Korean J Women Health Nurs.  2023 Mar;29(1):55-65. 10.4069/kjwhn.2023.02.21.3.

Factors influencing maternal-fetal attachment in pregnant women during the COVID-19 pandemic: a cross-sectional study

• Yoon H
• Choi H

• KMID: 2543802
• DOI: http://doi.org/10.4069/kjwhn.2023.02.21.3

Abstract

Purpose
Coronavirus disease 2019 (COVID-19) has spread widely throughout the world, causing psychological problems such as fear, anxiety, and stress. During the COVID-19 pandemic, pregnant women have been concerned about both their own health and the health of their fetuses, and these concerns could negatively affect maternal-fetal attachment. Thus, this study aimed to explore the level of COVID-19 stress, resilience, and maternal-fetal attachment among pregnant women during the COVID-19 pandemic, and to identify factors influencing maternal-fetal attachment. Methods: In total, 118 pregnant women past 20 weeks gestation were recruited from two maternity clinics in Daegu, Korea, to participate in this descriptive correlational study during COVID-19. The factors influencing maternal-fetal attachment were analyzed using hierarchical multiple regression analysis. Results: The mean scores for COVID-19 stress, resilience, and maternal-fetal attachment were 57.18±10.32 out of 84, 67.32±15.09 out of 100, and 77.23±9.00 out of 96, respectively. Nulliparous pregnant women reported greater maternal-fetal attachment than multiparous pregnant women (p=.003). Religious pregnant women also reported greater maternal-fetal attachment than non-religious pregnant women (p=.039). Resilience (β=.29, p=.002), COVID-19 stress (β=.20, p=.030) and parity (β=-.17, p=.047) were factors influencing maternal-fetal attachment, and these factors explained 26.4% of the variance in maternal-fetal attachment (F=10.12, p<.001). Conclusion: Converse to common sense, COVID-19 stress exerted a positive influence on maternal-fetal attachment in pregnant women during the COVID-19 pandemic. Healthcare providers need to recognize the positive influence of COVID-19 stress and implement intervention strategies to strengthen resilience in pregnant women to improve maternal-fetal attachment.

Keyword

COVID-19; COVID-19 stress syndrome; Maternal-fetal relations; Pregnant women; Psychological resilience

Reference

References

1. World Health Organization(WHO). Corona virus disease 2019 (COVID-19) dashboard [Internet]. Geneva: Author; 2022 [cited 2022 Oct 4]. Available from: https://covid19.who.int/.

2. Korea Disease Control and Prevention Agency (KDCA). Corona virus disease 2019 (COVID-19) dashboard [Internet]. Cheongju: Author; 2022 [cited 2022 Oct 4]. Available from: http://ncov.mohw.go.kr/.

3. Chamaa F, Bahmad HF, Darwish B, Kobeissi JM, Hoballah M, Nassif SB, et al. PTSD in the COVID-19 era. Curr Neuropharmacol. 2021; 19(12):2164–2179. https://doi.org/10.2174/1570159X19666210113152954.

4. Sim M. Psychological effects of the coronavirus disease 2019 pandemic. Korean J Med. 2020; 95(6):360–363. https://doi.org/10.3904/kjm.2020.95.6.360.

5. Liu CH, Erdei C, Mittal L. Risk factors for depression, anxiety, and PTSD symptoms in perinatal women during the COVID-19 Pandemic. Psychiatry Res. 2021; 295:113552. https://doi.org/10.1016/j.psychres.2020.113552.

6. Bridgland VME, Moeck EK, Green DM, Swain TL, Nayda DM, Matson LA, Hutchison NP, Takarangi MKT. Why the COVID-19 pandemic is a traumatic stressor. PLoS One. 2021; 16(1):e0240146. https://doi.org/10.1371/journal.pone.0240146.

7. Ji EK, Pretorius DH, Newton R, Uyan K, Hull AD, Hollenbach K, et al. Effects of ultrasound on maternal-fetal bonding: a comparison of two- and three-dimensional imaging. Ultrasound Obstet Gynecol. 2005; 25(5):473–477. https://doi.org/10.1002/uog.1896.

8. Cranley MS. Development of a tool for the measurement of maternal attachment during pregnancy. Nurs Res. 1981; 30(5):281–284. https://doi.org/10.1097/00006199-198109000-00008.

9. Jo AR, Noh Y. Effects of pregnancy stress and social support on maternal-fetal attachment in pregnant women. Korea Rev Crisis Emerg Manag. 2022; 18(4):161–172. https://doi.org/10.14251/crisisonomy.2022.18.4.161.

10. Craig F, Gioia MC, Muggeo V, Cajiao J, Aloi A, Martino I, et al. Effects of maternal psychological distress and perception of COVID-19 on prenatal attachment in a large sample of Italian pregnant women. J Affect Disord. 2021; 295:665–672. https://doi.org/10.1016/j.jad.2021.08.102.

11. Hwang RH. Self-esteem, body image and factors influencing on maternal fetal attachment behavior of pregnant women. J Digit Converg. 2018; 16(9):197–206. https://doi.org/10.14400/JDC.2018.16.9.197.

12. Lee SH, Jung EJ. Factors influencing maternal-fetal attachment among advanced maternal age: anxiety, spousal support. AJMAHS. 2017; 7(1):661–671. https://doi.org/10.35873/ajmahs.2017.7.1.059.

13. Chung MR, Choi JH, Kang S. The influence of pregnant woman’s temperament on maternal-fetal attachment: mediating effect of stress coping style. Korean J Child Educ Care. 2015; 15(2):195–214.

14. Yu M, Kim M. The contribution of maternal-fetal attachment: taegyo, maternal fatigue and social support during pregnancy. Child Health Nurs Res. 2014; 20(4):247–254. https://doi.org/10.4094/chnr.2014.20.4.247.

15. Kim JS. Effects of pregnant woman social support, pregnancy stress and anxiety on quality of life. J Converg Inform Technol. 2021; 11(5):50–56. https://doi.org/10.22156/CS4SMB.2021.11.05.050.

16. Lee YJ, Kim YS, Park GH. The effects of self-confidence in maternal role of pregnant women on depression, stress and social support. JKAIS. 2022; 23(1):587–593. https://doi.org/10.5762/KAIS.2022.23.1.587.

17. Fatima M, Srivastav S, Mondal AC. Prenatal stress and depression associated neuronal development in neonates. Int J Dev Neurosci. 2017; 60:1–7. https://doi.org/10.1016/j.ijdevneu.2017.04.001.

18. Wee H, Park SY. The relationships between anxiety, depression, prenatal stress, maternal-fetal attachment and gratitude. J Korean Soc Matern Child Health. 2012; 16(2):274–286. https://doi.org/10.21896/jksmch.2012.16.2.274.

19. Phoswa WN, Khaliq OP. Is pregnancy a risk factor of COVID-19? Eur J Obstet Gynecol Reprod Biol. 2020; 252:605–609. https://doi.org/10.1016/j.ejogrb.2020.06.0581.

20. Park HY, Choi JY. Factors associated with post-traumatic growth in patients with breast cancer based on a model of post-traumatic growth. Asian Oncol Nurs. 2022; 22(2):65–73. https://doi.org/10.5388/aon.2022.22.2.65.

21. Connor KM, Davidson JR. Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety. 2003; 18(2):76–82. https://doi.org/10.1002/da.10113.

22. Ha BY, Jung EJ, Choi SY. Effects of resilience, post-traumatic stress disorder on the quality of life in patients with breast cancer. Korean J Women Health Nurs. 2014; 20(1):83–91. https://doi.org/10.4069/kjwhn.2014.20.1.83.

23. Noroozi M, Gholami M, Mohebbi-Dehnavi Z. The relationship between hope and resilience with promoting maternal attachment to the fetus during pregnancy. J Educ Health Promot. 2020; 9:54. https://doi.org/10.4103/jehp.jehp_386_19.

24. Kim E, Park S, Lee Y, Park H. Development and initial validation of the covid stress scale for Korean people. Korean J Couns. 2021; 22(1):141–163. https://doi.org/10.15703/kjc.22.1.202102.141.

25. Kim KY. Effects on maternal-infant attachment by the taegyo perspective prenatal class [dissertation]. Seoul: Yonsei University; 2000. 63 p.

26. Kang SJ, Yang MJ. Factors influencing pregnancy stress in pregnant women in Korea: a cross-sectional study. Korean J Women Health Nurs. 2022; 28(1):27–37. https://doi.org/10.4069/kjwhn.2022.02.03.

27. Kim SH. The effects of mothers’ COVID-19 stress on young children’s problem behavior: the mediating role of parenting efficacy. J Learner-Cent Curric Instr. 2022; 22(7):181–194. https://doi.org/10.22251/jlcci.2022.22.7.181.

28. Korean Society for Traumatic Stress Studies (KSTSS). COVID-19, The 2nd survey on the mental health of Korea [Internet]. Seoul: Author; 2022 [cited 2022 oct 4]. Available from: http://kstss.kr/?p=2823.

29. Stepowicz A, Wencka B, Bieńkiewicz J, Horzelski W, Grzesiak M. Stress and anxiety levels in pregnant and post-partum women during the COVID-19 pandemic. Int J Environ Res Public Health. 2020; 17(24):9450. https://doi.org/10.3390/ijerph17249450.

30. Kim BH, Lee BY, Lee YY. Effects of the COVID-19 pandemic on the physical activity and mental health of university students. J Korean Soc Integra Med. 2021; 9(3):59–68. https://doi.org/10.15268/ksim.2021.9.3.59.

31. Kim YS. Analysis on the effect of COVID-19 stress, job stress, and job satisfaction of special education teacher who have taught students with intellectual disabilities to psychological burnout. J Spec Educ Theory Pract. 2021; 22(3):29–54. https://doi.org/10.19049/JSPED.2021.22.3.02.

32. Chasson M, Taubman-Ben-Ari O, Abu-Sharkia S. Posttraumatic growth in the wake of COVID-19 among Jewish and Arab pregnant women in Israel. Psychol Trauma. 2022; 14(8):1324–1332. https://doi.org/10.1037/tra0001189.

33. Pieh C, Budimir S, Probst T. The effect of age, gender, income, work, and physical activity on mental health during coronavirus disease (COVID-19) lockdown in Austria. J Psychosom Res. 2020; 136:110186. https://doi.org/10.1016/j.jpsychores.2020.110186.

34. Yang HJ. Responding to negative emotions in COVID-19. JCCT. 2020; 6(3):135–143. https://doi.org/10.17703/JCCT.2020.6.3.135.

35. Kim BK, Sung MH. Impact of anxiety, social support, and taegyo practice on maternal-fetal attachment in pregnant women having an abortion. Korean J Women Health Nurs. 2019; 25(2):182–193. https://doi.org/10.4069/kjwhn.2019.25.2.182.

36. Woo K, Jee Y, Kim B. Influence factors of maternal fetal attachment on preparing for childbirth class. AJMAHS. 2015; 5(2):81–88. https://doi.org/10.35873/ajmahs.2015.5.2.009.

37. Son HJ, Park JS. Relationship between preterm labor stress, fetal attachment and maternal role confidence in pregnant women with preterm labor. J Korean Soc Matern Child Health. 2014; 18(1):86–96. https://doi.org/10.21896/jksmch.2014.18.1.86.

38. Chang HC, Chen SY, Chen CH. Predictors of antenatal psychosocial stress in Taiwanese women. J Nurs Res. 2016; 24(3):193–200. https://doi.org/10.1097/jnr.0000000000000122.

39. Çelik FP, Güneri SE. The relationship between adaptation to pregnancy and prenatal attachment in high-risk pregnancies. Psychiatr Danub. 2020; 32(Suppl 4):568–575.

40. Koire A, Mittal L, Erdei C, Liu CH. Maternal-fetal bonding during the COVID-19 pandemic. BMC Pregnancy Childbirth. 2021; 21(1):846. https://doi.org/10.1186/s12884-021-04272-9.

41. Babu MS, Chan SJ, Ein-Dor T, Dekel S. Traumatic childbirth during COVID-19 triggers maternal psychological growth and in turn better mother-infant bonding. J Affect Disord. 2022; 313:163–166. https://doi.org/10.1016/j.jad.2022.06.076.

42. Colli C, Penengo C, Garzitto M, Driul L, Sala A, Degano M, et al. Prenatal stress and psychiatric symptoms during early phases of the COVID-19 pandemic in Italy. Int J Womens Health. 2021; 13:653–662. https://doi.org/10.2147/IJWH.S315467.

43. Ranjbar F, Catja Warmelink Comma Comma J, Mousavi R, Gharacheh M. Maternal-fetal attachment and anxiety in pregnant women who conceived through assisted reproductive technology: a longitudinal study. Int J Reprod Biomed. 2022; 19(12):1075–1084. https://doi.org/10.18502/ijrm.v19i12.10058.

44. Tohme P, Abi-Habib R, Nassar E, Hamed N, Abou-Ghannam G, Chalouhi GE. The psychological impact of the COVID-19 outbreak on pregnancy and mother-infant prenatal bonding. Matern Child Health J. 2022; 26(11):2221–2227. https://doi.org/10.1007/s10995-022-03464-9.

45. Choi IY. Pregnant women confirmed with coivd-19 died during treatment after childbirth. The first case in Korea [Internet]. Seoul: Yonhap News; 2022 [cited 2022 Oct 5]. Available from: https://www.yna.co.kr/view/AKR20220107104300530.

46. Korea Disease Control and Prevention Agency (KDCA). COVID-19 and omicron mutation [Internet]. Cheongju: Author; 2022 [cited 2022 Oct 5]. Available from: https://www.kdca.go.kr/board/board.es?mid=a20501010000&bid=0015&act=view&list_no=717719.

47. Korea Policy Briefing. COVID-19 regular briefing (2021. 8. 27) [Internet]. Seoul: Author; 2022 [cited 2022 Oct 5]. Available from: https://www.korea.kr/news/pressReleaseView.do?newsId=156468157.

48. Ministry of Health and Welfare (MOHW). Press release (2022. 4. 29) [Internet]. Sejong: Author; 2022 [cited 2022 Oct 5]. Available from: https://www.mohw.go.kr/react/al/sal0301vw.jsp?PAR_MENU_ID=04&MENU_ID=0403&CONT_SEQ=371325.