A comparison of pregnancy health practices of women in inner-city and small urban communities

Intergenerational transmission of maternal prenatal anxiety to infant fearfulness: the mediating role of mother-infant bonding

PURPOSE

This study is the first to directly investigate the mechanistic role of maternal bonding toward her infant in the early intergenerational pathway of risk from maternal anxiety to infant fearfulness.

METHODS

Mothers (N = 216; Mage=32.78) reported on their anxiety and bonding at four time-points between pregnancy and ten-months postpartum. At four and ten-months postpartum, infant temperamental precursors of anxiety were assessed through maternal report and observation.

RESULTS

Cross-lagged longitudinal path modeling indicated a significant link between prenatal maternal anxiety and infant temperamental fearful withdrawal at 10-months postpartum (R2 = 0.117), which was fully explained by decreased maternal bonding at one-month postpartum and increased infant temperamental negative reactivity at 4-months postpartum.

CONCLUSION

Results support the need to foster maternal bonding in preventive perinatal care, particularly in the context of maternal anxiety.

Relationship between health practices with attitudes towards pregnancy and motherhood and pregnancy symptoms in Iranian pregnant women: a cross-sectional study

OBJECTIVES

Pregnancy is a vulnerable period for women's health, and health practices play an essential role in this period. This study aimed to determine the relationship between health practices with attitudes toward pregnancy and motherhood and pregnancy symptoms.

DESIGN

It was a cross-sectional study using cluster sampling conducted on 351 pregnant women in 2021-2022. Data were collected using questionnaires of socio-demographic characteristics, health practices in pregnancy (Health Practices Questionnaire-II), attitude towards motherhood and pregnancy (Prenatal Attitudes Towards motherhood and Pregnancy) and pregnancy symptoms (Pregnancy Symptoms Inventory). The general linear model (GLM), with the adjustment of socio-demographic characteristics, was used to determine the relationship of the health practices with attitudes towards motherhood and pregnancy and pregnancy symptoms.

SETTING

Health centres in Tabriz city, Iran.

PARTICIPANTS

Women were eligible if living in the Tabriz city, Iran, were pregnant and had a personal health record at the health centre.

RESULTS

The mean (SD) of the total health practices score was 117.9 (20.5) out of 34-170. The mean (SD) of the attitudes towards motherhood and pregnancy was 33.4 (4.5) out of 11-44. The mean (SD) of the pregnancy symptoms was 28.0 (12.1) out of 0-123. According to the Pearson correlation test, there was a significant direct correlation between health practices with attitudes towards motherhood and pregnancy (r=0.39; p<0.001) and a significant inverse correlation with pregnancy symptoms (r=-0.29; p<0.001). Based on the GLM with an increase in the score of health practices, the mean score of the attitude towards motherhood and pregnancy increased (B=0.07; 95% CI: 0.05 to 0.1), and the mean score of pregnancy symptoms decreased (B=-0.1; 95% CI: -0.2 to -0.05).

CONCLUSION

Considering the relationship between health practices with the attitude towards motherhood and pregnancy symptoms, healthcare providers better use educational and counselling strategies to promote health practices in pregnant women.

Prenatal attachment, foetal health locus of control and influencing factors in pregnancy

AIM

The aim of this study was to determine prenatal attachment and foetal health locus of control in pregnant women and factors affecting these parameters.

METHODS

This cross-sectional study was conducted with 156 pregnant women (77 low-risk and 79 high-risk pregnancies). The study was carried out between August 2015 and February 2016. The data collection instruments included a Participant Information Form, the Prenatal Attachment Inventory and the Foetal Health Locus of Control Scale.

RESULTS

Pregnant women's education and foetal health locus of control levels had positive and significant effects on prenatal attachment, and education had an effect on foetal health locus of control. Foetal health locus of control explained 6.3% of the total variance in prenatal attachment levels.

CONCLUSION

As the educational statuses of pregnant women affected their prenatal attachment and foetal health locus of control, information, counselling and care should be prioritized for women with low education levels, in line with their needs. This is particularly important in terms of improving the control of pregnant women with lower prenatal attachment levels or internal locus of control over foetal health.

The Relationship Between Bonding Impairment and Maternal Postpartum Smoking

OBJECTIVES

Maternal postpartum smoking is associated with several negative outcomes for mother and child. The relationship between bonding impairment (BI) and maternal postpartum smoking is less known. The aim of the present study was to assess the relationship between BI and maternal postpartum smoking at 6 to 8 months after childbirth in a primary care sample of low-income mothers who had depression during the previous pregnancy.

METHODS

We performed a cross-sectional, secondary analysis from a community trial with 356 postpartum women from public primary care clinics in São Paulo, Brazil. The main outcome measure was maternal postpartum smoking. The main exposure variable was BI assessed with the Postpartum Bonding Questionnaire. A socio-demographic questionnaire evaluated maternal and obstetric characteristics. Postpartum depression was assessed with the Patient Health Questionnaire. Crude and adjusted prevalence ratios (PR) of the association between BI and maternal postpartum smoking, with 95% confidence intervals (CI), were calculated using Poisson regression. Multivariate analysis was performed using three models (Model 1 adjusted for randomization during pregnancy, Model 2 adjusted for Model 1 plus mother's socioeconomic and obstetric characteristics, and Model 3 adjusted for Model 2 plus postpartum depression).

RESULTS

Maternal postpartum smoking occurred in 16.7% of our sample. In the multivariable analysis, BI was associated with maternal postpartum smoking (PR:2.04; CI 95% 1.08:3.84).

CONCLUSIONS FOR PRACTICE

Women presenting bonding problems are at higher risk of smoking after childbirth. Intervention to enhance mother-child bonding may have the potential to decrease maternal postpartum smoking.

Psychosocial factors and health practices in pregnancy: A cross-sectional study

AIM

The aim of this study was to investigate psychosocial, demographic and obstetric factors that affect health practices in pregnancy.

METHODS

This cross-sectional study was conducted with pregnant women selected by using random sampling in a public hospital in Turkey. The pregnant women (n = 383) completed the Health Practices Questionnaire in Pregnancy, the Center for Epidemiologic Studies Depression Scale, the Beck Anxiety Inventory and the Multidimensional Scale of Perceived Social Support. Multiple linear regression was used to examine predictors of participation in health practices. The variables were subjected to multiple linear regression analysis to estimate the effect of each independent variable (depression, anxiety, perceived social support, age, educational level, gestational week and parity) on the dependent variable (health practices).

RESULTS

Depression and anxiety were not significantly related to gestational health practices. The multiple linear regression model showed that inadequate social support, low education level, early gestational week and high parity were significant predictors of nonengagement in favourable health practices during pregnancy.

CONCLUSIONS

Pregnant women with inadequate social support and specific demographic and obstetric characteristics are less likely to participate in gestational health practices. This study suggests that more attention should be paid to these groups to improve the health practices of pregnant women.

"I am pregnant. Am I different?": Psychopathology, psychological stress and hair cortisol levels among pregnant and non-pregnant women

Pregnancy is a life process that brings about a series of associated changes, both physical and psychological, in women. The psychopathological changes occurring in pregnant women due to the simple fact of this new vital stage are unknown. Therefore, the objective of this study was to compare the psychopathological symptoms present during pregnancy with those present in non-pregnant women, as well as the perceived stress and hair cortisol levels. For this, a group of non-pregnant women (n = 171) were compared with pregnant women who were in the first trimester (n = 124), second trimester (n = 200) and third trimester (n = 190). Moreover, 77 women were followed up to verify their psychopathological course of pregnancy. Differences were found between pregnant and non-pregnant women relating to a wide range of psychopathological symptoms, perceived stress and hair cortisol levels. The symptoms were greater in the group of pregnant women. By studying different types of psychopathological symptoms associated with pregnancy, it is possible to assign psychological interventions to given characteristics of pregnant women. In addition, we can broaden our knowledge about the psychological aspects of pregnancy and the changes associated with it.

Becoming a mother: Predicting early dissatisfaction with motherhood at three weeks postpartum

OBJECTIVE

The peripartum period can go along with increased insecurity, strain or frustration, potentially leading to a dissatisfying experience of motherhood, which itself is associated with poorer postnatal adjustment. Identifying prenatal influencing factors on the early postnatal dissatisfaction with motherhood is crucial to enable specific support for parents from pregnancy on. The aim of this study was to investigate the predictive relevance of prenatal levels of anxiety and hostility as manifestations of prenatal strain, and further maternal-fetal bonding, adult attachment style and recalled parenting by the own mother on the dissatisfaction with motherhood.

DESIGN

Data was assessed longitudinally.

SETTING

The study took place at the University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

PARTICIPANTS

N=100 pregnant women from the general population.

MEASUREMENTS AND FINDINGS

Pregnancy-related anxiety, hostility, maternal-fetal bonding and adult attachment style were assessed in the last trimester of pregnancy, and recalled parenting by the own mother and current dissatisfaction with motherhood at three weeks postpartum. Hierarchical regression analysis showed that lower recalled care by the own mother predicted higher dissatisfaction with overall motherhood, from the perspective as an adult and related to their child. Higher pregnancy-related anxiety predicted higher overall and child-related dissatisfaction. Higher hostility predicted higher child-related dissatisfaction.

KEY CONCLUSION

Prenatal negative emotional states and lower recalled care by the own mother can serve as indicators for maternal dissatisfaction.

IMPLICATION FOR PRACTICE

Shaping professional support around negative emotional states and addressing experiences of own upbringing already prenatally might prevent an early dissatisfaction with motherhood and negative consequences for mother and child.

Couples' prenatal bonding to the fetus and the association with one's own and partner's emotional well-being and adult romantic attachment style

OBJECTIVE

Developing an emotional bond to the fetus is a highly relevant task for both parents. However, research on the influence of emotional well-being and relationship dynamics on parental-fetal bonding is limited, especially regarding the paternal experience. Additionally, the roles of prenatal anxiety and hostility in parental bonding need further investigation. The aim of this study was to investigate the importance of one's own anxiety and hostility, adult romantic attachment style and one's partner's anxiety and hostility for parental-fetal bonding quality and intensity.

DESIGN

Data were assessed cross-sectionally and analyzed using linear regression models.

SETTING

The study took place at the University Medical Center Hamburg-Eppendorf, Germany.

PARTICIPANTS

Ninety-three pregnant women and their partners (total n = 186).

MEASUREMENTS AND FINDINGS

Participants completed questionnaires in mid to late pregnancy. For mothers, higher levels of hostility and attachment-related avoidance were associated with lower bonding quality. Unexpectedly, higher levels of partner hostility were associated with higher bonding quality. Fathers with higher attachment-related avoidance reported lower bonding intensity. Neither maternal bonding intensity nor paternal bonding quality was associated with the predictor variables.

KEY CONCLUSION

Prenatal bonding is individually influenced by emotional well-being and romantic attachment styles, with different effects in mothers and fathers.

IMPLICATIONS FOR PRACTICE

Potential negative emotional states and couple dynamics in the peripartum period should be addressed in prenatal care. Birth preparation classes might be an ideal context to generally inform parents about these topics. Distressed parents might benefit from interdisciplinary support focusing on perinatal mental health and parental-fetal bonding.

The importance of attachment in infant and influencing factors

Attachment is a pattern of interaction and communication established and developed between mother and baby. For the growth of mentally and physically healthy individuals, the mother is expected to create a suitable attachment starting before the birth and to maintain it afterwards. It is also necessary for the baby to establish appropriate and safe attachment towards the mother in a similar manner. There are several factors that affect the attachment. Also, some studies show that children with attachment problems also have problems in their future lives. Healthcare professionals need to be aware of these factors and evaluate the child in terms of healthy parental communication and child development in well-child visits. As a result of these evaluations, multidisciplinary approaches to the mother-child pair can be established and the child’s health is protected mentally and physically for healthy generations.

Psychometric properties of 13-item versions of the maternal and paternal antenatal attachment scales in German

OBJECTIVE

To assess scale reliability and factorial validity of the Maternal and Paternal Antenatal Attachment Scale in a German sample.

BACKGROUND

Prenatal bonding to the child is an important aspect for parents and has been associated with the early parent-child relationship. The maternal and paternal versions of the Antenatal Attachment Scale (MAAS/PAAS) with the dimensions bonding quality and intensity are among the best-established questionnaires for parental-fetal bonding. However, a German translation of the PAAS and investigations of the factor structure of both MAAS and PAAS are still lacking.

METHOD

263 women and 128 men from Hamburg, Germany, were assessed during pregnancy (total sample N = 391).

RESULTS

Factor analyses did not support the original factor structures of both scales. Still, two factors equivalent to the original quality and intensity dimensions were identified. Scale reliability for the extracted factors was satisfying to good for both instruments.

CONCLUSION

The revised 13-item versions for MAAS and PAAS are proposed as reliable and valuable measurements of parental-foetal bonding. The scales contribute to the cross-cultural comparison of research on maternal and paternal-foetal bonding. Identifying parents with bonding difficulties already prenatally can enable specific forms of support addressing the parent-child-relationship in the peripartum period.

ABBREVIATIONS

Maternal Antenatal Attachment Scale (MAAS). Paternal Antenatal Attachment Scale (PAAS). confirmatory factor analysis (CFA). Root Mean Squared Error of Approximation (RMSEA). Standardized Root Mean Square Residual (SRMR). Comparative Fit Index (CFI). Tucker Lewis Index (TLI). principal axis factoring (PAF). mean (M). standard deviation (SD). standard error (SE). item difficulty (Pi). Kaiser-Meyer-Olkin value (KMO).

Psychometric Properties of the Short Form of the Health Practices Questionnaire-II Chinese Version

OBJECTIVE

To examine the psychometric properties of the Health Practice Questionnaire-II Chinese version (HPQ-II CV), a self-report instrument designed to measure the health behaviors of pregnant women.

DESIGN

Cross-sectional, psychometric design.

SETTING

Prenatal clinics of four hospitals in southern Taiwan.

PARTICIPANTS

Two convenience samples, 368 pregnant women in Phase 1 and 289 pregnant women in Phase 2.

METHODS

In Phase 1, the 34-item HPQ-II was translated into Chinese. Then, we explored the factor structure of the HPQ-II CV using exploratory factor analysis, determined the factors of the HPQ-II CV, and shortened the length of the scale. In Phase 2, we used confirmatory factor analysis to cross-validate the factor structure of the 13-item HPQ-II CV.

RESULTS

In Phase 1, we used item analysis to reduce the 34-item HPQ-II CV to 21 items. Using exploratory factor analysis and parallel analysis, we shortened the 21-item HPQ-II CV to 15 items grouped in four factors: Taking Safety Measures (4 items), Eating A Healthy Diet (3 items), Coping With Uncertainty (3 items), and Seeking Help From Professionals (5 items), which accounted for 45.70% of the total variance. In Phase 2, two items were removed from the 15-item HPQ-II CV after confirmatory factor analysis. Cronbach's alpha coefficient of the 13-item HPQ-II CV was .80, and the cross-sample validity supported the best-fit model for the 13-item HPQ-II CV.

CONCLUSION

We found acceptable validity and reliability statistics for the 13-item HPQ-II CV when administered to pregnant, Taiwanese women.

The association between maternal-fetal bonding and prenatal anxiety: An explanatory analysis and systematic review

BACKGROUND

The prenatal period can be associated with an increase in distress and anxiety. Research indicates that impaired mental well-being influences the development of prenatal maternal-fetal bonding, which manifests in representations, emotions and behaviors. However, the impact of prenatal anxieties on maternal-fetal bonding is still not fully understood, partly due to heterogeneity in the conceptualization and the measurement of both constructs. The aims of this review were to identify studies assessing the relation between both constructs and to investigate direction and size of effects for different types of prenatal anxiety and conceptualizations of maternal-fetal bonding.

METHODS

A systematic search was carried out on January 7, 2017, and updated on October 23, 2017, based on four electronic databases and a targeted reference search. Of the 3845 identified publications, K = 31 studies fit the eligibility criteria.

RESULTS

While components of maternal-fetal bonding centering around pregnancy or maternal role were not affected, the quality of perceived emotional proximity to the child, as assessed by the Maternal Antenatal Attachment Scale, was impaired by anxieties across studies. Associations were overall negative and of low to moderate size.

LIMITATIONS

Studies focusing on high-risk subpopulations were excluded. Included studies mostly assessed samples from Western societies, which limits the generalizability of results to non-Western cultures.

CONCLUSION

The quality of perceived emotional proximity to the fetus was consistently impaired by anxiety. Nevertheless, varying effect sizes indicate a more complex association that is influenced by underlying confounders. Multivariate analyses are needed to improve the understanding of the interacting factors that influence maternal-fetal bonding.

Meta-Analyses of Predictors of Health Practices in Pregnant Women

The aims of this study were to identify predictors of health practices of pregnant women in the literature reviewed, to use meta-analysis to ascertain the mean effect size (ES) across studies between each predictor and health practices, and to examine four moderators on each predictor-health practices relationship. Using preferred reporting items for systematic reviews and meta-analyses guidelines for the literature assessed, 32 published studies or doctoral dissertations completed between 1992 and 2015 met the inclusion criteria. Twelve predictors were identified, and each predictor in relation to health practices was subjected to meta-analysis. One predictor (maternal-fetal attachment) of health practices had a large ES, two predictors (depression and stress) had medium ESs, six predictors (income, education, parity, social support, employment, and age) had small ESs, and three predictors (gestational age, marital status, and race) had trivial ESs. Findings are interpreted relative to health practices in pregnant women.

Predictors of postnatal mother-infant bonding: the role of antenatal bonding, maternal substance use and mental health

The emotional bond that a mother feels towards her baby is critical to social, emotional and cognitive development. Maternal health and wellbeing through pregnancy and antenatal bonding also play a key role in determining bonding postnatally, but the extent to which these relationships may be disrupted by poor mental health or substance use is unclear. This study aimed to examine the extent to which mother-fetal bonding, substance use and mental health through pregnancy predicted postnatal mother-infant bonding at 8 weeks. Participants were 372 women recruited from three metropolitan hospitals in Australia. Data was collected during trimesters one, two and three of pregnancy and 8 weeks postnatal using the Maternal Antenatal Attachment Scale (MAAS), Maternal Postnatal Attachment Scale (MPAS), the Edinburgh Antenatal and Postnatal Depression Scale (EPDS), the Depression and Anxiety Scales (DASS-21), frequency and quantity of substance use (caffeine, alcohol and tobacco) as well as a range of demographic and postnatal information. Higher antenatal bonding predicted higher postnatal bonding at all pregnancy time-points in a fully adjusted regression model. Maternal depressive symptoms in trimesters two and three and stress in trimester two were inversely related to poorer mother-infant bonding 8 weeks postnatally. This study extends previous work on the mother's felt bond to her developing child by drawing on a large sample of women and documenting the pattern of this bond at three time points in pregnancy and at 8 weeks postnatally. Utilising multiple antenatal waves allowed precision in isolating the relationships in pregnancy and at key intervention points. Investigating methods to enhance bonding and intervene in pregnancy is needed. It is also important to assess maternal mental health through pregnancy.

Outcomes of Depression in Black Single Mothers

Despite suggestions in the literature that depression has serious consequences, few studies have examined specific health and psychosocial outcomes of depression in Black single mothers. The purpose of this study was to estimate paths in a just-identified theoretical model of outcomes of depression for Black single mothers based on theoretical propositions and empirical findings. The model included the variables, depressive cognitions, depressive symptomatology, perceived social support, and positive health practices. Five direct and two indirect hypothesized relationships were estimated using structural equation modeling. A nonprobability sample of convenience of 159 Black single mothers aged 18 to 45 years was recruited for the study. This study used a cross-sectional correlational design. The participants responded in person or via the U.S. mail to the Center for Epidemiologic Studies-Depression scale, the Depressive Cognition Scale, the Personal Resource Questionnaire 85-Part 2, and the Personal Lifestyle Questionnaire. Beta and Gamma path coefficients were statistically significant for four out of five hypothesized direct relationships within the model ( p < .01). The direct path between depressive cognitions and positive health practices was not supported (Gamma = -.11, p > .05). The two indirect paths were weak but statistically significant ( p < .01). Depressive symptoms and perceived social support were outcomes of depressive cognitions. Positive health practices was not a direct outcome of depressive cognitions. Perceived social support and positive health practices were outcomes of depressive symptoms.

Effects of Maternal Mental Health on Engagement in Favorable Health Practices During Pregnancy

INTRODUCTION

A woman's health practices during pregnancy are associated with maternal and neonatal outcomes. Yet limited research has examined predictors of a woman's engagement in favorable health practices, particularly in pregnant women at greatest risk for adverse outcomes. We examined the role of mental health on engagement in favorable health practices during pregnancy in a sample of pregnant, low-income, predominantly African American women.

METHODS

A convenience sample of pregnant women was obtained from 3 obstetric clinics within a large Mid-Atlantic academic health system. Pregnant women (N = 166) completed measures of depression, social support, and engagement in favorable health practices during their second trimester. Six domains of health practices (ie, balance of rest and exercise, safety measures, nutrition, substance use, health care access, access to pregnancy-related information) were assessed by the Health Practices in Pregnancy Questionnaire-II. Multiple linear regression was used to examine predictors of engagement in favorable health practices.

RESULTS

Fifty-nine percent of the study participants experienced depressive symptomatology during pregnancy. Multivariate linear regression modeling demonstrated that increased depressive symptoms, decreased social support, young age, and prepregnancy overweight or obesity were significant predictors of nonengagement in favorable health practices during pregnancy.

DISCUSSION

Findings suggest that pregnant women with poor mental health (eg, depressive symptomatology, poor social support) and specific sociodemographic characteristics (eg, young age, prepregnancy overweight or obesity) were less likely to engage in favorable health practices during pregnancy. Health care providers are uniquely positioned to assess a woman's mental health and related indicators to optimize pregnancy and neonatal outcomes.

A longitudinal study of maternal attachment and infant developmental outcomes

Extant research has demonstrated that compared to adults with insecure attachment styles, more securely attached parents tend to be more responsive, sensitive, and involved parents, resulting in improved outcomes for their children. Less studied is the influence of a mother's attachment style on her attachment to her unborn child during pregnancy and the consequent developmental outcomes of the child during early childhood. Thus, the aim of this prospective longitudinal study was to examine the relationship between maternal-fetal attachment (MFA) during pregnancy and infant and toddler outcomes and the role of mothers' attachment style on early childhood developmental outcomes in an economically disadvantaged sample of women and their children. Gamma regression modeling demonstrated that an avoidant maternal attachment style (b = .98, 95 % CI [.97, .98], p < 0.001) and post-partum depressive symptomatology (b = .97, 95 % CI [.96-.99], p = 0.03) were significant predictors of early childhood development. Women demonstrating higher avoidant attachment styles and greater depressive symptomatology were more likely to have children demonstrating early childhood developmental delays than those women with less avoidant attachment styles and less depressive symptomatology. Furthermore, women reporting higher MFA during pregnancy had more secure attachment styles, and their children had more optimal early childhood development than those women reporting lower MFA and less secure attachment styles. Findings have implications for enhancing early intervention programs aimed at improving maternal and childhood outcomes. An earlier identification of disruptions in attachment may be beneficial in tailoring interventions focused on the mother-child dyad.

Maternal psychosocial determinants of fetal and infant health and the National Children's Study

The purpose of this article is to inform perinatal nurses about the longitudinal National Children's Study (NCS), which was mandated by Congress. The NCS was designed to follow infants from before birth to age 21, and researchers propose to study 100,000 children. This complex and extensive study will provide especially relevant information to perinatal nurses in practice, teaching, and research.

Planned and unplanned pregnancy: effects on health practice and depression during pregnancy

AIM

The aim of the study was to explore the prevalence and characteristics of women with unplanned pregnancy (UP) and to examine the associations between pregnancy planning status and women's health practice and depression during pregnancy in Manisa, Turkey.

MATERIAL AND METHODS

The study was conducted with pregnant women (n=550) who attended a state hospital for antenatal care in Manisa, Turkey. Health practices of women during pregnancy were assessed with the Health Practices Questionnaire (HPQ II) and depression was measured by the Beck Depression Inventory (BDI).

RESULTS

Of the 550 pregnancies, 149 (27.1%) were unplanned. Women whose pregnancies were planned were likely to be younger, more educated, employed, to perceive more social support and to be more satisfied in marriage life than women whose pregnancies were unplanned. The number of pregnancies, births and children was higher in women whose pregnancies were unplanned. Women with UP had significantly lower HPQ scores (mean 118.4, SD=13.5) than women with planned pregnancies (mean 124.0, SD=14.1). Women with UP also had a significantly higher score for BDI (mean 10.3, SD 6.9 vs mean 8.1, SD 5.8).

CONCLUSIONS

Women with UP had engaged in fewer healthy practices and experienced more depressive symptoms during pregnancy. Health-care providers should screen for UP at an early stage and offer health education programs to help women to develop positive health practices and to improve their emotional health.

The role of mental health on maternal-fetal attachment in low-income women

OBJECTIVE

To examine and describe the influence of maternal depressive symptoms on maternal-fetal attachment (MFA) in predominantly low-income women.

DESIGN

Mixed method.

SETTING

Three urban obstetric/gynecologic (OB/GYN) clinics serving predominantly low-income women.

PARTICIPANTS

A convenience sample of 166 women participated in the quantitative component and a purposeful subsample of 12 women participated in the qualitative component; all women were between 24 and 28 weeks gestation at the time of data collection.

METHODS

Linear regression models were used to examine the influence of depressive symptoms and social support on MFA. Individual in-depth interviews were conducted among a subsample of women to explore the influence of maternal depressive symptoms on MFA.

RESULTS

Fifty-nine percent (n = 98) of participants had scores that were clinically significant for depressive symptoms. In the final model of social support and depressive symptoms regressed on MFA, social support (b = .23, 95% CI [0.09, .37], p = .002) and depressive symptoms (b = -1.02, 95% CI [-1.32, -.73], p < 0.001) were significant predictors. This multivariate linear regression model with two variables accounted for 65.2% of the total variance in overall MFA. Qualitative participants discussed the importance of social support in contributing to their mood state and MFA.

CONCLUSIONS

Findings from this study highlight the importance of assessing for depressive symptoms during pregnancy given its influence on MFA. By understanding how important it was for these women to have a supportive person to experience their pregnancies with, nurses can improve the pregnancy experience for vulnerable populations.

The influence of maternal-fetal attachment and health practices on neonatal outcomes in low-income, urban women

Maternal-fetal attachment (MFA) has been associated with health practices during pregnancy, but less is known about this relationship in low-income women, and no identified studies have examined this relationship to neonatal outcomes. This longitudinal descriptive study was conducted to examine the relationships among MFA, health practices during pregnancy, and neonatal outcomes in a sample of low-income, predominantly African-American women and their neonates. MFA was associated with health practices during pregnancy and adverse neonatal outcomes. Health practices during pregnancy mediated the relationships of MFA and adverse neonatal outcomes. The results support the importance of examining MFA in our efforts to better understand the etiology of health disparities in neonatal outcomes.

Perinatal attachment in naturally pregnant and infertility-treated pregnant women in Taiwan

AIM

This article is a report of a study of the differences in maternal-foetal attachment and maternal-infant attachment among naturally pregnant and infertility-treated pregnant women in Taiwan.

BACKGROUND

Studies have shown that infertility treatment is likely to make up an increasing proportion in the coming years. As these experiences are unique, the attachment relationship may be affected.

METHOD

The research data were collected from two obstetrics clinics which were located in central Taiwan. In 2008, all participants (n = 125) were asked to fill out the prenatal questionnaires at the beginning of the study and were followed up with postnatal questionnaires that were mailed to them 1-2 months after labour (n = 110). We used chi-square tests for categorical and t- tests for continuous variables. Multivariate analysis of variances was then performed, and changes in the maternal-foetal attachment and maternal-infant attachment Scales were assessed.

FINDINGS

Women who became pregnant after fertility treatment had higher maternal-foetus and maternal-infant attachment scores, and this result was statistically significant; pregnancy mode and level of education are the main factors that have a significant effect on maternal-foetus attachment; and pregnancy mode and participation in prenatal education have a main effect on maternal-infant attachment.

CONCLUSION

Development of a specific support group for mothers, such as a group for prenatal education, and providing useful resources for pregnant women with a lower level of education are involved in the future research studies for therapeutic intervention.

Mother's stress, mood and emotional involvement with the infant: 3 months before and 3 months after childbirth

Adverse effects of maternal anxiety and depression are well documented, namely on the foetus/child behaviour and development, but not as much attention has been given to the mother's emotional involvement with the offspring. To study mother's prenatal and postpartum stress, mood and emotional involvement with the infant, the State-Trait Anxiety Inventory, the Edinburgh Postnatal Depression Scale and the Mother-to-Infant Bonding Scale were filled in and cortisol levels were measured, 3 months before and 3 months after childbirth, in a sample of 91 Portuguese women. From pregnancy to the postpartum period, mother's cortisol levels, anxiety and emotional involvement toward the child decrease. No significant change was observed regarding mother's depression. Mother's depression predicted a worse emotional involvement before childbirth, while mother's anxiety predicted a worse emotional involvement with the infant after childbirth. Additionally, pregnant women with a worse emotional involvement with the offspring are at risk of poorer emotional involvement with the infant and higher anxiety and depression at 3 months postpartum. It should be given more attention to mother's poor emotional involvement with the offspring during pregnancy, as it interferes with her emotional involvement with the infant and her psychological adjustment 3 months after childbirth.

A literature update on maternal-fetal attachment

OBJECTIVE

To critically review and synthesize original research published since 2000 designed to measure factors that influence maternal-fetal attachment.

DATA SOURCES

EBSCOhost Research Databases that included PubMed, CINAHL Plus, PsycINFO, and SCOPUS were searched for journal articles published in the past 7 years (2000-2007) that examined variables thought to increase, decrease, or cause no change in level of maternal-fetal attachment. Keyword searches included maternal-fetal attachment, parental attachment, and prenatal attachment.

STUDY SELECTION

Twenty-two studies were selected that met the inclusion criteria of original research, clear delineation of the measurement of maternal-fetal attachment, measurement of maternal-fetal attachment during pregnancy, and inclusion of women or couples, or both.

DATA EXTRACTION

Studies measuring maternal-fetal attachment included a broad range of variables as potential risk or protective factors, or both. Factors associated with higher levels of maternal-fetal attachment included family support, greater psychological well-being, and having an ultrasound performed. Factors such as depression, substance abuse, and higher anxiety levels were associated with lower levels of maternal-fetal attachment.

DATA SYNTHESIS

The large majority of studies reviewed were limited by small, homogenous samples deemed insufficient to detect significant differences, inconsistent measurement of maternal-fetal attachment during gestational periods, and cross-sectional designs.

CONCLUSIONS

Further research is essential to identify factors influencing maternal-fetal attachment. Specifically, research needs to be conducted on larger sample sizes of greater racial and ethnic diversity.

Smoking in pregnancy: the role of the transtheoretical model and the mother's attachment to the fetus

This study investigated whether pregnant smokers demonstrated cognitive and behavioural patterns hypothesised to underpin the different stages of change (SOC) and whether fetal attachment varied according to this process. A cross-sectional design with women categorised by SOC was used and the sample was recruited from hospital maternity services in the U. K at their booking clinics with a mean gestation of 14 weeks. Experiential and behavioural processes together with self-efficacy and attachment to the fetus were measured in 637 women. As predicted by the transthoretical model experiential processes were used mostly by women in contemplation and preparation; behavioural processes mostly by women in preparation and action. However, self-efficacy remained constant between pre-contemplation, contemplation and preparation, but women in action showed significantly higher levels. Women in preparation were significantly more attached to the fetus than women in pre-contemplation and never smokers. The relevance of the transtheoretical model with pregnant smokers is supported. Foetal attachment may be differentially associated with different SOC in smoking cessation and yield potential for the development of new interventions.

Screening for Depression Among Pregnant and Postpartum Women

The purpose of this study was to examine the screening of depression among pregnant and postpartum participants in a community-based program. This cross-sectional study used archival data from 98 women participating in a community-based visiting nurse program in a midwestern U.S. city. Depression screening was accomplished using the Center for Epidemiologic Studies Depression scale (CES-D) and Edinburgh Postnatal Depression scale (EPDS); both instruments ask respondents to answer questions regarding their mood during the past week. The CES-D identified more pregnant and postpartum women as depressed than did the EPDS. A standard regression analysis using previous pregnancies, history of depression, married versus nonmarried, presence of support, and breast-feeding as predictor variables did not produce statistically significant findings for predicting depression among the pregnant and postpartum women in this study. This finding underscores the value of brief depression screening instruments for nurses working with pregnant and postpartum women.