IN REVIEW
A Literature Update on Maternal-Fetal Attachment

https://doi.org/10.1111/j.1552-6909.2008.00241.xGet rights and content

ABSTRACT

Objective

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

Data Sources

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

Study Selection

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

Data Extraction

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

Data Synthesis

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

Conclusions

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

Section snippets

Methods

Four electronic databases were systematically searched to identify research articles deemed relevant for this review. They included PubMed, CINAHL Plus, PsycINFO, and SCOPUS. The limits placed on the database searches included original research articles published between 2000 and 2007 that studied human participants and were written in English. The following inclusion criteria were used: (a) original research, (b) studies that clearly delineated the measurement of MFA, (c) measurement of MFA

Definition and measurement of MFA

Kennell, Slyter, and Klaus’s (1970) observations of the intense grief displayed by mothers of infants who died during birth marked one of the first empirical suggestions that a prenatal connection existed between a mother and her unborn child. Further work by Klaus et al., (1972) demonstrated the deleterious effects of early separation between a mother and her child thereby focusing their efforts on interventions to enhance early postnatal attachment. These findings undoubtedly fueled the

The role of technology and diagnostics in MFA

It is only within the past 30 years that visualizing the living fetus has been possible. Previously, its life was often acknowledged once “quickening” developed, when the pregnant woman first felt her baby moving within her uterus. The option and ability to view the fetus as an independent being at an earlier point in pregnancy likely contributes to the maternal-fetal relationship developing at a much earlier point in fetal development (Stormer, 2003).

Five studies reviewed examined how the use

Demographic variables

It is widely known that much of the health disparity in preterm delivery, low birth weight, and other poor pregnancy outcomes are associated with those racial and ethnic groups exposed to poor social, economic, and health conditions (Patrick & Bryan, 2005). Similarly, MFA has been shown to predict engagement in health practices with higher levels of MFA correlating with high-quality health practices (Walker, Cooney, & Riggs, 1999), such as receiving prenatal care (Lowry & Beikirch, 1998),

Mood state influence on MFA

There is growing evidence that depression and anxiety disorders can begin prenatally and that the prevalence of depression during pregnancy is comparable to postpartum rates (Austin 2003, Austin 2004, Evans et al., 2001, Green 1998). Hart and McMahon (2006) sought to examine the impact of depression and anxiety on MFA and found that those women characterized as having low quality of fetal attachment reported significantly higher levels of anxiety (state and trait) and depression. However,

Previous fetal loss or abnormality

Perinatal loss is a traumatic event that can profoundly affect the lives of families. When a mother experiences such a loss she may grieve for many years, and a subsequent pregnancy may evoke great trepidation thereby disrupting attachment. Likewise, the diagnosis of a fetal abnormality may be devastating to a woman and her partner as abnormalities detected in utero rarely have options for treatment (Kenner and Dreyer 2000, Sandelowski and Corson Jones 1996, Sandelowski and Corson Jones 1996).

Discussion

The principle findings of this systematic review reveal that there are certain factors that threaten MFA including depression, anxiety, and substance abuse, while others appear to enhance MFA. Unfortunately, those factors deemed favorable to MFA are often highly correlated with higher socioeconomic status such as improved access to timely and comprehensive prenatal care (ultrasound) and the presence of stable family relationships and support systems. The scarcity of research on MFA in ethnic

Clinical implications and future directions

While research on MFA has increased over the past 20 years, significant gaps remain in examining the relationship between MFA and aspects of prenatal care. A critical aspect of MFA, which has been inadequately addressed, is the relationship between MFA and health practices during pregnancy. Lindgren 2001, Lindgren 2003 research illustrated the link between the two; however, she rightfully acknowledged that the cross-sectional designs prevent causal inferences. Other factors that likely impact

Conclusions

The transition to motherhood is both complex and challenging. It requires extensive effort psychologically, socially, and physically. Maternal-fetal attachment has been considered both a developmental task of pregnancy and an indicator of adaptation to pregnancy, as well as being positively associated with prenatal health practices (Callister 2002, Lindgren 2001). As health care providers, it is our responsibility to work tirelessly in conducting and using research as the basis for the

Acknowledgment

Supported by Interdisciplinary Research Training on Violence Predoctoral Fellowship: Institutional NRSA (T32 MH20014-08). The author thanks Drs. Phyllis W. Sharps and Jacquelyn C. Campbell.

References (75)

  • M.E. Muller

    Prenatal and postnatal attachment: A modest correlation

    Journal of Obstetric, Gynecologic, and Neonatal Nursing

    (1996)
  • T.E. Patrick et al.

    Research strategies for optimizing pregnancy outcomes in minority populations

    American Journal of Obstetrics and Gynecology

    (2005)
  • P.H. Pollock et al.

    Maternal antenatal attachment style and potential fetal abuse

    Child Abuse and Neglect

    (1999)
  • M. Sandelowski et al.

    “Healing fictions”: Stories of choosing in the aftermath of the detection of fetal anomalies

    Social Science & Medicine

    (1996)
  • C. Shieh et al.

    Maternal-fetal attachment in pregnant women who use illicit drugs

    Journal of Obstetric, Gynecologic, and Neonatal Nursing

    (2002)
  • C. Shieh et al.

    Severity of drug use, initiation of prenatal care, and maternal-fetal attachment in pregnant marijuana and cocaine/heroine users

    Journal of Obstetric, Gynecologic, and Neonatal Nursing

    (2006)
  • P. Slade et al.

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

    Addictive Behaviors

    (2006)
  • L.O. Walker et al.

    Psychosocial and demographic factors related to health behaviors in the 1st trimester

    Journal of Obstetric, Gynecologic, and Neonatal Nursing

    (1999)
  • N.R. Ahern et al.

    Maternal-fetal attachment in African-American and Hispanic-American women

    Journal of Perinatal Education

    (2003)
  • D.S. Armstrong

    Emotional distress and prenatal attachment in pregnancy after perinatal loss

    Journal of Nursing Scholarship

    (2002)
  • M.P. Austin

    Perinatal mental health: Opportunities and challenges for psychiatry

    Australasian Psychiatry

    (2003)
  • M.P. Austin

    Antenatal screening and early intervention for “perinatal” distress, depression and anxiety: Where to from here?

    Archive of Women’s Mental Health

    (2004)
  • C.R. Bauer et al.

    The maternal lifestyle study: Drug exposure during pregnancy and short-term maternal outcomes

    American Journal of Obstetrics and Gynecology

    (2002)
  • C.T. Beck

    Available instruments for research on prenatal attachment and adaptation to pregnancy

    American Journal of Maternal/Child Nursing

    (1999)
  • J.C. Berryman et al.

    Pregnancy after 35 and attachment to the fetus

    Journal of Reproductive and Infant Psychology

    (1996)
  • K.C. Bloom

    The development of attachment behaviours in pregnant adolescents

    Nursing Research

    (1995)
  • C.F. Boukydis et al.

    Women’s responses to ultrasound examinations during routine screens in an obstetric clinic

    Journal of Ultrasound in Medicine

    (2006)
  • J. Bowlby

    Attachment, separation and loss

    (1969)
  • A.A. Bryan

    Enhancing parent-child interaction with a prenatal couple intervention

    American Journal of Maternal/Child Nursing

    (2000)
  • L.C. Callister

    Comments: Relationships among maternal-fetal attachment, prenatal depression, and health practices in pregnancy

    American Journal of Maternal/Child Nursing

    (2002)
  • B.L. Cannella

    Maternal-fetal attachment: An integrative review

    Journal of Advanced Nursing

    (2005)
  • S. Cnattingius et al.

    Caffeine intake and the risk of first-trimester spontaneous abortion

    New England Journal of Medicine

    (2000)
  • J.T. Condon et al.

    The correlates of antenatal attachment in pregnant women

    British Journal of Medical Psychology

    (1997)
  • M.S. Cranley

    Development of a tool for the measurement of maternal attachment during pregnancy

    Nursing Research

    (1981)
  • EBSCO. Industries

    EBSCO host research databases

    (2007)
  • B.V. Elsivier

    SCOPUS info

    (2007)
  • J. Evans et al.

    Cohort study of depressed mood during pregnancy and after childbirth

    British Medical Journal

    (2001)
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