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

BackgroundExperiences of prenatal trauma exacerbates 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.MethodsA 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). ResultsWe found that the pandemic has affected UK expectant mothers’ mental health by increasing prevalence of depression, anxiety and stress. Women for whom COVID-19 had a higher psychological impact were more likely to suffer from depressive symptoms. High depressive symptoms were associated with reduced attachment to the unborn baby. Whilst women who appraised the impact of COVID-19 to be more negative showed higher levels of anxiety, higher social support acted as a protective factor and was associated with lower anxiety.LimitationsThe cross-sectional nature of the study hinders conclusions about causality. Future research should include paternal prenatal mental health. ConclusionsDirect 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.

Paternal Response to Ultrasound Predicts Increased Paternal-Fetal Attachment

Utilizing data from a longitudinal online survey of couples expecting their first child, this study sought to examine the trajectory of paternal-fetal attachment across the three trimesters of pregnancy. Expectant fathers (N=124) who completed at least the first two assessments were included in the analysis. Attachment was assessed using the Paternal Antenatal Attachment Scale, and paternal response to the ultrasound was measured with a four-item scale developed for this study. Longitudinal multilevel regression was used to model change in paternal-fetal attachment across assessments. Paternal-fetal attachment increased among all fathers, including those who showed less response to ultrasound and those who reported the pregnancy as mistimed or undesired. However desired pregnancy and stronger paternal response to ultrasound were associated with a larger increase in paternal-fetal attachment. The findings of the study have implications for the support of paternal-fetal attachment in health care and other settings.

Validity and reliability of Turkish version of “Paternal Antenatal Attachment Questionnaire”

Objective:The study was carry out in order to evaluate the validity and reliability of Paternal-Antenatal Attachment Questionnaire. Method: Research was made with 155 expectant fathers who attended routine pregnancy controls with their partners in a obstetric and gynecology clinic in Izmir, were literate, aged 18 or older and without any health risk of fetus. Data were collected by information form and Paternal-Antenatal Attachment Questionnaire by developed Condon in 1993. İnitially the language validity of the scale was made by using the translation-back translation method with five experts. The Turkish version of the scale was presented to the opinion of ten experts using Davis technique for the content validity and content validity index was calculated. Factor structure was tested.by exploratory and confirmatory factor analysis. In the confirmatory factor analysis, structural equation modelling fit indices were examined. Findings: Content validity index of each item was determined to vary between .80–1.00. As a result of exploratory factor analysis, a two-factor structure explaining 36.54% of the total variance of the scale was determined. Factor loads vary between 0.41-0.84 in the one dimension and 0.30-0.82 in the another dimension. Confirmatory factor analysis showed that this two-factor structure was appropriate (RMSEA 0.044, GFI 0.912, AGFI 0.880 χ2/df ise 1.298(p=0.025). The Cronbach’s alpha value of scale was 0.79. Conclusions: The two-factor structure of the scale, as “attachment quality” and “time spent of attachment mode” is valid and reliable for the use of expectant fathers’ Turkish society. ​Extended English summary is in the end of Full Text PDF (TURKISH) file. Özet Amaç: Araştırma “Paternal Antenatal Bağlanma Ölçeği”nin geçerlik ve güvenirliğini incelemek amacıyla gerçekleştirilmiştir. Yöntem: Araştırma İzmir’de bir kadın doğum kliniğine, eşleriyle birlikte rutin gebelik kontrollerine katılan, okuma yazma bilen, 18 yaş üzeri ve fetüste herhangi sağlık riski bulunmayan 155 baba adayı ile gerçekleştirilmiştir. Veriler sosyodemografik bilgi formu ve Condon tarafından 1993 tarihinde geliştirilmiş olan “Paternal Antenatal Bağlanma Ölçeği” ile toplanmıştır. Öncelikle beş uzman ile çeviri-geri çeviri yöntemi kullanılarak ölçeğin dil geçerliği yapılmıştır. Türkçe son hali oluşturulmuş ölçek kapsam geçerliliği için Davis tekniği kullanılarak on alan uzmanın görüşüne sunulmuş ve kapsam geçerlik indeksi hesaplanmıştır. Açımlayıcı ve doğrulayıcı faktör analizi ile ölçeğin faktör yapısı değerlendirilmiştir. Doğrulayıcı faktör analizi için yapısal eşitlik modeli uyum indeksleri incelenmiştir. Ölçeğin güvenirlik analizinde cronbach alfa güvenirlik katsayısı ve madde toplam kolelasyon değerleri hesaplanmıştır. Bulgular: Kapsam geçerlik indeksi sonucu her bir maddenin 0,80-1,00 arasında değiştiği belirlenmiştir. Açımlayıcı faktör analizi ile ölçeğin toplam varyansının % 36.54’ünü açıklayan iki faktörlü bir yapı belirlenmiştir. Faktör yükleri ilk boyutta 0.41- 0.84 arasında değişirken diğer boyutta 0.30-0.82 değerleri arasında değişmektedir. Doğrulayıcı faktör analizi bu iki faktörlü yapının uygun olduğunu göstermiştir (RMSEA 0.044, GFI 0.912, AGFI 0.880 χ2/df ise 1.298(p=0.025). Ölçeğin Cronbach’s Alpha değeri 0.79 bulunmuştur. Sonuç: “Bağlanma kalitesi” ve “bağlanmaya yönelik geçirilen zaman” olmak üzere iki faktörlü yapıdan oluşan ölçek Türk toplumunda bebek bekleyen baba adaylarının kullanılması için geçerli ve güvenilirdir.

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

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

Does prenatal attachment increase over pregnancy?

Background Prenatal measurement can highlight early attachment issues in mothers and prenatal attachment could be a predictor of postnatal attachment. It is necessary to better understand prenatal attachment trends in both genders to identify and intervene quicker when attachment issues are present. Aims This paper explores the changes in parent-fetal attachment throughout pregnancy, examining attachment score changes and differing gender trends. Methods Of the participants, 101 parents (59 female, 42 male) completed the respective Maternal/Paternal Antenatal Attachment Scale ( Condon, 1993 ) at two administrations during pregnancy. Findings Paired t-tests revealed a significant increase in female scores (p<0.0001) and a non-significant increase in male scores (p=0.102) from first to second administration. Conclusion Female attachment increased in strength as pregnancy progressed, while male attachment remained relatively stable throughout. Further research is needed to examine gender differences across trimesters, the impact of interventions designed to improve attachment and attachment in more diverse populations.