Human placental lactogen (human chorionic somatomammotropin) and oxytocin during pregnancy: Individual patterns and associations with maternal-fetal attachment, anxiety, and depression.

Previous studies support links among maternal-fetal attachment, psychological symptoms, and hormones during pregnancy and the post-partum period. Other studies connect maternal feelings and behaviors to oxytocin and suggest that an increase in oxytocin during pregnancy may prime maternal-fetal attachment. To date, researchers have not examined a possible association between maternal-fetal attachment with human placental lactogen although animal models are suggestive. In the current study, we sought to describe oxytocin and human placental lactogen levels as related to psychological constructs across pregnancy. Seventy women participated in the study. At each of three time-points (early, mid, and late pregnancy), the women had their blood drawn to assess oxytocin and human placental lactogen levels, and they completed psychological assessments measuring maternal-fetal attachment, anxiety, and depression. Our results indicate that oxytocin levels were statistically similar across pregnancy, but that human placental lactogen significantly increased across pregnancy. Results did not indicate significant associations of within-person (comparing individuals to themselves) oxytocin or human placental lactogen levels with maternal-fetal attachment. Additionally, results did not show between-person (comparing individuals to other individuals) oxytocin or human placental lactogen levels with maternal-fetal attachment. Oxytocin levels were not associated with anxiety; rather the stage of pregnancy moderated the effect of the within-person OT level on depression. Notably, increasing levels of human placental lactogen were significantly associated with increasing levels of both anxiety and depression in between subject analyses. The current study is important because it describes typical hormonal and maternal fetal attachment levels during each stage of pregnancy, and because it suggests an association between human placental lactogen and psychological symptoms during pregnancy. Future research should further elucidate these relationships.

Manifest anxiety and maternal-fetal attachment in pregnant women with previous fetal losses.

AIM: To explore associations between manifest anxiety (Taylor's Manifest Anxiety Scale, TMAS), major obstetric and demographic features and maternal-fetal attachment (MFA) (Maternal Antenatal Attachment Scale, MAAS) in women with previous miscarriages. SUBJECTS AND METHODS: One hundred pregnant women with previous miscarriages, having uncomplicated singleton pregnancy, not receiving any medications, and conceived in a natural manner . Ages ranged between 19 and 47 years, gestational age between 4 and 35 weeks. Hierarchical multiple linear regression, Kruskal-Wallis test, and ANCOVA were used in data analysis. RESULTS: Maternal age, gestational age, previous abortions, parity, maternal education, and marital status in combination contributed significantly to the regression model in prediction of the MAAS quality and intensity scores. Adding the TMAS score accounted for an additional 17% of variation in the MAAS quality score, and the change in R2 was significant. There was a negative relationship between the TMAS and the MAAS quality scores. The TMAS score did not contribute to prediction of the MAAS intensity. The highest TMAS values were in the women having anxious, ambivalent or affectless preoccupation. CONCLUSION: Prevention of negative consequences of poor quality of MFA in women with previous miscarriages should include early screening for manifest anxiety.

Exploring the psychometric qualities of prenatal attachment inventory in France.

OBJECTIVES: The aim of the study was to explore the structure of the Prenatal Attachment Inventory (PAI) on a French sample of pregnant women. METHODS: Three hundred and nine pregnant women were recruited in gynecology-obstetrics departments and on social networks. To be included, women had to be pregnant, aged between 18 and 45 years old, and not have somatic complications of pregnancy. The women completed a questionnaire including questions on sociodemographic information, and the PAI. The structure of PAI was explored with an exploratory structural equation model (ESEM). RESULTS: Three factorial solutions were explored: two-, three- and four-factor. The 2-factor solution was excluded due to its CFI, TLI and RMSEA indexes, which were lower than the reference values. The choice between the 3- and 4-factor solutions was made according to the clinical meaning of the items included in the factors. The 3-factor solution was retained with the factors: "current and future representations of the baby", "maternal-fetal relationship", and "proprioceptive feeling". The scale had good internal consistency. CONCLUSIONS: The PAI is the first standardized multidimensional assessment tool for maternal-fetal attachment in the French language. In view of the results obtained, this tool can be disseminated and used by professionals in perinatal care.

Effects of Fetal Images Produced in Virtual Reality on Maternal-Fetal Attachment: Randomized Controlled Trial.

BACKGROUND: Maternal-fetal attachment (MFA) has been reported to be associated with the postpartum mother-infant relationship. Seeing the fetus through ultrasound might influence MFA, and the effect could be increased by more realistic images, such as those generated in virtual reality (VR). OBJECTIVE: The aim was to determine the effect of fetal images generated in VR on MFA and depressive symptoms through a prenatal-coaching mobile app. METHODS: This 2-arm parallel randomized controlled trial involved a total of 80 pregnant women. Eligible women were randomly assigned to either a mobile app-only group (n=40) or an app plus VR group (n=40). The VR group experienced their own baby's images generated in VR based on images obtained from fetal ultrasonography. The prenatal-coaching mobile app recommended health behavior for the pregnant women according to gestational age, provided feedback on entered data for maternal weight, blood pressure, and glucose levels, and included a private diary service for fetal ultrasound images. Both groups received the same app, but the VR group also viewed fetal images produced in VR; these images were stored in the app. All participants filled out questionnaires to assess MFA, depressive symptoms, and other basic medical information. The questionnaires were filled out again after the interventions. RESULTS: Basic demographic data were comparable between the 2 groups. Most of the assessments showed comparable results for the 2 groups, but the mean score to assess interaction with the fetus was significantly higher for the VR group than the control group (0.4 vs 0.1, P=.004). The proportion of participants with an increased score for this category after the intervention was significantly higher in the VR group than the control group (43% vs 13%, P=.005). The feedback questionnaire revealed that scores for the degree of perception of fetal appearance all increased after the intervention in the VR group. CONCLUSIONS: The use of a mobile app with fetal images in VR significantly increased maternal interaction with the fetus. TRIAL REGISTRATION: ClinicalTrials.gov NCT04942197; https://clinicaltrials.gov/ct2/show/NCT04942197.

Does the immigration affect prenatal attachment levels?

Pregnancy is an important period in which mother-infant attachment begins, includes bio-psychological changes, and has physical and psychological effects on the future life of the fetus. This study aims to evaluate the prenatal attachment levels of Syrian refugee and Turkish mothers in Turkey and to determine the variables that affect these. This cross-sectional study conducted in the obstetric outpatient clinics with 397 pregnant women 197 Syrian and 200 native women. Inclusion criteria were a pregnancy of at least 20 weeks, no communication or mental disorders, no chronic diseases, no diagnosis of high-risk pregnancy, literacy in the pregnant Turkish women, Turkish language proficiency in the pregnant Syrian women, and residence in Turkey for at least three years. Data were collected using a Sociodemographic form and The Prenatal Attachment Inventory (PAI). The data were analyzed by conducting independent t-tests, and hierarchical multiple linear regression analysis. The mean prenatal attachment score of Turkish pregnant women (61.79 ± 8.55) was higher than Syrian women (48.38 ± 10.39) (p < .05). Education level, pre-pregnancy counseling, regular checkup, support from spouses, relatives, and friends, and being a refugee of pregnant women were determined as predictors of prenatal attachment. The results showed that 67 percent of the total variance in the prenatal attachment levels could be explained in model 2 (F = 35.524, R2 variation = .673, p = .001). The low prenatal attachment level of Syrian pregnant women was a result of the detrimental impacts of being a refugee on pregnancy. The integration of transcultural knowledge, culture-specific perspectives, and cross-cultural theories into clinical practices is essential for immigrant women.

The Effect of Maternal-Foetal Attachment-Based Training Programme on Maternal Mental Health Following an Unintended Pregnancy.

INTRODUCTION: Unintended pregnancy is a risk factor for less maternal-fetal attachment (MFA) and low levels of psychological well-being. This study was conducted to determine the effect of an MFA-based training programme on maternal anxiety, depression and worries following an unintended pregnancy. METHODS: This randomised clinical trial was conducted on 68 women with an unintended pregnancy in north of  Iran during 2018-2019. Participants were allocated to the trained and control groups through simple randomisation. The trained group received the MFA-based training for three 90-min sessions. Demographic questionnaire, London measure of unplanned pregnancy, Cranley's MFA scale, Edinburgh postnatal depression, Spielberger anxiety and prenatal distress questionnaires were used. Data were analysed by descriptive statistics, chi square, Fisher's exact test, independent and paired-samples t-tests, Mann-Whitney U, analysis of covariance, and multivariate analysis of variance. RESULTS: After the intervention, the mean MFA, anxiety and depression scores were not significantly different between the trained and control groups Worry was significantly decreased in the trained group (p = 0.001) and increased in the control group (p = 0.03). DISCUSSION: Although the MFA-based training could not significantly improve MFA, maternal anxiety and depression, it has been effective on worry in women with the unintended pregnancies.

Will I love my second baby as much as my first? Prevalence and psychosocial correlates of maternal-fetal relationship anxiety for second-time mothers.

Most mothers have more than one child. Second-time mothers may worry about whether they will love the second baby as much as their first child. The current study examined mothers' maternal-fetal relationship anxiety (MFRA) to their second baby, the prediction of mother-infant bonding (MIB) and infant-mother attachment security post-partum, and the psychosocial correlates of mothers' MFRA during pregnancy. Mothers (N = 241, 85.9% White, 5.4% Black, 2.9% Asian/American, 3.7% Latina) and their second-born infants (55% boys) living in the Midwestern United States participated in a longitudinal investigation starting in the last trimester of pregnancy, and 1, 4, 8, and 12 months postpartum. Most women reported little to no anxiety about forming an attachment to their second baby (89.1%). MFRA predicted less maternal warmth toward the baby at 1, 4, and 8 months postpartum, but did not predict security of the infant-mother attachment at 12 months. Prenatal MFRA was also related to maternal depressive symptoms, an insecure attachment with the first child, more marital distress, and more adult attachment avoidance and ambivalence prenatally. Mothers worrying about loving a second baby as much as their first child may be experiencing other psychosocial risks that have repercussions for the developing mother-infant relationship.

La mayoría de las madres tiene más de un niño. Las que son madres por segunda vez se preocupan de si ellas amarán al segundo bebé tanto como al primer niño. El presente estudio examinó la ansiedad de la relación materno-fetal (MFRA) con su segundo bebé, la predicción del apego madre-infante y la seguridad de la afectividad madre-infante posterior al parto, así como las correlaciones sicosociales de la MFRA de las madres durante el embarazo. Las madres (N = 241, 85.9% blancas, 5.4% negras, 2.9 asiático-americanas, 3.7% latinas) y sus segundos infantes (55% varones), quienes vivían en el medio-oeste de los Estados Unidos, participaron en una investigación longitudinal comenzando en el último trimestre del embarazo, y a 1, 4, 8 y 12 meses después del parto. La mayoría de las mujeres reportó entre poca y ninguna ansiedad acerca de formar una relación afectiva con su segundo bebé (89.1%). La MFRA predijo menos calidez materna hacia el bebé a 1, 4 y 8 meses después del parto, pero no predijo la seguridad de la afectividad madre-infante a los 12 meses. La MFRA prenatal también se relacionó con los síntomas depresivos maternos, una afectividad insegura con el primer niño, más angustia marital, así como un mayor sentido adulto de ambivalencia y de evitar la afectividad prenatalmente. Las madres que se preocupan acerca de querer a su segundo bebé tanto como a su primer niño pudieran experimentar otros riesgos sicológicos y tener repercusiones para el desarrollo de la relación madre-infante.

La plupart des mères ont plus d'un seul enfant. Les mères pour la deuxième fois peuvent s'inquiéter si elles aimeront le second bébé autant que leur premier enfant. Cette étude a examiné l'anxiété de la relation maternelle-fœtale (abrégé MFRA selon l'anglais) des mères en lien à leur second bébé, la prédiction du lien mère-nourrisson et la sécurité de l'attachement nourrisson-mère postpartum ainsi que les corrélats psychosociaux de la MFRA des mères durant la grossesse. Les mères (N = 241, 85,9% blanches, 5,4% noires, 2,9% asiatiques américaines, 3,7% latinas) et leur deuxième bébé (55% de garçons) vivant dans le centre nord des Etats-Unis d'Amérique ont participé à une enquête longitudinale commençant le dernier trimestre de la grossesse et à 1, 4, 8 et 12 mois postpartum. La plupart des femmes ont fait état de presque aucune anxiété quant à la formation de l'attachement à leur second bébé (89,1%). La MFRA a prédit moins de chaleur maternelle envers le bébé à 1, 4, et 8 mois postpartum mais n'a pas prédit la sécurité de l'attachement bébé-mère à 12 mois. La MFRA prénatale était aussi liée aux symptômes dépressifs maternels, à un attachement insécure avec le premier enfant, à plus de détresse conjugale et à plus d'évitement et d'ambivalence de l'attachement adulte avant la naissance.

The role of pregnancy acceptability in maternal mental health and bonding during pregnancy.

BACKGROUND: Pregnancy is an important time for women's mental health and marks the foundations of the emerging bond between mother and baby. This study aimed to investigate the role of pregnancy acceptability and intendedness in maternal mental health and bonding during pregnancy. METHODS: Data were collected from a community sample of 116 Australian pregnant women (M = 29.54, SD = 5.31) through a series of self-report questionnaires pertaining to mental health and antenatal bonding. RESULTS: Lower pregnancy acceptability was correlated with higher depression, anxiety and total distress, lower physical and environmental quality of life and lower antenatal bonding. Women who reported their pregnancy was intended reported higher physical quality of life than those who reported their pregnancy was unintended. The relationship between total distress and antenatal bonding was moderated by women's degree of pregnancy acceptability (low versus high). For women with low acceptability, higher distress was associated with lower bonding, but there was no such association for women with high pregnancy acceptability. The moderation model examining associations between distress and pregnancy acceptability explained 15% of the variance in antenatal bonding scores. CONCLUSION: Consideration of women's appraisal of their pregnancy acceptability may provide a valuable framework for identifying individuals who may be at risk for mental health and bonding difficulties.

What tools should be used to identify women in need of additional support in pregnancy?

OBJECTIVE: This study aimed to identify and inform recommendation of self-report and interview-based instruments that are feasible, reliable and valid to evaluate the quality of the maternal-fetal relationship (MFR). BACKGROUND: Several constructs predicting parent-infant interaction and later infant adjustment are used to assess mothers' thoughts and feelings towards their unborn baby, including reflective functioning, mind-mindedness, representation, and fetal attachment. As yet, there is no existing review comparing the quality and accessibility of instruments across each of these constructs. METHODS: A systematic literature review was undertaken to synthesise psychometric information on measures reporting on the MFR. Searches of six databases were conducted. English articles were selected based on inclusion and exclusion criteria. The QATSDD checklist was used to assess study quality. RESULTS:  Of 669 studies identified, 28 met inclusion criteria. Thirteen different instruments were identified for evaluation. Reported reliability and validity varied significantly across instruments, as well as availability for research and/or clinical use. CONCLUSION: Suggestions for research and clinical practice include further evaluation of the psychometric properties of tools, particularly for self-report measures of reflective functioning, use of interviews to scaffold reflexivity, and development of clinical policies and procedures to clarify care pathways for expectant mothers needing further support.

Maternal-fetal attachment, parenting stress during infancy, and child outcomes at age 3 years.

Maternal-fetal attachment (MFA), a woman's relationship with and affiliative behaviors toward her unborn child, has been linked to near-term infant physical and developmental outcomes. However, further longitudinal research is needed to understand whether the impact of MFA extends past the earliest years of life. The current study explored relationships between MFA and child socioemotional competence and behavior problems at age 3 and whether parenting stress mediated the association between MFA and child outcomes. Data were collected from 221 primarily Black/African-American mothers who completed a scale of MFA during pregnancy. Mothers reported on parenting stress at infant age 7 months and reported on child socioemotional competence and problem behaviors at child age 3 years. In path analyses, MFA was directly associated with child socioemotional competence at age 3 years, but an indirect association between MFA and socioemotional competence via parenting stress was not significant. We also observed a significant indirect association between lower MFA and child internalizing behavior problems via parenting stress that was related to maternal dissatisfaction regarding interactions with her child. Findings suggest that assessing MFA may serve as a means to identify dyads who would benefit from support to promote individual health outcomes.

La afectividad materno-fetal (MFA), la relación y comportamientos de afiliación de una mujer hacia su niño en el vientre, ha sido conectada a los resultados físicos y de desarrollo del infante cuya gestación está cerca al término. Sin embargo, se necesita investigación longitudinal adicional para comprender si el impacto de MFA se extiende más allá de los más tempranos años de vida. El presente estudio exploró las relaciones entre MFA y la competencia socioemocional y problemas de comportamiento del niño a la edad de 3 años y si el estrés de crianza medió la asociación entre MFA y los resultados en el niño. Se recogió información de 221 madres, primariamente negras/afroamericanas, que completaron una escala de MFA durante el embarazo. Las madres reportaron sobre el estrés de crianza cuando el infante tenía 7 meses y reportaron sobre la competencia socioemocional y los problemas de comportamiento del niño cuando éste tenía 3 años. En análisis de trayectoria, se asoció MFA directamente con la competencia socioemocional del niño a la edad de 3 años, pero una asociación indirecta entre MFA y la competencia socioemocional por medio del estrés de crianza no fue significativa. También observamos una significativa asociación indirecta entre MFA y la internalización de problemas del comportamiento por parte del niño vía el estrés de crianza que se relacionó con la insatisfacción materna en cuanto a las interacciones con su niño. Los resultados indican que evaluar MFA pudiera servir como un medio de identificar díadas que se beneficiarían del apoyo para promover resultados de salud individuales.

L'attachement maternel foetal (Maternal-fetal attachment, soit MFA), une relation de la femme avec son enfant à naître et des comportements affiliatifs envers l'enfant à naître, a été lié à des résultats physiques et développementaux du bébé quasiment à terme. Cependant des recherches longitudinales plus approfondies sont nécessaires afin de comprendre si l'impact du MFA dépasse les premières années de la vie. Cette étude a exploré les relations entre le MFA et la compétence socio-émotionnelle de l'enfant et les problèmes de comportement à l'âge de trois ans et si le stress de parentage affectait l'association entre le MFA et les résultats sur l'enfant. Les données ont été recueillies à partir de 221 mères américaines majoritairement noires/afro-américaines qui ont rempli l'échelle du MFA durant la grossesse. Les mères ont fait état de stress de parentage à l'âge de 7 mois pour le bébé et répondu à des questions sur la compétence socio-émotionnelle de l'enfant et les problèmes de comportement à l'âge de 3 ans. Dans les analyses de trajectoire le MFA était directement lié à la compétence socio-émotionnelle de l'enfant à l'âge de 3 ans, mais un lien indirect entre le MFA et la compétence socio-émotionnelle à travers le stress de parentage n'était pas important. Nous avons aussi observé un lien indirect important entre le MFA et les problèmes de comportement d'internalisation de l'enfant au travers du stress de parentage qui était lié à l'insatisfaction maternelle concernant les interactions avec son enfant. Les résultats suggèrent que l'évaluation du MFA peut servir de moyen d'identifier des dyades qui bénéficierait d'un soutien pour promouvoir des résultats de santé individuels.

Maternal-fetal attachment in pregnant Italian women: multidimensional influences and the association with maternal caregiving in the infant's first year of life.

BACKGROUND: Maternal-Fetal Attachment (MFA) describes the cognitive-representational, emotional, and behavioral aspects of the mother-fetus relationship that develops during pregnancy. We present two studies conducted on pregnant Italian women. In Study I, we aimed to explore multifaceted associations of MFA with variables important for a healthy pregnancy (e.g., maternal mental health, the couple's relationship). In Study II, we investigated the predictive role of MFA on observed maternal caregiving during the first months of the infant's life. METHODS: In Study I, 113 pregnant Italian women were assessed on MFA (Maternal Antenatal Attachment Scale, MAAS), maternal depression (Beck Depression Inventory-II, BDI-II), maternal anxiety (State Trait Anxiety Inventory - State version, STAI), adjustment of the couple (Dyadic Adjustment Scale, DAS), and perceived parental care (The Parental Bonding Instrument, PBI). In Study II, 29 mother-infant pairs were followed up at 4 months to assess observational variables of maternal caregiving through the Emotional Availability Scale (EAS) and to test for an association with MFA in pregnancy. RESULTS: Study I showed a significant association between MFA and the quality of the couple relationship (ß = .49, P < .001) and between MFA and the recall of memories of care received in childhood (ß = .22, P = .025). Study II showed a predictive effect of MFA on maternal structuring observed during mother-infant interactions at 4 months of age (ß = 0.36, P = .046). CONCLUSION: The study points out relevant relationship contexts that might receive care and support throughout pregnancy to protect MFA. The findings also provide thoughtful insights on the role of MFA in early maternal caregiving, suggesting that MFA might be a candidate as one putative antecedent of mother-infant interaction processes.

The mediating role of prenatal depression in adult attachment and maternal-fetal attachment in primigravida in the third trimester.

BACKGROUND: Prenatal depression and adult attachment are factors that affect the establishment of an intimate relationship between a mother and fetus. The study explored differences in prenatal depression and maternal-fetal attachment (MFA) scores between different types of adult attachment and the effects of maternal depression scores and attachment dimensions on maternal intimacy with the fetus. METHODS: The Edinburgh Postnatal Depression Scale (EPDS), Experience of Close Relationship (ECR) scale, Maternal Antenatal Attachment Scale (MAAS) and a general data scale were used to investigate 260 primigravida. An exploratory analysis was performed to analyze the effects of the depression score and adult attachment on MFA. RESULTS: The results showed that pregnant women with insecure attachment exhibited an increased prevalence of prenatal depression, lower total MFA scores, and lower MFA quality compared with those women with secure adult attachment. The explorative analysis showed that the depression scores mediated the relationship between adult attachment avoidance and MFA quality. CONCLUSIONS: Primigravida who had insecure adult attachment exhibited an increased prevalence of prenatal depression and lower MFA. Maternal depression and adult attachment may affect the emotional bond between a mother and fetus. This finding should be seriously considered, and timely intervention needs to take personality traits into consideration.

Prevalence and correlates of maternal early stimulation behaviors during pregnancy in northern Ghana: a cross-sectional survey.

BACKGROUND: Per UNICEF's Nurturing Care Framework, early childhood development (ECD) begins during pregnancy and many lower-resource settings need data to inform their programs for optimal child development. The maternal-fetal relationship can be partly examined via a series of bonding activities called early stimulation behaviors (ESB). This study describes early stimulation behaviors and the associated correlates among pregnant women in Ghana. METHODS: This cross-sectional study used data from a cluster-randomized trial in two districts of Northern Ghana. A total of 374 pregnant women were enrolled at baseline and administered a pre-intervention survey. Communication-related early stimulation behaviors was the primary outcome which was evaluated using three maternal-fetal bonding activities; did the woman self-report touching and/or talking, singing, and/or talking about family to her belly. A generalized estimating equation modified Poisson model was used for the bivariate and multivariable analysis. RESULTS: About half of the participants reported performing communication-related ESB during pregnancy frequently or sometimes. Bivariate analysis revealed that negative life experiences including higher rates of emotional, physical and sexual intimate partner violence (IPV) and having moderate to severe depressive symptoms were associated with women performing early stimulation behaviors more often. In the multivariable model, physical intimate partner violence remained significantly associated with early stimulation behaviors. CONCLUSION: Research on early stimulation behaviors is still in a nascent phase. It is unclear why our results revealed an association between intimate partner violence and early stimulation behaviors; this could reflect a coping mechanism for the expectant mother. Further research is needed to better understand this association and explore potential long-term impacts of early stimulation behaviors during pregnancy on child development. TRIAL REGISTRATION: Clinical Trials # NCT03665246 , August 29, 2018.

A pilot study of a group-based perinatal depression intervention on reducing depressive symptoms and improving maternal-fetal attachment and maternal sensitivity.

To conduct a pilot study of a group-based perinatal depression intervention, the Mothers and Babies Course, on depressive symptomatology, maternal-fetal attachment, and maternal sensitivity, 60 pregnant women with moderate to severe depressive symptomatology were randomized to a 6-week intervention or usual care group at their initial prenatal care visit. Measures of depressive symptomatology and maternal-fetal attachment were collected at baseline and 36 weeks gestation. At 12 weeks postpartum, participants completed a measure of depressive symptomatology, and an objective measure of maternal sensitivity was collected. Participants randomized to the intervention group completed an average of 5.2 sessions, and 70% of women completed all six sessions. Exploratory analyses showed that at 12 weeks postpartum, participants randomized to the intervention group had an 8.32-point decrease from baseline on the Edinburgh Postnatal Depression Scale (EPDS) as compared to a 4.59-point decrease among participants randomized to usual care. Participants randomized to the intervention group had a mean change score of 12.60 in maternal-fetal attachment via the Maternal Fetal Attachment Scale (MFAS) as compared to 4.60 among participants in usual care. Maternal sensitivity scores, assessed via the Nursing Child Assessment Satellite Training-Feeding Scale (NCAST-Feeding), were higher at 12 weeks postpartum for women in the intervention group as compared to women in usual care (59.2 and 51.8, respectively). Our pilot study findings provide preliminary support for the benefits of a perinatal depression intervention, delivered in a group setting, on reducing depressive symptomatology, and improving maternal-fetal attachment and maternal sensitivity. Further research, conducted with larger samples, is necessary to determine the effect of this intervention on indicators of maternal attachment.

Prenatal attachment: using measurement invariance to test the validity of comparisons across eight culturally diverse countries.

Studies in high-income countries (HICs) have shown that variability in maternal-fetal attachment (MFA) predict important maternal health and child outcomes. However, the validity of MFA ratings in low- and middle-income countries (LMICs) remains unknown. Addressing this gap, we assessed measurement invariance to test the conceptual equivalence of the Prenatal Attachment Inventory (PAI: Muller, 1993) across eight LMICs. Our aim was to determine whether the PAI yields similar information from pregnant women across different cultural contexts. We administered the 18-item PAI to 1181 mothers in the third trimester (Mean age = 28.27 years old, SD = 5.81 years, range = 18-48 years) expecting their first infant (n = 359) or a later-born infant (n = 820) as part of a prospective birth cohort study involving eight middle-income countries: Ghana, Jamaica, Pakistan, Philippines, Romania, South Africa, Sri Lanka and Vietnam. We used Multiple Group Confirmatory Factor Analyses to assess across-site measurement invariance. A single latent factor with partial measurement invariance was found across all sites except Pakistan. Group comparisons showed that mean levels of MFA were lowest for expectant mothers in Vietnam and highest for expectant mothers in Sri Lanka. MFA was higher in first-time mothers than in mothers expecting a later-born child. The PAI yields similar information about MFA across culturally distinct middle-income countries. These findings strengthen confidence in the use of the tool across different settings; future studies should explore the use of the PAI as a screen for maternal behaviour that place children at risk.

Relationship of health practices with depression and maternal-fetal attachment in adolescent pregnant women: A prospective study.

AIM: To determine the relationship of health practices with depression and maternal-fetal attachment in adolescent pregnant women. METHODS: This prospective study was conducted on 316 adolescent pregnant women with medical records at the health centers in Tehran, Iran. The participants were selected through the complete enumeration. Data were collected using the socio-demographic and obstetrics questionnaire, the Health Practices Questionnaire-II (HPQ-II), the Edinburgh Postnatal Depression Scale (EPDS), and the Cranley's Maternal-Fetal Attachment Scale (MFAS). The data were analyzed with the Pearson correlation test, the independent t-test, one-way ANOVA, and the general linear model. RESULTS: The mean scores of health practices, depression, and maternal-fetal attachment were 135.3 (SD 9.1, range 34-170), 10.1 (SD 5.4, range 0-30), and 91.6 (SD 8.6, range 24-120), respectively. The results of Pearson correlation test showed that health practices had a significant relationship with depression (r = -0.29) and maternal-fetal attachment (r = 0.37). Results of general linear model showed that an increase in the health practices score led to a significant decrease in depression score during pregnancy [ß = -0.10; 95% CI: -0.17 to -0.04] and a significant increase in maternal-fetal attachment score [ß = 0.30; 95% CI: 0.19 to 0.40]. CONCLUSION: There is significant relationship between health practices and depression, as well as maternal-fetal attachment in adolescent pregnant women. Therefore, intervention to improve one of them may improve the other one(s).

Effect of counselling on maternal-fetal attachment in unwanted pregnancy: a randomised controlled trial.

Purpose: The present study aimed to determine the effect of group counselling on Maternal-Fetal Attachment (MFA) in mothers with unwanted pregnancy.Methods: This study was a randomised clinical trial. The participants were 80 mothers with unwanted pregnancy during 28-34 weeks of pregnancy who referred to health centres of Karaj to receive prenatal care in 2018. The women were randomly assigned into intervention (N = 40) and control groups (N = 40). The intervention group received four weekly group counselling sessions to promote MFA and the control group received routine care. Cranley's Maternal-Fetal Attachment Scale was used to assess the attachment of mother to fetus at baseline and two weeks after counselling. An ANCOVA test was performed to evaluate the effect of intervention and the number of parity.Results: There was no significant difference between the two groups in terms of general health scores and attachment of mother to fetus at baseline, but after the intervention, the mean scores of MFA in the intervention group had a significant difference with the control group (p < 0.001); the ANCOVA test indicated that attachment scores were significant in terms of intervention and pregnancy group and attachment scores indicated further increase in the primipara group compared to the multipara group (p = 0.041).Conclusion: Considering the effectiveness of group counselling in improving MFA in unplanned pregnancy, it can be used in prenatal care.

The association of maternal-fetal attachment with smoking and smoking cessation during pregnancy in The FinnBrain Birth Cohort Study.

BACKGROUND: Smoking in pregnancy constitutes a preventable risk factor for fetal/child development and maternal-fetal attachment (MFA) seems to contain a momentum that can break the chain of adverse outcomes by promoting maternal prenatal health practices. This study aimed to explore the association of MFA with smoking at any time during pregnancy and smoking cessation in early pregnancy, and the modifying role of MFA on the expected effects of education and prenatal psychological distress (PPD) on prenatal smoking behavior. METHODS: The pregnant women (n = 3766) participated in the The FinnBrain Birth Cohort Study in Finland between December 2011 and April 2015. The binary outcomes, smoking at any time during pregnancy and smoking cessation in early pregnancy, were obtained from self-reports at gestational weeks (gwks) 14 and 34 and The Finnish Medical Birth Register. MFA was assessed with the Maternal-Fetal Attachment Scale (MFAS) at gwks 24 and 34. Logistic regression analyses were used to determine the association between MFA and maternal prenatal smoking behavior. FINDINGS: The prevalence of smoking was 16.5%, and 58.1% of the smokers quit smoking during pregnancy. The independent associations of total MFA scores with prenatal smoking behavior were not established (aOR = 1.00-1.02, multiplicity adjusted p > 0.05). A higher score in the altruistic subscale of MFA, Giving of self, associated with a higher probability of smoking cessation (24 gwks: aOR = 1.13, 95% CI [1.04, 1.24], p = 0.007, multiplicity adjusted p = 0.062; 34 gwks: aOR = 1.17, 95% CI [1.07, 1.29], p < 0.001, multiplicity adjusted p = 0.008). The modifying effect of MFA on the observed associations between PPD and smoking in pregnancy and between maternal education and smoking in pregnancy / smoking cessation in early pregnancy was not demonstrated. CONCLUSIONS: The altruistic dimension of maternal-fetal attachment associates with an increased probability of smoking cessation during pregnancy and therefore strengthening altruistic maternal-fetal attachment may constitute a promising novel approach for interventions aiming at promoting smoking cessation during pregnancy.

Effect of counseling on maternal-fetal attachment in women with unplanned pregnancy: a randomized controlled trial.

Introduction: Since the maternal-fetal attachment level in unplanned pregnancies is weaker than their planned counterparts, this study aimed to determine the effect of counselling on maternal-fetal attachment in women with unplanned pregnancy.Methods: This was a randomised controlled clinical trial on pregnant women with unplanned pregnancy and weak-average maternal-fetal attachment scores. Participants were assigned to a control (n = 40) and an intervention (n = 40) group through randomised blocking. The intervention group attended 1-3 individual and 6 group counselling sessions and the control group received routine care. The participants completed the Maternal-Fetal Attachment Scale before and four weeks after the intervention.Results: The mean (standard deviation) maternal-fetal attachment score of the intervention group was increased from 73.6 (8.9) before the intervention to 96.6 (9.3) after the intervention. However, the mean (standard deviation) maternal-fetal attachment scores of the control group were 76.0 (9.4) and 76.5 (6.4) before and after the intervention, respectively. The mean maternal-fetal attachment score of the counselling group was significantly higher than that of the control group (adjusted mean difference: 21.7; 95% confidence interval: 18.6 to 24.9; P < 0.001).Conclusion: Counseling has a positive contribution to improving maternal-fetal attachment in women with unplanned pregnancies.

A cross-sectional study of maternal-fetal attachment and perceived stress at the first antenatal visit.

BACKGROUND: Maternal-fetal attachment (MFA) psychologically is well described. Suboptimal attachment may have negative consequences particularly if it is associated with unhealthy maternal behaviour that may potentially increase the risk of adverse pregnancy outcomes. The perception of stress or anxiety is also associated with potential adverse outcomes including preterm birth. OBJECTIVE: This cross-sectional study examined MFA and perceived stress at the time of the first ultrasound examination in early pregnancy. METHODS: Convenience sampling was used to recruit women after they presented to the Ultrasound Department for a routine dating ultrasound at their first antenatal visit. Informed consent was obtained and clinical and sociodemographic details were recorded. Women were invited to complete validated Cranley MFA and Perceived Stress Scale (PSS) questionnaires. RESULTS: Of the 90 women recruited, 80 completed the questionnaires successfully. No association was found between the MFA score and maternal age, parity, education, marital status, previous pregnancy loss or smoking behaviour. An unplanned pregnancy was associated with a lower mean MFA score (p < 0.01) and a higher mean PSS score (p < 0.005). These relationships persisted in a multiple regression analysis controlling for maternal age and parity. CONCLUSION: In early pregnancy, an unplanned pregnancy is associated with a lower MFA and higher PSS score. Additional research is required to assess if this persists as pregnancy advances. ABBREVIATIONS: Maternal-Fetal Attachment (MFA), Maternal-Fetal Attachment Scale (MFAS), Perceived stress scale (PSS), Maternal Antenatal Attachment Scale (MAAS), Standard Deviation (SD), Central Statistics Office (CSO), Body Mass Index (BMI), Relative Risk (RR).