Prenatal Attachment and Emotional Bonds

Prenatal Attachment

• Prenatal attachment refers to the unique relationship forming between a pregnant woman and her fetus.
• This emotional bond isn't dependent on the woman's feelings about herself as a pregnant person or her perception of herself as a mother.
• The bond develops from the moment of pregnancy discovery.
• Women often envision their future child and how they will impact the child and themselves.
• Quickening (feeling fetal movement) around 16-20 weeks triggers greater emotional investment and visualization of the baby.
• Prenatal attachment is linked to grief, particularly in cases of stillbirth or miscarriage.
• Strong prenatal attachment correlates with better mother-infant attachment later.
• Prenatal attachment can be measured using tools like the Prenatal Attachment Inventory and the Maternal Antenatal Attachment Scale.
• A loving partner relationship can strengthen prenatal attachment; conversely, abusive relationships can weaken it and increase risk for postpartum difficulties.
• Attachment strength predicts later mother-infant bonding

Pregnancy-Related Deaths

• Data shows pregnancy-related death rates vary significantly between different demographic groups.

Prenatal Attachment Inventory (Representative Items)

• This inventory is used to gauge prenatal attachment.
• Includes items like "I wonder what the baby looks like now," "I feel love for the baby," "I plan the things I will do with my baby", and "I buy/make things for the baby." (reflective of increasing attachment)
• Examples of items with reversed coding (R): "I wish I could stop carrying the baby around for a little while," "I'm tired of having the baby in me"

Perinatal Mental Health

• Perinatal refers to the period of pregnancy and up to one year postpartum.
• The placenta, a fetal organ, is highly invasive, secreting hormones to establish pregnancy and suppress maternal immune response.
• Placental Hormones play vital roles:
  • hCG: Maintains corpus luteum initially.
  • Progesterone: Main source from 8th week and significantly higher than ovulation levels.
  • Placental Growth Hormone (PGH) and Human Chorionic Somatomammotropic Hormone (hCS): Regulate maternal metabolism.
  • Estrogen: Maintains pregnancy
  • DHEA (from fetal adrenal gland): Precursor to placental estrogen
  • CRH (Corticotropin-releasing hormone): Significantly elevated to regulate maternal adrenal glands.

Perinatal Mental Health Conditions

• Conditions like baby blues, major depression, anxiety disorders (GAD, panic, OCD), PTSD, and psychosis can impact new mothers.
• Prevalence rates of these conditions vary.
• Baby blues: temporary emotional fluctuations post-birth common to 26-84%
• Major Depression (7-20%) symptoms often involve feelings of anger, withdrawal, distancing from the baby, and worry about self or baby's safety
• Anxiety disorders: GAD (6-8%), Panic (0.5-3%), OCD (4%)-often comorbid with major depression
• Post-Traumatic Stress Disorder (PTSD) risk elevated after difficult or traumatic deliveries (4% overall, 18 % after difficult deliveries): symptoms include the same as non-pregnant
• Psychosis: rapid onset involving mood fluctuations, confusion, unusual behaviors, and hallucinations (0.1-0.2%)-associated with Infanticide (20% of psychosis cases)
• Suicide risk (2-3/100,000 or 5% of perinatal maternal deaths) elevated in the year following birth.
• Postpartum hormonal changes, birth trauma, and caring for a newborn contribute to perinatal mental health issues.

Hormone Changes Postpartum

• Hormonal levels immediately after birth drop towards pre-pregnancy levels (1-4 days).
• This drop can be considered hormone withdrawal analogous to drug withdrawal.
• Hormones produced by the placenta have behavioral effects even in non-pregnant individuals (depression, anxiety are linked with dysregulation of the HPA axis)
• Perinatal mental health problems are common due to these hormonal changes coupled with the trauma of childbirth and newborn care.