Mother-infant bonding is the primary bond across mammalian species that ensures the infant's survival. Maternal bonding provides the infant with sustained protection and nurturing while fostering long-term neurobiological, cognitive, and social-emotional growth. Unfortunately, in some cases optimal maternal bonding is not achieved, which can lead to enduring behavioral and emotional problems in the child. Poor bonding is common in women with postpartum depression (PPD) and/or anxiety-related disorders. Obstetrical complications (e.g., Caesarian section) may also be associated with poor bonding. Impaired maternal bonding may worsen postpartum depressive and anxiety symptoms and in extreme cases lead to maternal mortality, to the obvious detriment of the child, the prevention of which is a stated Agency mission. Although conventional PPD interventions usually target mother's depression, they may not work for the mother-infant bond. Recent findings show that the immediate postpartum period is an important time for the formation of bonding that promotes child outcomes. Currently there is lack of pharmacological interventions designed to boost bonding in mothers at risk in the immediate postpartum days. This calls for identifying means that are safe, feasible, cost- effective, and adherent to the special needs of mothers to augment existing (non-pharmacological) bonding treatments. Here, we propose a pharmacological intervention targeted at promoting mother-infant bonding and reducing PPD, to the obvious welfare of the child. We will examine the heretofore uninvestigated clinical preventive potential of the posterior pituitary peptide oxytocin (OXT) administered to mothers during the first postpartum days. A sample of women at risk for maternal bonding failure and PPD will be studied prospectively from the third trimester. Utilizing a randomized, controlled design, patients will receive a four-day course of double-blind, intranasal (IN) Syntocinon (synthetic OXT) or placebo starting within hours of delivery in the dosage previously studied to promote lactation, and to be useful in other mental disorders. Mother-infant bonding, quantified by self-report and an observational measure; breastfeeding habits; and mental health (PPD and anxiety symptoms), will be measured at 5 and 45 days postpartum, as well as child development. Establishing an effective add-on preventive intervention may modify the trajectories of depressed women and their children. In accord with the Agency's mission that all children have the chance to achieve their full potential for healthy and productive lives, strengthening the important process of maternal bonding from the very beginning of life may have long-lasting beneficial effects on the child's development. We further expect that our findings will advance scientific knowledge concerning the role of OXT in social interaction, its anti- anxiety and anti-depressive properties in humans, and the dosage and timing required to achieve optimal central nervous system effects. This study will further explore the role of pharmacological intervention at the immediate postpartum period as a therapeutic strategy for PPD and other anxiety-related disorders.
Securing early optimal mother-infant bonding is crucial for infant?s health, and impairment in this process has detrimental effects on infant?s long-term development. A significant number of women find it difficult to immediately bond with their newborn, and those with postpartum depression are at risk, suggesting that mother-infant bonding impairment is a costly public health concern. If we succeed in documenting an effective intervention to enhance bonding, as proposed in this study, it will have significant implications for public health.
