Relationship between maternal- fetal attachment with anxiety and demographic factors in high- risk pregnancy primipara women

Background & Aims: Pregnancy is one of the most important stages of a woman's life, which is associated with physiological and psychological changes, but sometimes pregnancy faces complications that lead to the risk of psychological vulnerability and nervousness. High-risk pregnancies are one of the major problems of midwifery, in which the mother, fetus, and baby are at risk of death. Preeclampsia and hypertension are some of the worst consequences of pregnancy with the highest frequency problems. Preterm labor is also one of the high-risk pregnancies due to its higher incidence than other pregnancy complications in Iran. Addressing the above three complications is of particular importance. Generally, women are concerned about pregnancy and childbirth, the health of the fetus, and accepting the role of the mother. High-risk pregnancies also increase this anxiety. Fetal attachment related to the mother's emotional conflicts closely. The mother-child relationship and the relationship with others, which can affect the mother's mental state. Anxiety and worries affects the mother's attachment to the fetus and causes maternal complications and fetal health.There are divergences in the results of studies on the relationship between stress in high-risk pregnancies and maternal-fetal attachment behaviors. This study aimed to determine the relationship between fetal attachment and anxiety and demographic characteristics of nulliparous women with the risk of preeclampsia and preterm labor.Methods: The present study was a cross-sectional descriptive study. Two hundred pregnant women who had preeclampsia, hypertension, and preterm were select in the two prenatal clinics of Iran University Medical Sciences, where had the most referrals. This study was carried from ۲۰۱۸ to ۲۰۱۹. The Sample method was via simple random. First, according to the daily referral statistics of ۸ to ۱۰ women with high-risk pregnancies in the three mentioned complications, the researcher prepared a list of their names on the same day. Using the table of random numbers were selected four to five names. The researcher introduced herself to women. Then clarify the purpose of the study, and obtain their consent, and completed the consent form. Inclusion criteria included Iranian nationality, ability to read and write, gestational age between ۲۸ and ۴۰ weeks, and no mental illness as a self-report or medical record. The questionnaire included a demographic and midwifery form. Cranley fetal attachment and a Wendenberg pregnancy anxiety questionnaire. Sampling started in July ۲۰۱۸ and ended in June ۲۰۱۹ from Saturday to Wednesday. Data analyzed by Spss software version ۱۶ using independent t-test, analysis of variance and Pearson correlation coefficient and logistic regression.Results: The mean of fetal attachment was ۵۵.۲۶ ± ۱۲.۶۸ which was reported as moderate. The mean of women's anxiety was ۱۹۶.۲۰ ± ۳۴.۶۶ which was higher than the median of the scale. There was a statistically significant correlation between the total score of fetal attachment and the total score of female anxiety (P <۰.۰۰۱), that’s mean with increasing fetal attachment, anxiety also increased in high-risk pregnant women. The mean of age of women was ۳۱.۷۶ ± ۳.۹۲ years and the mean gestational age was ۳۴.۲۲ ± ۲.۴۸. The mean number of years of education for women was ۱۴.۶۸ ± ۲.۵۵, more than half of women reported ۱۲ and ۱۶ their education years, and their husbands also ۱۵.۶۵ ± ۲.۱۲. ۸۴.۵% of women had a planned pregnancy. ۶۲% of women received relatively good social support from their husbands. Higher education of mother and father, more support of the spouse to the pregnant mother, planning for pregnancy in the current pregnancy were significantly and inversely related to maternal attachment to the fetus and maternal anxiety during pregnancy. That’s mean the higher the education of the parents had along with the less attachment to the fetus and the less anxiety, and the more support the spouses during pregnancy was reported the less anxiety and attachment to fetus. Mothers with unplanned pregnancies also had more anxiety and reported more attachment to the fetus despite being high risk (P <۰.۰۰۱).Conclusion: There was a correlation between fetal attachment and anxiety in high-risk pregnant mothers. Pregnant mother's education, spouses' education, spouse's support of the pregnant mother, planning to become pregnant were inversely related to fetal attachment. Maternal anxiety was also inversely related to the personal characteristics mentioned above. In other words, less education of pregnant mothers and lack of planning to become pregnant had caused them to become more attached to the fetus, and these mothers had expressed more concern in the face of pregnancy complications and preeclampsia, hypertension, and preterm labor. It seems that the efforts of staff and health care providers should be towards pregnancy care in this group of women with higher quality and more consultation time. To increase mothers' knowledge when occur special problems and timely referral of the mothers. Obeying the necessary treatment. To follow-up on pregnancy. To ensure safe pregnancy and delivery and a healthy baby, it will also guarantee women's mental health. It should be a useful step in the positive experience of childbearing and natural childbirth.

Keywords:

Maternal Fetal Attachment , Anxiety , High Risk Pregnancy , Preeclampsia , Preeclampsia , Hypertension