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BACKGROUND: Predicting the course and complications of perinatal depression through the identification of clinical subtypes has been previously undertaken using the Edinburgh Postnatal Depression Scale and has the potential to improve the precision of care and improve outcomes for women and their children. METHODS: Edinburgh Postnatal Depression Scale scores were collected twice in pregnancy and twice in the postpartum in a sample of 360 women who met diagnostic criteria for perinatal depression using the Structured Clinical Interview for DSM disorder. These data were used to compare with previous, though conflicting, evidence from cross-sectional studies and extend this by undertaking longitudinal measurement invariance modelling to test the structural validity across the perinatal period. Latent profile and transition modelling was used to identify distinct subtypes of women and assess the utility of these subtypes and transition profiles to predict clinically meaningful outcomes. RESULTS: Although our data supported one of the previously reported three-factor Edinburgh Postnatal Depression Scale structures used to compute subfactor totals for depressed mood, anxiety and anhedonia at both early pregnancy and 6 months postpartum, there was little value in using these Edinburgh Postnatal Depression Scale subfactor scores to identify subtypes predictive of clinically meaningful postpartum symptom subtypes, or of general health, pregnancy and neonatal outcomes. CONCLUSION: Our study does not support the use of the Edinburgh Postnatal Depression Scale to distinguish perinatal depressive subtypes for the purposes of predicting course and complications associated with perinatal depression. However, the results give guidance on alternative ways to study the value of personalised management in improved outcomes for women living with or at risk for perinatal depression.

BACKGROUND: Low social support has been identified as a risk factor for perinatal mental health problems. However, previous studies mainly focused on partner support or general social support and neglected the roles of grandparents. Here, we examine whether a lack of grandparental support is related to increased risk of a diagnosis of perinatal depression. In addition, we examine whether poor grandparental support is related to more depressive symptoms in mothers with and without previously diagnosed perinatal depression and whether perceived grandparental support buffers against parenting difficulties in mothers with perinatal depression. METHODS: The sample was drawn from an Australian pregnancy cohort study and consisted of 725 women, including 230 women who met criteria for Major Depression. At 12 months postpartum, women reported on grandparental geographical proximity and hours of grandparental childcare support. Perceived grandparental support was assessed with the Postpartum Social Support Questionnaire and parenting difficulties and depressive symptoms with the Parenting Stress Index and the Edinburgh Postnatal Depression Scale. RESULTS: Perceived grandparental support was related to fewer depressive symptoms among mothers with perinatal depression. In addition, higher levels of perceived grandparental support were related to lower parenting stress in mothers with and without perinatal depression. LIMITATIONS: Intergenerational conflicts and quality of grandparenting were not assessed. CONCLUSIONS: Our findings indicate that supportive grandparents may prevent the development of more severe perinatal depression in mothers experiencing perinatal mental health problems. Future studies should examine whether involving grandparents in treatment may add to the effectiveness of existing perinatal mental health interventions.

Objective: Maternal mental disorders have been associated with adverse perinatal outcomes such as low birthweight and preterm birth, although these links have been examined rarely among Australian Aboriginal populations. We aimed to evaluate the association between maternal mental disorders and adverse perinatal outcomes among Aboriginal births. Methods: We used whole population-based linked data to conduct a retrospective cohort study (N = 38,592) using all Western Australia singleton Aboriginal births (1990–2015). Maternal mental disorders were identified based on the International Classification of Diseases diagnoses and grouped into six broad diagnostic categories. The perinatal outcomes evaluated were preterm birth, small for gestational age, perinatal death, major congenital anomalies, foetal distress, low birthweight and 5-minute Apgar score. We employed log-binomial/-Poisson models to calculate risk ratios and 95% confidence intervals. Results: After adjustment for sociodemographic factors and pre-existing medical conditions, having a maternal mental disorder in the five years before the birth was associated with adverse perinatal outcomes, with risk ratios (95% confidence intervals) ranging from 1.26 [1.17, 1.36] for foetal distress to 2.00 [1.87, 2.15] for low birthweight. We found similar associations for each maternal mental illness category and neonatal outcomes, with slightly stronger associations when maternal mental illnesses were reported within 1 year rather than 5 years before birth and for substance use disorder. Conclusions: This large population-based study demonstrated an increased risk of several adverse birth outcomes among Aboriginal women with mental disorders. Holistic perinatal care, treatment and support for women with mental disorders may reduce the burden of adverse birth outcomes.

Objectives The principles of gender equity are important to achieve the Royal Australian and New Zealand College of Psychiatrists the College strategic goals 1 To present the data on gender equity 2 To describe how the action plan was developed 3 To discuss how this work aligns with a commitment to inclusion and diversity Methods Firstly the formation of a working group with representation from across the College Secondly undertaking a data snapshot and discussion paper on gender equity to support consultation Thirdly reviewing similar action plans a literature review and undertaking broad consultation across the College Finally collating data using a thematic analysis to support the development of an action plan Results Data obtained on gender equity identified clear gaps in leadership roles academic activities and awards Our review and consultation identified themes focused on gaps in gender equity including a role for organisational leadership approach Together this has then informed an action plan for gender equity for the College Conclusions There are no simple solutions that will solve gender inequity this requires systemic solutions to achieve meaningful change However the development of the action plan is a significant step towards addressing the current gender inequities The Royal Australian and New Zealand College of Psychiatrists 2023

Ensuring that women can make fully informed decisions about all aspects of their care in pregnancy is not only required by law in many jurisdictions, but is integral to the provision of respectful and contemporary person-centred health care...

Introduction Placental dysfunction and inefficiency, is important in understanding fetal growth restriction and low birth weight. Two recent studies have examined the relationship between antidepressant use in pregnancy and placental weight ratios; one found lower placental weight ratio associated with antidepressant use and the other found a higher ratio. Methods This study examined 342 women recruited in early pregnancy, including 75 taking antidepressants, 29 with current depression and 238 controls. Antidepressant use was measured through self-report in early and late pregnancy, hospital records at delivery and drug concentrations in umbilical cord and maternal blood obtained at delivery. Maternal depression was measured using the Structured Clinical Interview for the DSM IV (SCID) at recruitment. Placentas were collected at delivery and weighed, and infant birth weight recorded. Placental efficiency was measured using standardised placental weight residuals and included as the outcome in general linear models (ANOVA/ANCOVA) to test hypotheses. Results While placental weight was higher for those on antidepressants compared to controls (z=.30 c.f. Z=-0.08, p=.012), there were no significant differences between the three groups after adjusting for maternal body mass index at recruitment. When comparing antidepressant groups separately there were small-to-moderate positive associations between (SSRI) concentrations and placental weight (rho's > 0.20, p's > 0.05), which did not reach significance. Conclusion Antidepressant use in pregnancy was not associated with significant changes in placental efficiency after adjustment for confounding variables. Future research should expand on this to examine other aspects of placental function and include a wide range of potential confounding variables to draw clinically meaningful conclusions.

Objective: To examine the risk of perinatal depression, parenting stress and infant sleep practices in Australian culturally and linguistically diverse (CaLD) women. Method: Within the Mercy Pregnancy and Emotional Wellbeing Study, we examined 487 pregnant women of whom 52 were CaLD and 435 non-CaLD. Depression was measured using the Structured Clinical Interview for DSM-IV and the Edinburgh Postnatal Depression Scale. In addition, Parenting Stress Index and infant sleep measures were collected. Results: Fewer CaLD women had a depression diagnosis but there were no differences between CaLD and non-CaLD women for perinatal mental health symptoms. More mothers in the CaLD group were bed sharing with their infant during the night at six months; however, bedsharing was only associated with higher parenting stress for non-CaLD mothers. Conclusions: Findings suggest both differences in infant sleep parenting practices and in parenting stress but not general emotional wellbeing. Future research is required to replicate these findings.

Objective To identify whether a diagnosis of depression combined with rurality, compared with either depression or living in metropolitan areas alone, is associated with experiencing more stressful life events in pregnancy. Design This study uses data from 402 pregnant women (206 metropolitan and 196 rural), enrolled in the Western Australian arm of the Mercy Pregnancy and Emotional Wellbeing Study. Mercy Pregnancy and Emotional Wellbeing Study is a prospective, longitudinal cohort with women recruited during early pregnancy (<20 weeks) across 3 groups: those with diagnosed depression, those taking antidepressant medication and control. Participants Women were recruited from 3 metropolitan and 3 rural hospitals in Western Australia from 2017 to 2018 and 2018 to 2020, respectively. This study uses antenatal data collected at recruitment and during third trimester (weeks 32-34). Main outcome measures The Stressful Life Events Scale was used to measure the number of self-reported stressful events. The degree of perceived stress due to the stressful event was also reported. Results Compared to pregnant metropolitan women diagnosed with depression, pregnant rural women with depression were more likely to report experiencing at least 1 stressful life event. Despite this, pregnant women with depression in both regions reported similar numbers of stressful life events. Conclusions This study highlights women in rural Western Australia diagnosed with depression might be more vulnerable to experiencing stressful life events than rural women without depression and their metropolitan counterparts. Due to known adverse effects of antenatal depression and stress on maternal well-being and child outcomes, there is a clear need for targeted, preventative interventions for Australian rural women during this period.

OBJECTIVE: To examine the risk of perinatal depression, parenting stress and infant sleep practices in Australian culturally and linguistically diverse (CaLD) women. METHOD: Within the Mercy Pregnancy and Emotional Wellbeing Study, we examined 487 pregnant women of whom 52 were CaLD and 435 non-CaLD. Depression was measured using the Structured Clinical Interview for DSM-IV and the Edinburgh Postnatal Depression Scale. In addition, Parenting Stress Index and infant sleep measures were collected. RESULTS: Fewer CaLD women had a depression diagnosis but there were no differences between CaLD and non-CaLD women for perinatal mental health symptoms. More mothers in the CaLD group were bed sharing with their infant during the night at six months; however, bedsharing was only associated with higher parenting stress for non-CaLD mothers. CONCLUSIONS: Findings suggest both differences in infant sleep parenting practices and in parenting stress but not general emotional wellbeing. Future research is required to replicate these findings.

While two editorials have raised concerns about the decline in Australian academic psychiatry, for a genuine rejuvenation to ever occur, we will need to re-examine how women can be better included in this important endeavour. While attainment of fellowship has reached gender parity, academic psychiatry has disappointingly lagged, with 80% of its senior leadership roles across Australia and New Zealand still held by men, with a similar situation in the United Kingdom and the United States as well as many other countries. Encouraging women into academic psychiatry is not only critical to progress as a profession but also will help address the current blindness to sex differences in biological psychiatry, as well the social impact of restrictive gender norms and the effects of gender-based violence on mental health. This potentially creates opportunities for significant gains and insights into mental disorders. However, addressing the barriers for women in academia requires tackling the entrenched disparities across salaries, grant funding, publications, teaching responsibilities, keynote invitations and academic promotions alongside the gender-based microaggressions, harassment and tokenism reported by many of our female academics. Many women must grapple with not just a ‘second shift’ but a ‘third shift’, making the burden of an academic career unreasonable and burnout more likely. Addressing this is no easy task. The varied research in academic medicine reveals no quick fixes, although promoting gender equity brings significant potential benefits. Areas such as academic psychiatry need to recognise our community’s growing discomfort with workplaces that choose to maintain status quo. Gender equity must be a critical part of any quest to revive this important area of practice for our profession.

Objective Perinatal emotional well-being is more than the presence or absence of depressive and anxiety disorders; it encompasses a wide range of factors that contribute to emotional well-being. This study compares perinatal well-being between women living in metropolitan and rural regions. Design Prospective, longitudinal cohort. Participants/setting Eight hundred and six women from Victoria and Western Australia recruited before 20 weeks of pregnancy and followed up to 12 months postpartum. Main outcome measures Rurality was assessed using the Modified Monash Model (MM Model) with 578 in metropolitan cities MM1, 185 in regional and large rural towns MM2-MM3 and 43 in rural to remote MM4-MM7. The Structured Clinical Interview for DSM-IV (SCID-IV) was administered at recruitment to assess depression, and symptoms of depression and anxiety were measured using the Edinburgh Post-natal Depression Scale and the State and Trait Anxiety Scale, respectively. Other measures included stressful events, diet, exercise, partner support, parenting and sleep. Results The prevalence of depressive disorders did not differ across rurality. There was also no difference in breastfeeding cessation, exercise, sleep or partner support. Women living in rural communities and who also had depression reported significantly higher parenting stress than metropolitan women and lower access to parenting activities. Conclusions Our study suggests while many of the challenges of the perinatal period were shared between women in all areas, there were important differences in parenting stress and access to activities. Furthermore, these findings suggest that guidelines and interventions designed for perinatal mental health should consider rurality.

Aim This paper aims to examine the maternal and child mental health and parenting outcomes in the context of COVID-19 pandemic conditions using a sample from Melbourne, Australia – a city exposed to one of the longest lockdowns world-wide in response to the pandemic. Methods This study utilises observational data from a prospective, pregnancy cohort, Mercy Pregnancy Emotional Wellbeing Study and includes 468 women and their children followed up in Melbourne to 3–4 years postpartum pre-COVID pandemic and compared to those followed up during the COVID-19 pandemic. Results When compared to mothers followed up at 3–4 years postpartum pre-pandemic, those followed up during the COVID-19 pandemic showed higher depressive symptoms with a steep incline in their symptom trajectory (EMMdifference = 1.72, Bonferroni-corrected P < 0.01, d = 0.35) and had a three times higher risk of scoring 13 or above on the EPDS (aRR = 3.22, Bonferroni-corrected P < 0.01). Although this increase was not associated with the variation in the duration of exposure to pandemic conditions, the steep increase in depressive symptoms was more pronounced in those with pre-existing depressive disorders. There was no difference in parenting stress or adjusted childhood mental health symptoms or disorder. Conclusions Our findings highlight the vulnerability of those with pre-existing clinical mental health disorders and the need for adequate clinical care for this vulnerable group. Equally, our study indicates the possibility that parenting and early childhood mental health outcomes, at least in the short term, may be resilient.

Background: Hypertensive disorders of pregnancy are associated with longer term cardiovascular risk. Understanding if depression or antidepressant use in pregnancy is associated with HDP is important in identifying those potentially vulnerable to poorer health in later life. This study examines if depression and antidepressants are associated with HDP. Methods: In all, 815 pregnant women were recruited within an Australian pregnancy cohort study at less than 20 weeks of pregnancy, all undertook the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and were assigned to four groups for this paper: those with unmedicated depression meeting criteria for current depression (n = 97), those taking selective serotonin reuptake inhibitors in early pregnancy (n = 101), those taking serotonin and noradrenaline reuptake inhibitors in early pregnancy (n = 31), and those without depression or taking antidepressant medication (control; n = 586). Women were then assessed again following birth. Hypertensive disorders of pregnancy were diagnosed according to the Society of Obstetric Medicine in Australia and New Zealand Guidelines. Results: Use of serotonin and noradrenaline reuptake inhibitors (SNRIs) (adjusted risk ratio = 9.10, 95% confidence interval = [3.82, 21.67]) and unmedicated depression (adjusted risk ratio = 3.11, 95% confidence interval = [1.32, 7.35]) were independently associated with significantly higher risk for developing hypertensive disorders of pregnancy compared to controls. Selective serotonin reuptake inhibitors (SSRIs) use did not confer any increased risk. Higher doses of SNRIs, but not selective serotonin reuptake inhibitors, were associated with significantly higher risk for developing HDP (adjusted risk ratio = 4.83, 95% confidence interval = [1.50, 15.58]). Conclusions: Our findings suggest that those with depression in pregnancy and/or on an serotonin and noradrenaline reuptake inhibitor should

Our study aimed to examine pregnancy, neonatal and psychosocial outcomes for women treated with LAIs at tertiary maternity hospital. A retrospective review of all women who were treated with LAIs between 1999 and 2017. Cases were identified via the hospital dispensary system and outcome data were extracted case notes as well as the midwifery notification system. Measures included sociodemographic data, smoking, alcohol and illicit substance use, pregnancy complications such as gestational diabetes, and neonatal outcomes. Psychosocial profiles such as psychiatric admission during pregnancy and statutory child protection involvement were also assessed. Where available, outcomes were compared with state population data. The study found 38 pregnancies to 36 women, who had LAI treatment. Two congenital malformations (5.7%) were recorded. Compared to general population data, pregnant women treated with LAIs were more likely to have obstetric complications including gestational diabetes and pregnancy hypertension and special care nursery admission for their babies. They also had elevated rates of psychiatric admissions during pregnancy and statutory child protection involvement. Outcomes were similar first and second generation LAIs exposure. As women on LAI have limited options for treatment of their psychotic disorders, the findings point towards a need for enhanced multidisciplinary pregnancy care for this vulnerable cohort.

Fostering the next generation of academic psychiatrists is crucial to maintaining our leading role in providing evidence-based care for the patients we serve...

Anorexia nervosa is a potentially severe, chronic, and relapsing mental disorder that is more common in women and girls during the reproductive years (usually defined as those aged 12–51 years). It is associated with suicide and mortality linked with the physical consequences of starvation. Although anorexia nervosa is a disorder of low prevalence, and even lower prevalence in pregnancy, it is associated with substantial risks for the mother and infant when under-recognised and undermanaged. Despite the complexity and risk of managing anorexia nervosa in pregnancy, few studies are available to guide care. We conducted a systematic review, identifying only eight studies that addressed the management of anorexia nervosa in pregnancy. These studies were case studies or case reports examining narrow aspects of management. Subsequently, we conducted a state-of-the-art review across research in relevant disciplines and areas of expertise for managing anorexia nervosa in pregnancy and synthesised the findings into recommendations and principles for multidisciplinary management of anorexia nervosa in pregnancy. These recommendations included a focus on the specialist mental health, obstetric, medical, and nutritional care required to ensure optimal outcomes for women and their infants. Despite the complexity and risks, a gap exists in the comprehensive guidelines and recommendations for managing anorexia nervosa in pregnancy. This Review provides multidisciplinary recommendations for clinical care in this area. Managing anorexia nervosa in pregnancy is an area of clinical care that requires a multidisciplinary approach and includes those experienced in managing high-risk pregnancies.

AIM: This paper aims to examine the maternal and child mental health and parenting outcomes in the context of COVID-19 pandemic conditions using a sample from Melbourne, Australia - a city exposed to one of the longest lockdowns world-wide in response to the pandemic. METHODS: This study utilises observational data from a prospective, pregnancy cohort, Mercy Pregnancy Emotional Wellbeing Study and includes 468 women and their children followed up in Melbourne to 3-4 years postpartum pre-COVID pandemic and compared to those followed up during the COVID-19 pandemic. RESULTS: When compared to mothers followed up at 3-4 years postpartum pre-pandemic, those followed up during the COVID-19 pandemic showed higher depressive symptoms with a steep incline in their symptom trajectory (EMMdifference = 1.72, Bonferroni-corrected P < 0.01, d = 0.35) and had a three times higher risk of scoring 13 or above on the EPDS (aRR = 3.22, Bonferroni-corrected P < 0.01). Although this increase was not associated with the variation in the duration of exposure to pandemic conditions, the steep increase in depressive symptoms was more pronounced in those with pre-existing depressive disorders. There was no difference in parenting stress or adjusted childhood mental health symptoms or disorder. CONCLUSIONS: Our findings highlight the vulnerability of those with pre-existing clinical mental health disorders and the need for adequate clinical care for this vulnerable group. Equally, our study indicates the possibility that parenting and early childhood mental health outcomes, at least in the short term, may be resilient.

INTRODUCTION: Placental dysfunction and inefficiency, is important in understanding fetal growth restriction and low birth weight. Two recent studies have examined the relationship between antidepressant use in pregnancy and placental weight ratios; one found lower placental weight ratio associated with antidepressant use and the other found a higher ratio. METHODS: This study examined 342 women recruited in early pregnancy, including 75 taking antidepressants, 29 with current depression and 238 controls. Antidepressant use was measured through self-report in early and late pregnancy, hospital records at delivery and drug concentrations in umbilical cord and maternal blood obtained at delivery. Maternal depression was measured using the Structured Clinical Interview for the DSM IV (SCID) at recruitment. Placentas were collected at delivery and weighed, and infant birth weight recorded. Placental efficiency was measured using standardised placental weight residuals and included as the outcome in general linear models (ANOVA/ANCOVA) to test hypotheses. RESULTS: While placental weight was higher for those on antidepressants compared to controls (z=.30 c.f. Z=-0.08, p=.012), there were no significant differences between the three groups after adjusting for maternal body mass index at recruitment. When comparing antidepressant groups separately there were small-to-moderate positive associations between (SSRI) concentrations and placental weight (rho's > 0.20, p's > 0.05), which did not reach significance. CONCLUSION: Antidepressant use in pregnancy was not associated with significant changes in placental efficiency after adjustment for confounding variables. Future research should expand on this to examine other aspects of placental function and include a wide range of potential confounding variables to draw clinically meaningful conclusions.

Placental 11β-HSD2 has been a focus of research for understanding potential fetal programming associated with maternal emotional disorders. This study examined the pathway from antenatal mental health via placental 11β-HSD2 mRNA to cortisol regulation in the infant offspring. This study reports on data obtained from 236 participants in the Mercy Pregnancy and Emotional Wellbeing Study (MPEWS). At term, placental tissue was collected within 30 min of birth from 52 participants meeting current criteria for a depressive disorder, and 184 control participants. Depressive disorders were diagnosed using the SCID-IV. In addition, antidepressant use, depressive and anxiety symptoms were measured in early and late pregnancy. Placental 11β-HSD2 mRNA expression was measured using qRT-PCR. Infant salivary cortisol samples were taken at 12 months of age. Women on antidepressant medication and with higher trait anxiety had higher placental 11β-HSD2 expression compared to women not taking medication. Furthermore, the offspring of women taking an antidepressant and who also had a current depressive disorder and high trait anxiety had high cortisol reactivity at 12 months of age and this was mediated through 11β-HSD2 mRNA expression. In contrast, offspring of women not taking antidepressant medication with depressive disorder and high anxiety there was low cortisol reactivity observed. Our findings suggest that the relationship between maternal antenatal depression and anxiety and infant cortisol reactivity is mediated through placental 11β-HSD2 mRNA expression. Furthermore, the direction differed for women taking antidepressants, where infant cortisol reactivity was high whereas when compared to those with unmedicated depression and anxiety, where infant cortisol reactivity was low.

Mood disorders, the most common co-morbidity associated with the perinatal period, have the capacity to influence the wellbeing not only of the woman but also of her unborn child or infant...

Background The effects of maternal depression on mother-infant relationship quality likely vary according to depression heterogeneity. We investigated the effects of different presentations of major depression on mother-infant emotional availability (EA). Methods Data were obtained from 115 mother-infant dyads from a longitudinal pregnancy cohort. Disorders, symptoms, and antidepressant use were assessed in pregnancy and postpartum, and EA was observed 6-month postpartum. Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD) were assessed using the Structured Clinical Interview for the DSM-5. A series of multivariate analyses of covariance analyses' examining the effects of disorder on EA were conducted. Results After controlling for maternal age, antidepressant use, and postpartum depressive symptoms, MDD accounted for 20% of the variance in EA. In the MDD/GAD group, 93% of interactions were rated as emotionally unavailable, nearly threefold the comparison group rate. Conclusions Findings demonstrate that different presentations of major depression are associated with observed differences in mother-infant EA.

Background Maternal depression during the perinatal period predicts adverse developmental outcomes for children, via poorly understood mechanisms. One plausible pathway may involve child executive function, a suite of cognitive capacities associated with social, emotional and educational outcomes. Systematic review and meta-analysis are applied to evaluate evidence of association between maternal perinatal depression and child executive function. Methods Medline, Embase, PubMed, PsycInfo, and SCOPUS were searched for relevant articles to August 2020, with hand-search of relevant bibliographies. Original research published in English measuring maternal depressive symptoms during pregnancy and the first year postpartum, and child executive function outcomes at any age was included. 27 studies met criteria for review. 16 studies reporting raw data of the association between depressive symptoms and executive function were used for meta-analysis. Results Our systematic review identified inadequate assessment of maternal depression, and unreliable measures of executive function in many studies. Assessment of confounders was also inconsistent. Our meta-analysis identified a small, statistically significant relationship between perinatal depression and child executive function (effect size r = 0.07; 95% CI 0.03-0.10); equivalent to Cohen's d = 0.14. Limitations Variable quality of available studies leads to cautious interpretation of results. Conclusions This meta-analysis is consistent with the hypothesis that maternal perinatal depression does have an impact on executive function in offspring. Future studies must use robust measurement of depression and executive function, and account for the chronicity of maternal depression, and developmental context to produce meaningful results.

Background Social support theory suggests that parental social support may influence the nature of early parenting behaviours and specifically the mother-infant relationship. This study examines whether support from a partner, friends or family is associated with differences in quality of mother-infant interactions in the context of maternal depression. Methods 210 women were followed from early pregnancy to six months postpartum within Australian pregnancy cohort, the Mercy Pregnancy and Emotional Wellbeing Study (MPEWS). Mother-infant interactions within a standardised observation at six months postpartum were measured by the Emotional Availability (EA) Scales using total scores of the parental scales. In early and late pregnancy and at six months postpartum, mothers rated perceived maternal social support from a partner, family and friends using subscales of the Multidimensional Scale of Perceived Social Support. Depression was measured in early pregnancy and at six months postpartum using the Structured Clinical Interview for the DSM-IV-TR, with repeated measurement of depressive symptoms by the Edinburgh Postnatal Depression Scale (EPDS). Data was analysed using structural equation models. Results There were significant interactions between depressive symptoms in early pregnancy and perceived maternal support from a partner (B = .18, 95% CI = 03, .31) and separately from family (B = .12, 95% CI = .03, .32) in predicting maternal emotional availability. No such interaction was found for support from friends. While partner and family support moderated the association between early depressive symptoms and emotional availability, there were no direct associations between maternal depressive disorder in early pregnancy and perceived support, and further, maternal depression was not a significant predictor of emotional availability. Limitations Future studies should consider extending measurement of the mother-infant relationship beyond the EA Scales, inclusion of a

Background There is increasing interest in the association between perinatal depression and diet including whether diet may have an impact on depressive symptoms and equally whether depression influences diet. Furthermore, whether pharmacological treatment of depression with antidepressant medication also may influence diet. Methods We examine diet, perinatal depression, and antidepressant use in 442 women recruited in early pregnancy and followed until 12 months postpartum as part of the Mercy Pregnancy Emotional Wellbeing Study. Measures included Structured Clinical Interview for the DSM at recruitment in early pregnancy and comprehensive dietary intake questions, Edinburgh Postnatal Depression Scale, and self-report and recorded antidepressant use at third trimester and 6 and 12 months postpartum. Results This study found that those women with untreated, current depression in pregnancy had higher unhealthy takeaway food intake across the perinatal period compared to those taking antidepressant medication or healthy control women, albeit the overall effects were small and the clinical significance unknown. Higher depressive symptoms in the postpartum were also associated with higher takeaway intake. There was no difference in fruit and vegetable intake between the three groups and intake was highest for all women late in pregnancy and declined in the postpartum period. In all, women's takeaway food intake increased from pregnancy across the postpartum. Limitations Lack of information on pre-pregnancy diet. Conclusions Unhealthy takeaway intake was found to be associated with depression; however, for those women who took antidepressant treatment, their diet patterns were similar to healthy controls. Future research should examine the relationship of treatments for depression in addition to depression and associated dietary behaviours.

Objective: Poorer mother–infant interaction quality has been identified among women with major depression; however, there is a dearth of research examining the impact of bipolar disorder. This study sought to compare mother–infant emotional availability at 6 months postpartum among women with perinatal major depressive disorder, bipolar disorder and no disorder (control). Methods: Data were obtained for 127 mother–infant dyads from an Australian pregnancy cohort. The Structured Clinical Interview for the DSM-5 was used to diagnose major depressive disorder (n = 60) and bipolar disorder (n = 12) in early pregnancy (less than 20 weeks) and review diagnosis at 6 months postpartum. Prenatal and postnatal depressive symptoms were measured using the Edinburgh Postnatal Depression Scale, along with self-report psychotropic medication use. Mother and infant’s interaction quality was measured using the Emotional Availability Scales when infants reached 6 months of age. Multivariate analyses of covariance examining the effects of major depressive disorder and bipolar disorder on maternal emotional availability (sensitivity, structuring, non-intrusiveness, non-hostility) and child emotional availability (responsiveness, involvement) were conducted. Results: After controlling for maternal age and postpartum depressive symptoms, perinatal disorder (major depressive disorder, bipolar disorder) accounted for 17% of the variance in maternal and child emotional availability combined. Compared to women with major depressive disorder and their infants, women with bipolar disorder and their infants displayed lower ratings across all maternal and child emotional availability qualities, with the greatest mean difference seen in non-intrusiveness scores. Conclusions: Findings suggest that perinatal bipolar disorder may be associated with additional risk, beyond major depressive disorder alone, to a mother and her offspring’s emotional availability at 6 months postpartum, particularly in m

Background: Pregnancy and the first year of life is recognized as an important developmental period for lifelong health and well-being, including for mental disorders such as depression and anxiety. Understanding important exposures and environmental influences during the perinatal period from conception to 12 months that may act as risk or protective factors is an area of increasing focus. Objectives: To explore the key risk and protective factors across pregnancy and the first year of life for later child depression and anxiety disorders. To examine whether treatment of maternal depression in pregnancy with antidepressant medication increases, decreases or has no impact on the risk of a child developing depression and anxiety. To discuss future clinical and research directions for maternal depression and child emotional disorders. Methods: The Mercy Pregnancy Emotional Wellbeing Studies is a prospective, pregnancy longitudinal study that recruits women in early pregnancy and follows-up to 4 years of age. Mental health is assessed using both diagnostic measures as well as self-report and antidepressant use is assessed by self-report, hospital records and maternal and cord blood levels. Child mental health is assessed using the diagnostic measure Preschool Age Psychiatric Assessment at 4 years of age together with neuropsychological assessment. Findings: Pathways from maternal depression in pregnancy to child depression and anxiety disorders at 4 years of age are complex and multifactorial with evidence to suggest the importance of biological as well as psychological and social factors operating together and independently to increase risk. These provide important insights into the development of new interventions. Conclusions: Understanding the early life pathways to childhood depression and anxiety and the relationship to maternal depression in pregnancy is important to progress the aims of prevention and early intervention and to improve outcomes for women and chi

Objectives Women with severe mental illnesses (SMI) may have elevated rates of hypertensive disorders in pregnancy (HDP) due to an accumulation of risk factors. This study aims to determine the prevalence rate of HPD within a population of women with SMI and to report on rates within different mental illness diagnoses and types of medication exposure. Study design A retrospective multicentre study of 521 pregnant women attending specialised antenatal clinics for the management of established SMI. Main outcome measures Measures included sociodemographic characteristics, pregnancy complications, mental health diagnosis and psychotropic medication use. Results Overall, 14% of women in the study had HDP. Compared to women with non-affective psychotic and other non-psychotic disorders (10.3%), women with depression and anxiety disorders demonstrated an increased risk of having a diagnosis of HDP (18.8%; RR = 1.82 [95% CI: 1.01, 3.29], p = .048). Log-binomial regression demonstrated that both a BMI in the overweight and obese range (RR = 3.37 [95% CI: 1.04, 10.95], p = .044) and continuous SNRI treatment throughout pregnancy (RR = 2.79 [95% CI; 1.33, 5.83], p = .006) were significant predictors of HDP, after adjusting for maternal age, gestational diabetes, and other mental health diagnoses. Conclusion Women with severe mental illnesses have elevated risk of developing HPD. Management remains complex and should address their comorbid risk profiles, and weigh up the risks and benefits of psychotropic medication use, given these results provide evidence of elevated rates of HDP associated with exposure to SNRI when taken throughout pregnancy.

Attachment theory and research are drawn upon in many applied settings, including family courts, but misunderstandings are widespread and sometimes result in misapplications. The aim of this consensus statement is, therefore, to enhance understanding, counter misinformation, and steer family-court utilisation of attachment theory in a supportive, evidence-based direction, especially with regard to child protection and child custody decision-making. The article is divided into two parts. In the first, we address problems related to the use of attachment theory and research in family courts, and discuss reasons for these problems. To this end, we examine family court applications of attachment theory in the current context of the best-interest-of-the-child standard, discuss misunderstandings regarding attachment theory, and identify factors that have hindered accurate implementation. In the second part, we provide recommendations for the application of attachment theory and research. To this end, we set out three attachment principles: the child’s need for familiar, non-abusive caregivers; the value of continuity of good-enough care; and the benefits of networks of attachment relationships. We also discuss the suitability of assessments of attachment quality and caregiving behaviour to inform family court decision-making. We conclude that assessments of caregiver behaviour should take center stage. Although there is dissensus among us regarding the use of assessments of attachment quality to inform child custody and child-protection decisions, such assessments are currently most suitable for targeting and directing supportive interventions. Finally, we provide directions to guide future interdisciplinary research collaboration.

Attachment theory and research are drawn upon in many applied settings, including family courts, but misunderstandings are widespread and sometimes result in misapplications. The aim of this consensus statement is, therefore, to enhance understanding, counter misinformation, and steer family-court utilisation of attachment theory in a supportive, evidence-based direction, especially with regard to child protection and child custody decision-making. The article is divided into two parts. In the first, we address problems related to the use of attachment theory and research in family courts, and discuss reasons for these problems. To this end, we examine family court applications of attachment theory in the current context of the best-interest-of-the-child standard, discuss misunderstandings regarding attachment theory, and identify factors that have hindered accurate implementation. In the second part, we provide recommendations for the application of attachment theory and research. To this end, we set out three attachment principles: the child’s need for familiar, non-abusive caregivers; the value of continuity of good-enough care; and the benefits of networks of attachment relationships. We also discuss the suitability of assessments of attachment quality and caregiving behaviour to inform family court decision-making. We conclude that assessments of caregiver behaviour should take center stage. Although there is dissensus among us regarding the use of assessments of attachment quality to inform child custody and child-protection decisions, such assessments are currently most suitable for targeting and directing supportive interventions. Finally, we provide directions to guide future interdisciplinary research collaboration.

Antidepressant treatment of perinatal depression is increasingly common and accepted in clinical guidelines. It has been suggested that serotonergic antidepressants may effect changes in the oxytocinergic system, including oxytocin levels, and that this may be one of the beneficial mechanisms of action for these drugs. Furthermore, oxytocin has been associated with the quality of the parent-child relationship, which may be important in treatment of perinatal depression. This study will explore if there is a relationship between antidepressant use over the perinatal period and oxytocin levels. Data from a pregnancy cohort study are used from 279 women across three groups: women taking antidepressants in pregnancy (n = 48), women with untreated depression (n = 31) and healthy control women (n = 200). Data included antidepressant use, maternal depression and oxytocin plasma concentrations in pregnancy and up to 12 months postpartum. We found that concurrent oxytocin blood concentrations were not associated with perinatal antidepressant use. However, oxytocin blood concentrations increased more steeply in those on antidepressants across the perinatal period compared to control women. A steeper increase for Selective Serotonergic Reuptake Inhibitors was observed, however, this effect was on the boarder of statistical significance. In conclusion, although antidepressant use and oxytocin was not associated at any time point, women taking antidepressants during pregnancy had larger increases in oxytocin over the perinatal period. Future research could examine specific agents and class of antidepressant and the relationship to parenting.

Evidence about the association between maternal mental health disorders and stillbirth and infant mortality is limited and conflicting. We aimed to examine whether maternal prenatal mental health disorders are associated with stillbirth and/or infant mortality. MEDLINE, Embase, PsycINFO, and Scopus were searched for studies examining the association of any maternal prenatal (occurring before or during pregnancy) mental health disorder(s) and stillbirth or infant mortality. A random-effects meta-analysis was used to calculate pooled odds ratios (ORs) with 95% confidence intervals (CIs). The between-study heterogeneity was quantified using the I2 statistic. Subgroup analyses were performed to identify the source of heterogeneity. Of 4487 records identified, 28 met our inclusion criteria with 27 contributing to the meta-analyses. Over 60% of studies examined stillbirth and 54% of them evaluated neonatal or infant mortality. Thirteen studies investigated the association between maternal depression and anxiety and stillbirth/infant mortality, pooled OR, 1.42 (95% CI, 1.16–1.73; I2, 76.7%). Another 13 studies evaluated the association between severe maternal mental illness and stillbirth/infant mortality, pooled OR, 1.47 (95% CI, 1.28–1.68; I2, 62.3%). We found similar results for the association of any maternal mental health disorders and stillbirth/infant mortality (OR, 1.59; 95% CI, 1.43–1.77) and in subgroup analyses according to types of fetal/infant mortality. We found no significant evidence of publication bias. Maternal prenatal mental health disorders appear to be associated with a moderate increase in the risk of stillbirth and infant mortality, although the mechanisms are unclear. Efforts to prevent and treat these disorders may reduce the scale of stillbirth/infant deaths.

Motor development underlies many aspects of education and learning. There has been uncertainty about the impact of exposure of antidepressant medication in pregnancy on child motor outcomes. This paper examines whether exposure to antidepressants in utero increases the risk of poorer motor development in two areas: sensorimotor and visuospatial processing. Data were obtained from 195 women and children across 3 groups: women with untreated depression in pregnancy, women treated with antidepressants and control women. Data were collected across pregnancy, postpartum and until 4 years for mother and child. Maternal depression was established at baseline with the Structured Clinical Interview for DSM-IV. Antidepressant exposure, including type, dose and timing, was measured through repeated self-report across pregnancy and the postpartum, medical records at delivery and in cord blood samples collected at delivery. Child sensorimotor and visuospatial outcomes were assessed at 4 years of age with four subtests from the NEPSY-II. Our study found for sensorimotor development, visuomotor precision completion time was associated with better performance for antidepressant-exposed children compared to those with mothers with untreated depression. Yet another measure of sensorimotor development, motor manual sequences, was poorer in those exposed to antidepressants. One subtest for visuospatial processing, block construction, was associated with poorer performance in antidepressant-exposed children who had poor neonatal adaptation and those exposed to a higher dose of antidepressant. These findings suggest an inconsistent association between sensorimotor development and antidepressant use in pregnancy. However, the findings for visuospatial processing would support further exploration of antidepressant associated poor neonatal adaption and later motor development.

Attachment theory and research are drawn upon in many applied settings, including family courts, but misunderstandings are widespread and sometimes result in misapplications. The aim of this consensus statement is, therefore, to enhance understanding, counter misinformation, and steer family-court utilisation of attachment theory in a supportive, evidence-based direction, especially with regard to child protection and child custody decision-making. This article is divided into two parts. In the first part, we address problems related to the use of attachment theory and research in family courts, and discuss reasons for these problems. To this end, we examine family court applications of attachment theory in the current context of the best-interest-of-the-child standard, discuss misunderstandings regarding attachment theory, and identify factors that have hindered accurate implementation. In the second part, we provide recommendations for the application of attachment theory and research. To this end, we set out three attachment principles: the child’s need for familiar, non-abusive caregivers; the value of continuity of good-enough care; and the benefits of networks of attachment relationships. We also discuss the suitability of assessments of attachment quality and caregiving behaviour to inform family court decision-making. We conclude that assessments of caregiver behaviour should take center stage. Although there is dissensus among us regarding the use of assessments of attachment quality to inform child custody and child-protection decisions, such assessments are currently most suitable for targeting and directing supportive interventions. Finally, we provide directions to guide future interdisciplinary research collaboration.

The Emotional Availability Scales (EAS) are the most widely reported observational assessment measure of parent–child relationships and has been of particular interest in understanding differences between samples of depressed and nondepressed mothers and their offspring. Despite its widespread use, psychometric validation of the factor structure in normative samples and the measurement of invariance within clinical samples has not been published. We evaluated the internal structure (dimensionality, reliability, convergent, and discriminant validity) of the EAS fourth edition using a nondepressed sample of 157 Australian women and their infants aged 6 months, including testing the measurement invariance of the EAS between the same nondepressed sample (n = 157), and a depressed group (n = 185) of mother–infant dyads, using MPlus. Participants were recruited from tertiary hospitals, and depression status was established using a diagnostic measure. Higher-order confirmatory factor analyses on the EAS’ six dimensions supported a unidimensional factor solution in our data. Full measurement invariance was not demonstrated due to metric noninvariance of the maternal nonintrusiveness and child responsiveness dimensions. Full scalar invariance supported mean comparisons, and a medium effect of .78SD lower mean emotional availability for the depressed group was found; Cohen’s d = .63, 95% CI [.41, .85]. While arguments exist for the clinical utility of differentiating between multiple dimensions of emotional availability, the current findings do not support a multidimensional factor structure or full multigroup measurement invariance of the EAS. Similar psychometric investigations of the EAS in clinical and nonclinical samples are needed.

Objective: Understanding the relationship between attachment and mental health has an important role in informing management of perinatal mental disorders and for infant mental health. It has been suggested that experiences of attachment are transmitted from one generation to the next. Maternal sensitivity has been proposed as a mediator, although findings have not been as strong as hypothesised. A meta-analysis suggested that this intergenerational transmission of attachment may vary across populations with lower concordance between parent and infant attachment classifications in clinical compared to community samples. However, no previous study has examined major depression and adult attachment in pregnancy as predictors of infant–parent attachment classification at 12 months postpartum. Methods: Data were obtained on 52 first-time mothers recruited in early pregnancy, which included 22 women who met diagnostic criteria for current major depression using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders. The Adult Attachment Interview was also administered before 20 weeks of pregnancy. A history of early trauma was measured using the Childhood Trauma Questionnaire and maternal sensitivity was measured at 6 months postpartum using the observational measure of the Emotional Availability Scales. Infant–parent attachment was measured using the Strange Situation Procedure at 12 months. Results: Overall, we found no significant association between the Adult Attachment Interview and the Strange Situation Procedure classifications. However, a combination of maternal non-autonomous attachment on the Adult Attachment Interview and major depression was a significant predictor of insecure attachment on the Strange Situation Procedure. We did not find that maternal sensitivity mediated parental and infant attachment security in this sample. Conclusion: While previous meta-analyses identified lower concordance in clinical samples, o

Understanding if maternal depression is a predictor of infant-parent attachment classification is important to furthering knowledge about the early pathways and predictors of socio-emotional development. Yet few studies that have utilised the Strange Situation Procedure, the gold standard for measurement of infant-parent attachment, have examined antenatal depression as a predictor of attachment, and none has also included a measure of maternal trauma. This study uses data on 224 women recruited in early pregnancy and followed up until 12 months postpartum. Maternal depression was measured in pregnancy using the Structured Clinical Interview for the DSM and repeat Edinburgh Postnatal Depression Scale as well as Stressful Life Events scale across pregnancy and postpartum including items on domestic violence. A past history of trauma was measured using the Childhood Trauma Questionnaire. Attachment was measured using the Strange Situation Procedure (SSP) at 12 months postpartum. We found that maternal depression was not associated with insecure or disorganized attachment. However, a maternal history of childhood trauma and current domestic violence both predicted insecure-avoidant attachment at 12 months, whereas increased number of stressful life events prior to conception and in pregnancy was associated with insecure-resistant attachment. Neither trauma, past or current, nor depression predicted disorganized attachment. In the first study to have included measures of antenatal depression, maternal childhood trauma, and current stressful events as predictors of infant attachment measured using the SSP, we found maternal experiences of past and current trauma but not depression were significant predictors of infant-parent attachment security.

Introduction Optimal mental health in the pre-conception, pregnancy and postpartum periods is important for both maternal and infant wellbeing. Few studies, however, have focused on Indigenous women and the specific risk and protective factors that may prompt vulnerability to perinatal mental disorders in this culturally diverse population. Objectives To assess mental health contacts in the period before childbirth among Australian Aboriginal and Torres Strait Islander women, the association with socioeconomic factors and whether it differs by geographic remoteness. Methods This is a retrospective cohort study of 19,165 Aboriginal mothers and includes all Aboriginal mothers and their children born in Western Australia from January 1990 to March 2015. It draws on population-level, linked administrative data from hospitals and mental health services, with a primary focus on the mental health contacts of Aboriginal women in the 5 years leading up to childbirth. Results The prevalence of maternal mental health contacts in the five years prior to birth was 27.6% (93.6% having a single mental health disorder), with a greater likelihood of contact in metropolitan areas compared with regional and remote settings. There was a positive relationship between socioeconomic advantage and the likelihood of a mental health contact for women in metropolitan (β = 0.044, p=0.003) and inner regional areas (β = 0.033, p=0.018), and a negative association in outer regional (β = -0.038, p=0.022), remote (β = -0.019, p=0.241) and very remote regions (β = -0.053, p<0.001). Conclusions The findings from this study provide new insights on the dynamic relationship between SES, geographic location and mental health issues among Aboriginal women in the five years leading up to childbirth. The results underscore the need to apply location-specific approaches to addressing the material and psychosocial pathways that lead to mental health problems and the provision of culturally safe, appropriate a

Understanding how a mother’s traumatic experiences influence her interactions with her infant may have importance for understanding infant development and mental health. Data for this study were drawn from an Australian pregnancy cohort, the Mercy Pregnancy and Emotional Wellbeing Study. Maternal trauma from Childhood, Childbirth Experiences, and Stressful Life Events were examined. At six-months postpartum, 211 predominantly first-time mothers (mean age 31.5 years), and their infants, were video-recorded interacting for 40 minutes. Interactions were assessed with the Emotional Availability (EA) Scales. Using structural equation modelling to test multiple mediation pathways, moderate-to-severe childhood trauma had only a direct effect on reducing maternal EA with the infant (β=−.17, p=.031), as did current stressful life events (β=−.19, p=.019), after controlling for maternal depression, age, and tertiary education. This highlights that proximate trauma specific to the perinatal period may not account for the effect of distal childhood trauma on maternal EA at six-months postpartum.

Motor development underlies many aspects of education and learning. There has been uncertainty about the impact of exposure of antidepressant medication in pregnancy on child motor outcomes. This paper examines whether exposure to antidepressants in utero increases the risk of poorer motor development in two areas: sensorimotor and visuospatial processing. Data were obtained from 195 women and children across 3 groups: women with untreated depression in pregnancy, women treated with antidepressants and control women. Data were collected across pregnancy, postpartum and until 4 years for mother and child. Maternal depression was established at baseline with the Structured Clinical Interview for DSM-IV. Antidepressant exposure, including type, dose and timing, was measured through repeated self-report across pregnancy and the postpartum, medical records at delivery and in cord blood samples collected at delivery. Child sensorimotor and visuospatial outcomes were assessed at 4 years of age with four subtests from the NEPSY-II. Our study found for sensorimotor development, visuomotor precision completion time was associated with better performance for antidepressant-exposed children compared to those with mothers with untreated depression. Yet another measure of sensorimotor development, motor manual sequences, was poorer in those exposed to antidepressants. One subtest for visuospatial processing, block construction, was associated with poorer performance in antidepressant-exposed children who had poor neonatal adaptation and those exposed to a higher dose of antidepressant. These findings suggest an inconsistent association between sensorimotor development and antidepressant use in pregnancy. However, the findings for visuospatial processing would support further exploration of antidepressant associated poor neonatal adaption and later motor development.

In the postscript to “Attachment Across the Life Cycle,” John Bowlby wrote: “Once we postulate the presence within the organism of an attachment behavioral system regarded as the product of evolution and as having protection as its biological function, many of the puzzles that have perplexed students of human relationships are found to be soluble” (1). This statement displays Bowlby's theoretical integration of evolutionary, functional, and behavioral levels of analysis, thereby giving attachment theory the ability to investigate a wide range of social and emotional relationships at both psychological and biological levels. There is a complex interaction between a person's attachment history, the quality of early experiences, and their propensity to addictive behaviors. Clinicians and therapists working in the addiction field address this reality on a daily basis, but the research that brings precision, systematization, and the capacity to test these assumptions is only beginning to gather pace. Connecting research in the two areas of attachment and addiction can be beneficial to each; the neurobiology of basic motivational systems of social affiliation might help us understand behavioral patterns and motivations of addiction, while the biology of addiction might help us identify the evolved systems underlying attachment. In May 2018, in the grounds of the Schloß Schönbrunn in Vienna nearly 400 delegates gathered to discuss the many facets of the relationship between attachment and addiction. Following the success of the “Sucht und Bindung” [Addiction and Attachment] conference—graciously hosted by the Grüner Kreis Society—we put out a call for papers for a Frontiers Research Topic. We were delighted to receive 22 high quality papers providing both original studies, reviews of the latest findings, theoretically oriented discussions, and applications to clinical treatments.

The prevalence of pacifier use is high but when it occurs outside of the recommended sleep context, it becomes more controversial. Using 211 mother-infant dyads recorded as part of the Mercy Pregnancy and Emotional Wellbeing Study, we examined the maternal psychosocial predictors of pacifier use within an interaction task (i.e., ten minutes face-to-face followed by 30-minutes unstructured play). Predictors included maternal emotional availability measured with the Emotional Availability Scales; depression measured by the Structured Clinical Interview for the DSM-IV-TR Clinician Version; and maternal history of childhood trauma measured by the Childhood Trauma Questionnaire. An unadjusted odds ratio demonstrated that women classified as non-emotionally available to their infants were three-and-a-half-times more likely to use a pacifier. Multivariate logistic regression including all maternal psychosocial predictors demonstrated that even when adjusting for cessation of breastfeeding, maternal emotional availability remained the only significant predictor of pacifier use. This is the first time that predictors of pacifier use have been examined with a sample of clinically depressed women, as well as women with childhood trauma history. The results provide preliminary evidence that women who are not emotionally available might be more likely to rely on a pacifier during mother-infant interaction.

Background The development of childhood anxiety disorders (CADs) is likely to depend on pathways that can be programmed by early-life risk factors. We test the hypothesis that early-life maternal factors can predict this programming effect on CAD. Methods Data were obtained from 198 women and children from the Mercy Pregnancy and Emotional Wellbeing Study (MPEWS), a cohort study with data collected across pregnancy, postpartum and until 4 years of age. Maternal antenatal depression was measured using the Structured Clinical Interview for DSM-IV (SCID-IV), together with antenatal hair cortisol concentrations, maternal childhood trauma and parenting stress at 6 months postpartum. CAD was assessed with the Preschool Age Psychiatric Assessment and the Child Behaviour Checklist. Results Antenatal depression, a history of maternal childhood trauma and lower gestational age at birth were each associated with anxiety disorders at 4 years of age in their children. A multivariate binary logistic model with these early predictors explained approximately 9% of variance in CAD outcome at 4 years of age; however, only maternal trauma and gestational age were significant predictors in the model. The effect of early parenting stress on CAD was found to vary by the concentration of maternal antenatal hair cortisol, whereby postpartum parenting stress was associated with CAD only when there were higher maternal antenatal cortisol levels. Conclusions This study suggests the importance of maternal factors pre-conception, pregnancy and in the postnatal period, which predict CADs and this is consistent with a developmental programming hypothesis for CAD.

Oxytocin has been a hormone of interest in understanding both depression and parenting. Here, the role of oxytocin has been explored in understanding the interaction between perinatal depression, history of trauma and subsequent longer-term child socio-emotional outcomes. Data were obtained from 203 pregnant women from the Mercy Pregnancy and Emotional Wellbeing Study (MPEWS), a pregnancy cohort study with data collected across pregnancy, postpartum and until 4 years for mother and child. Maternal antenatal depression was measured using the Structured Clinical Interview for DSM-IV (SCID-IV) together with the Childhood Trauma Questionnaire to measure maternal trauma history. Maternal oxytocin levels were measured by enzyme immunoassay following extraction at four time points across pregnancy and the postpartum. The offspring consisted of 203 children followed up from birth until 4 years of age when they were assessed for DSM 5 depression and anxiety disorders (emotional disorders) using the Preschool Age Psychiatric Assessment. Maternal oxytocin levels increased over pregnancy and the postpartum in both control and depressed women with no difference between groups. Maternal childhood trauma and antenatal antidepressant use was also not associated with maternal oxytocin levels. Lower gestational age, maternal depression and early childhood trauma, and late pregnancy oxytocin concentrations were associated with later childhood emotional disorders; together they predicted 10% of variance for emotional disorders. Oxytocin is a hormone whose role in understanding intergenerational risk from pregnancy to child emotional disorders is dependent on relational context. Future research can expand on understanding these important early predictors of childhood mental health.

Over the past 70 years, attachment theory and associated research have documented the crucial role of continuity of care and stable caregivers to serve as attachment figures, and this has had a major effect on public mental health policy...

Pregnancy is a time of physical and emotional vulnerability, which can potentially lead to or exacerbate depression. Sadly, suicide is a leading cause of death in both high- and low-income countries.1,2 Although psychological therapies are effective and may be sufficient treatment for depression in pregnancy, for some women, antidepressant treatment may be required. Research also suggests that when women abruptly cease antidepressants in pregnancy, suicidal ideation may increase.3

Background Both antidepressant use and depression in pregnancy have the potential to impact on outcomes for the women, their mother-infant relationship and their infants. Methods Data were obtained from 485 pregnant women within Mercy Pregnancy and Emotional Wellbeing Study, a pregnancy cohort study. The sampling frame was in three groups: those depressed women taking antidepressants in pregnancy, women with diagnosed depression not taking an antidepressant and control women. Depression was measured using the Structured Clinical Interview for DSM-IV and repeat Edinburgh Postnatal Depression Scale and antidepressant use by repeat self-report, hospital records and blood levels. In addition, data on key maternal, parenting and infant outcomes were collected. Results This study found, for women taking SNRI antidepressant medication there was an elevated rate of pregnancy hypertension. Infants exposed to antidepressants had lower Apgar scores and higher birth weight and this was not associated with dose or class of antidepressant. In contrast, women with higher depressive symptoms had lower maternal antenatal attachment and higher postpartum parenting stress. Both women with depression and those taking antidepressants were less likely to initiate breastfeeding. On the Ages and Stages Questionnaire, there was a significant difference in communication skills in SSRI antidepressant exposed infants at 12 months. Limitations Individual antidepressants could not be examined and development was only measured to 12 months Conclusions Overall, the study identified that antidepressant treatment in pregnancy was significantly associated with only a limited number of poorer maternal and infant outcomes and was not associated with poorer parenting outcomes.