Journal of Postgraduate Medicine
 Open access journal indexed with Index Medicus & ISI's SCI  
Users online: 5742  
Home | Subscribe | Feedback | Login 
About Latest Articles Back-Issues Articlesmenu-bullet Search Instructions Online Submission Subscribe Etcetera Contact
 
  NAVIGATE Here 
  Search
 
  
 RESOURCE Links
 ::  Similar in PUBMED
 ::  Search Pubmed for
 ::  Search in Google Scholar for
 ::Related articles
 ::  Article in PDF (445 KB)
 ::  Citation Manager
 ::  Access Statistics
 ::  Reader Comments
 ::  Email Alert *
 ::  Add to My List *
* Registration required (free) 

  IN THIS Article
 ::  Abstract
  ::  Introduction
Materials and Me...
  ::  Results
  ::  Discussion
  ::  Conclusion
 ::  References
 ::  Article Figures
 ::  Article Tables

 Article Access Statistics
    Viewed4440    
    Printed189    
    Emailed0    
    PDF Downloaded18    
    Comments [Add]    
    Cited by others 4    

Recommend this journal


 


 
  Table of Contents     
ORIGINAL ARTICLE
Year : 2019  |  Volume : 65  |  Issue : 4  |  Page : 212-218

Maternal depression and its association with responsive feeding and nutritional status of infants: A cross-sectional study from a rural medical college in central India


Department of Community Medicine, MGIMS, Sewagram, Wardha, Maharashtra, India

Date of Submission29-Sep-2018
Date of Decision26-Nov-2018
Date of Acceptance09-Jan-2019
Date of Web Publication14-Oct-2019

Correspondence Address:
A V Raut
Department of Community Medicine, MGIMS, Sewagram, Wardha, Maharashtra
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpgm.JPGM_479_18

Rights and Permissions


 :: Abstract 


Context: Globally, around half of all under-5 deaths are attributable to undernutrition. The magnitude of child undernutrition in India is one of the highest in the world. Responsive feeding that has the potential to optimize nutrition and development depends on a “healthy mother”. Objectives: The objective of this study was to find out the magnitude and determinants of maternal depression among mothers of infants who attended immunization clinic in a rural medical college in central India and observe its association with infant-feeding practices and nutritional status of infants. Study Design: This was an analytical cross-sectional study. Materials and Methods: Study was conducted among consecutively chosen 300 mothers and their infants who visited the immunization clinic of hospital during May-September, 2016. Data were collected individually by interviewing each mother, and anthropometry of her infant was done. The mothers with depression were diagnosed according to the 10-item Edinburgh Postnatal Depression Scale. Magnitude of depression has been reported using frequency and percentage, whereas association has been studied using prevalence odds ratio with 95% confidence interval (CI) and logistic regression at 0.05 significance level. Results: The magnitude of maternal depression was 19% (95% CI 14.4-23.5). Mothers with depression had significantly higher odds for not indulging in responsive feeding. Maternal education had significant association with maternal depression after adjusting for other variables. Conclusions: Burden of maternal depression is high among mothers of infants who attended immunization clinic in a rural medical college in central India and is significantly associated with nonresponsive feeding practices.


Keywords: Maternal depression, nurturing care, postnatal depression, postpartum depression, responsive feeding, undernutrition


How to cite this article:
Joshi M N, Raut A V. Maternal depression and its association with responsive feeding and nutritional status of infants: A cross-sectional study from a rural medical college in central India. J Postgrad Med 2019;65:212-8

How to cite this URL:
Joshi M N, Raut A V. Maternal depression and its association with responsive feeding and nutritional status of infants: A cross-sectional study from a rural medical college in central India. J Postgrad Med [serial online] 2019 [cited 2023 Sep 25];65:212-8. Available from: https://www.jpgmonline.com/text.asp?2019/65/4/212/260248





 :: Introduction Top


Inadequate nutrition in the first 1000 days of a child's life can lead to undernutrition, impaired growth, and development. Almost 50% of all deaths in children under 5 years are attributable to undernutrition.[1] The magnitude of child undernutrition in India is one of the highest in the world. Around 39% of under-5 children in India are stunted, 15% are wasted, and 29% are underweight. In India, along with the burden of macronutrient deficiencies, 72% of infants suffer from anemia.[2]

World Health Organization recommends that feeding should be both responsive and sensitive. Responsive feeding that has the potential to optimize nutrition and development is an important component of infant feeding.[3],[4] One of the key determinants for responsive feeding is a “healthy mother.” A depressed mother is not able to identify signs of hunger in her child and respond appropriately. Available evidence suggests significant association between maternal depression and impaired child growth in developing countries.[5]

Globally, approximately 10–20% of women experience depression either during pregnancy or in the first 12-month postpartum, whereas in India, maternal depression has been reported to range from around 11% to 23%.[6],[7]

The present study was conducted as magnitude of maternal depression is not exactly known among mothers in our area. The primary objective of the study was to find out the magnitude and determinants of maternal depression among mothers of infants who attended immunization clinic in a rural medical college in central India. The secondary objectives included to study the association of maternal depression with responsive feeding and nutritional status of infants.

Study design

This was an analytical cross-sectional study.


 :: Materials and Methods Top


This hospital-based study was conducted between May and September, 2016, with mothers of infants who visited the immunization clinic of a single hospital. The sample did not include antenatal mothers or mothers of under-5 children beyond infancy.

The study was initiated after prior approval from the Institutional Ethics Committee for Human subjects. Only mothers who gave written informed consent for them and their infants' participation were included in the study.

Maternal depression was defined as the spectrum of depressive conditions that can affect mothers up to 12 months postpartum and mothers to be.[6] Estimated sample size using OpenEpi software was 300 assuming a 95% confidence level, prevalence of maternal depression (p) as 23%,[7] an absolute precision of 5%, and a nonresponse rate of 10%. The sample size of 300 was sufficient to capture a 50% prevalence of responsive feeding and undernutrition (underweight, wasting, and stunting) with an absolute precision of 6% (post-hoc assessment). Infants with any diagnosed congenital problems, and who came for immunization with other relatives such as father and grandparents, were excluded. Mothers who were on treatment for any concurrent chronic illness (e.g., hypertension, epilepsy, diabetes, etc.) were also excluded from the study. We used consecutive sampling and offered participation to each successive mother–infant pair that visited the immunization clinic during the study period until the desired sample size of 300 was recruited.[8],[9] Data were collected individually by interviewing each participant maintaining confidentiality and privacy.

A pretested semistructured interview schedule was used to collect information pertaining to sociodemographic profile. It included details on age, education, working status, economic status, husband's occupation, age, and gender of the child and family type. Alcohol by husband, being blamed for girl child, and domestic violence were either considered as “yes” or “no” as reported by the mother herself based on her experience during the preceding week. A mother was classified as literate (if she could read and write with understanding in any language) or illiterate (can neither read nor write or can read but cannot write in any language) and education level was the highest level of education completed. Occupation of the mother was categorized as employed if she was engaged in any kind of economically productive work or a homemaker if she was unemployed. In India, public distribution system issues ration card to families by assessing their economic status. In this study, the type of ration card possessed by her family was taken as proxy indicator of her economic status, that is, yellow and orange/white-colored cards for below poverty line (BPL) and above poverty line families, respectively. Those who did not have ration card were considered as non-BPL.

The mothers were screened using the 10-item Edinburgh Postnatal Depression Scale (EPDS) that has been used and validated in India.[10] It is a 10-item self-reported scale based on 1-week recall, designed to screen postnatal depression (PND), yielding a total score of 0–30. Responses are scored 0, 1, 2, and 3 based on the seriousness of the symptom. Items 3 and 5–10 are reverse scored (i.e. 3, 2, 1, and 0). The total score is found by adding together the scores for each of the 10 items. For this study, a cutoff score of ≥10 was used to diagnose maternal depression.[11] Diagnosis was confirmed by careful clinical assessment by a trained physician, and the mothers detected with maternal depression were referred to psychiatry for counseling and/or treatment. Standard definitions of underweight, stunting, and wasting were considered as defined in the WHO Child Growth Standards.[12] For responsive feeding assessment, a tool used in Bangladesh by Aboud et al. was adapted and used.[13] The responsive feeding tool included information on who fed the child, child eats meal alone or together with someone, talking to the child while feeding, refusal to eat, forced feeding, self-feeding, and adult feeding. Responses were marked 1 or 0 depending on the response; a mother scoring 3 or more was considered to be indulging in responsive feeding. Data were entered and analyzed using Epi-info software. Magnitude is reported using frequency and percentage, whereas association has been studied using prevalence odds ratio (POR) with 95% confidence interval (CI) and the prevalence ratio (PR). We used logistic regression for estimating the predictors for maternal depression and get the adjusted odds ratio (AOR). Mothers with undernourished children were also counseled regarding proper infant and young child feeding practices and responsive feeding.


 :: Results Top


[Table 1] gives the background characteristics of study participants. The mean age of mother's was around 25 years with around 3/4th staying in nuclear families. Very few of the parents (<2%) were illiterate. Majority (74%) of the mothers were homemakers and did not indulge in any paid work, while all the father's indulged in one or other type of paid work. Around 22% of the mothers belonged to BPL families. Around 25% of the newborns were of low birth weight. The magnitude of underweight, stunting, and wasting was around 33%, 45%, and 22%, respectively.
Table 1: Background characteristics of study participants

Click here to view


The proportion of maternal depression among mothers of infants who attended immunization clinic was 19% (57 mothers) as depicted in [Figure 1]. The 95% CI for proportion of maternal depression among mothers of infants was 14.4–23.5. The mean age of mothers with depression was 25.39 ± 3.57 years and without depression was 25.12 ± 3.36 years. Similarly, the mean birth weight of infants of depressed mothers was 2729 ± 539 g, whereas that of those who were not depressed was 2659 ± 482 g.
Figure 1: Magnitude of maternal depression

Click here to view


[Table 2] shows the association of maternal depression with the probable determinants. Only the association between education of mother and father with maternal depression was found to be statistically significant. The proportion of mothers with depression was 2.3-fold (CI 1.2–4.3) greater if she had received primary or lesser level of education. Similarly, proportion of mothers with depression was twofold (CI 1.1–3.7) greater if the father of the child had received primary or lesser level of education. Other variables like birth weight, type of family, sex of the child, alcoholism of husband, domestic violence, poverty, being blamed for girl child, age of mother, age of child, and occupation of mother were not found to be statistically significant as depicted by CIs that contain the null value.
Table 2: Determinants of maternal depression

Click here to view


We used logistic regression analysis to determine predictors of maternal depression as shown in [Table 3]. P value of 0.05 was considered as significant. The predictor for maternal depression in study participants was education of mother at P < 0.01. Mothers who had received primary or less education were associated with higher maternal depression after adjusting for other factors. Mothers who had received primary or less education were having 1.7 times more likelihood of having maternal depression than who had received secondary or higher education. (AOR 1.717, 95% CI 1.174–2.490).
Table 3: Predictors of maternal depression

Click here to view


[Table 4] shows the association between maternal depression and responsive feeding. Mothers who were depressed had significantly lower odds (POR = 0.297) of practicing responsive feeding. Only 22 (38.6%) mothers who were depressed were indulging in responsive feeding as compared to 165 (67.9%) who were not depressed. The association between responsive feeding and maternal depression was found to be statistically significant (95% CI 0.163–0.540). The PR was 0.568, meaning that the proportion of mothers indulging in responsive feeding was around 44% less if a mother was having maternal depression.
Table 4: Association between responsive feeding and maternal depression

Click here to view


Association of maternal depression was studied with all the three indicators for nutritional assessment in children, that is, weight for age (underweight), length for age (stunting), and weight for length (wasting) as shown in [Table 5]. POR and PR were higher for stunting among infants of depressed mothers; however, this was not statistically significant as depicted by CIs that contain the null value.
Table 5: Association between nutritional status and maternal depression

Click here to view



 :: Discussion Top


This hospital-based analytical cross-sectional study was conducted with mothers of infants who visited the immunization clinic of rural medical college. We preferred to use analytical cross-sectional design as it is useful for examining the association between exposure and disease onset for chronic diseases where researchers specifically lack information on time of onset. The association has been studied using POR as for chronic disease studies or studies of long-lasting risk factors, POR is the preferred measure of association in cross-sectional studies. Of the 300 mothers, those scoring 10 or more on EPDS were diagnosed to have depression.

We found that 57 (19%, 95% CI 14.4–23.5) participants had maternal depression. Our results are in accordance with the findings of other studies and reflect that the magnitude of maternal depression in the study area is similar to other regions of India and Southeast Asia. A similar survey by the World Health Organization showed the prevalence of maternal depression to be 10–15%.[14] The study by Surkan et al. showed 15–57% prevalence of depression in mothers,[5] whereas study by Shidhaye found that in India, 10–20% mothers face postpartum depression (PPD).[6]

Shivalli et al. in their study in a rural hospital from Karnataka found poverty, birth of female baby, and pregnancy complications or known medical illness as independent predictors of PND.[15] Similarly, studies from other countries on PPD or PND found place of residence, form of marriage, mother's job, house income level, no family support, mothers' education, lack of social support, and history of violence as predictors for maternal depression.[16],[17],[18],[19],[20] A study from Sudan found that older age of mothers, exclusive breast feeding, and regular prenatal vitamins during pregnancy result in decreasing odds of PND. In the present study, only mothers' and fathers' education was found to be statistically significant on bivariate analysis, while on logistic regression, only maternal education was found to be a significant predictor for maternal depression. Therefore, along with the identification and treatment of maternal depression, it is imperative to act on distal determinant like maternal education if this important public health problem is to be tackled. Other variables like birth weight, type of family, sex of the child, alcoholism of husband, domestic violence, poverty, being blamed for girl child, age of mother, age of child, and occupation of mother were not found to be statistically significant. The difference in findings could be attributed to the different sociocultural context in which these studies were conducted. Other factors found to be significant in these studies were preexisting depression or psychiatric conditions, chronic health problems, primiparity, vaginal delivery, women experiencing complications at time of delivery, unintended pregnancy, and obesity.[16],[17],[18],[19],[20] In the present study, antenatal and intranatal factors were not considered as we presumed that they would be subjected to recall bias. Moreover, presence of known chronic conditions in mother was an exclusion criteria.

In Indian culture, preference to male child is deeply entrenched. Birth of a girl child acts as a family and social stressor and hence was hypothesized to be a determinant for maternal depression. However, the present study did not find a significant association with either the gender of the baby or being blamed for girl child. The not-significant results for being blamed for girl child or some of the other variables like domestic violence may be due to the smaller sample size in these subgroups in our study. Nonetheless, the higher odds are indicative of plausible association with negative mileu in which a mother may have to live and should be evaluated further with studies involving adequate power for respective subgroup analysis.

In our study, a significant statistical association was found between responsive feeding and maternal depression. Similar results were found in another study by Hurley et al. which stated that depressed mothers had a tendency to view their infant's behavior negatively, which were a reflection of them having nonresponsive feeding styles.[21] A study done by Wachs et al. found that negativity and lesser responsiveness by the caregiver contribute to very high rates of insecure attachment as seen in infants of mothers undergoing depression.[22] Similarly depressed mothers in our study showed nonresponsiveness for their infants and lack of proper feeding practices. Post-hoc power analysis showed that study was adequately powered to find association with responsive feeding (power: 97.9%).

The systematic review, conducted by Hurley et al., found the association between nonresponsive feeding and high birth weight of infants.[23] Similarly, the study conducted by Worobey et al. found that infants whose mothers did not identify their children's satiety cues gained more weight significantly from 6 to 12 months than infants of sensitive mother.[24] In our study, we found that the mean birth weight of infants of depressed mothers (2729.6 g) was higher than the standard normal weight of 2500 g.

Maternal depression was shown to have higher odds for having undernutrition among infants, especially stunting (POR = 1.5) which was not statistically significant. Post-hoc power analysis showed that study was not adequately powered to find association with nutritional status (power: <70%). The long-term effects of maternal depression on nutritional status of children should be evaluated further with studies involving adequate power.

In a study conducted by Bentley et al., it was proved that infants who are fed with responsiveness show significantly less proportion of stunting, wasting, and underweight compared to those who were not fed actively.[25] In our study, we found significant association of maternal depression with nonresponsive feeding. The long-term consequences of nonresponsive feeding warrant further evaluation through valid prospective observational studies to confirm these findings in the Indian context.

The present study has several limitations. The study was conducted with mothers of infants (age range 3–344 days) who visited the immunization clinic of a single hospital. As a hospital-based sample, it is likely to be a biased one, especially prone to selection bias with limited external generalizability. Moreover, the magnitude of maternal depression determined may be an underestimate as the study was conducted among mothers of infants (0–11 months) and did not include assessment during antenatal period. As the questionnaire included some sensitive questions like blame for girl child, alcoholism of husband, domestic violence, and suicidal tendencies, a possibility of underreporting may not be denied despite our best efforts. In general, analytical cross-sectional studies are useful for establishing only a preliminary evidence for a causal relationship as these studies are affected by the antecedent–consequent bias. Therefore, although a significant association was found with maternal education and responsive feeding interpretation of results requires caution, the findings should be confirmed with prospective study designs of adequate power that will not be affected by antecedent–consequent bias or survival bias.


 :: Conclusion Top


The present study demonstrates that burden of maternal depression is high among mothers of infants who attended immunization clinic in a rural medical college in central India and is significantly associated with nonresponsive feeding practices.

Acknowledgments

  • We deeply acknowledge the mothers of all the infants who spared their valuable time for answering the questions related to the present study
  • We also acknowledge the support from Faculty and Staff of Department of Community Medicine, MGIMS, Sevagram, towards completion of this research work.


Financial support and sponsorship

This study was funded by the Indian Council of Medical Research (ICMR) under its Short-term Studentship program (ICMR-STS). The STS Reference ID was 2016-01258.

Conflicts of interest

There are no conflicts of interest.



 
 :: References Top

1.
UNICEF. UNICEF Statistics. [cited 2016 Sep 14]. Available from: http://data.unicef.org/nutrition/malnutrition.html.  Back to cited text no. 1
    
2.
Government of India. Ministry of Women and Child Development. Rapid Survey on Children 2013-14 National Report. 2014 [cited 2016 Sep 14]. Available from: http://wcd.nic.in/sites/default/files/RSOC National Report 2013-14 Final.pdf.  Back to cited text no. 2
    
3.
Dewey K, Lutter C, Martines J, Daelmans B. World Health Organization. Guiding Principles for Complementary Feeding of the Breastfed Child. Washington, DC: PAHO/WHO; 2001. Available from: https://www.who.int/nutrition/publications/guiding_principles_compfeeding_breastfed.pdf. [Last accessed on 2019 Feb 12].  Back to cited text no. 3
    
4.
World Health Organization. Guiding Principles for Complementary Feeding of the Non-Breastfed Child. WHO; 2005. Available from: https://apps.who.int/iris/bitstream/handle/10665/43281/9241593431.pdf;jsessionid=E8201BD7261D2F46EE072DE97A36ACC1?sequence=1. [Last accessed on 2019 Feb 12].  Back to cited text no. 4
    
5.
Surkan PJ, Kennedy CE, Hurley KM, Black MM. Maternal depression and early childhood growth in developing countries: Systematic review and meta-analysis. Bull World Health Organ 2011;89:608-15.  Back to cited text no. 5
    
6.
Shidhaye PR. GPA. Maternal depression: A hidden burden in developing countries. Ann Med Heal Sci Res 2014;4:463-5.  Back to cited text no. 6
    
7.
Chandran M, Tharyan P, Muliyil J, Abraham S. Post-partum depression in a cohort of women from a rural area of Tamil Nadu, India. Incidence and risk factors. Br J Psychiatry 2002;181:499-504.  Back to cited text no. 7
    
8.
Straus, SE, Richardson, WS, Glasziou P, Haynes, RB. Evidence-Based Medicine: How to Practice and Teach EBM. 3rd ed. New York, NY: Elsevier; 2005.  Back to cited text no. 8
    
9.
Roach KE. A clinician's guide to specification and sampling. J Orthop Sports Phys Ther 2001;31:753-8.  Back to cited text no. 9
    
10.
Patel V, Rodrigues M, DeSouza N. Gender, poverty, and postnatal depression: A study of mothers in Goa, India. Am J Psychiatry 2002;159:43-7.  Back to cited text no. 10
    
11.
Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry 1987;150:782-6.  Back to cited text no. 11
    
12.
UNICEF/WHO/World Bank Group. Levels and Trends in Child Malnutrition. UNICEF/WHO/World Bank Group Joint Child Malnutrition Estimates. Key findings of the 2016 edition. Washington D.C.: New York, Geneva; 2016. Available from: http://www.who.int/nutgrowthdb/estimates2015/en/.  Back to cited text no. 12
    
13.
Aboud FE, Shafique S, Akhter S. A responsive feeding intervention increases children's self-feeding and maternal responsiveness but not weight gain. J Nutr 2009;139:1738-43.  Back to cited text no. 13
    
14.
Stewart DE, Robertson FE, Phil M, Dennis C-L, Grace SL, Wallington T. Postpartum Depression: Literature Review of Risk Factors and Interventions. University Heal Netw Women's Heal Progr 2003. Available from: http://www.who.int/mental_health/prevention/suicide/lit_review_postpartum_depression.pdf. [Last cited on 2016 Oct 15].  Back to cited text no. 14
    
15.
Shivalli S, Gururaj N. Postnatal depression among rural women in south India: Do socio-demographic, obstetric and pregnancy outcome have a role to play? PLoS One 2015;10:e0122079.  Back to cited text no. 15
    
16.
Coşkun TD, Aydın S, Çatak B. Do social determinants of health affect postpartum depression? TAF Prev Med Bull 2016;15:414-20.  Back to cited text no. 16
    
17.
Tikmani SS, Soomro T, Tikmani P. Prevalence and determinants of postpartum depression in a tertiary care hospital. Austin J Obstet Gynecol 2016;3:1057.  Back to cited text no. 17
    
18.
Chaaya M, Campbell OM, El Kak F, Shaar D, Harb H, Kaddour A. Postpartum depression: Prevalence and determinants in Lebanon. Arch Womens Ment Health 2002;5:65-72.  Back to cited text no. 18
    
19.
Khalifa DS, Glavin K, Bjertness E, Lien L. Determinants of postnatal depression in Sudanese women at 3 months postpartum: A cross-sectional study. BMJ Open 2016;6:e009443.  Back to cited text no. 19
    
20.
Ogbo FA, Eastwood J, Hendry A, Jalaludin B, Agho KE, Barnett B, et al. Determinants of antenatal depression and postnatal depression in Australia. BMC Psychiatry 2018;18:49.  Back to cited text no. 20
    
21.
Hurley KM, Black MM, Papas MA, Caulfield LE, Caufield LE. Maternal symptoms of stress, depression, and anxiety are related to nonresponsive feeding styles in a statewide sample of WIC participants. J Nutr 2008;138:799-805.  Back to cited text no. 21
    
22.
Wachs TD, Black MM, Engle PL. Maternal depression: A global threat to children's health, development, and behavior and to human rights. Child Dev Perspect 2009;3:51-9.  Back to cited text no. 22
    
23.
Hurley KM, Cross MB, Hughes SO. A systematic review of responsive feeding and child obesity in high-income countries. J Nutr 2011;141:495-501.  Back to cited text no. 23
    
24.
Worobey J, Lopez MI, Hoffman DJ. Maternal behavior and infant weight gain in the first year. J Nutr Educ Behav 2009;41:169-75.  Back to cited text no. 24
    
25.
Bentley ME, Wasser HM, Creed-Kanashiro HM. Responsive feeding and child undernutrition in low- and middle-income countries. J Nutr 2011;141:502-7.  Back to cited text no. 25
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]

This article has been cited by
1 Nutritional factors and cross-national postpartum depression prevalence: an updated meta-analysis and meta-regression of 412 studies from 46 countries
Adi Fish-Williamson, Jennifer Hahn-Holbrook
Frontiers in Psychiatry. 2023; 14
[Pubmed] | [DOI]
2 Impact of maternal depression and social factors on child’s nutritional status: a case–control study in Egypt
MahaA Hassan, GihanM Bebars, SalwaM.R Taha
Egyptian Journal of Psychiatry. 2022; 43(2): 108
[Pubmed] | [DOI]
3 Integrative Review of Mental Health and Feeding Styles in Parents of Bottle-Fed Infants
Taylor Nelson, Courtney Caiola, Deborah Tyndall
Journal of Obstetric, Gynecologic & Neonatal Nursing. 2022;
[Pubmed] | [DOI]
4 Postpartum Depression, Complications During Pregnancy, and Offspring Behavior Problems in Early Childhood
Aya Ben-Harush, Miriam Schiff, Naama Sulimani, Ruth Pat-Horenczyk
Child & Youth Care Forum. 2021;
[Pubmed] | [DOI]



 

Top
Print this article  Email this article
 
Online since 12th February '04
© 2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
Published by Wolters Kluwer - Medknow