Objective. This study investigated whether stronger mother-fetal attachment (MFA) predicts more positive postpartum mother-infant outcomes, including observed maternal behaviors (higher sensitivity, closer proximity, more affiliative touches), maternal reports of the infant (easier temperament, greater warmth, less invasiveness), and longer breastfeeding persistence. Design. During the routine antenatal care, a community sample (N = 105) completed the 20-item Mother-Fetal Attachment Scale (MFAS) in the third trimester. At 4 months postpartum, masked trained coders evaluated maternal sensitive responsiveness from mother-infant interactions, and mothers rated or reported on infant temperament, mother-object relations, and breastfeeding persistence (n = 80). At 8 months postpartum, another team of masked trained coders counted maternal affiliative touches and evaluated the physical proximity between mother and infant from mother-infant interactions of a subsample (n = 30). Results. MFA was assessed as a total score and as statistically derived dimensions. The first analysis identified a three-factor model of MFAS, comprising anticipating/fantasizing, attributing, and empathizing. MFAS empathizing uniquely predicted observed maternal sensitive responsiveness, whereas MFAS Attributing predicted mother-reported infant orienting-regulatory temperament. MFAS total predicted three specific postpartum relational outcomes in the expected direction-mother-reported infant warmth toward her, mother-reported infant orienting-regulatory temperament, and observed mother-infant proximity. MFAS was not associated with maternal touches, other mother-reported temperament dimensions, mother-reported infant invasiveness, or breastfeeding persistence. Conclusions. Higher overall MFA in the third trimester was linked to greater physical closeness during mother-infant interactions and more positive mother-reported infant characteristics (warmth and regulatory capacity). Greater maternal empathizing toward fetal "emotional states" was specifically linked with maternal sensitivity. Theoretical, measurement, and clinical implications are discussed.

Introduction Improving the lives of children and adolescents with parental mental illness (CAPRI) remains an urgent political and public health concern for the UK and European Union. Recurrent parental mental illness is believed to lead to fractures in the family, academic and social lives of these children, yet interventions are poorly targeted and non-specific. Part of an interdisciplinary programme of work (the CAPRI Programme; grant number: 682741), CAPRI-Voc aims to achieve two goals: first, to test the feasibility of our longitudinal imaging paradigm in mother–infant pairs where the mother has a diagnosis of severe mental illness. Second, to compare development of vocal processing in these infants with infants in the general population. Methods and analysis Recruitment of 100 infants of mothers with mental illness, alongside 50 infants of healthy mothers. Both cohorts of infants will undergo functional near infrared spectroscopy (fNIRS) brain imaging at three time points: 9, 12 and 18 months to explore differences between cohorts in their neural responses to vocal stimuli in our language paradigm. Mothers will complete an interview and psychological questionnaires. We shall also complete an infant developmental battery and mother–child interaction play session. Data on recruitment, retention and dropout will be recorded. Ethics and dissemination It will be made clear that fNIRS is a safe, non-invasive technology widely used in infant clinical and psychological research. We shall reassure mothers that no definitive causal link exists between maternal mental illness and language development in infants, and that individual data will only exist as part of the wider dataset. As the study includes both children and vulnerable adults, all research staff will complete National Health Service (NHS) Safeguarding level 3 training. Dissemination will be via direct feedback to stakeholders, patient and advisory groups, and through presentations at conferences, journal publications and university/NHS trust communications. The study was approved through North West–Greater Manchester West Research Ethics Committee (17/NW/0074) and Health Research Authority (212715).

Quality of maternal caregiving not only impacts children's development but can also result in heritable changes in gene expression (i.e., in an epigenetic manner). Consequently, when women become mothers, they adopt parenting behavior similar to that they received at family of origin. This transgenerational transmission of maternal behavior may also be associated with changes in the neurobiological system of future mothers. This review aims to highlight the effect quality of perceived parenting has on maternal behavior and the neurobiological system of mothers, specifically the oxytocin system, brain morphology and brain function. This would likely help in finding biomarkers that profile the impact of perceived parenting on mothers, and thus allow identification of mothers who experience poor-quality parenting for intervention.

Functional magnetic resonance imaging (fMRI) has increasingly been employed to establish whether there is a specific brain neural network dedicated to maternal responsiveness. We undertook systematic review and meta-analysis of all studies in which healthy new mothers were exposed to visual stimuli of own versus other infants to determine the quality of evidence for a dedicated maternal neural network. Systematic literature review revealed a pattern of specific neural responses commonly induced by visual infant paradigms. Brain areas consistently reported as activated in mothers in response to own versus unknown infant included the left thalamus, bilateral pre-central gyrus, left limbic lobe, uncus, amygdala and left caudate. These regions are implicated in reward, attention, emotion processing and other core social cognitive skills. Meta-analysis, however, revealed a more limited subset of brain areas activated in mothers specifically in response to their own versus unknown infant and suggested considerable inter-study variability. Further work is needed if functional imaging is to become an objective tool for the assessment of neural pathways associated with distinct patterns of maternal care behaviour. Such a tool would be invaluable in developing biomarkers of neural activity associated with healthy maternal care and for monitoring treatment/intervention effects of costly parenting interventions.

Functional magnetic resonance imaging (fMRI) has increasingly been employed to establish whether there is a specific brain neural network dedicated to maternal responsiveness. We undertook systematic review and meta-analysis of all studies in which healthy new mothers were exposed to visual stimuli of own versus other infants to determine the quality of evidence for a dedicated maternal neural network. Systematic literature review revealed a pattern of specific neural responses commonly induced by visual infant paradigms. Brain areas consistently reported as activated in mothers in response to own versus unknown infant included the left thalamus, bilateral pre-central gyrus, left limbic lobe, uncus, amygdala and left caudate. These regions are implicated in reward, attention, emotion processing and other core social cognitive skills. Meta-analysis, however, revealed a more limited subset of brain areas activated in mothers specifically in response to their own versus unknown infant and suggested considerable inter-study variability. Further work is needed if functional imaging is to become an objective tool for the assessment of neural pathways associated with distinct patterns of maternal care behaviour. Such a tool would be invaluable in developing biomarkers of neural activity associated with healthy maternal care and for monitoring treatment/intervention effects of costly parenting interventions.

This study investigated the psychometrics of a recently developed global rating measure of videotaped parent-infant interaction, the Manchester Assessment of Caregiver–Infant Interaction (MACI), in a normative sample. Inter-rater reliability, stability over time, and convergent and discriminant validity were tested. Six-minute play interactions were blind-rated by trained coders in 147 healthy mother-infant dyads at 3–10 months postpartum using the MACI; 51% were re-assessed 4 or 7 months later. Infant cognitive functioning, language and temperament, parent-reported infant warmth and invasion, parental mood, and the parent’s own recalled experiences of being parented were measured. We report the internal psychometrics of the MACI, evidence of stability as predicted, and inter-rater reliability. MACI caregiver sensitive responsiveness showed convergent validity with parental state of mind (mood at 3–4 months; report of own childhood care and overprotection), while MACI infant affect (but not the caregiver scales) was associated with parent-rated infant warmth. All MACI scales showed discriminant validity with concurrent cognitive and language developmental status, and most temperament dimensions. In conclusion, the MACI demonstrates utility, reliability and preliminary validity data in a normative sample, which complements previous work using the MACI. Follow-up is needed to test predictive validity. The findings inform further improvements to the tool, and may guide those looking for a relatively brief way to examine the global qualities of parent, infant and dyadic interaction.

Increasing evidence suggests that discrete neural networks that mediate emotion processing are activated when mothers respond to infant's images or cries. Accumulating data also indicate that natural variation in maternal caregiving behavior is related to maternal oxytocin (OT) levels. However, brain activation to infant cues has not been studied comparing mothers at disparate ends of the "maternal sensitivity" spectrum. Based on observed mother-infant play interaction at 4-6 months postpartum in 80 antenatally recruited mothers, 15 mothers with the highest sensitivity (HSMs) and 15 mothers with the lowest sensitivity (LSMs) were followed at 7-9 months using functional magnetic resonance imaging (fMRI) to examine brain responses to viewing videos of their "own" versus an "unknown" infant in 3 affect states (neutral, happy, and sad). Plasma OT measurements were taken from mothers following play interactions with their infant. Compared with LSMs, HSMs showed significantly greater brain activation in right superior temporal gyrus (STG) in response to own versus unknown neutral infant and to own happy versus neutral control. Changes in brain activation were significantly negatively correlated with plasma OT responses in HSMs mothers. Conversely, compared with HSMs, LSMs showed no significant activation difference in response to own infant separately or in contrast to unknown infant. Activation of STG may index sensitive maternal response to own infant stimuli. Sensitive parenting may have its unique profile in relation to brain responses which can act as biomarkers for future intervention studies that enhance sensitivity of maternal care. (PsycINFO Database Record

Behavioural and Neurobiological Correlates of Maternal Sensitivity in Healthy New Mothers Alya Mohamed Ahmed Elmadih Doctor of Philosophy (PhD) The University of Manchester June 2013 ABSTRACTBackground: In spite of the importance of maternal sensitivity as a construct that fosters secure attachment and promotes a child?s social and cognitive development, no routine clinical screening currently identifies mothers at risk of poor maternal sensitivity. This is partly because researchers have not identified all the factors that influence maternal sensitivity. As a result, parenting interventions to promote maternal sensitivity and optimise child outcomes tend to focus on clinical groups. Thus, more attention is needed to identify possible determinant factors. The neurobiological mechanisms underlying natural variation in maternal sensitivity (i.e. sensitive and less sensitive mothers) are poorly understood, especially the putative role of the hormone Oxytocin (OT). Literature has suggested that this variation in maternal sensitivity is an outcome of interaction between maternal OT, as well as social factors (e.g. perceived parenting) and this interaction charts the discrete profile of the maternal brain that is mediated by stress- and reward-related neural systems. To date no study examined for the neurobiological correlates of maternal sensitivity in a distinct group of mothers representing natural variations in maternal sensitivity. Methods: Out of 105 women recruited from community antenatal clinics during their pregnancy, to complete a set of self-reported questionnaires assessing their psychosocial characteristics, a total of 80 new (i.e. early postpartum) mothers and their infants were followed up and underwent evaluation of maternal sensitivity at 4-6 months postpartum. Using a stepwise regression, we examined for predictors of maternal sensitivity among the sample (Study I). Later, at 7-9 months postpartum, 30 mothers, representing extremes in maternal sensitivity, were selected from this sample of 80: 15 mothers with higher scores (high sensitivity mothers - HSMs), and 15 with lower scores for maternal sensitivity (low sensitivity mothers - LSMs), underwent functional Magnetic Resonance Imaging (fMRI) to examine their brain responses when viewing videos of their own and an unknown infant. Maternal plasma OT levels were also measured before and following an interactive play with their infant (Study II). Results: Mothers? self-reported experience of own parental care, and household income, independently predicted maternal sensitivity, accounting for 17% of the variance. Comparing mothers grouped by maternal sensitivity level, HSMs showed a drop in their plasma OT levels following the interaction with their infant. HSMs also showed significant brain activation in the right superior temporal gyrus in response to own infant (compared to unknown infant) when compared to LSMs. By contrast LSMs did not show any change in their plasma OT levels following interaction with their infant, and their brain responses to own infant did not show any significant brain activation when compared to HSMs. Conclusions: The findings may have implications for future novel approaches for early assessment of mothers at risk of low maternal sensitivity so they could be targeted by specialised assessments and consequently interventions to improve their parenting (Study I). Maternal sensitivity is accompanied by neural correlates that could act as a biomarker for future intervention studies that target vulnerable mothers (Study II).