Mediating Role Of Prenatal Depression In Attachment And Maternal-fetal Attachment In Primigravida In Late Pregnancy

Background and objective: Pregnancy means that pregnant women need to face both physical and psychological challenges,which is easy to produce a variety of mental health problems.Prenatal depression is a common psychological reaction of pregnancy.Attachment is an emotional connection with the main caregiver early in life.Adult attachment is the recollection and reproduction of early attachment,reflecting the individual’s ability to regulate feelings and behavior,insecure attachment can be activated in the face of stressful events such as pregnancy.Maternal-fetal attachment is a special link between mother and fetus,which also plays an important role in promoting pregnant women to actively adapt to the role of motherhood and helping pregnant women to make a smooth transition to pregnancy and parturition,and lays a foundation for postpartum mother-to-child integration and early nursing.The adult attachment of pregnant women and the emotion during pregnancy are both important factors that affect the establishment of maternal-fetal intimate relationship.The purpose of this study was to explore the differences of prenatal depression and maternal-fetal attachment scores among different attachment styles in late pregnant women,and the effects of prenatal depression scores and attachment avoidance and anxiety dimensions on maternal and fetal intimacy,that is,maternal-fetal attachment.Methods: A total of 260 primigravidas in the third trimester of pregnancy were included in the study.The demographic variables of pregnant women were collected,including age,gestational week,education level,planned pregnancy,prenatal education,exercise,work status,marital satisfaction and so on.Prenatal depression was assessed by Edinburgh Postpartum Depression scale(EPDS),and attachment was assessed by the Experience of Close Relationship scale(ECR),and the Maternal Antenatal Attachment Scale(MAAS)was used to evaluate the degree of maternal-fetal attachment.Then compare the difference of prenatal depression score and maternal-fetal attachment dimension score between secure attachment and insecure attachment pregnant women.The correlation analysis was used to compare the correlation between prenatal depression score and anxiety and avoidance dimension of attachment and maternal-fetal attachment dimension score.Finally,according to the correlation results,exploratory intermediary analysis was used to explore the effects of prenatal depression score and attachment dimension on maternal-fetal attachmentResults: 1.The prenatal depression score and prevalence of prenatal depression in primigravidas with insecure attachment were higher than those with secure attachment(8.64 ±4.47 vs 6.99 ±4.24,P = 0.003,25.21% vs 13.48%,P = 0.016).The total score of maternal-fetal attachment and the score of maternal-fetal attachment quality dimension were lower than those of secure attachment pregnant women(72.87 ±7.14 vs 75.17±7.33,P =0.011;45.03 ±4.63 vs 46.60 ±4.76,P = 0.002).);2.The results of correlation analysis showed that the score of prenatal depression was positively correlated with the dimensions of avoidance and anxiety of attachment(P < 0.01),but negatively correlated with the quality of maternal-fetal attachment(P < 0.01).There was a negative correlation between attachment avoidance and all dimensions of maternal-fetal attachment(P < 0.05).The results of intermediary analysis showed that the score of prenatal depression played an intermediary role in the relationship between attachment avoidance and maternal-fetal attachment quality(b=-0.235,SE=0.116,95%CI=[-0.5280~-0.0595]).Conclusion: The prenatal depression of pregnant women with insecure attachment is more serious,and the degree of maternal-fetal attachment is lower.Prenatal depression and attachment of pregnant women can affect the emotional connection between pregnant women and fetus,and the score of prenatal depression partially mediates the effect of attachment avoidance on the quality of maternal-fetal attachment.This suggests that we should take the attachment and emotion of pregnant women into account in the process of prenatal examination and intervention,and screen high-risk pregnant women with insecure attachment,high avoidance attachment and high score of prenatal depression.Customized individual and phased interventions for pregnant women with this high risk to help them develop high-quality maternal-fetal attachment and go through pregnancy healthily,so as to promote a good pregnancy outcome.