Maja Brekalo

Maternal-foetal bonding represents a bond that a mother has with her foetus. This study aimed to examine the psychometric properties of the Prenatal Attachment Inventory (PAI) in Croatian pregnant women. Adult pregnant women (N = 850) between 13 and 28 weeks of pregnancy filled out the PAI, Edinburgh Postnatal Depression Scale (EPDS), anxiety subscale of the Depression, Anxiety, and Stress Scale (DASS-21), and Pregnancy Concerns Scale (PCS). Confirmatory factor analyses (CFA) have shown that the hypothesised factor structures from previous studies demonstrated poor model fit. Subsequently, exploratory factor analysis (EFA) was conducted on half of the sample (n = 425) and revealed a two-factor structure. However, this was not confirmed by the CFA on the other half of the sample. Because the items mainly referred to baby movement, the process was repeated in a sub-sample of women pregnant 20 weeks or more (n = 502), with EFA and CFA conducted on half of the sub-sample. In the EFA, 21 items were reduced to 13, with three factors identified. In the CFA, we accepted the higher-order factor model with three first-order factors: Affection towards the foetus, Familiarity with foetal movement and behaviour, and Fantasising about the foetus. The total scale and three subscales demonstrated high reliability, good divergent validity, and adequate discriminant validity. Prenatal Attachment Inventory with 13 items has good psychometric properties when applied after 20 weeks of pregnancy. Further research is needed to establish valid measures for early maternal-foetal bonding

Mother-infant bonding refers to emotional, cognitive, neurobiological, and behavioural ties between mother and infant. It is a process that develops from pregnancy throughout infancy. Rejection sensitivity could be one of the risk factors for impaired bonding, and it is defined as a personality disposition that is characterised by an anxious expectation of rejection in social situations. It is known that rejection sensitivity is a predictor of problems in relationships, but its association with difficulties in mother-infant bonding is still unknown. This was a three-wave online longitudinal study. In this study, 1052 women participated in the second trimester of pregnancy (T1), 879 of them participated during the third trimester (T2), and 758 of them in the postpartum period (T3; 6-21 weeks). Women completed the Adult Rejection Sensitivity Questionnaire, Prenatal Attachment Inventory, Postpartum Bonding Questionnaire, and Sociodemographic and obstetric data. Mother-infant bonding had three dimensions: Impaired bonding, Anxiety about care and maternal distress, and Lack of enjoyment and affection with the baby. The path analysis was conducted where rejection sensitivity (T1) was the predictor, mother-foetal bonding (T2) mediator, and mother-infant bonding (T3) criterium while parity, education level, and place of living were covariates. Higher rejection sensitivity predicted impaired dimensions of mother-infant bonding in the postpartum directly and indirectly via lower mother-foetal bonding during pregnancy. Women with high rejection sensitivity are at risk for impaired bonding in the peripartum period. Those women should be identified during pregnancy, and special attention should be given to prevent bonding difficulties.

Gestational diabetes mellitus (GDM) and peripartum depression (PPD) are increasing global health issues with potentially long-lasting adverse outcomes. While limited studies suggest a bidirectional relationship between GDM and PPD, most research has been cross-sectional and focused on one direction of the relationship, primarily if GDM predicts postpartum depression. The interplay between antenatal depression and GDM is less explored, with a critical lack of prospective bidirectional studies. This longitudinal study aimed to investigate the bidirectional relationship between GDM and PPD in a total sample and according to different pre-pregnancy body mass index (BMI) categories. Specifically, we examined whether antenatal depression symptoms predict a subsequent GDM diagnosis and whether GDM predicts subsequent postpartum depression symptoms. A three-wave online longitudinal study included 360 women who were followed from the second trimester (20–28 weeks, T1) through the third trimester (32–42 weeks, T2), and into the postpartum period (6–20 weeks after birth, T3). Participants completed the General Data Questionnaire, one item about the diagnosis of GDM, and the Edinburgh Postnatal Depression Scale (EPDS). The sample was stratified according to pre-pregnancy BMI into normal-weight (N = 247) and overweight/obese (N = 113) subgroups. Women with type I and II diabetes, GDM at T1, and underweight BMI were excluded. In the total sample, antenatal depression symptoms predicted GDM, whereas GDM did not predict postpartum depression symptoms. A bidirectional relationship was observed in normal-weight women, where antenatal depression symptoms predicted subsequent GDM diagnosis, and GDM diagnosis predicted postpartum depression symptoms. In contrast, no associations were found in either direction in the overweight/obese subgroup. This study provides evidence of a bidirectional relationship between GDM and PPD only in women with normal body weight before pregnancy. The results highlight the complexity of the relationship between peripartum mental and metabolic health, that is dependent on pre-pregnancy BMI. Clinicians should be aware that normal-weight women may have a unique sensitivity to the bidirectional interplay between GDM and PPD. Pregnant women should be closely monitored for both mental and metabolic health issues and targeted for prevention programs to reduce the risks and burdens associated with both conditions.

Although scales that evaluate postpartum stress exist, they lack specificity in maternal postpartum stress. The MPSS was created because there was a need to assess maternal stress during the postpartum stage. The introduction of the MPSS has enriched the evaluation tools for postpartum stress and has helped understand maternal stress at various postpartum time points and identify women at high risk for postpartum stress during this period. The aim was to translate the MPSS into Spanish and study its psychometric properties. Postpartum women (N = 167) with a mean age of 34.26 (SD = 4.71) were involved in this study. In addition to the MPSS, a battery of instruments was administered: a demographic sheet, the Birth Satisfaction Scale-Revised (BSS-R) and the Edinburgh Postnatal Depression Scale (EPDS). The MPSS data were analyzed, checking item communality first. As a result, three items showed unsatisfactory communality values (h² < 0.40). Confirmatory Factor Analysis was conducted, comparing factor models using the full pool of MPSS items or the version without items with unacceptable communality. As a result, the original three-factor structure was endorsed on the Spanish MPSS, with better fit indices when removing items with low communality (RMSEA = 0.067, CFI = 0.99, TLI = 0.99). The reliability of this version was satisfactory (ω = 0.93). Finally, group comparisons for some perinatal variables were performed, showing no significant differences between groups of interest (p = 0.05 and above). To conclude, the MPSS will contribute to the existing literature, having a wider capacity to assess perinatal mental health difficulties in Spanish-speaking populations.

Objectives: The metacognitive model of rumination and depression (Papageorgiou & Wells, 2003, Cognitive Therapy and Research , 27, 261) postulates that beliefs that perseverative negative thinking, i.e. rumination, will help solve problems contributing to rumination. However, this activates negative beliefs about the uncontrollability and social consequences of ruminations, which exacerbate depression. The metacognitive model has been well‐supported but with some inconsistencies in specific pathways. It has also not yet been tested for postpartum depression (PPD). Therefore, this study aimed to examine the relations between the metacognitive model of rumination and depression when applied to PPD symptoms and to compare it with the cognitive model of depression. Design: This is a cross‐sectional study. Method: Postpartum mothers ( N = 603) participated in an online study in their first postpartum year. They completed the Edinburgh Postnatal Depression Scale (EPDS), Postnatal Negative Thoughts Questionnaire (PNTQ), Ruminative Responses Scale (RRS), Positive Beliefs about Rumination Scale (PBRS) and Negative Beliefs about Rumination Scale (NBRS). Results: A path analysis revealed that the model had an excellent fit to the data. Specifically, positive beliefs about rumination predicted engagement in rumination that, in turn, predicted PPD, both directly and indirectly, through negative beliefs about uncontrollability and the social consequences of rumination. A cognitive model with ruminations as a partial mediator between negative postpartum thoughts and PPD symptoms also had a good fit. Conclusion: The findings of this study contribute to the understanding of the cognitive and metacognitive mechanisms underlying postpartum depression, which might be similar to depression in general and have important implications for treatment strategies.

The City Infant Faces Database (CIFD; Webb et al., 2018) is a database of 154 infant emotional expressions for use in experimental studies of infant facial communication, facial expression recognition, and parental sensitivity. The CIFD was validated only in a small sample from the general public and student midwives and nurses in the UK. This study, therefore, aimed to validate it in a larger sample of Croatian students and parents of 1-12 months old infants. Three-hundred and fifty students (Study 1), 422 mothers and 106 fathers (Study 2) were presented with images of Caucasian infant faces. The students rated images from the CIFD and Tromso Infant Faces. They also completed questionnaires measuring empathy, alexithymia, and perceiving and expressing emotions. The parents rated the valence of facial expressions of images from the CIFD. The results were consistent with the initial validation in both the students and parents' sample, except that agreement for negative images was lower for Croatian parents than in the UK study. Compared to the UK study, students rated images as more intense, clear, genuine, and reported stronger internal emotion. Furthermore, there was no difference in accuracy between mothers and fathers or between first-time parents and experienced parents. The CIFD is, therefore, a promising tool for research and should be further validated in other countries, focusing on its predictive validity.