Attachment disturbances in infants born subsequent to perinatal loss: A pilot study

Heller, Sherryl Scott; Zeanah, Charles H.

doi:10.1002/(sici)1097-0355(199922)20:2<188::aid-imhj6>3.0.co;2-h

Cited by 52 publications

(41 citation statements)

References 36 publications

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“…Limited available data suggest that mothers may have more concerns about and greater difficulty managing the needs of a child born after a prenatal loss; 19,28 also, 12-month-old infants born following prenatal loss were reported to show higher rates of disorganised attachment patterns to their mothers than children born into families without a loss history. 29,30 Thus, even if there is no persistence of mood disturbance into the postnatal period, there may still be adverse effects of a previous prenatal loss on the parent–child relationship and child outcomes. This possibility requires further attention.…”

Section: Discussionmentioning

confidence: 99%

Previous prenatal loss as a predictor of perinatal depression and anxiety

et al. 2011

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Background Prenatal loss, the death of a fetus/child through miscarriage or stillbirth, is associated with significant depression and anxiety, particularly in a subsequent pregnancy. Aims This study examined the degree to which symptoms of depression and anxiety associated with a previous loss persisted following a subsequent successful pregnancy. Method Data were derived from the Avon Longitudinal Study of Parents and Children cohort, a longitudinal cohort study in the west of England that has followed mothers from pregnancy into the postnatal period. A total of 13133 mothers reported on the number and conditions of previous perinatal losses and provided self-report measures of depression and anxiety at 18 and 32 weeks’ gestation and at 8 weeks and 8, 21 and 33 months postnatally. Controls for pregnancy outcome and obstetric and psychosocial factors were included. Results Generalised estimating equations indicated that the number of previous miscarriages/stillbirths significantly predicted symptoms of depression (β = 0.18, s.e. = 0.07, P < 0.01) and anxiety (β = 0.14, s.e. = 0.05, P < 0.01) in a subsequent pregnancy, independent of key psychosocial and obstetric factors. This association remained constant across the pre- and postnatal period, indicating that the impact of a previous prenatal loss did not diminish significantly following the birth of a healthy child. Conclusions Depression and anxiety associated with a previous prenatal loss shows a persisting pattern that continues after the birth of a subsequent (healthy) child. Interventions targeting women with previous prenatal loss may improve the health outcomes of women and their children.

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Section: Discussionmentioning

confidence: 99%

Previous prenatal loss as a predictor of perinatal depression and anxiety

et al. 2011

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“…However, there is evidence to suggest that some mothers seem to show decreased attachment in subsequent pregnancies. These behaviors could serve as a protective and even practical approach women use to deal with the uncertainty of the outcome of their pregnancy What is unknown and perhaps more significant is to determine the effect of these behaviors on paternal attachment in the newborn period and beyond, especially because earlier and limited research in this area has shown problems with attachment (Heller & Zeanah, 1999) and disrupted parenting (Forrest, Standish, & Baum, 1982; Hunfeld et al, 1997; Phipps, 1985-86) for infants born after a subsequent pregnancy. Investigators in this review have noted the importance of future research in this area.…”

Section: Discussionmentioning

confidence: 99%

The Parental Experience of Pregnancy After Perinatal Loss

DeBackere¹,

Hill

Kavanaugh

2008

Journal of Obstetric, Gynecologic & Neonatal Nursing

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Objective-To review the research literature on the parental experience of pregnancy, primarily maternal, subsequent to perinatal loss. Data Sources-Computerized searches on CINAHL and PubMed databases.Study Selection-Articles from indexed journals relevant to the objective were reviewed from January 1997 to December 2007. Only research-based studies in English were included.Data Extraction-The review was performed using the methodology of Whittemore and Knafl (2005). Data were extracted and organized under headings: author/year/setting; purpose; sample; design/instruments; results; and nursing implications for parents during a pregnancy following a perinatal loss.Data Synthesis-Depression and anxiety are frequently seen in pregnant women subsequent to a perinatal loss. The parental experience is filled with intense and conflicting emotions as parents balance being hopeful while worrying about another potential loss.

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“…To date, three studies have reported on the effect of pregnancy loss on infant attachment. Goldberg et al found that at 1 year all of five surviving twins had a secure relationship with their mothers, but this study did not assess infant disorganisation (Goldberg, Perrotta, Minde & Carter, 1986), whereas an uncontrolled study of 19 infants born subsequent to perinatal loss found 45 % to be disorganised at 1 year (Heller & Zeanah, 1999). A study of 30 women who had previously miscarried in early pregnancy did not report on infant attachment categories, and found low levels of unresolved classification in the mothers, but observed an association between mothers' scores on the unresolved scale of the Adult Attachment Interview and scores for infant disorganisation (BakermansKranenburg, .…”

Section: Introductionmentioning

confidence: 85%

Disorganised Attachment Behaviour among Infants Born Subsequent to Stillbirth

Hughes

Turton

Hopper

et al. 2001

Child Psychology Psychiatry

115

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There is limited evidence that siblings of stillborn infants are more vulnerable to psychological problems. This case-controlled study examines the relationship between previous stillbirth and the next child's pattern of attachment and explores factors in the mother which may be associated with and which may explain the pattern of infant attachment. We examined 53 infants next-born after a stillbirth, and 53 control infants of primigravid mothers. Maternal demographic, psychiatric, and attachment data were collected in pregnancy, and self-report measures of depression collected in the first year. Infant attachment patterns to the mothers were assessed when the infants were 12 months old using the Ainsworth Strange Situation Procedure. Infants next-born after stillbirth showed significant increase in disorganisation of attachment to the mother compared with control infants (p < .04). The difference was not accounted for by differences in psychiatric symptoms or demography. It was strongly predicted by maternal unresolved status with respect to loss as measured in the Adult Attachment Interview, and less strongly by maternal experience of elective termination of pregnancy and by the mother having seen her stillborn infant. The study adds weight to previously reported clinical observations, that infants born after stillbirth may be at risk of an increase in psychological and behavioural problems in later childhood. The strong association between disorganisation of infant attachment and maternal state of mind with respect to loss suggests that the mother's state of mind may be causal, and raises interesting questions about the mechanism of intergenerational transmission. Given the existing evidence of later developmental problems, longer-term follow-up of these children would be valuable.

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Attachment disturbances in infants born subsequent to perinatal loss: A pilot study

Cited by 52 publications

References 36 publications

Previous prenatal loss as a predictor of perinatal depression and anxiety

Previous prenatal loss as a predictor of perinatal depression and anxiety

The Parental Experience of Pregnancy After Perinatal Loss

Disorganised Attachment Behaviour among Infants Born Subsequent to Stillbirth

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