A systemic review of maternal wellbeing and its relationship with maternal fetal attachment and early postpartum bonding

The effects of unintended pregnancy on maternal bonding impairment among Japanese mothers: a longitudinal study from pregnancy to one month postpartum

BACKGROUND

Numerous studies have been conducted regarding maternal bonding; however, there is a lack of studies investigating the association with unintended pregnancy. This study aimed to examine the effects of unintended pregnancy on maternal bonding using a longitudinal design from pregnancy to one month postpartum.

METHODS

Participants were 78 mothers who attended the Department of Obstetrics for prenatal care at 20.5 weeks of gestational age. They responded to the Postpartum Bonding Questionnaire (PBQ) and the Edinburgh Postnatal Depression Scale (EPDS). Furthermore, we asked whether the pregnancy was unintended. At one month postpartum, they responded to the questionnaires again. We performed two-way repeated-measures analysis of variance to assess the effect of group (unintended pregnancy or intended pregnancy) and time (during pregnancy or one month postpartum) on the PBQ and EPDS scores.

RESULTS

Mothers who had unintended pregnancies had significantly impaired maternal bonding compared to expected pregnancy mothers, both during pregnancy and one month postpartum. In addition, both unintended and expected pregnancy mothers had significantly decreased impaired maternal bonding at one month postpartum. Regarding depression, mothers with unintended pregnancy had significantly higher EPDS scores than mothers with expected pregnancy, both during pregnancy and one month postpartum.

CONCLUSIONS

Our findings emphasize that healthcare providers should promptly identify mothers with unintended pregnancies and conduct thorough assessments of mother-infant interactions postpartum.

Fuzzy‑set qualitative comparative analysis and fuzzy cognitive maps: Exploring pregnancy outcomes and maternal depression

The maternal antenatal attachment scale (MAAS), the pregnancy outcome questionnaire (POQ) and the Centre for Epidemiologic Studies Depression Scale (CESD), among other approaches, have been developed to address pregnancy-related psychological issues. However, the need to develop and validate effective scales to screen the complex experiences of pregnant women continues to be extensively discussed in the literature. The aim of the present study was to build and validate fuzzy models that represent the necessary and sufficient causal combinations that lead to higher levels of anxiety regarding pregnancy outcomes, maternal prenatal attachment to the unborn child and depressive symptoms, respectively. For this purpose, measurements from the MAAS, POQ and CESD scales, along with demographic data, were collected from 135 pregnant women, including cases of natural conception (NC) and assisted reproduction (ART) births. Fuzzy-set qualitative comparative analysis (FSQCA) was employed to produce sets of causal combinations, which were validated against their consistency and coverage. These combinations were then used to develop and validate fuzzy cognitive maps (FCMs) to model the fluctuations in the status of pregnant women. To the best of our knowledge, the present study is the first to utilize FSQCA or FCM to address this issue. The results indicated that the POQ was the distinguishing factor between NC and ART that led to higher MAAS levels. Marital status (MS) and state anxiety were found to lead to higher POQ levels for pregnancies derived from NC. For pregnancies following ART, the factors to consider include income, week of pregnancy, MS, MAAS intensity and trait anxiety. POQ was found to lead to higher levels of CESD for ART pregnancies, while NC, MS and state anxiety are also prerequisites. On the whole, the present study demonstrates that the proposed FSQCA- and FCM-based approach enables obstetricians and midwives to incorporate their expertise in evaluating cases on an individual basis, while also providing a framework for creating intelligent systems to support healthcare policy decisions.

The relationship between maternal psychopathology and maternal-fetal attachment: a cross-sectional study from the Czech Republic

BACKGROUND

Maternal-fetal attachment might be associated with maternal mental health issues, but previous results have been inconsistent, particularly regarding prenatal anxiety. We compared maternal-fetal attachment between pregnant women with and without symptoms of antenatal depression and anxiety. Additionally, we examined the relationships between prenatal depressive and anxiety symptoms, psychosocial stress, and maternal-fetal attachment.

METHODS

We conducted a cross-sectional study involving a sample of 2,233 pregnant women. The data were collected between March 2021 and March 2023 at outpatient clinics in the Czech Republic. We used self-report questionnaires to assess symptoms of prenatal depression (Edinburgh Postnatal Depression Scale, EPDS), anxiety (Perinatal Anxiety Screening Scale, PASS), psychosocial stress (Prenatal Psychosocial Profile, PPP), and maternal-fetal attachment (Prenatal Attachment Inventory - Revised, PAI-R).

RESULTS

Women without symptoms of antenatal depression had higher total scores on the PAI-R (U = 336,357; p = .013) and on the PAI-R Interaction subscale (U = 322,913; p < .001), suggesting a higher quality of maternal-fetal attachment than women with symptoms. No other significant associations were found between antenatal depression, anxiety and the PAI-R subscales scores.

CONCLUSIONS

Our results suggest that women experiencing increased depressive, but not anxiety, symptoms in pregnancy, have a poorer quality of attachment to their child, although the effect size is small. Consequently, treating prenatal depression in women could have a positive effect on maternal-fetal attachment.

Application of Three-Dimensional Printing in Maternity and Pediatric Nursing Care

ABSTRACT

Thre e-dimensional (3D) printing is an emerging technology that expanded quickly into a diverse array of clinical applications over the last decade. 3D printing, often called additive manufacturing, uses specialized printers to create objects through the addition of materials layer-by-layer. Using computer-aided design software via a 3D scanner or a digital camera, objects can be printed to highly precise and specific dimensions. This technology, including both the hardware and software, has applications in surgical procedures, dental implants and crowns, pharmaceuticals, and biomedical products. With the enormous potential of using 3D printing in multiple health care sectors, there is still limited usage for this technology in maternal and child health nursing practice. We provide an overview of 3D printing technology, review the current health care applications, and explore the opportunities and challenges of 3D printing in maternal and child nursing.

Hebrew validation of the postpartum bonding questionnaire: a study of mothers and fathers

OBJECTIVE

The Postpartum Bonding Questionnaire (PBQ) is a self-report questionnaire designed to screen disorders of the mother-infant relationship. The PBQ was adapted to several countries, though there is no agreement on the accepted number of items and factors. This study aimed to assess the validity and reliability of the Hebrew version for both mothers and fathers.

METHODS

Participants (602 mothers and 144 fathers) from two separate samples were randomly recruited in the maternity ward of a large tertiary health centre. The mothers' samples were combined and redivided to form subsamples A and B. At T1 (1-4 days postpartum), the participants completed demographic questionnaire in person the PBQ and the Edinburgh Postpartum Depression Scale (EPDS) were administered online at T2 (8-12 weeks postpartum). The PBQ was also administrated at T3 (six-months).

RESULTS

EFA on subsample A resulted in a two-factor structure, which was tested using CFA on subsample B. The model's fit was very good; χ(35)2 = 83.68, p < .001, CFI = .97, TLI = .91, RMSEA = .07, SRMR = .03. Additional reliability and validity analyses showed a very good fit for mothers. Scalar measurement invariance across mothers and fathers yielded satisfactory results. CFA among fathers, revealed adequate goodness of fit; χ2/df = 87.65/46, p < .001, CFI = .95, TLI = .89, RMSEA = .08, SRMR = .05.

CONCLUSIONS

The Hebrew version of the PBQ demonstrated satisfactory validity for both mothers and fathers. The revised version, with 14 items, measures bonding as a continuum rather than measuring bonding disorders like the original version. These findings emphasise the importance of validating the scale in different cultural contexts.

Maternal-antenatal attachment is higher in young pregnant women with more social support, mentors, and lower fear of childbirth

The goal of this study was to examine correlates of maternal-fetal attachment in a diverse sample of young pregnant mothers. Although studies have looked at social determinants of health and maternal-fetal attachment, none have examined correlates that may be more prevalent in younger populations including prenatal drug use or fear of childbirth. We analyzed data from a prospective cohort of 154 pregnant adolescents and young adults (75.5% Black/African American, 15.6% white, 7.5% biracial, 1.4% other) ranging from 14-21 years old. Participants were recruited early in pregnancy and completed online surveys during each trimester of pregnancy. Maternal fetal attachment was measured with the Maternal Antenatal Attachment Scale (MAAS) between 30-36 weeks gestation. A linear regression model was constructed to determine the independent contributions of demographic variables (age, race, sexual minority status), maternal mental health, substance use, and social support to maternal-fetal attachment. Third trimester social support, presence of a natural mentor, not having a younger partner, and lower fear of childbirth were associated with higher MAAS scores, and therefore greater maternal fetal attachment, accounting for 32% of the variance in MAAS scores. Maternal age, substance use, and psychological symptoms were not significantly related to maternal fetal attachment in this sample. Social support and patient education to lessen fear of childbirth should be the target of interventions to improve maternal-fetal attachment in adolescent and young adult women. Fostering and supporting mentorship may also be a promising avenue to improve maternal-fetal bonding in younger patients. More research is needed to better understand the impact of perceived health, body dissatisfaction, physical fitness, healthcare access, pre-existing OB/GYN conditions, fear of breastfeeding, history of emotional neglect, and future child rearing support to address gaps in knowledge within this field.

My 'normal' isn't your normal...What is maternal wellbeing? A scoping review

PROBLEM

Many global health strategies are developed to optimise 'maternal wellbeing'. However, what is meant by this term and therefore how it is interpreted and understood by different groups of people is currently poorly understood.

BACKGROUND

For midwives to provide woman-centred care they must recognise the diverse understandings of what is considered 'maternal wellbeing' and be able to identify factors underpinning this.

AIM

To identify and synthesise the literature related to the meaning and understanding of the term 'maternal wellbeing.'

METHODS

A search of PubMed, CINAHL Ultimate, OVID and Emcare databases was conducted between 2015 and 2024 for studies related to maternal wellbeing. Data from fourteen studies were charted and thematically analysed.

FINDINGS

Two overarching but interrelated themes were identified. One refers to the inner self, and the second to the woman's place in her social world. Theme 1, sense of self, comprises two sub-themes: finding a sense of self and sustaining a sense of self. Theme 2, the sense of place, comprises two sub-themes: sustaining place and making space in place.

DISCUSSION

Disconnects between the practice-oriented concept of wellbeing and wellbeing as perceived by women exist. Current maternal wellbeing assessment methods only measure the woman's sense of identity, and sense of self in their changed worlds.

CONCLUSION

Clear articulation of maternal wellbeing is needed to operationalise health strategies, institutional policies, procedures and standards of care that support positive maternal and infant outcomes. Midwives are pivotal to promoting maternal wellbeing during transitions across the pregnancy, birth, and motherhood continuum.

Psychological Well-being during Pregnancy: The Contribution of Stress Factors and Maternal-Fetal Bonding

BACKGROUND

Pregnancy and anticipation of the birth of the first child is considered a happy and exciting time. However, the stress involved in pregnancy has been found to put women at greater risk of impaired psychological well-being, or higher distress. Confusion in the theoretical literature between the terms 'stress' and 'distress' makes it difficult to understand the underlying mechanism that may enhance or reduce psychological well-being. We suggest that maintaining this theoretical distinction and examining stress from different sources, may allow us to gain new knowledge regarding the psychological well-being of pregnant women.

OBJECTIVE

Drawing on the Calming Cycle Theory, to examine a moderated mediation model for the explanation of the dynamic between two stress factors (COVID-19-related anxiety and pregnancy stress) that may pose a risk to psychological well-being, as well as the protective role of maternal-fetal bonding.

METHODS

The sample consisted of 1,378 pregnant women who were expecting their first child, recruited through social media and completed self-report questionnaires.

RESULTS

The higher the COVID-19-related anxiety, the higher the pregnancy stress, which, in turn, was associated with lower psychological well-being. However, this effect was weaker among women who reported greater maternal-fetal bonding.

CONCLUSION

The study expands knowledge of the dynamic between stress factors and psychological well-being during pregnancy, and sheds light on the unexplored role of maternal-fetal bonding as a protective factor against stress.

Reliability and validity of the original and brief German version of the Maternal Antenatal Attachment Scale (MAAS): Longitudinal study findings

BACKGROUND

Maternal-foetal attachment (MFA) seems essential for adapting to motherhood and the healthy development of the child, with direct implications for clinical practice. It is often assessed using the Maternal Antenatal Attachment Scale (MAAS), which covers two dimensions: quality and intensity of attachment. However, studies including the MAAS presented missing or inadequate psychometric properties. Therefore, the current study aimed to investigate the reliability and validity of both the original and the recently introduced brief German version of the MAAS.

MATERIALS AND METHODS

Data from 184 pregnant women from a longitudinal study were used. Women (≥ 18 years old) were recruited between the 18th and 22nd weeks of gestation while waiting for routine prenatal diagnostic appointments. Participants answered the MAAS, together with other questionnaires measuring maternal mental health, self-esteem, and social support. For both versions of the MAAS (19 items vs. 13 items), item characteristics, confirmatory factor analysis, internal consistency, and test-retest reliability were calculated and compared. Moreover, associations between the brief German MAAS and theoretically related constructs were analysed using correlation coefficients.

RESULTS

In this study, item analyses revealed better psychometric properties for the brief German MAAS than for the original MAAS, with a significant reduction in items with inadequate discriminatory power. The internal consistency (α ≥ .69) and test-retest reliability (ICC ≥ .62) were acceptable to good for both MAAS versions. With regard to structural validity, factor analysis of the German MAAS presented acceptable to good global model fit indices for the model with correlated factors (GFI > .90; RMSEA ≤ .08; SRMR < .10) in the current sample. In contrast, most global model fit indices of the original MAAS were not acceptable. The construct validity of the German MAAS was demonstrated on the basis of small-to-moderate correlations with a variety of constructs (e.g., measures of depression, anxiety, stress).

CONCLUSIONS

According to the present results, the brief German version of the MAAS represents a reliable and valid measurement instrument of MFA for use in clinical practice. Further studies examining possible cut-off values are needed to identify pregnant women with significant attachment difficulties who may benefit from additional support.

The effectiveness of Parentbot - a digital healthcare assistant - on parenting outcomes: A randomized controlled trial

BACKGROUND

Transitioning to parenthood is a stressful period that makes parents more prone to depression and anxiety. Mobile application-based interventions and chatbots could improve parents' well-being across the perinatal period. Hence, the Parentbot - a Digital healthcare Assistant was developed to support parents across the perinatal period.

OBJECTIVE

To evaluate the effectiveness of the Parentbot - a Digital healthcare Assistant in improving parenting self-efficacy (primary outcome), stress, depression, anxiety, social support, parent-child bonding, and parenting satisfaction (secondary outcomes) among parents across the perinatal period.

METHODS

A two-group pre-test and repeated post-test randomized controlled trial was used where 118 heterosexual couples (118 mothers and 118 fathers) were recruited from a public tertiary hospital in Singapore. Couples were randomly assigned to the intervention group receiving the Parentbot - a Digital healthcare Assistant and standardized care (59 couples) and a control group receiving the standard care only (59 couples). Data collection occurred at baseline (>24 weeks of gestation - age of viability in Singapore) and at one month (post-test 1) and three months (post-test 2) postpartum. Linear mixed models were used to compare parental outcomes between groups and a linear mixed model with repeated measures was used to analyze within-group differences. General linear models were used to conduct subgroup analyses of mothers and fathers between groups.

RESULTS

After adjusting for baseline values and sociodemographic covariates, parents in the intervention group had higher parenting self-efficacy compared to the control group at one-month postpartum (mean difference = 1.22, 95 % CI: 0.06 to 2.39, p = 0.04; Cohen standardized effect size = 0.14), and mothers had lower state-anxiety compared to the control group at three-months postpartum (mean difference = -2.21, 95 % CI: -4.18 to -0.24, p = 0.03; Cohen standardized effect size = -0.22). Non-statistically significant differences between groups were reported for the other parental outcomes.

CONCLUSIONS

This study showed that the Parentbot - a Digital healthcare Assistant is feasible and promising in supporting parents especially enhancing their self-efficacy across the perinatal period. The lack of statistical significance in most outcomes showed that further evaluation of the intervention is required among varied populations of parents across different cultural and geographical contexts. The intervention could be enhanced to support more diverse groups of parents including single parents, parents with high-risk pregnancies and infants with medical complications, and parents with limited English language skills. Future trials could explore the cost-effectiveness of such interventions and investigate infant outcomes for a more comprehensive assessment of mobile application-based perinatal interventions.

TRIAL REGISTRATION

Clinicaltrails.gov (NCT05463926).

COVID-19 Public Health Restrictions and New Mothers' Mental Health: A Qualitative Scoping Review

Public health restrictions to protect physical health during the COVID-19 pandemic had unintended effects on mental health, which may have disproportionately affected some potentially vulnerable groups. This scoping review of qualitative research provides a narrative synthesis of new mothers' perspectives on their mental health during COVID-19 pandemic restrictions through pregnancy to the postpartum period. Database searches in PubMed, CINAHL, and PsycINFO sought primary research studies published until February 2023, which focused on new mothers' self-perceived mental health during the pandemic (N = 55). Our synthesis found that new mothers' mental health was impacted by general public health restrictions resulting in isolation from family and friends, a lack of community support, and impacts on the immediate family. However, public health restrictions specific to maternal and infant healthcare were most often found to negatively impact maternal mental health, namely, hospital policies prohibiting the presence of birthing partners and in-person care for their infants. This review of qualitative research adds depth to previous reviews that have solely examined the quantitative associations between COVID-19 public health restrictions and new mothers' mental health. Here, our review demonstrates the array of adverse impacts of COVID-19 public health restrictions on new mothers' mental health throughout pregnancy into the postpartum period, as reported by new mothers. These findings may be beneficial for policy makers in future public health emergency planning when evaluating the impacts and unintended consequences of public health restrictions on new mothers.

Psychometric properties of the Maternal Postnatal Attachment Scale and the Postpartum Bonding Questionnaire in three German samples

BACKGROUND

Forming an emotional bond towards the infant is an important developmental aspect of the mother-child relationship. Two questionnaires frequently used for the assessment of mother-infant bonding, namely the Maternal Postnatal Attachment Scale (MPAS) and the Postpartum Bonding Questionnaire (PBQ), have shown inconclusive psychometric properties. To ensure comparability of results across studies, it is crucial to examine the replicability of psychometric properties and previously proposed factor structures of measurements when adapted to other languages.

AIM

The study aim was to investigate the psychometric properties of the German versions of both MPAS and PBQ, across three different German-speaking study samples.

METHODS

Maternal data from three longitudinal studies from Hamburg, Germany (PAULINE-PRINCE study, N = 229), and Dresden, Germany (MARI study, N = 286; DREAM study, N = 1,968), were used to investigate the psychometric properties (descriptive statistics, item difficulty, inter-item correlations) and the factorial structure (confirmatory factor analysis, CFA; principal axis factoring, PAF) of both MPAS and PBQ. Correlations with maternal-fetal bonding, adult romantic attachment style, attachment style to one's own mother, postpartum depressive symptoms, and education level were investigated.

RESULTS

Across the three samples, both MPAS and PBQ showed convincing results regarding the psychometric properties for their total scores, with satisfying to excellent internal consistencies. A strong correlation between the MPAS and PBQ total scores was observed (r=-.71, p < .001). In PAF, for both questionnaires, factor structures on subscale level differed across samples and assessment points. For MPAS and PBQ total scores, significant small to medium-sized associations in the expected directions with maternal-fetal bonding and depressive symptoms, as well as for MPAS with adult romantic attachment style, and for PBQ with attachment towards one's own mother were found. In two samples, higher educated participants reported less optimal MIB.

CONCLUSION

The results across the three included samples provide evidence for the validity of the construct assessed with the German adaptations of both MPAS and PBQ. However, the factor analytical results on subscale level highlight the need to further investigate the concept of mother-infant bonding in the first year after birth as well as to develop instruments applicable for use in clinical and community samples with satisfying psychometric properties.

The effect of the level of perceived social support in the postpartum period on maternal functioning and maternal attachment

AIM

This study aims to examine the effect of the level of perceived social support in the postpartum period on maternal functioning and maternal attachment.

METHODS

This study was conducted between January and May 2023 in two family health centers selected by simple randomization among 11 family health centers affiliated with the Health Directorate located in eastern Türkiye. The population of the study consisted of 410 mothers in the postpartum period who had babies aged 6-11 weeks old. Data were collected face-to-face using the "Personal Information Form", the "Multidimensional Scale of Perceived Social Support", the "Barkin Index of Maternal Functioning Scale" and the "Maternal Attachment Scale". Data analysis was performed using numbers, percentages, arithmetic means, independent groups t-tests, ANOVA, Pearson correlation analysis, and simple linear regression analysis.

FINDINGS

A positive, moderately significant relationship was found between maternal attachment and maternal functioning (r = 0.554; p < .05). A positive, moderately significant relationship was found between maternal attachment and perceived social support (r = 0.585; p < .05). A positive, highly significant relationship was detected between social support and maternal functioning (r = 0.861; p < .05).

CONCLUSION

This study found that postpartum women's attachment levels increased with the increase in their maternal functioning. It was also found that mothers' attachment levels increased with the increase in their perceived social support levels. Social support levels were proven to be effective on maternal functioning as well as maternal attachment. Women's maternal functioning levels were found to increase with the increase in their social support levels.

PRACTICE IMPLICATIONS

In light of these findings, pediatric nurses and obstetric nurses have great responsibilities. Starting from the prenatal period and including the postnatal period, both the mother and everyone around her should be explained the importance of social support.

Maternal-fetal attachment and interrelated factors in pregnant women assisted in Primary Health Care

BACKGROUND

(1) Maternal-fetal attachment should be assessed in Primary Health Care.

BACKGROUND

(2)  Depressive symptoms were negatively related to maternal-fetal attachment.

BACKGROUND

(3)  Social support and family functionality had a positive effect on attachment.

BACKGROUND

(4)  Greater household crowding had a negative effect on the outcome.

BACKGROUND

(5)  It is recommended to screen pregnant women with depression, poor social and family support.

to analyze maternal-fetal attachment and interrelated factors in pregnant women assisted in Primary Health Care.

a cross-sectional, population-based, analytical epidemiological survey. A sample of 937 participants attended by Family Health Strategy teams was investigated. Maternal-fetal attachment (outcome), sociodemographic and clinical variables, social support, family functionality, depressive symptoms and perceived stress were assessed. Multivariate analysis was adopted using structural equation modeling.

maternal-fetal attachment had an average of 92.6 (SD=±15.3). The adjusted structural model showed that the following factors had a direct effect on the outcome: gestational weeks (β=0.29; p<0.001), household crowding (β=-0.07; p=0.027), depressive symptoms (β=-0.11; p=0.003), social support (β=0.08; p<0.001) and family functionality (β=0.19; p<0.001). Indirect effects of social support (β=-0.29; p<0.001) and family functionality (β=-0.20; p<0.001) were identified, mediated by depressive symptoms.

a set of interrelationships was identified between maternal-fetal attachment, gestational weeks, household crowding, depressive symptoms, social support and family functionality. It is suggested that the Family Health Strategy offer prenatal care anchored in integrality and humanization, which promotes biopsychosocial well-being during pregnancy and healthy maternal-fetal attachment.

Influence of postpartum depression on maternal-infant bonding and breastfeeding practices among mothers in Abeokuta, Ogun state

BACKGROUND

Postpartum Depression (PPD) is a severe mental health condition that adversely affects mothers and their infants. The influence of PPD on maternal-infant bonding and breastfeeding practices has been scarcely reported in Nigeria. Therefore, we examined the prevalence of PPD, the associated factors, and the relationship with maternal-infant bonding and breastfeeding practices in Abeokuta, Nigeria.

METHOD

A descriptive cross-sectional survey was conducted among 600 mothers within the extended postpartum period (≤ 1 year) from three government-owned immunisation clinics at primary, secondary, and tertiary health facilities in Abeokuta, Ogun State. PPD was assessed using the Edinburgh postnatal depression Scale (EPDS ≥ 13), and maternal-infant bonding was evaluated using the Postpartum Bonding Questionnaire (PBQ ≥ 50). We also examined breastfeeding practices (i.e. the time to initiation by 30 min, exclusive breastfeeding for 6 months and early commencement of complementary feeding by 2 months). Data was analysed using chi-square and logistics regression models at a 5% significance level.

RESULTS

The prevalence of PPD was 21.8%, 95% CI (18.7-25.3). Factors associated with PPD were maternal age: 25-34 years [AOR = 0.52; 95% CI (0.29-0.90)]; ≥ 35 years [AOR = 0.44; 95% CI (0.20-0.96)], being married [AOR = 0.43; 95% CI (0.21-0.85)], perceived stress increased the odds of PPD: moderate stress level [AOR = 8.38; 95% CI (3.50-19.9)]; high-stress level [AOR = 47.8; 95% CI (8.65-263.7)] and self-reported history of emotional problems [AOR = 3.25; 95% CI (1.43-7.38)]. There was a significant direct association between PPD and poor maternal-infant bonding [AOR = 3.91; 95% CI (1.04-4.60)]. PPD reduces the odds of early breastfeeding initiation [AOR = 0.43; 95% CI (0.28-0.68)], but no association was found between PPD and exclusive breastfeeding [AOR = 1.07; 95% CI (0.07-1.67)].

CONCLUSION

The prevalence of PPD was high in our study population and associated with poor maternal-infant bonding and late breastfeeding initiation but not with exclusive breastfeeding. Promoting maternal mental health to foster stronger mother-infant relationships and better breastfeeding practices has become crucial.

Understanding the relationship between childhood emotional abuse and neglect and psychological distress in pregnant women: the role of prenatal attachment

BACKGROUND

Childhood abuse and neglect pose important risk factors for the development of psychopathology during pregnancy. However, only a few studies have assessed the effects of a specific type of abuse during the perinatal period, namely, psychological maltreatment, which includes emotional abuse and neglect. These studies have found that women who have experienced psychological maltreatment exhibit higher levels of antenatal depressive symptoms and greater difficulties forming attachment with their babies than women who have not experienced this kind of adversity. The aim of this study was to examine how emotional abuse and neglect experiences may favor the occurrence of psychological distress in pregnant women, and whether prenatal attachment might explain this association.

METHODS

Participants comprised 128 Italian pregnant women ranging in age from 21 to 46 years (Mage = 33.4; SD = 6.10). Women responded to the following self-report instruments: CECA.Q and CTQ-SF, for the assessment of psychological maltreatment experiences; MAAS, for the evaluation of prenatal attachment; and PAMA, for the assessment of perinatal psychological distress.

RESULTS

Pearson correlations revealed a positive association between childhood neglect and perinatal psychological distress and a negative association between childhood neglect and prenatal attachment scores. No significant correlations were found for emotional abuse. Perinatal psychological distress was negatively associated with prenatal attachment. Mediation analyses showed significant associations between childhood neglect and the dimensions of perinatal affectivity and prenatal maternal attachment. Prenatal maternal attachment mediated the relationship between neglect and perinatal psychological distress.

CONCLUSIONS

The transition to motherhood is a sensitive period, particularly for women who have experienced abuse and neglect during childhood. These experiences may negatively impact a woman's disposition to emotionally and behaviorally engage in the formation of a bond with their unborn baby. These results may have important prevention and clinical implications and thus warrant further exploration.

Mother-child bond and its relationship with maternal postpartum depression

BACKGROUND

The mother-child bond may be related to maternal health, especially postpartum depression (PPD). Existing studies show the need for further in-depth research on the subject.

AIM

To determine the relationship between bonding and the probability of the development and presence of PPD in women with a biological child between 6 weeks and 18 months of age.

METHODS

A cross-sectional study was conducted. A questionnaire containing sociodemographic, psychosocial, and health variables referring to the mother and the newborn, a questionnaire measuring the mother-child bond (VAMF-bond), and the Edinburgh Postpartum Depression Scale (EDPS) were administered.

RESULTS

1114 women participated. The association between the items of the VAMF-bond subscale and the risk of PPD was statistically significant for all items (p < 0.05), except items 4 and 10. The multivariate analysis showed that the risk of PPD (EPDS scale) was lower in women with higher scores on bond (Adjusted Odds Ratio: aOR = 0.85; 95%CI: 0.81, 0.88), whose birth experience was good or very good (aOR = 0.57; 95%CI: 0.36, 0.89), who received high or very high support from their partner (aOR = 0.34; 95%CI: 0.18, 0.66), and family (aOR = 0.53; 95%CI: 0.32, 0.86). The presence of PPD was less frequent in women who presented higher scores for bond (aOR = 0.90; 95%CI: 0.84, 0.97), who had skin-to-skin contact (aOR = 0.39; 95%CI: 0.17, 0.93) and who received high or very high support from the family (aOR = 0.36; 95%CI: 0.12, 1.04).

CONCLUSIONS

High scores on the subscale VAMF-bond were associated with a lower risk of PPD.

Trait mindfulness during pregnancy and maternal-infant bonding: Longitudinal associations with infant temperament and social-emotional development

Maternal love and caregiving are pillars for optimal child development and may affect infant outcomes from pregnancy onwards. The present study aimed to examine whether maternal trait mindfulness during pregnancy and pre- and postnatal maternal-infant bonding were associated with maternal perceptions of infant temperament and social-emotional development. In total, 408 Dutch women (Mage = 31.33, SD = 3.59) participated in a prospective perinatal cohort study and completed questionnaires on trait mindfulness, prenatal bonding, postnatal bonding, infant temperament, and infant social-emotional development at 20 and 28 weeks of gestation, and 10 weeks, 6 and 12 months postpartum, respectively. Path analyses demonstrated that higher levels of the trait mindfulness facet non-judging (i.e., refraining from judgments about own feelings and thoughts) were associated with more pre- and postnatal maternal bonding and fewer social-emotional problems as perceived by the mother. Adopting an accepting and non-judgmental attitude may promote positive feelings of bonding and benefit the infant in terms of having fewer social-emotional problems in the first year of life. Mindfulness interventions may be offered to pregnant women in order to enhance maternal bonding and improve infant outcomes after birth.

Pregnancy intendedness and happiness as predictors of maternal-foetal bonding: evidence for mediation

INTRODUCTION

Prior research has identified associations between pregnancy intendedness and maternal-foetal bonding, but no studies have examined the potential mediation of pregnancy happiness on the development of the maternal-infant relationship.

METHODS

In 2017-2018, a clinic-based pregnancy cohort of 177 low-income and racially diverse women in a South-Central U.S. state participated in a study examining their pregnancy intentions, attitudes and behaviours. Pregnancy intentions and happiness and demographic characteristics were measured during the first trimester assessment, and maternal-foetal bonding was measured with the Prenatal Attachment Inventory (PAI) during the second trimester. Structural equation modelling was used to examine the associations between intendedness, happiness and bonding.

RESULTS

Findings indicate positive associations between intended pregnancies and pregnancy happiness and pregnancy happiness to bonding. The direct effect from intended pregnancy to maternal-foetal bonding was not significant, providing evidence for full mediation. We did not find any associations between pregnancies that were unintended or ambivalent with pregnancy happiness or maternal-foetal bonding.

CONCLUSIONS

Pregnancy happiness provides one potential explanation for the association between intended pregnancies and maternal-foetal bonding. These findings have implications for research and practice, as inquiring about mothers' pregnancy attitudes (e.g. how happy they are about their pregnancy) may be more important for maternal psychological health outcomes, such as the maternal-child relationship, than whether or not their pregnancies were intended.

The role of lack of grandparental support in perinatal depression

BACKGROUND

Low social support has been identified as a risk factor for perinatal mental health problems. However, previous studies mainly focused on partner support or general social support and neglected the roles of grandparents. Here, we examine whether a lack of grandparental support is related to increased risk of a diagnosis of perinatal depression. In addition, we examine whether poor grandparental support is related to more depressive symptoms in mothers with and without previously diagnosed perinatal depression and whether perceived grandparental support buffers against parenting difficulties in mothers with perinatal depression.

METHODS

The sample was drawn from an Australian pregnancy cohort study and consisted of 725 women, including 230 women who met criteria for Major Depression. At 12 months postpartum, women reported on grandparental geographical proximity and hours of grandparental childcare support. Perceived grandparental support was assessed with the Postpartum Social Support Questionnaire and parenting difficulties and depressive symptoms with the Parenting Stress Index and the Edinburgh Postnatal Depression Scale.

RESULTS

Perceived grandparental support was related to fewer depressive symptoms among mothers with perinatal depression. In addition, higher levels of perceived grandparental support were related to lower parenting stress in mothers with and without perinatal depression.

LIMITATIONS

Intergenerational conflicts and quality of grandparenting were not assessed.

CONCLUSIONS

Our findings indicate that supportive grandparents may prevent the development of more severe perinatal depression in mothers experiencing perinatal mental health problems. Future studies should examine whether involving grandparents in treatment may add to the effectiveness of existing perinatal mental health interventions.

The prenatal caregiving expectations questionnaire‐revised version: Factor structure, internal consistency, and initial construct validity

An efficient, multidimensional instrument is needed to screen non-optimal prenatal parental representations predictive of postnatal parenting behavior and child attachment. The present work aimed to revise and validate the Prenatal Caregiving Expectations Questionnaire-Revised (PCEQ-R). Survey data from two independent samples of pregnant, primarily Danish, women (N = 300/322) were collected to 1) test the factor structure and select items for a 20-item version, and 2) confirm the factor structure, examine internal consistency, and establish initial construct validity. Confirmatory factor analysis supported a three-factor model of helpless-dysregulated, anxious-hyperactivated, and avoidant-deactivated caregiving representations. Internal consistency was acceptable (α > .73). Construct validity analyses showed that higher helpless-dysregulated caregiving was associated with low maternal antenatal attachment quality (rs = -.36) and intensity (rs = -.11), increased risk of perinatal depression (rs = .37), and trait anxiety (rs = .37). Higher anxious-hyperactivated caregiving was associated with better maternal antenatal attachment quality (rs = .20) and higher intensity (rs = .26), while avoidant-deactivated caregiving was not associated with maternal antenatal attachment. These findings support the validity and multidimensional structure of the measure. The homogenous nature of the sample limits generalizability of results. Future studies should examine predictive validity of the PCEQ-R and include clinical samples.

The Turkish version of the Postpartum Bonding Questionnaire (PBQ): Examination of the validity and reliability and scale structure

PURPOSE

The aim of this study is to investigate the validity and reliability of the Turkish version of the Postpartum Bonding Questionnaire (PBQ).

DESIGN AND METHODS

This methodological study was conducted with 250 women who presented to three family health centers in Istanbul/Turkey between April and June 2022 and met the sampling criteria. Validity analysis was performed using the content validity index, exploratory factor analysis, and confirmatory factor analysis. Pearson product-moment correlation and Cronbach Alpha reliability coefficients were used for reliability analysis.

RESULTS

To evaluate invariance of the instrument over time, test-retest measurements were conducted at least two weeks apart and showed no difference in mean scores (p > .05). Adjusted goodness-of-fit index >0.97 and comparative fit index >0.98 confirmed the construct validity of the Turkish PBQ. Each item had a content validity index of 96%. Corrected item-total score correlations ranged from 0.50 to 0.93. The Cronbach Alpha was found to be 0.96, indicating high internal consistency.

CONCLUSION

The results of this study show that the Turkish version of the PBQ is valid and reliable. It can be used as a measurement tool to determine the degree of maternal bonding in the postpartum period.

Promoting sleep health during pregnancy for enhancing women's health: a longitudinal randomized controlled trial combining biological, physiological and psychological measures, Maternal Outcome after THERapy for Sleep (MOTHERS)

BACKGROUND

Sleep is vital for maintaining individuals' physical and mental health and is particularly challenged during pregnancy. More than 70% of women during the gestational period report insomnia symptoms. Sleep dysfunction in the peripartum increases the risk for a cascade of negative health outcomes during late pregnancy, birth, and postpartum. While psychological interventions are considered the first line treatment for sleep difficulties, they are still scarcely offered during pregnancy and there is a lack of longitudinal research combining psychological and physiological indices.

METHODS

The present protocol outlines a randomized controlled trial aimed at testing the long-term effectiveness of an automatized digitalized psychoeducational intervention for insomnia for expectant mothers complaining insomnia symptoms without comorbidity. Outcomes include physiological, hormonal, and subjective indices of maternal psychopathology, stress, and emotional processes, and sleep and wellbeing of the family system. The trial is part of a longitudinal study evaluating expectant mothers from early pregnancy (within the 15th gestational week) to 6-months postpartum through 6 observational phases: baseline (BSL), 6- and 12-weeks from BSL (FU1-FU2), 2-to-4 weeks after delivery (FU3), and 3- and 6-months after delivery (FU4-5). We plan to recruit 38 women without sleep difficulties (Group A) and 76 women with sleep difficulties (Group B). Group B will be randomly assigned to digital psychological control intervention (B1) or experimental psychoeducational intervention targeting insomnia (B2). At 3 time points, an ecological-momentary-assessment (EMA) design will be used to collect data on sleep and emotions (diaries), sleep-wake parameters (actigraphy) and stress reactivity (salivary cortisol). We will also test the DNA methylation of genes involved in the stress response as biomarkers of prenatal poor sleep. Information on partner's insomnia symptoms and new-borns' sleep will be collected at each stage.

DISCUSSION

The proposed protocol aims at testing an easily accessible evidence-based psychoeducational intervention for expectant mothers to help them improving sleep, health, and wellbeing in the peripartum. The results could improve the understanding and management of sleep difficulties and peripartum depression.

TRIAL REGISTRATION

The study protocol has been registered on 22 April 2024 with ClinicalTrials.gov Protocol Registration and Results System (PRS), ID: NCT06379074.

PROTOCOL VERSION

April 23, 2024.

Factors related to a disturbance in the mother-child bond and attachment

INTRODUCTION

Establishing an adequate bond and attachment between a mother and child is essential for preventing pathologies and developing this relationship in the future.

PURPOSE

To identify the factors related to a disturbance of the mother-child bond or attachment.

METHODS

A cross-sectional descriptive study was carried out with women with a biological child between 6 weeks and 18 months of age. The Mother-Child Bond-Attachment Questionnaire (VAMF, for its name in Spanish) was administered to measure the bond and postnatal attachment together with a questionnaire containing sociodemographic, psychosocial, and health variables referring to the mother and the newborn.

RESULTS

1114 women participated. The multivariate analysis showed that skin-to-skin contact (aOR = 0.58; 95% CI: 0.37, 0.90) and breastfeeding (aOR = 0.55; 95% IC: 0.35, 0.86) reduce the probability of presenting a bond disturbance. Anxiety during pregnancy, childbirth, and the puerperium (aOR = 3.95; 95% CI: 2.57, 6.05) and postpartum complications (aOR = 1.60; 95% CI: 1.03, 2.48) increase the chance of having a bond disturbance. Skin-to-skin contact (aOR = 0.61; 95% CI: 0.38, 1.00), breastfeeding (aOR = 0.47; 95% CI: 0.27, 0.80,) and an older age of the infant (months) (aOR = 0.77: 95% CI: 0.72, 0.82) reduces the probability of presenting an attachment disturbance.

CONCLUSIONS

Skin-to-skin contact and breastfeeding are associated with a lower probability of impaired bonding and attachment. Anxiety states during pregnancy, childbirth, and the puerperium, and complications after childbirth increase the probability of developing a bond disorder. The older the age of the infant, the lower the frequency of having an impaired attachment.

IMPLICATIONS TO PRACTICE

Identifying the factors associated with the establishment of the mother-child bond and attachment is essential for the development of prevention strategies and early identification of cases that may present alterations and avoid their consequences on the health of the mother and child.

The relationship between maternal-infant bonding and postpartum depression/anxiety: moderating effect of childhood psychological abuse and validation of the Mother-to-Infant Bonding scale (MIBS-8) in Arabic

BACKGROUND

The emotional bond that a mother senses to her infant is essential to their social, emotional, and cognitive development. Understanding the level of mother-infant bonding plays an imperative role in the excellence of care. However, in Lebanon, there is a paucity of information about mother-infant bonding in the postpartum period. Given that Lebanese pregnant women constitute an important part of the population to look at, the objectives of the study were to (1) validate the Arabic version of the mother-infant bonding scale and (2) the relation between mother-infant bond and postpartum depression/anxiety; (3) the moderating effect of child abuse in the association between mother-infant bond and postpartum depression/anxiety.

METHODS

This cross-sectional study was conducted from September 2022 until June 2023, enrolling 438 women 4-6 weeks after delivery (mean age: 31.23 ± 5.24 years). To examine the factor structure of the mother-infant bond scale, we used an Exploratory-Confirmatory (EFA-CFA) strategy. To check if the model was adequate, several fit indices were calculated: the normed model chi-square (χ2/df), the Steiger-Lind root mean square error of approximation (RMSEA), the Tucker-Lewis Index (TLI) and the comparative fit index (CFI).

RESULTS

EFA was conducted on the first subsample. Three items were removed. The five items remaining loaded on one factor, which explained 73.03% of the common variance (ω = .91 / α = .90). After adding a correlation between residuals for items 2-7 and 5-8, fit indices of the CFA results were acceptable: χ2/df = 6.97/3 = 2.32, RMSEA = .068 (90% CI .001, .135), SRMR = .017, CFI = .996, TLI = .988. The interaction maternal-infant bonding by child psychological abuse was significantly associated with depression and anxiety respectively. At low, moderate and high levels of child psychological abuse, higher maternal-infant bonding scores (greater difficulty in bonding) were significantly associated with higher depression and higher anxiety respectively.

CONCLUSION

This study provides, for the first time, a specific Arabic scale to assess mother-infant bonding reliably and validly. Furthermore, our study has suggested the existence of factors that have additive effects in potentiating the risk for depression and anxiety among Lebanese postpartum women, namely a history of psychological child abuse. Therefore, laborious awareness programs and healthcare services need to be implemented in order to prevent maternal mental health disorders from being unrecognized and left untreated.

Maternal stressors and maternal bonding among immigrant and Refugee Arab Americans resettled in the United States

Maternal bonding with the infant and child is essential for the growth and development of the child, and for establishing the relationship between them. The effect of maternal acculturative stress, trauma, and depressive symptoms on maternal bonding has been established in nonimmigrant populations, but not in immigrant and refugee populations. In this study, we aimed to (1) examine the relationships among maternal psychosocial stress (acculturative stress, posttraumatic stress), depressive symptoms, and maternal bonding, and (2) examine whether maternal depression is a mediator of the relationship between maternal psychosocial stress and maternal bonding among a sample of Arab American immigrant and refugee mothers. Using a cross-sectional design, we recruited 78 immigrant and refugee Arab American mothers. Acculturative stress was correlated with posttraumatic stress (ρ = 0.56, p < 0.001), depressive symptoms (ρ = 0.48, p < 0.001), and bonding impairment (ρ = 0.39, p < 0.001). Posttraumatic stress and depressive symptoms were also correlated with maternal bonding impairment (ρ = 0.39, and 0.52, respectively, p < 0.001 for both). The effect of maternal psychosocial stress on maternal bonding was mediated by depressive symptoms. We concluded that higher levels of acculturative stress and posttraumatic stress were associated with higher levels of depressive symptoms and impairment of maternal bonding. Additionally, maternal depressive symptoms mediated the relationship between maternal stress and bonding. Assessing the stressors and depressive symptoms of immigrant and refugee mothers is key to avoiding negative effects on child outcomes.

The concept analysis of parent-infant bonding during pregnancy and infancy: a systematic review and meta-synthesis

INTRODUCTION

Despite the emerging body of literature on mother-to-infant bonding and the associated variables, there are various definitions of bonding construct. Also, there is a lack of a comprehensive conceptual framework of antecedents and consequences of bonding that would guide empirical work.

OBJECTIVE

Aim of the study was to provide a systematic review and synthesis of concept analysis studies on maternal-foetal, mother-infant, or father-infant bonding.

METHOD

A systematic search was performed in PubMed, EBSCOHost (including PsycINFO), ProQuest, and CINAHL. In addition, a hand search was conducted. Papers were eligible for inclusion if they conducted concept analyses on mother or father to foetus/infant bonding. A qualitative meta-synthesis was applied to synthesise the findings.

RESULTS

Eight papers on concept analyses were eligible for inclusion. In meta-synthesis, six aspects of parent-to-(unborn) child bonding emerged, including direction, domain, process, timing, endurance, and parental gender. Defining attributes are (i) a close relationship, (ii) filled with positive parental affection, (iii) manifested during pregnancy as monitoring foetal development and behaviour and after childbirth in proximity and interaction. Antecedents, affecting factors, and consequences of the parent-child bonding have been summarised.

CONCLUSION

Parent-infant bonding refers to an emotional, behavioural, cognitive, and neurobiological tie of the parent to the (unborn) child, as a process from intention to have a child throughout infancy. This is a parental-driven process which can continue to evolve throughout child's and parent's life, characterised as enduring, committed, and engaged. Based on meta-synthesis, a conceptual structure of parent-infant bonding has been provided, which needs further empirical testing.

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

OBJECTIVE

This study aimed to identify and inform recommendation of self-report and interview-based instruments that are feasible, reliable and valid to evaluate the quality of the maternal-fetal relationship (MFR).

BACKGROUND

Several constructs predicting parent-infant interaction and later infant adjustment are used to assess mothers' thoughts and feelings towards their unborn baby, including reflective functioning, mind-mindedness, representation, and fetal attachment. As yet, there is no existing review comparing the quality and accessibility of instruments across each of these constructs.

METHODS

A systematic literature review was undertaken to synthesise psychometric information on measures reporting on the MFR. Searches of six databases were conducted. English articles were selected based on inclusion and exclusion criteria. The QATSDD checklist was used to assess study quality.

RESULTS

 Of 669 studies identified, 28 met inclusion criteria. Thirteen different instruments were identified for evaluation. Reported reliability and validity varied significantly across instruments, as well as availability for research and/or clinical use.

CONCLUSION

Suggestions for research and clinical practice include further evaluation of the psychometric properties of tools, particularly for self-report measures of reflective functioning, use of interviews to scaffold reflexivity, and development of clinical policies and procedures to clarify care pathways for expectant mothers needing further support.

A global analysis of the determinants of maternal health and transitions in maternal mortality

The reduction of maternal mortality and the promotion of maternal health and wellbeing are complex tasks. This Series paper analyses the distal and proximal determinants of maternal health, as well as the exposures, risk factors, and micro-correlates related to maternal mortality. This paper also examines the relationship between these determinants and the gradual shift over time from a pattern of high maternal mortality to a pattern of low maternal mortality (a phenomenon described as the maternal mortality transition). We conducted two systematic reviews of the literature and we analysed publicly available data on indicators related to the Sustainable Development Goals, specifically, estimates prepared by international organisations, including the UN and the World Bank. We considered 23 frameworks depicting maternal health and wellbeing as a multifactorial process, with superdeterminants that broadly affect women's health and wellbeing before, during, and after pregnancy. We explore the role of social determinants of maternal health, individual characteristics, and health-system features in the production of maternal health and wellbeing. This paper argues that the preventable deaths of millions of women each decade are not solely due to biomedical complications of pregnancy, childbirth, and the postnatal period, but are also tangible manifestations of the prevailing determinants of maternal health and persistent inequities in global health and socioeconomic development. This paper underscores the need for broader, multipronged actions to improve maternal health and wellbeing and accelerate sustainable reductions in maternal mortality. For women who have pregnancy, childbirth, or postpartum complications, the health system provides a crucial opportunity to interrupt the chain of events that can potentially end in maternal death. Ultimately, expanding the health sector ecosystem to mitigate maternal health determinants and tailoring the configuration of health systems to counter the detrimental effects of eco-social forces, including though increased access to quality-assured commodities and services, are essential to improve maternal health and wellbeing and reduce maternal mortality.

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.

Childbirth, trauma and family relationships

Background: Childbirth is a major life event with expected positive outcomes, yet for some women postnatal psychopathological symptoms may harm women's interpersonal relationships. We hypothesized that higher levels of postnatal depression, post-traumatic stress (PTSD) symptoms, and fear of childbirth would be associated with mother-baby bond disorders and relationship dissatisfaction in couples.Method: A cross-sectional self-report online questionnaire was used to survey partnered women who had delivered in the year prior to the study. We used a convenience sample of 228 women recruited through purposive and snowball sampling. Childbirth experience, PTSD symptoms, attachment style, depression, mother-baby bond disorders, and couple relationship dissatisfaction were measured.Results: Women with higher PTSD and postnatal depression scores reported higher levels of mother-baby bond disorders-a relationship fully mediated by postnatal depression symptoms. Women who perceived childbirth as fearful or anxiety provoking had higher levels of PTSD and postnatal depression symptoms. Fearful and anxious birth perception was positively associated with mother-baby bond disorders-an association partly mediated by PTSD symptoms. Insecure attachment style was not found to be significantly associated with fearful or anxious perceptions of childbirth.Limitations: Women who have postnatal PTSD/depression are less inclined to participate in a study of this nature. Also, online surveys prevented the use of clinical diagnoses of PTSD and depression.Discussion and conclusions: Our results suggest that PTSD and postnatal depression affect women's mental health and family bonding. Women should be assessed for negative traumatic birth experiences, PTSD, and depression, to allow targeted observation for psychopathologies and therapeutic interventions.

The relationship between pregnancy and birth experience with maternal-fetal attachment and mother-child bonding: a descriptive-analytical study

BACKGROUND

Pregnancy and childbirth experience can be important factors for a pleasant relationship between mother and baby. This study assessed the relationship between the pregnancy and birth experience with maternal-fetal attachment (MFA) and mother-child bonding.

METHODS

A descriptive-analytical study was conducted among 228 pregnant women in Tabriz, Iran February 2022 to March 2023. Using cluster random sampling method, we included 228 women with gestational age 28-36 weeks and followed them up until six weeks postpartum. Data were collected in two stages using the following questionnaires: Pregnancy Experience Scale (hassles and uplifts), Maternal-Fetal Attachment Questionnaire (during the third trimester of pregnancy), Postpartum Bonding Questionnaire, and Childbirth Experience Questionnaire (six weeks postpartum). Data were analyzed using Pearson's correlation test and general linear model.

RESULTS

The mean score of MFA was significantly higher among women with feelings of being uplifted during pregnancy [β (95% CI) = 1.14 (0.87 to 1.41); p < 0.001]. However, there was no statistically significant relationship between pregnancy hassles and MFA and mother-child bonding (p > 0.05). Also, there was no statistically significant relationship between childbirth experience and mother-child bonding (p > 0.05).

CONCLUSION

According to the results of this study, pregnancy uplifts have a positive role in improving MFA. Therefore, it is recommended to plan interventions to make pregnancy period a pleasant experience for mothers.

The identification and measurement of postpartum anxiety in England: A Delphi survey

Postpartum anxiety has negative consequences for both mother and infant, so effective identification and measurement is vital to enable intervention. Despite NICE recommendations to prioritise the measurement of postpartum anxiety in mothers, current clinical measurement in England remains both fragmented and flawed. The Postpartum Specific Anxiety Scale [PSAS] offers an alternative, as it measures maternal-focused anxieties which can enable specifically targeted interventions. However, it is only currently used as a research tool and may require modification for clinical use. To inform modification of the PSAS, nineteen stakeholders from a variety of organisations participated in a two-round Delphi consensus survey to measure its clinical relevance and potential for effective identification of clinical anxiety. Descriptive analyses revealed all subscales of the PSAS scored highly across all domains, excluding Practical Infant Care Anxieties. Analyses also indicated good consensus between stakeholders across specific items, suggesting that the some items on the PSAS are relevant and effective at identifying clinical postpartum anxiety. Participants also expressed a need for a shorter version of the PSAS for clinical use, and that additional items may need including. Future research must now adapt the existing PSAS based on the results of this study and pilot the adapted measure in a clinical population.

Mother-to-infant bonding mediates the effects of depressive and anxious postpartum symptoms on parenting stress

A number of studies have suggested close associations between maternal postpartum mental health (depressive and anxious symptoms), mother-infant bonding, and parenting stress. However, the relationship between maternal bonding and parenting stresshas hardly been explored in published literature. This cross-sectional study explored whether maternal bonding could mediate the effect of postpartum maternal mental health on parenting stress. This study assessed maternal bonding (MPAS), depressive and anxious symptoms (EPDS; STAI), and parenting stress (PSI) at 3 months postpartum in a community sample of 105 women (M (SD) = 32.60 (4.18) years old). Spearman's correlation analyses showed moderate to high correlations between these factors. The three mediation models run showed that mother's MPAS partially mitigates the effects of EPDS (b = 0.71; SE = 0.217; 95% CI = 0.290/1.136) and STAI State (b = 0.39; SE = 0.113; 95% CI = 0.178/0.625) on PSI, and totally mediated the relationship between STAI Trait and PSI (b = 0.59; SE = 0.155; 95% CI = 0.303/0.912). Maternal bonding resulted to be a relevant factor in the association between maternal mental health and parenting stress. This highlights the importance of interventions focusing on mother-infant relationship to reduce parenting stress and prevent developmental difficulties in children.

Emotional and relational protective factors during pregnancy and psychological well-being and personal growth after childbirth

BACKGROUND

Studies in the perinatal literature tend to focus on potential negative outcomes, but little attention has been paid to the protective factors that may be associated with better psychological well-being or positive mental changes, such as personal growth.

OBJECTIVE

Drawing on the Broaden and Build Theory of Positive Emotions, the study employed a prospective design and a sequential mediation model to examine the mechanism by which protective factors during pregnancy (dispositional gratitude, perceived relationship quality with the partner, perceived maternal-foetal bonding) may be associated, in sequence, with higher psychological well-being and personal growth after childbirth among first-time mothers.

METHODS

The sample consisted of 515 women who were recruited through social media and completed questionnaires in two phases: Time 1, during the second half of their pregnancy; and Time 2, around 12 weeks after the birth of their first baby.

RESULTS

Results show that gratitude was associated with higher perceived relationship quality during pregnancy, which was associated with higher maternal-foetal bonding, which in turn was associated with higher psychological well-being and personal growth after childbirth. The indirect effects were significant.

CONCLUSION

The study expands knowledge of positive outcomes in the transition to motherhood, and demonstrates that positive emotions, such as gratitude, may be the first link in the chain of factors predicting better outcomes from pregnancy to childbirth.

Randomized controlled trial to prevent postpartum depressive symptomatology: An infant carrier intervention

BACKGROUND

There is a need for effective interventions to reduce symptomatology of postpartum depression. The objective of this study was to test whether providing an ergonomic infant carrier would reduce postpartum depression symptomatology.

METHODS

A randomized two-arm, parallel-group trial with 100 participants was conducted between February 2018 and June 2019 in a low-income community. At 30-weeks' gestation, 50 participants were randomly assigned to receive an ergonomic infant carrier and instructions on proper use (intervention group), and 50 participants were assigned to a waitlist (control group). Participants tracked the extent of their infant carrier use and completed the Edinburgh Postpartum Depression Scale (EPDS) to assess postpartum depression symptomatology at 6-weeks postpartum.

RESULTS

Participants in the intervention group reported using an infant carrier significantly more often than the control group (β = 2.69, SE = 0.347, p < .001, 95 % CI = 2.08-3.41). The intervention group reported fewer depressive symptoms at 6-weeks postpartum than the control group (β = -0.541, p = .042).

LIMITATIONS

The sample size was relatively small and thus our results may not be generalizable to the general population.

CONCLUSION

Infant carrying may be a cost-effective intervention to reduce postpartum depression symptomatology. Large-scale studies are warranted to further examine the efficacy and cost-effectiveness of providing carriers as an intervention to reduce postpartum depression symptomatology.

CLINICAL TRIAL REGISTRATION

Clinicaltrials.gov id: NCT04376021. Data Sharing Statement: Deidentified individual participant data will not be made available because we did not obtain permission to share individual data.

CLINICAL TRIAL REGISTRATION NUMBER

NCT0437602; https://beta.

CLINICALTRIALS

gov/study/NCT04376021.

Precursors of Prenatal Attachment and Anxiety during Pregnancy in Women Who Procreate Naturally and Pregnant Women following Assisted Reproduction Technology

The process of adaptation of the woman to pregnancy seems to be influenced by many factors, such as the type of conception, the mother's age, the possible presence of other children, and socio-cultural factors. Women who conceived with an assisted reproductive technique are emotionally vulnerable; compared with pregnant women who procreated naturally, they manifest elevated anxiety, which seems to be correlated to the fright of being separated from their child. Objectives of the present research are as follows: (1) to analyze the relationship between age, gestational age, time expectancy, previous failed attempts, perception of a high-risk pregnancy, and presence of other children, with the level of maternal-fetal attachment (MFA); (2) explore the level of maternal-infant attachment and anxiety by comparing the control and experimental group; (3) to measure a possible relationship between anxiety levels and MFA in ART pregnant women; (4) to identify variables predictive of prenatal attachment. The study group is formed by ninety-five women aged between 18-42 years (M = 30.57; S.D. = 5.47), pregnant from the 23rd to the 37th week (M = 28.95; S.D. = 3.99); on which 50 women who procreate naturally and 45 pregnant women following assisted reproductive technology. They completed: Maternal-Fetal Attachment Scale (MFAS), State-Trait Anxiety Inventory (STAI), and ad hoc questionnaire to collect anamnestic data. The results show the presence of a correlation between gestational age and waiting period, between the number of assisted fertilization attempts with the worry about their ability to become pregnant, but a negative correlation between pregnancy weeks and the level of maternal-fetal attachment. The study shows the predictive role of anxiety on the MFA. The applications and indications for future research are analyzed.

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 prenatal attachment during the COVID-19 pandemic: exploring the roles of pregnancy-related anxiety, risk perception, and well-being

Pregnant women have faced novel physical and mental health risks during the pandemic. This situation is remarkable because a parent's emotional bond with their unborn baby (also known as prenatal attachment) is related to the parent's mental state. Prenatal attachment helps parents psychologically prepare for the transition into parenthood. Moreover, it plays a pivotal role in the future parentchild relationship and psychosocial development of the baby. Based on the available literature, the current study integrated risk perception theories with mental health indicators to examine maternal prenatal attachment during the pandemic. Pregnant women (n = 258) completed the Pregnancy-Related Anxiety Questionnaire-Revision 2 (PRAQ-R2), the WHO Well-being Index (WHO-5), the Prenatal Attachment Inventory (PAI), and answered questions about COVID-19 risk perception. The findings illustrated that pregnancy-related anxiety was positively associated with maternal prenatal attachment. Moreover, COVID-19 risk perception and well-being mediated this relationship. In other words, the higher levels of pregnancy-related anxiety were associated with increased COVID-19 risk perception and decreased well-being, inhibiting prenatal attachment in pregnant women. Considering the importance of prenatal attachment, it is crucial to understand the experiences of pregnant women and develop policies for promoting prenatal attachment, especially during challenging times such as the COVID-19 pandemic.

Effects of Parity and Postpartum Depression on Mother-Infant Bonding in the First Month Postpartum: A Retrospective Study

Objective This study aimed to examine the relationship between parity, postpartum depression (PPD), and mother-infant bonding (MIB) failure in the first month postpartum. Methods The study included 1,509 Japanese patients (748 primiparous and 761 multiparous). MIB was assessed using the Mother-to-Infant Bonding Scale Japanese version (MIBS-J), which was translated in 2012, and its subscales, including lack of affection (LA) and anger and rejection (AR). Postpartum depression (PPD) was assessed using the Japanese version of the Edinburgh Postnatal Depression Scale (EPDS) and its subscales, including anxiety (ANX), anhedonia (ANH), and depression (DEP). Multiple regression analyses using interaction terms were performed to examine the association of parity with the MIBS-J and EPDS. Results Parity was significantly associated with AR. ANX and ANH were strongly associated with LA, and ANX and DEP were strongly associated with AR. The interaction term "parity×EPDS total" was significantly associated with MIBS-J total, LA, and AR scores. Conclusions Primiparas and mothers with high ANX had more negative emotions toward their children during the first month postpartum, and mothers with high ANX or ANH had less interest in their children.

Prenatal Attachment and Mental Well-Being Among Expectant Fathers Amidst COVID-19: A Cross-Sectional Study

Background The COVID-19 pandemic has posed significant threats to global physical and mental health, notably impacting the psychological management of pregnancy. The mental health of parents plays a critical role in fostering the emotional bond with their unborn child, referred to as prenatal attachment. Despite the significance of this bond, research has primarily concentrated on maternal outcomes, often neglecting the paternal aspect during the pandemic. This study investigates the correlation between coronavirus disease 2019 (COVID-19) risk perception and paternal prenatal attachment, further exploring the mediating role of well-being within this association. Methods A total of 141 expectant fathers attending the gynecology and obstetrics outpatient clinic with their partners were recruited. Participants completed measures including the Paternal Antenatal Attachment Scale (PAAS), the World Health Organization Well-being Index (WHO-5), and the COVID-19 Perceived Risk Scale (CPRS). Results Data analysis revealed a significant negative correlation between COVID-19 risk perception and well-being (ß = -.34, p < .001). There was a positive correlation between well-being and prenatal attachment (ß = .37, p = .002). The prenatal attachment was also positively linked to COVID-19 risk perception (ß = .20, p = .047). Furthermore, well-being mediated the relationship between COVID-19 risk perception and prenatal attachment. Conclusion The findings underscore the potential of the COVID-19 risk perception to disrupt the prenatal attachment process for expectant fathers by interfering with psychological well-being. However, it can also promote prenatal attachment through various mechanisms. Consequently, acknowledging and understanding the experiences of fathers during pregnancy is of paramount importance. Future longitudinal studies are necessitated to examine the parent-child relationship dynamics that have evolved under the influence of the pandemic.

Heatwaves and wildfires suffocate our healthy start to life: time to assess impact and take action

Adverse environmental exposures in utero and early childhood are known to programme long-term health. Climate change, by contributing to severe heatwaves, wildfires, and other natural disasters, is plausibly associated with adverse pregnancy outcomes and an increase in the future burden of chronic diseases in both mothers and their babies. In this Personal View, we highlight the limitations of existing evidence, specifically on the effects of severe heatwave and wildfire events, and compounding syndemic events such as the COVID-19 pandemic, on the short-term and long-term physical and mental health of pregnant women and their babies, taking into account the interactions with individual and community vulnerabilities. We highlight a need for an international, interdisciplinary collaborative effort to systematically study the effects of severe climate-related environmental crises on maternal and child health. This will enable informed changes to public health policy and clinical practice necessary to safeguard the health and wellbeing of current and future generations.

Maternal-infant bonding and partner support during pregnancy and postpartum: Associations with early child social-emotional development

The first 1000 days after conception are considered critical for healthy development and well-being throughout life. Fundamental to health practices during pregnancy and positive parenting after birth is the development of maternal-infant bonding. Previous research has demonstrated the importance of having an involved partner during pregnancy and in parenting for optimal maternal-infant bonding. The current study examined maternal-infant bonding and partner support during pregnancy and the postpartum period, and their associations with early child social-emotional development. A total of 227 women completed the Pre- and Postnatal Bonding Scale (PPBS) and Tilburg Pregnancy Distress Scale (TPDS) during pregnancy (32 weeks of gestation) and at 8 months postpartum, assessing maternal-infant bonding and partner support. Additionally, a questionnaire on social-emotional behavior of the Bayley Scales of Infant and Toddler Development was administered to mothers to measure child development at 2 years of age. Path analyses revealed an indirect positive effect of prenatal maternal-infant bonding on child social-emotional development through postnatal maternal-infant bonding, as well as mediating effects of pre- and postnatal maternal-infant bonding on the association between pre- and postnatal partner support and child social-emotional development. Our findings support the notion that an emotional connection from mother to child originates in pregnancy and that experiencing positive feelings towards the fetus promotes positive maternal-infant bonding after birth and social-emotional capacities of the child. Additionally, having a supportive partner during pregnancy and postpartum, might be essential for the development of optimal maternal-infant bonding.

The effect of spousal support on distress experienced during pregnancy in COVID-19 pandemic: Sample of Türkiye

We conducted this study with 147 volunteer pregnant women to determine the effect of spousal support on the stress experienced during pregnancy during the COVID-19 pandemic period. We determined that the prenatal stress level of the pregnant women was low (15.34 ± 7.07), they were not at risk for distress, and the spousal support level was high (74.58 ± 8.78). We found that the rate of spousal support was 0.897 times higher for women who did not experience distress. Due to the stay-at-home rule during the pandemic, couples had to be together at home, which caused high spousal support, and we found that women's stress levels were lower.

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.

Parent-child interactions in early life mediating association between prenatal maternal stress and autistic-like behaviors among preschoolers

A range of studies have shown that prenatal maternal stress (PNMS) exposure is associated with offspring autistic-like behaviors, however the potential pathways remain unexplored. This study aimed to evaluate the mediating role of parent-child interactions in early life in the association between PNMS exposure and preschoolers' autistic-like behaviors. Data from 65,928 child-parent dyads were obtained via a primary caregiver-reported questionnaire administered as part of the Longhua Child Cohort Study. To strengthen confidence in the reliability of the results, the analyses were initially conducted on a random selection of 70% of the total sample, and then validated on the remaining 30% of the sample. Analysis of covariance and multiple linear models were employed to estimate the associations between PNMS exposure, parent-child interactions in early life, and children's autistic-like behaviors. The results showed that PNMS exposure was positively associated with the presence of autistic-like behaviors at preschool age. The total indirect effect of the frequency of positive parent-child interactions in early life accounted for 9.69% or 8.99% of the variance of the association. Our findings indicate that parent-child interactions in early life might function as potential mediators of the association between PNMS and the increased risk of offspring autistic-like behaviors.

Associations between maternal psychological distress and mother-infant bonding: a systematic review and meta-analysis

PURPOSE

Maternal psychological distress and mother-infant bonding problems each predict poorer offspring outcomes. They are also related to each other, yet the extensive literature reporting their association has not been meta-analysed.

METHODS

We searched MEDLINE, PsycINFO, CINAHL, Embase, ProQuest DTG, and OATD for English-language peer-reviewed and grey literature reporting an association between mother-infant bonding, and multiple indicators of maternal psychological distress.

RESULTS

We included 133 studies representing 118 samples; 99 samples (110,968 mothers) were eligible for meta-analysis. Results showed concurrent associations across a range of timepoints during the first year postpartum, between bonding problems and depression (r = .27 [95% CI 0.20, 0.35] to r = .47 [95% CI 0.41, 0.53]), anxiety (r = .27 [95% CI 0.24, 0.31] to r = .39 [95% CI 0.15, 0.59]), and stress (r = .46 [95% CI 0.40, 0.52]). Associations between antenatal distress and subsequent postpartum bonding problems were mostly weaker and with wider confidence intervals: depression (r = .20 [95% CI 0.14, 0.50] to r = .25 [95% CI 0.64, 0.85]), anxiety (r = .16 [95% CI 0.10, 0.22]), and stress (r = .15 [95% CI - 0.67, 0.80]). Pre-conception depression and anxiety were associated with postpartum bonding problems (r = - 0.17 [95% CI - 0.22, - 0.11]).

CONCLUSION

Maternal psychological distress is associated with postpartum mother-infant bonding problems. Co-occurrence of psychological distress and bonding problems is common, but should not be assumed. There may be benefit in augmenting existing perinatal screening programs with well-validated mother-infant bonding measures.

The effect of the COVID-19 pandemic on UK parent experiences of pregnancy ultrasound scans and parent-fetal bonding: A mixed methods analysis

INTRODUCTION

Companionship in antenatal care is important for facilitating positive parental experiences. During the COVID-19 pandemic, restrictions on partner attendance at fetal ultrasound scans were introduced nationally to minimise transmission of the virus. This study aimed to explore the effect of these restrictions on maternal and paternal experiences of pregnancy scans and evaluate their potential effect on parent-fetal bonding.

METHODS

A UK-wide, anonymous cross-sectional survey was completed by new and expectant parents (n = 714) who had, or were awaiting a pregnancy scan during the COVID-19 pandemic. The CORE-10 and an adapted version of the Prenatal Attachment Inventory were used to evaluate psychological distress and prenatal bonding. Additional survey questions captured parental experiences of scans. Separate statistical and thematic analyses of the data were undertaken. A joint display matrix was used to facilitate integration of quantitative and qualitative claims to generate a comprehensive interpretation of study findings.

FINDINGS

When fathers did not attend the scan, feelings of excitement and satisfaction were significantly reduced (p<0.001) and feelings of anxiety increased (p<0.001) in both parents. Mothers were concerned about receiving unexpected news alone and fathers felt excluded from the scan. Mean paternal bonding (38.22, SD 10.73) was significantly lower compared to mothers (47.01, SD 7.67) although no difference was demonstrated between those who had attended the scan and those who had not. CORE-10 scores suggested low-to-mild levels of psychological distress, although the mean difference between mothers and fathers was not significant. Key themes described both parents' sense of loss for their desired pregnancy scan experience and reflected on sonographers' central role in providing parent-centred care during scans.

CONCLUSION

Restrictions on partner attendance at scans during the COVID-19 pandemic had a negative effect on parental experiences of antenatal imaging. Provision of parent-centred care, which is inclusive of partners, is essential for improved parental experiences.

Accounts of women identified as drinking at 'high risk' during pregnancy: A meta-ethnography of missing voices

BACKGROUND

Drinking alcohol during pregnancy is associated with Foetal Alcohol Spectrum Disorders (FASD), and women who drink at higher levels are more likely to have a baby with FASD. Public health responses focus on population-level approaches to FASD prevention such as promoting abstinence and alcohol brief interventions. Efforts to better understand and respond to 'high risk' drinking during pregnancy have been largely ignored. This meta-ethnography of qualitative research aims to inform this policy and practice agenda.

METHODS

Ten health, social care, and social sciences databases were searched for qualitative studies published since 2000 exploring drinking during pregnancy. Studies that included accounts of women who described themselves, or were diagnosed as, alcohol-dependent during pregnancy, or reported drinking during pregnancy at levels considered by the Word Health Organisation to constitute 'high risk' drinking, were eligible. Noblit and Hare's analytic approach to meta-ethnography was used to synthesise the studies and eMERGe reporting guidance was followed.

RESULTS

Nine diverse studies were included. All explored the impact of social norms and relationships, women's knowledge about the risks involved in drinking during pregnancy, the behaviour of women, and the advice they received. Three key themes were identified: drinking is social and relational, knowledge is not enough, and multiple adversities matter. Multiple adversities were interconnected and primarily related to structural inequalities and oppression. The complex needs of women and the wider context in which their drinking occurred were rarely explored or responded to during pregnancy.

CONCLUSION

This meta-ethnography provides a more nuanced understanding of the complex dynamics involved in women's 'high risk' drinking during pregnancy, the contexts in which they drink and their unmet needs. These findings can inform future policy and practice responses to 'high risk' drinking during pregnancy. Further research should explore women's experiences in a UK context and consider how services could meet women's needs.

Self-objectification during the perinatal period: The role of body surveillance in maternal and infant wellbeing

Pregnancy represents a unique time during which women's bodies undergo significant physical changes (e.g., expanding belly, larger breasts, weight gain) that can elicit increased objectification. Experiences of objectification set the stage for women to view themselves as sexual objects (i.e., self-objectification) and is associated with adverse mental health outcomes. Although women may experience heightened self-objectification and behavioral consequences (such as body surveillance) due to the objectification of pregnant bodies in Western cultures, there are remarkably few studies examining objectification theory among women during the perinatal period. The present study investigated the impact of body surveillance, a consequence of self-objectification, on maternal mental health, mother-infant bonding, and infant socioemotional outcomes in a sample of 159 women navigating pregnancy and postpartum. Utilizing a serial mediation model, we found that mothers who endorsed higher levels of body surveillance during pregnancy reported more depressive symptoms and body dissatisfaction, which were associated with greater impairments in mother-infant bonding following childbirth and more infant socioemotional dysfunction at 1-year postpartum. Maternal prenatal depressive symptoms emerged as a unique mechanism through which body surveillance predicted bonding impairments and subsequent infant outcomes. Results highlight the critical need for early intervention efforts that not only target general depression, but also promote body functionality and acceptance over the Western "thin ideal" of attractiveness among expecting mothers.