Abstract
Extant research has demonstrated that compared to adults with insecure attachment styles, more securely attached parents tend to be more responsive, sensitive, and involved parents, resulting in improved outcomes for their children. Less studied is the influence of a mother's attachment style on her attachment to her unborn child during pregnancy and the consequent developmental outcomes of the child during early childhood. Thus, the aim of this prospective longitudinal study was to examine the relationship between maternal–fetal attachment (MFA) during pregnancy and infant and toddler outcomes and the role of mothers' attachment style on early childhood developmental outcomes in an economically disadvantaged sample of women and their children. Gamma regression modeling demonstrated that an avoidant maternal attachment style (b = .98, 95 % CI [.97, .98], p < 0.001) and post-partum depressive symptomatology (b = .97, 95 % CI [.96–.99], p = 0.03) were significant predictors of early childhood development. Women demonstrating higher avoidant attachment styles and greater depressive symptomatology were more likely to have children demonstrating early childhood developmental delays than those women with less avoidant attachment styles and less depressive symptomatology. Furthermore, women reporting higher MFA during pregnancy had more secure attachment styles, and their children had more optimal early childhood development than those women reporting lower MFA and less secure attachment styles. Findings have implications for enhancing early intervention programs aimed at improving maternal and childhood outcomes. An earlier identification of disruptions in attachment may be beneficial in tailoring interventions focused on the mother–child dyad.
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References
Ahern NR, Ruland JP (2003) Maternal–fetal attachment in African–American and Hispanic–American women. J Perinat Educ 12:27–35
Ainsworth MD (1979) Infant–mother attachment. Am Psychol 34:932–937
Alhusen JL, Gross D, Hayat MJ, Rose L, Sharps P (2012a) The role of mental health on maternal–fetal attachment in low-income women. J Obstet Gynecol Neonatal Nurs: JOGNN / NAACOG 41:E71–E81
Alhusen JL, Gross D, Hayat MJ, Woods AB, Sharps PW (2012b) The influence of maternal–fetal attachment and health practices on neonatal outcomes in low-income, urban women. Res Nurs Health 35:112–120
Allen JP, McElhaney KB, Kuperminc GP, Jodl KM (2004) Stability and change in attachment security across adolescence. Child Dev 75:1792–1805
Antonucci TC, Akiyama H, Takahashi K (2004) Attachment and close relationships across the life span. Attach Hum Dev 6:353–370
Belsky J, Cassidy J (1994) Attachment: theory and evidence. In: Rutter M, Hay D (eds) Development through life: a handbook for clinicians. Blackwell, Oxford, pp 373–402
Berlin LJ, Whiteside-Mansell L, Roggman LA, Green BL, Robinson J, Spieker S (2011) Testing maternal depression and attachment style as moderators of early head start's effects on parenting. Attach Hum Dev 13:49–67
Bifulco A, Moran PM, Ball C, Bernazzani O (2002) Adult attachment style. I: its relationship to clinical depression. Soc Psychiatry Psychiatr Epidemiol 37:50–59
Bowlby, J (1982/1969) Attachment and loss: volume 1. Attachment (2nd edn). New York: Basic Books
Bowlby J (1978) Attachment theory and its therapeutic implications. Adolesc Psychiatry 6:5–33
Brandon AR, Trivedi MH, Hynan LS, Miltenberger PD, Labat DB, Rifkin JB, Stringer CA (2008) Prenatal depression in women hospitalized for obstetric risk. J Clin Psychiatry 69:635–643
Candelaria M, Teti DM, Black MM (2011) Multi-risk infants: predicting attachment security from sociodemographic, psychosocial, and health risk among African–American preterm infants. J Child Psychol Psychiatry 52:870–877
Caughy MO, O'Campo PJ, Muntaner C (2003) When being alone might be better: neighborhood poverty, social capital, and child mental health. Soc Sci Med 57:227–237
Cox J, Holden J, Sagovsky R (1987) Detection of postnatal depression—development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry 150:82–786
Cozzarelli C, Karafa JA, Collins NL, Tagler MJ (2003) Stability and change in adult attachment styles: associations with personal vulnerabilities, life events, and global constructs of self and others. J Soc Clin Psychol 22:315–346
Cranley MS (1981) Development of a tool for the measurement of maternal attachment during pregnancy. Nurs Res 30:281–284
Crittenden PM, Claussen A (2000) The organization of attachment relationships: maturation, culture, and context. Cambridge University Press, New York
Davila J, Burge D, Hammen C (1997) Why does attachment style change? J Pers Soc Psychol 73:826–838
Diener ML, Nievar MA, Wright C (2003) Attachment security among mothers and their young children living in poverty: associations with maternal, child, and contextual characteristics. Merrill-Palmer Q 49:154–182
Duggan AK, Berlin LJ, Cassidy J, Burrell L, Tandon SD (2009) Examining maternal depression and attachment insecurity as moderators of the impacts of home visiting for at-risk mothers and infants. J Consult Clin Psychol 77:788–799
Feeney JA, Noller P, Hanrahan M (1994) Assessing adult attachment. In: Sperling MB, Berman WH (eds) Attachment in adults. Guilford, New York, pp 128–151
Feeney BC, Collins NL (2003) Motivations for caregiving in adult intimate relationships: influences on caregiving behavior and relationship functioning. Personal Soc Psychol Bull 29:950–968
Gerlsma C, Luteijn F (2000) Attachment style in the context of clinical and health psychology: a proposal for the assessment of valence, incongruence, and accessibility of attachment representations in various working models. Br J Med Psychol 73:15–34
Gershoff ET, Aber JL, Raver CC, Lennon MC (2007) Income is not enough: incorporating material hardship into models of income associations with parenting and child development. Child Dev 78:70–95
Goodman SH, Gotlib IH (2002) Children of depressed parents: mechanisms of risk and implications for treatment. American Psychological Association, Washington, DC
Green BL, Furrer C, McAllister C (2007) How do relationships support parenting? Effects of attachment style and social support on parenting behavior in an at-risk population. Am J Community Psychol 40:96–108
Hart R, McMahon CA (2006) Mood state and psychological adjustment to pregnancy. Arch Womens Ment Health 9:329–337
Heinicke CM, Goorsky M, Levine M, Ponce VA, Ruth G, Silverman M, Sotelo C (2006) Pre and postnatal antecedents of a home visiting intervention and family developmental outcome. Infant Ment Health J 27:91–119
Kingston D, Tough S, Whitfield H (2012) Prenatal and postpartum maternal psychological distress and infant development: a systematic review. Child Psychiatry Hum Dev 43:683–714
Kitzman H, Olds DL, Henderson CR, Hanks C, Cole R, Tatelbaum R, McConnochie KM, Sidora K, Luckey DW, Shaver D, Engelhardt K, James D, Barnard K (1997) Effect of prenatal and infancy home visitation by nurses on pregnancy outcomes, childhood injuries, and repeated childbearing. A randomized controlled trial. JAMA 278:644–652
Lindgren K (2001) Relationships among maternal–fetal attachment, prenatal depression, and health practices in pregnancy. Res Nurs Health 24:203–217
Lyons-Ryth K, Lyubchik A, Wolfe R, Bronfman E (2002) Parental depression and child attachment: hostile and helpless profiles of parent and child behavior among families at risk. In: Goodman SH, Gotlib IH (eds) Children of depressed parents: mechanisms of risk and implications for treatment. American Psychological Association, Washington, DC, pp 89–120
Mackrides PS, Ryherd SJ (2011) Screening for developmental delay. Am Fam Physician 84:544–549
McFarland J, Salisbury AL, Battle CL, Hawes K, Halloran K, Lester BM (2011) Major depressive disorder during pregnancy and emotional attachment to the fetus. Arch Womens Ment Health 14:425–434
Meredith PJ, Strong J, Feeney JA (2006) The relationship of adult attachment to emotion, catastrophizing, control, threshold and tolerance, in experimentally-induced pain. Pain 120:44–52
Mikulincer M, Shaver PR (2007) Attachment, group-related processes, and psychotherapy. Int J Group Psychother 57:233–245
Mills-Koonce WR, Gariepy JL, Sutton K, Cox MJ (2008) Changes in maternal sensitivity across the first three years: are mothers from different attachment dyads differentially influenced by depressive symptomatology? Attach Hum Dev 10:299–317
National Research Council (2009) Depression in parents, parenting, and children: opportunities to improve identification, treatment, and prevention. The National Academies, Washington, DC
Oken E, Kleinman KP, Rich-Edwards J, Gillman MW (2003) A nearly continuous measure of birth weight for gestational age using a United States national reference. BMC Pediatr 3:6
Olds DL, Kitzman HJ, Cole RE, Hanks CA, Arcoleo KJ, Anson EA, Luckey DW, Knudtson MD, Henerson CR Jr, Bondy J, Stevenson AJ (2010) Enduring effects of prenatal and infancy home visiting by nurses on maternal life course and government spending: follow-up of a randomized trial among children at age 12 years. Arch Pediatr Adolesc Med 164:419–424
Olds DL, Robinson J, O'Brien R, Luckey DW, Pettitt LM, Henderson CR Jr, Ng RK, Sheff KL, Korfmacher J, Hiatt S, Talmi A (2002) Home visiting by paraprofessionals and by nurses: a randomized, controlled trial. Pediatrics 110:486–496
Overbeek G, Vollebergh W, de Graaf R, Scholte R, de Kemp R, Engels R (2006) Longitudinal associations of marital quality and marital dissolution with the incidence of DSM-III-R disorders. J Fam Psychol: JFP: J Div Fam Psychol Am Psychol Assoc (Division 43) 20:284–291
Sadler LS, Slade A, Mayes L (2006) Minding the baby: a mentalization-based parenting program. In: Allen J, Fonagy P (eds) The handbook of mentalization-based treatment. Wiley, Hoboken, pp 271–288
Shieh C, Kravitz M (2006) Severity of drug use, initiation of prenatal care, and maternal–fetal attachment in pregnant marijuana and cocaine/heroine users. J Obstet Gynecol Neonatal Nurs 35:499–508
Shurman LA, Rodriguez CM (2006) Cognitive–affective predictors of women's readiness to end domestic violence relationships. J Interpers Violence 21:1417–1439
Siddiqui A, Hagglof B (2000) Does maternal prenatal attachment predict postnatal mother–infant interaction? Early Hum Dev 59:13–25
Simpson JA (1990) The influence of attachment styles on romantic relationships. J Pers Soc Psychol 59:273–280
Simpson JA, Rholes WS, Phillips D (1996) Conflict in close relationships: an attachment perspective. J Pers Soc Psychol 71:899–914
Squires J, Bricker D, Potter L (1997) Revision of a parent-completed development screening tool: ages and stages questionnaires. Pediatr Psychol 22:313–328
Stansfeld S, Head J, Bartley M, Fonagy P (2008) Social position, early deprivation and the development of attachment. Soc Psychiatry Psychiatr Epidemiol 43:516–526
Tandon SD, Cluxton-Keller F, Leis J, Le HN, Perry DF (2012) A comparison of three screening tools to identify perinatal depression among low-income African American women. J Affect Disord 136:155–162
Toohey J (2012) Depression during pregnancy and postpartum. Clin Obstet Gynecol 55:788–797
Van den Bergh BRH, Simons A (2009) A review of scales to measure the mother–foetus relationship. J Reprod Infant Psychol 27:114–126
Vernon-Feagans L, Garrett-Peters P, Willoughby M, Mills-Koonce R, The Family Life Project Key Investigators (2012) Chaos, poverty, and parenting: predictors of early language development. Early Child Res Q 27:339–351
Vrticka P, Vuilleumier P (2012) Neuroscience of human social interactions and adult attachment style. Front Hum Neurosci 6:212
Walsh J (2010) Definitions matter: if maternal–fetal relationships are not attachment, what are they? Arch Womens Ment Health 13:449–451
Waters E, Merrick S, Treboux D, Crowell J, Albersheim L (2000) Attachment security in infancy and early adulthood: a twenty-year longitudinal study. Child Dev 71:684–689
Zachariah R (2004) Attachment, social support, life stress, and psychological well-being in pregnant low-income women: a pilot study. Clin Excell Nurse Pract 8:60–67
Funding
This research was supported by the National Institute of Nursing Research (F31 NR010957) and the National Center for Research Resources (5KL2RR025006), a component of the NIH Roadmap for Medical Research.
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Alhusen, J.L., Hayat, M.J. & Gross, D. A longitudinal study of maternal attachment and infant developmental outcomes. Arch Womens Ment Health 16, 521–529 (2013). https://doi.org/10.1007/s00737-013-0357-8
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DOI: https://doi.org/10.1007/s00737-013-0357-8