Selected predictors of maternal-fetal attachment in pregnancies with congenital disorders, other complications, and in healthy pregnancies
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Institute of Psychology, University of Lodz, Lodz, Poland
Submission date: 2020-04-07
Final revision date: 2020-06-13
Acceptance date: 2020-06-15
Online publication date: 2020-07-15
Publication date: 2020-07-15
Health Psychology Report 2021;9(3):193–206
The mother-infant attachment begins to form during pregnancy and is important for the future development of the child. Pregnancy complications can affect this relationship. The purpose of the study was to identify predictors of maternal-fetal attachment in physiological and high-risk pregnancies.

Participants and procedure:
The study group included women in pregnancies with congenital disorders (n = 65) or with other pregnancy complications (n = 65). A third group included women in healthy pregnancies (n = 65). Data were collected by: the Maternal-Fetal Attachment Scale, the Questionnaire of Attachment Styles, the Rosenberg Self-Esteem Scale, the State-Trait Anxiety Inventory, the Social Support Scale, a standardized interview, the Dependency on Intimate Partner Scale, and the Pregnancy Experiences Scale.

No significant differences in maternal-fetal attachment (MFA) were found between the groups. No predictors of MFA were observed for the women with a pregnancy with a congenital disorder. In the group of pregnancies with other complications, the only predictor of attachment intensity was pregnancy experience: a more negative attitude toward pregnancy was associated with lower MFA. In physiological pregnancies, MFA was found to be determined by pregnancy experience, gestational age, maternal age and dependency on one’s intimate partner. MFA increased as pregnancy progressed. Younger mothers in physiological pregnancies, who have more positive pregnancy experiences and are less dependent on a partner, achieve higher levels of MFA.

The presence of high-risk pregnancy, or its absence, does not differentiate the intensity of the emotional bond between mother and fetus. However, women with healthy pregnancies demonstrate different predictors of MFA than those with high-risk pregnancies.

Abasi, E., Tafazzoli, M., Esmaily, H., & Hasanabadi, H. (2013). The effect of maternal-fetal attachment education on maternal mental health. Turkish Journal of Medical Sciences, 43, 815–820. https://doi.org/10.3906/sag-12....
Abasi, E., Tahmasebi, H., Zafari, M., & Nasiri Takami, G. (2012). Assessment on effective factors of maternal-fetal attachment in pregnant women. Life Science Journal, 9, 68–75.
Alhusen, J. L. (2008). A literature update on maternal-fetal attachment. Journal of Obstetric, Gynecologic and Neonatal Nursing, 37, 315–328. https://doi.org/10.1111/j.1552....
Asplin, N., Wessel, H., Marions, L., & Georgsson Öhman, S. (2015). Maternal emotional wellbeing over time and attachment to the fetus when a malformation is detected. Sexual & Reproductive Healthcare, 6, 191–195. https://doi.org/10.1016/j.srhc....
Babiuch, M. E., & Kriegelewicz, O. (2000). Skala do pomiaru zależności od współmałżonka [The Dependency on Intimate Partner Scale]. Own materials provided by the author of the method.
Bedyńska, S., & Książek, M. (2012). Statystyczny drogowskaz. Praktyczny przewodnik wykorzystania modeli regresji oraz równań strukturalnych. Tom 3 [Statistical signpost. A practical guide of regression models and structural equations]. Warszawa: Wydawnictwo Akademickie Sedno.
Bellieni, C. V., Ceccarelli, D., Rossi, F., Buonocore, G., Maffei, M., Perrone, S., & Petriaglia, F. (2007). Is prenatal bonding enhanced by prenatal education courses? Minerva Ginecologica, 59, 125–129.
Berryman, J. C., & Windridge, K. C. (1996). Pregnancy after 35 and attachment to the fetus. Journal of Reproductive and Infant Psychology, 14, 133–143. https://doi.org/10.1080/026468....
Bielawska-Batorowicz, E. (1995). Determinanty spostrzegania dziecka przez rodziców w okresie poporodowym [Determinants of the perception of the child by parents in the postpartum period]. Łódź: Wydawnictwo Uniwersytetu Łódzkiego.
Bielawska-Batorowicz, E. (2006). Psychologiczne aspekty prokreacji [Psychological aspects of procreation]. Katowice: Wydawnictwo Naukowe Śląsk.
Bielawska‐Batorowicz, E., & Siddiqui, A. (2008). A study of prenatal attachment with Swedish and Polish expectant mothers. Journal of Reproductive and Infant Psychology, 26, 373–384. https://doi.org/10.1080/026468....
Bieleninik, Ł., Preis, J., & Bidzan, M. (2010). Uwarunkowania więzi emocjonalnej z dzieckiem w okresie prenatalnym w ciążach wielopłodowych i pojedynczych [Conditions of the emotional bond with a child in the prenatal period in case of multifetal and unifetal pregnancies]. Perinatologia, Neonatologia i Ginekologia, 3, 223–231.
Bookwala, J. (2003). Being “single and unattached”: The role of adult attachment styles. Journal of Applied Social Psychology, 33, 1564–1570. https://doi.org/10.1111/j.1559....
Caccia, N., Johnsson, J. M., Robinsoon, G. E., & Barna, T. (1991). Impact of prenatal testing on maternal-fetal bonding: chorionic villus sampling versus amniocentesis. American Journal of Obstetrics & Gynecology, 165, 1122–1125. https://doi.org/10.1016/0002-9....
Chazotte, C., Comerford Freda, M., Elovitz, M., & Youchah, J. (1995). Maternal depressive symptoms and maternal–fetal attachment in gestational diabetes. Journal of Women’s Health, 4, 375–380. https://doi.org/10.1089/jwh.19....
Chrzan-Dętkoś, M., & Łockiewicz, M. (2015). Maternal romantic attachment, and antenatal and postnatal mother-infant attachment in a sample of Polish women. European Journal of Developmental Psychology, 12, 429–442. https://doi.org/10.1080/174056....
Collins, N. L., Cooper, M. L., Albino, A. W., & Allard, L. (2002). Psychosocial vulnerability from adolescence to adulthood: a prospective study of attachment style differences in relationship functioning and partner choice. Journal of Personality, 70, 965–1008. https://doi.org/10.1111/1467-6....
Cranley, M. S. (1981). Development of a tool for the measurement of maternal attachment during pregnancy. Nursing Research, 30, 281–284. https://doi.org/10.1097/000061....
da Cunha, A. C. B., Pereira Junior, J. P., Caldeira, C. L. V., & Carneiro, V. M. S. D. P. (2016). Diagnóstico de malformações congênitas: Impactos sobre a saúde mental de gestantes [Diagnosis of congenital malformations: Impact on the mental health of pregnant women]. Estudos de Psicologia, 33, 601–611. https://doi.org/10.1590/1982-0....
Delavari, M., Mohammad-Alizadeh-Charandabi, S., & Mirghafurvand, M. (2018). The relationship between maternal-fetal attachment and maternal self-efficacy in Iranian women: a prospective study. Journal of Reproductive and Infant Psychology, 36, 302–311. https://doi.org/10.1080/026468....
Doan, H. M., & Zimerman, A. (2003). Conceptualizing prenatal attachment: Toward a multidimensional view. Journal of Prenatal and Perinatal Psychology and Health, 18, 109–129.
Fonseca, A., & Canavarro, M. C. (2010). Parental reactions to perinatal congenital anomaly diagnosis of the baby: Implications for the intervention of health professionals. Psicologia, Saúde & Doenças, 11, 283–297.
Fuller, S. G., Moore, L. R., & Lester, J. W. (1993). Influence of family functioning on maternal-fetal attachment. Journal of Perinatology, 13, 453–460.
Gebuza, G., Kaźmierczak, M., Gierszewska, M., Mieczkowska, E., Banaszkiewicz, M., & Wróbel-Bania, A. (2015). Lek przed porodem w III trymestrze ciąży i jego powiązania ze stanem noworodka [Fear of childbirth in the third trimester of pregnancy and its correlation with the condition of neonate]. Medycyna Ogólna i Nauki o Zdrowiu, 21, 39–44.
Hazan, C., & Shaver, P. (1987). Romantic love conceptualized as an attachment process. Journal of Personality and Social Psychology, 52, 511–524. https://doi.org/10.1037/0022-3....
Heaman, M. (1998). Psychosocial impact of high-risk pregnancy: Hospital and home care. Clinical Obstetrics and Gynecology, 41, 626–639. https://doi.org/10.1097/000030....
Hee, L. S., & Young, L. E. (2015). Factors influencing maternal-fetal attachment in high-risk pregnancy. Advanced Science and Technology Letters, 104, 38–42.
Hjelmstedt, A., Widstrom, A. M., & Collins, A. P. (2006). Psychological correlates of prenatal attachment in women who conceived after in vitro fertilization and women who conceived naturally. Birth, 33, 303–310. https://doi.org/10.1111/j.1523....
Hopkins, J., Miller, J. L., Butler, K., Gibson, L., Hedrick, L., & Boyle, D. A. (2018). The relation between social support, anxiety and distress symptoms and maternal-fetal attachment. Journal of Reproductive and Infant Psychology, 36, 381–392. https://doi.org/10.1080/026468....
Jang, S. H., Kim, I. J., & Lee, S. H. (2015). Social support and maternal-fetal attachment in unmarried pregnant women in Korea: Does self-esteem play a mediating role? International Journal of Bio-Science and Bio-Technology, 7, 131–140. https://doi.org/10.14257/ijbsb....
Kaasen, A., Helbig, A., Malt, U. F., Næs, T., Skari, H., & Haugen, G. (2017). Maternal psychological responses during pregnancy after ultrasonographic detection of structural fetal anomalies: a prospective longitudinal observational study. PLoS One, 12, e0174412. https://doi.org/10.1371/journa....
Kemp, V. H., & Page, C. K. (1987). Maternal prenatal attachment in normal and high-risk pregnancies. Journal of Obstetric, Gynecologic and Neonatal Nursing, 16, 179–184. https://doi.org/10.1111/j.1552....
Kmiecik-Baran, K. (1995). Skala wsparcia społecznego. Teoria i właściwości psychometryczne [The Social Support Scale. Theory and psychometric properties]. Przegląd Psychologiczny, 38, 201–214.
Koniak-Griffin, D. (1988). The relationship between social support, self-esteem, and maternal-fetal attachment in adolescents. Research in Nursing and Health, 11, 269–278. https://doi.org/10.1002/nur.47....
Kroelinger, C. D., & Oths, K. S. (2000). Partner support and pregnancy wantedness. Birth, 27, 112–119. https://doi.org/10.1046/j.1523....
Kwiatek, M., Gęca, T., Biegaj-Fic, J., & Kwaśniewska, A. (2011). Szkoła rodzenia – profil pacjentek oraz wpływ zajęć na przebieg porodu i stan noworodka [Childbirth classes – patients’ profiles and effect of parental education on labour course and infant health outcome]. Medycyna Ogólna i Nauki o Zdrowiu, 17, 111–115.
Kuo, P. C., Bowers, B., Chen, Y. C., Chen, C. H., Tzeng, Y. L., & Lee, M. S. (2013). Maternal-fetal attachment during early pregnancy in Taiwanese women pregnant by in vitro fertilization. Journal of Advanced Nursing, 69, 2502–2513. https://doi.org/10.1111/jan.12....
Laxton-Kane, M., & Slade, P. (2002). The role of maternal prenatal attachment in a woman’s experience of pregnancy and implications for the process of care. Journal of Reproductive and Infant Psychology, 20, 253–266. https://doi.org/10.1080/026468....
Lindgren, K. (2001). Relationships among maternal-fetal attachment, prenatal depression, and health practices in pregnancy. Research in Nursing & Health, 24, 203–217. https://doi.org/10.1002/nur.10....
Lumley, J. M. (1982). Attitudes to the fetus among primigravidae. Journal of Paediatrics and Child Health, 18, 106–109. https://doi.org/10.1111/j.1440....
Łaguna, M., Lachowicz-Tabaczek, K., & Dzwonkowska, I. (2007). Skala samooceny SES Morrisa Rosenberga – polska adaptacja metody [The Rosenberg Self-Esteem Scale – Polish adaptation of the scale]. Psychologia Społeczna, 2, 164–176.
McNamara, J., Townsend, M. L., & Herbert, J. S. (2019). A systemic review of maternal wellbeing and its relationship with maternal fetal attachment and early postpartum bonding. PLoS One, 14, e0220032. https://doi.org/10.1371/journa....
Mercer, R. T., & Ferketich, S. L. (1990). Predictors of parental attachment during early parenthood. Journal of Advanced Nursing, 15, 268–280. https://doi.org/10.1111/j.1365....
Mercer, R. T., Ferketich, S., May, K., DeJoseph, J., & Sollid, D. (1988). Further exploration of maternal and paternal attachment. Research in Nursing and Health, 11, 83–95. https://doi.org/10.1002/nur.47....
Mikulincer, M., & Florian, V. (1999). Maternal-fetal bonding, coping strategies, and mental health during pregnancy: The contribution of attachment style. Journal of Social and Clinical Psychology, 18, 255–276. https://doi.org/10.1521/jscp.1....
Muller, M. E. (1992). A critical review of prenatal attachment research. Scholarly Inquiry for Nursing Practice, 6, 5–22.
Muller, M. E. (1996). Prenatal and postnatal attachment: a modest correlation. Journal of Obstetric, Gynecologic and Neonatal Nursing, 25, 161–166. https://doi.org/10.1111/j.1552....
Narita, S., & Maehara, S. (1993). The development of maternal-fetal attachment during pregnancy. Journal of Japan Academy of Nursing Science, 13, 1–9. https://doi.org/10.5630/jans19....
Ossa, X., Bustos, L., & Fernandez, L. (2012). Prenatal attachment and associated factors during the third trimester of pregnancy in Temuco, Chile. Midwifery, 28, 689–696. https://doi.org/10.1016/j.midw....
Palma, E., Armijo, I., Cifuentes, J., Ambiado, S., Rochet, P., Díaz, B., Gutierrez, J., & Mena, C. (2020). Hospitalisation in high-risk pregnancy patients: Is prenatal attachment affected? Journal of Reproductive and Infant Psychology, 1–13. https://doi.org/10.1080/026468....
Pawełczyk, A., Cypryk, K., & Bielawska-Batorowicz, E. (1999). Poziom lęku i więź emocjonalna z dzieckiem w okresie ciąży u kobiet z GDM i zdrowych ciężarnych [Anxiety and maternal-fetal attachment in gestational diabetic women]. Diabetologia Polska, 6, 189–192.
Pawlicka, P., Chrzan-Dętkoś, M., & Lutkiewicz, K. (2013). Prężność psychiczna przyszłych matek oraz kolejność ciąży jako moderatory budowania więzi z nienarodzonym jeszcze dzieckiem [Resilience of expectant mothers and order of pregnancy as moderators of mother-fetal attachment]. Family Forum, 3, 139–152.
Perwitasari, P., Hakimi, M., & Anjarwati, A. (2019). The effect of maternal-fetal attachment education on pregnant women’s mental health. Journal of Health Technology Assessment in Midwifery, 2, 50–58. https://doi.org/10.31101/jhtam....
Pisoni, C., Garofoli, F., Tzialla, C., Orcesi, S., Spinillo, A., Politi, P., Balottin, U., Tinelli, C., & Stronati, M. (2015). Complexity of parental prenatal attachment during pregnancy at risk for preterm delivery. Journal of Maternal-Fetal and Neonatal Medicine, 29, 771–776. https://doi.org/10.3109/147670....
Plopa, M. (2008a). Kwestionariusz Stylów Przywiązaniowych [The Questionnaire of Attachment Styles]. Warszawa: Vizja Press & IT.
Plopa, M. (2008b). Więzi w małżeństwie i rodzinie. Metody badań [Bonds in marriage and family. Research methods]. Kraków: Oficyna Wydawnicza Impuls.
Radovanović, M., & Mihić, I. (2018). Razvoj prenatalne vezanosti u kontekstu iskustva iż porodice porekla [Prenatal attachment in a context of experience of the family of origin]. Primenjena Psihologija, 11, 53–67. https://doi.org/10.19090/pp.20....
Rollè, L., Giordano, M., Santoniccolo, F., & Trombetta, T. (2020). Prenatal attachment and perinatal depression: a systematic review. International Journal of Environmental Research and Public Health, 17, 2644. https://doi.org/10.3390/ijerph....
Rosenberg, M. (1965). Society and the adolescent self-image. Princeton, NJ: Princeton University Press.
Rutkowska, A., Kowalska, A., Makara-Studzińska, M., & Kwaśniewska, A. (2011). Analiza struktury osobowości u kobiet w pierwszej ciąży prawidłowej i wysokiego ryzyka [The analysis of the personality structure in primiparas with normal and high-risk pregnancy]. Current Problems of Psychiatry, 12, 420–427.
Salisbury, A., Law, K., Ladasse, L., & Lester, B. (2003). Maternal-fetal attachment. Journal of the American Medical Association, 289, 1707. https://doi.org/10.1001/jama.2....
Siddiqui, A., Eisemann, M., & Hägglöf, B. (1999). An exploration of prenatal attachment in Swedish expectant women. Journal of Reproductive and Infant Psychology, 17, 369–380. https://doi.org/10.1080/026468....
Siddiqui, A., Hägglöf, B., & Eisemann, M. (2000). Own memories of upbringing as a determinant of prenatal attachment in expectant women. Journal of Reproductive and Infant Psychology, 18, 67–74. https://doi.org/10.1080/026468....
Sjögren, B., Edman, G., Widsröm, A. M., Mathiessen, A. S., & Uvnäs-Moberg, K. (2004). Maternal-fetal attachment and personality during first pregnancy. Journal of Reproductive and Infant Psychology, 22, 57–69. https://doi.org/10.1080/026468....
Spielberger, C. D., Gorsuch, R. L., & Lushene, R. E. (1970). Manual for the State-Trait Anxiety Inventory. Polo Alto, CA: Consulting Psychologists Press.
Spielberger, C. D., Strelau, J., Tysarczyk, M., & Wrześniewski, K. (1987). Inwentarz stanu i cechy lęku (polska adaptacja STAI) [The State-Trait Anxiety Inventory (Polish adaptation of STAI)]. Warszawa: Pracownia Testów Psychologicznych PTP.
Szymona-Pałkowska, K. (2005). Psychologiczna analiza doświadczeń rodziców w sytuacji ciąży wysokiego ryzyka [Psychological analysis of parents’ experiences in high-risk pregnancy]. Lublin: Towarzystwo Naukowe Katolickiego Uniwersytetu Lubelskiego.
Tani, F., Castagna, V., & Ponti, L. (2018). Women who had positive relationships with their own mothers reported good attachments to their first child before and after birth. Acta Paediatrica, 107, 633–637. https://doi.org/10.1111/apa.14....
Tardy, C. H. (1985). Social support measurement. American Journal of Community Psychology, 13, 187–202. https://doi.org/10.1007/BF0090....
Ustunsoz, A., Guvenc, G., Akyuz, A., & Oflaz, F. (2010). Comparison of maternal- and paternal-fetal attachment in Turkish couples. Midwifery, 26, 1–9. https://doi.org/10.1016/j.midw....
Walsh, J., Hepper, E. G., & Marshall, B. J. (2014). Investigating attachment, caregiving, and mental health: a model of maternal-fetal relationships. BMC Pregnancy and Childbirth, 14, 383–391. https://doi.org/10.1186/s12884....
White, O., McCorry, N. K., Scott-Heyes, G., & Dempster, M. (2008). Maternal appraisals of risk, coping and prenatal attachment among women hospitalised with pregnancy complications. Journal of Reproductive and Infant Psychology, 26, 74–85. https://doi.org/10.1080/026468....
Włodarczyk, E. (2012). O „rodzeniu się” macierzyństwa [About the “birth” of motherhood. In J. Deręgowska & M. Majorczyk (Eds.), Konteksty współczesnego macierzyństwa. Perspektywa młodych naukowców [Contexts of modern motherhood. Perspective of young scientists] (pp. 101–127). Poznań: Wydawnictwo Naukowe Wyższej Szkoły Nauk Humanistycznych i Dziennikarstwa.
Wrześniewski, K., Sosnowski, T., Jaworowska, A., & Fecenec, D. (2006). Inwentarz Stanu i Cechy Lęku STAI [The State-Trait Anxiety Inventory]. Warszawa: Pracownia Testów Psychologicznych.
Yercheski, A., Mahon, N. E., Yercheski, T. J., Hank, M. M., & Cannella, B. L. (2009). A meta-analytic study of predictors of maternal-fetal attachment. International Journal of Nursing Studies, 46, 708–715. https://doi.org/10.1016/j.ijnu....
Zaki, N., Ruiz-Ruano García, A. M., & López Puga, J. (2020). Attachment style and prenatal expectations from a Bayesian perspective. Psicothema, 32, 138–144. https://doi.org/10.7334/psicot....
Zdolska-Wawrzkiewicz, A., Chrzan-Dętkoś, M., & Bidzan, M. (2018). Maternal attachment style during pregnancy and becoming a mother in Poland. Journal of Reproductive and Infant Psychology, 36, 4–14. https://doi.org/10.1080/026468....
Zimerman, A., & Doan, H. M. (2003). Prenatal attachment and other feelings and thoughts during pregnancy in three groups of pregnant women. Journal of Prenatal and Perinatal Psychology and Health, 18, 131–148.