Bonding with bump: Interoceptive sensibility moderates the relationship between pregnancy body satisfaction and antenatal attachment

PROBLEM

There is limited understanding and contradictory results regarding the contribution of the pregnant bodily experience to antenatal attachment.

BACKGROUND

Antenatal attachment is an important aspect of pregnancy, which has been linked with positive maternal and infant outcomes. Given the profound physical process of pregnancy, it is likely that bodily experience is implicated in antenatal attachment, with research supporting the involvement of pregnancy body (dis)satisfaction. However, previous research reveals conflicting results and has only focused on exteroceptive bodily experience (appearance) rather than internal physiological sensations (interoception).

AIM

To examine the relative contributions of both external and internal bodily experience in antenatal attachment.

METHODS

This cross-sectional study collected online survey data from 159 pregnant participants with measures capturing interoceptive sensibility (subjective experience of interoception), pregnancy body dissatisfaction and antenatal attachment.

FINDINGS

We replicated previous findings that pregnancy body dissatisfaction is related to antenatal attachment. However, the relationship between pregnancy body dissatisfaction and antenatal attachment was moderated by worry about interoceptive signals. The interoceptive construct of body trust was most strongly associated with antenatal attachment.

DISCUSSION

The results suggest that interoception is important for antenatal attachment, particularly feelings of body trust. Moreover, for individuals who were less worried about bodily sensations, high levels of body dissatisfaction were associated with low attachment scores, whilst for those who were more concerned about these sensations, the relationship between body dissatisfaction and antenatal attachment was mitigated.

CONCLUSION

The results suggest that focusing on internal sensations may be a protective strategy against pregnancy body dissatisfaction to strengthen maternal bonds.

Prenatal attachment in women with twin versus singleton pregnancy: Socio-demographic, mental health and pregnancy-related predictors

BACKGROUND

While twin pregnancy (TP) is associated with increased maternal physical and psychological risks, little is known about how this context interferes with prenatal attachment.

AIMS

To compare the level of prenatal attachment between women with TP and singleton pregnancy (SP), and to investigate socio-demographic, maternal mental health and pregnancy-related predictors.

STUDY DESIGN

Case-control study in a university hospital.

SUBJECTS

119 women with TP during their last trimester of pregnancy versus 103 women with SP.

OUTCOME MEASURES

The Prenatal Attachment Inventory (PAI), the Edinburgh Postnatal Depression Scale (EPDS), in addition to the collection of general socio-demographic and medical data.

RESULTS

The mean PAI total score did not significantly differ between the two groups. In the group of women with TP, low but statistically significant correlations were found between the PAI total score and the EPDS total score (r = -0.21) and with maternal age (r = -0.20).

CONCLUSIONS

No major difference in prenatal attachment was found in women TP compared to those with SP. A higher level of depressive symptoms is worth considering to explore the risk of suboptimal attachment in this population. Questions were raised about the applicability of usual measures of prenatal attachment in this context.

The mental health crisis of expectant women in the UK: effects of the COVID-19 pandemic on prenatal mental health, antenatal attachment and social support

Background

Pregnancy has been shown to be times in a woman’s life particularly prone to mental health issues, however a substantial percentage of mothers report subclinical perinatal mental health symptoms that go undetected. Experiences of prenatal trauma, such as the COVID-19 pandemic, may exacerbate vulnerability to negative health outcomes for pregnant women and their infants. We aimed to examine the role of: 1) anxiety, depression, and stress related to COVID-19 in predicting the quality of antenatal attachment; 2) perceived social support and COVID-19 appraisal in predicting maternal anxiety and depression.

Methods

A sample of 150 UK expectant women were surveyed during the COVID-19 pandemic. Questions included demographics, pregnancy details, and COVID-19 appraisal. Validated measures were used to collect self-reported maternal antenatal attachment (MAAS), symptoms of anxiety (STAI), depression (BDI-II), and stress related to the psychological impact of COVID-19 (IES-r).

Results

We found that the pandemic has affected UK expectant mothers’ mental health by increasing prevalence of depression (47%), anxiety (60%) and stress related to the psychological impact of COVID-19 (40%). Women for whom COVID-19 had a higher psychological impact were more likely to suffer from depressive (95% HDPI = [0.04, 0.39]) and anxiety symptoms (95% HPDI = [0.40, 0.69]). High depressive symptoms were associated with reduced attachment to the unborn baby (95% HPDI [-0.46, -0.1]). Whilst women who appraised the impact of COVID-19 to be more negative showed higher levels of anxiety (HPDI = [0.15, 0.46]), higher social support acted as a protective factor and was associated with lower anxiety (95% HPDI = [-0.52, -0.21]).

Conclusions

The current findings demonstrate that direct experience of prenatal trauma, such as the one experienced during the COVID-19 pandemic, significantly amplifies mothers’ vulnerability to mental health symptoms and impairs the formation of a positive relationship with their unborn baby. Health services should prioritise interventions strategies aimed at fostering support for pregnant women.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-04387-7.

Health Pregnancy, Healthy Baby: testing the added benefits of pregnancy ultrasound scan for child development in a randomised control trial

BACKGROUND

The 2016 World Health Organization Antenatal Guidelines and the 2015 South African Maternal and Child Health Guidelines recommend one early antenatal ultrasound scan to establish gestational age and to detect multiple pregnancies and fetal abnormalities. Prior research indicates that ultrasound scan can also increase parental-fetal attachment. We aim to establish whether, compared to routine care, messages to promote parental attachment and healthy child development, conducted during one or two pregnancy ultrasound scans, improve early child development and growth, exclusive breastfeeding, parental-child interactions and prenatal and postnatal clinic attendance.

METHODS

The effect of messages to sensitise mothers and fathers to fetal development will be tested in a three-armed randomised trial with 100 mothers and their partners from Soweto, Johannesburg in each arm. The primary outcome is child development at 6 months postnatally. Secondary outcomes include infant feeding, parental attachment and interaction, parental mental health and infant growth, assessed at 6 weeks and 6 months. Parents in Arm 1 receive a fetal ultrasound scan < 25 weeks during routine antenatal care at tertiary hospitals, and a second standard ultrasound scan at the research site within 2 weeks. Arm 2 participants receive the routine antenatal ultrasound scan and an additional ultrasound scan < 25 weeks at the research site, together with messages to promote parental attachment and healthy child development. Arm 3 participants receive the routine ultrasound scan and two additional ultrasound scans at the research site, < 25 weeks and < 36 weeks, together with messages to promote parental attachment and healthy child development.

DISCUSSION

Evidence from high-income countries suggests that first-time prospective mothers and fathers enjoy seeing their fetus during ultrasound scan and that it is an emotional experience. A number of studies have found that ultrasound scan increases maternal attachment during pregnancy, a predictor of positive parent-infant interactions which, in turn, promotes healthy infant development. It is generally agreed that studies are needed which follow up parental-child behaviour and healthy child development postnatally, include fathers and examine the construct in a wider diversity of settings, especially in low and middle-income countries. Testing the added benefits of pregnancy ultrasound scan for child development is a gap that the proposed trial in South Africa seeks to address.

TRIAL REGISTRATION

Pan African Clinical Trials Registry, PACTR201808107241133. Registered on 15 August 2018.

The protective role of mentalizing: Reflective functioning as a mediator between child maltreatment, psychopathology and parental attitude in expecting parents

BACKGROUND

Childhood maltreatment impacts parenting and has intergenerational consequences. It is therefore crucial to identify clinically responsive resilience-promoting factors in pregnant women and expecting men with history of childhood maltreatment. Mentalization, or reflective functioning, appears as a promising concept to understand risk and resilience in the face of childhood maltreatment.

OBJECTIVE

This study evaluated the multivariate relationship between exposure to childhood maltreatment, reflective functioning, psychological symptoms and parental attitude in expecting parents.

METHODS

Two hundred and thirty-five pregnant women and 66 expecting fathers completed self-report assessment measures of childhood trauma, reflective functioning, depression, post-traumatic stress disorder, parental sense of competence and antenatal attachment. Twenty-eight percent (n = 85) of the community sample reported personal histories of childhood maltreatment.

RESULTS

Structural equation modeling indicated that reflective functioning (a) partially mediated the association between childhood maltreatment and psychological symptoms during pregnancy and (b) independently predicted participants' perception of parental competence and psychological investment toward the unborn child.

CONCLUSION

Overall, this study provides empirical evidence of the protective role of reflective functioning during the prenatal period in parents with histories of childhood maltreatment.

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

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

Surveying prenatal attachment in fathers: the Italian adaptation of the Paternal Antenatal Attachment Scale (PAAS-IT)

OBJECTIVE

This study focuses on the process of the father's bonding with the fetus and aims to assess the psychometric properties of the Italian translation of the Paternal Antenatal Attachment Scale (PAAS).

BACKGROUND

The construct of prenatal attachment has been created to systematically investigate the nature of the particular bond that develops in the minds of parents expecting a child. Paternal attachment to the unborn child has not been well explored until now, despite its undoubted importance. The PAAS is a 16-item questionnaire evaluating paternal thoughts, feelings, attitudes and emotions towards the fetus validated with Australian fathers.

METHODS

This is a cross-sectional study. A forward-backward translation was used to obtain the PAAS Italian version (PAAS-IT). A sample of 165 Italian fathers completed the PAAS-IT, the 20-Toronto Alexithymia Scale and a sociodemographic questionnaire also investigating the father's attitudes towards the fetus. The reliability and construct validity of the PAAS-IT were evaluated. A Principal Component Analysis (PCA) and a Confirmatory Factor Analysis (CFA) using Structural Equation Modelling (SEM) were conducted.

RESULTS

The PAAS-IT psychometric characteristics were adequate. The PCA yielded a two-dimensional model explaining 34% of the variance. The CFA acknowledges the truthfulness of this model. The items loading on the two factors did not exactly match that found in the original PAAS, suggesting the influence of specific cultural features.

CONCLUSIONS

The PAAS-IT is a reliable and valid instrument to use in Italian clinical settings to investigate the development of the paternal attachment towards the unborn child.

The growth of maternal-fetal emotional attachment in pregnant adolescents: a prospective cohort study

STUDY OBJECTIVE

To describe self-reported maternal-fetal emotional attachment in adolescent women over the course of pregnancy, compare it with adult pregnant women, and identify risk factors for poor attachment.

DESIGN

A prospective cohort study.

SETTING

Young mothers' clinics in 2 public hospitals in metropolitan Melbourne, Australia.

PARTICIPANTS

English-speaking young women aged 20 years and under attending their first antenatal visit.

METHODS

Self-report questionnaires were completed in each trimester. Validated measures were used to assess anxiety and depression symptoms and maternal-fetal emotional attachment. Data were analyzed with existing data from pregnant adults. Regression analyses were conducted to establish factors independently associated with higher mean first-trimester attachment score and lowest-quartile third trimester score adjusting for confounding variables.

MAIN OUTCOME MEASURE

Maternal-fetal emotional attachment, assessed by the Quality and Intensity subscales and Global score on Maternal Antenatal Attachment Scale (MAAS).

RESULTS

165/194 (85%) completed the first questionnaire; 130/165 (79%) provided complete data. Mean anxiety but not depression scores were significantly higher in adolescents than adults across pregnancy. Mean (95%CI) first-trimester adolescent Global MAAS was significantly lower than adults (70.3 (68.4, 72.2) vs 76.8 (75.4, 78.2) P < .01), but there were no significant second- or third-trimester between-group differences. Adjusted odds of a lowest-quartile third-trimester MAAS score was significantly associated with lower first-trimester score (P < .001), previous abortion (P = .02) and being born overseas (P = .002).

CONCLUSION

Adolescents report slower development of antenatal emotional attachment than adults. Women with risk factors for poor attachment in late pregnancy are identifiable in early pregnancy and may benefit from additional multidisciplinary care.

Effects of perinatal loss on current pregnancy in Turkey

OBJECTIVE

to evaluate how a history of pregnancy loss in the perinatal period (from 20 weeks of gestation to seven days post partum) affects women during subsequent pregnancies.

DESIGN

cross-sectional, descriptive study.

SETTING

Istanbul Medical School, Istanbul University between January and October 2009.

PARTICIPANTS

128 pregnant women with a history of pregnancy loss and 214 pregnant women without a history of pregnancy loss.

MEASUREMENTS AND FINDINGS

in all women, antenatal attachment was measured using the Prenatal Attachment Inventory, depression was measured using the Center for Epidemiologic Studies' Depression Scale, and coping with stress was measured using the Scale of Ways of Coping with Stress. The rates of undergoing tests (other than routine tests) (p<0.001), calling medical professionals (p<0.001) and visiting an obstetrician more than once per month (p<0.001) were higher in women with a history of pregnancy loss compared with women without a history of pregnancy loss. No difference was found between the groups in terms of coping with stress (p>0.05) and antenatal attachment (p=0.384). However, depressive symptoms were higher in women with a history of pregnancy loss (p=0.008).

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

levels of depression, antenatal attachment and coping with stress should be evaluated meticulously in women with a history of pregnancy loss, and appropriate interventions should be performed.