What factors are most important for the development of the maternal–fetal relationship? A prospective study among pregnant women in Danish general practice

Abstract

Background Development of the maternal antenatal attachment (MAA) constitutes an important aspect of the transition into motherhood. Early identification of women at risk of developing a poor MAA provides possibilities for preventive interventions targeting maternal mental health and the emerging mother-infant relationship. In this study, we investigate the relative importance of an extensive set of psychosocial, pregnancy-related, and physiological factors measured in the first trimester of pregnancy for MAA measured in third trimester. Methods A prospective study was conducted among pregnant women in Danish general practice (GP). Data were obtained in the first and the third trimester from pregnancy health records and electronic questionnaires associated with routine GP antenatal care visits. The Maternal Antenatal Attachment Scale (MAAS) was used to assess maternal antenatal attachment. The relative importance of potential determinants of maternal antenatal attachment was assessed by the relative contribution of each factor to the fit (R2) calculated from multivariable regression models. Results The sample consisted of 1328 women. Low antenatal attachment (Total MAAS ≤ 75) was observed for 513 (38.6%) women. Perceived social support (having someone to talk to and having access to practical help when needed) emerged as the most important determinant. Furthermore, scores on the MAAS decreased with worse self-rated health, poor physical fitness, depression, increasing age, having given birth previously, and higher education. Conclusion Pregnant women reporting lack of social support and general low physical and mental well-being early in pregnancy may be at risk for developing a poor MAA. An approach targeting both psychosocial and physiological well-being may positively influence expectant mothers’ successful adaptation to motherhood.

It takes two: An antenatal to postnatal RDoC framework for investigating the origins of maternal attachment and mother–infant social communication

“…Although not an exclusion criteria per se, the sample does not include women under treatment for significant mental health issues that may jeopardize psychological well-being during pregnancy. Mean MAAS (antenatal attachment) values recently reported from two large, population-based cohorts in Denmark (Ertmann et al, 2021) and Australia (Le Bas et al, 2021) were very similar to those found in our United States-based sample, although MPAS (postnatal attachment) values in our sample were considerably lower than in Australia (Le Bas et al, 2021). An interesting cross-cultural study provides evidence for measurement equivalence of the construct of antenatal attachment across eight low-and middle-income countries and found no differences in mean antenatal attachment levels among six of them (Foley et al, 2021).…”

“…This scale assesses maternal feelings of closeness, preoccupation, and emotionality towards the fetus within the time frame of the previous two weeks of pregnancy (Condon, 1993). It, and the postnatal version, were used in two recent, population-based studies of maternal attachment totaling nearly 3,000 participants (Ertmann et al, 2021;Le Bas et al, 2021). Unlike some other antenatal attachment scales which include feelings about being pregnant, all MAAS items are directed specifically towards the fetus.…”

“…The principal limitation of this report is that it is based on a sample of primarily well-educated women with wanted pregnancies and lifestyles permitting them to attend repeated laboratory-based visits. Maternal attachment is often found to be unrelated to sociodemographic factors (Van den Bergh & Simons, 2009) although when associations are detected, more educated women tend to report lower levels of antenatal and postnatal attachment (Ertmann et al, 2021;Lindgren, 2001;van Bussel et al, 2010).…”

Maternal-fetal bonding during the COVID-19 pandemic

“…The mean scores for COVID-19-related worries were 12.02 (SD = 3.70) for health worries, 20.15 (SD = 6.42) for worries regarding impact on pregnancy, and 11.48 (SD = 4.24) for worries regarding access to resources. Finally, participants had an average sum 71.82 (SD = 7.29) out of a total possible score of 90 on the MAAS; a sum of 71 or below, corresponding to less than 80% the maximum MAAS, may be interpreted to represent low antenatal bonding [ 53 ]. The responses for COVID-19-related worries were further examined in Table 3 , with a response of ‘Worried’ or ‘Very Worried’ being considered to represent high levels of concern.…”

Komunikacja matki z dzieckiem w okresie prenatalnym

“…Okres oczekiwania na urodzenie pierwszego dziecka to przygotowawczy etap kształtowania się tożsamości macierzyńskiej (Stern, 1998). Założenia te potwierdzają wyniki duńskiego badania przywiązania matki do dziecka w okresie prenatalnym (Ertmann i in., 2021). Autorzy badania zwracają także uwagę na to, że kobiety posiadające dzieci, kobiety lepiej wykształcone i kobiety starsze wykazują mniejsze zaabsorbowanie dzieckiem w łonie (uzyskały niższe wyniki w skali przywiązania matki do dziecka w okresie prenatalnym MAAS -Maternal Antenatal Attachment Scale), co tłumaczą przypisywaniem przez nie mniejszej wartości macierzyństwu w rozumieniu poczucia spełnienia w tejże roli, a także większemu realizmowi i zaniepokojeniu zmianami zachodzącymi w organizmie w czasie ciąży.…”