• Users Online: 652
  • Print this page
  • Email this page

 Table of Contents  
Year : 2020  |  Volume : 7  |  Issue : 2  |  Page : 126-135

Effect of maternal–fetal/Neonatal attachment interventions on perinatal anxiety and depression: A narrative review

1 Department of Midwifery, Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
2 Department of Psychiatry, Faculty of Medicine, Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
3 Health Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran
4 Department of Midwifery, Sexual and Reproductive Health Research Center, Mazandaran University of Medical Sciences, Sari, Iran

Date of Submission28-May-2019
Date of Acceptance13-Jul-2019
Date of Web Publication06-Apr-2020

Correspondence Address:
Mrs. Marjan Ahmad Shirvani
Faculty of Nursing and Midwifery, Vesal St., Sari
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JNMS.JNMS_28_19

Rights and Permissions

Pregnancy and postpartum period may be accompanied with maternal anxiety and depression, each of which causes unfavorable outcomes in the mother and the infant. The maternal–fetal/neonatal interaction called attachment may influence these mental states. The present research has been performed with the goal to review the effect of maternal–fetal/neonatal attachment on perinatal anxiety and depression. This narrative review study has been done on the interventional studies in Persian and English published in 2006–2018 through searching the databases such as Google Scholar, Science Direct, Magiran, PubMed, Scientific Information Database, and Scopus and the keywords, such as anxiety, depression, and maternal–fetal/neonatal attachment. At the end, 14 articles have been included in the study. The findings have been organized into two categories: maternal–fetal attachment (10 papers) including three categories such as (1) paying attention to the fetus made up of two subcategories as relationship with the fetus and mental imagery, (2) awareness raising, and (3) relaxation techniques covering three subcategories as relaxation, exercise, and music and maternal–neonatal attachment (4 papers) including two categories such as (1) physical touch with infant and (2) pregnancy period training. Maternal–fetal/ neonatal attachment increase using various interventions can reduce pregnancy- and postpartum-induced anxiety and depression. Although regarding the mutual attachment and physiological health relationship, it is not possible to state which of these two variables get improved initially by the interventions and finally the expected result, i.e., the above factors' improvement is achieved. Thus, training attachment enhancement techniques to pregnant women's care providers are recommended.

Keywords: Anxiety, Attachment, Depression, Fetus, Infant, Mother

How to cite this article:
Mahmoudi P, Elyasi F, Nadi A, Ahmad Shirvani M. Effect of maternal–fetal/Neonatal attachment interventions on perinatal anxiety and depression: A narrative review. J Nurs Midwifery Sci 2020;7:126-35

How to cite this URL:
Mahmoudi P, Elyasi F, Nadi A, Ahmad Shirvani M. Effect of maternal–fetal/Neonatal attachment interventions on perinatal anxiety and depression: A narrative review. J Nurs Midwifery Sci [serial online] 2020 [cited 2023 Sep 27];7:126-35. Available from: https://www.jnmsjournal.org/text.asp?2020/7/2/126/281990

  Introduction Top

Although one of the most appealing stages of a woman's life resulting in her development is motherhood process, in this period the changes in mother's body and mind may make her obsessed with some stress and worries. If these mental changes get abnormal, some mental pressures will pop up in the long term and will produce a very stressful period.[1] The WHO (2008) estimated that over 80% of the women with low-risk gestation have experienced some degrees of anxiety in their pregnancy. Of 3–5 pregnant women in developing countries, one undergoes anxiety problems. This is 1 of 10 pregnant women in developed countries.[2] In various parts of Iran, the prevalence of anxiety among pregnant women has been reported as ranging from 26.6% to 43%.[3] Anxiety causes increased muscle contraction and decreased oxygen to the brain and muscle. As a result, the mother feels more fatigue, sensitivity, and stress to pain and cannot adapt herself to pain.[4] The individual's performance and communication with others are negatively affected by anxiety. Furthermore, it leads to somatic and mental disorders,[5] delayed maturing of fetal heart rate and movement,[6] negative outcomes during birth and infancy,[7] and inappropriate responses of the mother to the fetus.[8] The depression symptoms' prevalence in pregnant women is around 25%–35%.[9] In Iran, pregnancy-induced depression outbreak has been reported as 30.6%.[10] Pregnancy-induced depression causes the mother to underperform in emotional communication with the newborn, resort to smoking, alcohol, and drug abuse, and also commit suicide, fetal distress, birth underweight, premature neonate, neonatal behavior change, and postpartum depression.[11] Postpartum depression causes the mother not to do her motherhood care properly, and there is a suicide risk of 5% and infanticide of 4%. The induced long-term effects are marriage conflicts, permanent depression, and impaired mother–infant communication.[12]

Since there are some limitations regarding drug prescriptions during gestation and lactation, nonpharmacological methods are on the focus to prevent and improve the perinatal period-induced anxiety and depression. One of these interventions is to train mother–fetus/infant attachment increase skills.[13] Attachment is a sustained mother–infant intimacy-based relationship which results in satisfaction and relief and facilitates the maternal–fetal/infant interaction.[14] This emotional relationship is strengthened after delivery.[15] Maternal attachment starts from the 10th week of gestation and rapidly promotes in the 16th week.[16] When the mother considers her health interrelated with the fetus, her interaction with the fetus will get boosted.[17] Mother–fetus interaction can cause lower maternal anxiety[18] and results in raised maternal sensitivity to the infant and effective and sufficient care.[7]

There is a wide variety of methods to enhance the maternal–fetal/neonatal attachment. Often, the review studies have addressed the methods to create maternal–fetal/neonatal attachment, while they have not dealt with related anxiety and depression. Besides, the Iranian studies on the subject have not been included in the research.[8],[19],[20] Regarding the adverse consequences of maternal anxiety and depression during pregnancy and postpartum period, finding safe, low-cost, and convenience technique to improve mothers' mental health is important. Although practitioners usually believe that mental health has a negative effect on mother–fetal/infant attachment, reviewing some clinical studies shows that attachment may have a positive effect on mother psychological condition. Hence, the current study has been performed to investigate the effect of maternal–fetal/infant attachment interventions on perinatal period anxiety and depression.

  Materials And Methods Top

This narrative review study has been conducted on the research cases focused on the interventions related to maternal–fetal/neonatal attachment and its effect on anxiety and depression in the mothers during pregnancy and postpartum period.

  Research Questions Top

We have reviewed the published articles in order to answer the following questions:

  1. Do maternal–fetal attachment interventions affect the mother's anxiety and depression in pregnancy?
  2. Do maternal–fetal attachment interventions affect the mother's anxiety and depression in postpartum period?

  Search Strategy Top

The search has been done based on the study questions. The researchers have done the initial search in the electronic databases including Google Scholar, Science Direct, Magiran, PubMed, Scientific Information Database, and Scopus and with the keywords including anxiety, depression, maternal–fetal relationship, and maternal–neonatal attachment.

The interventional studies (clinical trial, field and semi-experimental studies) in Persian and English during 2006-2018, that used the effective techniques on maternal-fetal/neonatal attachment and reported perinatal induced anxiety and depression were included in the study.

  Exclusion Criteria Top

The noninterventional studies (descriptive, case–control, and cohort) not dealing with the research questions and merely analyzing the maternal attachment or mental problems were excluded from the study.

  Data Collection Method Top

In the first stage, the papers have been picked up by the researchers separately using the keywords and based on the topic. In the second stage, the repeated irrelevant topics have been crossed out. After that, the abstract and the full text of the papers have been examined, and the ones on the desired topic have been included in the research. At last, the researcher attempted to obtain the original form of the papers that abstract of which was only available through re-browsing other databases and communicating with the authors. Furthermore, surveying the papers' resources, other relevant papers have been searched. In this manner, totally 453 papers were gathered, of which 324 restated as irrelevant ones, 99 in the abstract screening, and 16 following text analysis were removed. At the end, 14 articles were included in this review [Chart 1].[INLINE:1]

  Report Of Findings Top

The findings have been reported in two main categories. Besides, based on an interventional procedure, each of the groups has been categorized in several subgroups.

  Ethical Considerations Top

The ethical considerations have been followed on loyalty in translation, lack of plagiarism, and respecting intellectual property rights.

  Results Top

Overall, 14 papers have been included in this study – 10 ones reporting maternal–fetal attachment and 4 ones reporting maternal–infant attachment. The findings are organized into categories and subcategories [Table 1].
Table 1: Categorize of maternal-fetal/neonatal attachment interventions

Click here to view


attachment and its effect on pregnancy-induced anxiety and depression

The findings' summary related to the pregestation intervention effect has been depicted in [Table 2]. These findings have been divided into three categories as it follows:
Table 2: Studies on maternal-fetal attachment interventions' effect on anxiety and depression during pregnancy

Click here to view

Paying attention to the fetus

Relationship with the fetus

It is done through speaking, touching the abdomen, paying attention to the movements and counting it, calling the fetus with a nickname, guessing the position of its organs, focusing on the fetus and recognizing it as an independent entity, and performing ultrasound in pregnancy. In reviewing the literature, four articles examined the above behaviors:

In a study, training how to touch the abdomen, recognizing the fetus, counting the movements and recording them, speaking with it, calling the fetus with a nickname, looking at the abdomen, focusing on the fetus and recognizing it as an independent identity, guessing the position of its organs, and calming it down by touching the abdomen were done. In addition, mental imagery has been applied. The mean anxiety score significantly decreased in the intervention group and increased in the control group. Depression and attachment variation has not been reported, and only maternal–fetal attachment has been addressed, showing a significant increase.[21] In another research, training to count and record the fetus' movements, speaking with the fetus, and touching the abdomen accompanied with mental imagery have been performed. The fetal attachment and the mental health level revealed a significant difference between the two groups.[22]

In a study, ultrasound counseling was performed consisting of four phases: (1) demonstrating the fetus physical features, gender, and position; (2) searching the fetus' physical movements, reflex, and orientation changes in the uterus; (3) allowing the mother to explore the fetus' responses to actions such as laughing, pressing the abdomen, talking to the fetus, and singing for it, and (4) postcounseling session maternal questioning. The mean fetal attachment has increased in the intervention group and the mean anxiety dropped. The changes were not significant in the control group. Depression level variation was not examined, and it has only been dealt with in one stage ahead of sonography between the two groups, which indicates no significant difference.[23]

A researcher compared the fetal communication techniques with relaxation training, in which the anxiety level of the training groups has been lower than that of the control group but not significantly different between two interventions. However, postpartum depression was lower in the relaxation group.[24]

Mental imagery

It includes imagining having the baby in one's arms, guided motherhood role imagery, visualizing herself when breastfeeding, and the fetus' appearance as positive. Four studies have investigated the mental imagery effect on anxiety and depression:

In a study, mothers were trained about the positive imagination of the fetus' appearance, visualizing hugging and breastfeeding the new born and communication skills with the fetus. As reported above, the anxiety level of the intervention group dropped significantly and that of the control group increased.[21]

In another study, the mental imagery of motherhood role has been trained accompanied with relaxation and rising awareness. A significant difference has popped up in depression, anxiety, and stress scales between the two groups. Furthermore, a significant difference was displayed in the mean of total score and subscales of maternal–fetal attachment.[25]

In a research, the guided imagery on maternal–fetal attachment had been trained. The fetal attachment, anxiety, and depression were significantly better in the intervention group.[26]

In another research, positive imagery about the appearance of the fetus and that of her own while breastfeeding along with fetal communication techniques resulted to a significant difference in terms of the psychological health and fetal attachment between the groups. In this research, anxiety and depression have not been measured independently.[22]

Awareness rising

It involves training about the pregnancy-induced anatomical, physiological, and hormonal changes and these changes' effect on the maternal body and mind; some strategies to adapt more with pregnancy changes; attachment concept and the benefits of higher attachment in pregnancy; embryo development; the effect of nutrition and care on maternal–fetal health; exercise; getting familiar with labor process;[21] familiarity with the husband's role as a supporter; and training attachment skills to the fathers by pregnant women.[24]

In a research, the general concept of attachment, fetal attachment and communication skills, psychological and physical changes during pregnancy, and general knowledge about labor manner and process were trained. Furthermore, in the second intervention group, only relaxation has been done. Both relaxation and training groups came up with a significant difference with the control group in terms of anxiety level. Fetal attachment was not reported.[24]

In another research, awareness rising including the description and analysis of the maternal expectations and changes physically and emotionally, the maternal and paternal emotional and physical health during and after pregnancy, and the embryo development were deal with. Besides, relaxation and mental imagery were employed. Attachment, depression, anxiety and stress were significantly different between the trained and control groups.[25]

Relaxation techniques


In a study, training relaxation was conducted. The fetal attachment and anxiety showed a significant difference. Depression was not measured in this study.[27]

A researcher focused on relaxation training including getting familiar with the general concept of anxiety and relaxation, the logic behind applying relaxation during pregnancy, familiarity with muscle relaxation technique and breathing exercises, and a thorough review of relaxation. The difference of anxiety level in the relaxation group was not significant with attachment training but was lower than the control groups.[24]

A study, as pointed out in the prior categories, worked on training relaxation accompanied with mental imagery and awareness rising. The two groups' depression, anxiety, stress, and attachment level have denoted a significant difference.[25]


In a study, training exercises such as stretching, breathing, and meditation have been addressed. This exercise called Qi is common in South Korea and it originates from yoga. This exercise elevates mental capacity and physical performance. Except of anxiety, the two groups' differences in fetal attachment and depression were significant.[28]

A research dealt with yoga exercise training. In the yoga group, the fetal attachment and psychological health have increased more.[29]


One study surveyed the effect of music therapy during transvaginal sonography. A significant difference was observed regarding the anxiety but not with the attachment. Depression has not been addressed in this research.[30]

Maternal–neonatal attachment interventions and its effect on postpartum anxiety and depression

The findings related to the intervention-induced effect on postpartum maternal psychological condition have been listed in [Table 3]. These findings have been divided into two categories:
Table 3: Studies about maternal-neonatal attachment enhancement interventions' effect on postpartum anxiety and depression

Click here to view

Physical touch with infant

This category includes mother–newborn skin contact or skin contiguity immediately after delivery, breast sucking, mother–newborn rooming-in, newborn touching and massaging, keeping the newborn close to the body, hugging, and kissing.

In a study, skin contact has been done at least 20–30 min daily. The two groups revealed a significant difference in terms of the attachment and anxiety in the 3rd and 10th days. This research has not reported depression.[31]

In another study, the maternal–neonatal skin contact immediately after delivery was done. The neonatal attachment and anxiety levels were significantly different.[32]

Pregnancy period training

Gestation and labor physiological training, being aware of the fetal feelings and perception, attachment concept, mental imagery, and attachment behavior (communicating with the fetus, anxiety control, negative thoughts, proper sleep patterns, exercise, and nutrition) during pregnancy have been surveyed in two studies.

In a research, relaxation training has been carried out in one group during pregnancy, and in another group, attachment behaviors, pregnancy-induced psychological and physical changes, general knowledge about labor manner and process, and familiarity with the paternal role as a supporter were trained. The mean scores of postpartum depression in the attachment and relaxation group were significantly lower than the control group but were not different between the two groups.[24]

In a study, training in the form of speech, discussion, film watching, and role playing were performed. The maternal anxiety level 3 months after delivery was lower in the intervention group.[33]

  Discussion Top

Maternal–fetal attachment intervention influencing pregnancy-induced anxiety and depression

The findings derived from the current study demonstrated that various fetal communication techniques have influenced the maternal attachment increase and the maternal depression and anxiety drop during pregnancy. Attachment behavior learning exerts a positive effect on maternal–fetal attachment enhancement and maternal anxiety decrease.[4],[34] In fact, the quality of attachment determines anxiety level.[35],[36] Although a researcher reported the maternal–fetal attachment in surrogate mothers as lower than that of the normal mothers while their anxiety is not more,[37] regarding the confounders' effect, it is not possible to generalize lack of relationship between the attachment and anxiety among this group of mothers to the others. Besides, depression symptoms have shown a significant relationship with maternal–fetal attachment.[38]

Why training attachment reduces pregnant mothers' anxiety? When answering this question, we have to point out the major reasons behind pregnancy-induced anxiety. The most important reasons include fearing labor, fearing a disabled abnormal infant, and fearing facial and bodily changes. The peak of this anxiety is in mid-pregnancy. The three-dimensional model explaining the causes of pregnancy-induced anxiety indicates that the educational content of attachment can effectively cover the sides of this triangle. One of the attachment-related training contents is familiarity with the delivery process, fetus' development process, and explaining and making pregnancy-induced physiological changes perceived. Thus, making the mothers aware of these processes can cover the three sides of anxiety triangle, and it certainly has a positive effect on maternal anxiety. As seen in the two studies, raising maternal knowledge and awareness has accompanied with the mothers' psychological health getting boosted.[24],[25] Of course, in these studies along with maternal information increase during pregnancy, training fetal attachment increase methods has been presented. Thus, it is not possible to definitely determine if raising awareness and knowledge alone can influence their psychological health.

Moreover, some studies have reported the training effect of fetal interaction techniques such as focusing on the movements, speaking with the fetus, guided imagery, and touching the abdomen on attachment increase and anxiety and depression decrease.[21],[22],[39] It can be stated that this training has an effect on the second side of the anxiety triangle, i.e., the mother fearing to deliver a disabled infant. Furthermore, fetal communication indirectly and through distracting the mother to avoid fearing facial and bodily changes influences the third side of the anxiety triangle. The results of a study revealed that presenting embryonic images through sonography during early pregnancy and before the mother understands pregnancy signs brings about reassuring importance for the mothers perceiving the true life in their womb and results in their intense attachment emotions to the unborn infant[40] and increases maternal health during gestation.[41] Behaviors such as counting the fetus' movements will stimulate the maternal feelings and boost the interactions with the fetus. Fetal movements may have a positive effect on prenatal attachment because fetus' life will turn as real for the mother after feeling its movements. The mothers with higher fetal attachment are more focused on the fetus' movements and detect them.[42]

In the studies, relaxation techniques as solely or integrated with other methods have been effective in boosting the maternal attachment, anxiety, and depression.[24],[25],[27],[28] One of the renown conventional methods for lowering anxiety is relaxation which can cover all three sides of maternal fear.[24] Although in another study, relaxation alone has led to increased attachment and decreased anxiety,[27] it cannot be definitely concluded whether attachment increase brings about anxiety drop or vice versa, but the positive effect of this method on maternal–fetal attachment improvement cannot be overlooked. The findings suggest that pregnancy relaxation is a befitting and influencing opportunity for mental relaxation and concentration on the fetus and positive imagery about pregnancy and increased maternal–fetal attachment.[43] The individual's blood circulation gets boosted via doing the right relaxation and the maternal brain function improvement, and positive attitude will reduce her stress, anxiety, and depression.[44] One research suggested that Qi exercise as mind–body bonding intervention and similar to yoga as a more advanced form can decrease maternal depression and raise fetal attachment.[28] Although Qi decreased anxiety in the intervention group compared to the control group, no significant statistical difference was spotted. It seems that more studies are required to be done to prove the effectiveness of this technique. In another research in which yoga movements have been trained, maternal–fetal attachment and maternal psychological health have raised.[29] This way, it seems that these sorts of exercises as combined mental and physical relaxation techniques can affect the maternal–fetal attachment and pregnant women's mental health. One of the studies denoted that music lowered maternal anxiety, but it did not increase attachment.[30] Of course, in this research, the intervention was done at the time of sonography, so it has been short term. Therefore, it seems that the reduction of anxiety, especially short-term and intermittent, cannot improve fetal attachment. On the other hand, researchers reported that maternal attachment can get promoted through a combined plan based on music, exercise, and reading educational books.[45] Thus, it seems that if music is accompanied with other attachment boosting strategies, it can exert a higher effect on this dimension. In the recent decade, music therapy effects on the body and mind have been identified.[46] Music removes negative feelings, uplifts stress threshold, coordinates internal processing, facilitates patients' recovery, accelerates the individual's relaxation and calmness, and reduces stress. Enjoying beauty by the right hemisphere releases endorphins from the pituitary gland; music alters the interaction of thalamus and the reticular activating system and influences emotions, muscular system, and bodily autonomic system's function, such as blood pressure, heart, and respiration.[47],[48],[49] According to the above effects, music can have effects on attachment and anxiety.

Apart from the effect inducing from the techniques of the maternal–fetal attachment formation and pregnant women's anxiety and depression decrease, group training of such techniques in most cases leads to the women's getting together that has a meaningful effect on the person's mental states and spirit. It has been reported that through the women entering a new social network and visiting other mothers, attachment training gives pregnant women the chance to receive emotional and social supports and better benefit from medical and care service.[38] Therefore, group training may reduce depression in pregnant women.[50]

Maternal–neonatal attachment interventions influencing postpartum maternal anxiety and depression

A review of the studies indicates that not only the postpartum interaction with a newborn but also the fetal interaction during pregnancy can affect maternal–neonatal attachment and the postpartum maternal mental health.[21],[24],[32],[33] Maternal–fetal attachment training reduces postpartum anxiety through strengthening acceptance and complying with motherhood role.[51] It also improves the maternal confidence attachment and her adapting to maternity conditions and causes the mother to respond more positively to infant's behaviors and, as a result, reduces her postpartum depression.[52]

Reviewing the studies indicated that early maternal–fetal skin contact can be applied as an easy, inexpensive, and noninvasive technique to increase maternal–fetal attachment and to lower the anxiety about newborn.[31],[32] Because of the maternal–neonatal close contact, verbal interaction, and more contact between the mother and the neonate and creating attachment between these two, the mothers prefer skin-to-skin contact to typical care approaches.[53],[54],[55],[56] Attachment behaviors such as looking at, speaking with, and touching the neonate in the group with immediate contact with their neonate were more than those women having contact with their baby only at breastfeeding time.[57] Probably, the biochemical process by oxytocin, which is secreted by early maternal and infant contact, breast sucking, and the mother and the neonate room-in, leads to attachment formation.[58] The maternal–neonatal interaction increases during skin contact causing the mother's body to respond more to stimuli, and the nutritional behaviors will be stimulated and promoted due to neonatal smelling as a result of which the newborn gets the mother's breast and starts feeding. As a result of the newborn's sucking during the 1st h of birth, the maternal hormonal response is activated and oxytocin is secreted more.[59],[60] The maternal–neonatal emotional connection is formed through touching, getting the baby close to the body, hugging and smiling at the newborn and speaking with it, calling its name, properly responding to the neonate's movements and hints, and directly and face-to-face looking at the neonate.[61] The results derived from the study revealed that pregnancy and postpartum presence of mind increases the maternal attention to perceiving, observing, and describing the neonate's movements, voice, and other behaviors that overall these factors promote the mother's attention to the baby and, as a result, decreases stress, anxiety, and attachment between the mother and the neonate.[62],[63]

One of the strengths of this study is to investigate the effective methods to strengthen prenatal and postpartum maternal–neonatal attachment and its relationship with depression and anxiety in mothers, which has been less considered in previous surveys. One of the limitations of the study is failure to investigate the role of fathers in enhancing maternal-fetal/neonatal attachment, which is suggested to be assessed in future studies. Moreover, comparing various attachment techniques can define the efficiency of each of the techniques alone. Concerning this matter that most studies have surveyed anxiety and depression and the other maternal psychological health dimensions have not been much investigated and also, limitation of investigations about maternal–neonatal attachment, it seems required to do some studies in this area.

  Conclusion Top

Considering the study extracted results, it seems that training attachment can cause maternal–fetal/neonatal attachment increase and the maternal perinatal depression and anxiety drop. Of course, in most studies, a series of attachment interventions, including various techniques for communicating with the fetus, have been trained concurrently. Therefore, it is not possible to precisely conclude about the effect of each of these measures. On the other hand, concerning the mutual relationship that may exist between attachment and psychological health, it cannot be definitely concluded that the measures taken in cases like relaxation on which of these two variables have influenced first. By training the attachment formation techniques to health personnel before childbirth and establishing these behaviors in the mothers, it can be hoped that pregnant mothers and, as a result, the next generation will benefit from more appropriate mental health. Regarding the current study extracted results, the midwives and other health-medical group members are recommended to keep in contact with the mother in order to present maternal attachment behaviors counseling and training as a simple, inexpensive, and enjoyable technique as part of prenatal period in order to take steps toward maternal–infant health by achieving its results.

Conflict of interests

There is no conflict of interest for authors.

Authors' contribution

Mahmoudi and Shirvani were responsible for search and evaluation of articles, writing the first draft and revision of the final draft, Elyasi and Nadi contributed in critical revision and analyzed the data. All authors contributed to the development of the study design.

Financial support and sponsorship

This project was financially supported by Mazandaran University of Medical Sciences.


This study has been approved by the Student Research Committee of Mazandaran University of Medical Sciences (3650). Hereby, we sincerely appreciate the support by this committee and the vice president of research and technology of Mazandaran University of Medical Sciences.

  References Top

Mckee MD, Cunningham M, Jankowski KR, Zayas L. Health-related functional status in pregnancy: Relationship to depression and social support in a multi-ethnic population. Obstet Gynecol 2001;97:988-93.  Back to cited text no. 1
Bennett IM, Schott W, Krutikova S, Behrman JR. Maternal mental health, and child growth and development, in four low-income and middle-income countries. J Epidemiol Community Health 2016;70:168-73.  Back to cited text no. 2
Sadeghi N, Azizi, S, Molaeinezhad M. Anxiety study of pregnant mothers in the third trimester of pregnancy and its related factors in patients referring to Bandar Abbas hospitals in 2012. J Obstet Gynecol Infertil 2014;17:8-15.  Back to cited text no. 3
Braverman J, Roux JF. Screening for the patient at risk for postpartum depression. Obstet Gynecol 1978;52:731-6.  Back to cited text no. 4
Beck CT. Predictors of postpartum depression: An update. Nurs Res 2001;50:275-85.  Back to cited text no. 5
Fink NS, Urech C, Berger CT, Hoesli I, Holzgreve W, Bitzer J, et al. Maternal laboratory stress influences fetal neurobehavior: Cortisol does not provide all answers. J Matern Fetal Neonatal Med 2010;23:488-500.  Back to cited text no. 6
Solchany JE. Promoting Maternal Mental Health during Pregnancy. NCAST Programs; 2013.  Back to cited text no. 7
Alhusen JL. A literature update on maternal-fetal attachment. J Obstet Gynecol Neonatal Nurs 2008;37:315-28.  Back to cited text no. 8
Gotlib IH, Whiffen VE, Mount JH, Milne K, Cordy NI. Prevalence rates and demographic characteristics associated with depression in pregnancy and the postpartum. J Consult Clin Psychol 1989;57:269-74.  Back to cited text no. 9
Karbakhsh M. Sedaghat M. Depression in pregnancy: Implications for prenatal screening. Payesh 2002;1:49-55.  Back to cited text no. 10
Evans J, Heron J, Patel RR, Wiles N. Depressive symptoms during pregnancy and low birth weight at term: Longitudinal study. Br J Psychiatry 2007;191:84-5.  Back to cited text no. 11
Lee DT, Chan SS, Sahota DS, Yip AS, Tsui M, Chung TK. A prevalence study of antenatal depression among Chinese women. J Affect Disord 2004;82:93-9.  Back to cited text no. 12
Beck CT. A meta-analysis of predictors of postpartum depression. Nurs Res 1996;45:297-303.  Back to cited text no. 13
Varvogli L, Darviri C. Stress management techniques: Evidence-based procedures that reduce stress and promote health. Health Sci J 2011;5:74-89.  Back to cited text no. 14
Saastad E, Ahlborg T, Frøen JF. Low maternal awareness of fetal movement is associated with small for gestational age infants. J Midwifery Womens Health 2008;53:345-52.  Back to cited text no. 15
Edwards LD. Adaptation to Parenthood. Maternity Nursing. 5th ed. St. Louis: Mosby; 1999. p. 449-88.  Back to cited text no. 16
Ustunsoz A, Guvenc G, Akyuz A, Oflaz F. Comparison of maternal-and paternal-fetal attachment in Turkish couples. Midwifery 2010;26:e1-9.  Back to cited text no. 17
Kim JS, Cho KJ. The effect of mother-fetus interaction promotion program of talking and tactile stimulation on maternal-fetal attachment. J Korean Acad Child Health Nurs 2004;10:153-64.  Back to cited text no. 18
Cannella BL. Maternal-fetal attachment: An integrative review. J Adv Nurs 2005;50:60-8.  Back to cited text no. 19
Dipietro JA. Psychological and psychophysiological considerations regarding the maternal-fetal relationship. Infant Child Dev 2010;19:27-38.  Back to cited text no. 20
Toosi M, Akbarzadeh M, Zare N, Sharif F. Effect of attachment training on anxiety and attachment behaviors of first-time mothers. Hayat 2011;17:69-79.  Back to cited text no. 21
Abasi E, Tafazzoli M, Esmaily H, Hasanabadi H. The effect of maternal–fetal attachment education on maternal mental health. Turk J Med Sci 2013;43:815-20.  Back to cited text no. 22
Boukydis CF, Treadwell MC, Delaney-Black V, Boyes K, King M, Robinson T, et al. Women's responses to ultrasound examinations during routine screens in an obstetric clinic. J Ultrasound Med 2006;25:721-8.  Back to cited text no. 23
Rafiee B, Akbarzade M, Asadi N, Zare N. Comparison of attachment and relaxation training effects on anxiety in third trimester and postpartum depression among primipara women. Hayat 2013;19:76-88.  Back to cited text no. 24
Hosseinian S, Yazdi SM, Alavinezhad S. The effectiveness of fetal attachment training program on maternal- fetal relationship and mental health of pregnant women. JCMH 2016;2:75-87.  Back to cited text no. 25
Kordi M, Fasanghari M, Asgharipour N, Esmaily H. Effect of guided imagery on maternal fetal attachment in nulliparous women with unplanned pregnancy. J Midwifery Reprod Health 2016;4:723-31.  Back to cited text no. 26
Toosi M, Akbarzadeh M, Ghaemi Z. The effect of relaxation on mother's anxiety and maternal-fetal attachment in primiparous IVF mothers. J Natl Med Assoc 2017;109:164-71.  Back to cited text no. 27
Ji ES, Han HR. The effects of Qi exercise on maternal/fetal interaction and maternal well-being during pregnancy. J Obstet Gynecol Neonatal Nurs 2010;39:310-8.  Back to cited text no. 28
Akarsu RH, Rathfisch G. The effect of pregnancy yoga on the pregnant's psychosocial health and prenatal attachment. Indian J Tradit Knowle 2018;17:732-40.  Back to cited text no. 29
Shin HS, Kim JH. Music therapy on anxiety, stress and maternal-fetal attachment in pregnant women during transvaginal ultrasound. Asian Nurs Res (Korean Soc Nurs Sci) 2011;5:19-27.  Back to cited text no. 30
Nematbakhsh F, Kordi M, Sahebi A, Esmaeeli H. The effect of mother-infant skin to skin contact on mother's attachement. Q J Fund Ment Health 2007;9:25-32.  Back to cited text no. 31
Karimi A, Tara F, Khadivzadeh T, Aghamohammadian-Sherbaf HR. Effect of mother and baby skin contact immediately after delivery on maternal attachment and anxiety related to neonate: Randomized clinical trial. IJOGI 2013;16:7-15.  Back to cited text no. 32
Akbarzadeh M, Dokuhaki A, Joker A, Pishva N, Zare N. Teaching attachment behaviors to pregnant women: A randomized controlled trial of effects on infant mental health from birth to the age of three months. Ann Saudi Med 2016;36:175-83.  Back to cited text no. 33
Bellieni CV, Ceccarelli D, Rossi F, Buonocore G, Maffei M, Perrone S, et al. Is prenatal bonding enhanced by prenatal education courses? Minerva Ginecol 2007;59:125-9.  Back to cited text no. 34
Schmidt EB, de Lima Argimon II. Pregnant women's bonding and maternal-fetal attachment. Paidéia 2009;19:211-20.  Back to cited text no. 35
Hart R, McMahon CA. Mood state and psychological adjustment to pregnancy. Arch Womens Ment Health 2006;9:329-37.  Back to cited text no. 36
Ghelichi F, Roshan R, Khodabakhshi Kolaee A. Comparing of maternal -fetal attachment and pregnancy anxiety in surrogate women and normal pregnancy. Iran J Obstet Gynecol Infertil 2016;19:46-53.  Back to cited text no. 37
Alhusen JL, Gross D, Hayat MJ, Rose L, Sharps P. The role of mental health on maternal-fetal attachment in low-income women. J Obstet Gynecol Neonatal Nurs 2012;41:E71-81.  Back to cited text no. 38
Maeda K, Morokuma S, Yoshida S, Ito T, Pooh RK, Serizawa M. Fetal behavior analyzed by ultrasonic actocardiogram in cases with central nervous system lesions. J Perinat Med 2006;34:398-403.  Back to cited text no. 39
Dykes K, Stjernqvist K. The importance of ultrasound to first-time mothers' thoughts about their unborn child. J Reprod Infant Psychol 2001;19:104-59.  Back to cited text no. 40
Lerum CW, LoBiondo-Wood G. The relationship of maternal age, quickening, and physical symptoms of pregnancy to the development of maternal-fetal attachment. Birth 1989;16:13-7.  Back to cited text no. 41
Velazquez MD, Rayburn WF. Antenatal evaluation of the fetus using fetal movement monitoring. Clin Obstet Gynecol 2002;45:993-1004.  Back to cited text no. 42
Atkinson RL, Atkinson RC, Smith EE, Bem DJ, Nolen-Hoeksema S. Hilgards Introduction to Psychology. Fort Worth; London: Harcourt College Publishers; 2000.  Back to cited text no. 43
Neff K, Hsieh Y, Dejitterat K. Self-compassion, achievement goals, and coping with academic failure. Self Identity 2005;4:263-87.  Back to cited text no. 44
Yang KM, Kim SL. Effects of a Taegyo program on parent-fetal attachment and parenthood in first pregnancy couples. J Korean Acad Nurs 2010;40:571-9.  Back to cited text no. 45
Liu YH, Chang MY, Chen CH. Effects of music therapy on labour pain and anxiety in Taiwanese first-time mothers. J Clin Nurs 2010;19:1065-72.  Back to cited text no. 46
Bonde LO, Wiagram TA. Comprehensive Guide to Music Therapy: Theory, Clinical Practice, Research and Training. London: Jessica Kingsley Publishers; 2002. p. 384.  Back to cited text no. 47
Sidorenko VN. Clinical application of medical resonance therapy music in high-risk pregnancies. Integr Physiol Behav Sci 2000;35:199-207.  Back to cited text no. 48
Chang MY, Chen CH, Huang KF. Effects of music therapy on psychological health of women during pregnancy. J Clin Nurs 2008;17:2580-7.  Back to cited text no. 49
Lara-Cinisomo S, Wisner KL, Burns RM, Chaves-Gnecco D. Perinatal depression treatment preferences among Latina mothers. Qual Health Res 2014;24:232-41.  Back to cited text no. 50
Braveman PM, Sarnoff R, Egerter S, Rittenhouse D, Salganicoff A. Promoting Access to Prenatal Care: Lessons from the California Experience. Vol. 1. Menlo Park, Calif: Kaiser Family Foundation; 2003. p. 59-6.  Back to cited text no. 51
Leifer M. Psychological changes accompanying pregnancy and motherhood. Genet Psychol Monogr 1977;95:55-96.  Back to cited text no. 52
Carfoot S, Williamson P, Dickson R. A randomised controlled trial in the North of England examining the effects of skin-to-skin care on breast feeding. Midwifery 2005;21:71-9.  Back to cited text no. 53
Khadivzadeh T, Karimi A. The effects of post-birth mother-infant skin to skin contact on first breastfeeding. Int J Nurs Midwifery Res 2009;14:111-6.  Back to cited text no. 54
Mahmood I, Jamal M, Khan N. Effect of mother-infant early skin-to-skin contact on breastfeeding status: A randomized controlled trial. J Coll Physicians Surg Pak 2011;21:601-5.  Back to cited text no. 55
Moore ER, Anderson GC. Randomized controlled trial of very early mother-infant skin-to-skin contact and breastfeeding status. J Midwifery Womens Health 2007;52:116-25.  Back to cited text no. 56
Prodromidis M, Field T, Arendt R, Singer L, Yando R, Bendell D. Mothers touching newborns: A comparison of rooming-in versus minimal contact. Birth 1995;22:196-200.  Back to cited text no. 57
Conde-Agudelo A, Díaz-Rossello JL. Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Cochrane Database Syst Rev 2016;(8):CD002771.  Back to cited text no. 58
Moore ER, Anderson GC, Bergman N, Dowswell T. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev 2012;5:3519.  Back to cited text no. 59
Velandia M, Uvnäs-Moberg K, Nissen E. Sex differences in newborn interaction with mother or father during skin-to-skin contact after caesarean section. Acta Paediatr 2012;101:360-7.  Back to cited text no. 60
Carter-Jessop L. Promoting maternal attachment through prenatal intervention. MCN Am J Matern Child Nurs 1981;6:107-12.  Back to cited text no. 61
Ghorbani N, Bing NM, Watson P, Kristl Davison H, Mack AD. Self-reported emotional intelligence: Construct similarity and functional dissimilarity of higher-order processing in Iran and the United States. Int J Psychol 2002;37:297-308.  Back to cited text no. 62
Neff KD. The role of self-compassion in development: A healthier way to relate to oneself. Hum Dev 2009;52:211-4.  Back to cited text no. 63


  [Table 1], [Table 2], [Table 3]

This article has been cited by
1 Effects of a Mindfulness-Based Parental Reflection Intervention on Pregnancy-Related Distress: A Pilot Study
Lucia Ciciolla, Samantha Addante, Karina M. Shreffler, Julie M. Croff
Women's Health Reports. 2023; 4(1): 78
[Pubmed] | [DOI]
2 3D printed models in pregnancy and its utility in improving psychological constructs: a case series
John Joseph Coté, Brayden Patric Coté, Amy S. Badura-Brack
3D Printing in Medicine. 2022; 8(1)
[Pubmed] | [DOI]
3 The Effect of Maternal–Foetal Attachment–Based Training Programme on Maternal Mental Health Following an Unintended Pregnancy
Parastou Mahmoudi,Forouzan Elyasi,Aliasghar Nadi,Marjan Ahmad Shirvani
Journal of Reproductive and Infant Psychology. 2021; : 1
[Pubmed] | [DOI]


Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  In this article
Materials And Me...
Research Questions
Search Strategy
Exclusion Criteria
Data Collection ...
Report Of Findings
Ethical Consider...
Article Tables

 Article Access Statistics
    PDF Downloaded470    
    Comments [Add]    
    Cited by others 3    

Recommend this journal