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ABSTRACT:The objective of this longitudinal study was to investigate the prevalence of infants’ social withdrawal and mothers’ depressive symptomsin a cohort of full-term infants and their mothers and in a cohort of moderately premature infants and their mothers at 3, 6, and 9 months’ postpartum.The Alarm Distress Baby Scale (ADBB) was used to assess social withdrawal; the Edinburgh Postnatal Depression Scale (EPDS) was administeredto ascertain postpartum depressive symptoms. The results revealed a higher proportion of premature infants with social withdrawal at 6 months’postpartum and significantly higher ADBB composite scores at 3 and 6 months of age, as compared with the full-term infants. A higher proportion ofmothers in the premature cohort had symptoms of postpartum depression at the 3-month assessment, and they reported a significantly higher EPDScomposite score at 3 months’ postpartum. There was a significant relation between maternal depressive symptoms at 3 and 6 months and infants’ socialwithdrawal at 9 months, and a significant concurrent relation between the two variables at 6 and 9 months in the full-term cohort. The findings suggesta need to screen for both infant social withdrawal and maternal depressive symptoms in moderately prematurely born infants and their caregivers.

Expert’s note: The premature baby, even slightly premature, is a vulnerable baby and this study shows that this vulnerability is also related to relational withdrawal. Prematurity undermines the establishment of the first bonds and thus the interactional dyadic synchrony that should normally be established between a baby and his mother. The sustained relational withdrawal is the consequence for the baby of a chronic desynchronization of the interactions which undermines its relational expectations. Prematurity thus disorganizes the first moments of the parent-baby bond and can therefore be the origin of both postpartum depression on the parent’s side and relational withdrawal in the baby, establishing an interactive spiral that can authorize the emergence of an insecure or disorganized attachment profile later in development. The ADBB scale associated with the EPDS allows for the early detection and interruption of this potentially deleterious interactive spiral for the parent-child bond, prior to any serious symptomatology.