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Reliability and validity of the German version of the Maternal–Fetal Attachment Scale

  • Maternal-Fetal Medicine
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Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Objectives

In understanding early disturbances in the mother–child relationship, maternal–fetal attachment has become an important concept. To date no study has investigated the reliability and validity of the German version of the Maternal Fetal Attachment Scale (MFAS). The present study aimed to close this gap.

Methods

Questionnaires were completed in a sample of 324 women [third trimester (T1), first week postpartum (T2), and 4 months postpartum (T3)]. In addition to the MFAS (T1), the following measures were assessed: the questionnaire of partnership (T1), the postpartum bonding questionnaire (T2), the Edinburgh Postnatal Depression Scale (T1–T3), the State Trait Anxiety Inventory (T1–T3), and the pregnancy related anxiety questionnaire (T1–T3). Factor structure was analyzed using a principal component analysis (PCA) with varimax rotation. Internal and convergent validities were calculated.

Results

In contrast to the original version with five subscales, PCA yielded a three-factor solution, consisting of the three independent dimensions “anticipation”, “empathy”, and “caring”, explaining 34.9% of the variance together. Good internal reliabilities were found for the total MFAS scale. Maternal–fetal attachment showed a significant negative correlation with postpartum bonding impairment. While no correlations were found with depression, general anxiety and pregnancy-related anxiety during pregnancy, maternal–fetal attachment was significantly related to aspects of partnership quality. In the postpartum period, maternal attachment showed a strong negative correlation with maternal anxiety.

Conclusions

Our results suggest that the German version of the MFAS is a reliable and valid questionnaire to measure the emotional relationship of the mother to the unborn child during pregnancy.

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References

  1. Anand L, Hima B (2012) Validation of Tamil version of Cranley’s 24-item Maternal fetal Attachment Scale in Indian pregnant women. J Obstet Gynecol India 62:630–634

    Article  Google Scholar 

  2. Armstrong D, Hutti M (1998) Pregnancy after perinatal loss: the relationship between anxiety and prenatal attachment. J Obstet Gynecol Neonatal Nurs 27:183–189

    Article  CAS  PubMed  Google Scholar 

  3. Barone L, Bramante A, Lionetti F, Pastore M (2014) Mothers who murdered their child: an attachment-based study on filicide. Child Abuse Negl 38:1468–1477. https://doi.org/10.1016/j.chiabu.2014.04.014

    Article  PubMed  Google Scholar 

  4. Bergant AM, Nguyen T, Heim K, Ulmer H, Dapunt O (1998) German language version and validation of the Edinburgh postnatal depression scale. Dtsch Med Wochenschr 123:35–40. https://doi.org/10.1055/s-2007-1023895

    Article  CAS  PubMed  Google Scholar 

  5. Bicking Kinsey C, Hupcey JE (2013) State of the science of maternal–infant bonding: a principle-based concept analysis. Midwifery 29:1314–1320. https://doi.org/10.1016/j.midw.2012.12.019

    Article  PubMed  Google Scholar 

  6. Bowlby J (1969) Attachment and loss attachment, vol 1. Basic Books, New York

    Google Scholar 

  7. Brockington IF, 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 3:133–140

    Article  Google Scholar 

  8. Busch AL, Cowan PA, Cowan CP (2008) Unresolved loss in the adult attachment interview: implications for marital and parenting relationships. Dev Psychopathol 20:717–735. https://doi.org/10.1017/S0954579408000345

    Article  PubMed  Google Scholar 

  9. Busonera A, Cataudella S, Lampis J, Tommasi M, Zavattini GC (2016) Psychometric properties of a 20-item version of the Maternal Fetal Attachment Scale in a sample of Italian expectant women. Midwifery 34:79–87. https://doi.org/10.1016/j.midw.2015.12.012

    Article  PubMed  Google Scholar 

  10. Castellano R, Velotti P, Crowell JA, Zavattini GC (2014) The role of parents’ attachment configurations at childbirth on marital satisfaction and conflict strategies. J Child Fam Stud 23:1011–1026

    Article  Google Scholar 

  11. Cattell RB, Scheier IH (1961) The meaning and measurement of neuroticism and anxiety. Ronald, Oxford

    Google Scholar 

  12. Condon JT (1993) The assessment of antenatal emotional attachment: development of a questionnaire instrument. Br J Med Psychol 66(Pt 2):167–183

    Article  PubMed  Google 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 27:293–299. https://doi.org/10.1097/00004583-198805000-00005

    Article  CAS  PubMed  Google Scholar 

  14. Condon JT, Esuvaranathan V (1990) The influence of parity on the experience of pregnancy: a comparison of first- and second-time expectant couples. Br J Med Psychol 63(Pt 4):369–377

    Article  PubMed  Google Scholar 

  15. Cox JL, Holden JM, Sagovsky R (1987) Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry 150:782–786

    Article  CAS  PubMed  Google Scholar 

  16. Cranley MS (1981) Development of a tool for the measurement of maternal attachment during pregnancy. Nurs Res 30:281–284

    Article  CAS  PubMed  Google Scholar 

  17. Curry MA (1987) Maternal behavior of hospitalized pregnant women. J Psychosom Obstet Gynaecol 7:165–182

    Article  Google Scholar 

  18. Damato EG (2004) Predictors of prenatal attachment in mothers of twins. J Obstet Gynecol Neonatal Nurs 33:436–445

    Article  PubMed  Google Scholar 

  19. Damato EG (2004) Prenatal attachment and other correlates of postnatal maternal attachment to twins. Adv Neonatal Care 4:274–291

    Article  PubMed  Google Scholar 

  20. Doan HM, Cox NL, Zimerman A (2003) The maternal fetal attachment scale: some methodological ponderings. J Prenat Perinat Psychol Health 18(2):167–188

    Google Scholar 

  21. Dubber S, Reck C, Muller M, Gawlik S (2015) Postpartum bonding: the role of perinatal depression, anxiety and maternal–fetal bonding during pregnancy. Arch Womens Ment Health 18:187–195. https://doi.org/10.1007/s00737-014-0445-4

    Article  CAS  PubMed  Google Scholar 

  22. 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 14:752–761. https://doi.org/10.1111/j.1467-7687.2010.01021.x

    Article  PubMed  Google Scholar 

  23. Goldberg S, Benoit D, Blokland K, Madigan S (2003) Atypical maternal behavior, maternal representations, and infant disorganized attachment. Dev Psychopathol 15:239–257

    Article  PubMed  Google Scholar 

  24. Gotlib IH, Joormann J (2010) Cognition and depression: current status and future directions. Annu Rev Clin Psychol 6:285–312. https://doi.org/10.1146/annurev.clinpsy.121208.131305

    Article  PubMed  PubMed Central  Google Scholar 

  25. Grant KA, McMahon C, Reilly N, Austin MP (2010) Maternal sensitivity moderates the impact of prenatal anxiety disorder on infant mental development. Early Hum Dev 86:551–556. https://doi.org/10.1016/j.earlhumdev.2010.07.004

    Article  PubMed  Google Scholar 

  26. Hahlweg K (1979) Konstruktion und Validierung des Partnerschaftsfragebogens PFB. Z Klin Psychologie 8:17–40 (German)

    Google Scholar 

  27. Hart R, McMahon CA (2006) Mood state and psychological adjustment to pregnancy. Arch Womens Ment Health 9:329–337. https://doi.org/10.1007/s00737-006-0141-0

    Article  CAS  PubMed  Google Scholar 

  28. Heidrich SM, Cranley MS (1989) Effect of fetal movement, ultrasound scans, and amniocentesis on maternal–fetal attachment. Nurs Res 38:81–84

    Article  CAS  PubMed  Google Scholar 

  29. Hinz A, Stöbel-Richter Y, Brähler E (2001) Der Partnerschaftsfragebogen (PFB): Normierung und soziodemographische Einflussgrößen auf die Partnerschaftsqualität. Diagnostica

  30. Hjelmstedt A, Widstrom AM, Collins A (2006) Psychological correlates of prenatal attachment in women who conceived after in vitro fertilization and women who conceived naturally. Birth 33:303–310. https://doi.org/10.1111/j.1523-536X.2006.00123.x

    Article  PubMed  Google Scholar 

  31. Ji EK, Pretorius DH, Newton R, Uyan K, Hull AD, Hollenbach K, Nelson TR (2005) Effects of ultrasound on maternal–fetal bonding: a comparison of two- and three-dimensional imaging. Ultrasound Obstet Gynecol Off J Int Soc Ultrasound Obstet Gynecol 25:473–477. https://doi.org/10.1002/uog.1896

    Article  Google Scholar 

  32. Kemp VH, Page CK (1987) Maternal prenatal attachment in normal and high-risk pregnancies. J Obstet Gynecol Neonatal Nurs 16:179–184

    Article  CAS  PubMed  Google Scholar 

  33. Laux L, Glanzmann P, Schaffner P, Spielberger CD (1981) Das State-Trait-Angstinventar (Testmappe mit Handanweisung, Fragebogen STAI-G Form X 1 und Fragebogen STAI-G Form X 2). Beltz, Weinheim

    Google Scholar 

  34. Lederman RP (1990) Anxiety and stress in pregnancy: significance and nursing assessment. NAACOG’s Clin Issues Perinat Womens Health Nurs 1:279–288

    CAS  Google Scholar 

  35. Leigh B, Milgrom J (2008) Risk factors for antenatal depression, postnatal depression and parenting stress. BMC Psychiatry 8:24. https://doi.org/10.1186/1471-244X-8-24

    Article  PubMed  PubMed Central  Google Scholar 

  36. Lindgren K (2001) Relationships among maternal-fetal attachment, prenatal depression, and health practices in pregnancy. Res Nurs Health 24:203–217

    Article  CAS  PubMed  Google Scholar 

  37. Little RJ (1988) A test of missing completely at random for multivariate data with missing values. J Am Stat Assoc 83(404):1198–1202. https://doi.org/10.1080/01621459.1988.10478722

    Article  Google Scholar 

  38. Matthey S, Barnett B, Kavanagh DJ, Howie P (2001) Validation of the Edinburgh Postnatal Depression Scale for men, and comparison of item endorsement with their partners. J Affect Disord 64:175–184

    Article  CAS  PubMed  Google Scholar 

  39. Mercer RT, Ferketich S, May K, DeJoseph J, Sollid D (1988) Further exploration of maternal and paternal fetal attachment. Res Nurs Health 11:83–95

    Article  CAS  PubMed  Google Scholar 

  40. Mikulincer M, Florian V (1999) The association between parental reports of attachment style and family dynamics, and offspring’s reports of adult attachment style. Fam Process 38:243–257

    Article  CAS  PubMed  Google Scholar 

  41. Mikulincer M, Florian V (1999) Maternal–fetal bonding, coping strategies, and mental health during pregnancy—the contribution of attachment style. J Soc Clin Psychol 18:255–276

    Article  Google Scholar 

  42. Misri S, Kendrick K, Oberlander TF, Norris S, Tomfohr L, Zhang H, Grunau RE (2010) Antenatal depression and anxiety affect postpartum parenting stress: a longitudinal, prospective study. Can J Psychiatry 55:222–228

    Article  PubMed  Google Scholar 

  43. Morse CA, Buist A, Durkin S (2000) First-time parenthood: influences on pre- and postnatal adjustment in fathers and mothers. J Psychosom Obstet Gynaecol 21:109–120

    Article  CAS  PubMed  Google Scholar 

  44. Muller M, Ferketich S (1993) Factor analysis of the Maternal Fetal Attachment Scale. Nurs Res 42:144–147

    CAS  PubMed  Google Scholar 

  45. Muller ME (1992) A critical review of prenatal attachment research. Sch Inq Nurs Pract 6:5–22

    CAS  PubMed  Google Scholar 

  46. Muller ME (1996) Prenatal and postnatal attachment: a modest correlation. J Obstet Gynecol Neonatal Nurs 25:161–166

    Article  CAS  PubMed  Google Scholar 

  47. Nonnenmacher N, Noe D, Ehrenthal JC, Reck C (2016) Postpartum bonding: the impact of maternal depression and adult attachment style. Arch Womens Ment Health 19:927–935. https://doi.org/10.1007/s00737-016-0648-y

    Article  CAS  PubMed  Google Scholar 

  48. O’Connor BP (2000) SPSS and SAS programs for determining the number of components using parallel analysis and velicer’s MAP test. Behav Res Methods Instrum Comput 32:396–402

    Article  PubMed  Google Scholar 

  49. Reck C, Klier CM, Pabst K, Stehle E, Steffenelli U, Struben K, Backenstrass M (2006) The German version of the postpartum bonding instrument: psychometric properties and association with postpartum depression. Arch Womens Ment Health 9:265–271. https://doi.org/10.1007/s00737-006-0144-x

    Article  CAS  PubMed  Google Scholar 

  50. Reck C, Zietlow AL, Muller M, Dubber S (2016) Perceived parenting stress in the course of postpartum depression: the buffering effect of maternal bonding. Arch Womens Ment Health 19:473–482. https://doi.org/10.1007/s00737-015-0590-4

    Article  CAS  PubMed  Google Scholar 

  51. Rossen L et al (2016) Predictors of postnatal mother–infant bonding: the role of antenatal bonding, maternal substance use and mental health. Arch Womens Ment Health 19:609–622. https://doi.org/10.1007/s00737-016-0602-z

    Article  PubMed  Google Scholar 

  52. Salmon P, Miller R, Drew NC (1990) Women’s anticipation and experience of childbirth: the independence of fulfillment, unpleasantness and pain. Br J Med Psychol 63(Pt 3):255–259

    Article  PubMed  Google Scholar 

  53. Schimmenti A (2013) Linking lack of care in childhood to anxiety disorders in emerging adulthood: the role of attachment styles. Child Adolesc Ment Health 20:41–48

    Article  Google Scholar 

  54. Shieh C, Kravitz M, Wang HH (2001) What do we know about maternal–fetal attachment? Kaohsiung J Med Sci 17:448–454

    CAS  PubMed  Google Scholar 

  55. Siddiqui A, Hagglof B (2000) Does maternal prenatal attachment predict postnatal mother–infant interaction? Early Hum Dev 59:13–25

    Article  CAS  PubMed  Google Scholar 

  56. Sjögren B, Edman G, Widström AM, Mathiesen AS, Uvnäs-Moberg K (2004) Maternal foetal attachment and personality during first pregnancy. J Reprod Infant Psychol 22:57–69

    Article  Google Scholar 

  57. Spielberger CD, Gorsuch RL, Lushene RE (1970) The State-Trait Anxiety Inventory (test manual). Consulting Psychologists Press, Palo Alto

    Google Scholar 

  58. Stadlmayr W et al (2006) Memory of childbirth in the second year: the long-term effect of a negative birth experience and its modulation by the perceived intranatal relationship with caregivers. J Psychosom Obstet Gynaecol 27:211–224

    Article  CAS  PubMed  Google Scholar 

  59. Ustunsoz A, Guvenc G, Akyuz A, Oflaz F (2010) Comparison of maternal– and paternal–fetal attachment in Turkish couples. Midwifery 26:e1–e9. https://doi.org/10.1016/j.midw.2009.12.006

    Article  CAS  PubMed  Google Scholar 

  60. van Bussel JC, Spitz B, Demyttenaere K (2010) Reliability and validity of the Dutch version of the maternal antenatal attachment scale. Arch Womens Ment Health 13:267–277. https://doi.org/10.1007/s00737-009-0127-9

    Article  PubMed  Google Scholar 

  61. Van den Bergh B, Simons A (2009) A review of scales to measure the mother–foetus relationship. J Reprod Infant Psychol 27:114–126

    Article  Google Scholar 

  62. Wallwiener S et al (2016) Predictors of impaired breastfeeding initiation and maintenance in a diverse sample: what is important? Arch Gynecol Obstet 294:455–466. https://doi.org/10.1007/s00404-015-3994-5

    Article  PubMed  Google Scholar 

  63. Walsh J, Hepper EG, Marshall BJ (2014) Investigating attachment, caregiving, and mental health: a model of maternal–fetal relationships. BMC Pregnancy Childbirth 14:383. https://doi.org/10.1186/s12884-014-0383-1

    Article  PubMed  PubMed Central  Google Scholar 

  64. White MA, Wilson ME, Elander G, Persson B (1999) The Swedish family: transition to parenthood. Scand J Caring Sci 13:171–176

    Article  CAS  PubMed  Google Scholar 

  65. Zachariah R (1994) Maternal–fetal attachment: influence of mother–daughter and husband–wife relationships. Res Nurs Health 17:37–44

    Article  CAS  PubMed  Google Scholar 

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Funding

This study was funded by the German Society of Psychosomatics in Gynecology and Obstetrics.

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Author notes

  1. Anne Doster and Stephanie Wallwiener contributed equally to this work.

Authors and Affiliations

  1. Department of Gynecological Endocrinology and Fertility Disorders, Ruprecht-Karls University Heidelberg, Heidelberg, Germany

    Anne Doster & Ruben-Jeremias Kuon

  2. Department of Obstetrics and Gynecology, Ruprecht-Karls University Heidelberg, Heidelberg, Germany

    Stephanie Wallwiener, Lina Maria Matthies, Katharina Plewniok, Sandra Feller, Christof Sohn, Joachim Rom & Markus Wallwiener

  3. Department of Psychology, Ludwig Maximilian University, Munich, Germany

    Mitho Müller & Corinna Reck

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  1. Anne Doster
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  2. Stephanie Wallwiener
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  3. Mitho Müller
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Correspondence to Stephanie Wallwiener.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Doster, A., Wallwiener, S., Müller, M. et al. Reliability and validity of the German version of the Maternal–Fetal Attachment Scale. Arch Gynecol Obstet 297, 1157–1167 (2018). https://doi.org/10.1007/s00404-018-4676-x

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  • DOI: https://doi.org/10.1007/s00404-018-4676-x

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