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Major depressive disorder during pregnancy and emotional attachment to the fetus

Archives of Women's Mental Health volume 14, Article number: 425 (2011) Cite this article

Abstract

While there is good evidence that depression negatively impacts mother-to-infant emotional attachment in the postpartum period, the impact of depression in pregnancy on maternal emotions and cognitions about the fetus (often termed “maternal–fetal attachment” or MFA) is unclear. This study compared MFA scores from women meeting clinical criteria for Major Depressive Disorder (MDD) with scores from nondepressed women. Participants were 161 women enrolled at 23–36 weeks gestation, of whom 65 met criteria for MDD via the Structured Clinical Interview for the DSM-IV-TR during their second and/or third trimesters. Cranley’s Maternal Fetal Attachment Scale was administered at 26 and 36 weeks gestation. Generalized linear modeling was used to assess the effect of MDD, anxiety, and antidepressant use on MFA. MDD was negatively related to MFA (LR) = 4.58, df = 1, p < 0.04). Neither anxiety (LR = 0.22, p < 0.64), nor antidepressant use (LR = 0.20, df = 1, p < 0.66) were related to MFA. Depression severity was negatively related to MFAS scores (B = −0.005, SE = .002, p < 0.0012) when including the interaction of MDD group and HRSD scores in the model. This study is the first to demonstrate that clinically defined MDD during pregnancy negatively impacts MFA, suggesting that the basis for poor mother-to-infant attachment in postpartum MDD may have roots in pregnancy.

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References

  • Ainsworth MD (1979) Infant–mother attachment. Am Psychol 34(10):932–937

    PubMed  Article  CAS  Google Scholar 

  • American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders. Fourth edn. American Psychiatric Association, Text Revision. Washington, DC

  • Battle CL, Salisbury AL (2010) Treatment of antenatal depression. J Midwifery Wom Health 55(5):479. author reply 479–480

    Article  Google Scholar 

  • Beck CT (1998) The effects of postpartum depression on child development: a meta-analysis. Arch Psychiatr Nurs 12(1):12–20

    PubMed  Article  CAS  Google Scholar 

  • Bloom KC (1995) The development of attachment behaviors in pregnant adolescents. Nurs Res 44(5):284–289

    PubMed  Article  CAS  Google Scholar 

  • Bonari L, Pinto N, Ahn E, Einarson A, Steiner M, Koren G (2004) Perinatal risks of untreated depression during pregnancy. Can J Psychiatr 49(11):726–735

    Google Scholar 

  • 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 Psychiatr 69(4):635–643

    Article  Google Scholar 

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

    PubMed  Article  Google Scholar 

  • Condon JT, Corkindale C (1997) The correlates of antenatal attachment in pregnant women. Br J Med Psychol 70(Pt 4):359–372

    PubMed  Article  Google Scholar 

  • Cranley MS (1981) Development of a tool for the measurement of maternal attachment during pregnancy. Nurs Res 30(5):281–284

    PubMed  Article  CAS  Google Scholar 

  • Cranley MS (1992) Response to “A critical review of prenatal attachment research”. Sch Inq Nurs Pract: An International Journal 6(1):23–26

    Google Scholar 

  • Davila J, Bradbury TN, Cohan CL, Tochluk S (1997) Marital functioning and depressive symptoms: evidence for a stress generation model. J Pers Soc Psychol 73(4):849–861

    PubMed  Article  CAS  Google Scholar 

  • Doan HM (2003) The maternal fetal attachment scale: some methodological ponderings. J Prenat Perinat Psychol Health 18(2):167–188

    Google Scholar 

  • Downey G, Coyne JC (1990) Children of depressed parents: an integrative review. Psychol Bull 108(1):50–76

    PubMed  Article  CAS  Google Scholar 

  • Dum M, Sobell LC, Sobell MB, Heinecke N, Voluse A, Johnson K (2009) A quick drinking screen for identifying women at risk for an alcohol-exposed pregnancy. Addict Behav 34(9):714–716.

    PubMed  Article  Google Scholar 

  • Field T, Healy BT, Goldstein S, Guthertz M (1990) Behavior-state matching and synchrony in mother–infant interactions on nondepressed versus depressed dyads. Dev Psychol 26(1):7–14

    Article  Google Scholar 

  • First MB, Spitzer RL, Miriam G, Williams JBW (2002) Structured clinical interview for DSM-IV-TR axis I disorders, research version, non-patient edition. (SCID-I/NP). Biometrics Research, New York State Psychiatric Institute, New York

  • Flynn HA, Blow FC, Marcus SM (2006) Rates and predictors of depression treatment among pregnant women in hospital-affiliated obstetrics practices. Gen Hosp Psychiatr 28(4):289–295.

    Article  Google Scholar 

  • Fowles ER (1998) The relationship between maternal role attainment and postpartum depression. Health Care Women Int 19(1):83–94

    PubMed  Article  CAS  Google Scholar 

  • Fuller JR (1990) Early patterns of maternal attachment. Health Care Women Int 11(4):433–446

    PubMed  Article  CAS  Google Scholar 

  • Garber MC, Nau DP, Erickson SR, Aikens JE, Lawrence JB (2004) The concordance of self-report with other measures of medication adherence: a summary of the literature. Med Care 42(7):649–652

    PubMed  Article  Google Scholar 

  • Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T (2005) Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol 106(5 Pt 1):1071–1083.

    Google Scholar 

  • Goodman JH (2009) Women’s attitudes, preferences, and perceived barriers to treatment for perinatal depression. Birth 36(1):60–69.

    PubMed  Article  Google Scholar 

  • Gottfried AW (1985) Measures of socioeconomic status in child development research: data and recommendations. Merrill-Palmer-Quarterly 31(1):85–92

    Google Scholar 

  • Grace JT (1989) Development of maternal-fetal attachment during pregnancy. Nurs Res 38(4):228–232

    PubMed  Article  CAS  Google Scholar 

  • Hamilton M (1960) A rating scale for depression. J Neuro Neurosurg Psychiatr 23:56–62

    Article  CAS  Google Scholar 

  • Hart R, McMahon CA (2006) Mood state and psychological adjustment to pregnancy. Arch Womens Ment Health 9(6):329–337

    PubMed  Article  CAS  Google Scholar 

  • Herring M, Kaslow NJ (2002) Depression and attachment in families: a child-focused perspective. Fam Process 41(3):494–518

    PubMed  Article  Google Scholar 

  • Hollingshead AB (1975) A four-factor index of social status. Unpublished working paper. Department of Sociology, Yale University, New Haven, CT

  • Honjo S, Arai S, Kaneko H, Ujiie T, Murase S, Sechiyama H, Sasaki Y, Hatagaki C, Inagaki E, Usui M, Miwa K, Ishihara M, Hashimoto O, Nomura K, Itakura A, Inoko K (2003) Antenatal depression and maternal–fetal attachment. Psychopathology 36(6):304–311

    PubMed  Article  Google Scholar 

  • Ingersoll KS, Knisely JS, Dawson KS, Schnoll SH (2004) Psychopathology and treatment outcome of drug dependent women in a perinatal program. Addict Behav 29(4):731–741.

    PubMed  Article  Google Scholar 

  • Ingersoll KS, Farrell-Carnahan L, Cohen-Filipic J, Heckman CJ, Ceperich SD, Hettema J, Marzani-Nissen G (2011) A pilot randomized clinical trial of two medication adherence and drug use interventions for HIV + crack cocaine users. Drug Alcohol Depend 116(1–3):177–187.

    PubMed  Article  Google Scholar 

  • Josefsson A, Berg G, Nordin C, Sydsjo G (2001) Prevalence of depressive symptoms in late pregnancy and postpartum. Acta Obstet Gynecol Scand 80(3):251–255

    PubMed  Article  CAS  Google Scholar 

  • Konlak-Griffin D, Verzemnieks I (1991) Effects of nursing intervention on adolescents maternal role attainment. Issues in Contemporary Pediatric Nursing 14:121–137

    Article  Google Scholar 

  • Kunkel GF, Doan HM (2003) Fetal attachment and depression: measurement matters. J Prenat Perinat Psychol Health 19(2):149–166

    Google Scholar 

  • Leifer M (1977) Psychological changes accompanying pregnancy and motherhood. Genet Psychol Monogr 95(1):55–96

    PubMed  CAS  Google Scholar 

  • Lindgren K (2001) Relationships among maternal–fetal attachment, prenatal depression, and health practices in pregnancy. Res Nurs Health 24(3):203–217

    PubMed  Article  CAS  Google Scholar 

  • Manber R, Blasey C, Allen JJ (2008) Depression symptoms during pregnancy. Arch Womens Ment Health 11(1):43–48

    PubMed  Article  CAS  Google Scholar 

  • Matthey S (2010) Assessing the experience of motherhood: the Being a Mother Scale (BaM-13). J Affect Disord. doi:101016/j.jad.2010.06.032

  • Mercer RT (2004) Becoming a mother versus maternal role attainment. J Nurs Scholarsh 36(3):226–232

    PubMed  Article  Google Scholar 

  • Mercer RT, Ferketich S, May K, DeJoseph J, Sollid D (1988) Further exploration of maternal and paternal fetal attachment. Res Nurs Health 11(2):83–95

    PubMed  Article  CAS  Google Scholar 

  • Muller ME (1993) Development of the prenatal attachment inventory. West J Nurs Res 15(2):199–211, discussion 211–195

    PubMed  Article  CAS  Google Scholar 

  • Muller ME (1996) Prenatal and postnatal attachment: a modest correlation. J Obstet Gynecol Neonatal Nurs 25(2):161–166

    PubMed  Article  CAS  Google Scholar 

  • Muller ME, Ferketich S (1993) Factor analysis of the maternal fetal attachment scale. Nurs Res 42(3):144–147

    PubMed  CAS  Google Scholar 

  • Murray L, Fiori-Cowley A, Hooper R, Cooper P (1996) The impact of postnatal depression and associated adversity on early mother–infant interactions and later infant outcome. Child Dev 67(5):2512–2526

    PubMed  Article  CAS  Google Scholar 

  • O’Mahen HA, Flynn HA (2008) Preferences and perceived barriers to treatment for depression during the perinatal period. J Womens Health (Larchmt) 17(8):1301–1309.

    Article  Google Scholar 

  • 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 20(2):284–291.

    PubMed  Article  Google Scholar 

  • Ranson KE, Urichuk LJ (2008) The effect of parent–child relationships on child biopsychosocial outcomes: a review. Early Child Dev Care 2:129–152

    Article  Google Scholar 

  • Salisbury A, Law K, LaGasse L, Lester B (2003) MSJAMA. Maternal–fetal attachment. Jama 13:1701

    Article  Google Scholar 

  • Scharfe E (2007) Cause or consequense?: exploring causal links between attachment and depression. J Soc Clin Psychol 26:1048–1064

    Article  Google Scholar 

  • Siddiqui A, Hagglof B (2000) Does maternal prenatal attachment predict postnatal mother–infant interaction? Early Hum Dev 59(1):13–25

    PubMed  Article  CAS  Google Scholar 

  • Sobell LC, Brown J, Leo GI, Sobell MB (1996) The reliability of the Alcohol Timeline Followback when administered by telephone and by computer. Drug Alcohol Depend 42(1):49–54

    PubMed  Article  CAS  Google Scholar 

  • Sobell LC, Agrawal S, Annis H, Ayala-Velazquez H, Echeverria L, Leo GI, Rybakowski JK, Sandahl C, Saunders B, Thomas S, Zioikowski M (2001) Cross-cultural evaluation of two drinking assessment instruments: alcohol timeline followback and inventory of drinking situations. Subst Use Misuse 36(3):313–331

    PubMed  Article  CAS  Google Scholar 

  • SPSS Inc (2008) SPSS statistics 17.0. SPSS, Chicago

    Google Scholar 

  • StatSoft Inc. Statistica 9.0. StatSoft, Tulsa, OK

  • Steer RA, Scholl TO, Hediger ML, Fischer RL (1992) Self-reported depression and negative pregnancy outcomes. J Clin Epidemiol 45(10):1093–1099

    PubMed  Article  CAS  Google Scholar 

  • Teti DM, Gelfand DM, Messinger DS, Isabella R (1995) Maternal depression and the quality of early attachment: an examination of infants, preschoolers, and their mothers. Dev Psychol 31(3):364–376

    Article  Google Scholar 

  • Van den Bergh B, Simons A (2009) A review of scales to measure the mother–foetus relationship. J Reprod Infant Psychol 27(2):114–126.

    Article  Google Scholar 

  • Walsh J (2010) Definitions matter: if maternal–fetal relationships are not attachment, what are they? Arch Wom Ment Health 13(5):449–451.

    Article  Google Scholar 

  • Whisman MA, Davila J, Goodman SH (2011) Relationship adjustment, depression, and anxiety during pregnancy and the postpartum period. J Fam Psychol 25(3):375–383.

    PubMed  Article  Google Scholar 

  • Yarcheski A, Mahon NE, Yarcheski TJ, Hanks MM, Cannella BL (2009) A meta-analytic study of predictors of maternal–fetal attachment. Int J Nurs Stud 46:708–715

    PubMed  Article  Google Scholar 

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Affiliations

  1. Brown Center for the Study of Children at Risk, Warren Alpert Medical School, Brown University, Women & Infants Hospital of RI, 101 Dudley Street, Providence, RI, 02905, USA

    Julie McFarland, Amy L. Salisbury, Katheleen Hawes, Katherine Halloran & Barry M. Lester

  2. Warren Alpert Medical School-Brown University, Butler Hospital, Women & Infants Hospital of RI, 101 Dudley Street, Providence, RI, 02905, USA

    Cynthia L. Battle

Authors
  1. Julie McFarland
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  2. Amy L. Salisbury
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  3. Cynthia L. Battle
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  4. Katheleen Hawes
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  5. Katherine Halloran
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  6. Barry M. Lester
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Correspondence to Amy L. Salisbury.

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McFarland, J., Salisbury, A.L., Battle, C.L. et al. Major depressive disorder during pregnancy and emotional attachment to the fetus. Arch Womens Ment Health 14, 425 (2011). https://doi.org/10.1007/s00737-011-0237-z

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  • DOI: https://doi.org/10.1007/s00737-011-0237-z

Keywords

  • Depression
  • Pregnancy
  • Mother–infant relationship