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Postpartum Depression Effects on the Baby

Postpartum Depression Effects on the Baby

Abstract

Postpartum depression occurs commonly among new mothers, but may affect both parents. Previous research proved that the mood deteriorations cause negative effects on the baby. This paper aims to describe the postpartum depression effects on the newborn, both short and long-term. The paper discusses the primary research and big literature reviews from respected institutions regarding this problem. Data from observational studies is discussed and possible pathophysiological mechanisms are introduced. The limitations of these studies are also mentioned. Results from both high- and low-income countries are compared and critically analyzed. This manuscript shows that postpartum depression clearly has early harmful effects on the baby. However, the remote consequences may not be as deleterious if the mood disorder is compensated. At the same time, the long-term effects are still not known.

Introduction

Postpartum depression is a common complication of childbearing. This condition poses potential negative effects for the mother, her maternal abilities, the family, and the child. A newborn baby has little resources for physical and mental development, except for those provided by the mother. The mother feeds the newborn baby and supplies her offspring with psychological nurture. Although in the majority of cases depressive complications are limited to women, poorly managed postpartum depression can have a number of adverse effects on the baby. In the early period, premature cessation of breastfeeding can occur. The latter may cause stunting and growth retardation of the child. Behavioral effects on the baby persist in the first years. In the longer periods, cognitive impairments develop, and children may show lower IQ levels. At the same time, the literature is inconclusive on the long-term consequences, so this area still needs verification and additional studies. Postpartum depression is evidently an indicator of the lower development score, but its exact mechanisms need to be studied more. Careful and individualized approach to such situations may neutralize the adverse effects of postpartum depression on babies.

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Definition

In 1994, the American Psychiatric Association recognized the major depressive disorder as a clinical entity for the first time. At the time, experts suggested that a major depressive disorder is:

A period of at least 2 weeks during which there is either depressed mood or loss of interest or pleasure in nearly all activities. The individual must also experience at least four symptoms: changes in appetite or weight, sleep and psychomotor activity, decreased energy, feelings or worthless or guilt, difficulty thinking, concentrating or making decisions, or recurrent thoughts of death or suicidal ideation, plans or attempts. The episode must be accompanied by clinically significant distress or impairment in social, occupational, or other important areas of functioning (Segre & Davis, 2013).

The Diagnostic and Statistical Manual of Mental Disorders initially included postpartum onset, defined as deterioration within four weeks after delivery. In the following decades, hard scientific discussions continued and currently the official classification states that depression may have a postpartum specification that includes a time period of six months after the delivery (Segre & Davis, 2013). In general, the symptoms of postpartum depression among mothers are the same as those of other women, except they are linked to the delivery. The World Health Organization study reports that about 13% of all women suffer from this condition after parturition; the real incidence may be higher and reach 20%-40% because postpartum depression is still underdiagnosed (Field, 2010; Stewart et al., 2003). At the same time, the rate of maternal postpartum depression naturally diminishes by the first year after the event (Morais et al., 2013).

Problem Statement

Postpartum depression carries specific risks both for the parents and for the baby. Soon after birth, a child undergoes rapid mental and physical development. The baby grows fast, and within this process, all organs and systems mature also including the nervous system. Adequate body maturation requires nutrients and energy supplementation, while for the nervous and psychological development environment ought to be healthy. For a long time, psychologists have seen that in the first weeks of life the mother and the baby enter each other’s social world and interact intimately (Stewart et al., 2003). The parents, especially the mother are the cornerstone of the new human’s world. Therefore, it is logical to assume that the psychological condition of the mother will have a strong impact on the future life of the child. A good relationship between the mother and a newborn makes the child feel loved, and it is the basis of good behavior and social skills. The abilities to learn the relevant skills in behavior, thinking, and communication are encoded by the early patterns presented to the baby.

Postpartum depression in the woman is professionally managed in modern healthcare (Segre & Davis, 2013). However, the impact of postpartum disorders on newborn infants has not been thoroughly studied yet. The mother’s ongoing depression can contribute to the emotional, behavioral, cognitive, and interpersonal problems in her child’s life (Stewart et al., 2003). Recent researches indicate that there is an increase in the numbers of toddlers who experience problems in their psychological development based on postpartum depression. Apparently, bringing up a child with psychological posttraumatic conditions can be problematic for the family. The number of trained nurses who can handle cases of postpartum disorders is still low. Therefore, there is an emerging need to conduct research on the strategies that can enhance the wellbeing of the affected.

The negative effects of postpartum depression on the baby can be avoided or, at least, partially alleviated. Parents, in collaboration with the child’s physician, can apply several mechanisms to reduce the effects of postpartum depression. For instance, a mother who plays around with her child can help the infant overcome their feelings of fear and development of relevant skills. Besides, breastfeeding enhances the bonding between the mother and her child, which can resolve negative effects. A mother of an infant who suffers from postpartum stress can seek advice from family and friends, which can be of benefit in taking care of the child. Furthermore, an improvement of the education system for clinicians can enhance their skills in detection of postpartum disorders and giving appropriate support.

Background

The exact mechanism of why depression develops remains unknown. The recent neuroscience data suggests that a disturbance in serotonin activity in the central nervous system is the leading mechanism (Figure 1)

Mechanism of depression

Figure 1. Mechanism of depression. The spinal horns (shown in the left part) send signals to the hippocampus (shown in the brain). Here, the serotonin-sensitive neurons process the information. Hippocampus also receives signals from the adrenal glands through the pituitary gland. When the balance of the limbic-hypothalamic-pituitary-adrenal axis is altered, depression occurs. Enhancement of serotonin amounts in the neuronal axons with pharmacological agents is one of the treatment plans offered by psychiatry (modified from López, 2016).

Delivery is thought to disrupt the normal neuronal patterns that support the hippocampus and cause serotonin depletion. The risk factors for the depression in the postpartum period are depression/anxiety and stressful life events during pregnancy or the early puerperium, low levels of social support, and having a previous history of depression (Stewart et al., 2003). Hormonal disarrangements and genetic factors may also play an important role (López, 2016). If left untreated, postpartum depression causes problems for the mother herself, the father, and the child.

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Purpose of the Study

The current paper provides a literature review about the effects of postpartum depression on the baby. A thorough scientific research is performed and scholarly articles are identified. The current understanding of the problem will be discussed, including its prevalence, etiology, pathophysicological explanations, short and long-term outcomes.

Methods

The scientific free research tool PubMed was used to find relevant articles about the problem. Keywords included ‘postpartum depression + effects on the baby’. From the presented papers, recent experimental results and reviews were selected. Different types of papers were considered: primary research, meta-analysis, literature reviews. The papers were categorized according to the country of origin, methods, and primary results of the study.

Results

A short description of basic sources used for this paper are given in Table 1. Six papers were included – one big literature review from the World Health Organization, two literature reviews based on reports from high and low-outcome countries, three primary studies from Canada, Brazil, and Israel. All papers came out in the recent decades, though the primary resources engaged in the literature reviews may trace back to the early 1990s.

Author(s)/

Country

Year of Publication

Type of Study

Methods

Key Findings

Field/

USA

2010

Qualitative literature analysis

Review of 120 articles from America

Postpartum depression results in poor performance of maternal skills by the mother

Letourneau & Joshko/

Canada

2016

Primary research

Not described

Having a depressed mother at 2 years increases the risk of depression at 11

Morais et al./

Brazil

2013

Primary research

Observation mothers and their babies in Brazil

Infants showed worse interactional indicators at 4 moths, but better motor skills at 12 months

Nauert/

Israel

2016

Primary research

Observation on 971 mothers and their babies in Israel

At the age 9 months poorer social abilities from depressed mothers

Parsons et al./

UK & South Africa

2012

Qualitative and semi-quantitative meta-analysis

Review of 84 articles from low-income nations, mostly Africa and Asia

The incidence of postpartum depression may be high than previously thought, postpartum depression is associated with adverse outcomes in children

Stewart et al./

Canada under the supervision of the World Health Organization

2003

Qualitative and semi-quantitative meta-analysis

Review of 120 articles from America and England

Postpartum depression has early psychological effects, but the long-term outcomes are not conclusive

Surkan et al./

USA

2011

Quantitative meta-analysis

Review of 210 abstracts from Africa, South America, Caribbean, Asia

In developing countries, maternal postpartum depression is linked to stunting and growth retardation

Table 1. Studies included in the paper (authors in alphabetical order).

The basic paper, “Postpartum Depression: Literature Review of Risk Factors and Interventions” was developed by a team of contributors from Canada under the supervision of the World Health Organization (Stewart et al., 2003). It provides general information about postpartum depression and the effects the condition has on babies. According to the manuscript, chronic and recurrent maternal depressions show a stronger negative impact on the child than the postpartum depression. The contributors identified 120 articles starting from 1990 that specifically studied the effects of postpartum depression on the baby. According to their deductions, postpartum depression results in impairment of mother-infant interaction and leads to more negations and fewer infant affirmations. In the early years, children from such families tend to show less psychological skills and a less sociable attitude towards strangers. At the same time, when the child becomes older, the negative consequences become less evident and children show results equal to those of their counterparts. The IQ levels of children with mothers suffering from postpartum depression tend to be lower, but the data needs support from bigger studies (Stewart et al., 2003). Another Canadian research shows that children at the age of 11 are at an increased risk of depression, if the mother was depressed (Letourneau & Joshko, 2016). Summarizing, the postpartum depression has salient but selective negative effects on the child.

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Problems with pediatric development after a postpartum depression are similar in all countries. South African scientists also noted that postpartum depression had an impact on the mother-infant interactions; Japanese researchers support this observation (Stewart et al., 2003). In developing countries, maternal depression is associated with stunting and impaired child growth (Surkan et al., 2011). A recent Israeli study showed that the infants of depressed mothers at the age of nine months were unable to self-regulate in novel situations and fused more often (Nauert, 2016). Scholars from Brazil found that at the age of four and eight months infants show worse interactional indicators and gross motor indicator, but better fine motor indicators and one language indicator at twelve months (Morais et al., 2013). The last study shows how difficult it is to make strong conclusions in this area.

A recent substantial review collected data about postpartum depression in the low-income nations of Asia and Africa (Parsons et al., 2012). The incidence of postpartum depression is high among women all over the world, and especially so in countries marked yellow and red. Many countries in Africa, South America, and Asia still lack concrete data about this condition (countries marked white) and thus the problem is underestimated (Figure 2).

The estimated incidence of postpartum depression among non-high income countries

Figure 2. The estimated incidence of postpartum depression among non-high income countries (Parsons et al., 2012).

In the low-income countries, the conditions for the newborn may be challenging and include limited water supplies or poor living conditions. The addition of mental troubles leads to breastfeeding failure. The latter component results in poor weight gain and stunting (Parsons et al., 2012). This study confirmed that the emotional and behavioral performance of children in low-income nations is lower if the mother has postpartum depression.

In her review, Field addresses the mother-infant interaction (Field, 2010). Non-depressed mothers switch face-to-face interactions and vocalize more easily, while depressed parents lessen the ‘playing field’ for their children. Women suffering from postpartum depression fail to accomplish their maternal tasks, such as breastfeeding, have sleep problems, and experience thoughts of harming their infants in 41% of cases. At the same time, mothers without depression may develop thoughts of harming their children only in 7% of cases (Field, 2010).

Discussion

Infants are highly sensitive to the quality of early care they receive. Malnutrition evidently causes disorders in the body, while interpersonal environment influences the growth and development. A child’s behavior is influenced by the mother’s irritability, sadness, impaired concentration, social withdrawal, and other symptoms of depression. When a mother loses her child, she still has other potential alternatives to make her life meaningful – social activities, occupation, relatives, or the spouse. Should the child lose healthy contacts, the creation of behavioral, interpersonal, social, and cognitive abilities becomes considerably more challenging. A healthy development of a baby requires harmonic maternal patterns that act as clues on how to act in the upcoming life situations. Postpartum depression evidently alters the normal mother-infant dialogue (Stewart et al., 2003). Short-term disorders may be compensated if the depression vanishes and the child acquires further healthy treatment (Morais et al., 2013). However, persisting maternal negativities and neglect definitely make the child vulnerable to worse prognoses (Nauert, 2016). Long-standing depression that sometimes emerges from postpartum depression carries substantial risks for the psychological development of the baby (Stewart et al., 2003).

The sensitive behavior of the mother plays a significant role in the evolution of her child. It is difficult to describe the effects of postpartum depression on the baby quantitatively (Field, 2010). In deeper studies, the associations are not always clear, and the results of some studies are contradictive. For example, the Brazilian study suggested that stressed infants may even show some better qualities at the age of 12 months (Morais et al., 2013) Moreover, it is still not clearly described how the effective psychotherapy or pharmacological interventions on the mother affect the short or long term outcomes of the baby. One may assume that the severity and chronicity of depression will have a more profound effect than a short period of emotional misbalance. The duration of depression is a strong negative factor for children. It is also important to note that the child may have unknown internal factors that determine the type of reaction against stress. These factors may be protective or damaging (Morais et al., 2013). Even when the mother or the father is depressed, they may still deliver adequate care to their children and devalue the impact of postpartum depression on the offspring life.

Limitations

This study, as well as other dedicated papers, has methodological and theoretical limitations. Postpartum depression may affect fathers, because the spouse is an important part of the psychological climate around the newborn, but this issue is not highlighted in the available literature. Information about the effects of maternal/parental treatment on the baby is not sufficient. The authors use various psychological tests and questionnaires that make some of the results subjective or incomparable. This may explain why so few quantitative meta-analyses are available. Considering the multifactor nature of human social upbringing, the long-term effects of postpartum depression on the baby are difficult to trace.

Conclusion

Postpartum depression frequently occurs among mothers shortly after delivery. It may also engage the father. The exact etiology of depression is not clear, however previous history of mood disorders predisposes an individual to deterioration. Babies naturally empathize with their parents’ psychological condition to acquire experience. Postpartum depression may have negative effects on the psychological and mental abilities on the child. These children may develop more slowly and show worse intellectual or social abilities. At the same time, at least some of those impacts are reversible or potentially modifiable.

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Research Proposal

Research Proposal Section of Conclusion

1) Title of Proposal. Postpartum depression harmful effects on the baby.

2) What is the problem being addressed? Postpartum depression occurs in one of eight women after the delivery of the baby. This is a common mood disorder that causes turbulent emotions and destructive situations. The newborn baby acquires most information from the mother, so harmful psychological and other patterns may be incorporated into the child’s behavior.

Purpose

3) Is the problem clearly presented? The literature data clearly shows that there is a link between maternal depression and the newborn’s outcome. The babies show lower social adaptations and experience slower psychological development. It is clearly shown that long-standing depression has considerably worse effects than short periods of mood misbalance. However, the quantitative methods in newborn psychology vary and it is difficult to apply strict protocol in the assessment of this problem. Moreover, with the child’s growth, new sources of education may emerge and the negative consequences might resolve on their own.

Audience

4) Who will benefit from research? Apparently, all families may benefit from the research in delivering the best care. Healthcare givers familiar with this problem in depth will be able to help in such situations.

5) Why do we need this research, how will it change what had already been done to address the problem? The incidence of postpartum depression is underestimated, so this research may focus the attention of medical workers on the effects the illness may have on babies. This research also gives optimism to the parents, since they will know that temporary mood disorders can be overcome.

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Project Plan and Description

6) Identify how you would conduct the project. The project can involve all mothers and fathers in a selected city over one or two years. They will answer questionnaires about postpartum depression at 1, 3, and 6 months. All babies from these families should undergo a standard protocol of developmental investigation at 3, 6, and 9 months, as well as within a year. Additional information about depression treatment may be included. The results will be compared with the help of sophisticated mathematical tools.

Budget

7) Find a project similar to what you propose and estimate the budget of your proposal. A similar project was conducted in Israel (Nauert, 2016). However, fathers were ignored and the follow-up was shorter. The budget will consist of fees to the heathcare practitioners who perform the diagnostics of postpartum depression and developmental assessment of children.

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