Skip to main content
Download PDF

Effect of nausea and vomiting during pregnancy on mother-to-infant bonding and the mediation effect of postpartum depression: the Japan Environment and Children’s Study

BMC Pregnancy and Childbirth volume 23, Article number: 704 (2023) Cite this article

Abstract

Background

Mother-to-infant bonding (MIB) is critical for the health and well-being of the mother and child. Furthermore, MIB has been shown to boost the social-emotional development of infants, while also giving mothers a sense of happiness in raising their children. Nausea and vomiting during pregnancy (NVP) is a normal complication of pregnancy, occurring in approximately 50–90% of pregnant women in the early stages of pregnancy. Despite widespread knowledge of MIB and postpartum depression, little research attention has been given to the effects of NVP on MIB. This study aimed to investigate the relationship between NVP and MIB and the mediating effects of postpartum depression.

Methods

We analyzed the data of 88,424 infants and 87,658 mothers from the Japan Environment and Children’s Study (JECS), which is a government-funded nationwide birth prospective cohort study. The Japanese version of the Mother-to-Infant Bonding Scale (MIBS-J) was used to assess MIB, and the Edinburgh Postpartum Depression Scale (EPDS) was utilized to assess postpartum depression. We divided participants into four groups according to a self-reported questionnaire assessing NVP (No NVP, Mild NVP, Moderate NVP, and Severe NVP). MIB disorder was defined as a MIBS-J score ≥ 5. Logistic analysis was performed to evaluate the effect of NVP on MIB disorder at one year after delivery. A mediation analysis was conducted to examine whether postpartum depression mediated the association between NVP and MIBS-J scores.

Results

The logistic regression analysis results revealed reduced risks of MIB disorder among mothers with Moderate NVP (adjusted OR 0.93; 95% confidence interval, 0.86–0.99) and Severe NVP (adjusted OR 0.81; 95% confidence interval, 0.74–0.89), compared to those with No NVP. The mediation analysis revealed that NVP positively correlated with MIBS-J score in the indirect effect via postpartum depression, while NVP (Mild NVP, Moderate NVP, and Severe NVP) negatively correlated with MIBS-J score in the direct effect.

Conclusion

The risks of MIB disorder were reduced in the Moderate NVP and Severe NVP mothers, although NVP inhibited the development of MIB via postpartum depression. The development of effective interventions for postpartum depression is important to improve MIB among mothers with NVP.

Peer Review reports

Background

Mother-to-infant bonding (MIB) refers to the emotions and feelings that a mother experiences toward her child while caring for her child [1, 2]. These emotions and feelings, such as love, connection, and contentment, are inherited from the mother [2]. MIB is critical for the health and well-being of both the mother and the child. Furthermore, MIB has been shown to boost the social-emotional development of infants, while also giving mothers a sense of happiness in raising their children [3,4,5]. In contrast, poor MIB has been noted as a risk factor for the growth and development of children, similar to child neglect or abuse [6]. In recent years, studies have reported that a large number of mothers experience MIB disorder [7,8,9,10,11]. In Japan, for instance, MIB disorder reportedly affects 10–21% of mothers [12,13,14]. Research has also revealed that the mother–child relationship during the first year after delivery is an important predictor of social relationship development in the child’s later life [15]. This is even as several studies have found that the development of mother–child bonding starts during pregnancy and continues until early infancy [1, 16] and that maternal antenatal bonding is positively correlated with MIB after delivery [17,18,19,20]. Consequently, it is important to identify the factors associated with mother–child bonding and prescribe measures to prevent MIB disorder as early as possible.

Several factors such as maternal age, education level, household income, marital status, social support [21], number of deliveries [22, 23], feelings about pregnancy [24, 25], maternal personality [26], preterm birth [10, 27], perinatal complication [28, 29], and intimate partner violence [30, 31] have been reported as likely determinants of MIB. Above all, studies have reported that maternal mental status such as psychological distress and postpartum depression [32,33,34,35,36,37] also affect MIB development. Similarly, the Japan Environment and Children Study (JECS) revealed that mothers experiencing postpartum depression at multiple points postpartum are more likely to have poor MIB [33]. Relatedly, postpartum depressive symptoms at multiple points until four months have been found to be associated with the development of MIB until fourteen months [36]. Furthermore, maternal depressive symptoms are associated with MIB postpartum [17, 35], just as bonding disorders are often present in postpartum depression [37].

Nausea and vomiting during pregnancy (NVP) can affect maternal physical and mental health during pregnancy and the postpartum period [38,39,40]. NVP is a normal complication of pregnancy, often known as morning sickness, occurring in approximately 50–90% of pregnant women in the early stages of pregnancy [41,42,43,44]. Furthermore, approximately 0.3–2% of pregnant women develop hyperemesis gravidarum (HG), a serious type of NVP characterized by weight loss, dehydration, and electrolyte and metabolic abnormalities [45, 46]. However, studies on the relationship between NVP and MIB are limited. A previous study revealed that HG negatively affects maternal antenatal bonding, nevertheless, this negative effect is time-limited to early pregnancy and disappears when HG symptoms disappear [47]. Another study reported that HG is not directly associated with MIB at six weeks after delivery [48]. On the other hand, NVP has been linked to mental health in pregnant women, regardless of the severity of its symptoms [49]. Additionally, women who experienced NVP are more likely to experience postpartum depression [50, 51]. Therefore, we speculate that NVP, including relatively mild cases as a risk factor for postpartum depression, affects the development of MIB. Previous JECS studies suggest that NVP induces physical and mental anguish in mothers, which is positively associated with postpartum depression [50], and postpartum depression inhibits the development of MIB [33]. The findings of these two studies show a predictable relationship between NVP, postpartum depression, and MIB. However, they did not establish how NVP affects MIB via postpartum depression. Therefore, the aim of our study was to investigate the effect of NVP on MIB at one year after delivery. To this end, mediation analysis was used to analyze the direct effects of NVP on MIB and the indirect effects via postpartum depression, by severity of NVP.

Methods

Study design

We analyzed the existing dataset of the JECS, which is a nationwide government-funded birth cohort study that started in 2011. The study enrollment period ended in March 2014 [52]. The JECS aims to assess the impact of environmental exposure during the prenatal stage and early childhood on children’s health and development [53, 54]. Pregnant women were recruited from 15 Regional Centers situated throughout Japan.

Study data

The current study was based on the dataset “jecs-ta-20190930,” which contained 104,062 fetal records. After removing records of miscarriage, stillbirth, and missing birth data (n = 3,759), as well as records missing data on the sex of the infants (n = 18) and the mothers’ NVP (n = 2,261), 98,024 fetal records of infants with mothers with NVP remained. Finally, the study population consisted of 88,424 infants and 87,658 mothers after eliminating missing data on the MIB at one year after delivery (n = 9,600) (Fig. 1).

Fig. 1
figure 1

Participant flow diagram. Note: JECS = The Japan Environment and Children’s Study. NVP = nausea and vomiting during pregnancy. MIBS-J score = the Japanese version of the Mother-to-Infant Bonding Scale score

Full size image

Measurements

Nausea and vomiting during pregnancy (NVP)

We collected information on NVP from self-reported questionnaires administered during mid/late pregnancy. Mothers were asked, “Did you have morning sickness during the first 12 weeks of pregnancy?” (1 = never, 2 = nausea but no vomiting, 3 = vomiting but being able to eat, 4 = vomiting and being unable to eat). We classified participants as No NVP, Mild NVP, Moderate NVP, and Severe NVP, respectively [50, 55].

Mother-to-infant bonding (MIB)

MIB was assessed at one year after delivery using the Japanese version of the Mother-to-Infant Bonding Scale (MIBS-J) [56]. The MIBS-J consists of ten items with total scores ranging from 0 to 30. Each item is scored on a four-point scale from 0 to 3. Higher scores indicated worse MIB. We considered MIBS-J scores of five or more as likely to have MIB disorder. This cut-off (4/5) is used in the Japanese version of MIBS [13, 14, 26]. The Cronbach’s alpha of MIBS-J is 0.72 in our study.

Postpartum depression

Postpartum depression was assessed at one month after delivery using the Japanese version of the Edinburgh Postnatal Depression Scale (EPDS) [57]. The EPDS consists of ten items with total scores ranging from 0 to 30, each rated on a four-point scale from 0 to 3. A higher score implies more severe depressive symptoms. The EPDS Japanese version's Cronbach's alpha was 0.78, indicating potent internal consistency.

Covariates

We picked the following covariates to adjust the logistic regression and mediation models, based on other studies on the risk factors of NVP and MIB [19, 58]: maternal age, multiple births, parity, maternal educational level, paternal educational level, annual household income, marital status, feelings about the pregnancy, psychological distress (assessed by the Kessler Psychological Distress Scale [K6] during mid/late pregnancy) [59], verbal abuse from a partner, physical abuse from a partner, maternal alcohol intake, maternal smoking status, paternal smoking status, and infant’s sex. The categorization of these variables is shown in Table 1.

Table 1 Demographic and obstetric characteristics of mothers (n = 87,658) and infants (n = 88,424)
Full size table

Statistical analysis

The demographic characteristics of the participants were presented using descriptive statistics. All continuous variables included in this study, such as the total scores for the EPDS and MIBS-J, were calculated to determine means and standard deviations. Logistic analysis was performed to evaluate the relationship between NVP and MIB disorder at one year after delivery, with NVP (4 categories) as the independent variable (reference, No NVP) and the MIBS-J binary variable (MIB disorder, ≥ 5) as the dependent variable. Odds ratios (ORs) and 95% confidence intervals (CIs) were determined in crude (cOR) and adjusted (aOR) models controlling for covariates. A mediation analysis was conducted to examine whether postpartum depression mediated the association between NVP and MIBS-J scores. In the mediation model (Fig. 2), NVP (four categories) was used as the independent variable, with No NVP as the reference group. The continuous MIBS-J score was used as the dependent variable, and the EPDS score was used as the mediator variable. The relative indirect effect was used to determine whether the independent variable influenced the dependent variable through the mediator. Bias-corrected (BC) bootstrap 95% CIs were obtained for the potential mediators. These were utilized to examine the significance of the relative total and indirect effects, based on 5,000 bootstrap samples. The indirect effect was deemed significant if the BC bootstrap 95% CI did not contain zero.

Fig. 2
figure 2

Mediating effect of EPDS score on the association between NVP and MIBS-J score – Mediation model. NVP = nausea and vomiting during pregnancy; EPDS score = Edinburgh Postnatal Depression Scale score; MIBS-J score = the Japanese version of the Mother-to-Infant Bonding Scale score

Full size image

All statistical analyses were performed using SPSS version 25 software (IBM Corp., Armonk, NY, USA). The mediation analysis was conducted using PROCESS macro for SPSS Ver.4.0 (Andrew F. Hayes).

Results

Table 1 displays the demographic and obstetric characteristics of the mothers and infants. Of the 88,424 mothers, 78,219 (88.5%) did not report MIB disorder, while 10,205 (11.5%) did. Of the 87,658 mothers, 15,038 (17.2%) were No NVP mothers, 37,778 (43.1%) were Mild NVP mothers, 25,276 (28.8%) were Moderate NVP mothers, and 9,566 (10.9%) were Severe NVP mothers. Regarding maternal age during pregnancy, 71.7% of the mothers were 20 to 34 years old. In addition, 95.2% of the mothers were married, and 90.6% felt happy when they found out they were pregnant.

Table 2 shows the association between NVP and MIB disorder at one year after delivery. We found that mothers with Moderate NVP had a reduced risk of MIB disorder in the adjusted model (aOR 0.83; 95% CI, 0.86, 0.99). Moreover, mothers with Severe NVP had a reduced risk of MIB disorder in the crude model (cOR 0.91; 95% CI, 0.84, 0.98) and the adjusted model (aOR 0.81; 95% CI, 0.74, 0.99). For the Mild NVP mothers, there were no significant differences in either the crude or adjusted models.

Table 2 The odds ratio of MIB disorder in relation to the NVP status
Full size table

Table 3 shows the mediating effects of postpartum depression on the association between NVP and MIBS-J score at one year after delivery, in the crude and adjusted models. In the relative indirect effects via postpartum depression, the Mild NVP (standardized path coefficient [β]: 0.022; BC 95% CI: 0.016, 0.027 in the adjusted model), Moderate NVP (β: 0.020; BC 95% CI: 0.015, 0.026), and Severe NVP (β: 0.028; BC 95% CI: 0.020, 0.035) showed positive associations with MIBS-J score (i.e., bonding suppression) compared with the No NVP. In the relative direct effects, Moderate NVP (β: -0.023; 95% CI: -0.101, -0.006) and Severe NVP (β: -0.091; 95% CI: -0.268, -0.147) were negatively associated with MIBS-J scores (i.e., bonding promotion). As the relative total effects, Severe NVP (β: -0.063; 95% CI: -0.207, -0.081) was negatively associated with MIBS-J score (i.e., bonding promotion).

Table 3 Mediation effect of NVP on MIBS-J score through EPDS score in mediation analysis
Full size table

Discussion

In our study, 11.5% of mothers developed MIB disorder, which is consistent with other studies that a significant number of mothers experienced MIB disorders after birth [12,13,14]. Also, we found that 82.8% of pregnant women experienced NVP in the current pregnancy, which is also consistent with other studies that revealed 50–90% of pregnant women experience NVP [41,42,43,44]. We found that 10.9% of Japanese mothers had Severe NVP, defined as vomiting and not being able to eat. The percentage was consistent with a birth cohort study in the United Kingdom reporting that 11% of pregnant women experienced Severe NVP [55].

The findings of the logistic regression analysis demonstrate that mothers with Moderate NVP and Severe NVP had a reduced risk of MIB disorder at one year after delivery in our study. Similarly, the total effect of mediation analysis also revealed a negative association with MIBS-J score (i.e., bonding promotion) in the Severe NVP mothers. Mitchell-Jones et al. examined the association between HG and MIB at six weeks after delivery, in which no significant difference was observed [48]. This mismatch between studies may be due to factors including differences in the definition of NVP (questionnaire-based vs. diagnosed), in the timing of MIB evaluation (1 year vs. 6 weeks after delivery), or in ethnicity and dietary patterns.

The findings of our study demonstrate that NVP may have a direct effect on MIB. MIB may be affected by pregnancy-related hormonal changes. It has been found that mothers with a high estrogen/progesterone ratio during pregnancy have more positive attitudes toward their newborns immediately after birth [60]. Although the exact mechanism is unknown, estradiol is thought to stimulate parental behavior by acting on the medial preoptic area of the forebrain and other brain regions related to maternal behavior [61]. Furthermore, estrogen levels have been reported to be higher in pregnant women with NVP than in those without NVP [58, 62]. Therefore, increased estrogen levels during pregnancy may have had a beneficial effect on the development of MIB.

Contrary to the direct effect, the indirect effect via postpartum depression from NVP (Mild NVP, Moderate NVP, and Severe NVP) was found to inhibit the development of MIB at one year after delivery. NVP has also been found to be positively associated with postpartum depression [39, 51], and, postpartum depression inhibits the development of MIB [21]. Although Mitchell-Jones et al. reported the association between HG and postpartum depression, there was no direct association of HG with infant bonding in their study [48]. This result suggests that NVP or HG plays a role in the establishment of infant bonding in a different way from postpartum depression. Our findings highlight that NVP promotes the development of MIB but suppresses it through postpartum depression. Thus, we suggest monitoring the NVP symptoms during pregnancy to provide timely and effective intervention. We believe that if a pregnant woman is cared for from the onset of NVP to reduce the risk of postpartum depression, the risk of poor MIB may also be reduced.

Our study has several strengths. First, it is groundbreaking, as it is, to the best of our knowledge, the first study to examine the association between NVP and MIB, along with the mediation effect of postpartum depression on the association between NVP and MIB. Second, we analyzed data from a large Japanese birth cohort, with the individual characteristics of mothers and children roughly corresponding to Japanese national statistics [54]; so our findings are highly representative of the Japanese population. Despite these clear strengths, our study has some limitations. First, information on NVP was collected using a self-reported questionnaire, while this can reduce the burden on participating mothers to answer the questionnaire, it could also limit the objectivity of the data and could cause recall bias. Second, despite our large sample size, there is still a possibility of coincidental results in the statistical analysis process. Third, even though the results of this study were obtained after adjusting for maternal and paternal educational levels, annual household income, and other confounding factors, the analysis results could be impacted by the change in Japan's current socio-economic situation given that the data was collected from 2011 to 2014. Finally, our study only examined the effect of NVP on MIB at one year after delivery; however, MIB changes over time. Therefore, more research on time-series changes in MIB caused by NVP is required to investigate how the effect of NVP on MIB varies from pregnancy up to one year after delivery.

Conclusion

Our study revealed that mothers who experienced Moderate NVP and Severe NVP had a lower risk of MIB disorder. In addition, NVP inhibits the development of MIB through postpartum depression. Importantly, our findings suggest that it is essential to provide interventional care for mothers from the onset of NVP to prevent postpartum depression to exert the promoting effect of NVP on MIB. Also, our study provides new insights into the facilitating effect of NVP on MIB when assessing the relationship between NVP and MIB. Future research should investigate the indirect impacts of familial or social support generated by the NVP on MIB. We believe that promoting MIB through intervention benefits both the mental health of the mother and the growth and development of the child.

Availability of data and materials

Data are unsuitable for public deposition due to ethical restrictions and legal framework of Japan. It is prohibited by the Act on the Protection of Personal Information (Act No. 57 of 30 May 2003, amended on 9 September 2015) to publicly deposit data containing personal information. Ethical Guidelines for Medical and Health Research Involving Human Subjects, enforced by the Japan Ministry of Education, Culture, Sports, Science and Technology and the Ministry of Health, Labour and Welfare, also restricts the open sharing of epidemiologic data. Any questions about data access should be directed to Dr. Shoji F. Nakayama, JECS Program Office, National Institute for Environmental Studies, at jecs-en@nies.go.jp.

Abbreviations

EPDS:

Edinburgh Postpartum Depression Scale

HG:

Hyperemesis gravidarum

JECS:

Japan Environment and Children’s Study

MIB:

Mother-to-infant bonding

MIBS-J:

Mother-to-Infant Bonding Scale (Japanese version)

NVP:

Nausea and vomiting during pregnancy

References

  1. Bicking Kinsey C, Hupcey JE. State of the science of maternal-infant bonding: a principle-based concept analysis. Midwifery. 2013;29:1314–20.

    PubMed  Google Scholar 

  2. Hill R, Flanagan J. The maternal–infant bond: clarifying the concept. Int J Nurs Knowl. 2020;31:14–8.

    PubMed  Google Scholar 

  3. Behrendt HF, Scharke W, Herpertz-Dahlmann B, Konrad K, Firk C. Like mother, like child? Maternal determinants of children’s early social-emotional development. Infant Ment Health J. 2019;40:234–47.

    PubMed  Google Scholar 

  4. Le Bas GA, Youssef GJ, Macdonald JA, Mattick R, Teague SJ, Honan I, et al. Maternal bonding, negative affect, and infant social-emotional development: a prospective cohort study. J Affect Disord. 2021;281:926–34.

    PubMed  Google Scholar 

  5. Mason ZS, Briggs RD, Silver EJ. Maternal attachment feelings mediate between maternal reports of depression, infant social-emotional development, and parenting stress. J Reprod Infant Psychol. 2011;29:382–94.

    Google Scholar 

  6. Brockington I. Maternal rejection of the young child: present status of the clinical syndrome. Psychopathology. 2011;44:329–36.

    PubMed  Google Scholar 

  7. Chandra PS, Desai G, Reddy D, Thippeswamy H, Saraf G. The establishment of a mother-baby inpatient psychiatry unit in India: adaptation of a Western model to meet local cultural and resource needs. Indian J Psychiatry. 2015;57:290–4.

    PubMed  PubMed Central  Google Scholar 

  8. Afolabi O, Bunce L, Lusher J, Banbury S. Postnatal depression, maternal–infant bonding and social support: a cross-cultural comparison of Nigerian and British mothers. J Ment Heal. 2020;29:424–30.

    Google Scholar 

  9. Mazúchová L, Kelčíková S, Porubská A, Malinovská N, Grendár M. Mother-infant bonding in the postpartum period and its predictors. Cent Eur J Nurs Midwifery. 2020;11:121–9.

    Google Scholar 

  10. Bieleninik Ł, Lutkiewicz K, Cieślak M, Preis-Orlikowska J, Bidzan M. Associations of maternal-infant bonding with maternal mental health, infant’s characteristics and socio-demographical variables in the early postpartum period: a cross-sectional study. Int J Environ Res Public Health. 2021;18:1–19.

    Google Scholar 

  11. Hailemeskel HS, Kebede AB, Fetene MT, Dagnaw FT. Mother-infant bonding and its associated factors among mothers in the postpartum period, Northwest Ethiopia, 2021. Front Psychiatry. 2022;13:1–9.

    Google Scholar 

  12. Takeishi Y, Nakamura Y, Yoshida M, Kawajiri M, Atogami F, Yoshizawa T. Associations between coparenting relationships and maternal depressive symptoms and negative bonding to infant. Healthc. 2021;9:375.

    Google Scholar 

  13. Matsunaga A, Takauma F, Tada K, Kitamura T. Discrete category of mother-to-infant bonding disorder and its identification by the mother-to-infant bonding Scale: a study in Japanese mothers of a 1-month-old. Early Hum Dev. 2017;111:1–5.

    PubMed  Google Scholar 

  14. Tsuchiya S, Tsuchiya M, Momma H, Koseki T, Igarashi K, Nagatomi R, et al. Association of cleft lip and palate on mother-to-infant bonding: a cross-sectional study in the Japan Environment and Children’s Study (JECS). BMC Pediatr. 2019;19:1–8.

    Google Scholar 

  15. Bornstein M. Human infancy … and the rest of the lifespan. Annu Rev Psychol. 2014;65:121–58.

    PubMed  Google Scholar 

  16. de Cock ESA, Henrichs J, Vreeswijk CMJM, Maas AJBM, Rijk CHAM, van Bakel HJA. Continuous feelings of love? The parental bond from pregnancy to toddlerhood. J Fam Psychol. 2016;30:125–34.

    PubMed  Google Scholar 

  17. Rossen L, Hutchinson D, Wilson J, Burns L, A Olsson C, Allsop S, et al. Predictors of postnatal mother-infant bonding: the role of antenatal bonding, maternal substance use and mental health. Arch Womens Ment Health. 2016;19:609–22.

    PubMed  Google Scholar 

  18. Dubber S, Reck C, Müller M, Gawlik S. Postpartum bonding: the role of perinatal depression, anxiety and maternal–fetal bonding during pregnancy. Arch Womens Ment Health. 2015;18:187–95.

    CAS  PubMed  Google Scholar 

  19. Tichelman E, Westerneng M, Witteveen AB, Van Baar AL, Van Der Horst HE, De Jonge A, et al. Correlates of prenatal and postnatal motherto-infant bonding quality: a systematic review. PLoS One. 2019;14:e0222998.

    CAS  PubMed  PubMed Central  Google Scholar 

  20. Alhusen JL, Hayat MJ, Gross D. A longitudinal study of maternal attachment and infant developmental outcomes. Arch Womens Ment Health. 2013;16:521–9.

    PubMed  Google Scholar 

  21. Bicking Kinsey C, Baptiste-Roberts K, Zhu J, Kjerulff KH. Birth-related, psychosocial, and emotional correlates of positive maternal-infant bonding in a cohort of first-time mothers. Midwifery. 2014;30:e188–94.

    Google Scholar 

  22. Tsuchida A, Hamazaki K, Matsumura K, Miura K, Kasamatsu H, Inadera H, et al. Changes in the association between postpartum depression and mother-infant bonding by parity: longitudinal results from the Japan Environment and Children’s Study. J Psychiatr Res. 2019;110:110–6.

    PubMed  Google Scholar 

  23. Yoshida T, Matsumura K, Tsuchida A, Hamazaki K, Inadera H. Influence of parity and mode of delivery on mother–infant bonding: the Japan Environment and Children’s Study. J Affect Disord. 2020;263:516–20.

    PubMed  Google Scholar 

  24. Tokuda N, Kobayashi Y, Tanaka H, Sawai H, Shibahara H, Takeshima Y, et al. Feelings about pregnancy and mother-infant bonding as predictors of persistent psychological distress in the perinatal period: the Japan Environment and Children’s Study. J Psychiatr Res. 2021;140:132–40.

    PubMed  Google Scholar 

  25. Foster DG, Biggs MA, Raifman S, Gipson J, Kimport K, Rocca CH. Comparison of health, development, maternal bonding, and poverty among children born after denial of abortion vs after pregnancies subsequent to an abortion. JAMA Pediatr. 2018;172:1053–60.

    PubMed  PubMed Central  Google Scholar 

  26. Murakami K, Ueno F, Nakamura I, Ishikuro M, Noda A, Onuma T, et al. Maternal personality and postnatal bonding disorder in Japan: the Tohoku medical megabank project birth and three-generation cohort study. J Affect Disord. 2021;282:580–6.

    PubMed  Google Scholar 

  27. Vizzari G, Morniroli D, D’Auria A, Travella P, Bezze E, Sannino P, et al. Feeding difficulties in late preterm infants and their impact on maternal mental health and the mother–infant relationship: a literature review. Nutrients. 2023;15:2180.

    PubMed  PubMed Central  Google Scholar 

  28. Dinç T, Kanbur A. The effect of delayed umbilical cord clamping on the infant’s beta-endorphin level, mother-infant attachment and breastfeeding. Eur J Obstet Gynecol Reprod Biol. 2023;285:187–92.

    PubMed  Google Scholar 

  29. Farré-Sender B, Torres A, Gelabert E, Andrés S, Roca A, Lasheras G, et al. Mother–infant bonding in the postpartum period: assessment of the impact of pre-delivery factors in a clinical sample. Arch Womens Ment Health. 2018;21:287–97.

    PubMed  Google Scholar 

  30. Kita S, Haruna M, Matsuzaki M, Kamibeppu K. Associations between intimate partner violence (IPV) during pregnancy, mother-to-infant bonding failure, and postnatal depressive symptoms. Arch Womens Ment Health. 2016;19:623–34.

    PubMed  Google Scholar 

  31. Yamada K, Kimura T, Cui M, Kubota Y, Tanaka E, Wakaizumi K, et al. Antenatal pain, intimate partner violence, and maternal bonding disorder: data from the Japan Environment and Children’s Study. Pain. 2021;162:749–59.

    PubMed  Google Scholar 

  32. Daglar G, Nur N. Level of mother-baby bonding and influencing factors during pregnancy and postpartum period. Psychiatr Danub. 2018;30:433–40.

    PubMed  Google Scholar 

  33. Kasamatsu H, Tsuchida A, Matsumura K, Shimao M, Hamazaki K, Inadera H. Understanding the relationship between postpartum depression one month and six months after delivery and mother-infant bonding failure one-year after birth: results from the Japan Environment and Children’s study (JECS). Psychol Med. 2020;50:161–9.

    PubMed  Google Scholar 

  34. Muzik M, Bocknek EL, Broderick A, Richardson P, Rosenblum KL, Thelen K, et al. Mother-infant bonding impairment across the first 6 months postpartum: The primacy of psychopathology in women with childhood abuse and neglect histories. Arch Womens Ment Health. 2013;16:29–38.

    PubMed  Google Scholar 

  35. Barnes J, Theule J. Maternal depression and infant attachment security: a meta-analysis. Infant Ment Health J. 2019;40:817–34.

    PubMed  Google Scholar 

  36. Moehler E, Brunner R, Wiebel A, Reck C, Resch F. Maternal depressive symptoms in the postnatal period are associated with long-term impairment of mother-child bonding. Arch Womens Ment Health. 2006;9:273–8.

    CAS  PubMed  Google Scholar 

  37. Gilden J, Molenaar NM, Smit AK, Hoogendijk WJG, Rommel AS, Kamperman AM, et al. Mother-to-infant bonding in women with postpartum psychosis and severe postpartum depression: a clinical cohort study. J Clin Med. 2020;9:1–10.

    Google Scholar 

  38. Hirose M, Tamakoshi K, Takahashi Y, Mizuno T, Yamada A, Kato N. The effects of nausea, vomiting, and social support on health-related quality of life during early pregnancy: a prospective cohort study. J Psychosom Res. 2020;136:110168.

    PubMed  Google Scholar 

  39. Kjeldgaard HK, Eberhard-Gran M, Benth JŠ, Vikanes ÅV. Hyperemesis gravidarum and the risk of emotional distress during and after pregnancy. Arch Womens Ment Health. 2017;20:747–56.

    PubMed  PubMed Central  Google Scholar 

  40. Mitchell-Jones N, Gallos I, Farren J, Tobias A, Bottomley C, Bourne T. Psychological morbidity associated with hyperemesis gravidarum: a systematic review and meta-analysis. BJOG An Int J Obstet Gynaecol. 2017;124:20–30.

    CAS  Google Scholar 

  41. Bozzo Bsc P, Einarson R, Koren G, Einarson A. Nausea and vomiting of pregnancy (NVP) and depression: cause or effect? Clin Invest Med. 2011;34:E245.

    Google Scholar 

  42. Gadsby R, Barnie-Adshead AM, Jagger C. A prospective study of nausea and vomiting during pregnancy. Br J Gen Pract. 1993;43:245–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  43. Zhu S, Zhao A, Lan H, Li P, Mao S, Szeto IM, et al. Nausea and vomiting during early pregnancy among Chinese women and its association with nutritional intakes. Nutrients. 2023;15:933.

    CAS  PubMed  PubMed Central  Google Scholar 

  44. Kramer J, Bowen A, Stewart N, Muhajarine N. Nausea and vomiting of pregnancy: prevalence, severity and relation to psychosocial health. MCN Am J Matern Nurs. 2013;38:21–7.

    Google Scholar 

  45. Simpson SW, Murphy Goodwin T, Robins SB, Rizzo AA, Howes RA, Buckwalter DK, et al. Psychological factors and hyperemesis gravidarum. J Women’s Heal Gender-Based Med. 2001;10:471–7.

    CAS  Google Scholar 

  46. Veenendaal MVE, Van Abeelen AFM, Painter RC, Van Der Post JAM, Roseboom T. Consequences of hyperemesis gravidarum for offspring: a systematic review and meta-analysis. BJOG An Int J Obstet Gynaecol. 2011;118:1302–13.

    CAS  Google Scholar 

  47. McCormack D, Scott-Heyes G, McCusker CG. The impact of hyperemesis gravidarum on maternal mental health and maternal-fetal attachment. J Psychosom Obstet Gynecol. 2011;32:79–87.

    Google Scholar 

  48. Mitchell-Jones N, Lawson K, Bobdiwala S, Farren JA, Tobias A, Bourne T, et al. Association between hyperemesis gravidarum and psychological symptoms, psychosocial outcomes and infant bonding: A two-point prospective case-control multicentre survey study in an inner city setting. BMJ Open. 2020;10:1–12.

    Google Scholar 

  49. Mazzotta P, Stewart D, Atanackovic G, Koren G, Magee LA. Psychosocial morbidity among women with nausea and vomiting of pregnancy: prevalence and association with anti-emetic therapy. J Psychosom Obstet Gynaecol. 2000;21:129–36.

    CAS  PubMed  Google Scholar 

  50. Muchanga SMJ, Eitoku M, Mbelambela EP, Ninomiya H, Iiyama T, Komori K, et al. Association between nausea and vomiting of pregnancy and postpartum depression: the Japan Environment and Children’s Study. J Psychosom Obstet Gynecol. 2022;43:2–10.

    Google Scholar 

  51. Iliadis SI, Axfors C, Johansson S, Skalkidou A, Mulic-Lutvica A. Women with prolonged nausea in pregnancy have increased risk for depressive symptoms postpartum. Sci Rep. 2018;8:1–9.

    CAS  Google Scholar 

  52. Ishitsuka K, Nakayama SF, Kishi R, Mori C, Yamagata Z, Ohya Y, et al. Japan Environment and Children’s Study: backgrounds, activities, and future directions in global perspectives. Environ Health Prev Med. 2017;22:1–9.

    Google Scholar 

  53. Kawamoto T, Nitta H, Murata K, Toda E, Tsukamoto N, Hasegawa M, et al. Rationale and study design of the Japan environment and children’s study (JECS). BMC Public Health. 2014;14:25.

    PubMed  PubMed Central  Google Scholar 

  54. Michikawa T, Nitta H, Nakayama SF, Yamazaki S, Isobe T, Tamura K, et al. Baseline profile of participants in the Japan environment and children’s study (JECS). J Epidemiol. 2018;28:99–104.

    PubMed  PubMed Central  Google Scholar 

  55. Crozier SR, Inskip HM, Godfrey KM, Cooper C, Robinson SM. Nausea and vomiting in early pregnancy: effects on food intake and diet quality. Matern Child Nutr. 2017;13:1–10.

    Google Scholar 

  56. Yoshida K, Yamashita H, Conroy S, Marks M, Kumar C. A Japanese version of mother-to-infant bonding scale: factor structure, longitudinal changes and links with maternal mood during the early postnatal period in Japanese mothers. Arch Womens Ment Health. 2012;15:343–52.

    PubMed  PubMed Central  Google Scholar 

  57. Okano T, Murata M, Masuji F, Tamaki R, Omura J, Miyaoka H, et al. Validation and reliability of a Japanese version of the EPDS. Arch Psychiatr Diagnostics Clin Eval. 1996;1996(7):525–33.

    Google Scholar 

  58. Lee NM, Saha S. Nausea and vomiting of pregnancy. Gastroenterol Clin North Am. 2011;40:309–34.

    PubMed  PubMed Central  Google Scholar 

  59. Furukawa TA, Kawakami N, Saitoh M, Ono Y, Nakane Y, Nakamura Y, et al. The performance of the Japanese version of the K6 and K10 in the World Mental Health Survey Japan. Int J Methods Psychiatr Res. 2008;17(Suppl 1):S78-82.

    Google Scholar 

  60. Fleming AS, Ruble D, Krieger H, Wong PY. Hormonal and experiential correlates of maternal responsiveness during pregnancy and the puerperium in human mothers. Horm Behav. 1997;31:145–58.

    CAS  PubMed  Google Scholar 

  61. Bornstein MH. Handbook of parenting: biology and ecology of parenting. 3rd ed. New York: Routledge; 2019.

    Google Scholar 

  62. Bustos M, Venkataramanan R, Caritis S, Pittsburgh TS, Sciences R, Womens M, et al. Nausea and vomiting of pregnancy-what’s new? HHS Public Access. 2018;202:62–72.

    Google Scholar 

Download references

Acknowledgements

We are very grateful to all the participants in this study and express our appreciation to the individuals who cooperated in data collection.

Consortia: The Japan Environment and Children's Study (JECS) Group

Michihiro Kamijima4 (Principal Investigator), Shin Yamazaki5, Yukihiro Ohya6, Reiko Kishi7, Nobuo Yaegashi8, Koichi Hashimoto9, Chisato Mori2,3, Shuichi Ito10, Zentaro Yamagata11, Hidekuni Inadera12, Takeo Nakayama13, Tomotaka Sobue14, Masayuki Shima15, Seiji Kageyama16, Narufumi Suganuma17, Shoichi Ohga18, and Takahiko Katoh19.

5 National Institute for Environmental Studies, Tsukuba, Japan.

6 National Center for Child Health and Development, Tokyo, Japan.

7 Hokkaido University, Sapporo, Japan.

8 Tohoku University, Sendai, Japan.

9 Fukushima Medical University, Fukushima, Japan.

10 Yokohama City University, Yokohama, Japan.

11 University of Yamanashi, Chuo, Japan.

12 University of Toyama, Toyama, Japan.

13 Kyoto University, Kyoto, Japan.

14 Osaka University, Suita, Japan.

15 Hyogo Medical University, Nishinomiya, Japan.

16 Tottori University, Yonago, Japan.

17 Kochi University, Nankoku, Japan.

18 Kyushu University, Fukuoka, Japan.

19 Kumamoto University, Kumamoto, Japan.

Funding

This study was funded by the Ministry of the Environment, Japan. The findings and conclusions of this article are the sole responsibility of the authors and do not represent the official views of the government.

Author information

Authors and Affiliations

  1. Department of Nutrition and Metabolic Medicine, Center for Preventive Medical Sciences, Chiba University, 1-33 Yayoicho, Inageku, Chiba, Japan

    Gui Yang & Kenichi Sakurai

  2. Department of Sustainable Health Science, Center for Preventive Medical Sciences, Chiba University, 1-33 Yayoicho, Inageku, Chiba, Japan

    Aya Hisada, Midori Yamamoto, Akiko Kawanami & Chisato Mori

  3. Department of Bioenvironmental Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba, Japan

    Chisato Mori

Authors
  1. Gui Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aya Hisada
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Midori Yamamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Akiko Kawanami
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Chisato Mori
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kenichi Sakurai
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

The Japan Environment, Children’s Study (JECS) Group

  • Michihiro Kamijima
  • , Shin Yamazaki
  • , Yukihiro Ohya
  • , Reiko Kishi
  • , Nobuo Yaegashi
  • , Koichi Hashimoto
  • , Chisato Mori
  • , Shuichi Ito
  • , Zentaro Yamagata
  • , Hidekuni Inadera
  • , Takeo Nakayama
  • , Tomotaka Sobue
  • , Masayuki Shima
  • , Seiji Kageyama
  • , Narufumi Suganuma
  • , Shoichi Ohga
  •  & Takahiko Katoh

Contributions

GY., AH., KS.: Conceptualized and designed the research. GY: Performed statistical analysis, and was a major contributor in writing the manuscript. AH., MY., KS.: Revised the study concept and design, and contributed to the analysis. GY., AH., MY., AK., KS.: Involved in data interpretation. KS., CM.: Supervised and reviewed the research. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Kenichi Sakurai.

Ethics declarations

Ethics approval and consent to participate

The Japan Environment and Children’s Study (JECS) protocol was reviewed and approved by the Ministry of the Environment’s Institutional Review Board on Epidemiological Studies (no. 100910001), and the Ethics Committees of all participating institutions, i.e., National Institute for Environmental Studies, National Center for Child Health and Development, Hokkaido University, Sapporo Medical University, Asahikawa Medical College, Japanese Red Cross Hokkaido College of Nursing, Tohoku University, Fukushima Medical University, Chiba University, Yokohama City University, University of Yamanashi, Shinshu University, University of Toyama, Nagoya City University, Kyoto University, Doshisha University, Osaka University, Osaka Medical Center and Research Institute for Maternal and Child Health, Hyogo College of Medicine, Tottori University, Kochi University, University of Occupational and Environmental University, Kyushu University, Kumamoto University, University of Miyazaki, and the University of the Ryukyus. The JECS was conducted in accordance with the Declaration of Helsinki, and all participants provided written informed consent. Written informed consent was obtained from all the study participants.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yang, G., Hisada, A., Yamamoto, M. et al. Effect of nausea and vomiting during pregnancy on mother-to-infant bonding and the mediation effect of postpartum depression: the Japan Environment and Children’s Study. BMC Pregnancy Childbirth 23, 704 (2023). https://0-doi-org.brum.beds.ac.uk/10.1186/s12884-023-06014-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://0-doi-org.brum.beds.ac.uk/10.1186/s12884-023-06014-5

Keywords

BMC Pregnancy and Childbirth

ISSN: 1471-2393

Contact us