The association between prenatal maternal anxiety disorders and postpartum perceived and observed mother-infant relationship quality

Introduction
Prenatal maternal anxiety disorders have been associated with adverse outcomes in offspring including emotional, behavioral and cognitive problems. There is limited understanding of the mechanisms underpinning these associations, although one possible candidate is an impaired mother-infant relationship. The authors investigated whether prenatal anxiety disorders were associated with poorer postpartum mother-infant relationship quality, measured by maternal self-reported bonding and observed mother-infant interactions.

Methods
A cohort of 454 pregnant women recruited from an inner-city maternity service in London (UK) were assessed for mental disorders using the Structured Clinical Interview for DSM-IV and followed up at mid-pregnancy and 3-months postpartum. Depressive symptoms were assessed at baseline and mid-pregnancy (using the Edinburgh Postnatal Depression Scale). At three months postpartum, women were assessed for self-reported bonding difficulties (Postpartum Bonding Questionnaire) and a subsample (n = 204) participated in video-recorded mother-infant interaction, coded using the Child-Adult Relationship Experimental Index by an independent rater.

Results
Prenatal anxiety disorders were associated with higher perceived bonding impairment, but not associated with observed poor mother-infant interaction quality. Higher levels of depressive symptoms were associated with lower maternal sensitivity.

Conclusions
Interventions for anxiety disorders in the perinatal period could be tailored to address anxieties about mother-infant relationship and co-morbid depressive symptoms.