Preterm Birth and Maternal Mood States: What Is the Impact on Bonding?

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

I recommend publication of this provocative paper. The researchers sought to illuminate more clearly the relationship between a preterm birth and a mother’s mood states and the consequences of the two for infant-mother bonding. 

 

This is an important topic. Preterm childbirth, defined as less than 37 completed weeks gestation, is a global phenomenon that accounts for 15 million annual births; it is a major cause of infant death. The number of such births has been growing as technological advances have led more very low birthweight and extremely low birthweight children to survive. While this is obviously good news for the parents, such babies are at higher to much higher risk of negative developmental consequences. Moreover, preterm births can be hard on the physical, mental, and emotional health of new mothers, for instance, experiencing a preterm birth may produce feeling of guilt in the mother and/or lead her to feel alienated from her newborn. 

 

Understanding the extent and nature of the relationship between prematurity, maternal mood and maternal bonding is therefore significant for public health. The researchers were surprised to find no significant relationship between preterm birth characteristics and overall maternal mood states. However, they found a significant relationship between specific aspects of maternal mood and the quality of maternal bonding. Using the Profile of Maternal Mood States tool and the Postpartum Bonding Questionnaire they found that self-reported feelings of tension, anger, and confusion affected maternal bonding, demonstrating the importance of providing mothers of preterm babies with comprehensive support and, if needed, interventions.

 

Albeit significant, the longer-term implications of the findings are unclear since the time frame of the study was just two weeks postpartum. The article refers to this fact. 

 

The article’s strong discussion section reveals how little is known about the subject of prematurity and maternal mood and how many questions remain. From a public policy perspective, however, it seems expeditious to implement what is known in addition to carrying out additional research.

 

The article is generally well written although there were a few places that needed clarification: lines 34-35 sentence not clear; typo line 154 should be she; meaning of line 155 not clear; also, lines 169-170; lines 270 and 336 also difficult to understand. 

 

 

 

 

 

 

 

 

Comments on the Quality of English Language

indicated at end of my commentary were those that caught my eye. In all likelihood there may be more. 

Author Response

Dear reviewer,

We revised the manuscript entitled “Preterm birth and maternal mood states: what impact on bonding?”, submitted to Frontiers.

We thank the editor and the reviewers for taking the time to review our article. 

We are grateful for the meaningful suggestions they have provided us with.

We have followed the reviewers’ suggestions, trying to answer all comments.

You can find our response for each point highlight below.

Comment #1: I recommend publication of this provocative paper. The researchers sought to illuminate more clearly the relationship between a preterm birth and a mother’s mood states and the consequences of the two for infant-mother bonding. 

Reply#1: we thank the reviewer for the positive comment.

Comment #2: This is an important topic. Preterm childbirth, defined as less than 37 completed weeks gestation, is a global phenomenon that accounts for 15 million annual births; it is a major cause of infant death. The number of such births has been growing as technological advances have led more very low birthweight and extremely low birthweight children to survive. While this is obviously good news for the parents, such babies are at higher to much higher risk of negative developmental consequences. Moreover, preterm births can be hard on the physical, mental, and emotional health of new mothers, for instance, experiencing a preterm birth may produce feeling of guilt in the mother and/or lead her to feel alienated from her newborn. 

Reply #2: We are glad that you share interest on the topic and agree on its relevance.

Comment #3: Understanding the extent and nature of the relationship between prematurity, maternal mood and maternal bonding is therefore significant for public health. The researchers were surprised to find no significant relationship between preterm birth characteristics and overall maternal mood states. However, they found a significant relationship between specific aspects of maternal mood and the quality of maternal bonding. Using the Profile of Maternal Mood States tool and the Postpartum Bonding Questionnaire they found that self-reported feelings of tension, anger, and confusion affected maternal bonding, demonstrating the importance of providing mothers of preterm babies with comprehensive support and, if needed, interventions.

Reply #3: we agree on the need to provide mothers with appropriate support, especially after having confirmed that negative mood states affect not only them but also their children.

Comment #4: Albeit significant, the longer-term implications of the findings are unclear since the time frame of the study was just two weeks postpartum. The article refers to this fact. 

Reply #4: we agree that it would be important to understand long term implications of our findings. This is something that should be examinated in the future in order to obtain a better understanding of the long-term consequences of preterm birth, maternal mood states and bonding.

 Comment #5: The article’s strong discussion section reveals how little is known about the subject of prematurity and maternal mood and how many questions remain. From a public policy perspective, however, it seems expeditious to implement what is known in addition to carrying out additional research.

Comment #5: we agree that what is known to work in terms of facilitating maternal and infant bonding should be implemented in all NICU environments. For instance, practices like Skin to Skin and Kangaroo care, which are proven to be effective, should always be implemented post-partum. However, we agree on the need to carry out further research to see what else can be done at this time. 

Comment #6: The article is generally well written although there were a few places that needed clarification: lines 34-35 sentence not clear; typo line 154 should be she; meaning of line 155 not clear; also, lines 169-170; lines 270 and 336 also difficult to understand. 

Reply #6: we thank the reviewer for the positive comment and proceeded to correct or rephrase sentences which were incorrect or unclear, as suggested.

Reviewer 2 Report

Comments and Suggestions for Authors

A well written study.

Few comments to improve the quality of the results and addressing more stressors that may affect mood and bonding :

1. Where there differences in the bonding scale among mothers or fathers of single vs multiple births?

2. Any differences between fathers and mothers results?

3. Any effect of first or above delivery on the results?

4. Although the questionnaires were provided to parents two weeks after delivery short term morbidity of the preterm neonates might impact mental mood such as ventilation, brain ultra sound results, infection, ect.  

 

 

Author Response

Dear reviewer,

We revised the manuscript entitled “Preterm birth and maternal mood states: what impact on bonding?”, submitted to Frontiers.

We thank the editor and the reviewers for taking the time to review our article. 

We are grateful for the meaningful suggestions they have provided us with.

We have followed the reviewers’ suggestions, trying to answer all comments.

You can find our response for each point highlight below.

Comment #1: A well written study.

Reply #1: we thank the reviewer for the positive comment.

Comment #2: Few comments to improve the quality of the results and addressing more stressors that may affect mood and bonding: Were there differences in the bonding scale among mothers or fathers of single vs multiple births?

Reply #2: we thank you for your comment which mentions an interesting variable worth considering for its potential impact on maternal and infant bonding. Our study chose to only consider certain characteristics related specifically to preterm birth. Therefore, it did not consider the possible impact of premature births on maternal-infant bonding. We recommend this might be an interesting perspective to further analyze in the future, along with other socio-demographic variables which would most likely have an impact on maternal mood states and on maternal and infant bonding.

Comment #3: Any differences between fathers and mother’s results?

Reply #3: Although the longitudinal study that our research is part of included fathers of preterm infants, our research team made the choice to not consider their results in order to fully concentrate on the maternal point of view. However, we agree on the importance of the paternal role, who’s lack of consideration in our study constitutes a limit but also a future perspective which should be analyzed. Because you mentioned it, we have added this consideration to our “strengths and limitations” paragraph.

Comment #4: Any effect of first or above delivery on the results?

Reply #4: with the present data, it is not possible to say. However, future analyses might find that there is an impact.  

Comment #5: Although the questionnaires were provided to parents two weeks after delivery short term morbidity of the preterm neonates might impact mental mood such as ventilation, brain ultrasound results, infection, ect.  

Reply #5: We thank the reviewer for this comment. We acknowledge that preterm infants may have serious complications immediately after birth. This is an aspect that our study did not consider but that is very relevant and would most likely have repercussions on maternal mood states and therefore, on bonding.

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

Please add all the above to the limitations of the study.

Author Response

Dear reviewer,
thank you for your comment. We have now incorporated your comments within the limits of the work.