Prenatal bonding to the fetus: its associated factors in mothers and fathers and its predictive relevance for the postpartum dissatisfaction with motherhood.

Abstract

Background: A central theme during pregnancy is to develop a first emotional bond to the fetus. Regarding the connection of parental-fetal bonding with associated factors and its relation to the experience of motherhood, mixed or limited results were reported in the literature so far. This dissertation addresses these gaps by investigating i) patterns in the reported associations of maternal-fetal bonding with prenatal anxiety, ii) the influence of hostility of parents as well as their own romantic attachment style on prenatal bonding, and iii) the effect of maternal-fetal bonding on postnatal dissatisfaction with motherhood. Method: A systematic review of the available literature was conducted after searching four electronic databases. Self-report, questionnaire-based data was collected from pregnant women (total N=360) and their partners (total N=128) from Hamburg, Germany, in the second to third trimester of pregnancy. Mothers were reassessed at three weeks postpartum. Data was analyzed cross-sectionally and longitudinally via bi- and multivariate analyses. Also, the psychometric properties of German translations of two questionnaires on parental-fetal bonding and pregnancy-related anxiety were investigated using methods from classical test theory. Results: The systematic review of 31 studies showed that especially the quality of the maternal-fetal bond was across studies associated with different forms of anxiety. Cross-sectional analysis of the data showed that women with higher hostility and attachment-related avoidance reported lower maternal-fetal bonding quality. Unexpectedly, a more hostile partner predicted higher maternal-fetal bonding quality. For fathers, no associations were found for bonding quality. Only the intensity of mental preoccupation with the fetus was negatively associated with attachment-related avoidance. In longitudinal analysis, maternal-fetal bonding did not predict postnatal dissatisfaction with motherhood. Conclusion: Overall, the reported results indicate that women with elevated levels of anxiety, hostility, and attachment-related avoidance might struggle with developing an emotional bond to the fetus. Further research on factors influencing paternal-fetal bonding is needed. Further, clinical research and practice might benefit from an approach including dynamics between family members to fully understand the development of the parent-child relationship across the peripartum period.