A longitudinal study on the maternal–fetal relationship and postnatal maternal sensitivity

Maternal antenatal depression, oxytocin, and infant temperament: The roles of ethnicity and adult attachment avoidance

This study examined the associations between maternal depression and oxytocin in pregnancy, caregiving sensitivity and adult attachment style, and infant temperament. One hundred and six women recruited from a public hospital antenatal clinic in Australia, and their infants completed assessments at three time points (Time 1: pregnancy; Time 2: 3-month postpartum; Time 3: 12-month postpartum). Mothers completed self-report questionnaires assessing maternal depression symptom severity at Time 1-3, adult attachment style at Time 2, and infant temperament at Time 3. At Time 1, they also provided a blood sample to assess peripheral oxytocin levels, and at Time 2, participated in a parent-child interaction session, which was later coded for caregiving behavior (sensitivity). Neither maternal depression nor lower levels of oxytocin during pregnancy predicted difficult infant temperament; rather, it was predicted by non-Caucasian ethnicity. When all other variables were free to vary, adult attachment avoidance mediated an association between maternal depression during pregnancy and difficult infant temperament. Results highlight the potential value of interventions focusing on adult attachment insecurity for pregnant women and raise questions about associations between culture/ethnicity and infant temperament.

Prenatal affective cognitive training to reduce the risk of postpartum depression (PACT): study protocol for a randomized controlled trial

BACKGROUND

Postpartum depression (PPD) affects 30-50% of women with a history of previous depression or bipolar disorder and 8% of women with no history of depression. Negative cognitive biases in the perception of infant cues and difficulties with emotion regulation are replicated risk factors. Current interventions focus on detecting and treating rather than preventing PPD. The aim of this randomized controlled intervention trial is therefore to investigate the potential prophylactic effects of prenatal affective cognitive training for pregnant women at heightened risk of PPD.

METHODS

The study will enrol a total of 292 pregnant women: 146 at high risk and 146 at low risk of PPD. Participants undergo comprehensive assessments of affective cognitive processing, clinical depressive symptoms, and complete questionnaires at baseline. Based on the responses, pregnant women will be categorized as either at high or low risk of PPD. High-risk participants will be randomized to either prenatal affective cognitive training (PACT) or care as usual (CAU) immediately after the baseline testing. The PACT intervention is based on emerging evidence for efficacy of affective cognitive training approaches in depression, including cognitive bias modification, attention bias modification, mindfulness-inspired emotion regulation exercises, and working memory training. Participants randomised to PACT will complete five individual computerised and virtual reality-based training sessions over 5 weeks. The primary outcome is the difference between intervention arms in the incidence of PPD, assessed with an interview 6 months after birth. We will also assess the severity of depressive symptoms, rated weekly online during the first 6 weeks postpartum.

DISCUSSION

The results will have implications for future early prophylactic interventions for pregnant women at heightened risk of PPD. If the PACT intervention reduces the incidence of PPD, it can become a feasible, non-invasive prophylactic strategy during pregnancy, with positive mental health implications for these women and their children.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06046456 registered 21-09-2023, updated 08-07-2024.

Affective cognition in response to infant stimuli in pregnant compared with non-pregnant women

Physiological, neurocognitive, and psychological changes facilitates adaptation to motherhood. This cross-sectional study aimed to examine differences between pregnant and non-pregnant women in affective cognitive and psychophysiological responses to infant stimuli. We hypothesized that pregnant women would display (I) reduced negative emotional reactivity and perception of distressed infant stimuli, (II) increased attention toward infants compared to adults, and (III) greater psychophysiological response to infant distress. The sample comprised 22 pregnant women (22-38 weeks gestation) and 18 non-pregnant nulliparous women. Four computerized tasks were administered to measure affective cognitive processing of infant stimuli, while recording facial expressions, electrodermal activity, and eye gazes. Results indicated that pregnant women exhibited fewer negative facial expressions, reported less frustration when exposed to distressed infant cries, and showed greater attention to emotional infant faces compared to non-pregnant women, but the differences did not remain statistically significant after correction for multiple comparisons. No differences were observed in psychophysiological responses. The findings indicate a possible pregnancy-mediated effect regarding the cognitive processing of infant stimuli, potentially as preparation for motherhood. Future research with larger samples and longitudinal design is needed to understand the predictors, timing, and plasticity of cognitive changes during pregnancy.

The Protective Role of Maternal-Fetal Bonding for Postpartum Bonding Following a NICU Admission

INTRODUCTION

Admission of a newborn to a neonatal intensive care unit (NICU) can be a highly stressful event that affects maternal psychological well-being and disrupts the early maternal-infant bonding relationship. Determining factors that promote maternal-infant bonding among those with a NICU admission is essential for the development of effective interventions.

METHODS

Using a longitudinal clinic-based sample of diverse and low-income pregnant women, we examined whether maternal-fetal bonding measured during the second trimester moderated the association between NICU admission and postpartum bonding measured at six months post birth, controlling for demographic characteristics.

RESULTS

Approximately 18% of the sample experienced a NICU admission at birth. NICU admission was associated with lower postpartum bonding (b = -8.74; p < .001, Model 1), whereas maternal-fetal bonding was associated with higher bonding reported at six months postpartum (b = 3.74, p < .001, Model 2). Results of the interaction revealed that women who reported higher maternal-fetal bonding reported higher postnatal bonding regardless of NICU admission status.

DISCUSSION

Because maternal-fetal bonding can be enhanced through intervention, it is a promising target for reducing the risks of NICU admission for the early maternal-infant relationship.

Antenatal mind-mindedness and its relationship to maternal-fetal attachment in pregnant women

In this study, researchers aimed to investigate whether a relationship exists between maternal-fetal attachment (MFA) and antenatal mind-mindedness in a sample of Australian pregnant women (n = 43). Participants completed the Maternal Fetal Attachment Scale (MFAS) in their second and third trimester, and a modified 'describe your baby' interview with the inclusion of general prompts as a measure of antenatal mind-mindedness in their third trimester. Positive correlations were observed between mental comments, but not total predictions, made by women during the modified antenatal mind-mindedness task and MFAS scores at the second and third trimesters. An average of 6.07 total predictions and 1.30 mental predictions were made before prompts, increasing to 17.65 total comments and 6.58 mental comments after prompts. Prompts within the mind-mindedness task resulted in 42 participants making at least one mental prediction (M = 6.58). Our findings provide the first evidence for a relationship between MFA and antenatal mind-mindedness, and highlight the importance of considering mind-mindedness during pregnancy in the developing bond from mother to baby.

Maternal mind-mindedness over infants' first three months

Maternal mind-mindedness refers to mothers' ability to reflect upon their infants' mental states and respond appropriately. The present study assessed mind-mindedness longitudinally from the newborn period to the infant age of three months. The study is the first to assess maternal mind-mindedness in the infant's early life prior to three months (one week, one month, two months, three months). To measure maternal mind-mindedness, mothers' speech to their infants is coded for mental state comments about the infants' thoughts, desires, and emotions. Appropriate mind-minded comments are judged to accurately reflect the infants' mental states; non-attuned mind-minded comments are judged to misinterpret the infants' mental states. Mothers' individual stability (rank order stability) and group level continuity (mean level of stability across the infant ages) were assessed. Mothers showed modest temporal stability in both appropriate and non-attuned mind-mindedness over the infants' first three months. The continuity of mind-mindedness showed that appropriate mind-mindedness increased over the infant ages, but non-attuned mind-mindedness showed no change. In infants' early lives, mothers' ability to accurately interpret their infants' mental states is enhanced as the mother-infant relationship develops and infants become more communicative partners.

Prediction of postpartum depression with an online neurocognitive risk screening tool for pregnant women

Postpartum depression (PPD) is a severe mental illness affecting 10-15% of mothers. Emerging evidence indicates that negative neurocognitive bias in response to infant distress during pregnancy marks an increased risk of PPD. This proof-of-concept study aimed to investigate the association between negatively biased neurocognitive processing of infant distress during pregnancy and subsequent PPD and to explore the feasibility of an online risk screening tool. In the second or third trimester of pregnancy, 87 participants underwent two online tests of reactivity to and evaluation of infant distress and completed questionnaires regarding psychosocial risk factors. After birth, participants rated their depressive symptoms online and underwent a diagnostic telephone interview concerning PPD. Irrespective of depressive symptoms during pregnancy, negative reactivity to and evaluation of infant distress predicted PPD (reactivity: Exp(B)=1.33, p = 0.04) and depressive symptoms after birth (reactivity: B = 0.04, p = 0.048; evaluation: B = 0.10, p = 0.04). The negative reactivity toward infant distress showed high sensitivity and moderate specificity (89% and 77%, respectively), while the evaluation of infant distressed cries showed lower sensitivity and specificity (67% and 66%, respectively). The relatively small sample size prevented the inclusion of additional risk variables in the regression models. The replication of an association between negative neurocognitive bias during pregnancy with PPD risk is noteworthy and has clinical implications in terms of early prevention. However, the low response rate indicates that this tool is not feasible in its current form. Future larger-scale studies are needed to further investigate candidate risk factors in a brief online screening tool.

Mother-infant bonding in the first nine months postpartum: the role of mother's attachment style and psychological flexibility

INTRODUCTION

Mother's bond to the infant in the postpartum period plays an important role in the subsequent mother-infant relationship and the infant's socio-emotional functioning. Several maternal characteristics, such as attachment style and psychological flexibility, may contribute to the quality of mother-infant bonding, though literature examining these variables is still scarce. The present study aimed to examine the impact of mother's attachment on mother-infant bonding in the first month postpartum and the mediating role of psychological flexibility on that association.

METHODS

Participants were 226 mothers of an infant up to 9 months old, who reported on their own attachment style (in terms of anxiety, comfort with proximity, trust in others), psychological flexibility (in terms of openness to experience, behavioural awareness, valued action) and mother-infant bonding.

RESULTS

Results showed that mother's attachment anxiety predicted a bond with the infant directly and indirectly via mother's psychological flexibility, specifically through behavioural awareness and valued action. Trust in others had an impact on mother-infant bonding through behavioural awareness, whereas comfort with proximity influenced mother-infant bond indirectly, via valued action. Finally, mothers' civil status, schooling and number of children were relevant to better understand the variance of our mediating and dependent variables.

DISCUSSION

Our findings highlight the importance of mother's attachment and psychological flexibility in promoting the quality of mother-infant bonding, which can inform future intervention programmes targeting modifiable factors, such as psychological flexibility, to promote early positive parent-infant relationships, particularly for single, first-time mothers, with higher levels of education.

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.

Daily relationships among maternal rumination, mood and bonding with infant

There is little research examining the association between maternal maladaptive emotion regulation strategies such as rumination and perceived maternal bonding and mood. This study investigated the concurrent and prospective relationship of both trait and daily rumination with daily perceived maternal bonding and mood. Ninety-three mothers of infants aged between 3 and 14 months completed a ten-day diary study investigating the relationship between daily and trait ruminative self-focus, negative affect and perceived maternal bonding, or her perceived feelings of closeness with her infant. The majority of mothers reported mild to moderate depressive symptoms. The data were analysed using Hierarchical Linear Modelling. Baseline depressive symptoms and trait rumination were each positively associated with mean levels of daily ruminative self-focus and mood over the ten-day sampling period. Bonding with infant at baseline was not associated with mean levels of daily rumination, mood or bonding over the sampling period. Concurrently, daily rumination and daily bonding were negatively correlated, after accounting for daily mood. Prospectively, lower levels of daily bonding predicted increases in daily rumination and depressive mood on the subsequent day. Interestingly, daily rumination did not predict increases in depressive mood or bonding on the subsequent day, suggesting that rumination occurred in response to perceived disruptions in feelings of closeness with the infant, but did not lead to prospective decreases in these feelings of closeness. These findings hold important implications for understanding the relationship between the mother-infant relationship, and maternal rumination and depressive mood, suggesting that disruptions in the way mothers perceive they are bonding to their infants may contribute to depressongenic processes.

Effects of health promotion program on maternal attachment, parenting self-efficacy, infant development: a randomised controlled trial

This study was designed to test the efficacy of the health promotion program used on maternal-infant attachment, parental self-efficacy, infant development. For this experimental study parallel-group randomised control design was used. Data was collected from 64 mother and their infants. The intervention group received the health promotion program in addition to standard care, the control group received only the standard care. Family Information Form, Prenatal Attachment Inventory, Maternal Attachment Inventory, Parenting Self-Efficacy Scale, and Denver II Developmental Screening Tests were used for the collection of the data. Pearson χ2 test, Yates corrected χ2 test, independent t-test, and Mcnemar test were used for analysing the collected data. The groups on maternal-infant attachment (d:1.20 [CI:0.671-1.736]), parental self-efficacy (d:1.37 [CI:0.835 to 1.925]), and development delays of infants (p = .003, C.V: 0.41) were found to be statistically significant. Health promotion program positively influenced the maternal attachment, parental self-efficacy, the development of the infants.IMPACT STATEMENTWhat is already known on this subject? Pregnancy and postpartum is a difficult period for mothers. Mothers need support. Parenting self-efficacy and maternal attachment are important for improving infant health. Infant should be supported to prevent developmental delays.What do the results of this study add? With the education and support program applied before and after birth, mother and baby were evaluated together and multi-faceted support was provided.What are the implications of these findings for clinical practice and/or further research? Supporting parenting self-efficacy, maternal attachment and infant development should be started during pregnancy and should be continued in the postpartum period.

Narrative coherence across the transition to parenthood: Primiparous parents' representations of their child in relation to parental sensitivity

Narrative coherence reflects parents' ability to provide a believable, clear, relevant, and internally consistent story about their child. Parents demonstrating more narrative coherence have been theorized to show higher parental sensitivity, but this has not been examined in a normative sample, nor across the transition to parenthood, and only once in fathers. The aim of this study was to examine stability and change in narrative coherence across the transition to parenthood in mothers and fathers, as well as the relation between pre- and postnatal narrative coherence and postnatal parental sensitivity. The sample consisted of 105 primiparous expecting parents. Narrative coherence was measured at 36-weeks pregnancy and when the child was 4 months old, using the Five Minute Speech Sample procedure. Parental sensitivity was observed in three episodes. Results demonstrated that narrative coherence was moderately stable (correlations) across the transition to parenthood in fathers only. Both mothers' and fathers' narrative coherence improved over time. Furthermore, mothers and fathers were overall equally coherent, and maternal and paternal narrative coherence were positively interrelated during pregnancy only. Lastly, our findings showed weak evidence for the theorized link between narrative coherence and parental sensitivity: only postnatal narrative coherence predicted paternal sensitivity, only during free play. Our findings give new insight in the development of narrative coherence across the transition to parenthood, and how it relates to actual parenting. More research is needed to confirm our findings and further explore this topic.

Closeness with a partner and parental bond with a child during the transition to parenthood

OBJECTIVE

The aim of this longitudinal study was to examine the dyadic interdependence of the relationships between partners' perception of closeness with one another and their pre- and postnatal bonds with a child.

RESEARCH DESIGN AND PARTICIPANTS

A total of 213 first-time expectant couples participated in the study both during pregnancy (1st stage) and after the child's birth (2nd stage).

MEASUREMENTS

The participants completed the following measures: the one-item pictorial Inclusion of Other into the Self (IOS) scale and the brief maternal and paternal versions of the Antenatal Attachment Scales (MAAS/PAAS, respectively) and Postnatal Attachment Scales (MPAS/PPAS, respectively).

FINDINGS

The Actor-Partner Interdependence Models (APIM) for distinguishable dyads were performed and revealed the positive effect of parents' perceptions of closeness with their partners regarding both their own and their partners' bond with their child during pregnancy. However, after the child's birth, for both mothers and fathers, only their own perception of closeness with their partners was associated with their bond with their child. Moreover, only the actor effects of bonding with a child during pregnancy as well as the change in perception of closeness with a partner on the partner's bond with their child after birth were found (no partner effect).

KEY CONCLUSIONS

Couple attributes during the transition to parenthood should be emphasized to promote the development of parental pre- and postnatal bonds.

Maternal perceived bonding towards the infant and parenting stress in women at risk of postpartum psychosis with and without a postpartum relapse

BACKGROUND

Postpartum psychosis (PP) is the most severe psychiatric disorder associated with childbirth. However, there is little research on maternal bonding towards the infant and parenting stress in this clinical population.

METHODS

We investigated maternal bonding during pregnancy and post-partum in 75 women: 46 at risk of PP (AR), because of a DSM-IV diagnosis of bipolar disorder, schizoaffective disorder or previous PP, and 29 healthy controls. Of the AR women, 19 developed a psychiatric relapse within 4 weeks' post-partum (AR-unwell), while 27 remained symptom-free (AR-well). We investigated childhood maltreatment, parenting stress and psychiatric symptoms as potential predictors of maternal bonding.

RESULTS

In pregnancy, AR-unwell women reported a more negative affective experience towards their infants than AR-well women (d = 0.87, p = .001), while postnatally there was no significant difference in bonding. In contrast, AR women as a group reported a more negative affective experience than HC postnatally (d = 0.69, p = .002; d = 0.70, p = .010), but not antenatally. Parenting stress and psychiatric symptoms significantly predicted less optimal postnatal bonding (b = -0.10, t = -4.29, p < .001; b = -0.37, t = -4.85, p < .001) but only psychiatric symptoms explained the difference in bonding between AR and HC (b = -1.18, 95% BCa CI [-2.70,-0.04]).

LIMITATIONS

A relatively small sample size precluded a more in-depth investigation of underlying pathways.

CONCLUSION

This study provides new information on maternal bonding in women at risk of PP, and particularly in those that do and do not develop a postpartum relapse. The results suggest that improving maternal symptoms and parenting stress in the perinatal period in women at risk of PP could also have positive effects on bonding.

Fear of childbirth during pregnancy: associations with observed mother-infant interactions and perceived bonding

Fear of childbirth (FOC) is a common phenomenon that can impair functioning in pregnancy but potential longer term implications for the mother-infant relationship are little understood. This study was aimed at investigating postpartum implications of FOC on the mother-infant relationship. A UK sample of 341 women in a community setting provided data on anxiety, mood and FOC in mid-pregnancy and subsequently completed self-report measures of postnatal bonding in a longitudinal cohort study. Postnatal observations of mother-infant interactions were collected and rated for a subset of 141 women. FOC was associated with maternal perception of impaired bonding, even after controlling for sociodemographic factors, concurrent depression and the presence of anxiety disorders (Coef = 0.10, 95% CI 0.07-0.14, p < 0.001). Observed mother-infant interactions were not associated with FOC (Coef = -0.01-0.03 CI - 0.02 to 0.02, p = 0.46), weakly with concurrent depression (Coef = - 0.10, CI - 0.19 to 0.00, p = 0.06) and not associated with anxiety disorders. The self-efficacy component of FOC was most strongly associated with lower reported bonding (Coef 0.37, 95% CI 0.25-0.49, p < 0.001) FOC makes a distinct contribution to perceived postpartum bonding difficulties but observed mother-infant interaction quality was not affected. This may be due to low self-efficacy impacting psychological adjustment during pregnancy. Targeted interventions during pregnancy focusing both on treatment of key childbirth fears and bonding could help women adjust earlier.

Pregnancy intendedness, maternal-fetal bonding, and postnatal maternal-infant bonding

This study models associations between pregnancy intendedness and prenatal maternal-fetal bonding with postnatal maternal-infant bonding. Unintended pregnancies are associated with disruptions in maternal-infant bonding, which has long-term adverse implications for maternal and child well-being. Given the high proportion of births that are unintended in the United States, identifying protective factors is critical. Pregnant women (ages 16-38) were recruited from two prenatal clinics in a metropolitan city in the South Central United States at their first prenatal visit and followed throughout pregnancy and postbirth. Multiple regression analyses examined associations, mediation, and moderation. Results indicate that the more unintended/unwanted women reported their pregnancies to be, the lower they reported their maternal-infant bonding postbirth, and higher maternal-fetal bonding scores are associated with higher postnatal maternal-infant bonding. An interaction revealed that a higher level of prenatal bonding is protective for postnatal bonding among those with unintended/unwanted pregnancies. Because prenatal bonding can be enhanced through intervention, it is a promising target to reduce the risks associated with unintended pregnancy.

A longitudinal investigation of young mothers' prenatal attachment, depressive symptoms, and early parenting behaviour

Objectives: This study explores whether young, low-income mothers' prenatal attachment to their infants is related to attachment and parenting behaviour postnatally.Background: A small literature has documented continuity in maternal attachment from pregnancy to postpartum and shown that early maternal attachment is associated with positive parenting behaviour. Less is known about whether prenatal attachment has a unique impact on parenting behaviour, or if it is primarily a step in the development of postnatal attachment, which in turn influences parenting. Additionally, it is unclear whether associations between attachment and early parenting might be attributable to other factors such as depressive symptoms.Method: This longitudinal study followed young primiparous mothers from pregnancy through 3-weeks postnatal. 240 ethnically/racially diverse low-income American women reported their attachment-related thoughts and feelings and their depressive symptoms during pregnancy and postnatally. At 3 weeks postpartum, mothers were observed interacting with their infant.Results: There was stability in attachment and depressive symptoms from pregnancy to postpartum. In multivariate path models, prenatal attachment was directly associated with two types of parenting behaviour: positive engagement and encouragement of learning, even when accounting for depressive symptoms and postnatal attachment. There was an indirect effect of prenatal attachment on sensitivity through postnatal attachment.Conclusion: The foundation of a mother's emotional connection to her infant begins before birth. Parenting support programmes for young mothers should begin during pregnancy. Supporting the establishment of positive prenatal attachment may also have a positive influence on later parenting behaviour among mothers, including mothers experiencing depressive symptoms.

Cognitive processing of infant stimuli in pregnant women with and without affective disorders and the association to postpartum depression

Pregnancy and childbirth are among the strongest risk factors for depression but the neurocognitive mechanisms underlying this enhanced risk are unknown. This study investigated emotional and non-emotional cognition in 57 pregnant women with or without an affective disorder during their third trimester, and the association between cognitive biases and subsequent postpartum depression (PPD). Of the pregnant women, 22 had a diagnosis of unipolar disorder (UD) and seven of bipolar disorder (BD) in full or partial remission, while 28 had no history of affective disorder. We included a control group of 29 healthy non-pregnant women. First, participants were interviewed, completed non-emotional and emotional cognitive tests and lastly filled out questionnaires. The participants were assessed two times after birth: at a home visit shortly after birth, and with a telephone interview to assess PPD in the first six months after birth. Healthy pregnant women rated infant cries less negatively than non-pregnant women, possibly reflecting preparation for motherhood. Pregnant women with UD exhibited a negative bias in ratings of infant cries, whereas pregnant women with BD showed a positive bias in ratings of infant happy faces and recognition of adult facial expressions. Across all pregnant women, more negative ratings of infant cries were associated with enhanced risk of PPD. Negatively biased perception of infant cries during pregnancy may thus signal vulnerability toward PPD.

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.

Prenatal bonds among Polish expectant couples: a brief version of the parental antenatal attachment scales

OBJECTIVE

To examine the psychometric properties of the Maternal and Paternal Attachment Scales (MAAS/PAAS) in a Polish sample of expectant couples.

BACKGROUND

A parental prenatal bond is important for the psychological and health outcomes of children and parents. The MAAS/PAAS is one of the well-established measures for parental prenatal bonding. However, there is a lack of Polish investigations of the factor structure and construct validity of these scales.

METHODS

The sample consisted of 341 Polish expectant couples who were surveyed about their prenatal bond, closeness with their unborn child, relationship satisfaction, and gender-role attitudes towards parenthood. The reliability and construct validity of the MAAS/PAAS were evaluated. A Confirmatory Factor Analysis (CFA) and a Principal Axis Factoring (PAF) were conducted.

RESULTS

The obtained results did not confirm the original factor structures of the MAAS/PAAS. However, in the proposed  single 11-item version for the MAAS/PAAS, two factors equivalent to the original structure were extracted. The scale reliability for the brief MAAS/PAAS version was good. The construct validity was confirmed.

CONCLUSION

The single Polish brief version for the MAAS/PAAS is a reliable and valid measure to use in Polish context. The obtained results support the importance of couple functioning for the MAAS/PAAS.

Newborn Behavioral Observation, maternal stress, depressive symptoms and the mother-infant relationship: results from the Northern Babies Longitudinal Study (NorBaby)

BACKGROUND

Families can experience the postpartum period as overwhelming and many report a special need for support. The Newborn Behavioral Observation (NBO) aims to promote a positive parent-infant relationship by sensitising parents to the infant's signals. This article evaluates the NBO as a universal preventive intervention within the regular well-baby clinic service on measures of maternal depressive symptoms, parental stress, the mother-infant relationship and satisfaction/benefit of the postpartum follow-up.

METHODS

This investigation is part of a larger longitudinal study comprising 220 women and 130 of their partners recruited between 2015 and 2017. The study had a non-randomised cluster-controlled design with 6 measurement points. This article is based on a sample of 196 women using data from T1 (gestational weeks 13-39), T4 (5-15 weeks postpartum) and T5 (3-9 months postpartum). Participants were allocated to a group receiving the NBO (n = 82) and a care as usual comparison group (n = 114). We measured maternal depressive symptoms and parental stress using the Edinburgh Postnatal Depression Scale (EPDS) and the Parenting Stress Index (PSI). The mother-infant relationship was assessed with the Parental Reflective Functioning Questionnaire (PRFQ), the Maternal Postnatal Attachment Scale (MPAS) and the Maternal Confidence Questionnaire (MCQ). Participants also answered questions about satisfaction/benefit of the postpartum follow-up.

RESULTS

A Mann-Whitney U test indicated that participants in the NBO-group learned significantly more than the comparison group from the follow-up about the baby's signals in relation to sleep/sleep patterns, social interaction and crying/fuzziness. Multivariate analyses of covariance (MANCOVA) and repeated measures ANCOVA found no significant differences between the groups for the mother-infant relationship domain and few differences in depressive symptoms and parental stress. The repeated measures ANCOVA found that participants in the NBO-group scored slightly higher on parental stress, although the difference was small.

CONCLUSIONS

The results indicate that the NBO-group learned more than the comparison group about reading their child's signals in important everyday situations. However, the benefits of the NBO were limited for depressive symptoms, parental stress and self-reported mother-infant relationship. The study sample was generally well-functioning, and the results indicate that the benefits of the NBO may be limited within a well-functioning sample.

TRIAL REGISTRATION

ClinicalTrials, NCT02538497, Registered 2 September 2015.

Adult attachment style and maternal-infant bonding: the indirect path of parenting stress

BACKGROUND

The quality of maternal-infant bonding is related to important child outcomes. The literature has assumed that the ability to form relationships is a relatively stable trait, and research studies have suggested that a mother's attachment style in close adult relationships is related to mother-infant bonding. The transition to parenthood is also often stressful, and the adult attachment style may relate to parenting stress in the first year after birth. Such stress could possibly have a negative relationship with the mother-infant bond. In the present study, we examined the associations between maternal adult attachment styles and the quality of mother-infant bonding and whether this relationship is mediated by parenting stress.

METHODS

The present study sample comprised 168 women (mean age 31.0 years, SD 4.23 years). Between weeks 31 and 41 of gestation, the anxious and avoidant adult attachment dimensions were measured with the Experiences in Close Relationships questionnaire (ECR). Between 5 and 15 weeks after birth mother-infant bonding and parenting stress were measured with the Maternal Postnatal Attachment Scale (MPAS) and the Parenting Stress Index-Parent Domain (PSI-PD), respectively.

RESULTS

Both attachment-related avoidance and attachment-related anxiety correlated significantly and negatively with mother-infant bonding. However, a regression analysis showed that only attachment-related avoidance was a significant predictor of mother-infant bonding when controlling for demographic variables and maternal mental health history. The relationship between the adult attachment style and bonding was mediated by parenting stress. Higher scores on attachment avoidance and anxiety were related to increased stress, which was related to decreased quality of bonding. The overall parent domain and the subscale of competence in the parent-related stress dimension mediated between attachment avoidance and bonding, and the overall parent domain and the subscales of competence and role restriction mediated between attachment anxiety and bonding. There was no direct relationship between the adult attachment style and mother-infant bonding when parenting stress was included as a mediator.

CONCLUSIONS

This study illustrates that maternal adult attachment style relates to mother-infant bonding. This relationship was mediated by parenting stress. The results may have implications for the early identification of mothers at risk of having bonding difficulties.

The relationship between romantic and prenatal maternal attachment: The moderating role of social support

The aim of this study was to examine the relationships between three types of maternal attachment bonds: anxious romantic, avoidant romantic and prenatal. The moderating role of perceived social support is also analysed. Ninety-one pregnant women in or near their thirtieth week of gestation (M = 29.59; SD = 4.57) were recruited, all of whom completed a series of questionnaires to assess the quality of their romantic and prenatal attachment bonds and their levels of perceived social support. The results reveal that both anxious and avoidant romantic attachments were significantly associated with low levels of maternal prenatal attachment. Moreover, the level of social support perceived during pregnancy moderated the relationship between anxious and prenatal attachments but had no effect on avoidant romantic and prenatal attachments. Our discussion of these findings considers the emotional and behavioural characteristics of various forms of insecure romantic attachments. Overall, the data highlight the relevance of the quality of intimate close relationships on maternity experiences and women's caregiving abilities.

The mother-child attachment bond before and after birth: The role of maternal perception of traumatic childbirth

The quality of the mother-child attachment bond is a relevant factor for the psychosocial well-being of a child. However, some variables could affect this relationship, such as a perceived traumatic childbirth experience. The aim of this study was to explore the mediating role of the childbirth experience on the relationship between prenatal and postnatal attachment. A predictive study was conducted on 105 pregnant women aged 26 to 44 years. The data was collected at two different times: at week 31-32 of gestation (T1) and three months after childbirth (T2). The quality of maternal prenatal attachment has a significant and direct effect on postnatal mother-child attachment. Moreover, the quality of prenatal attachment represents a protective factor for the quality of childbirth experience, promoting a higher quality of postnatal attachment bond. Our results highlight the importance of supporting women throughout the perinatal period, starting from pregnancy to after childbirth.

Early maladaptive schemas as predictors of maternal bonding to the unborn child

Background

The quality of an expectant mother’s bonding to the fetus has been shown to be associated with important developmental outcomes. Previous studies suggest that bonding quality is predicted by, for example, social support, psychological well-being, and depression. However, little is known regarding the role of maternal cognition in maternal-fetal bonding. Early maladaptive schemas (EMSs) are negative and stable assumptions about oneself and one’s relationships with others that are developed during childhood and adolescence. In the present study, we examined the associations between EMSs and the quality of the bonding to the fetus in expectant mothers.

Methods

The present investigation is part of a larger study in which 220 pregnant women (approximately 12% of the pregnant women in the region) and 130 of their partners were recruited from October 2015 until December 2017. The sample for the current study comprised 165 pregnant women (mean age 30.8 years, SD 4.1 years). The participants completed the Young Schema Questionnaire Short Form 3 (YSQ-S3) between gestational weeks 24 and 37 and the Maternal Antenatal Attachment Scale (MAAS) and the Edinburgh Postnatal Depression Scale (EPDS) between gestational weeks 31 and 41.

Results

All EMS domains correlated significantly and negatively with scores for quality of maternal-fetal bonding on the MAAS. Only the Disconnection and Rejection domain correlated significantly and negatively with MAAS scores for intensity of preoccupation with the fetus. The Disconnection and Rejection domain was a significant independent predictor of the quality of maternal-fetal bonding. Symptoms of depression mediated the effect of the EMS domains on the quality of maternal-fetal bonding. The EMS domains Disconnection and Rejection, Impaired Autonomy and Performance, and Impaired Limits showed significant direct effects on bonding quality.

Conclusions

EMSs are related to expectant mothers’ self-reported bonding to their fetuses. This association was mediated by the mothers’ symptoms of depression. The results may have implications for the early identification of pregnant women at risk of bonding difficulties and encourage more studies on cognitive schemas and mechanisms for maternal-fetal bonding.

Mother's attachment history and antenatal attachment to the second baby: the moderating role of parenting efficacy in raising the firstborn child

In this exploratory study, we examined the associations between mothers' attachment history, parenting efficacy in raising the firstborn child, and antenatal attachment to the second baby. Mothers in the third trimester of pregnancy with their second child were recruited to attend this quantitative study. Data were obtained by means of mother-report questionnaires. Mothers completed questionnaires assessing their attachment to their own mother, parenting efficacy in raising their first child, and antenatal attachment to their second baby. Hierarchical regression modeling was conducted. Mothers' attachment to their own mother was associated with antenatal attachment to their second baby, but this association was moderated by parenting efficacy in raising the first child. Specifically, mothers' attachment to their own mother was positively associated with antenatal attachment among mothers with high parenting efficacy. The results suggest that parenting efficacy may enhance the role of maternal attachment on emotional relationships between second-time mothers and their baby during the pregnancy. Second-time mothers who experienced low parenting efficacy in raising their first child should receive training in parenting. It may be beneficial to take parenting-related cognition into account when planning interventions.

The relation between social support, anxiety and distress symptoms and maternal fetal attachment

OBJECTIVE

The aims of this study were to: (1) examine the relation between social support, trait anxiety, symptoms of maternal distress (including stress, depression and anxiety) and maternal-fetal attachment; and (2) to determine if social support buffers the relation between trait anxiety, symptoms of distress and maternal-fetal attachment.

DESIGN

Ninety-four pregnant women completed five self-report questions. Two hierarchical regression analyses were conducted to examine the influence of trait anxiety, symptoms of distress, and social support on two factors of maternal-fetal attachment, quality and intensity/frequency.

RESULTS

In the first model with the dependent measure as the maternal-fetal attachment quality score, trait anxiety (β = -.24, p < .05) and social support (β = .30, p < .01) were significant predictors, accounting for 18% of the variance. In the second model with the dependent measure as the maternal-fetal attachment intensity/frequency score, trait anxiety (β = -.23, p < .05) and social support (β = .32, p < .01) were significant predictors, accounting for 23% of the variance. In addition, the interaction term contributed a significant 4% of the variance, indicating that when social support is high, the relation between anxiety and maternal-fetal attachment intensity/frequency is attenuated.

CONCLUSIONS

This study demonstrates that prenatal attachment is related to trait anxiety and social support. These findings suggest that interventions to decrease anxiety and increase social support could enhance maternal-fetal attachment.

Development of the Korean Paternal-Fetal Attachment Scale (K-PAFAS)

PURPOSE

This study is a methodological study aimed to develop the Korean Paternal-Fetal Attachment Scale (K-PAFAS) to measure the level of attachment between the father and the expected baby, and to examine its validity and reliability.

METHODS

The K-PAFAS was developed in four steps. The first step involved derivation of the initial items through review of the literature and in-depth interviews with 10 expectant fathers. The second step was the process of expert panel review, examining content validity for the initial items. In the third step, items were examined for their usability through a preliminary survey with 30 expectant fathers. As the last step, the final K-PAFAS was applied to 200 participants and examined for its psychometric profile.

RESULTS

K-PAFAS consisted of 20 items, and used a 5-point Likert scale with the total score ranging from 20 points to 100 points. A higher score indicated a higher level of attachment between the father and his unborn child. The K-PAFAS was composed of four factors. The K-PAFAS demonstrated satisfactory criterion validity, which was supported by its significant correlations with the Paternal Antenatal Attachment Scale, the Korean Dyadic Adjustment Scale, and the Center for Epidemiological Studies-Depression Scale. The Cronbach α of the K-PAFAS was .89. In test-retest reliability, the K-PAFAS showed a correlation coefficient of .91.

CONCLUSION

The K-PAFAS demonstrated initial validity and reliability. It was short, and relatively easy for use in evaluating the degree of paternal-fetal attachment in the antenatal management stage.

M. Maas A, Vreeswijk CMJM, Meeus WHJ, van Bakel HJA. Longitudinal Associations Between Parental Bonding, Parenting Stress, and Executive Functioning in Toddlerhood

Early executive functioning is an important predictor for future development of children's cognitive skills and behavioral outcomes. Parenting behavior has proven to be a key environmental determinant of child executive functioning. However, the association of parental affect and cognitions directed to the child with child executive functioning has been understudied. Therefore, in the present study we examine the associations between parental bonding (i.e., the affective tie from parent to child), parenting stress, and child executive functioning. At 26 weeks of pregnancy, and at 6 months and 24 months postpartum the quality of the maternal (N = 335) and paternal (N = 261) bond with the infant was assessed. At 24 months, postnatal parenting stress and child executive functioning were measured by means of parent-report questionnaires. Results indicated that for both mothers and fathers feelings of bonding negatively predicted experienced parenting stress over time. In addition, for both parents a negative indirect effect of bonding on child executive functioning problems was found via experienced parenting stress. These findings indicate the importance of monitoring parents who experience a low level and quality of early parent-child bonding, as this makes them vulnerable to parenting stress, consequently putting their children at risk for developing executive functioning problems.