Archives of Women's Mental Health

, Volume 19, Issue 4, pp 609–622 | Cite as

Predictors of postnatal mother-infant bonding: the role of antenatal bonding, maternal substance use and mental health

  • Larissa Rossen
  • Delyse Hutchinson
  • Judy Wilson
  • Lucy Burns
  • Craig A Olsson
  • Steve Allsop
  • Elizabeth J Elliott
  • Sue Jacobs
  • Jacqueline A. Macdonald
  • Richard P Mattick
Original Article


The emotional bond that a mother feels towards her baby is critical to social, emotional and cognitive development. Maternal health and wellbeing through pregnancy and antenatal bonding also play a key role in determining bonding postnatally, but the extent to which these relationships may be disrupted by poor mental health or substance use is unclear. This study aimed to examine the extent to which mother-fetal bonding, substance use and mental health through pregnancy predicted postnatal mother-infant bonding at 8 weeks. Participants were 372 women recruited from three metropolitan hospitals in Australia. Data was collected during trimesters one, two and three of pregnancy and 8 weeks postnatal using the Maternal Antenatal Attachment Scale (MAAS), Maternal Postnatal Attachment Scale (MPAS), the Edinburgh Antenatal and Postnatal Depression Scale (EPDS), the Depression and Anxiety Scales (DASS-21), frequency and quantity of substance use (caffeine, alcohol and tobacco) as well as a range of demographic and postnatal information. Higher antenatal bonding predicted higher postnatal bonding at all pregnancy time-points in a fully adjusted regression model. Maternal depressive symptoms in trimesters two and three and stress in trimester two were inversely related to poorer mother-infant bonding 8 weeks postnatally. This study extends previous work on the mother’s felt bond to her developing child by drawing on a large sample of women and documenting the pattern of this bond at three time points in pregnancy and at 8 weeks postnatally. Utilising multiple antenatal waves allowed precision in isolating the relationships in pregnancy and at key intervention points. Investigating methods to enhance bonding and intervene in pregnancy is needed. It is also important to assess maternal mental health through pregnancy.


Maternal bonding Pregnancy Postnatal Mental health Substance use 



The research was funded by an Australian National Health and Medical Research Council (NHMRC) Project Grant #GNT630517 for $2,196,179 to Richard P Mattick, Delyse Hutchinson, Steve Allsop, Jake Najman, Elizabeth Elliott, Lucy Burns, Sue Jacobs, Craig A Olsson and Anne Bartu, and was financially supported by the National Drug and Alcohol Research Centre (NDARC), University of NewSouth Wales (UNSW), and the National Drug Research Institute (NDRI), Curtin University. NDARC and NDRI are funded by the Australian Government under the Substance Misuse Prevention and Service Improvements Grants Fund. Richard P Mattick is financially supported by an NHMRC Principal Research Fellowship Award from the NHMRC; Delyse Hutchinson is financially supported by an Australian Unity Industry Partner Senior Research Fellowship; Craig Olsson is supported by an Australian Research Council Senior Research Fellowship (DORA: DP 130101459); and, Elizabeth Elliott is supported by an NHMRC Practitioner Fellowship (#1021480).

We gratefully acknowledge the investigators not listed as authors; the research staff and students who assisted with collection of the data; the hospitals and antenatal clinics for their assistance with recruitment; and, the study participants and their families. We also wish to acknowledge the Longitudinal Cohorts Research Consortium (LCRC; Formerly the Cannabis Cohorts Research Consortium; NHMRC Project Grants: AAP1009381, AAP1064893).

Compliance with ethical standards

Conflicts of interest

We do not have any conflicts of interest affecting the conduct or reporting of this research.

Supplementary material

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737_2016_602_MOESM3_ESM.pdf (91 kb)
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  1. Ainsworth MDS, Blehar MC, Waters E, Wall S (1978) Patterns of attachment. A psychological study of the strange situation. Erlbaum, Hillsdale, NJGoogle Scholar
  2. Alhusen JL, Gross D, Hayat MJ, Rose L, Sharps P (2012) The role of mental health on maternal-fetal attachment in low-income women. J Obstet Gynecol Neonatal Nurs 41(6):E71–E81PubMedPubMedCentralCrossRefGoogle Scholar
  3. Armstrong D, Hutti M (1998) Pregnancy after perinatal loss: the relationship between anxiety and prenatal attachment. J Obstet Gynecol Neonatal Nurs 27(2):183–189PubMedCrossRefGoogle Scholar
  4. Austin M-P, Hadzi-Pavlovic D, Leader L, Saint K, Parker G (2005) Maternal trait anxiety, depression and life event stress in pregnancy: relationships with infant temperament. Early Hum Dev 81(2):183–190PubMedCrossRefGoogle Scholar
  5. Belsky J, Rovine M, Taylor DG (1984) The Pennsylvania infant and family development project, III: the origins of individual differences in infant-mother attachment: maternal and infant contributions. Child Dev 55(3):718–728PubMedCrossRefGoogle Scholar
  6. Brandon AR, Pitts S, Denton WH, Stringer CA, Evans HM (2009) A history of the theory of prenatal attachment. J Prenat Perinatal Psychol Health 23(4):201–222Google Scholar
  7. Brockington IF (1996) Motherhood and mental health. Oxford University Press, OxfordGoogle Scholar
  8. Brockington IF (2004) Postpartum psychiatric disorders. Lancet 363(9405):303–310PubMedCrossRefGoogle Scholar
  9. Brockington I, Oates J, George S, Turner D, Vostanis P, Sullivan M, Loh C, Murdoch C (2001) A screening questionnaire for mother-infant bonding disorders. Arch Womens Ment Health 3(4):133–140CrossRefGoogle Scholar
  10. Choi H, Yamashita T, Wada Y, Narumoto J, Nanri H, Fujimori A, Yamamoto H, Nishizawa S, Masaki D, Fukui K (2010) Factors associated with postpartum depression and abusive behavior in mothers with infants. Psychiatry Clin Neurosci 64(2):120–127PubMedCrossRefGoogle Scholar
  11. Condon JT (1993) The assessment of antenatal emotional attachment: development of a questionnaire instrument. Br J Med Psychol 66:167–183PubMedCrossRefGoogle Scholar
  12. Condon JT, Corkindale CJ (1998) The assessment of parent-to-infant attachment: development of a self-report questionnaire instrument. J Reprod Infant Psychol 16(1):57–76CrossRefGoogle Scholar
  13. Condon JT, Dunn DJ (1988) Nature and determinants of parent-to-infant attachment in the early postnatal period. J Am Acad Child Adolesc Psychiatry 27(3):293–299PubMedCrossRefGoogle Scholar
  14. Cranley MS (1981) Development of a tool for the measurement of maternal attachment during pregnancy. Nurs Res 30(5):281–284PubMedCrossRefGoogle Scholar
  15. Curry MA (1987) Maternal behavior of hospitalized pregnant women. J Psychosom Obstet Gynecol 7(3):165–182CrossRefGoogle Scholar
  16. Damato EG (2004) Prenatal attachment and other correlates of postnatal maternal attachment to twins. Adv Neonatal Care 4(5):274–291PubMedCrossRefGoogle Scholar
  17. De Cock ESA, Maas AJBM, Vreeswijk CMJM, Van Bakel HJA (2011) Maternal prenatal attachment and mother-infant interaction at 6 months of age. Paper presented at the 15th European Conference on Developmental Psychology, 40128 Bologna.Google Scholar
  18. Diniz E, Koller SH, Volling BL (2015) Social support and maternal depression from pregnancy to postpartum: the association with positive maternal behaviours among Brazilian adolescent mothers. Early Child Dev Care 185(7):1053–1066. doi: 10.1080/03004430.2014.978309 CrossRefGoogle Scholar
  19. Feldman R, Gordon I, Zagoory-Sharon O (2011) Maternal and paternal plasma, salivary, and urinary oxytocin and parent–infant synchrony: considering stress and affiliation components of human bonding. Dev Sci 14(4):752–761PubMedCrossRefGoogle Scholar
  20. Finke MD, Rojo S, Roos N, van Huis A, Yen AL (2015) The European Food Safety Authority scientific opinion on a risk profile related to production and consumption of insects as food and feed. J Insects Food Feed 1(4):245–247CrossRefGoogle Scholar
  21. Gaffney KF (1986) Maternal–fetal attachment in relation to self-concept and anxiety. Matern Child Nurs J 15(2):91–101PubMedGoogle Scholar
  22. Goecke TW, Voigt F, Faschingbauer F, Spangler G, Beckmann MW, Beetz A (2012) The association of prenatal attachment and perinatal factors with pre- and postpartum depression in first-time mothers. Arch Gynecol Obstet 286(2):309–316PubMedCrossRefGoogle Scholar
  23. Grace JT (1989) Development of maternal-fetal attachment during pregnancy. Nurs Res 38(4):228–232PubMedCrossRefGoogle Scholar
  24. Grant KA, McMahon C, Austin MP (2008) Maternal anxiety during the transition to parenthood: a prospective study. J Affect Disord 108(1–2):101–111PubMedCrossRefGoogle Scholar
  25. Grant K-A, McMahon C, Reilly N, Austin M-P (2010) Maternal sensitivity moderates the impact of prenatal anxiety disorder on infant mental development. Early Hum Dev 86(9):551–556PubMedCrossRefGoogle Scholar
  26. Green J, Goldwyn R (2002) Annotation: Attachment disorganisation and psychopathology: new findings in attachment research and their potential implications for developmental psychopathology in childhood. J Child Psychol Psychiatry 43(7):835–846PubMedCrossRefGoogle Scholar
  27. Hamilton CE (2000) Continuity and discontinuity of attachment from infancy through adolescence. Child Dev 71(3):690–694PubMedCrossRefGoogle Scholar
  28. Hart R, McMahon CA (2006) Mood state and psychological adjustment to pregnancy. Arch Womens Ment Health 9(6):329–337PubMedCrossRefGoogle Scholar
  29. Hawthorne G, Elliott P (2005) Imputing cross-sectional missing data: comparison of common techniques. Aust N Z J Psychiatry 39(7):583–590PubMedCrossRefGoogle Scholar
  30. Hilder L, Zhichao Z, Parker M, Jahan S, Chambers GM (2014) Australia’s mothers and babies 2012. Perinatal statistics series no. 30. In: Australian Institute of Health and Welfare (ed), (cat. no. PER 69 ed.). AIHW National Perinatal Epidemiology and Statistics Unit, CanberraGoogle Scholar
  31. Huisman M (2000) Imputation of missing item responses: some simple techniques. Qual Quant 34(4):331–351CrossRefGoogle Scholar
  32. Hutchinson D, Moore EA, Breen C, Burns L, Mattick RP (2013) Alcohol use in pregnancy: prevalence and predictors in the longitudinal study of Australian children. Drug Alcohol Rev 32(5):475–482PubMedGoogle Scholar
  33. Lindgren K (2001) Relationships among maternal-fetal attachment, prenatal depression, and health practices in pregnancy. Res Nurs Health 24(3):203–217PubMedCrossRefGoogle Scholar
  34. Lindgren K (2003) A comparison of pregnancy health practices of women in inner-city and small urban communities. J Obstet Gynecol Neonatal Nurs 32(3):313–321PubMedCrossRefGoogle Scholar
  35. LovibondP (1995) Manual for the Depression Anxiety Stress Scales short-form (DASS-21). Sydney: Sydney Psychology editionGoogle Scholar
  36. McFarland J, Salisbury A, Battle C, Hawes K, Halloran K, Lester B (2011) Major depressive disorder during pregnancy and emotional attachment to the fetus. Arch Womens Ment Health 14(5):425–434PubMedPubMedCentralCrossRefGoogle Scholar
  37. McMahon C, Ungerer JA, Tennant C, Saunders D (1997) Psychosocial adjustment and the quality of the mother-child relationship at four months postpartum after conception by in vitro fertilization. Fertil Steril 68(3):493–500CrossRefGoogle Scholar
  38. Mercer RT, Ferketich SL (1990) Predictors of parental attachment during early parenthood. J Adv Nurs 15(3):268–280PubMedCrossRefGoogle Scholar
  39. Müller ME (1996) Prenatal and postnatal attachment: a modest correlation. J Obstet Gynecol Neonatal Nurs 25(2):161–166PubMedCrossRefGoogle Scholar
  40. O’Connor MJ, Paley B (2006) The relationship of prenatal alcohol exposure and the postnatal environment to child depressive symptoms. J Pediatr Psychol 31(1):50–64PubMedCrossRefGoogle Scholar
  41. O’Connor MJ, Sigman M, Kasari C (1992) Attachment behavior of infants exposed prenatally to alcohol: mediating effects of infant affect and mother-infant interaction. Dev Psychopathol 4(02):243–256CrossRefGoogle Scholar
  42. O’Connor MJ, Sigman M, Kasari C (1993) Interactional model for the association among maternal alcohol use, mother-infant interaction, and infant cognitive development. Infant Behav Dev 16(2):177–192CrossRefGoogle Scholar
  43. O’Connor MJ, Kogan N, Findlay R (2002a) Prenatal alcohol exposure and attachment behavior in children. Alcohol Clin Exp Res 26(10):1592–1602PubMedCrossRefGoogle Scholar
  44. O’Connor MJ, Kogan N, Findlay R (2002b) Prenatal alcohol exposure and attachment behavior in children. Alcohol Clin Exp Res 26(10):1592–1602PubMedCrossRefGoogle Scholar
  45. O’Connor TG, Heron J, Golding J, Beveridge M, Glover V (2002c) Maternal antenatal anxiety and children’s behavioural/emotional problems at 4 years. Report from the Avon Longitudinal Study of Parents and Children. Br J Psychiatry 180(6):502–508PubMedCrossRefGoogle Scholar
  46. Ohoka H, Koide T, Goto S, Murase S, Kanai A, Masuda T, Aleksic B, Ishikawa N, Furumura K, Ozaki N (2014) Effects of maternal depressive symptomatology during pregnancy and the postpartum period on infant-mother attachment. Psychiatry Clin Neurosci 68(8):631–639PubMedCrossRefGoogle Scholar
  47. O’Leary CM, Bower C, Zubrick SR, Geelhoed E, Kurinczuk JJ, Nassar N (2010) A new method of prenatal alcohol classification accounting for dose, pattern and timing of exposure: improving our ability to examine fetal effects from low to moderate alcohol. J Epidemiol Community Health 64:956–962PubMedCrossRefGoogle Scholar
  48. Ossa X, Bustos L, Fernandez L (2012) Prenatal attachment and associated factors during the third trimester of pregnancy in Temuco, Chile. Midwifery 28(5):e689–e696PubMedCrossRefGoogle Scholar
  49. Patock-Peckham JA, Morgan-Lopez AA (2010) Direct and mediational links between parental bonds and neglect, antisocial personality, reasons for drinking, alcohol use, and alcohol problems. J Stud Alcohol Drugs 71(1):95PubMedCrossRefGoogle Scholar
  50. Quinlivan JA, Evans SF (2005) Impact of domestic violence and drug abuse in pregnancy on maternal attachment and infant temperament in teenage mothers in the setting of best clinical practice. Arch Womens Ment Health 8(3):191–199PubMedCrossRefGoogle Scholar
  51. Righetti-Veltema M, Conne-Perreard E, Bousquet A, Manzano J (2002) Postpartum depression and mother-infant relationship at 3 months old. J Affect Disord 70(3):291–306PubMedCrossRefGoogle Scholar
  52. Schore AN (2001) The effects of early relational trauma on right brain development, affect regulation, and infant mental health. Infant Ment Health J 22(1–2):201–269CrossRefGoogle Scholar
  53. Sedgmen B, McMahon C, Cairns D, Benzie RJ, Woodfield RL (2006) The impact of two-dimensional versus three-dimensional ultrasound exposure on maternal–fetal attachment and maternal health behavior in pregnancy. Ultrasound Obstet Gynecol 27(3):245–251PubMedCrossRefGoogle Scholar
  54. Siddiqui A, Hagglof B (2000) Does maternal prenatal attachment predict postnatal mother-infant interaction? Early Hum Dev 59(1):13–25PubMedCrossRefGoogle Scholar
  55. Stanton F, Golombok S (1993) Maternal-fetal attachment during pregnancy following in vitro fertilization. J Psychosom Obstet Gynecol 14(2):153–158CrossRefGoogle Scholar
  56. Thun-Hohenstein L, Wienerroither C, Schreuer M, Seim G, Wienerroither H (2008) Antenatal mental representations about the child and mother–infant interaction at three months post partum. Eur Child Adolesc Psychiatry 17(1):9–19PubMedCrossRefGoogle Scholar
  57. Van Bussel JCH, Spitz B, Demyttenaere K (2010a) Reliability and validity of the Dutch version of the maternal antenatal attachment scale. Arch Womens Ment Health 13(3):267–277PubMedCrossRefGoogle Scholar
  58. Van Bussel JCH, Spitz B, Demyttenaere K (2010b) Three self-report questionnaires of the early mother-to-infant bond: reliability and validity of the Dutch version of the MPAS, PBQ and MIBS. Arch Womens Ment Health 13(5):373–384PubMedCrossRefGoogle Scholar
  59. Van den Bergh BRH, Mulder EJH, Mennes M, Glover V (2005) Antenatal maternal anxiety and stress and the neurobehavioural development of the fetus and child: links and possible mechanisms. A review. Neurosci Biobehav Rev 29(2):237–258PubMedCrossRefGoogle Scholar
  60. Warren SL, Huston L, Egeland B, Sroufe LA (1997) Child and adolescent anxiety disorders and early attachment. J Am Acad Child Adolesc Psychiatry 36(5):637–644PubMedCrossRefGoogle Scholar
  61. Waters E, Weinfield NS, Hamilton CE (2000) The stability of attachment security from infancy to adolescence and early adulthood: general discussion. Child Dev 71(3):703–706PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Wien 2016

Authors and Affiliations

  • Larissa Rossen
    • 1
  • Delyse Hutchinson
    • 1
    • 2
    • 3
    • 4
  • Judy Wilson
    • 1
  • Lucy Burns
    • 1
  • Craig A Olsson
    • 2
    • 3
    • 4
  • Steve Allsop
    • 5
  • Elizabeth J Elliott
    • 6
  • Sue Jacobs
    • 7
  • Jacqueline A. Macdonald
    • 2
    • 3
    • 4
  • Richard P Mattick
    • 1
  1. 1.Faculty of Medicine, National Drug and Alcohol Research CentreUniversity of New South WalesSydneyAustralia
  2. 2.Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of HealthMelbourneAustralia
  3. 3.Centre for Adolescent HealthMurdoch Childrens Research InstituteParkvilleAustralia
  4. 4.Department of PaediatricsThe University of MelbourneMelbourneAustralia
  5. 5.National Drug Research InstituteCurtin UniversityBentlyAustralia
  6. 6.Paediatrics and Child Health, Children’s Hospital WestmeadUniversity of SydneySydneyAustralia
  7. 7.Gynaecology and ObstetricsRoyal Prince Alfred HospitalSydneyAustralia

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