by the mother. Adopting an accepting and non-judgmental attitude may promote positive feelings of bonding and benefit the infant in terms of having fewer social-emotional problems in the first year of life. Mindfulness interventions may be offered to pregnant women in order to enhance maternal bonding and improve infant outcomes after birth., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Adaptations of the immune system throughout gestation have been proposed as important mechanisms regulating successful pregnancy. Dysregulation of the maternal immune system has been associated with adverse maternal and fetal outcomes. To translate findings from mechanistic preclinical studies to human pregnancies, studies of serum immune markers are the mainstay. The design and interpretation of human biomarker studies require additional insights in the trajectories and drivers of peripheral immune markers. The current study mapped maternal inflammatory markers (C-reactive protein (CRP), interleukin (IL)-1β, IL-6, IL-17A, IL-23, interferon- γ ) during pregnancy and investigated the impact of demographic, environmental and genetic drivers on maternal inflammatory marker levels in four multi-ethnic and socio-economically diverse population-based cohorts with more than 12,000 pregnant participants. Additionally, pregnancy inflammatory markers were compared to pre-pregnancy levels. Cytokines showed a high correlation with each other, but not with CRP. Inflammatory marker levels showed high variability between individuals, yet high concordance within an individual over time during and pre-pregnancy. Pre-pregnancy body mass index (BMI) explained more than 9.6% of the variance in CRP, but less than 1% of the variance in cytokines. The polygenic score of CRP was the best predictor of variance in CRP (>14.1%). Gestational age and previously identified inflammation drivers, including tobacco use and parity, explained less than 1% of variance in both cytokines and CRP. Our findings corroborate differential underlying regulatory mechanisms of CRP and cytokines and are suggestive of an individual inflammatory marker baseline which is, in part, genetically driven. While prior research has mainly focused on immune marker changes throughout pregnancy, our study suggests that this field could benefit from a focus on intra-individual factors, including metabolic and genetic components.

Aims/background: The mother-to-infant is important for healthy child development. The current study focused on the association between maternal trait mindfulness and the course of maternal bonding from pregnancy to one year postpartum., Design/methods: Women participating in a prospective perinatal cohort study ( n  = 1003) completed online questionnaires on maternal bonding (Pre- and Post-natal Bonding Scale) at 28 weeks of pregnancy, and at 8 weeks, 6 months and 12 months postpartum. At 20 weeks of pregnancy, women completed the Three Facet Mindfulness Questionnaire - Short Form. Multilevel analyses were used to analyse 1) changes in maternal bonding over time and 2) the relationship of these changes with different facets of trait mindfulness measured once during pregnancy. Demographics, obstetrics, and depressive symptoms were controlled for., Results: Results showed that maternal bonding first increased from pregnancy to 8 weeks postpartum and then remained relatively stable throughout the first-year postpartum. On average, women with high scores on acting with awareness and non-judging also scored higher on maternal bonding, but demonstrated a smaller increase in maternal bonding scores over time when compared to women with medium and low scores on these mindfulness facets. Furthermore, non-reacting was also positively associated with the level of maternal bonding but was not related to the course of bonding over time. The main effects of non-reacting and non-judging were not significant after adjusting for covariates. Depressive symptoms and a high educational level were negatively associated with bonding., Conclusion: Mindfulness-based interventions may be helpful in supporting expectant mothers who are at risk for suboptimal bonding.

Background: The number of people using social media has substantially increased over the past years. Previous studies have shown associations between social media overuse and mental health problems during pregnancy. The current study evaluates changes in social media use during pregnancy., Methods: Pregnant women were recruited at their first antenatal appointment between January 2020 and July 2022 (N = 1135). The time spent on social media, frequency of social media use and problematic social media use, using the Bergen Social Media Addiction Scale (BSMAS), were assessed at 12, 20 and 28 weeks of pregnancy. Pearson r correlations and repeated measures ANOVAs were performed to assess possible changes in social media use over the course of pregnancy. Lastly, we stratified social media use throughout pregnancy for parity., Results: There was a significant change in social media use over time, for the time spent on social media, frequency of social media use and problematic social media use. Mean social media scores were the lowest at 12 weeks of pregnancy and increased significantly at 20 weeks of pregnancy, after which they remained stable at 28 weeks. Compared to multiparous women, primiparous women spent more time on social media at 20 weeks of pregnancy, but not at 12 or 28 weeks., Conclusion: Because overuse of social media has been associated with poor mental health, healthcare professionals should be aware of the intensity of social media use throughout pregnancy., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Accumulating research has shown associations between excessive social media use (SMU) with depressive symptoms. Depression is common during pregnancy, but it is not known whether SMU plays a role in the etiology and clinical course of depressive symptoms during pregnancy., Methods: The current study is a prospective cohort study with Dutch-speaking pregnant women recruited at the first antenatal appointment (N = 697). Depressive symptoms were measured at each trimester of pregnancy using the Edinburgh Depression Scale. Growth mixture modeling was used to determine classes of women based on longitudinal trajectories of depressive symptoms. SMU was assessed at 12 weeks of pregnancy, specifically, intensity (time and frequency) and problematic SMU (Bergen Social Media Addiction Scale). Multinomial logistic regression analyses were used to examine the associations between SMU and trajectories of depressive symptoms., Results: Three trajectories of depressive symptoms during pregnancy were identified: a low stable (N = 489, 70.2 %), intermediate stable (N = 183, 26.3 %), and high stable (N = 25, 3.6 %) class. SMU Time and Frequency were significantly associated with belonging to the high stable class. Problematic SMU was significantly associated with belonging to the intermediate or high stable class., Limitations: The study does not allow to draw conclusions about causality. The group sizes of the three trajectories differed considerably. Data were collected during the COVID-19 pandemic which may have influenced the results. SMU was measured by self-report., Conclusions: These results indicate that both higher intensity of SMU (time and frequency) and problematic SMU may be a risk factor for higher levels of prenatal depressive symptoms during pregnancy., Competing Interests: Declaration of competing interest All other authors declare that they have no conflicts of interest., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Objectives: Anxiety is highly prevalent in the perinatal period and can have negative consequences for the mother and the child. Extensive research has been done on risk factors for anxiety during the perinatal period, but less is known about protective factors. The current study aims to determine the relative contribution of trait mindfulness as a protective factor for anxiety., Methods: A longitudinal study design was used, with four measurement points: 12, 22, and 32 weeks of pregnancy (T0, T1, and T2, respectively), and 6 weeks postpartum (T3). General anxiety was measured at T1, T2, and T3, pregnancy-specific distress was measured at T1 and T2, mindfulness facets (acting with awareness, non-reacting, and non-judging) and partner involvement were measured at T1, and other known risk factors for anxiety were measured at T0. Multilevel regression models were used for statistical analyses., Results: Mindfulness facets measured at T1 were negatively associated with anxiety at T1, T2, and T3, and pregnancy-specific distress at T1 and T2. Of the mindfulness facets, non-judging was shown to have the largest protective effect against anxiety and pregnancy-specific distress. Also compared to partner-involvement and known risk factors, non-judging showed the largest effect on anxiety and pregnancy-specific distress., Conclusions: For pregnant women who are at risk for developing or experiencing high levels of anxiety, it may be beneficial to participate in a mindfulness training with special attention for the attitudinal aspects of mindfulness., Competing Interests: Declaration of competing interest The authors declare that they do not have any conflicting interests., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

The birth of an infant marks a period of profound change in first-time parents. Parental love and warmth, however, already begin to develop during pregnancy. Also for fathers, the development of bonding to the infant may be a unique process. The current qualitative study aimed to explore views and experiences of first-time fathers on the origins and development of paternal bonding during pregnancy and early childhood. In total, 30 in-depth semi-structured interviews were conducted with expectant fathers (second or third trimester of pregnancy; n  = 10) and fathers of infants (0-6 months postpartum; n  = 11) and toddlers (2-3 years of age; n  = 9). Two major themes were uncovered from the data: feelings of bonding and facilitators of bonding. The first theme was supported with three subthemes: 1) from abstract to concrete, 2) positive emotions, and 3) uncertainties and worries. The second theme, facilitators of bonding, was supported with four subthemes: 1) experiencing the foetus, 2) meeting the child, 3) interaction, and 4) communication. Similar to previous studies, our results suggested that, in most fathers, paternal bonding originates in pregnancy and that it evolves over time. Seeing or feeling the child, both during pregnancy and postpartum, as well as interacting or communicating with the child, appears to facilitate fathers' feelings of bonding. Involving fathers in pregnancy, childbirth, and parenting may be essential for their bonding process.

The first 1000 days after conception are considered critical for healthy development and well-being throughout life. Fundamental to health practices during pregnancy and positive parenting after birth is the development of maternal-infant bonding. Previous research has demonstrated the importance of having an involved partner during pregnancy and in parenting for optimal maternal-infant bonding. The current study examined maternal-infant bonding and partner support during pregnancy and the postpartum period, and their associations with early child social-emotional development. A total of 227 women completed the Pre- and Postnatal Bonding Scale (PPBS) and Tilburg Pregnancy Distress Scale (TPDS) during pregnancy (32 weeks of gestation) and at 8 months postpartum, assessing maternal-infant bonding and partner support. Additionally, a questionnaire on social-emotional behavior of the Bayley Scales of Infant and Toddler Development was administered to mothers to measure child development at 2 years of age. Path analyses revealed an indirect positive effect of prenatal maternal-infant bonding on child social-emotional development through postnatal maternal-infant bonding, as well as mediating effects of pre- and postnatal maternal-infant bonding on the association between pre- and postnatal partner support and child social-emotional development. Our findings support the notion that an emotional connection from mother to child originates in pregnancy and that experiencing positive feelings towards the fetus promotes positive maternal-infant bonding after birth and social-emotional capacities of the child. Additionally, having a supportive partner during pregnancy and postpartum, might be essential for the development of optimal maternal-infant bonding., Competing Interests: Declarations of interest None., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Pregnancy distress among childbearing women is common and can negatively affect both mother and infant. Mindfulness-based interventions (MBIs) may have a positive effect on pregnancy distress but randomized controlled trials with sufficient power are lacking. The current study examined the effectiveness of an online self-guided MBI in pregnant women with pregnancy distress., Methods: Pregnant women with elevated pregnancy distress levels at 12 weeks of pregnancy, measured with the Edinburgh Depression Scale (EDS) and Tilburg Pregnancy Distress Scale negative affect (TPDS-NA), were randomized into an intervention group (online MBI, N = 109) or control group (care as usual, N = 110). The primary outcome was the change in pregnancy distress post-intervention and at eight-weeks-follow-up. Secondary outcomes were mindfulness skills (Three Facet Mindfulness Questionnaire-Short Form), rumination (Rumination-Reflection Questionnaire), and self-compassion (Self-Compassion Scale-Short Form) at post-intervention and follow-up in the intervention group., Results: Significant improvements were found in pregnancy distress scores, but no significant differences between intervention and control group appeared. The MBI group showed improvements in mindfulness skills, rumination, and self-compassion., Limitations: Low adherence to the intervention and assessment of secondary outcome measures in the intervention group only., Conclusions: An intervention trial with one of the largest samples (N = 219) provided no evidence of a significant effect of an online self-guided MBI in distressed pregnant women. An online MBI may be associated with an improvement in mindfulness skills, rumination, and self-compassion. Future research should address the effectiveness of MBI's with different formats (online and group-based combined) and examine a possible delayed effect., Trial Registration: ClinicalTrials.gov: NCT03917745, registered on 4 March 2019., Competing Interests: Conflict of interest None., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Objectives: High plasma copper (Cu) and low zinc (Zn) levels have been associated with depression. However, most studies used low sample sizes and a cross-sectional design, and perinatal data are scarce. We investigated the possible association between pregnancy-specific psychological distress and the plasma CuZn ratio using a prospective design., Methods: Pregnancy-specific distress symptoms were assessed at each trimester by means of the Tilburg Pregnancy Distress Scale, negative affect subscale, in 2036 pregnant women. Cu and Zn were assessed at 12 wk of gestation in plasma samples by inductively coupled plasma mass spectrometry. Growth mixture modeling determined trajectories of women's pregnancy-specific negative affect (P-NA) symptoms, which were entered in a multiple logistic regression analysis as dependent variable and the CuZn ratio as independent variable., Results: Two P-NA symptom classes were found: 1) persistently low (n = 1820) and 2) persistently high (n = 216). A higher CuZn ratio was independently associated with persistently high P-NA symptom scores (odds ratio = 1.52; 95% confidence interval, 1.13-2.04) after adjustment for confounders. A sensitivity analysis was performed excluding all women with high P-NA scores at 12 wk of gestation (>1 SD above the mean P-NA score). In the 1719 remaining women, a higher CuZn ratio significantly predicted the development of increasing P-NA symptom scores after adjustment for confounders (odds ratio = 1.40; 95% confidence interval, 1.04-1.95)., Conclusions: A higher CuZn plasma ratio is an independent determinant of developing pregnancy-specific distress symptoms throughout pregnancy, suggesting that micronutrients could be used as novel biomarkers for psychological distress research of perinatal mood disorders., (Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objective: To assess the association between trajectories of comorbid anxiety and depressive (CAD) symptoms assessed in each pregnancy trimester and physiological birth., Design: Large longitudinal prospective cohort study with recruitment between January 2013 and September 2014., Setting: Primary care, in the Netherlands., Population: Dutch-speaking pregnant women with gestational age at birth ≥37 weeks, and without multiple pregnancy, severe psychiatric disorder or chronic disease history., Methods: Pregnancy-specific anxiety and depressive symptoms were measured prospectively in each trimester of pregnancy using the negative affect subscale of the Tilburg Pregnancy Distress Scale and Edinburgh (Postnatal) Depression Scale. Data on physiological birth were obtained from obstetric records. Multivariate growth mixture modelling was performed in MPLUS to determine longitudinal trajectories of CAD symptoms. Multiple logistic regression analysis was used to examine the association between trajectories and physiological birth., Main Outcome Measures: Trajectories of CAD symptoms and physiological birth., Results: Seven trajectories (classes) of CAD symptoms were identified in 1682 women and subsequently merged into three groups: group 1-persistently low levels of symptoms (reference class 1; 79.0%), group 2-intermittently high levels of symptoms (classes 3, 6 and 7; 11.2%), and group 3-persistently high levels of symptoms (classes 2, 4 and 5; 9.8%). Persistently high levels of CAD symptoms (group 3) were associated with a lower likelihood of physiological birth (odds ratio 0.67, 95% confidence interval 0.47-0.95, P = 0.027) compared with the reference group (persistently low levels of symptoms), after adjusting for confounders., Conclusions: This study is the first showing evidence that persistently high CAD levels, assessed in each pregnancy trimester, are associated with a lower likelihood of physiological birth., (© 2022 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)

Objectives: Trait mindfulness could function as a protective factor against distress. The current study investigated the relationship of the five distinct facets of mindfulness and COVID-19 related distress., Methods: An online self-report study was conducted in a Dutch sample (N = 811; M age  = 49 ± 17; 54.5 % female) in February 2021. Dispositional mindfulness was assessed with the Five Facet Mindfulness Questionnaire, and the COVID Stress Scale was used to assess COVID-19 related distress., Results: Multivariate regression analyses showed that describing and non-judging were inversely related to COVID-19 related distress. Specifically, describing was related to fewer socioeconomic worries, while describing and non-judging were negatively associated with traumatic stress symptoms. Non-judging was negatively associated with COVID-19-related compulsive checking., Conclusions: The results indicate that individuals high in mindfulness traits describing and non-judging, experience less distress during the pandemic. Teaching mindfulness skills and practice could be helpful in global situations like pandemics., Competing Interests: Declaration of competing interest None., (Copyright © 2023. Published by Elsevier B.V.)

Pregnant women may be specifically prone to experience pregnancy-specific distress, which has been associated with adverse maternal, pregnancy and child outcomes. Accurately identifying pregnancy-specific distress is thus crucial. The Tilburg Pregnancy Distress Scale (TPDS) - translated into many different languages - was previously developed to measure pregnancy-specific distress, resulting in a 16-item screening scale with a partner involvement dimension (PI) and a negative affect dimension (NA). A critical evaluation of the psychometric properties of the TPDS-NA items and feedback from pregnant women over the last decade has led to the need to revise the TPDS. Therefore, in the current study, we describe the procedure for revision and evaluate the psychometric properties of the revised TPDS (TPDS-R). More specifically, we describe the revision of the TPDS-R-PI (4 items) and the TPDS-R-NA (10 items: five-item pregnancy and five-item childbirth subcomponent). A sample of 1081 pregnant women participating in the Brabant Study completed the TPDS-R at 12, 20 and 28 weeks of pregnancy. An exploratory factor analysis and confirmatory factor analysis, descriptive statistics and repeated measures ANOVA demonstrated good test-retest reliability, concurrent validity, internal consistency, and construct validity of the TPDS-R. The TPDS-R provides a robust screening tool to accurately identify pregnant women at risk of pregnancy-specific distress., Competing Interests: Declaration of competing interest Each author confirmed that there is no conflict of interest between the author and the study., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: It is unclear whether levels of hypothyroid symptoms in pregnant women with (sub)clinical thyroid dysfunction differ from euthyroid controls and whether free thyroxine (fT4)/thyrotropin (TSH) changes throughout pregnancy affect hypothyroid symptom levels. The objective was twofold: (1) To compare hypothyroid symptom levels between thyroid dysfunction subgroups and a carefully defined reference group; (2) to assess the association between fT4/TSH changes throughout pregnancy and hypothyroid symptom levels adjusted for depressive symptoms. Methods: The current study was a longitudinal prospective cohort study in 1800 healthy pregnant women. At each trimester of pregnancy, hypothyroid symptoms were assessed with a 12-item symptom hypothyroidism checklist and depressive symptoms with the Edinburgh Depression Scale. Thyroid dysfunction was defined using the 2.5-97.5th fT4/TSH percentile of thyroid peroxidase antibodies-negative women. Euthyroid controls consisted of women with appropriate fT4 levels within the 10-90th percentile and with a normal TSH level. Hypothyroid symptom mean scores were compared between controls and several thyroid dysfunction subgroups. Growth mixture modeling was performed to evaluate possible longitudinal trajectories of hypothyroid and depressive symptoms. The association between hypothyroid symptom trajectories (adjusted for depression) and fT4/TSH changes was assessed with multivariate logistic regression analysis. Results: Women with overt hypothyroidism (fT4 < 2.5th, TSH >97.5th) and hypothyroxinemia (fT4 < 2.5th, TSH: 2.5-97.5th) showed higher hypothyroid symptom levels compared with the euthyroid controls and women with subclinical hypothyroidism (SCH, fT4: 2.5-97.5th, TSH >97.5th), because 82% of these SCH women had fT4 levels in the euthyroid range. Two groups of hypothyroid and depressive symptoms were defined: a persistently low and persistently high symptom group. fT4 decreased in 98% of the women from the first to third trimester and per unit pmol/L fT4 decrease (not TSH increase), the likelihood to present persistently high hypothyroid symptoms increased with 46%, adjusted for depression. Conclusions: A properly defined euthyroid control group distinguishes women with hypothyroid symptoms. An fT4 decrease toward end term is associated with persistently high hypothyroid symptom levels. Clinicians should be aware of the importance of fT4 stratification in SCH women.

Perinatal depression is common, affecting approximately 7-13% of women. Studies have shown an association between unplanned pregnancy and perinatal depressive symptoms, but many used a cross-sectional design and limited postnatal follow-up. The current study investigated the association of unplanned pregnancy with perinatal depressive symptoms using a longitudinal cohort study that followed women from the first trimester until 12 months postpartum. Pregnant women (N = 1928) provided demographic and clinical data and information about pregnancy intention at the first trimester. Depressive symptoms were assessed during each trimester of pregnancy and five times postpartum using the Edinburgh Postnatal Depression Scale (EPDS) until 12 months postpartum. Mixed model analyses were used to investigate the association between an unplanned pregnancy and the level of depressive symptoms. Women with an unplanned pregnancy (N = 111, 5.8%) reported persistently higher levels of depressive symptoms during the entire perinatal period compared to women with a planned pregnancy, after adjustment for confounders (p < 0.001). However, the course of depressive symptom scores over time in women with an unplanned pregnancy was similar to that of women with a planned pregnancy. Lower age (p = 0.006), unemployment (p = 0.004), and history of depression (p < 0.001) were significantly associated with higher levels of perinatal depressive symptoms. An unplanned pregnancy may have a long-lasting negative impact on a woman's perinatal mental health. Therefore, women with an unplanned pregnancy may benefit from systematic follow-up during the perinatal period with contingent mental health support., (© 2022. The Author(s).)

Background: The Coronavirus Disease 2019 (COVID-19) pandemic elevated the risk for mental health problems in pregnant women, thereby increasing the risk for long-term negative consequences for mother and child well-being. There was an immediate need for easily accessible interventions for pregnant women experiencing elevated levels of pandemic related stress., Methods: A three-session intervention "Online Communities" (OC) was developed at the beginning of the Dutch lockdown, and implemented by a team of midwives and psychologists specialized in Infant Mental Health. Pretest (N = 34) and posttest (N = 17) measurements of depressive symptoms, worries about COVID-19 and worries in general, and mother-to-infant bonding were administered, as well as a posttest evaluation., Results: At pretest, the OC group was compared to two reference groups of pregnant women from an ongoing pregnancy cohort study: a COVID-19 (N = 209) and pre-COVID-19 reference group (N = 297). OC participants had significantly more depressive symptoms than both reference groups, and less positive feelings of bonding than the COVID-19 but not the pre-COVID-19 reference group. Compared to pretest, significant decreases in depressive symptoms (with significantly less participants scoring above cut-off) and worries about COVID-19 (large effect sizes) and worries in general (moderate to large effect size) were found at posttest for the OC participants. No significant improvement was found in bonding. Participants rated the intervention positively., Conclusions: The current study provides initial evidence supporting the idea that OC is a promising and readily accessible intervention for pregnant women experiencing stress due to the COVID-19 pandemic, and possibly also applicable to other stressors., Trial Registration: This intervention was registered in the Netherlands Trial Registration (registration number Trial NL8842 , registration date 18/08/2020)., (© 2022. The Author(s).)

Objective: Pregnancy-induced hypertension (PIH) is associated with serious complications in both the mother and the unborn child. We examined the possible association between trajectories of maternal psychological distress symptoms and PIH separately in primiparous and multiparous women., Methods: Pregnancy-specific negative affect (P-NA) and depressive symptoms were assessed prospectively at each trimester using the Tilburg Pregnancy Distress Scale pregnancy negative affect subscale (P-NA) and the Edinburgh Depression Scale (EDS). Data on PIH were collected from medical records. Growth mixture modeling analysis was used to identify trajectories of P-NA and EDS. The independent role of P-NA and EDS symptom trajectories on developing PIH was examined using multivariate logistic regression models., Results: One hundred (7.6%) women developed PIH and were compared with 1219 women without hypertension or other complications during pregnancy. Three P-NA trajectories were identified: low stable (reference group; 90%), decreasing (5.2%), and increasing (4.8%). The latter two classes showed persistently and significantly higher P-NA symptoms during pregnancy compared with the reference group. In multiparous women, high P-NA scores (belonging to classes 2 and 3) were related to PIH (odds ratio [OR] = 6.91, 95% confidence interval [CI] = 2.26-21.2), independent of body mass index (OR = 1.17, 95% CI = 1.06-1.27) and previous PIH (OR = 14.82, 95% CI = 6.01-32.7). No associations between P-NA and PIH were found in primiparous women. EDS trajectories were not related to PIH in both primiparous and multiparous women., Conclusions: In multiparous women, persistently high levels of P-NA symptoms but not depressive symptoms were independently associated with development of PIH., (Copyright © 2022 by the American Psychosomatic Society.)

Background: The Covid-19 pandemic has put an unprecedented pressure on families with children. How parents were affected by the first Covid-19 lockdown during the early postpartum period, an already challenging period for many, is unknown., Aim: To investigate the associations between Covid-19 related stress, mental health, and insensitive parenting practices in mothers and fathers with young infants during the first Dutch Covid-19 lockdown., Methods: The Dutch Covid-19 and Perinatal Experiences (COPE-NL) study included 681 parents of infants between 0 and 6 months (572 mothers and 109 fathers). Parents filled out online questionnaires about Covid-19 related stress, mental health (i.e. anxiety and depressive symptoms), and insensitive parenting. Hierarchical regression models were used to analyze the data., Results: Parents of a young infant reported high rates of Covid-19 related stress, with higher reported stress in mothers compared to fathers. Additionally, the percentages of mothers and fathers experiencing clinically meaningful mental health symptoms during the pandemic were relatively high (mothers: 39.7% anxiety, 14.5% depression; fathers: 37.6% anxiety, 6.4% depression). More Covid-19 related stress was associated with more mental health symptoms in parents and increased insensitive parenting practices in mothers., Conclusions: The results emphasize the strain of the pandemic on young fathers' and mothers' mental health and its potential negative consequences for parenting. As poor parental mental health and insensitive parenting practices carry risk for worse child outcomes across the lifespan, the mental health burden of the Covid-19 pandemic might not only have affected the parents, but also the next generation., (© 2022. The Author(s).)

The COVID-19 pandemic has forced developmental researchers to rethink their traditional research practices. The growing need to study infant development at a distance has shifted our research paradigm to online and digital monitoring of infants and families, using electronic devices, such as smartphones. In this practical guide, we introduce the Experience Sampling Method (ESM) - a research method to collect data, in the moment, on multiple occasions over time - for examining infant development at a distance. ESM is highly suited for assessing dynamic processes of infant development and family dynamics, such as parent-infant interactions and parenting practices. It can also be used to track highly fluctuating family dynamics (e.g., infant and parental mood or behavior) and routines (e.g., activity levels and feeding practices). The aim of the current paper was to provide an overview by explaining what ESM is and for what types of research ESM is best suited. Next, we provide a brief step-by-step guide on how to start and run an ESM study, including preregistration, development of a questionnaire, using wearables and other hardware, planning and design considerations, and examples of possible analysis techniques. Finally, we discuss common pitfalls of ESM research and how to avoid them., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 van den Heuvel, Bülow, Heininga, de Moor, Janssen, Vanden Abeele and Boekhorst.)

The COVID-19 pandemic affects society and may especially have an impact on mental health of vulnerable groups, such as perinatal women. This prospective cohort study of 669 participating women in the Netherlands compared perinatal symptoms of depression and stress during and before the pandemic. After a pilot in 2018, recruitment started on 7 January 2019. Up until 1 March 2020 (before the pandemic), 401 women completed questionnaires during pregnancy, of whom 250 also completed postpartum assessment. During the pandemic, 268 women filled out at least one questionnaire during pregnancy and 59 postpartum (1 March-14 May 2020). Pregnancy-specific stress increased significantly in women during the pandemic. We found no increase in depressive symptoms during pregnancy nor an increase in incidence of high levels of postpartum depressive symptoms during the pandemic. Clinicians should be aware of the potential for increased stress in pregnant women during the pandemic., (© 2021. The Author(s).)

Background: For patients with carpal tunnel syndrome (CTS), the only long-term effective treatment option is carpal tunnel release surgery. Up to one-third report recurrent symptoms, and 12% needs repeated surgery. This study aimed to evaluate the long-term effects of mechanical traction as a non-invasive treatment option for CTS compared to care as usual. Methods: Patients with electrodiagnostically confirmed CTS [ N = 181; mean age, 58.1 (13.0) years; 67% women] were recruited from an outpatient neurology clinic in the Netherlands. Patients completed baseline questionnaires and randomized to the intervention group (12 treatments with mechanical traction, twice a week for 6 weeks) or care as usual. The primary clinical outcome measure was surgery during the 12-month follow-up. Secondly, we assessed symptom severity with the Boston Carpal Tunnel Questionnaire (BCTQ) at baseline and at the 12-month follow-up. Changes in CTS symptom severity between baseline and the 12-month follow-up were analyzed between groups using t -tests and a multiple linear regression analyses, adjusting for duration of complaints, age, gender, and symptom severity at baseline. Results: At the 12-month follow-up, 35 of 94 (37%) patients in the intervention group had surgery, compared to 38 of 87 (44%) in the care-as-usual group ( χ 1 2 = 0.78, p = 0.377). Symptom severity and functional status scores did not significantly differ between the intervention ( n = 81) and care-as-usual group ( n = 55) at follow-up. For patients who did not have surgery, BCTQ scores decreased significantly more from baseline to the 12-month follow-up in the intervention group ( n = 53) compared to patients in the care-as-usual group ( n = 25). For patients who did not have surgery, belonging to the intervention group and a higher BCTQ score at baseline were related to a greater decrease in BCTQ scores from baseline to the 12-month follow-up, as well as symptom severity and functional status. Conclusions: Mechanical traction is effective in reducing symptom severity compared to current conservative treatment options in standard care and can therefore benefit the large number of patients that prefer conservative treatment for CTS. Clinical Trial Registration: Clinical Trials NL44692.008.13. Registered 19 September 2013, https://clinicaltrials.gov/ct2/show/NCT01949493., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Meems, Boekhorst and Pop.)

Women's subjective childbirth experience is a risk factor for postpartum depression and childbirth-related posttraumatic stress symptoms. Subjective childbirth experience is influenced not only by characteristics of the childbirth itself but also by maternal characteristics. A maternal characteristic that may be associated with a more positive childbirth experience is trait mindfulness. The current study aimed to assess this association and to assess whether trait mindfulness during pregnancy had a moderating role in the possible association between non-spontaneous delivery and perception of childbirth. A subsample of 486 women, participating in a longitudinal prospective cohort study (Holistic Approach to Pregnancy and the first Postpartum Year study), completed the Three Facet Mindfulness Questionnaire-Short Form at 22 weeks of pregnancy. Women completed the Childbirth Perception Scale and the Edinburgh Postnatal Depression Scale between 7 and 21 days postpartum. The mindfulness facets acting with awareness and non-reacting were significantly associated with a more positive perception of childbirth, after adjusting for covariates. Moderation analyses showed a significant interaction between acting with awareness and non-spontaneous delivery and non-judging and non-spontaneous delivery. Non-spontaneous delivery was associated with a more negative perception of childbirth for low/medium scores of acting with awareness and non-judging, but not for high scores on these mindfulness facets. Trait mindfulness during pregnancy may enhance a positive perception of childbirth. Because this is among the first studies examining the association between maternal dispositional mindfulness and perception of childbirth, future research is needed to confirm the results of the current study.

Purpose: Offspring of mothers with a bipolar disorder are at high-risk for impaired developmental outcomes and psychopathology (e. g., mood, anxiety, sleep disorders) later in life. This increased risk of psychopathology is not only because of genetic vulnerability, but environmental factors may play an important role as well. The often long and debilitating mood episodes of mothers with bipolar disorder might hamper their qualities as a caregiver and may impact the child. We examined early mother-to-infant bonding 1 year postpartum in mothers with bipolar spectrum disorder as compared to mothers of the general population. The association between mother-to-infant bonding and the type of bipolar spectrum diagnosis (bipolar I, bipolar II, bipolar Not Otherwise Specified) as well as relapse within 12 months postpartum was also assessed. Methods: In total, 75 pregnant women with a bipolar spectrum disorder participated in the current study. The participants were included in a longitudinal cohort study of women with bipolar spectrum disorder and were prospectively followed from pregnancy until 1 year postpartum. Mother-to-infant bonding was assessed using the Pre- and Postnatal Bonding Scale. A longitudinal population-based cohort of 1,419 pregnant women served as the control group. Multiple linear regression analyses were used to assess the association between bipolar spectrum disorder and mother-to-infant bonding scores, controlling for several confounders. Results: Women with bipolar spectrum disorder perceived the bonding with their child as less positive compared to the control group. The type of bipolar spectrum disorder was not associated with poorer bonding scores. Relapse during the 1st year after delivery also did not affect bonding scores in women with bipolar spectrum disorder. Conclusions: Our findings could imply that women with bipolar spectrum disorder are more vulnerable to impairments in bonding due to the nature of their psychopathology, regardless of the occurrence of postpartum relapse. Careful follow-up including monitoring of mother-to-infant bonding of pregnant women with a history of bipolar spectrum disorder should be a standard to this vulnerable group of women. In addition, regardless of severity and mood episode relapse, an intervention to improve bonding could be beneficial for all mothers with bipolar spectrum disorder and their newborns., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Boekhorst, Beerthuizen, Hillegers, Pop and Bergink.)

The COVID-19 pandemic affects the mental health status of perinatal women, which makes it important to gain insight into and to effectively measure specific stressors of the COVID-19 pandemic. Therefore, we aimed to develop a COVID-19 Perinatal Perception Questionnaire (COVID19-PPQ). In-depth interviews were conducted during the first national lockdown period with pregnant women, new mothers and perinatal healthcare professionals, resulting in (a) a 27-item pregnancy and (b) a 21-item postpartum scale. Explorative factor analyses (EFA) in sample Ia (N = 154) and Ib (N = 90), and confirmatory factor analyses (CFA) in sample IIa (N = 113) and IIb (N = 81) were conducted to test the psychometric properties of both scales. For the pregnancy scale, EFA suggested a three-factor solution (risk of infection, contact, future), which was confirmed by CFA and resulted in a final nine-item scale. For the postpartum scale, a three-factor solution (first postpartum week, COVID-19 measures, fear for infection) was suggested by EFA and confirmed by CFA, resulting in a final ten-item scale. Symptoms of depression and pregnancy-specific distress were significantly correlated with the pregnancy (sub)scale(s), while symptoms of postpartum depression and anxiety showed significant correlations with the COVID-19 measures and fear for infection subscale. The COVID19-PPQ seems to be a valid instrument for assessment of perinatal COVID-19-related stress perception, showing adequate psychometric properties for both the pregnancy and postpartum scale. Future research should examine the use of this instrument in clinical practice during new episodes of the COVID-19 pandemic., Competing Interests: Conflicts of interestLianne P. Hulsbosch, Myrthe G. B. M. Boekhorst, Lotte Muskens, Eva S. Potharst, Ivan Nyklíček, and Victor J. M. Pop declare that they have no conflicts of interest that are relevant to the content of this article., (© The Author(s) 2021.)

We previously developed the Tilburg Pregnancy Distress Scale (TPDS). The aim of the current study was to further assess its test-retest reliability, internal consistency, and construct and concurrent validity in 1739 pregnant women. TPDS scores during pregnancy were highly inter-correlated (r ≥ .70), with similar findings for its Negative Affect and Partner Involvement subscales. Pregnancy and delivery worries varied in different subgroups of women regarding their obstetric history. Nullipara reported more pregnancy- and delivery-related worries at all trimesters of pregnancy. Women with previous pregnancy-related complications reported more pregnancy-related worries, and those with previous delivery-related problems reported more delivery-related worries than women without these problems in the past. The TPDS seems to be a valid and reliable instrument to assess pregnancy-specific distress.

Background: Psychological distress during pregnancy is common: up to 20% of the childbearing women experience symptoms of depression and anxiety. Apart from the adverse effects on the woman herself, pregnancy distress can negatively affect pregnancy outcomes, infant health, postpartum mother-child interaction and child development. Therefore, the development of interventions that reduce pregnancy distress is very important. Mindfulness-based interventions (MBIs) show promising positive effects on pregnancy distress, but there is a need for randomized controlled trials with sufficient power. Trials on online MBIs, which are readily accessible and not expensive, also show positive effects on stress reduction in non-pregnant populations. Moreover, specific working mechanisms of MBIs remain unclear. The aim of the current study is to test the effectiveness of an online MBI in pregnant women with pregnancy distress, as well as exploring potential working mechanisms., Methods: The current study is a randomized controlled trial with repeated measures. Consenting women with elevated levels of pregnancy distress will be randomized into an intervention group (MBI) or control group (care as usual) around 12 weeks of pregnancy, with an intended sample size of 103 women in each group. The primary outcome, pregnancy distress, will be assessed via questionnaires at baseline, halfway through the intervention and post intervention in both intervention and control group, and after 8 weeks follow-up in the intervention group. Secondary outcomes are mindfulness skills, rumination and self-compassion, which are also seen as potential working mechanisms, and will be assessed via questionnaires before intervention, halfway through the intervention, post intervention and after 8 weeks follow-up in the intervention group. Tertiary outcome variables are obstetric data and will be collected from the obstetric records for both intervention and control group. Analyses will be based on the intention-to-treat principle. Multilevel regression models for repeated measures (mixed models) will be used to evaluate changes in primary and secondary outcome variables. Tertiary outcomes will be compared between groups using independent t-tests and Chi Square analyses., Discussion: The trial is expected to increase knowledge about the effectiveness of online MBIs during pregnancy in women with pregnancy distress and to evaluate potential working mechanisms., Trial Registration: ClinicalTrials.gov: NCT03917745, registered on 4 March 2019. Protocol Version 3.0., 20 February 2020.

Objectives: The prevalence of maternal stress in early years of parenting can negatively impact child development. Therefore, there is a need for an early intervention that is easily accessible and low in costs. The current study examined the effectiveness of an 8-session online mindful parenting training for mothers with elevated levels of parental stress., Methods: A total of 76 mothers were randomized into an intervention ( n = 43) or a waitlist control group ( n = 33). The intervention group completed pretest assessment prior to the online intervention. Participants completed a post intervention assessment after the 10 weeks intervention and a follow-up assessment 10 weeks later. The waitlist group completed waitlist assessment, followed by a 10-week waitlist period. After these 10 weeks, a pretest assessment took place, after which the waitlist group participants also started the intervention, followed by the posttest assessment. Participating mothers completed questionnaires on parental stress (parent-child interaction problems, parenting problems, parental role restriction) and other maternal (over-reactive parenting discipline, self-compassion, symptoms of depression and anxiety) and child outcomes (aggressive behavior and emotional reactivity) while the non-participating parents (father or another mother) were asked to also report on child outcomes., Results: The online mindful parenting intervention was shown to be significantly more effective at a 95% level than a waitlist period with regard to over-reactive parenting discipline and symptoms of depression and anxiety (small and medium effect sizes), and significantly more effective at a 90% level with regard to self-compassion, and mother-rated child aggressive behavior and child emotional reactivity (small effect sizes). The primary outcome, parental stress, was found to have a 95% significant within-group effect only for the subscale parental role restriction (delayed small effect size improvement at follow-up). No significant improvements on child outcomes were found for the non-participating parent., Conclusion: To conclude, the results provide first evidence that an online mindful parenting training may be an easily accessible and valuable intervention for mothers with elevated levels of parental stress.

Background: Up to 10-15% of women experience high levels of depressive symptoms during pregnancy. Since these levels of symptoms can vary greatly over time, the current study investigated the existence of possible longitudinal trajectories of depressive symptoms during pregnancy, and aimed to identify factors associated with these trajectories., Methods: Depressive symptoms were assessed prospectively at each trimester in 1832 women, using the Edinburgh (Postnatal) Depression Scale (E(P)DS). Growth mixture modeling was used to identify trajectories of depressive symptoms during pregnancy., Results: Three trajectories of depressive symptoms (E(P)DS scores) were identified: low stable (class 1, reference group, 83%), decreasing (class 2, 7%), and increasing (class 3, 10%). Classes 2 and 3 had significantly higher mean E(P)DS scores (7-13 throughout pregnancy) compared to the reference group (stable; E(P)DS <4). Factors associated with trajectories 2 and 3 included previous depressive episodes, life events during pregnancy, and unplanned pregnancy. Notably, the only factor distinguishing classes 2 and 3 was the perception of partner involvement experienced by women during their pregnancies. Class 2 (with decreasing E(P)DS scores) reported high partner involvement, while class 3 (with increasing E(P)DS scores) reported poor partner involvement throughout pregnancy., Limitations: Depressive symptoms were assessed by self-report rather than a diagnostic interview. The participants were more often both highly educated and of Caucasian ethnicity compared to the general Dutch population., Conclusions: Poor partner involvement was associated with increasing depressive symptoms during pregnancy. Health professionals should focus on partner involvement during pregnancy in order to identify women who are potentially vulnerable for perinatal depression., (Copyright © 2019 Elsevier B.V. All rights reserved.)