The Relationship Between Attachment Styles and Prenatal Attachment in Iranian Pregnant Women Mediated by Body Image and Gender Roles in the Third Trimester of Pregnancy: A Structural Equation Modeling

Traumatic perceptions of childbirth and beliefs about the birth process may influence the emotional bond formed between a mother and her unborn baby. This study aimed to examine the relationships between traumatic birth perception, birth beliefs, and prenatal attachment in pregnant women. This descriptive and correlational study was conducted between December 2024 and June 2025 in the antenatal outpatient clinic of a hospital located in the Central Anatolia region of Türkiye. A total of 390 pregnant individuals who attended the clinic during the study period were included. Data were collected using a Personal Information Form, the Traumatic Childbirth Perception Scale (TCPS), the Birth Beliefs Scale (BBS), and the Maternal Antenatal Attachment Scale (MAAS). The participants had a mean age of 24.23±3.70 years, and most were in the third trimester of pregnancy (72.6%). Overall, participants reported moderate levels of traumatic childbirth perception and relatively high prenatal attachment. Correlation analyses indicated a statistically significant but small negative association between traumatic childbirth perception and prenatal attachment (r=-0.155, p<0.01). Prenatal attachment was also positively associated with beliefs that conceptualize childbirth as a natural process; however, this relationship was likewise small in magnitude (rₛ=0.103, p<0.05). Multiple regression analysis further showed that traumatic childbirth perception was a significant but small negative predictor of prenatal attachment (β=-0.157, p<0.01). Traumatic childbirth perception was inversely associated with prenatal attachment, whereas beliefs that conceptualize childbirth as a natural process were positively associated with prenatal attachment. The findings suggest that addressing traumatic childbirth perceptions and supporting positive childbirth beliefs may be relevant considerations in antenatal care practices aimed at promoting prenatal attachment.

The coronavirus disease (COVID-19) pandemic has disrupted the lives of people around the world, causing illness, death, fear, and trauma. This study aims to determine the effect of fear of contracting COVID-19 on pregnancy stress and prenatal attachment in pregnant women. This cross-sectional and descriptive study was conducted with 270 pregnant women who were registered in the family health center of a city located in the eastern part of Turkey. Data were collected between November 2020 and March 2021. The average age of the participants was 28.24 ± 5.69. A positive and weak correlation was found between the Fear of COVID-19 Scale Mean score and the Prenatal Attachment Inventory (PAI) and Pregnancy Stress Rating Scale (PSRS) mean scores ( r = 0.379, 0.478; P &lt; 0.001, respectively). In addition, a weak correlation was detected between the PAI mean score and the PSRS mean score ( r = 0.495; P &lt; 0.001). Results showed that the fear of COVID-19 affected prenatal attachment at a proportion of 14% and pregnancy stress at a proportion of 22%. This study found that the fear of COVID-19 had effects on pregnancy stress and prenatal attachment. Healthcare professionals should consider the fear caused by the pandemic as a factor in the treatment-care and consultancy services provided to pregnant women in extraordinary, unprecedented times like the COVID-19 pandemic. [ Psychiatr Ann . 2023;53(8):381–388.]

Bu çalışmanın amacı primipar gebelerde algılanan doğum korkusunun prenatal bağlanmaya etkisini belirlemektir. Araştırma; Erzurum’daki bir kadın doğum hastanesine Aralık 2016-Nisan 2017 tarihleri arasında başvuran 28-40 gebelik haftası aralığında olan prenatal kontrolleri sırasında NST polikliniğine gelen ve araştırmaya katılabilme kriterlerini taşıyan 251 primipar gebe ile yürütülmüştür. Veriler; kişisel bilgi formu, Doğum Tutum Ölçeği (DTÖ) ve Prenatal Bağlanma Envanteri (PBE) kullanılarak toplanmıştır. Verilerin değerlendirilmesinde; tanımlayıcı istatistikler, t testi, Kruskal Wallis testi, Pearson Korelasyon Analizi ve varyans analizi kullanılmıştır. Gebelerin %53.0’ı 19-23 yaş arasında, %72.5’i ilde yaşamakta, %52.6’sı ilköğretim mezunu, %85.7’si herhangi bir işte çalışmamakta, %70.1’i çekirdek aile yapısına sahip, % 80.1’inin ekonomik düzeyi gelir gidere eşittir. %62.5’inin evlilik süresi 1 yıl ve altı, %81.7’sinin gebeliği planlı, %35.5’inin gebelik haftası 32-35 gebelik haftaları arasındadır, %56.6’sının bebeğinin cinsiyeti erkek, %72.5’inin ise gebelikte herhangi bir eğitim almadığı belirlenmiştir. DTÖ’den aldıkları toplam puan ortalaması 43.63±10.06 ve PBE’den aldıkları toplam puan ortalaması 42.43±10.39 olarak bulunmuştur. Ölçeklerden alınan toplam puan ortalamaları ortancanın biraz üzerindedir. DTÖ ile PBE puan ortalamaları arasında ilişki incelendiğinde; gebelerde algılanan doğum korkusu ile prenatal bağlanma arasında ilişki saptanmamıştır. Algılanan doğum korkusunun prenatal bağlanma düzeyini etkilemediği belirlenmiştir.

Background: Prenatal attachment and positive adaptation with the concept of motherhood play a pivotal role in maternal and fetal health. The present study aimed to evaluate the effect of the beliefs, attitudes, subjective norms, and enabling factors (BASNEF) model on maternal fetal attachment in the pregnant women referring to prenatal clinics. Methods: This quasi-experimental study was conducted on 100 nulliparous women in their third pregnancy trimester (36-41 weeks), who referred to the selected prenatal clinics in Shiraz, Iran during 2011-2012. Intervention was performed based on the BASNEF model in six training sessions for 90 minutes. Data collection tools were the Cranley’s maternal-fetal attachment scale and BASNEF model. Data analysis was performed in SPSS version 18 using Pearson’s correlation-coefficient, independent t-test, and Chi-square at the significance level of 0.05.Results: After the intervention, a significant difference was observed in the mean score of maternal-fetal attachment in the intervention group compared to the control group (P<0.001). In addition, there was a significant positive correlation between the score of maternal-fetal attachment and enabling factors one month after the training in the intervention group (P=0.039). Conclusion: According to the results, training based on the BASNEF model could increase the maternal-fetal attachment in nulliparous pregnant women and improve the psychological health indicators of the neonates.

Effects of maternal psychological distress and perception of COVID-19 on prenatal attachment in a large sample of Italian pregnant women

This randomized controlled trial investigated the effects of the Mindfulness-Based Stress Reduction (MBSR) program on stress, subjective anxiety, self-compassion, and prenatal attachment in pregnant women with perinatal loss. A total of 112 women were randomly assigned to MBSR (n = 56) or control (n = 56) groups. The MBSR program was delivered face-to-face in eight sessions over 4 weeks. Pretest comparisons showed no significant differences between groups (p >.05). Posttest results indicated that the MBSR group had significantly lower Tilburg Pregnancy Distress Scale (partner involvement and negative affect) and Subjective Units of Disturbance Scale scores, with large effect sizes (η2 = .677, .679, .143, .621). The MBSR group also showed significantly higher Self-Compassion Scale-Short Form scores (η2 = .542) and higher Maternal Antenatal Attachment Scale scores, including both time spent on attachment and attachment quality (η2 = .620, .760, .557). Findings suggest MBSR effectively reduces stress and anxiety while enhancing self-compassion and prenatal attachment in women with perinatal loss.

This study aimed to explore the relationship between disaster anxiety and prenatal attachment in pregnant women. A descriptive, cross-sectional design was used with 443 pregnant women recruited between April and August 2023. Data were collected using the Demographic Data Form, Disaster Anxiety Scale, and Prenatal Attachment Inventory. Statistical analysis was conducted using SPSS 29.0. The mean Disaster Anxiety Scale score was 11.87 ± 7.49, and the mean Prenatal Attachment Inventory score was 64.93 ± 9.16. Disaster anxiety increased with maternal age, extended family living, and higher numbers of pregnancies and children, while prenatal attachment decreased in these groups. No significant correlation was found between disaster anxiety and prenatal attachment. The findings suggest that maternal age, family structure, and parity influence disaster anxiety and prenatal attachment levels. Healthcare providers should develop targeted interventions to reduce disaster anxiety and enhance prenatal attachment, particularly for high-risk groups such as older mothers or those with larger families.

The experience of miscarriage and its impact on prenatal attachment during the following pregnancy: A mixed-methods study

Pregnant women have faced novel physical and mental health risks during the pandemic. This situation is remarkable because a parent's emotional bond with their unborn baby (also known as prenatal attachment) is related to the parent's mental state. Prenatal attachment helps parents psychologically prepare forthe transition into parenthood. Moreover, it plays a pivotal role in the future parentchild relationship and psychosocial development of the baby. Based on the available literature, the current study integrated risk perception theories with mental healthindicators to examine maternal prenatal attachment during the pandemic. Pregnant women (n = 258) completed the Pregnancy-Related Anxiety Questionnaire-Revision 2 (PRAQ-R2), theWHO Well-being Index (WHO-5), the Prenatal Attachment Inventory (PAI), and answeredquestions about COVID-19 risk perception. The findings illustrated that pregnancy-related anxiety was positively associated with maternal prenatal attachment. Moreover, COVID-19 risk perception and well-being mediated this relationship. In other words, the higher levels of pregnancy-related anxiety were associated with increased COVID-19 risk perception and decreased well-being, inhibiting prenatal attachment in pregnant women. Considering the importance of prenatal attachment, it is crucial to understand the experiences of pregnant women and develop policies for promoting prenatal attachment, especially during challenging times such as the COVID-19 pandemic.

Objectives: The study has two main objectives: (1) assessment of the perception of body image among a sample of women in their third trimester of pregnancy; and (2) examination of the relationship between body image, gender role orientation, gender role stress and self-esteem. Background: Body image has received much attention in the psychological literature, but little work has been conducted with pregnant women or outside of the United States. Research suggests that women experience both anxieties and positive emotions about their body image during pregnancy, which might be associated with their personal characteristics. Methods: 100 pregnant women were approached in seven different ‘Schools of Birth’ in Poland. Participants completed questionnaires assessing body image, feminine gender role stress, psychological masculinity–femininity and self-esteem during their third trimester of pregnancy. Results: Pregnant Polish women generally have a positive body image, which is positively associated with self-esteem. Feminine gender role stress was related to a negative body image, masculinity and androgyny positively correlated with body image. Structural equation modelling suggests that body image is a mediator between gender factors and self-esteem. Conclusion: Our findings underline the multidimensional nature of the body image and the importance of mediating factors in predicting the psychological outcomes of pregnancy.

The importance of prenatal attachment, probably as the initial attachment of a pregnant woman to the fetus and which turn into the maternal-baby attachment after birth, for the well-being of the newborn and mother is well known. The aim of the present study was to explore the possible socio-demographic and clinical factors (personality features, styles used in coping with stress, depression, and situational anxiety levels, and marital adjustment) affecting maternal-fetal attachment. Eighty women on their third trimesters of pregnancy were included in the study. After examination by a psychiatrist, a detailed socio-demographic form and scales including Prenatal Attachment Inventory, Basic Personality Traits Scale, Coping with Stress Attitudes Inventory, State-Trait Anxiety Inventory-1, Beck Depression Inventory (BDI), and Marital Adjustment Scale were applied. Educational level, marital adjustment, social support, and turning to religion as a coping mechanism with stress were found to be positively correlated with prenatal attachment scores. The duration of marriage and number of giving births and the avoidance/disengagement subscale of Coping with Stress Scale and BDI scores were negatively correlated with prenatal attachment scores. A BDI score of ≥17 (this score suggests moderate and/or severe symptoms of depression) was found to be an independent and a negative variable on prenatal attachment. We suggest that the detection of symptoms of depression and other factors that may affect prenatal attachment, may help shed light to the interventions to be performed to improve the quality of maternal-fetal attachment by society and governments.

It is stated that the attachment patterns of alexithymic individuals who have difficulty expressing and conveying their emotions are insecure. It is very important to determine prenatal attachment risks, especially in pregnant women, and to prepare the woman for motherhood. In this study, it was aimed to determine the relationship between alexithymia level and prenatal attachment in pregnant women. The sample of the descriptive and cross-sectional study consisted of 335 pregnant women. Data were obtained using the Introductory Information Form, Toronto Alexithymia Scale-20, Prenatal Attachment Inventory. It was found that 17% of the pregnant women were alexithymic. It has been determined that alexithymia in pregnant women is affected by variables such as education, work, income level, marriage willingly, participation in social activities, planned pregnancy, having problems during pregnancy, paying attention to weight before pregnancy, both her and her partner’s choice of birth style and participation in the preparatory class. The total alexithymia score obtained from the study was 48.93 ± 9.61, and the total prenatal attachment score was 66.68 ± 10.24. No significant correlation was found between alexithymia and prenatal attachment. There was no significant difference between prenatal attachment scores according to the alexithymic status of the pregnant women.

AimThis study aims to examine the relationships between perception of traumatic childbirth, prenatal attachment, stress, anxiety, and depression in pregnant women.MethodThis cross‐sectional study involved 304 pregnant women who visited the obstetrics and gynecology outpatient clinic of a hospital in Türkiye between June 2024 and June 2025. Data were collected using a Demographic Information Form, the Depression, Anxiety, Stress Scale (DASS‐21), the Traumatic Childbirth Perception Scale (TCPS), and the Prenatal Attachment Inventory (PAI). Descriptive statistical methods, Pearson correlation, and multiple linear regression analysis were used in the analysis of the data.ResultsThe study determined that 22% of pregnant women experienced stress, 45.1% experienced depression, and 62.8% experienced anxiety. The mean PAI score of pregnant women was found to be 40.53 ± 7.97, and the mean TCPS score was 71.64 ± 28.02 (moderate). The study found that stress, depression, and anxiety scores in pregnant women were significantly correlated positively with the TCPS score and significantly correlated negatively with the PAI score. Depression (p = 0.003) and prenatal attachment (p = 0.018) were determined to be the predictors of traumatic birth perception.ConclusionThis study determined that as women’s depression, stress, anxiety, and levels increased, their perception of traumatic childbirth increased, and their prenatal attachment levels decreased. Depression and prenatal attachment were identified as predictors of traumatic childbirth perception. Providing mental health support to pregnant women by nurses can contribute to the protection and improvement of maternal and infant health.

AIM:The aim of this study was to determine the relationship between COVID-19 fear and the prenatal attachment of pregnant women in the pandemic.METHOD:The sample of this cross-sectional and descriptive study consisted of 377 participants aged 18–45. The study was conducted from August to December 2021 in the east of Turkey. The data were collected using the SocioDemographic Questionnaire, Fear of COVID-19 Scale, and Prenatal Attachment İnventory.Results:The mean Prenatal Attachment İnventory total score was 58.20 ± 10.61. The mean Fear of COVID-19 Scale total score of the women in the study was 24.43 ± 6.61. In this study, significant differences in prenatal attachment were observed for age, education, number of pregnancies, pregnancy week, and number of children. Moreover, the fear of COVİD-19 was detected as a statistically significant difference between the COVID-19 status and having several children (p < .05).Conclusion:There was a link found between fear of COVID-19 and prenatal attachment in pregnant women. Health centers were recommended to provide training and support programs to solve the fear caused by COVID-19 and improve women’s prenatal attachment.

BackgroundThe current study aims to investigate the relationship between attachment styles and happiness through the mediating role of reminiscence styles in the elderly.MethodsThis was a correlational study of structural equations modelling (SEM) type. The statistical population included all the elderly aged at least 60 years living in Kermanshah province, Iran in 2021, among whom 380 (182 men and 198 women) were selected using convenience sampling method. Participants filled out the questionnaires of Adult Attachment Styles, Oxford Happiness, and Amani et al.’s Reminiscence Styles.ResultsThe results indicated that secure attachment style has a positive and negative relationship with positive reminiscence (PR) and negative reminiscence (NR), respectively. However, the opposite held true for both avoidant and ambivalent attachment styles. It was also found that secure attachment style has a positive relationship, and avoidant and ambivalent attachment styles have a negative relationship with happiness. Moreover, participants’ gender and age had no moderating effect on the mentioned relationships. The results of SEM indicated that secure and ambivalent attachment styles were associated with happiness through both PR and NR, and avoidant attachment style was associated with happiness only through NR.ConclusionsThe findings emphasize the significance of the development of internal working models based on the kind of parent-child’s reminiscences and narratives, and the lifelong effects of these models.