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Relationship Between Antenatal Maternal Anxiety and Feeding Behavior and Physiological Parameters of Neonates in Cesarean Section Mothers: A Cross-sectional Study

AUTHORS

avatar Majid Dejbakht 1 , avatar Elham Khooshab 2 , avatar Afsaneh Zeidabadi 3 , avatar Marzieh Akbarzadeh ORCID 4 , *

1 Department of Nursing, School of Nursing, Gerash University of Medical Sciences, Gerash, Iran

2 Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran

3 Department of Midwifery, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran

4 Department of Midwifery, Maternal–Fetal Medicine Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran

How to Cite: Dejbakht M, Khooshab E, Zeidabadi A, Akbarzadeh M. Relationship Between Antenatal Maternal Anxiety and Feeding Behavior and Physiological Parameters of Neonates in Cesarean Section Mothers: A Cross-sectional Study. Shiraz E-Med J.In Press(In Press):e116001.
doi: 10.5812/semj-116001.

ARTICLE INFORMATION

Shiraz E-Medical Journal: In Press (In Press); e116001
Published Online: April 19, 2022
Article Type: Research Article
Received: May 8, 2021
Revised: October 2, 2021
Accepted: January 9, 2022
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Abstract

Background:

Anxiety is one of the most common psychological disorders in pregnancy. It seems that a pregnant mother’s anxiety has adverse effects on physical growth, motor development, and breastfeeding behavior in her baby.

Objectives:

This study aimed to investigate the relationship between feeding behavior and physiological parameters of neonates with antenatal maternal anxiety in cesarean section mothers.

Methods:

In this cross-sectional study, with a multiple regression analysis method for each variable, 10 samples were selected based on consumptive sampling, and total 101 people were selected. Data were collected using Spielberger’s questionnaire for mothers’ anxiety before delivery, and Standard Infant Breastfeeding Assessment Tool for nutritional behavior, and physiological parameters of newborns was completed within 48 hours after delivery. Independent and dependent t-test and Pearson correlation coefficient tests were used to analyze the data using SPSS software version 16.

Results:

The mean total anxiety (state and trait) was 90.02 ± 18. 09. Pearson correlation test showed that there was no significant relationship between the two anxiety variables with the mean nutritional behavior of the neonates and the anxiety with the physiological parameters of the newborn.

Conclusions:

There was no significant relationship between anxiety and physiological parameters and nutritional behavior of infants. Further studies with a larger sample size are recommended in the area of psychosocial support around delivery and the effect of mothers’ anxiety on the infants’ nutritional behaviors and physiological parameters.

1. Background

Pregnancy is a phenomenon that changes women’s physical, mental, and social life and can be the major underlying cause of disorders such as anxiety. Anxiety is one of the most common psychological disorders in the pregnancy, which will negatively influence the mother’s and infant’s health (1, 2). Decreasing anxiety level is associated with increased oxytocin levels and prolactin and decreased cortisol levels, which will lead to increased milk secretion and easier sucking for the baby (3). The higher nutritional behavior score of the baby, including the power of sucking milk, will lead to more comfortable breastfeeding in the first hours after birth and many short-term and long-term benefits of breastfeeding (4). Dokuhaki et al., as quoted by Maldonado-Duran, reported the mother’s stress and negative experiences during pregnancy would negatively affect physical growth, motor-behavioral and psychological development of infant (5). Also, mothers who had less attachment to their fetus during their pregnancy and had gotten more depression after delivery, their infants had a more developmental delay. Moreover, Dokuhaki et al., as quoted by Punamäki et al., stated that the mother’s anxiety and unpleasant mood during pregnancy directly affected the mood of the fetus (6). Therefore, this study was designed since maternal anxiety can affect the developmental, psychological, and physiological factors of the newborn (7) as well as his/her nutritional behaviors.

2. Objectives

This study aimed to investigate the relationship between feeding behavior and physiological parameters of neonates with antenatal maternal anxiety in cesarean section mothers.

3. Methods

This study is a cross-sectional study. The research units were selected according to the inclusion and exclusion criteria of the study based on the statistical consulting method in the form of multiple regression analysis. For each variable, ten samples (a total of 101 subjects) were selected based on simple purposive. The inclusion criteria were being the mother of childbearing age, being non-emergency cesarean section, with gestational age between 38 - 42 weeks, singleton pregnancy, and tendency of mothers for breastfeeding, and willingness to participate in the study. Moreover, the exclusion criteria were the infant’s weight less than 2,500 and more than 4,000 grams, the Apgar score of less than 7 at 1 or 5 minutes after birth, the existence of meconium in amniotic fluid, the existence of any abnormality in the newborn, not taking anti-breastfeeding drugs in the mother during the breastfeeding, infant feeding with formula, and mother’s reluctance to continue the baby’s participation in the study. The study instrument consisted of maternal and neonatal demographic characteristics questionnaire, standard breastfeeding assessment tool, the form of number and duration of breastfeeding, infant physiological parameters registration form and anxiety inventory.

Standard Infant Breastfeeding Assessment Tool is a standard tool to evaluate breastfeeding. This standard tool was used in Beiranvand et al.’s study (8) in which its validity and reliability were calculated. This form includes four subscales of sucking, rooting, readiness, and latching. Each subscale has 0 - 3 scores and 0 - 12 scores in total. The data were recorded at the beginning of the first breastfeeding at the first hour of birth up to 48 hours (Table 1). The researcher recorded the infant physiological parameters in the registration form at the first hour of birth up to 48 hours. The Spielberger Anxiety Scale with 40 questions (80 scores) was used to assess the anxiety level of mothers. Items scored by a Likert Scale. The Spielberger anxiety test was used by Kalkhoran and Karimollahi in 2007 for 150 patients undergoing surgery in Iran in which the reliability was reported at 0.97. The present study is based on this scale (9).

Table 1. Standard Infant Breastfeeding Assessment Tool Based on Likert Scale
CriteriaScore
Readiness to feed
Readiness to feed without any effort3
Weak stimulation to start feeding2
Need more stimulation to start feeding1
Baby cannot wake up to feed (sleepiness)0
Latching
Feeding starts immediately3
Latching starts after 3 - 10 minutes2
Latching takes time more than 10 minutes1
Feeding does not start0
Sucking
Sucking is good on both breasts3
Sucking is medium but needs stimulation2
Sucking is weak, and it is for a short period 1
No sucking0
Rooting
Effective rooting starts immediately3
Needing stimulation and encouragement2
Rooting is weak even with encouragement1
No attempts for rooting0

3.1. Performance Method

Before cesarean section, firstly, the standard breastfeeding method was trained to mothers eligible for inclusion the study by the researcher assistant and their anxiety scores were recorded. After delivery, during 48 hours of maternal hospitalization, researcher and researcher assistant recorded infants’ nutritional behavior and physiological parameters (heart rate, respiratory rate, body temperature and percentage of arterial oxygen content). The researcher recorded physiological parameters by a tympanic thermometer, pulse oximetry, and a neonatal examination. Data of nutritional behavior of the infant were recorded by the researcher (nurse) and data of the number and duration of breastfeeding was recorded by the mother in the relevant form. The simultaneous examination by two nurses was conducted to confirm the reliability of Infant Breastfeeding Assessment Tool. Also, the reliability of the pulse oximeter, digital thermometer, and sphygmomanometer was measured by similar devices to ensure accuracy in calculating the physiological parameters of the infant.

3.2. Statistical Analysis Method

Statistical methods included descriptive analysis for indicators of mean, standard deviation, frequency, and percentage depending on the quantitative or qualitative variables, independent and dependent t-test, and Pearson correlation coefficient. Also, P-value of less than 0.05 was considered statistically significant, and the data were analyzed using SPSS software (version 16).

3.3. Ethical Considerations

This was a part of an interventional study of clinical trial type that was confirmed by the Ethics Code of Shiraz University of Medical Sciences (IR.SUMS.REC.1396.65). All participants signed written informed consent forms, and if they did not intend to continue participating in the research project, they could withdraw from the study.

4. Results

The results showed that the mean anxiety was 90.02 with a standard deviation of 18.09. The average religious health score was 45.98, with a standard deviation of 8.68. The average score of existential health was 04.04 with a standard deviation of 6.86, and the mean score of spiritual health was 89.02 with a standard deviation of 12.39 (Table 2).

Table 2. The Correlation of Mother’s Anxiety and the Mean Score of Neonatal Feeding Behavior
Mother’s AnxietyCorrelationNumber of NeonatesSignificance Level
Readiness to feed0.0421010.377
Rooting0.0951010.343
Latching0.0891010.376
Sucking0.0251010.801
Neonatal feeding behavior0.0441010.665

In 101 infants whose physiological parameters were recorded for them, the mean heart rate was 137.44 ± 10.35, the mean oxygen arterial blood pressure was 97.99 ± 1.32, the mean respiratory rate was 44.55 ± 6.38, the mean body temperature was 36.5 ± 0.49, and the mean score of nutritional behavior was 9.55 ± 1.07. Mean score of obvious anxiety in mothers was 46.63 ± 10.31, the mean of hidden anxiety was 43.69 ± 10.53, and the mean total anxiety score was 90.02 ± 18.09.

In the investigation of correlation between maternal anxiety and the mean score of nutritional behaviors, as well as physiological parameters of infants, Pearson correlation test showed no significant relationship between the two anxiety variables and the mean nutritional behavior of infants and also between the anxiety with the physiological parameters of the infant (Table 3).

Table 3. The Correlation of Mother’s Anxiety and the Mean Score of Neonatal Physiologic Parameters
Mother’s AnxietyCorrelationNumber of NeonatesSignificance Level
Heart rate-0/2171010.029
Arterial oxygen peroxidation0/0031010.973
Respiratory rate-0/1871010.061
Body temperature0.051010.62

5. Discussion

The total score of the mean of anxiety was 90.02 ± 18.09. The results of a study by Meades and Ayers (2011) (10) were consistent with the results of this study. They evaluated the amount of anxiety in the population of women at the time of delivery. The results of Meades and Ayers’s study showed no significant relationship between the two anxiety variables and the mean nutritional behavior of the infants, and also, there was no significant relationship between anxiety and physiological parameters of the infant (10). In a study by Johnson and Slade (2003) on the effect of anxiety on the pregnancy complications, the findings indicated no relationship between anxiety and maternal and fetal complications during perinatal period (11). The results of Littleton et al.’s study (2007) also showed that there was no significant relationship between anxiety and perinatal complications (12). Also, in Johnson and Slade’s study (2002), there was no relationship between anxiety and the need for emergency cesarean section (13). The results of these studies were consistent with the results of the present study.

Ding et al. (2014) concluded that maternal anxiety during pregnancy led to premature birth and low birth weight (14). Dunkel Schetter and Tanner (2012) study also found that maternal anxiety during pregnancy and around delivery time could had a negative effect on the development of neonatal motor behaviors leading to disruption in the correct functioning of the pituitary-hypothalamus axis in the mother and the infant as well as the reduction of the gray matter of the brain of the infant (15). The results of mentioned studies were inconsistent with the results of the present study.

Since anxiety is a mental data, it seems that the mother’s understanding of anxiety is different from one person to another depending on individual, genetic, family, and cultural characteristics. Therefore, different studies have reported very different results in this regard, particularly the effect of anxiety on mother’s breastfeeding and consequently the infant’s nutritional behaviors. Adedinsewo et al. (2014) found a significant relationship between maternal anxiety, maternal characteristics, and continued breastfeeding. Therefore, the mother’s anxiety should be monitored actively (16). On the other hand, considering the reasons given by mothers for anxiety around the time of delivery, including concerns about the health of the infant, birth weight, lack of ability for correct breastfeeding concerning nutritional behavior, it can be concluded that this wide range of reasons can affect the relationship between anxiety and other parameters in various studies in which these factors are reduced by appropriate interventions such as correct breastfeeding (17).

5.1. Conclusions

There was no significant relationship between anxiety and physiological parameters of the infant as well as nutritional behavior of infants. Given the prevalence of anxiety symptoms during pregnancy and its negative consequences on maternal and fetal health, it is recommended that further studies should be conducted in the field of psychosocial support interventions of mothers during pregnancy and around the time of delivery. In addition, according to the results of this study, it is suggested that further studies should be conducted on the effects of maternal anxiety and nutritional behaviors of the infant, as well as physiological parameters of the infant.

References

  • 1.

    Glover V, Ahmed-Salim Y, Capron L. Maternal Anxiety, Depression, and Stress During Pregnancy: Effects on the Fetus and the Child, and Underlying Mechanisms. Fetal Development. New York City, New York, USA: Springer International Publishing; 2016. p. 213-27. doi: 10.1007/978-3-319-22023-9_12.

  • 2.

    Mokhtaryan T, Yazdanpanahi Z, Akbarzadeh M, Amooee S, Zare N. The impact of Islamic religious education on anxiety level in primipara mothers. J Family Med Prim Care. 2016;5(2):331-7. doi: 10.4103/2249-4863.192314. [PubMed: 27843837]. [PubMed Central: PMC5084557].

  • 3.

    Hallowell SG, Froh EB, Spatz DL, Expert Panel on Breastfeeding of the American Academy of N. Human milk and breastfeeding: An intervention to mitigate toxic stress. Nurs Outlook. 2017;65(1):58-67. doi: 10.1016/j.outlook.2016.07.007. [PubMed: 27502763].

  • 4.

    Binns C, Lee M, Low WY. The Long-Term Public Health Benefits of Breastfeeding. Asia Pac J Public Health. 2016;28(1):7-14. doi: 10.1177/1010539515624964. [PubMed: 26792873].

  • 5.

    Dokuhaki A, Akbarzadeh M, Pishva N, Zare N. A study of the effect of training pregnant women about attachment skills on infants’ motor development indices at birth to four months. Fam. Med. Prim. Care Rev. 2017;2:114-22. doi: 10.5114/fmpcr.2017.67864.

  • 6.

    Dokuhaki S, Heidary M, Akbarzadeh M. Investigation of the effect of training attachment behaviors to pregnant mothers on some physical indicators of their infants from birth to three months based on the separation of male and female infants. Pediatr Neonatol. 2019;60(3):324-31. doi: 10.1016/j.pedneo.2018.08.002. [PubMed: 30201446].

  • 7.

    Granat A, Gadassi R, Gilboa-Schechtman E, Feldman R. Maternal depression and anxiety, social synchrony, and infant regulation of negative and positive emotions. Emotion. 2017;17(1):11-27. doi: 10.1037/emo0000204. [PubMed: 27441576].

  • 8.

    Beiranvand S, Valizadeh F, Hosseinabadi R, Pournia Y. The Effects of Skin-to-Skin Contact on Temperature and Breastfeeding Successfulness in Full-Term Newborns after Cesarean Delivery. Int J Pediatr. 2014;2014:846486. doi: 10.1155/2014/846486. [PubMed: 25610472]. [PubMed Central: PMC4291124].

  • 9.

    Kalkhoran MA, Karimollahi M. Religiousness and preoperative anxiety: a correlational study. Ann Gen Psychiatry. 2007;6:17. doi: 10.1186/1744-859X-6-17. [PubMed: 17603897]. [PubMed Central: PMC1947984].

  • 10.

    Meades R, Ayers S. Anxiety measures validated in perinatal populations: a systematic review. J Affect Disord. 2011;133(1-2):1-15. doi: 10.1016/j.jad.2010.10.009. [PubMed: 21078523].

  • 11.

    Johnson RC, Slade P. Obstetric complications and anxiety during pregnancy: is there a relationship? J Psychosom Obstet Gynaecol. 2003;24(1):1-14. doi: 10.3109/01674820309042796. [PubMed: 12685335].

  • 12.

    Littleton HL, Breitkopf CR, Berenson AB. Correlates of anxiety symptoms during pregnancy and association with perinatal outcomes: a meta-analysis. Am J Obstet Gynecol. 2007;196(5):424-32. doi: 10.1016/j.ajog.2007.03.042. [PubMed: 17466693].

  • 13.

    Johnson R, Slade P. Does fear of childbirth during pregnancy predict emergency caesarean section? BJOG. 2002;109(11):1213-21. doi: 10.1046/j.1471-0528.2002.01351.x. [PubMed: 12452457].

  • 14.

    Ding XX, Wu YL, Xu SJ, Zhu RP, Jia XM, Zhang SF, et al. Maternal anxiety during pregnancy and adverse birth outcomes: a systematic review and meta-analysis of prospective cohort studies. J Affect Disord. 2014;159:103-10. doi: 10.1016/j.jad.2014.02.027. [PubMed: 24679397].

  • 15.

    Dunkel Schetter C, Tanner L. Anxiety, depression and stress in pregnancy: implications for mothers, children, research, and practice. Curr Opin Psychiatry. 2012;25(2):141-8. doi: 10.1097/YCO.0b013e3283503680. [PubMed: 22262028]. [PubMed Central: PMC4447112].

  • 16.

    Adedinsewo DA, Fleming AS, Steiner M, Meaney MJ, Girard AW, Mavan team. Maternal anxiety and breastfeeding: findings from the MAVAN (Maternal Adversity, Vulnerability and Neurodevelopment) Study. J Hum Lact. 2014;30(1):102-9. doi: 10.1177/0890334413504244. [PubMed: 24065719].

  • 17.

    Sisk PM, Lovelady CA, Dillard RG, Gruber KJ. Lactation counseling for mothers of very low birth weight infants: effect on maternal anxiety and infant intake of human milk. Pediatrics. 2006;117(1):e67-75. doi: 10.1542/peds.2005-0267. [PubMed: 16396850].

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