Maternal Fetal Attachment as a Multidimensional Process: Implications for Depression, Attachment, and Caregiver-Infant Interaction Across the Postpartum Year

Abstract

Maternal-fetal attachment (MFA)—the relationship a caregiver develops with their fetusacross pregnancy—has been linked to important postpartum outcomes for mothers, infants, and their relationship. However, most studies investigating these associations have relied on global measures of MFA at only one time point during pregnancy. Across three longitudinal studies, this dissertation investigates MFA as a dynamic, multidimensional process and explores its implications for depression, attachment, and caregiver-infant interaction across the postpartum year. Study 1 used k-means clustering to identify unique patterns of MFA growth from the second to third trimester in a sample of 152 pregnant women. Three distinct patterns emerged across global and subscale MFA scores—High-Stable, Low-Increasing, and Low-Stable/Decreasing— highlighting the variability of MFA development across pregnancy. Study 2 linked these prenatal MFA patterns to maternal postnatal depression and attachment at 6 months postpartum. MFA cluster membership significantly predicted outcomes above and beyond prenatal depressive symptoms, with the High-Stable MFA group consistently associated with more positive postpartum outcomes. Study 3 utilized innovative dyadic head-mounted eye-tracking (D-ET) technology to investigate relationships between postpartum outcomes (i.e., depression and attachment at 6 months) and moment-by-moment social coordination in 49 caregiver-infant dyads at 9 months. Results showed that distinct dimensions of postnatal attachment (i.e., quality of attachment, pleasure in interaction) were associated with specific features of dyadic attention (e.g., caregiver attunement, joint attention). Further, a significant interaction revealed that attachment quality predicted caregiver attunement during play only among mothers with average or high levels of depressive symptoms, suggesting that attachment quality may be especially important for attuned caregiving when depressive symptoms are present. Together, results highlight MFA as a dynamic process comprised of dimensions with unique clinical implications for postpartum outcomes and, in turn, potential for early, targeted intervention development.