Amniocentesis, Maternal Psychopathology and Prenatal Representations of Attachment: A Prospective Comparative Study

Wissam El-Hage,Bruno Giraudeau,Julie Léger,Aude Delcuze,Franck Perrotin

doi:10.1371/journal.pone.0041777

Abstract

BackgroundThe aim of the study was to characterize the maternal dimensions of anxiety, depression and prenatal attachment in women undergoing an amniocentesis.Methodology/Principal FindingsA prospective observational study was conducted. Women were referred to early amniocentesis for increased nuchal translucency, elevated biochemical markers or advanced maternal age. All participants had 3 prenatal (16–18, 20–24, 30–34 weeks of gestation) and one postnatal (30–45 days) interviews reviewing for demographic, medical, and psychiatric information (STAI State-Trait Anxiety Inventory; EPDS: Edinburgh Postnatal Depression Scale; IRMAG: Interview of Maternal Representations of Attachment during pregnancy). We investigated 232 pregnant women who undergone an amniocentesis compared with 160 pregnant controls. Following the procedure, the amniocentesis group experienced transiently significantly higher levels of state-anxiety on the STAI (44.6 vs. 39.3) and depression as measured by the EPDS (9.4 vs. 6.3) than the controls. Overall in both groups, the maternal representations of attachment were well integrated and balanced, but the amniocentesis group experienced significantly more mother-directed representations.Conclusions/SignificanceAmniocentesis is associated with higher affective adaptive reactions that tend to normalize during the pregnancy, with overall preserved maternal fetal representations of attachment.

Highlights

Maternal fetal attachment is the extent to which women engage in behaviors that represent an affiliation and interaction with her unborn child [1,2]
Conclusions/Significance: Amniocentesis is associated with higher affective adaptive reactions that tend to normalize during the pregnancy, with overall preserved maternal fetal representations of attachment
After 7 months of pregnancy, maternal representations begin to decline in intensity, which in one theoretical frame is regarded as an undoing of their positive representations to prevent disappointment [10] and, in a more neurobiological frame, may reflect consolidation of the neural circuitry of attachment systems [11]

Summary

Introduction

Maternal fetal attachment is the extent to which women engage in behaviors that represent an affiliation and interaction with her unborn child [1,2]. Prenatal attachment increases throughout gestation [3,4,5,6,7,8] and fetal development is usually accompanied with changes in maternal representations. Several studies suggested the predictive value of maternal representations and the continuity between maternal prenatal and postnatal attachment [13,14,15,16,17]. To our knowledge, no study explored how anxiety level may directly affect maternal fetal attachment. The aim of the study was to characterize the maternal dimensions of anxiety, depression and prenatal attachment in women undergoing an amniocentesis

Objectives

Methods

Results

Discussion

Conclusion