ABSTRACT

Background
Childbirth is a critical transitional life event that can trigger several health and social
changes and are predisposed by biological, environmental, sociological psychological, and
organisational components. While existing western studies have established that mental
health problems in the perinatal period influence the nature of the birth outcomes and
certain developmental aspects for the infant, there is a paucity of longitudinal assessments
looking at the multidimensional nature of risk for women in the perinatal period and at the
inter-relatedness of the different components of the mother-infant relationship, from the
low-and-middle-income settings. In this context, the current study aims to identify the
prevalence of psychosocial risk factors during pregnancy and the postpartum and to study
its impact on postpartum maternal and mother infant outcomes.

Materials and methods

A prospective naturalistic longitudinal study design was adopted for this study.
127 women were recruited from an antenatal clinic and assessed in the 3rd trimester of
pregnancy on mental health and psychosocial parameters and community-based follow-up
assessments were conducted with 106 mothers between 8 - 16 weeks postpartum to re-
assess these parameters and to examine the outcomes of maternal and breastfeeding self-
efficacy, bonding, caregiving and mind-mindedness. Standardized measures were used for
examining the risk factors and the outcome variables. Mind-mindedness was assessed
through a novel methodology using the Five-minute speech sample.

Results
18.1% of antepartum mothers and 17% of postpartum mothers were identified to have
depression and 17.3% and 9.4% of mothers had significant anxiety symptoms during the
antepartum and postpartum periods respectively. 7.1% of mothers during the antepartum
period and 8.5% (9/106) of mothers during the postpartum period, reported being subjected
to some form of intimate partner violence. Overall 41.0% mothers had low psychosocial
risk, 37.0% had mild - moderate risk and 22.0% had high-risk during the antepartum while
12.6% mothers had high levels of psychosocial risk during the antepartum period.
Increase in antepartum social support and having a previous child were found to
significantly predict better maternal self-efficacy. Mothers experiencing greater number of
life events during the antepartum and postpartum periods had lower maternal self-efficacy.
Higher levels of antepartum and postpartum violence, antepartum depression and
postpartum anxiety all statistically significantly predicted poorer breastfeeding self-
efficacy and higher educational qualification predicted better breastfeeding self-efficacy.
Mothers who reported experiencing higher intimate partner violence during both pregnancy
and the postpartum periods, greater stress during pregnancy and higher levels depressive
symptoms during the postpartum were found to experience significantly lower levels of
bonding towards their infant. Higher antepartum depression and lower postpartum social
support scores predicted lower levels of caregiving for the infants by the mothers. Also,
mothers who had more number of children were less likely to indulge in caregiving tasks
for the infant. Increase in antepartum anxiety resulted in a decrease in the proportion of
mind – minded comments about the infant while for an increase in postpartum anxiety
scores the proportion of mind – minded comments saw a declined. Increase in maternal age
and lower antepartum social support predicted mothers making a lower proportion of mind-
minded statements.

Conclusion
The findings of the study indicate that the risk factors for poor perinatal maternal and
mother-infant dyadic outcomes are not merely restricted to mental health issues, but are
influenced by several other psychosocial factors which pose a greater risk for the outcomes
examined in this study. The interplay of these factors is complex and they have different
patterns of influence on the outcomes. Thus, while the magnitude of impact on certain
outcomes might be greater than others, all the risk factors examined have crucial
consequences for maternal and dyadic outcomes. The complexity of their interaction
warrants for taking a holistic approach in examining risk and for providing psychosocial
care services for pregnant women and mothers.