Volume 23, Issue 1 (Apr - May 2019)                   J Qazvin Univ Med Sci 2019, 23(1): 26-37 | Back to browse issues page

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Tork Zahrani S, Haji Rafiei E, Mohamad Khani Shahri L, Alavi Majd H. Investigation of Maternal- Fetal Attachment Behaviors and Its Related Factors in Pregnant Women, Qazvin in 2015. J Qazvin Univ Med Sci. 2019; 23 (1) :26-37
URL: http://journal.qums.ac.ir/article-1-2669-en.html
1- Department of Midwifery & Fertility Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
2- Department of Midwifery, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran. , Eli_h_rafiei@yahoo.com
3- Students Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.; Department of Midwifery, Faculty of Nursing and Midwifery, Karaj Branch, Islamic Azad University, Karaj, Iran.
4- Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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1. Introduction
regnancy is a natural occurrence in women's lives that is associated with many psychological and physical changes [1]. Emotional communication with a fetus is part of the process of adaptation to the maternal role during pregnancy [2]. Previous studies have investigated maternal-fetal attachment behavior. Hee and Young [8] showed that increased maternal-fetal attachment could reduce pregnancy stress. However, this association was not observed in the study of Mi-Kyung et al. [13].
Jamshidimanesh et al. reported a relationship between a mother's age and her attachment to the fetus, but Torshizi et al. found no such relationship [9, 10]. Instead, they reported an association between a mother's educational level and her attachment to the fetus, although this relationship was against the result of Abbasi et al. study [15]. Considering the importance of maternal-fetal attachment behaviors and contradictory findings of different studies on the effect of various factors on such behaviors, this study attempted to investigate the maternal-fetal attachment behaviors among Iranian pregnant women and examine the effect of different factors on these behaviors.
2. Materials and Methods
This is a descriptive cross-sectional study conducted on 200 pregnant women referred to health centers in Qazvin City, Iran, in 2015. For sampling, a multi-stage sampling method was used. First, Qazvin was divided into 3 regions. According to the population of each area, 29% of samples should be selected from the first region, 46% from the second region, and 25% from the third region. So, two health centers were randomly selected from the first region, three from the second region, and one from the third region.
Then, the samples were selected from each center randomly. The sample size was determined according to previous similar study [10]. To collect data, the Cranley's Maternal-Fetal Attachment scale was used. The reliability of this scale was confirmed using the Cronbach α coefficient (α=0.88). The collected data were analyzed in SPSS V.20 using descriptive statistics and inferential statistics (ANOVA and Tukey's test).
3. Results
Most of the participants were 23 years old or younger (24%) with a high school diploma (42%). The gestational age of the majority of the samples (5.54%)  ranged from 32 to 37 weeks, and most of them experienced their second pregnancy (42%). The results showed that 65.5% of the samples had a high attachment level, and 34.5% had a moderate attachment level.
The association of some variables with maternal-fetal attachment behaviors was assessed by One-way ANOVA. The results indicated a significant relationship between these behaviors and the number of deliveries, number of pregnancies, education, and stress (P<0.01). The results of Tukey's test showed that mothers with no history of delivery had more attachment to their fetus than mothers with a history of three deliveries. There was a significant difference in the attachment behaviors of the mothers who experienced the first pregnancy compared to those who were pregnant for the fifth time. Furthermore, mothers with university education had a stronger attachment compared to mothers with elementary education. Finally, mothers with high pregnancy stress had a higher attachment compared to mothers with a low level of stress.
4. Conclusion
The results showed that most participants had a high degree of attachment to their fetus, and the rest had moderate attachment level. Against the findings of Jamshidimanesh et al. study, no association was found between age and maternal-fetal attachment, which is consistent with the results of Torshizi et al. study [9, 10]
It seems that the difference in results is due to the lack of determined age range in the samples of Jamshidimanesh et al. study. Our results also reported no relationship between gestational age and maternal-fetal attachment, which was in agreement with the findings of Mehran et al. study [23]. Maternal-fetal attachment level was also associated with education level. This result is consistent with the findings of Walsh et al. [24].
There was a significant negative correlation between the number of pregnancies and maternal-fetal attachment. This finding is in line with the results of Ustunsoz et al. study [25]. The maternal-fetal attachment also had a significant negative correlation with the number of deliveries that is in agreement with the results of Walsh et al. study [24].
In the study of Mehran et al. the number of deliveries was a weak predictor of maternal-fetal attachment behavior [23]. This inconsistency can be because of the difference in sample size. Between income and maternal-fetal attachment, we found no association, which is in agreement with the findings of Torshizi et al. study [10].
There was no relationship between participation in prenatal education classes and maternal-fetal attachment. This finding is consistent with the results of Jamshidimanesh et al. study but against the results of Bellieni et al. study [9, 28].
The difference in results could be attributed to the content of the educational program and how the classes were being held. There was no association between maternal-fetal attachment and the history of abortion, infertility, and stillbirth. This finding is consistent with the result of Jamshidimanesh et al. study [9]. The maternal-fetal attachment also did not correlate with the occupation, which is in line with the results of Lindgren study [30].
Finally, the results of the present study showed that maternal-fetal attachment had a relationship with pregnancy stress. This finding is in agreement with the results of Hee and Young study but is against the findings of Mi-Kyung et al. study [8, 13]. This discrepancy may be because of the difference in individual, social, and cultural characteristics of the study participants.
Maternal-fetal attachment level was high in most of the pregnant women, and some individual and obstetric features were associated with the attachment behaviors. These findings emphasize the strengthening of maternal-fetal attachment behaviors as an effective way of adapting to changes during pregnancy.
One of the limitations of this study is its cross-sectional design. Hence, a longitudinal follow-up is recommended from the beginning to the end of pregnancy. Moreover, considering the beneficial effects of attachment behaviors, it is suggested that the impact of changes in educational programs be investigated through interventional studies.
Ethical Considerations
Compliance with ethical guidelines

The Research Ethics Committee of Shahid Beheshti University of Medical Sciences approved the study (ethical code: 116.636). Before sampling, Qazvin University of Medical Sciences issued an introductory letter too. The researcher explained the objectives of the study to the participants and assured them of the confidentiality of their information. After obtaining verbal consent, they completed the questionnaires.
This paper was extracted from a master thesis of the second author, Department of Midwifery, School of Midwifery and Nursing, Shahid Beheshti University of Medical Sciences. 
Authors' contributions
Study conceptualization: Shahnaz Tork Zahrani; Study sampling, data analysis, and writing the manuscript: Elnaz Haji Rafiei; Completion, review, and editing: Leila Mohamad Khani Shahri; Statistical counseling: Hamid Alavi Majd.
Conflicts of interest
The authors declare no conflict of interest. 
The authors would like to thank authorities of Shahid Beheshti University of Medical Sciences, Qazvin University of Medical Sciences, and all study participants for their valuable cooperation.

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Type of Study: Research | Subject: Nursing & Midwifery

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