STUDY QUESTION Analysis of maternal-fetal attachment during third trimester among pregnant women after Assisted Reproduction Techniques (ART) compared to spontaneously achieved pregnancies.

Navarro Aresti, L.1; Martínez Pampliega, A.1; Iraurgi Castillo, I.1; Martín Íñigo, S.2; and Barrenetxea Ziarrusta, G. 2,3 1 Universidad de Deusto (Spain) 2 Quirón Bilbao Assisted Reproduction Center (Spain) 3 Universidad del País Vasco/ Euskal Herriko Unibertsitatea (Spain) Contact email: lucia.navarro@deusto.es

SUMMARY ANSWER No differences were observed in maternal-fetal attachment between women pregnant after ART or spontaneously achieved pregnancies.

WHAT IS KNOWN ALREADY The study of prenatal attachment -one of the main predictors of mother-child attachment developed after birth- enables to detect possible difficulties for the mother when establishing an affective relationship with the fetus. This may affect the fetus development, delivery and future mother-child relationship. However, the studies that have assessed this construct among pregnant women through ART are few and have many methodological limitations.

METHOD - Study design: cross-sectional. - Participants: 365 pregnant women attending Maternal Education classes in Bizkaia (Spain), 47 of them after ART and 318 spontaneously pregnant. - Instruments:

1.  The Prenatal Bond Assessment Scale (PBAS): Likert scale composed of 24 items, with five options for each answer, divided in six subscales. 2.  Ad hoc developed questionnaire of reproductive background.

- Duration: June – December, 2013.

RESULTS

CONCLUSIONS - The results of this study are consistent with the findings of other authors who have investigated this issue. The use of an instrument with adequate psychometric properties to assess prenatal attachment provides robustness to the results. To our knowledge, this is the first approach to the assessment of this early affective relationship among Spanish population in women pregnant through ART. - It is necessary to keep on assessing the prenatal attachment and the link between this affective relationship and other variables by analysing them over the three trimesters of pregnancy and after birth. - The assessment of the emotional relationship between mother and fetus enables to detect potential problems in establishing this bond and to plan psychotherapeutic interventions to promote a healthy relationship with the fetus and a postnatal secure attachment.

Figure 1. Children from previous pregnancies Figure 2. Previous miscarriages

Table 2. Descriptive analysis

N M S. D. Prenatal bond 365 8,27 0,70 Fantasize about the fetus 365 7,92 1,10 Find information about the fetus 365 8,53 1,04 Recognize the fetus as an independent individual 365 6,92 1,73 Altruistic fetal protection 365 8,92 0,87 Interaction with the fetus 365 8,34 1,11 Anxiety about fetal loss 365 8,98 1 N = Number of participants; M = Mean; S. D. = Standard Deviation

Table 3. Correlational analysis

Age Gestational age

Prenatal bond -.10 .03 Fantasize about the fetus -.14** -.04 Find information about the fetus -.21** .02 Recognize the fetus as an independent individual

.09 .05

Altruistic fetal protection -.03 .01 Interaction with the fetus -.08 .01 Anxiety about fetal loss -.08 .02

** p < .001

Table 4. Differences between pregnant women through ART and spontaneously

ART N M S. D. t Sig. Prenatal bond

Yes 47 8,41 0,62 1,11 0,26 No 318 8,25 0,71

Fantasize about the fetus Yes 47 8,17 0,99 1,25 0,21 No 318 7,88 1,11

Find information about the fetus Yes 47 8,60 0,97 0,36 0,71 No 318 8,52 1,05

Recognize the fetus as an independent individual

Yes 47 6,92 1,61 0,01 0,99 No 318 6,91 1,74

Altruistic fetal protection

Yes 47 8,92 0,90 0,02 0,98 No 318 8,92 0,86

Interaction with the fetus Yes 47 8,60 0,97 1,28 0,20 No 318 8,30 1,13

Anxiety about fetal loss Yes 47 9,23 0,79 1,75 0,08 No 318 8,95 1,03

N = Number of participants; M = Mean; S. D. = Standard Deviation; t = statistical value of the Student t test; Sig. = Significance

-  Maternal-fetal attachment through the third trimester of pregnancy was strong: the women fantasized about the fetus, they altruistically protected the fetus and interacted with him. Also, pregnant women sought information about the fetus, showing anxiety secondary to a real or imaginary loss. Nevertheless, the identification of the fetus as a different individual to pregnant women was moderate. -  Maternal age and gestational age were not related to prenatal attachment. Two of the subscales of the PBAS, Fantasize about the fetus and Find information about the fetus, were related with the age of the pregnant women. Both correlations were negative, low and statistically significant. These results showed that younger women fantasize more and seek more information about the fetus. -  No differences were observed in maternal-fetal attachment between those pregnant women through ART and those pregnant spontaneously.

Table 1. Age and gestational age of participants

Mean Standard Deviation Minimum - maximum Age 33,53 4,37 18 - 44 Gestational age 30,94 4,68 25 - 41