The goal of this clinical trial is to learn about Maternal Reflective Function (MRF) during the transition to motherhood. The main questions it aims to answer are: Does MRF mediates the connection between risk factors for mental health difficulties during first pregnancy and motherhood (the transition to motherhood) and outcomes related to the mother, the infant, and their relationship. Participants will: Answer questionnaires and clinical interviews during pregnancy and after birth of the first child (twice at third trimester, 1 and 3 months after birth). intervention group will participate in an online short intervention to enhance MRF.
Using this trial, the investigators will be able to better understand rather MRF moderate the connection between risk factors to outcomes after birth related to both the mother and the infant. Using RCT design we will be able to understand mechanism of change.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
BASIC_SCIENCE
Masking
DOUBLE
Enrollment
200
4 session group online intervention focused on psycho-educational knowledge regarding emotional regulation and specifically MRF. group size- up to 15 participants. 2 sessions will be during pregnancy and 2 sessions will taken place 1 and 3 months after birth.
University of Haifa
Haifa, Israel
Maternal Reflective Functioning questionnaires
Will be measured using Parental Reflective Function questionnaires for pregnancy P-PRFQ (Pajulo et al., 2015) and after birth (Parental Reflective Functioning Questionnaire PRFQ, Luyten et al., 2017). Likert Scale from 1 (Greatly disagree) to 7 (Greatly agree).
Time frame: Twice in third trimester of pregnancy (Before and after intervention), 1 and 3 months after birth.
Maternal Reflective Functioning interviews
Will be measured using Pregnancy Interview (PI, Slade et al., 1987; Slade, 2003) before labor, and Parental Developmental Interview (PDI-R2 short form, Slade et al., 2003) after labor. Reflective Function Coding Scale- from -1 (No Reflective Function) to 9 (Very high Reflective Function)
Time frame: Once in third trimester of pregnancy ,1 months after birth.
Depression.
depression level before, during and after pregnancy and birth, using Edinburgh Postnatal Depression Scale (EPDS, Cox, Holden, \& Sagovsky, 1987). Likert Scale from 1 (Most of the time) to 4 (Almost never).
Time frame: Third trimester of pregnancy, 1 and 3 months after birth.
Anxiety
Anxiety level before, during and after pregnancy and birth using Depression Anxiety Stress Scale (DASS-21 short form, Lovibond \& Lovibond, 1995 ). Likert Scale from 0- Does not describe my situation at all, to 3- Describes my situation very much.
Time frame: Third trimester of pregnancy, 1 and 3 months after birth.
Exposure to traumatic life events
exposure to ongoing war and political violence in the region using Political Life Events (PLE; Based on Slone et al., 1997, elaborated and adjusted by Yael Meir \& Yael Enav, 2024, not published). Yes/No question and if Yes answered- Likert Scale from 1- Not at all to 5- Very much.
Time frame: At enrollment.
Social Support
Social support before and during pregnancy using Multidimensional Scale of Perceived Social Support (MSPSS, Zimet et al., 1988). Likert Scale from 1- Very agree, to 7- Very disagree.
Time frame: Third trimester of pregnancy, 1 and 3 months after birth.
Relationship satisfaction
Relationship satisfaction before and during pregnancy using Couple satisfaction index (CSI-16, Funk \& Rogge, 2007). Likert Scale from 0- Not true at all, to 5- Very true.
Time frame: Third trimester of pregnancy, 1 and 3 months after birth.
High risk pregnancy
Medical high risk during pregnancy using a single question in initial demographic and personal details questionnaire.
Time frame: At enrollment.
Cognitive bias
Cognitive bias before, during and after pregnancy and birth using an go-no-go, infants expression interpretation, and focus of attention assignments.
Time frame: Third trimester of pregnancy, 3 months after birth.
Mother-infant bonding
Mother-infant bonding before birth using Prenatal Attachment Inventory (PAI: Muller \& Mercer, 1993) after birth using Postpartum Bonding Questionnaire (PBQ, Brockington et al, 2006 ). PAI Likert Scale from 1- Almost never, to 4- Almost always.
Time frame: Third trimester of pregnancy, 1 and 3 months after birth.
Mother Emotional Regulation
Measured using Emotional Regulation Questionnaire (ERQ, Gross \& John, 2003). Likert Scale from 1- Strongly disagree to 7- Strongly agree. PBQ Likert Scale from 1- Never to 6- Always
Time frame: Third trimester of pregnancy, 1 and 3 months after birth.
Infant weight
Gain of weight using a single question regarding infant's weight.
Time frame: 1 and 3 months after birth.
Maternal self-efficacy
Measured using Maternal self-efficacy Scale (Kestler-Peleg et al., 2015). Likert Scale from 1- Not at all, to 4- Very much.
Time frame: 1 and 3 months after birth.
Quality of sleep
Quality of sleep using Brief Infant Sleep Questionnaire (BISQ; Sade, 2004). Likert Scale from 1- Not at all to 4- Usually.
Time frame: 1 and 3 months after birth.
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