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Gastrointestinal Symptoms in Infants of Mothers With a Psychiatric History and the Role of Depression and Bonding

de Kruijff, Ineke*; Choenni, Vandhana; Groeneweg, Jasja T.; Vlieger, Arine M.*; Benninga, Marc A.§; Kok, Rianne||; Kamperman, Astrid M.; Lambregtse-van den Berg, Mijke P.†,¶

Journal of Pediatric Gastroenterology and Nutrition: December 2019 - Volume 69 - Issue 6 - p 662–667
doi: 10.1097/MPG.0000000000002484
Original Articles: Gastroenterology

Objectives: Gastroesophageal reflux (GER), excessive crying, and constipation are common gastrointestinal symptoms in infancy of multifactorial origin in which psychosocial stress factors play an important role. The aims of this observational study were to investigate the presence of gastrointestinal symptoms in infants of mothers with or without a history of a psychiatric disorder, their association with maternal depressive symptoms, and the possible mediating role of bonding.

Methods: One hundred one mothers with a history of a psychiatric disorder and 60 control mothers were included. Infant gastrointestinal symptoms, maternal depressive symptoms, and mother-infant bonding were assessed using validated questionnaires and diagnostic criteria at 1.5 months postpartum.

Results: The mean total score on the Infant Gastroesophageal Reflux Questionnaire Revised reported in infants of mothers with psychiatric disorder (13.4 standard deviation 5.4) was significantly higher than that in infants of control mothers (10.8 standard deviation 5.4; P = .003). No significant differences were found in the presence of excessive crying (modified Wessel criteria and subjective experience) and constipation (ROME IV criteria) between both groups. Infant GER was associated with maternal depressive symptoms (P = 0.027) and bonding problems (P = <0.001). Constipation was related to maternal depressive symptoms (P = 0.045), and excessive crying (Wessel and subjective criteria) was associated with bonding problems (P = 0.022 and P = 0.002, respectively). The effect of maternal depressive symptomatology on infant GER symptoms and excessive crying was mediated by bonding problems.

Conclusion: Maternal psychiatric history is associated with infant gastrointestinal symptoms, in which mother-infant bonding is a mediating factor.

*Department of Pediatrics, St Antonius Hospital Nieuwegein, Nieuwegein

Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, Rotterdam

Arkin Institute for Mental Health

§Department of Pediatric Gastroenterology and Nutrition, Amsterdam University Medical Center, Amsterdam

||Department of Psychology, Education and Child Studies, Erasmus University Rotterdam

Department of Psychiatry, Erasmus MC, Rotterdam, The Netherlands.

Address correspondence and reprint requests to Ineke de Kruijff, MD, Department of Pediatrics, St Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands (e-mail:

Received 16 May, 2019

Accepted 18 August, 2019

The INCAS study was supported by a grant of the Sophia Foundation for Scientific Research (SSWO grant number 670).

The authors report no conflicts of interest.

© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,