Being a Mother under the COVID-19 Pandemic Lockdown: Evaluation of Perinatal Anxiety, Prenatal Attachment, and Maternal–Infant Attachment

Abstract

Objectives The novel coronavirus disease 2019 (COVID-19) pandemic has caused both physical and emotional stress throughout the population due to its worldwide impact. The unknowns about the disease, social isolation, pregnant women's concerns regarding exposure to the COVID-19, inaccessibility to necessary care, and the possibility of harm to their fetus may cause increased psychological distress during the perinatal period. We aimed to evaluate the association between perinatal anxiety, prenatal attachment, and maternal–infant attachment status among women with those who delivered their child in a tertiary-care center with rigid hospital restrictions.

Study Design Term pregnant women who experienced the last trimester of their pregnancy during COVID-19 curfews between December 2020 and May 2021 were asked specifically about their concerns during the COVID-19 pandemic and they filled out the Perinatal Anxiety Screening Scale (PASS) and the Prenatal Attachment Inventory (PAI). Those who continued the follow-up within a month of period following the delivery were invited to fill out the Maternal Attachment Inventory (MAI).

Results A total of 600 women completed the survey. While the evaluation of the relationship between participants' mean PAI and MAI scores showed a statistically significant positive correlation between scales (r = 0.124, p = 0.002), mean PAI and PASS scores showed a statistically significant negative correlation between scale scores (r = − 0.137, p = 0.001).

Conclusion Examining the factors, affecting the attachment process of pregnant and puerperal women, will guide the improvement of the quality of health services in the COVID-19 pandemic.

Key Points

• COVID-19 caused psychological distress, with increased anxiety among perinatal women.

• Elevated levels of anxiety about COVID-19 during pregnancy may lead to insecure attachment.

• Insecure attachment in the prenatal period will negatively contribute to mother − infant attachment.

Keywords

COVID-19 - pandemic - prenatal attachment - perinatal anxiety - maternal attachment

Ethical Approval

The trial protocol has been approved by the Ethics Committee of Izmir Katip Celebi University Faculty of Medicine (protocol no.: 23.07.2020/923).

Publication History

Received: 02 May 2022

Accepted: 24 June 2022

Accepted Manuscript online:
24 June 2022

Article published online:
12 September 2022

• References

• 1 Wang C, Horby PW, Hayden FG, Gao GF. A novel coronavirus outbreak of global health concern. Lancet 2020; 395 (10223): 470-473
• 2 The Republic of Turkey, Ministry of Health, General Directorate General of Public Health. COVID-19 (SARS-CoV-2 infection) (Study of Scientific Board): general information, epidemiology and diagnosis. Accessed July 6, 2022 at: https://hsgm.saglik.gov.tr/depo/covid19/Ingilizce/Rehber/COVID-19_Rehberi__Genel_bilgiler_epidemiyoloji_ve_tani_8.06.2020_eng.pdf
• 3 Motrico E, Bina R, Domínguez-Salas S. et al; Riseup-PPD-COVID-19 Group. Impact of the Covid-19 pandemic on perinatal mental health (Riseup-PPD-COVID-19): protocol for an international prospective cohort study. BMC Public Health 2021; 21 (01) 368
• 4 Chivers BR, Garad RM, Boyle JA, Skouteris H, Teede HJ, Harrison CL. Perinatal distress during COVID-19: thematic analysis of an online parenting forum. J Med Internet Res 2020; 22 (09) e22002
• 5 Lebel C, MacKinnon A, Bagshawe M, Tomfohr-Madsen L, Giesbrecht G. Elevated depression and anxiety symptoms among pregnant individuals during the COVID-19 pandemic. J Affect Disord 2020; 277: 5-13
• 6 Wu Y, Zhang C, Liu H. et al. Perinatal depressive and anxiety symptoms of pregnant women along with COVID-19 outbreak in China. Am J Obstet Gynecol 2020; 223: 240.e1-240.e9
• 7 Durankuş F, Aksu E. Effects of the COVID-19 pandemic on anxiety and depressive symptoms in pregnant women: a preliminary study. J Matern Fetal Neonatal Med 2022; 35 (02) 205-211
• 8 Kahyaoglu Sut H, Kucukkaya B. Anxiety, depression, and related factors in pregnant women during the COVID-19 pandemic in Turkey: a web-based cross-sectional study. Perspect Psychiatr Care 2021; 57 (02) 860-868
• 9 Saccone G, Florio A, Aiello F. et al. Psychological impact of coronavirus disease 2019 in pregnant women. Am J Obstet Gynecol 2020; 223 (02) 293-295
• 10 Field T. Prenatal depression risk factors, developmental effects and interventions: a review. J Pregnancy Child Health 2017; 4 (01) 301
• 11 Bretherton I. The origins of attachment theory: John Bowbly and Mary Ainsworth. Dev Psychol 1992; 28: 759-775
• 12 Brandon AR, Pitts S, Denton WH, Stringer CA, Evans HM. A history of the theory of prenatal attachment. J Prenat Perinat Psychol Health 2009; 23 (04) 201-222
• 13 Somerville S, Dedman K, Hagan R. et al. The Perinatal Anxiety Screening Scale: development and preliminary validation. Arch Women Ment Health 2014; 17 (05) 443-454
• 14 Mason ZS, Briggs RD, Silver EJ. Maternal attachment feelings mediate between maternal reports of depression, infant social–emotional development, and parenting stress. J Reprod Infant Psychol 2011; 29: 382-394
• 15 Trombetta T, Giordano M, Santoniccolo F, Vismara L, Della Vedova AM, Rollè L. Pre-natal attachment and parent-to-infant attachment: a systematic review. Front Psychol 2021; 12: 620942
• 16 Yazıcı E, Mutu Pek T, Uslu Yuvacı H. et al. Perinatal anxiety screening scale validiy and reliability study in Turkish (PASS-TR validity and reliability). Psychiatry Clin Psychopharmacol 2019; 29: 609-617
• 17 Muller ME. Development of the prenatal attachment inventory. West J Nurs Res 1993; 15 (02) 199-211 , discussion 211–215
• 18 Yılmaz SD, Kızılkaya Beji N. Turkish version of prenatal attachment inventory: a study of reliability and validity. J Anatolia Nursing and Health Sciences 2013; 16: 103-109
• 19 Müller ME. A questionnaire to measure mother-to-infant attachment. J Nurs Meas 1994; 2 (02) 129-141
• 20 Kavlak O, Şirin A. The Turkish version of maternal attachment inventory. J Human Sciences 2009; 6: 188-202
• 21 Hawryluck L, Gold WL, Robinson S, Pogorski S, Galea S, Styra R. SARS control and psychological effects of quarantine, Toronto, Canada. Emerg Infect Dis 2004; 10 (07) 1206-1212
• 22 Berthelot N, Lemieux R, Garon-Bissonnette J, Drouin-Maziade C, Martel É, Maziade M. Uptrend in distress and psychiatric symptomatology in pregnant women during the coronavirus disease 2019 pandemic. Acta Obstet Gynecol Scand 2020; 99 (07) 848-855
• 23 Ross LE, McLean LM. Anxiety disorders during pregnancy and the postpartum period: A systematic review. J Clin Psychiatry 2006; 67 (08) 1285-1298
• 24 Figueiredo B, Costa R. Mother's stress, mood and emotional involvement with the infant: 3 months before and 3 months after childbirth. Arch Women Ment Health 2009; 12 (03) 143-153
• 25 Basu A, Kim HH, Basaldua R. et al. A cross-national study of factors associated with women's perinatal mental health and wellbeing during the COVID-19 pandemic. PLoS One 2021; 16 (04) e0249780
• 26 Coşkuner Potur D, Doğan Merih Y, Demirci N. Primipar ve mulitpar gebelerin prenatal bağlanmalarını etkileyen faktörlerin değerlendirilmesi. Journal of Academic Research in Nursing 2020; 6: 132-140
• 27 Siddiqui A, Hägglöf B. Does maternal prenatal attachment predict postnatal mother-infant interaction?. Early Hum Dev 2000; 59 (01) 13-25
• 28 Betrán AP, Temmerman M, Kingdon C. et al. Interventions to reduce unnecessary caesarean sections in healthy women and babies. Lancet 2018; 392 (10155): 1358-1368
• 29 Grigoriadis S, Graves L, Peer M. et al. Maternal anxiety during pregnancy and the association with adverse perinatal outcomes: systematic review and meta-analysis. J Clin Psychiatry 2018; 79 (05) 17r12011
• 30 Grote NK, Bridge JA, Gavin AR, Melville JL, Iyengar S, Katon WJ. A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Arch Gen Psychiatry 2010; 67 (10) 1012-1024
• 31 Marcus SM. Depression during pregnancy: rates, risks and consequences–Motherisk Update 2008. Can J Clin Pharmacol 2009; 16 (01) e15-e22
• 32 Müller ME. Prenatal and postnatal attachment: a modest correlation. J Obstet Gynecol Neonatal Nurs 1996; 25 (02) 161-166
• 33 Alhusen JL. A literature update on maternal-fetal attachment. J Obstet Gynecol Neonatal Nurs 2008; 37 (03) 315-328
• 34 Laxton-Kane M, Slade P. The role of maternal prenatal attachment in a woman's experience of pregnancy and implications for the process of care. J Reprod Infant Psychol 2002; 20 (04) 253-266
• 35 Mehran P, Simbar M, Shams J, Ramezani-Tehrani F, Nasiri N. History of perinatal loss and maternal-fetal attachment behaviors. Women Birth 2013; 26 (03) 185-189
• 36 Ainsworth MD. Infant–mother attachment. Am Psychol 1979; 34 (10) 932-937
• 37 Coussons-Read ME. Effects of prenatal stress on pregnancy and human development: mechanisms and pathways. Obstet Med 2013; 6 (02) 52-57
• 38 Vedova AMD, Dabrassi F, Imbasciati A. Assessing prenatal attachment in a sample of Italian women. J Reprod Infant Psychol 2008; 26: 86-98
• 39 Lindgren K. Relationships among maternal-fetal attachment, prenatal depression, and health practices in pregnancy. Res Nurs Health 2001; 24 (03) 203-217
• 40 Camarneiro APF, de Miranda Justo JMR. Prenatal attachment and sociodemographic and clinical factors in Portuguese couples. J Reprod Infant Psychol 2017; 35 (03) 212-222