Maternal adult attachment and maternal–fetal attachment in the context of romantic relationship quality after premature birth–A cross sectional study
Karolina Lutkiewicz
Mariola Bidzan- Department of Clinical and Health Psychology, Faculty of Social Sciences, Institute of Psychology, University of Gdańsk, Gdańsk, Poland
Objective:The primary outcome of the study was to evaluate the maternal adult attachment and maternal–fetal attachment (MFA) in the context of romantic relationship quality among mothers of preterm born children. Associations between MFA, maternal adult attachment, maternal perceived stress, depressive symptoms, social support in the neonatal period were also examined as secondary outcomes.
Materials and methods:The study had a cross-sectional design and involved 260 of women after premature birth, who participated in the study in the early neonatal period. The following self-reported methods were used: Socio-demographic questionnaire, Attachment Styles Questionnaire (ASQ), Maternal–Fetal Attachment Scale (MFAS), The Perceived Stress Questionnaire (PSQ), The Dyadic Adjustment Scale (DAS), The Edinburgh Postnatal Depression Scale (EPDS), The Social Support Questionnaire (SSQ).
Results:The results showed that a secure attachment style is associated with a higher intensity of the MFA and consequently, a higher quality of the romantic relationship. Regression analysis presented that the higher the secure attachment score, the lower the perceived level of stress and depressive symptoms, which in turn lead to a higher quality of the partner relationship.
Conclusion:Maternal secure attachment positively impacts the romantic relationship quality and the maternal–fetal attachment. The findings also draw attention to the role of the secure attachment style as a protective factor while coping with stress and depressive symptoms.
Introduction
According to the World Health Organization (WHO) preterm birth occurs when babies are born before the 37th week of pregnancy. The number of premature births has been growing consistently with approximately 15 million children born prematurely worldwide (1）.In Poland this rate is between 6.3 and 8% of total births, and in other populations oscillates between 4 and 12% (2,3.）.Preterm birth is an important phenomenon due to many potential negative health outcomes and possible long-term complications in the mental and physical development of a child (4）.What is more, the experience of preterm birth is considered a stressful and sometimes even traumatic event (5）due to potential negative impacts on child, mother-child dyad, couples’ relationship, and whole family system (6）.Therefore, exploring adult attachment style and romantic relationship quality in the context of premature birth is of a great importance.
Based on existing knowledge, relationship quality between parents is an important aspect of a child’s development (7）, attachment style (8,9）, language development (10）, and the perception of the child (11）.Some studies also highlight further outcomes related to the psychological, socio-emotional child development and school performance, which can occur later in life (12）as well as insecure attachment with parents, and worse relationship quality in later life (13,14）.Parental intimacy, constructive communication, warm and empathetic interactions are essential for a child’s development (13–15）.What is more, research has shown that parents, who felt supported in their relationship presented more positive parenting behaviors (16）.文献表明,家庭动力学related with child’s wellbeing, understanding the input of different psychological elements, including adult attachment style, parental mental health as well as exploring the level of contribution of these factors may be a key, especially in the context of prematurity.
One of the significant factors influencing the romantic relationship quality is adult attachment style (17,18）.Adult attachment style is a mental representation of the self in relation with others, which guides individuals in their perceptions, reactions, and expectations in close relationships throughout the lifespan (19）.Thus, it is also related with parenthood (18）.Adult attachments have been studied in relation to various aspects of parenting. Research suggests that individuals with insecure adult attachment demonstrated fewer behaviors facilitating transition to parenthood than those with a secure attachment style (17）.Other studies have shown that maternal adult attachment has an impact on the antenatal attachment with her child (20,21）.母胎附件(MFA)之间的关系maternal thoughts, feelings, and behaviors toward her unborn child (22）.Brandjerdporn et al. (22）indicated for the link between MFA including different maternal sensory patterns and adult attachment style (22）.In another research Chrzan–Detkos and Lockiewicz (20）showed the relationship between maternal adult attachment and antenatal maternal bonding, but not with maternal bonding after birth. In Europe 7–8% of mothers reported a weakened bond with their children in the postnatal period (23）.Nordahl et al. (21）found that higher scores on avoidance and anxious attachment styles were related to increased stress, which in turn lead to a decreased quality of maternal bonding (21）.
The literature has also presented strong associations between adult attachment styles and mental health. Research showed that adult attachment coexists not only with stress (24）, but also between social support (25）, depression (26）, and anxiety (27）.Even though most women perceive parenthood as a positive life event, nevertheless up to 20% of women report anxiety, depression, or stress in the perinatal period (28）.As stated above, during pregnancy and the first postnatal year parents are more vulnerable to the experience of stress and various psychological problems, thus, another important aspect that needs to be considered is the psychological wellbeing of parents and its impact on relationship quality.
The connection between mental health and marital satisfaction has been widely studied (29,3.0）.Research results have reported that a low-quality relationship and lack of satisfaction during the perinatal period was associated with increased risk for depression and anxiety for both men and women (29,3.1,3.2）.In a systematic review of 29 studies, lack of support, especially spousal, was associated with anxiety and depression during pregnancy (3.3.）.As presented above, a satisfying romantic relationship significantly impacts an individuals’ general psychological wellbeing, life satisfaction, physical health (3.4,3.5）child development, parental experience, and engagement in the parental role (3.0）.The involvement and performance as a parent can be reduced due to poor relationship quality (3.6）, it has been found that relationship satisfaction predicts emotional availability, infant social-emotional behavior (3.7）, and maternal bonding with a child (3.8）.A systematic review showed that in 9 of 16 studies a higher quality of partner relationship was positively associated with mother-to-infant bonding quality (3.8）.
The child experiences, especially in the first years of their life, are very formative and may have a long-term impact on the child’s development and psychological functioning (14）.The parental relationship is found to be a significant component, which determines the quality of family life (7）.While a majority of studies concentrate on full term birth, this study focuses on exploring the mother’s attachment style and relationship quality in the context of other psychological variables shortly after the experience of preterm birth.
The literature on the subject presents a broad analysis of factors determining adult attachment style and quality of a partnership relation. However, despite its importance, little is known about the relationship quality among mothers, who experienced preterm birth in relation to maternal attachment style and MFA, including other psychological factors. Research in the early childhood period after preterm birth is limited. The majority of studies researching parental relationship satisfaction are related to adolescence or late childhood. Thus, the present study addresses the early neonatal period, which is a time of forming patterns of interactions and bonding with a baby, through feeding, touching, and spending time cuddling. Neonatal period is a sensitive time for parents who experienced premature birth due to challenges related with preterm birth such as long-term care in a Neonatal Intensive Care Unit, fear for the child’s health, separation of the mother-child dyad, and limitations in holding or touching the baby (5,3.9,40）.The experience of prematurity makes these families different and unique in many ways. Preterm birth can be related with more challenges and difficulties than full term birth, which can also impact a partner’s interactions, relationship quality, and parenting. Thus, in this study we decided to focus only on the mothers who experienced preterm birth.
这项研究的目的是获得更不如ve picture of psychological factors that are associated with the maternal experience in the post-partum period. The primary goal of this study was to examine the associations between the maternal adult attachment style and MFA, with romantic relationship quality among mothers of premature children. The secondary goal was to examine if there are associations between maternal adult attachment and MFA with maternal perceived stress, depressive symptoms, and social support. Sociodemographic factors were examined with maternal adult attachment and maternal depressive symptoms.
The following research questions were stated:
1. Whether maternal adult attachment is related with the romantic relationship quality among mothers of preterm children?
2. Whether maternal adult attachment is related with depressive symptoms, social support, and perceived stress among mothers of preterm born children?
3.. Whether maternal–fetal attachment (MFA) is related with romantic relationship quality and its components?
4. Whether maternal–fetal attachment (MFA) is related with maternal adult attachment, perceived stress, and social support in the neonatal period?
5. Whether maternal adult attachment and depressive symptoms are related with sociodemographic factors (maternal age, maternal education, paternal age and education, marital status, place of living, and financial status)?
Materials and methods
Study design and procedures
This cross-sectional study was a part of a broader project conducted in cooperation with the Clinic of Obstetrics at the Medical University of Gdańsk and the University of Gdańsk. The Research Ethics Board at the University of Gdańsk approved the procedures of the study (No. 25/2015).
Enrollment was provided by trained assistants in accordance with predetermined eligibility criteria through medical records of women who gave premature birth–birth to a child born below 37 weeks of pregnancy; preterm birth defined according to the international definition of prematuritym in the Neonatology, Gynaecology and Obstetrics Unit of the University Clinical Center in Gdańsk (Poland). Mothers of newborns after preterm birth were invited to take part in the study by trained assistants after delivery at the University Clinical Center in Gdansk, Poland in accordance with predetermined eligibility criteria through medical records. The study group consisted of mothers who gave birth to a child born below 37 weeks of pregnancy. New mothers were recruited through a personal invitation in the early neonatal period between the first and third day after childbirth–they answered the questionnaires at their convenience between the 1 and 3 day after the birth. Women who agreed to participate in the study, were informed about the procedures of the study and provided written informed consent. It was emphasized that enrollment in the study is voluntary, and parents could refuse to participate without giving any reason. Mothers of prematurely born children were asked to complete paper datasets of questionnaires regarding their subjective assessment of attachment style, relationship quality, perceived stress, depressive symptoms, social support, and MFA. Socio-demographic information were also gathered. Paper datasets were securely stored by the project manager. Each participant received an ID which was retrieved from their medical card. Only mothers in a romantic relationship (formal or informal) with a partner, after preterm birth were considered for inclusion to the study. Exclusion criteria were as follows: a personal decision to not participate in the study, cognitive or physical impairment, or single motherhood.
Materials and methods
Data in the study was obtained by self-report measures. Demographic characteristics included variables such as: maternal age and education, paternal age and education, place of living, maternal marital status, financial status, number of children in the household, number of pregnancies, gestational age, delivery type, child’s birth weight, and APGAR (Appearance, Pulse, Grimace, Activity, and Respiration) points.
Assessment of attachment style
The Attachment Styles Questionnaire (ASQ, (41））is a tool used to assess adult attachment styles in a romantic relation both directed to men and women (41）.This tool was developed by Plopa (41）, on the basis of Hazan’s and Shaver’s concept (42）.ASQ differentiates three attachment styles: secure, avoidant, and anxious-ambivalent style. The questionnaire consists of 24 items, organized into three scales, related to the above attachment styles. Raw results are calculated into sten scores. The respondents have to answer each of the items by using a seven-point scale. Secure attachment style is related with a high level of security in the relationship, mutual trust, openness in the relationship and a feeling of confidence with a partner in a difficult time. The anxious-ambivalent style is characterized by a lack of security and a high level of anxiety in terms of relationship stability, increased worries, openness, and trust. The avoidant style occurs when a person has difficulty in establishing and maintaining close relationships. The questionnaire has satisfactory methodological properties and criteria. Reliability for the secure style equals 0.91, for the ambivalent-anxious style is 0.78, and for the avoidant style is 0.80 (41）.In this study The Cronbach’s alpha reliability coefficient equaled 0.79 for the whole scale.
Assessment of relationship quality
The Dyadic Adjustment Scale (DAS, (43）; Polish version: (44））is a 32-item measure designed to assess the relationship quality between married or cohabitating couples. DAS has 32 items, which are organized into four subscales: Dyadic Consensus (the degree to which the couple agrees on matters of importance to the relationship), Dyadic Satisfaction (the degree to which the couple is satisfied with their relationship), Dyadic Cohesion (the degree of closeness and shared activities experienced by the couple), and Affective Expression (the degree of demonstrations of affection and sexual relationships) (43,44）.The results can be calculated by adding the overall score from all the categories. A higher quality of the relationship is indicated by a higher score. Meta-analysis with 128 samples (25,035 participants), reported that the Cronbach’s alpha reliability coefficient for the whole scale was 0.92 and the individual subscales ranged between 0.71 and 0.87 (45）.在这项研究中量表的阿尔法的可靠性coefficient equals 0.925.
Assessment of perceived stress
The Perceived Stress Questionnaire (PSQ, (46）, Polish version: (41））is a self-report tool used for the assessment of the general and subjective experience of stress within the last month (41,46）.Originally designed in English, Perceived Stress Questionnaire (PSQ) is a widely used tool, which was validated in many countries and translated into Polish (41）, Italian and English (46）, Spanish, German, and Swedish (47）.The PSQ consists of 30 items, which are organized into seven different components of stress: sense of fatigue (4–16 points), irritability (2–8 points), worries (5–20 points), psychological tension (4–16 points), no joy of life (7–28 points), sense of pressure (4–16 points), and being overwhelmed (4–16 points). The scores are the sum of the results from all the categories. The person can obtain the maximum score of 120, and the minimum is 30 points (41）.This instrument can be useful in studying prerequisites and predictors of health and wellbeing in general population (47）.The Cronbach’s alpha reliability coefficient equaled > 0.9 (46）.在这项研究中量表的阿尔法的可靠性coefficient equals 0.942.
Assessment of depressive symptoms
Depressive symptoms were measured by The Edinburgh Postnatal Depression Scale (EPDS, (48）; Polish version: Bielawska-Batorowicz), which is the most common screening tool used worldwide (48）.It can be used during pregnancy as well as in the year following the birth of a child. EPDS consists of a set of 10 questions about the symptoms of depression regarding the past 7 days. The scale uses the four-point Likert scale. The total score is calculated by adding the numbers selected for each of the 10 items. The higher the score, the higher the possibility of severe depressive symptoms. The cut-off values of 13/14 or higher are most often used to identify women who might have depression symptoms. The Cronbach’s α coefficients of reliability in a Polish version of EPDS equaled 0.9 (49）.The Cronbach’s alpha coefficient in this study calculates as 0.859.
Assessment of social support
The Social Support Questionnaire (SSQ, (50）; Polish version: (51））, is a quantitative self-report questionnaire designed to measure social support in the postnatal period (50,51）.It contains 14 statements that include three dimensions: social support obtained, desired, and an assessment of satisfaction with support from the subjective perspective of a person. The scale consists of 14 different resources that an individual can receive support from such as family, friends, healthcare workers, church, and community. The items are evaluated based on a four-point scale (1–not at all to 4–extremely agree). The total score ranges between 14 and 56 points (52）.The Polish version of the questionnaire for each dimension has the following reliability: desired support (0.85), obtained support (0.69), support assessment (0.88). The Cronbach’s alpha reliability coefficient for the whole scale is 0.864. In this study the Cronbach’s alpha reliability coefficient calculates 0.864.
Assessment of a maternal–fetal attachment
Maternal–Fetal Attachment Scale (MFAS, (53）; Polish version: (51））aims to characterize the MFA during pregnancy (51,53）.A 24-item scale is a measure divided into the five following subscales: (a) Taking the parental role, (b) Treating a child as a separate being, (c) Interacting with the child, (d) Assigning characteristics to the child, (e) Being guided by the needs of the child. The questions are evaluated through Likert-type responses. The person answers by selecting one of the following terms: A–definitely yes; B–rather yes; C–I find it difficult to answer; D–probably not; E–definitely not. The final score is obtained by the sum of all responses, which vary from 24 to 120 points. The higher the score obtained by the respondent, the higher MFA. Reliability for the Polish version for the entire questionnaire is calculated as 0.81, and for the scales, respectively: 0.66; 0.58; 0.52; 0.61; 0.50 (51）.在这项研究中量表的阿尔法的可靠性coefficient for the whole scale is 0.726.
Data analysis
Data analysis was obtained using the Statistical Package for Social Science (SPSS) version 24. In the first step of the statistical analysis, descriptive statistics were calculated. In the second step, initial associations between measured variables were obtained through Persons’ correlations. In the third step, linear hierarchical regression was used to examine whether attachment style is a predictor of relationship quality and finally individual pathways of the studied mediation models were calculated. Then, bootstrap testing for indirect effects was performed. To analyze the internal consistency of all research tools, reliability measures were calculated using the Cronbach’s alpha method. On the basis of the conducted analyses, it can be concluded that all research tools have reliability above 0.7, which means their internal consistency is high.
Results
The characteristics of the study group
A total of 260 women participated in this cross-sectional study who gave birth to a premature child. The majority of mothers (161 mothers, 79.7%). 60.3% (129 mothers) of respondents had a university degree, 75.9% (129 mothers) of participants reported living in a city with a population above 100,000 or more. The majority of women 75.4% (196 mothers) were pregnant with one child–single pregnancy as well as most of the women were primiparas (63.3%, 164 mothers). What is important, 66.3% (126 mothers) of women were hospitalized during their pregnancy. In 9 out of 10 cases (90.0%) the child was put into an incubator after birth. To conclude, most children were late-term preemies (78.4%, 200 infants). 14.5% of children (37 children) were born as mid-term preemies and 7.1% as early preterm infants (18 infants). Socio-demographic factors were not analyzed in this article with all psychological variables, as some of them were presented in the separate article (54）.Socio-demographic variables of the study sample are presented inTable 1.
Table 1.Socio-demographic variables of the study sample.
Maternal adult attachment and the romantic relationship quality among mothers
第一个研究问题的答案是否交配rnal adult attachment is related with the relationship quality among mothers of preterm children, correlation analysis was conducted. Correlation analysis revealed that secure attachment style correlated positively with all dimensions of relationship quality. All correlations were positive and strong. The strongest one occurred between the secure attachment style and the general relationship quality (r= 0.72,p= 0.01)。Maternal anxious attachment style correlated negatively with all dimensions of the relationship quality, apart from cohesion. All correlations observed were moderately strong. No statistically significant correlation was observed between the quality of the relationship quality and the avoidant attachment style (Table 2）.
Table 2.Pearson’s linear correlation coefficient for the relation between general satisfaction with the relationship quality and its components with maternal adult attachment.
Maternal adult attachment and its association with depressive symptoms, social support, and perceived stress
To answer the second research question whether maternal adult attachment is related with depressive symptoms, social support, and perceived stress among mothers of preterm born children correlation analysis was conducted. Correlation analyses showed that the anxious attachment style positively correlated with depressive symptoms (r= 0.43,p= 0.01)。The correlation between the anxious attachment style and perceived stress was very strong (r= 0.90,p= 0.01)。Similar associations were obtained regarding the avoidance attachment style, but the strength of these correlations was weaker. The results also show that the secure attachment style negatively correlated with maternal depressive symptoms and perceived stress. In terms of attachment style and social support dimensions, there was only one significant correlation (weak and negative) between anxious attachment style and the quality of the received support (r= -0.15,p= 0.05). All results are presented inTable 3.
Table 3.Pearson’s linear correlation coefficient for the relationship between maternal adult attachment styles with depression, social support, and perceived stress.
Table 4presents detailed analysis of correlations between adult attachment and perceived stress components. The anxious and avoidant attachment styles correlated positively with the sense of fatigue, irritability, worries, psychological tension, lack of joy of life, sense of pressure, and being overwhelmed. All correlations between the anxious style and all stress dimensions were very strong (abover= 0.70,p= 0.01)。与此同时,母亲之间的相关性nal avoidant attachment and all stress dimensions were statistically significant, but moderately strong. The maternal secure attachment style correlated negatively with the anxious attachment style, irritability, worries, psychological tension, lack of joy of life sense of pressure, and being overwhelmed. All the correlations were weak (Table 4）.
Table 4.Pearson’s linear correlation coefficient for the relation between maternal adult attachment and the perceived stress components.
Maternal–fetal attachment and romantic relationship quality and its components
To answer the third research question whether MFA is associated with romantic relationship quality and its components, correlation analysis was conducted. According to the stated hypothesis, the MFA is related to the romantic relationship quality in a group of mothers. The analysis showed that the MFA is positively correlated with the romantic relationship quality and all its dimensions in the neonatal period in mothers of premature babies (Table 5）.
Table 5.Pearson’s linear correlation coefficient for the relation between relationship quality and maternal–fetal attachment (MFA).
Maternal–fetal attachment and the association with maternal adult attachment, perceived stress, and social support in the neonatal period
To answer the fourth research question whether MFA is associated with maternal adult attachment, perceived stress, and social support in the neonatal period correlation analyzes was conducted. It was examined whether MFA coexists with other psychological factors (maternal stress, social support and maternal adult attachment style). It was shown that MFA during pregnancy positively correlated with the obtained social support and the quality of the obtained social support. What is more, MFA coexisted with the maternal secure attachment style, however, there were no associations between anxious and avoidant attachment styles and MFA (Table 6）.
Table 6.Pearson’s linear correlation coefficient for the relation between maternal–fetal attachment (MFA), social support, and perceived stress and maternal adult attachment.
Detailed correlation analysis related to stress and its component showed that MFA correlated negatively with a sense of fatigue, irritability, psychological tension, and lack of joy in life (Table 7）.
Table 7.Pearson’s linear correlation coefficient for maternal–fetal attachment (MFA) and maternal perceived stress with its components.
Sociodemographic factors and their associations with maternal adult attachment and depressive symptoms
To answer the question whether maternal adult attachment and depressive symptoms are related with sociodemographic factors (maternal age, maternal education, paternal age and education, marital status, place of living, and financial status) correlation analysis was conducted. Analyzes of the associations between the attachment style and social factors showed that only the anxious attachment style negatively correlated with the maternal education, paternal education, and the mother’s material status. Depressive symptoms negatively correlated with the paternal education, maternal marital status, and mother’s place of residence. Moreover, the correlation between marital status and maternal depressive symptoms is statistically significant. On this basis, it can be concluded that the informal partnership coexists with a risk of post-partum depression in mothers of premature babies. The collective results are presented inTable 8.
Table 8.Pearson’s linear correlation coefficients and point-two-series correlation coefficients for the relationship of maternal adult attachment and sociodemographic variables.
Regression analysis
A further hierarchical regression analysis was conducted to examine if the maternal adult attachment is a predictor of the romantic relationship quality. The results showed that secure attachment style is significantly associated with romantic relationship quality. Secure attachment style is related to relationship quality and all relationship quality components (consensus, cohesion, emotional expression, satisfaction). Obtained results are presented in theTables 9A,B. Based on the regression analysis in the conducted study, the strongest predictor of the romantic relationship quality is the maternal secure attachment style in her relationship with the partner. The results are presented inTables 9A,B.
Table 9A.Hierarchical regression analysis, where consensus, cohesion and satisfaction were explained variables.
Table 9B.Hierarchical regression analysis, where emotional expression and general satisfaction were explained variables.
Regression analyzes were performed to investigate the individual pathways of the studied mediation models. In the first model, the results first showed a significant association between the adult secure attachment and general satisfaction with the romantic relationship (path c). Secondly, the results showed a significant association between the secure attachment style and perceived stress (path a). Third, the results showed a significant association between perceived stress and general satisfaction with the relationship (path b) (seeTable 10）.Then, bootstrap testing for indirect effects was performed. The results showed that perceived stress was a partial mediator of the association between the secure attachment style and general satisfaction with the romantic relationship. The indirect effect was statistically significant and amounted toB= 2.32. The direct effect of the secure attachment style on the overall satisfaction with the relationship was statistically significant and amounted toB= 24.82.
Table 10.Non-standardized regression coefficients, Student’st-test values, andp-value for individual pathways in mediation models.
In the second model, first the results showed a significant association between the secure attachment style and overall satisfaction with the relationship (path c). Second, the results showed a significant association between the secure attachment style and depressive symptoms (path a). Third, the results showed a significant association between depressive symptoms and overall satisfaction with the relationship (lane b) (seeTable 10）.Then, bootstrap testing for indirect effects was performed. The results showed that depressive symptoms was a partial mediator of the association between the secure attachment style and overall satisfaction with the relationship. The indirect effect was statistically significant and amounted toB= 1.41. The direct effect of the secure attachment style on the general satisfaction with the relationship was statistically significant and amounted toB= 27.78.
In the third model, first, the results showed a significant association between the secure attachment style and general satisfaction with the relationship (path c). Second, the results showed a significant association between the secure attachment style and MFA (path a). Third, the results showed a significant association between MFA and general satisfaction with the relationship (path b) (seeTable 10）.Then, bootstrap testing of indirect effects was performed. The results showed that MFA was a partial mediator of the association between the secure attachment style and overall satisfaction with the relationship. The indirect effect was statistically significant and amounted toB= 0.83。安全附件的直接影响style on the overall satisfaction with the romantic relationship was statistically significant and amounted toB= 26.31.
Table 11presents the values of direct and indirect effects as well as the value of theR2coefficient together with 95% confidence intervals in individual mediation analyzes.
Table 11.Values of direct and indirect effects as well as the value of theR2coefficient together with 95% confidence intervals in individual mediation analyzes.
Discussion
Maternal adult attachment and romantic relationship quality of mothers of preterm children
Firstly, in this study, it was found that a maternal secure attachment style to her partner is positively related with the romantic relationship quality and its’ all dimensions. However, regression analysis showed that only the secure attachment style was the predictor of the relationship quality among mothers of preterm born children. These findings suggest that the adult secure attachment style fosters and increases the quality and satisfaction with the relationship quality and is connected with all components of the relationship quality: consensus, cohesion, emotional expression, and satisfaction with the relationship. A similar result was obtained by (55）, where attachment security was one of the main predictors of romantic relationship quality (55）.What is more, among first time parents, securely attached individuals reported higher relationship quality (56）, and a higher satisfaction from the relationship than those with other attachment styles (42,57,58）.Such results can be due to the fact that individuals with the secure attachment style have a positive image of themselves and the world, are featured by a greater trust and self-confidence, and are more open to their partners (59）.In contrast, individuals with the anxious attachment style often have a negative self-image and describe themselves as unable to trust another person, experiencing a constant and intense fear of rejection. Relationships based on the anxious-ambivalent and avoidant attachment styles are featured by a higher rate of conflicting behaviors, a lower level of intimacy, involvement, and satisfaction (58）.Obtained results in this study showed that anxious attachment style is related negatively with all dimensions of relationship quality, apart from cohesion. What is interesting, this research has found no significant correlation between the avoidant attachment style and the romantic relationship quality or its dimensions. Knoke et al. (59）have found that only the anxious attachment style is a significant indicator of the partnership relation’s quality that leads to a decrease in this quality (59）.However, meta-analyses reported that both insecure attachment styles, anxious and avoidant, are associated with dissatisfaction in the relationship and a lower quality of the relationship (60,61）.Insecure attachment styles in this study were not predictors of romantic relationship satisfaction. As presented above, these results are partially in line with the other research, where attachment styles are important predictors of the partnership relation’s quality and satisfaction (18,59,62）.It must be mentioned that the mechanisms of attachment styles are not yet fully understood and there are differences in research results. More information is needed to better understand the specific strategies and coping of individuals with higher levels of insecure attachments in specific situations (25）such as preterm birth.
Maternal adult attachment and its association with maternal depressive symptoms, social support, and perceived stress
In the second step, we examined whether maternal adult attachment is related to depressive symptoms, social support, and perceived stress among mothers of preterm born children. The conducted research has revealed that the avoidant and anxious attachment style is associated with a higher sense of stress and higher scores in depressive symptoms. Many research projects have been focused on investigating the relation between an individual attachment style and the risk of developing depression or a sense of stress (63,64）.Some studies have showed that anxious and avoidant attachment styles are related to higher levels of parental stress (21,65）.The results of the authors’ own research indicate that the anxious and avoidant attachment style of mothers of preterm children is related to their higher irritability, worrying, psychological tension, lack of joy of life, sense of pressure, and being overwhelmed. It can be said that avoidant or anxious attachment styles make partners more susceptible to the influence of distress (66）.Furthermore, in this study it was found that the insecure attachment styles pose a risk of post-partum depressive symptoms in mothers of preterm babies. This result corresponds with those obtained in a systematic review, where eight studies found both anxious and avoidant styles to be related with maternal postnatal depression (26）.Based on the obtained results, it can be claimed that a maternal secure attachment style is a protective factor in relation to depressive symptoms, perceived stress and their derivatives. Hirscherberger et al. (56）also suggested that the secure attachment style prevents the development of a high level of stress in a relationship, as compared to other attachment styles (56）.However, it must be highlighted that data explaining the coexistence of these factors in the transition to parenthood period in the case of mothers of preterm children, are still missing. In further mediation analysis, perceived stress and depressive symptoms experienced by mothers of prematurely born children were found to be mediators between secure attachment style and relationship quality in mothers. It can be said that a secure attachment style is associated with a lower level of perceived stress and depressive symptoms, which leads to a higher quality of the partner relationship. To our knowledge, no previous studies have directly assessed the relationships between adult attachment style, stress, depressive symptoms, and the quality of relationships between parents.
To conclude, it is very important to look closer at the role of adult attachment styles on the perception of social stressors and difficult emotions. People with insecure attachment styles demonstrate negative mental processing and vulnerability to stressful events, and they are more reactive toward such situations. Individuals with a secure attachment style have a more positive inner faith toward social support in stressful situations (67）.Research has shown that securely attached individuals report higher levels of perceived support and higher satisfaction with received support in comparison with insecurely attached people (68）.In this study there was only one significant correlation between anxious attachment style and the quality of the received support. The result is rather surprising, as according to the Bartholomew and Horowitz’s (69）model of attachment patterns, people with secure attachment are more willing to look for support, as in general they build more supportive and fulfilling relationships, whereas people with insecure attachment styles are more likely to perceive others’ responsiveness in a negative way (18,70）.
Maternal–fetal attachment and romantic relationship quality among mothers
In the second part of this study, MFA with the romantic relationship quality and its components was examined. It was found that MFA positively correlated with the quality of the romantic relationship and all its dimensions in the neonatal period. Research conducted by Bieleninik et al. (70)也显示之间存在关联the intensity of the emotional bond between the mother and the child and the high quality of the relationship, especially in multiple pregnancies (70）.Other researchers have shown that a positive relationship between partners is one of the determinants of a strong emotional attachment with the child (71,72）.
Maternal–fetal attachment and the associations with maternal adult attachment, perceived stress, and social support
The research of attachment styles indicates the important role of the maternal adult attachment in the process of transition to parenthood and shaping the relationship and bond with the newborn child (20,73,74,75）.Thus, in further step of the analysis, it was examined whether MFA coexists with maternal adult attachment. Studies reported that mothers with secure attachment styles have more positive mother–infant bonding during the first year post-partum (76,77）, while mothers attached insecurely reported some disruptions to the mother-infant bond (78）.Mikulincer and Florian (1999) found that women with secure romantic attachments develop stronger bonds with their children during the first trimester of pregnancy compared to anxious-ambivalent and avoidant women (79）.In this study we found that MFA coexisted with the mother’s adult secure attachment style. This can be explained that securely attached women to their partners activate their attachment style while transitioning to parenthood, which impacts the imaginary connection with the fetus. Thus, they are more prone to grow a positive prenatal bond with unborn child (80）.What is more, mediation analysis showed that MFA is a mediator between the adult secure attachment and the quality of the relationship. The results suggest that the maternal adult secure attachment style is associated with a higher intensity of MFA and, consequently, a higher quality of the relationship. To our knowledge, there are no studies examining the associations between maternal adult attachment style, MFA and romantic relationship quality. Surprisingly in this study there were no associations between maternal anxious and avoidant attachment style with their partner and MFA. In contrary to those results, Ponti et al. (80）found that both insecure attachment styles were significantly connected with low levels of prenatal attachment between a mother and a baby (80）.Mothers who claimed anxious and avoidant attachments with their partners also reported a lower proportion of positive and warm feelings toward their unborn baby (80）.
In the final step of the analysis, the associations between MFA with the perceived stress and social support were examined. Correlation analysis showed that they were negative correlations between MFA and perceived stress and its components such as the sense of fatigue, irritability, psychological tension, and lack of joy in life. Adapting to motherhood is a potentially stressful process, which activate many positive and negative reactions and feelings (81）.Complications in the course of pregnancy and/or during labor, negative reproductive experiences, high-risk pregnancy may cause additional stress and a high level of anxiety among new mothers. High psychological distress, a composite of depressive, anxious, and stress-related symptoms, was found to be associated with lower maternal fetal bond (82）.Nordahl et al. (21）found that each attachment style (analyzed separately) and maternal infant bonding was mediated by experienced stress, which suggest that stress is an important factor associated with the maternal bond with a child (21,83）.
A large body of literature points that social support, types of support, its impact on distress and access to the supportive resources for women after childbirth are vital for positive outcomes for women after they have had a baby (84）.In this study it was also showed that the obtained social support and the quality of the obtained social support had a positive correlation with MFA. This result is in line with results of systematic review conducted by McNamara et al. (72）, where six out of seven studies found that higher MFA was connected with the higher level of social support (72）.In other studies, received social support by the mother was among the determinants of the mother-child bond (85,86,75）.Thus, it can be claimed that having supportive relationships with significant others can foster a better emotional connection with a child (80）.
Strengths and limitations
The definite strength of this study is its conduction in the early neonatal period and including mothers of preterm born children. The presented study is novel, as it demonstrates further associations between maternal adult attachment, MFA and relationship quality, including other important psychological factors such stress, depressive symptoms and social support, which previously have not been fully explored in the research of the subject. Those psychological factors often play an important role in the post-partum period, so we obtained a more comprehensive picture of the factors that are associated with the maternal experience in the post-partum period.
On the other hand, there are several limitations in this study, which deserve attention. The main limitation of the study is the impossibility of making a comparison of psychological conditions of the partnership relation’s quality in the group of mothers with different experience of prematurity based on gestational age. Secondly, in this study most women gave birth to late-term preemies (78.4%), and data including group of infants classified as early premature children (between the 24th and 33rd week) was insufficient to conduct satisfying statistical analyses. However, it has to be mentioned that the distribution of preemies (divided into early, mid-term, or late-term) presented in the research is congruent with the distribution of preemies in the general population. Furthermore, the size of the sample group is rather small, which hinders the inclusion of more variables in the regression analysis, thus limiting the possibilities for testing different, more complex models of associations among the variables. Another definite limitation is a lack of comparison group of mothers after full term delivery and their relationship experiences. The lack of a comparison with full-term infants, and the lack of variation within the preterm birth group, makes it difficult to understand whether obtained findings are a function of the general factors or instead something specific to parents of premature infants. All the measures were self-report questionnaires, so the data is based solely on maternal caregiver report, thus, the interpretation of the conclusion should be done with caution. Also, it has to be mentioned that sociodemographic variables were not included in the analysis, as they were discussed in the previous article (54）.
Future studies should be conducted using a longitudinal design. Examining the changes in the relationship quality, monitoring its associations with the maternal bond and parental mental health during pregnancy and the postnatal period would be beneficial. Also, it would be interesting to find how exactly secure attachment style plays a role as a protective factor after preterm birth including in the study design control group of non-premature birth. Exploration of attachment styles high in anxiety and avoidance is also needed, as it is unknown how exactly they impact maternal–fetal attachment after the premature birth.
Conclusion and clinical implications
The paper enhances further understanding of maternal adult attachment, MFA, and its connections with relationship quality, stress, depressive symptoms, and social support. It can be concluded that adult secure attachment style can be a protective factor while experiencing stressful situations or coping with depressive symptoms. Also, it positively impacts the romantic relationship quality and maternal–attachment. These findings draw attention to the importance of adult attachment and suggest that secure attachment may promote positive relational outcomes for parents, couples, and families during the transition to parenthood. Postnatal screening of attachment, maternal–infant bond, maternal mental health, and relationship quality style should be implemented, especially after preterm birth, in order to detect potential difficulties that mothers and their families can experience. Interventions among mothers should be tailored based on the various attachment styles as the needs and ways of coping with difficulties during pregnancy and postnatal period may be different.
The results pay attention also to the earlier assessment of maternal psychological wellbeing during pregnancy, including an assessment of maternal adult attachment, which may help to identify high risk mothers and initiating interventions to prevent adverse neonatal and developmental outcomes. During perinatal and postnatal care, home visiting programs may allow early detections of challenges and problems that mothers experience and help while working with maternal adult attachment style to build secure mother–baby attachment beginning in pregnancy. The obtained results can be applied in individual and family therapies to target interpersonal conflicts contributing to mood and anxiety disorders. Individual and couples’ counseling should also be available in the perinatal and post-partum period as a supportive resource for parents as working toward a satisfactory relationship would enhance and support the process of bonding with a child.
Data availability statement
The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.
Ethics statement
The study protocol was approved by the Research Ethics Board at the University of Gdańsk, Poland (number 25/2015). The patients/participants provided their written informed consent to participate in this study.
Author contributions
KL conceived the study, analyzed the data, and wrote the manuscript. KL carried out data collection under the supervision of MB. Both authors designed the study, critically revised the manuscript for publication, and approved the final version.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher’s note
本文表达的所有索赔solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
Abbreviations
MFA,母胎附件;ASQ,附件圣yles Questionnaire; PSQ, The Perceived Stress Questionnaire; DAS, The Dyadic Adjustment Scale; EPDS, The Edinburgh Postnatal Depression Scale; SSQ, The Social Support Questionnaire; MFAS, Maternal–Fetal Attachment Scale; WHO, World Health Organization; APGAR, Appearance, Pulse, Grimace, Activity, and Respiration.
References
2. Bidzan M. Wyzwania dla psychologów i pedagogów specjalnych i leczniczych w rozwojaniu dobrostanu dziecka urodzonego przedwcześnie i jego rodziny. In: Domagała-Zyśk E, Borowicz A, Kołodziejczyk R, Martynowska K editors.Oblicza życia Księga Jubileuszowa Profesor Doroty Kornas-Bieli.(Lublin: Episteme) (2021). p. 227–54.
3.. Bidzan M, Bieleninik Ł. Psychomotor development of preterm babies in the context of biomedical predictors in a Polish sample.Health Psychol Rep.(2013) 1:18–33. doi: 10.5114/hpr.2013.40466
4. Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth.Lancet.(2008) 371:75–84. doi: 10.1016/S0140-6736(08)60074-4
5. Ettenberger M, Bieleninik Ł, Epstein S, Elefant C. Defining attachment and bonding: Overlaps, differences and implications for music therapy clinical practice and research in the neonatal intensive care unit (nicu).Int J Environ Res Public Health.(2021) 18:1733. doi: 10.3390/ijerph18041733
6. Ionio C, Colombo C, Brazzoduro V, Mascheroni E, Confalonieri E, Castoldi F, et al. Mothers and fathers in NICU: The impact of preterm birth on parental distress.Eur J Psychol.(2016) 12:604–21. doi: 10.5964/ejop.v12i4.1093
7. Feldkötter AL, Thomsen T, Lessing N. Die rolle von partnerschaft, erziehung und elternstress beim problemverhalten von kindern im vorschulalter.Kindheit Entwickl.(2019) 28:68–76. doi: 10.1026/0942-5403/a000272
8. de Wolff MS, van Ijzendoorn MH. Sensitivity and attachment: A meta-analysis on parental antecedents of infant attachment.Child Dev.(1997) 68:571–91. doi: 10.1111/j.1467-8624.1997.tb04218.x
9. Jasemi N, Mousavi P, Saki A, Javadifar N. Relationship between marital satisfaction with maternal-infant attachment and breastfeeding self-efficacy in primiparous and multiparous nursing mothers.Int J Women Health Reprod Sci.(2020) 8:68–72. doi: 10.15296/ijwhr.2020.09
10. Horwitz SM, Irwin JR, Briggs-Gowan MJ, Bosson HEENANJM, Mendoza J, Carter AS. Language delay in a community cohort of young children.J Am Acad Child Adolesc Psychiatry.(2003) 42:932–40. doi: 10.1097/01.CHI.0000046889.27264.5E
11. Bieleninik Ł, Prais J, Bidzan M. Uwarunkowania więzi emocjonalnej z dzieckiem w okresie prenatalnym w cia̧ży wielopłodowej i pojedynczej.Perinatol Neonatol Ginekol.(2010) 3:223–31.
12. Lickenbrock DM, Braungart-Rieker JM. Examining antecedents of infant attachment security with mothers and fathers: An ecological systems perspective.Infant Behav Dev.(2015) 39:173–87. doi: 10.1016/j.infbeh.2015.03.003
13. Fishman EA, Meyers SA. Marital satisfaction and child adjustment: Direct and mediated pathways.Contemp Fam Ther.(2000) 22:437–52. doi: 10.1037/e413782005-330
14. Harold G, Acquah D, Sellers R, Chowdry H.What Works to Enhance Inter-Parental Relationships and Improve Outcomes for Children.London: Early Intervention Foundation (2016).
15. Mensah MK, Kuranchie A. Influence of parenting styles on the social development of children.Acad J Interdiscip Stud.(2013) 2:123–9. doi: 10.5901/ajis.2013.v2n3p123
16. Howard KS, Brooks-Gunn J. Relationship supportiveness during the transition to parenting among married and unmarried parents.Parenting.(2009) 9:123–42. doi: 10.1080/15295190802656828
17. Curran M, Hazen N, Jacobvitz D, Feldman A. Representations of early family relationships predict marital maintenance during the transition to parenthood.J Fam Psychol.(2005) 19:189–97. doi: 10.1037/0893-3200.19.2.189
18. Mikulincer M, Shaver PR.Attachment in Adulthood: Structure, Dynamics, and Change.2nd ed. New York, NY: Guilford Press (2016).
19. Vollmann M, Sprang S, van den Brink F. Adult attachment and relationship satisfaction: The mediating role of gratitude toward the partner.J Soc Pers Relat.(2019) 36:3875–86. doi: 10.1177/0265407519841712
20. Chrzan-Dętkoś M, Łockiewicz M. Maternal romantic attachment, and antenatal and postnatal mother–infant attachment in a sample of Polish women.Eur J Dev Psychol.(2015) 12:429-42。doi: 10.1080 / 17405629.2015.1036024
21. Nordahl D, Rognmo K, Bohne A, Landsem IP, Moe V, Wang CEA, et al. Adult attachment style and maternal-infant bonding: The indirect path of parenting stress.BMC Psychol.(2020) 8:58. doi: 10.1186/s40359-020-00424-2
22. Branjerdporn G, Meredith P, Wilson T, Strong J. Maternal–fetal attachment: Associations with maternal sensory processing, adult attachment, distress and perinatal loss.J Child Fam Stud.(2021) 30:528–41. doi: 10.1007/s10826-020-01876-1
23. Ilska M, Przybyła-Basista H. Original article Measurement of women’s prenatal attitudes towards maternity and pregnancy and analysis of their predictors.Health Psychol Rep.(2014) 3:176–88. doi: 10.5114/hpr.2014.45300
24. Neff LA, Karney BR. Stress and reactivity to daily relationship experiences: How stress hinders adaptive processes in marriage.J Pers Soc Psychol.(2009) 97:435–50. doi: 10.1037/a0015663
25. Mikulincer M, Shaver PR. Attachment orientations and emotion regulation.Curr Opin Psychol.(2019) 25:6–10. doi: 10.1016/j.copsyc.2018.02.006
26. Warfa N, Harper M, Nicolais G, Bhui K. Adult attachment style as a risk factor for maternal postnatal depression: A systematic review.BMC Psychol.(2014) 2:56. doi: 10.1186/s40359-014-0056-x
27. Lonstein JS. Regulation of anxiety during the postpartum period.Front Neuroendocrinol.(2007) 28:115–41. doi: 10.1016/j.yfrne.2007.05.002
28. Austin MP, Kingston D. Psychosocial assessment and depression screening in the perinatal period: Benefits, challenges and implementation. In: Sutter-Dallay AL, Glangeaud-Freudenthal NC, Guedeney A, Riecher-Rössler A editors.Joint Care of Parents and Infants in Perinatal Psychiatry.(Cham: Springer) (2016).
29. Alipour Z, Kazemi A, Kheirabadi G, Eslami AA. Relationship between marital quality, social support and mental health during pregnancy.Community Ment Health J.(2019) 55:1064–70. doi: 10.1007/s10597-019-00387-8
3.0. Kersh J, Hedvat TT, Hauser-Cram P, Warfield ME. The contribution of marital quality to the well-being of parents of children with developmental disabilities.J Intellect Disabil Res.(2006) 50:883–93. doi: 10.1111/j.1365-2788.2006.00906.x
3.1. Malus A, Szyluk J, Galinska-Skok B, Konarzewska B. Incidence of postpartum depression and couple relationship quality.Psychiatr Polska.(2016) 50:1135–46. doi: 10.12740/PP/61569
3.2. Pilkington PD, Milne LC, Cairns KE, Lewis J, Whelan TA. Modifiable partner factors associated with perinatal depression and anxiety: A systematic review and meta-analysis.J Affect Disord.(2015) 178:165–80. doi: 10.1016/j.jad.2015.02.023
3.3.. Biaggi A, Conroy S, Pawlby S, Pariante CM. Identifying the women at risk of antenatal anxiety and depression: A systematic review.J Affect Disord.(2016) 191:62–77. doi: 10.1016/j.jad.2015.11.014
3.4. Proulx CM, Helms HM, Buehler C. Marital quality and personal well-being: A meta-analysis.J Marriage Fam.(2007) 69:576–93. doi: 10.1111/j.1741-3737.2007.00393.x
3.5. Robles TF, Slatcher RB, Trombello JM, McGinn MM. Marital quality and health: A meta-analytic review.Psychol Bull.(2014) 140:140–87. doi: 10.1037/a0031859
3.6. Alduncin N, Huffman LC, Feldman HM, Loe IM. Executive function is associated with social competence in preschool-aged children born preterm or full term.Early Hum Dev.(2014) 90:299–306. doi: 10.1016/j.earlhumdev.2014.02.011
3.7. Salo SJ, Pajulo M, Vinzce L, Raittila S, Sourander J, Kalland M. Parent relationship satisfaction and reflective functioning as predictors of emotional availability and infant behavior.J Child Fam Stud.(2021) 30:1214–28. doi: 10.1007/s10826-021-01934-2
3.8. Tichelman E, Westerneng M, Witteveen AB, van Baar AL, van der Horst HE, de Jonge A, et al. Correlates of prenatal and postnatal motherto-infant bonding quality: A systematic review.PLoS One.(2019) 14:e0222998. doi: 10.1371/journal.pone.0222998
3.9. Holditch-Davis D, Santos H, Levy J, White-Traut R, O’Shea TM, Geraldo V, et al. Patterns of psychological distress in mothers of preterm infants.Infant Behav Dev.(2015) 41:154–63. doi: 10.1016/j.infbeh.2015.10.004
40. Woodward LJ, Bora S, Clark CAC, Montgomery-Hönger A, Pritchard VE, Spencer C, et al. Very preterm birth: Maternal experiences of the neonatal intensive care environment.J Perinatol.(2014) 34:555–61. doi: 10.1038/jp.2014.43
42. Hazan C, Shaver P. Romantic love conceptualized as an attachment process.J Pers Soc Psychol.(1987) 52(3):511–24. doi: 10.1037/0022-3514.52.3.511
43. Spanier GB. Measuring dyadic adjustment: New scales for assessing the quality of marriage and similar dyads.J Marriage Fam.(1976) 38:15–28. doi: 10.2307/350547
44.Cieślak k .波兰Wersja Skali G.B. Spaniera年代łuża̧ca do pomiaru jakości zwia̧zku małżeńskiego (DAS).Przegl Psychol.(1989) 32:1042–9.
45. Graham JM, Conoley CW. The role of marital attributions in the relationship between life stressors and marital quality.Pers Relat.(2006) 13:231–41. doi: 10.1111/j.1475-6811.2006.00115.x
46. Levenstein S, Prantera C, Varvo V, Scribano ML, Berto E, Luzi C, et al. Development of the perceived stress questionnaire: A new tool for psychosomatic research.J Psychosom Res.(1993) 37:19–32. doi: 10.1016/0022-3999(93)90120-5
47. Østerås B, Sigmundsson H, Haga M. Psychometric properties of the perceived stress questionnaire (PSQ) in 15-16 years old norwegian adolescents.Front Psychol.(2018) 9:1850. doi: 10.3389/fpsyg.2018.01850
48. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression: Development of the 10-item Edinburgh postnatal depression scale.Br J Psychiatry.(1987) 150:782–6. doi: 10.1192/bjp.150.6.782
49. Kossakowska K. Edynburska skala depresji poporodowej—własìciwosìci psychometryczne i charakterystyka.Acta Univ Lodziensis Folia Psychol.(2013) 17:39–50.
50. Nieland MNS.Social Support Questionnaire.Unpublished manuscript. York: University of York (1992).
51. Bielawska-Batorowicz E.Determinanty Spostrzegania Dziecka Przez Rodziców w okresie Poporodowym.Łódź: Wydawnictwo Uniwersytetu Łódzkiego (1995).
52. Bielawska-Batorowicz E, Kossakowska-Petrycka K. Depressive mood in men after the birth of their offspring in relation to a partner’s depression, social support, fathers’ personality and prenatal expectations.J Reprod Infant Psychol.(2006) 24:21–9. doi: 10.1080/02646830500475179
53. Cranley MS. Development of a tool for the measurement of maternal attachment during pregnancy.孕育Res。(1981) 30:281–4. doi: 10.1097/00006199-198109000-00008
54. Lutkiewicz K. Social support, perceived stress, socio-demographic factors and relationship quality among polish mothers of prematurely born children.Int J Environ Res Public Health.(2020) 17:3876. doi: 10.3390/ijerph17113876
55. Eder SJ, Nicholson AA, Stefanczyk MM, Pieniak M, Martínez-Molina J, Pešout O, et al. Securing your relationship: Quality of intimate relationships during the COVID-19 pandemic can be predicted by attachment style.Front Psychol.(2021) 12:647956. doi: 10.3389/fpsyg.2021.647956
56.马什Hirschberger G,斯利瓦斯塔瓦年代,P,考恩CP, Cowan PA. Attachment, marital satisfaction, and divorce during the first fifteen years of parenthood.Pers Relatsh.(2009) 16:401–20. doi: 10.1111/j.1475-6811.2009.01230.x
57. Gallo LC, Smith TW. Attachment style in marriage: Adjustment and responses to interaction.J Soc Pers Relatsh.(2001) 18:263–89. doi: 10.1177/0265407501182006
58. Liberska H, Suwalska D. Styl przywia̧zania a relacje partnerskie we wczesnej dorosłości.Psychol Rozwoj.(2011) 16:25–39.
59. Knoke J, Burau J, Roehrle B. Attachment styles, loneliness, quality, and stability of marital relationships.J Divorce Remarriage(2010) 51:310–325. doi: 10.1080/10502551003652017
60. Hadden BW, Smith CV, Webster GD. Relationship duration moderates associations between attachment and relationship quality: Meta-analytic support for the temporal adult romantic attachment model.Pers Soc Psychol Rev.(2014) 18:42–58. doi: 10.1177/1088868313501885
61. Candel OS, Turliuc MN. Insecure attachment and relationship satisfaction: A meta-analysis of actor and partner associations.Pers Individ Dif.(2019) 147:190–9. doi: 10.1016/j.paid.2019.04.037
62. Butzer B, Campbell L. Adult attachment, sexual satisfaction, and relationship satisfaction: A study of married couples.Pers Relatsh(2008) 15:141–54. doi: 10.1111/j.1475-6811.2007.00189.x
63. Hammen CL, Burge D, Daley SE, Davila J, Paley B, Rudolph KD. Interpersonal attachment cognitions and prediction of symptomatic responses to interpersonal stress.J Abnorm Psychol.(1995) 104:436–43. doi: 10.1037/0021-843X.104.3.436
64. Gerlsma C, Luteijn F. 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.(2000) 73:15–34. doi: 10.1348/000711200160273
65. Jones JD, Cassidy J, Shaver PR. Parents’ self-reported attachment styles: A review of links with parenting behaviors, emotions, and cognitions.Pers Soc Psychol Rev.(2015) 19:44–76. doi: 10.1177/1088868314541858
66. Karney BR, Bradbury TN. The longitudinal course of marital quality and stability: A review of theory, method and research.Monitor Obshchestvennogo Mneniya.(2016) 1:3–34. doi: 10.1037/0033-2909.118.1.3
67. Keller H. Attachment and Culture.J Cross Cult Psychol.(2013) 44:175–94. doi: 10.1177/0022022112472253
68. Priel B, Shamai D. Attachment style and perceived social support: Effects on affect regulation.Pers Individ Dif.(1995) 19:235–41. doi: 10.1016/0191-8869(95)91936-T
69. Bartholomew K, Horowitz LM. Attachment styles among young adults: a test of a four-category model.J Pers Soc Psychol.(1991). 61:226–44. doi: 10.1037//0022-3514.61.2.226
70. Bidzan M, Bieleninik Ł, Zdolska A, Salwach D. Bond with a child in the prenatal period in case of prematurely born children. In: K Turowski editor.Wellness and success.(Lublin: NeuroCentrum) (2009). p. 35–54.
71. Siddiqui A, Hägglöf B, Eisemann M. An exploration of prenatal attachment in Swedish expectant women.J Reprod Infant Psychol.(1999) 17:369–80. doi: 10.1080/02646839908404602
72. McNamara J, Townsend ML, Herbert JS. A systemic review of maternal wellbeing and its relationship with maternal fetal attachment and early postpartum bonding.PLoS One.(2019) 14:e0220032. doi: 10.1371/journal.pone.022003
73. Hipwell AE, Goossens FA, Melhuish EC, Kumar R. Severe maternal psychopathology and infant-mother attachment.Dev Psychopathol.(2000) 12:157–75. doi: 10.1017/S0954579400002030
74. Zdolska-Wawrzkiewicz A, Chrzan-Dętkoś M, Pizuńska D, Bidzan M. Attachment styles, various maternal representations and a bond to a baby.Int J Environ Res Public Health.(2020) 17:3363. doi: 10.3390/ijerph17103363
75. Kucharska M. Selected predictors of maternal-fetal attachment in pregnancies with congenital disorders, other complications, and in healthy pregnancies.Health Psychology Report.(2021) 9:193–06. doi: 10.5114/hpr.2020.97295
76. van Bussel JCH, Spitz B, Demyttenaere K. 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 Women Ment Health.(2010) 13:373–84. doi: 10.1007/s00737-009-0140-z
77. Wilkinson RB, Mulcahy R. Attachment and interpersonal relationships in postnatal depression.J Reprod Infant Psychol.(2010) 28:252–65. doi: 10.1080/02646831003587353
78. Little KK, Sockol LE. Romantic relationship satisfaction and parent-infant bonding during the transition to parenthood: An attachment-based perspective.Front Psychol.(2068) 2020:11. doi: 10.3389/fpsyg.2020.02068
79. Mikulincer M, Florian V. Maternal-fetal bonding, coping strategies, and mental health during pregnancy – The contribution of attachment style.J Soc Clin Psychol.(1999) 18:255–76. doi: 10.1521/jscp.1999.18.3.255
80. Ponti L, Smorti M, Ghinassi S, Tani F. The relationship between romantic and prenatal maternal attachment: The moderating role of social support.Int J Psychol.(2021) 56:143–50. doi: 10.1002/ijop.12676
81. Walsh J. Definitions matter: If maternal-fetal relationships are not attachment, what are they?Arch Women Ment Health.(2010) 13:449–51. doi: 10.1007/s00737-010-0152-8
82. Dayton CJ, Brown S, Goletz J, Hicks L, Barron C, Sperlich M, et al. Pathways to parenting: Predictors of prenatal bonding in a sample of expectant mothers and fathers exposed to contextual risk.J Child Fam Stud.(2019) 28:1134–44. doi: 10.1007/s10826-019-01343-6
83. Bieleninik Ł, Lutkiewicz K, Jurek P, Bidzan M. Paternal postpartum bonding and its predictors in the early postpartum period: Cross-sectional study in a polish cohort.Front Psychol.(2021) 12:628650。doi: 10.3389 / fpsyg.2021.628650
84. de Sousa Machado T, Chur-Hansen A, Due C. First-time mothers’ perceptions of social support: Recommendations for best practice.Health Psychol Open.(2020) 7:2055102919898611.
85. Mercer RT, Ferkehch SL. Predictors of parental attachment during early parenthood.J Adv Nurs.(1990) 15:268–80. doi: 10.1111/j.1365-2648.1990.tb01813.x
Keywords: attachment style, maternal–fetal attachment, premature birth, relationship quality, depressive symptoms
Citation:Lutkiewicz K and Bidzan M (2022) Maternal adult attachment and maternal–fetal attachment in the context of romantic relationship quality after premature birth–A cross sectional study.Front. Psychiatry13:935871. doi: 10.3389/fpsyt.2022.935871
Received:04 May 2022;Accepted:02 August 2022;
Published:23 August 2022.
Edited by:
Amanda Venta, University of Houston, United StatesReviewed by:
Grace Branjerdporn, Gold Coast Health, AustraliaSrinivas Dannaram, Banner – University Medical Center Phoenix, Banner Health, United States
Copyright© 2022 Lutkiewicz and Bidzan. This is an open-access article distributed under the terms of theCreative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence:Karolina Lutkiewicz,karolina.lutkiewicz@ug.edu.pl
†ORCID:Karolina Lutkiewicz,orcid.org/0000-0001-9697-2303; Mariola Bidzan,orcid.org/0000-0003-0224-1994