This well-being of their infants. The research will

This literature review will consider four peer-reviewed research papers concerned with the causality of depression in pregnant women and the effects of maternal depression on the psychological and physical well-being of their infants. The research will differentiate
between quantitative and qualitative data and consider the appropriate methodology used to gather the data. I will examine how the research was undertaken and completed and whether the methodology was valid and reliable. I will also consider ethical issues and any concerns regarding the safeguarding of patient confidentiality.  

1. ‘Does
mothers’ postnatal depression influence the development of imitation?’ In this study, the authors hypothesise that postnatal depression (PND) may interfere with infants’ ‘imitation’, which is an early learning
ability that features in early mother–infant interaction and is linked to
memory, causal understanding and joint attention. 

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This study demonstrated a mixed methodology as the quantitative data was sufficient to present a nationally representative sample of British
first-time mothers and their infants and to examine whether there is a correlation between PND and a reduction in imitation. The qualitative data involved observation, interviews and questionnaires
and allowed the researchers to investigate aspects of sociodemographic
adversity and to find out whether there were causal elements of depression during pregnancy or prior to conception. 


332 first-time mothers represented the entire range of socioeconomic categories in the UK, so
the final sample was nationally representative, equivalent to the most recent
UK national cohort study. 

301 parents were interviewed and observed with their children. One parent
was interviewed by telephone, eight provided questionnaires. Six families withdrew from the study, four failed to
keep appointments, eight could not be traced within the time frame, and four
could not be assessed due to ill health or because of family circumstances. 

253 infants were presented with two imitation tasks that
varied in difficulty (manipulating a door knocker, light panel or spring; tapping on the wall of a box; and another, arbitrary task), of which 174 (68.8%) imitated a modelled action at least once.
The children of women who had experienced PND were significantly less likely than others to imitate the modelled actions. Only 10 (48%) of the infants
whose mothers had been depressed postpartum imitated the model at least once,
whereas 160 (70%) of other infants imitated at least one modelled action. The researchers only took into consideration completed tasks, which could possibly make this research less reliable but there was a small p-value which would indicate that the study suggested that the likelihood of PND influencing imitation tasks was greater than simple chance.  

The ethical considerations in this study are that informed consent would be needed in order to undertake experiments on children and there were issues of confidentiality?with mothers who have PND. That parents were given the right to withdraw from the programme demonstrates that correct ethical considerations were implemented. The potential benefits of being able to associate learning difficulties in children of mothers with PND and thereby supporting those children so that they are treated with justice, respect and equality within society outweigh any other ethical considerations. The study also demonstrates the power of social modelling as children imitate a ‘power’ role model. Those children who imitated more than once seem to get a positive reinforcement from
their role model and if the parent repeats this action their infants understand that what they have done is a good action.? 

The limitations of this study might be that the cohort size is not large enough to extrapolate into the wider population. Moreover,
the imitation exercises were perhaps too brief to be reliable or effective, especially because observation was limited. Perhaps some of the children showed poor imitation
because the parents had not had the experiment explained to them clearly enough. The Hawthorne effect could also be taken into account as both parent and child
might have been conscious that they were being observed. 

However, knowledge of the effects on learning of PND should inform health professionals in postnatal
care, which could lead to further studies and possible intervention strategies.  


2. ‘Mechanisms of Resilience in Children of Mothers Who
Self-Report with Depressive Symptoms in the First Postnatal Year’. 

The second study suggests that maternal postnatal depression symptoms are associated with an increased possibility of adverse effects on the development of the child. This
literature aims to determine the mechanism of resilience in children exposed to PND symptoms.  


Data was taken from a large-scale prospective cohort study. The methodology of this research is a qualitative review as mothers were given questionnaires during pregnancy and the child’s first two years asking the mothers
their views of parenting and how they judged the development of their child. The Edinburgh Postnatal Depression Scale (EPDS) was completed postnatally at 8 months and the
Strengths and Difficulties Questionnaire (SDQ) at 11 years. Children of mothers reporting PND who scored above the median score of children
of mothers not reporting PND were defined as resilient. 

The information was subjected to exploratory factor analysis to assist
with statistical data. It has been stated that modelling condition (Albert
Bandura) could affect the results: an individual’s belief in their ability and efficacy to exercise
control over their own lives and actions could be a contributing factor in
non-optimal child development. 

There were 14,541 pregnancies along with 13,988 children alive at the age of one. There were 10,923 pregnant mothers with PND. Those mothers excluded were those with multiple births and those whose children had died (4,423). 1,009 children in total were exposed to maternal PND.  

Positive parenting behaviours and interactions with their child were associated with better
verbal skills and fewer behavioural difficulties at a younger age in their study of the ALSPAC cohort (age 7 years compared with 11 years in
the current study). This confirms speculations suggesting that positive
maternal parenting characteristics may have important protective effects in
high-risk populations, serving to neutralise some of the effects of the risks encountered. 

One finding of the study was that children who at 15 months are
more able to communicate in a non-verbal way have a greater likelihood of being
resilient at 11 years. Due to the nature of the data collection in the ALSPAC sample, it is not clear whether the non-verbal
communication displayed by the children at age 2 elicited warm responses from their mothers. However, it could be
speculated that such non-verbal forms of communication might lead to positive
chains of responses from the mother, which in turn fostered resilience.  

Within the paper it is stated that ethical approval for the study was obtained from the ALSPA ethics committee and the local research
ethics committee. Parents were given the right to withdraw from receiving the
questionnaire through the post. However, again the Hawthorne effect might have made an impact and made data less reliable.  

There was only one method used to gather data, which might have made the information unreliable, as there may not have been enough evidence. Moreover, a numerical description rather than a detailed narrative generally provides less elaborate accounts of human perception. It has been suggested that there were difficulties within the questionnaires as some were completed at different points in the survey, reflecting differently on the
development of the children. A quantitative approach has shown that findings can give evidence either to support or contradict a hypothesis.  What is clear is that it might contradict the hypothesis as there is a low rate of reliance in children. Nonetheless, the growing knowledge on resilience may
be vital in guiding social policies for the promotion of well-being and
positive adaptation across populations. Early interventions could help improve
the long-term outcomes for children as well as potentially interrupt the
intergenerational transmission risk of depression. And by assessing those factors that have contributed to the
development of resilience in children who have been exposed to postnatal
depression there is a better understanding of those aspects of a child’s early
environment that may help support them to withstand the effects of the symptoms
of postnatal depression. 


3. In this third article it is called
influence of prenatal maternal stress maternal plasma cortisol and cortisol in
atomic fluid on both outcomes and child temperament at three months. This
literature review aims to investigate relationships and signs of maternal
paternal stress and the infant birth outcomes and the potential early
temperament in addition to examining patterns associated between psychological
such as cortisol and plasma concentration in addition to self-reports of
mothers with paternal stress.  


This is a prospective longitudinal
project into the effects of prenatal hormones on development in children. Has
been suggested that 185 women declared willingness to participate within the
study only single pregnancies were used however only 158 pregnant women. These
women were given questionnaires to be able to report stress levels. 26.04 which
was the mean of the perceived score in the sample. Cortisol in the atomic fluid
was determined by the radioanimus  variation that was taken from
the lower limit of the detection to be able to measure the average within the
cortisol whin the atomic fluid.  But the
questionnaires were taken for the temperament of the infants at three months in
regarding the behaviour such as stress to limitation and fear as bait baby
fears and crying in convening position during can I take in activities and
unable to perform certain actions. 


Methodology was Quantitive data as yet again they want to
see levels of stress in relation to cortisol in the atomic fluid to see if there
is an increase of stress and to see if it also increases the cortisol in the
atomic fluid. As they are interested in numbers as they do want to know the
mean average within this longitudinal prospective study.  


This demonstrate in the result as well
as in the table that the mean of the quarter the event the atomic fluid was
4206 but in the range it was 27 to 63, does show there
is an increase of cortisol. Whether this also demonstrates a low p value which
is less by chance there was no sex difference in the atomic fluid and Cortisol 
contraction. It has been suggested that it was moderate by maternal
state and is IT as there was no difference between stress and low anxious
mothers based on the ST a I test nor high and low mothers
as measured by these questionnaires handed handed out in comparisons. In the
relation to the independent Variables it has been suggested that maternal
plasma and the atomic fluid quarters or contractions were positively associated
due to a small P value questionnaires and says about giving birth within the
pregnancy do correlate as stress did not correlate with maternal state  anxiety. However they also suggest that they had
three hypotheses and one positive association between maternal and self-report
of stress and Anxiety and cortisol Contraction 


Each patient were given a  informed consent To the
procedure and the UMCU you medical ethical committee approved of the study
the maturity 96 was referred because of their age 36 or older had the amino
thesis because amniocentesis because of their deviate serum screening. As
because there is a high risk of maleficence being performed and there is a
Possibility mother losing the so the mother has to be aware The procedure they are going through
for legal document purposes. But can also be considered as benefices The study will open knowledge and
ways to enhance and understanding towards a fact of stress and to infant


4. ‘Effects of pre-natal depressive symptoms on maternal and infant
cortisol reactivity.’ 


The literature suggests that pre-natal depression is associated with adverse offspring outcomes, and the prevailing
theory to account for mood-associated effects implicates alterations of the
maternal and foetal hypothalamic-pituitary adrenal axes. Recent research
suggests that depression may be associated with a failure to attenuate cortisol
reactivity during early pregnancy.  


This study
investigates whether this effect continues into mid and late gestation. A
second aim is to test whether maternal pre-natal cortisol reactivity directly
predicts infant cortisol reactivity.  



The study investigated 103 pregnant women in the second and third
trimesters of their pregnancy. The participants were asked to complete a questionnaire which contained questions about their demographic characteristics and current levels
of mood. They were then asked to watch a 6-minute film of distressed babies. Saliva samples were collected five times during the test session; two samples were taken before the film; a third sample was taken immediately after the
film; fourth and fifth samples were taken 10 and 20 minutes after the film. Maternal depressive symptoms were self-reported via the questionnaires. Postnatal mood symptoms were further assessed by visits at the
participants’ homes and saliva samples were also taken from their infants by
the mothers.  


The methodology uses quantitative data as the researchers wanted to measure the amount of cortisol in the mothers’ saliva. Qualitative data regarding depressive symptoms was taken via questionnaire.  


One aspect of
the study that might render the findings less than universal is that the
participants were ‘primarily Caucasian … highly educated, had a mean age of
31 and all participants were primiparous’. The researchers admit that ‘the participants were drawn from a
low-risk community sample and levels of maternal prenatal depression were
relatively low.’ 


Contrary to the
researchers’ initial hypotheses, symptoms of depression were
not associated with maternal hyper-cortisol secretion in response to the infant
distress stimulus. Further, maternal cortisol reactivity did not directly
predict infant cortisol reactivity.  

The ethical
considerations were not clear in this study. The showing of the ‘short film depicting distressed young infants, all
under the age of 6 months’ might arguably have stimulated and increased cortisol levels and could be in conflict with the non-maleficence principle in
that it might effect levels of distress and anxiety in the participants.?It is worrying that the researchers reported that
‘the infant distress video may not have been a sufficiently potent stressor to
induce a cortisol stress response in this group of pregnant women, although
participants did report increases in state anxiety following the film.’ 


In conclusion, it is clear from these literature reviews that the topic of depression in pregnant women and the
effects of maternal depression on the psychological and physical well-being of
their infants is a field that demands a great amount of quantitative data and that knowledge of the effects on learning of PND should inform health professionals in postnatal
care, which could lead to further studies and possible intervention strategies.
Qualitative data is problematic given that studies are often self-selective.
Moreover, the studies here are arguably not as diverse in terms of sociodemographics as they might be. 

Ethically, all studies undertaken or proposed were bound by national and local
guidelines and there were no declared conflicts of interest. Women with
depression need to be treated perhaps more carefully than participants in
studies where mental health well-being is not an issue. Also, infants are
unable to give informed consent and their human rights must be taken into
account. My one concern was regarding the use of film of distressed infants,
first on the well-being of the babies showing distress and second on the
psychological well-being of the women who were shown the film.  

It is clear that there is importance in there being more research to monitor and enhance cognitive and motor skills in infants and to support the psychological well-being
of women pre- and postpartum.  



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