Maternal-fetal attachment (MFA) is a term used to describe the relationship
between a pregnant woman and her fetus. Qualitative descriptions of maternal
attitudes and adaptation to pregnancy indicate that MFA is based on cognitive
representations of the fetus. These may include imagined scenarios between
mother and child, as well as a mother's attribution of physical and emotional
characteristics to the fetus.1 MFA is manifested
in behaviors that demonstrate care and commitment to the fetus and include
nurturance (eating well, abstaining from harmful substances, such as alcohol),
comforting (stroking the belly), and physical preparation (buying baby clothes
The concept of MFA is relatively new and has not been well studied or
defined. Inquiry into a woman's psychological reaction and adjustment during
pregnancy began in the 1970s. Prior to that time, there are few scientific
data available on women's thoughts or feelings about their pregnancies. Historical
and literary accounts of women's experiences in childbirth prior to the 20th
century reveal that women were primarily concerned with enduring and surviving
pregnancy. Letters written by women in the 19th century show evidence of maternal
projections about the expected child as well as feelings of loss from a miscarriage
or infant death. Writings of their own physical suffering and fear of death
were more common.2
The declining mortality rate and technological developments in western
nations over the past 30 to 40 years have changed conceptions about pregnancy
and the fetus. Women can detect pregnancy earlier and are able to view high-resolution
images of their fetus at earlier dates. This knowledge may serve to allow
women to adopt optimal health practices earlier. The implications of MFA for
maternal and fetal health are now studied in other countries and across cultures
of developed nations, including China, Germany, Sweden, Israel, and Japan.3 MFA has not been studied in developing nations
in which the mortality rate for women and infants remains at or above 40%.
A broad spectrum of MFA has been observed during pregnancy.4 The frequency and intensity of MFA behaviors increase
with advancing gestational age, particularly after quickening at approximately
18 to 22 weeks of gestation. The rate and degree of MFA development appears
to be influenced by gestational age at quickening, amount of fetal movement,
pregnancy history, and the mother's own attachment history.5
Three scales measuring psychometric properties have been developed to
quantify MFA.6- 8 While
original versions of the 3 scales may be limited in their sensitivity to cultural
experience, revisions in other countries suggest that adequate adaptation
of these scales may be possible.3
MFA as measured by these scales is consistently related to pregnancy
planning, strength of the marital relationship, gestational age, and maternal
depressed mood.9 The variables of maternal
age, parity, self-esteem, and socioeconomic status are inconsistently related
to MFA across studies.10 Social support
of family members and peers is a significant predictor of MFA. Perceived support
of prenatal care providers was correlated with MFA at 0.74, providing further
evidence that psychosocial support is a critical component of prenatal care.11 Maternal mood state has also been consistently
related to ratings of MFA.12 It has been
reported that depression during pregnancy is related to poor prenatal health
demonstrated by poor weight gain, drug abuse, and smoking.13 The
relative paucity of research on MFA is limited due to methodological problems,
including inadequate operational definition of the construct; small, homogeneous
samples; and lack of sensitivity to cultural issues. Little is known about
the process by which MFA develops, including psychological and physiological
mechanisms that could shape the development of MFA. Future studies should
focus on improved measurement of MFA in large, diverse samples.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and
Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early
dhildhood mortality and growth failure data and their association with maternal
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