Stress parental et lien mère-enfant: impact sur le développement de l’enfant âgé d’un an

Maternal bonding and stress are two factors that may interfere with child development and have short and long term consequences. Although perinatal stress has often been studied, several pre and postnatal potential confounders (such as paternal stress, antidepressant use, perinatal depression, etc.) have not always been adjusted for. Compared to infant attachment, less research has focused on maternal bonding, especially among women with a diagnosis of depression and/or anxiety and taking antidepressants. This research project aimed to study these two factors and their association with one year old child development, taking into account maternal mental health (with or without psychological disorders) and pharmacological treatments. In order to improve developmental screening, this thesis also assessed the telephone administration of pre-screening and screening instruments currently used. Within this thesis, four research projects were conducted, which objectives were: to determine the psychometric properties of the 4-item perceived stress scale (English and French versions) during pregnancy (first study); to assess the impact of prenatal maternal and postnatal parental stress on one year-old child development (second study); to estimate the association between maternal bonding and child development at one year of age, stratifying on maternal antidepressant use (third study); to evaluate the telephone administration of the 12-month Ages and Stages Questionnaire (ASQ) and the 9-24 month Revised Pre-screening Denver Questionnaire, two instruments used to screen and prescreen child development, respectively(fourth study). This thesis was part of a bigger project named ″The Organization of Teratology Information Specialists (OTIS) Antidepressant in Pregnancy cohort study″ and designed to evaluate the effect of antidepressant use during gestation on maternal behaviors during pregnancy, and on child cognitive and behavioral development.  From 2006 to 2010, women were recruited during their first trimester of pregnancy (and followed until three years postpartum) through participating North American teratology information services, via the OTIS website, and from the Obstetrics and Gynecology Clinic of CHU Sainte-Justine, Montreal, Canada. Participants were eligible if they were: (a) at least 18 years of age; (b) no more than 14 completed weeks of pregnancy, where the beginning of pregnancy was defined as the first day of their last menstrual period; (c) taking antidepressants (for the user group) for at least the first day of gestation; (d) able to read and understand French or English. For the last three studies of this thesis, they have to live within 250 km radius from Montreal (to receive our psychometric home visit). In 2008, the assessment of maternal stress and maternal bonding were included in the OTIS study objectives. Thus, since 2008, every woman, recruited during the first trimester of pregnancy, completed data on stress and maternal bonding, and thus included in this thesis. Fathers of children were recruited at two months postpartum. Data were collected through telephone interview, self-administered questionnaires and during our home visit (children development assessment). For this thesis, participants were followed from the first trimester of pregnancy until one year postpartum. Our results suggest that the 4-item perceived stress scale is a reliable and valid tool for assessing maternal stress during pregnancy (for research purpose or clinicians). Maternal and paternal postnatal stress may be harmful for the motor and socio-emotional of one year old child development, respectively. However, prenatal maternal stress may improve motor skills. Optimal maternal bonding is likely to be beneficial with regards to child socio-emotional development, especially when the mothers are using antidepressants. Telephone-administration of the ASQ as well as the language, fine and gross motor scales of the R-PDQ could be good alternative to the self-administration mode. This could be of value when screening or pre-screening children development on large population or for research purpose.

Keyphrases: Stress, Maternal bonding, Pregnancy, Child development, Antidepressant