Introduction
Aims of the study
Method
Participants and general procedures
Measures
Pregnancy measures: maternal mental health
Disordered personality traits
Maternal depressive symptoms
Borderline personality disorder
Outcomes at 3 months postpartum
Mothers perceived bonding: Postpartum Bonding Questionnaire (PBQ)
Observational mother–infant interactions: CARE-Index
Sociodemographic characteristics
Maternal substance use
Missing data
Statistical analysis
Results
Sample representativeness
Descriptive statistics
PBQ data (N = 459) | CARE-Index data (sub-sample, n = 206) | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Low SAPAS scores < 3 N = 356 | High SAPAS scores ≥ 3 N = 103 | t/X2 (df) | p | Overall (total) N = 459 | Low SAPAS scores < 3 N = 144 | High SAPAS scores ≥ 3 N = 62 | t/X2 (df) | p | Overall (total) N = 206 | |
Maternal mental health | ||||||||||
Depressive symptoms across pregnancy EPDS | ||||||||||
Mean (SD) | 6.98 (4.83) | 11.52 (5.66) | − 8.07 (457) | < 0.001 | 8.00 (5.37) | 7.80 (5.00) | 12.15 (5.61) | − 5.51 (204) | < 0.001 | 9.11 (5.55) |
Range | 0–24 | 1–28 | 0–28 | 0–22 | 1–28 | 0–28 | ||||
Median (IQR) | 6.5 (7) | 11 (6.5) | 7 (7.5) | 7 (7.5) | 11.5 (8) | 9 (8.5) | ||||
Borderline personality disorder (SCID-II) | ||||||||||
No | 355 (99.7%) | 94 (91%) | 26.81 (1) | < 0.001 | 449 (98%) | 144 (100%) | 56 (90%) | 14.35 (1) | < 0.001 | 200 (97%) |
Yes | 1 (0.3%) | 9 (9%) | 10 (2%) | 0 (0%) | 6 (10%) | 6 (3%) | ||||
Maternal characteristics | ||||||||||
Age (years) | ||||||||||
Mean (SD) | 33.62 (5.19) | 30.49 (5.37) | 5.34 (457) | < 0.001 | 32.92 (5.39) | 33.80 (4.75) | 29.84 (5.34) | 5.28 (204) | < 0.001 | 32.60 (5.25) |
Range | 18–48 | 19–43 | 18–48 | 19–45 | 19–40 | 19–45 | ||||
Median (IQR) | 34.21 (6.71) | 31.01 (7.71) | 33.44 (7.52) | 34.44 (6.32) | 30.50 (8.26) | 33.01 (7.15) | ||||
Ethnicity | ||||||||||
White | 208 (58%) | 50 (48%) | 8.30 (4) | 0.071 | 258 (56%) | 88 (61%) | 32 (51%) | 9.06 (4) | 0.052 | 120 (58%) |
Black/Caribbean | 98 (27%) | 39 (38%) | 137 (30%) | 33 (23%) | 24 (39%) | 57 (28%) | ||||
Asian/Asian British | 13 (4%) | 6 (6%) | 19 (4%) | 4 (3%) | 3 (5%) | 7 (3%) | ||||
Mixed/multiple ethnicity | 17 (5%) | 1 (1%) | 18 (4%) | 8 (5%) | 0 (0%) | 8 (4%) | ||||
Other | 20 (6%) | 7 (7%) | 27 (6%) | 11 (8%) | 3 (5%) | 14 (7%) | ||||
Education | ||||||||||
None/school qualifications | 32 (9%) | 16 (15%) | 8.68 (2) | 0.013 | 48 (11%) | 12 (8%) | 11 (18%) | 5.93 (2) | 0.051 | 23 (11%) |
College/diploma/higher/certificate/training | 120 (34%) | 44 (43%) | 164 (36%) | 49 (34%) | 25 (40%) | 74 (36%) | ||||
Degree level/postgraduate qualifications | 204 (57%) | 43 (42%) | 247 (53%) | 83 (58%) | 26 (42%) | 109 (53%) | ||||
Employment statusa | ||||||||||
Employed | 254 (72%) | 51 (50%) | 18.61 (4) | 0.001 | 305 (67%) | 107 (75%) | 32 (52%) | 16.18 (4) | 0.002 | 139 (68%) |
Student | 15 (4%) | 4 (4%) | 19 (4%) | 2 (1%) | 3 (5%) | 5 (2%) | ||||
Unemployed | 31 (9%) | 18 (18%) | 49 (11%) | 11 (8%) | 10 (16%) | 21 (10%) | ||||
Homemaker | 36 (10%) | 19 (19%) | 55 (12%) | 19 (13%) | 8 (13%) | 27 (13%) | ||||
Not working due to illness/other | 19 (5%) | 10 (10%) | 29 (6%) | 4 (3%) | 8 (13%) | 12 (6%) | ||||
Incomeb | ||||||||||
< £15,000 | 37 (13%) | 20 (28%) | 13.59 (4) | 0.009 | 57 (16%) | 18 (15%) | 13 (28%) | 15.66 (4) | 0.004 | 31 (19%) |
£15,000–£30,999 | 46 (16%) | 14 (19%) | 60 (16%) | 12 (10%) | 13 (28%) | 25 (15%) | ||||
£31,000–£45,999 | 43 (15%) | 12 (17%) | 55 (15%) | 19 (16%) | 4 (9%) | 23 (14%) | ||||
£46,000–£60,999 | 50 (17%) | 8 (11%) | 58 (16%) | 18 (15%) | 4 (11%) | 23 (14%) | ||||
£61,000 or more | 115 (39%) | 18 (25%) | 133 (37%) | 53 (44%) | 5 (24%) | 64 (38%) | ||||
Relationship status | ||||||||||
In a relationship/marriage/cohabiting | 325 (91%) | 82 (80%) | 10.85 (1) | 0.001 | 407 (89%) | 133 (92%) | 48 (77%) | 9.07 (1) | 0.003 | 181 (88%) |
Single/separated/divorced/widowed | 31 (9%) | 21 (20%) | 52 (11%) | 11 (8%) | 14 (23%) | 25 (12%) | ||||
Have older children | ||||||||||
No | 171 (48%) | 54 (52%) | 0.62 (1) | 0.432 | 225 (49%) | 63 (44%) | 36 (58%) | 3.56 (1) | 0.059 | 99 (48%) |
Yes | 185 (52%) | 49 (48%) | 234 (51%) | 81 (56%) | 26 (42%) | 107 (52%) | ||||
Infant characteristics | ||||||||||
Gestational age at birth (weeks) | ||||||||||
Mean (SD) | 39.17 (1.99) | 39.12 (2.36)c | 0.22 (456) | 0.827 | 39.16 (2.07) | 39.44 (1.47) | 38.87 (2.55) | 2.11 (204) | 0.036 | 39.27 (1.88) |
Range | 24–42 | 25–42 | 24–42 | 33–41 | 25–42 | 25–42 | ||||
Median (IQR) | 39 (1) | 40 (3) | 40 (1) | 40 (2) | 39 (2) | 40 (1) | ||||
Birth weight (grams)d | ||||||||||
Mean (SD) | 3326 (534.55) | 3312 (697.49) | 0.20 (453) | 0.840 | 3323.14 (574.28) | 3380 (468.75) | 3273 (616.32) | 1.34 (201) | 0.181 | 3347.79 (518.26) |
Range | 490–4620 | 360–4720 | 360–4720 | 1596–4504 | 778–4160 | 778–4504 | ||||
Median (IQR) | 3365 (600) | 3450 (725) | 3390 (615) | 3390 (575) | 3300 (799) | 3375 | ||||
Infant sexe | ||||||||||
Female | 179 (50%) | 52 (50%) | 0.00 (1) | 0.991 | 231 (50%) | 78 (54%) | 34 (55%) | 0.01 (1) | 0.929 | 112 (54%) |
Male | 176 (50%) | 51 (50%) | 227 (50%) | 66 (46%) | 28 (45%) | 94 (46%) | ||||
Infant age (weeks) | ||||||||||
Mean (SD) | 15.40 (2.48) | 15.33 (2.16)2 | 0.24 (456) | 0.808 | 15.39 (2.41) | 15.90 (2.75) | 15.54 (2.25) | 0.93 (204) | 0.354 | 15.79 (2.61) |
Range | 11–24 | 12–21 | 11–24 | 11–23 | 12–21 | 11–23 | ||||
Median (IQR) | 15 (3) | 15 (3) | 15 (3) | 15 (4) | 15 (3) | 15 (3) | ||||
Maternal substance usef | ||||||||||
Alcohol consumption harmful or hazardous in the last year (AUDIT)g | ||||||||||
No | 323 (93%) | 85 (86%) | 5.67 (1) | 0.017 | 408 (92%) | 129 (93%) | 52 (87%) | 1.92 (1) | 0.166 | 181 (91%) |
Yes | 23 (7%) | 14 (14%) | 37 (8%) | 10 (7%) | 8 (13%) | 18 (9%) | ||||
Drug-related problem in the last year (DUDIT)h | ||||||||||
No | 318 (91%) | 88 (87%) | 1.63 (1) | 0.201 | 406 (90%) | 127 (90%) | 50 (82%) | 2.58 (1) | 0.108 | 177 (88%) |
Yes | 30 (9%) | 13 (13%) | 43 (10%) | 14 (10%) | 11 (18%) | 25 (12%) |
Low SAPAS scores < 3 | High SAPAS scores ≥ 3 | t/X2 (df) | p | Overall (total) | |
---|---|---|---|---|---|
Outcome | |||||
Mother’s perception of bonding (PBQ score) | |||||
N | 356 | 103 | 459 | ||
Mean (SD) | 7.42 (7.47) | 8.08 (7.99) | − 7.76 (457) | 0.438 | 7.57 (7.58) |
Range | 0–55 | 0–43 | 0–55 | ||
Median (IQR) | 5 (8) | 6 (10) | 5 (9) | ||
Mother–infant interaction patterns | |||||
N | 144 | 62 | 206 | ||
Maternal sensitivity | 4.49 (2.93) | 3.40 (2.66) | 2.51 (204) | 0.013 | 4.17 (2.89) |
Range | 0–13 | 0–11 | 0–13 | ||
Median (IQR) | 4 (4) | 3 (4) | 4 (4) | ||
Maternal control | 3.28 (3.96) | 4.82 (4.31) | − 2.50 (204) | 0.013 | 3.74 (4.12) |
Range | 0–13 | 0–14 | 0–14 | ||
Median (IQR) | 1 (7) | 4 (7) | 2 (7) | ||
Infant cooperation | 3.39 (3.02) | 2.32 (2.79) | 2.38 (204) | 0.018 | 3.07 (2.99) |
Range | 0–13 | 0–12 | 0–13 | ||
Median (IQR) | 3 (4) | 2 (3) | 2 (3) | ||
Infant compulsiveness | 3.97 (4.26) | 5.32 (4.23) | − 2.09 (204) | 0.038 | 4.38 (4.29) |
Range | 0–13 | 0–13 | 0–13 | ||
Median (IQR) | 2 (7) | 6 (9) | 3 (8) | ||
Infant difficult | 2.58 (2.38) | 2.98 (2.80) | − 1.05 (204) | 0.296 | 2.70 (2.52) |
Range | 0–10 | 0–11 | 0–11 | ||
Median (IQR) | 2 (2.5) | 2 (4) | 2 (3) |
Unadjusted univariate analysis
Outcomes | Model 1: unadjusted | Model 2: adjusting for maternal and infant confounding factorsa | Model 3: adjusting for maternal and infant confounding factors and maternal substance misuse in the last year prior to early pregnancyb | Model 4: adjusting for maternal and infant confounding factors, maternal substance misuse in the last year prior to early pregnancy and pregnancy depressive symptomsc | ||||
---|---|---|---|---|---|---|---|---|
Coefficient (95% CI) | p | Coefficient (95% CI) | p | Coefficient (95% CI) | p | Coefficient (95% CI) | p | |
PBQ (self-report) (n = 459) | 0.30 (− 0.19 to 0.79) | 0.230 | 0.41 (− 0.10 to 0.93) | 0.115 | 0.41 (− 0.12 to 0.94) | 0.129 | − 0.09 (− 0.65 to 0.57) | 0.750 |
Mother–infant patterns (n = 206) | ||||||||
Mother patterns | ||||||||
Sensitive | − 0.39 (− 0.65 to − 0.14) | 0.003 | − 0.28 (− 0.56 to − 0.01) | 0.044 | − 0.28 (− 0.56 to − 0.00) | 0.049 | − 0.19 (− 0.48 to 0.11) | 0.217 |
Control | 0.47 (0.10 to 0.83) | 0.012 | 0.24 (− 0.14 to 0.61) | 0.209 | 0.23 (− 0.15 to 0.61) | 0.229 | 0.15 (− 0.26 to 0.55) | 0.483 |
Infant patterns | ||||||||
Cooperative | − 0.36 (− 0.63 to − 0.10) | 0.007 | − 0.24 (− 0.52 to 0.04) | 0.096 | − 0.24 (− 0.53 to 0.05) | 0.105 | − 0.14 (− 0.45 to 0.17) | 0.370 |
Compulsive | 0.31 (− 0.07 to 0.70) | 0.110 | 0.03 (− 0.36 to 0.43) | 0.864 | 0.02 (− 0.38 to 0.41) | 0.931 | − 0.07 (− 0.49 to 0.36) | 0.764 |
Difficult | 0.12 (− 0.10 to 0.35) | 0.279 | 0.09 (− 0.16 to 0.34) | 0.486 | 0.10 (− 0.15 to 0.35) | 0.429 | 0.11 (− 0.16 to 0.38) | 0.413 |
Multivariable regression analysis
Maternal sensitivity | ||
---|---|---|
Adjusted R2 | 0.07 | |
Predictors | Coefficient (95% CI) | p |
Disordered personality traits (SAPAS scores continuous) | − 0.19 (− 0.48 to 0.11) | 0.217 |
Maternal age (years) | 0.10 (0.00–0.18) | 0.046 |
Older children | ||
No | Reference | |
Yes | − 0.15 (− 1.02 to 0.71) | 0.727 |
Infant gestational age at birth (weeks) | 0.01 (− 0.20 to 0.22) | 0.923 |
Infant gender | ||
Female | Reference | |
Male | − 0.17 (− 0.96 to 0.62) | 0.675 |
Maternal highest education level | ||
None/school qualifications | Reference | |
College/diploma/higher/certificate/training | − 0.32 (− 1.71 to 1.06) | 0.644 |
Degree level/postgraduate qualifications | 0.40 (− 0.01 to 2.80) | 0.578 |
Harmful or hazardous alcohol consumption during the year prior to pregnancy | ||
No | Reference | |
Yes | 0.44 (− 1.08 to 1.95) | 0.571 |
Drug-related problems during the year prior to pregnancy | ||
No | Reference | |
Yes | 0.88 (− 0.45 to 2.22) | 0.193 |
Pregnancy depressive symptoms (mean EPDS score continuous) | − 0.06 (− 0.14 to 0.01) | 0.100 |