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Background and objectives An unintended pregnancy can lead to an unfavorable relationship between the mother and infant and also include pregnancies that, although unintended, become wanted and may not have the same risks. This study aimed to investigate the effect of attachment training on maternal and fetal attachment in women with unintended pregnancy. Method This clinical trial study was conducted in 2019 on 84 women (two groups of 42 subjects) with unintended pregnancies (at least 28 weeks in the third trimester of pregnancy) in selected clinics affiliated with Shiraz University of Medical Sciences. Cranley’s Maternal–Fetal Attachment Scale (MFAS) was completed before and after the intervention in both groups; a demographic information questionnaire was filled out and written consent forms were signed before the intervention in both groups. Then, attachment training classes were conducted for 6 sessions of 90 min in the intervention group, while the control group received only routine pregnancy care. Chi-square, Fisher and independent t-test were used to analyze the data. Findings The mean scores of maternal–fetal attachment before attachment training in the experimental (57. 24 ± 5.03) and control groups (57.29 ± 6.96) were not significantly different ( P  = 0.86). Based on the results of independent t-test, the mean scores of maternal–fetal attachment after training in the intervention (66.43 ± 1.76) and control (57.14 ± 5.03) groups were significantly different ( P  = 0.0001). Conclusion The findings of this study showed the positive effect of education on the attachment behaviors of mothers with unintended pregnancies. Therefore, it is recommended that attachment skills training should be used in prenatal training programs. Trial registration Iran Randomized Clinical Trial Center registration IRCT20130710013940N5, Date of first trial registration: 2019.02.02.

•Conducting RCT of short music listening on pregnancy-related stress.•Music listening can be an effective coping strategy to reduce pregnancy stress.•Music therapy is used as a complementary therapy to enhance psychosocial well-being.•Short music intervention has no significant effect on maternal–fetal attachment. While music listening has been studied as an intervention to help reduce anxiety in pregnant women, few studies have explored the effect of music listening on pregnancy-specific stress relief. This study examines the effects of music listening on psychosocial stress and maternal–fetal attachment during pregnancy. A randomized controlled trial was implemented. A valid sample of 296 pregnant women in their second or third trimester was randomly distributed into an experimental group (n=145) and a control group (n=151). The experimental group received routine prenatal care and music listening. The control group received routine prenatal care only. Data were collected using a demographic form, Pregnancy Stress Rating Scale (PSRS), Perceived Stress Scale (PSS), and Maternal–Fetal Attachment Scale (MFAS). The post-test results identified a significantly lower level of psychosocial stress in the experimental group than in the control group, particularly in terms of the stresses related to baby care and changing family relationships and to maternal role identification. However, no statistically significant differences in terms of perceived stress and maternal–fetal attachment were found between the post-test results of the two groups. This study provides evidence in support of using of music in interventions designed to relieve psychosocial stress in prenatal women. IRB approval number: ER98223

Regular physical activity (PA) and the avoidance of prolonged sitting are essential for children's healthy growth, and for the physical and mental wellbeing of both children and adults. In the context of exercise, music may promote behavioral change through increased exercise adherence and participation. The purpose of this study was to determine whether a movement-to-music video program could reduce sedentary behavior (SB) and increase PA in mother-child pairs in the home environment. A randomized controlled trial was conducted in the Pirkanmaa region, Finland, in 2014-2016. The participants consisted of 228 mother-child pairs (child age 5-7 years). The primary outcomes of interest were tri-axial accelerometer-derived SB and PA, which were measured in weeks one (baseline), two, and eight in both the intervention and control groups. Further, the mothers and children in the intervention group used a movement-to-music video program from the beginning of week two to the end of week eight. Secondary outcomes included self-reported screen time. The statistical methods employed comprised an intention-to-treat and linear mixed effects model design. No statistically significant differences between groups were found in primary or secondary outcomes. Among the children in the control group, light PA decreased significantly over time and screen time increased from 89 (standard deviation, SD 37) to 99 (SD 41) min/d. Among mothers and children in the intervention group, no statistical differences were found. In supplementary analysis, the children who stayed at home instead of attending daycare/preschool had on average 25 (95% confidence interval, CI 19-30) min/d more sedentary time and 11 (95% CI 8-14) min/d less moderate-to-vigorous PA than those who were at daycare/preschool. The higher body mass index of mothers was related with 5 (95% CI 2-7) min/d more sedentary time and 1 (95% CI 0-2) min/d less moderate-to-vigorous PA. The movement-to-music video program did not change the objectively measured SB or PA of the mother-child pairs. However, mothers and children seemed to be more sedentary at home, and therefore interventions for decreasing SB and increasing PA should be targeted in the home environment.

Background Studies showed that pregnant women generally value routine ultrasounds in the first two trimesters because these provide reassurance and a chance to see their unborn baby. This, in turn, might help to decrease maternal anxiety levels and increase the bond with the baby. However, it is unclear whether pregnant women hold the same positive views about a third trimester routine ultrasound, which is increasingly being used in the Netherlands as a screening tool to monitor fetal growth. The aim of this study was to explore pregnant women’s experiences with a third trimester routine ultrasound. Methods We held semi-structured interviews with fifteen low-risk pregnant women who received a third trimester routine ultrasound in the context of the Dutch IUGR RIsk Selection (IRIS) study. The IRIS study is a nationwide cluster randomized controlled trial carried out among more than 13,000 women to examine the effectiveness of a third trimester routine ultrasound to monitor fetal growth. For the interviews, participants were purposively selected based on parity, age, ethnicity, and educational level. We performed thematic content analysis using MAXQDA. Results Most pregnant women appreciated a third trimester routine ultrasound because it provided them confirmation that their baby was fine and an extra opportunity to see their baby. At the same time they expressed that they already felt confident about the health of their baby, and did not feel that their bond with their baby had increased after the third trimester ultrasound. Women also reported that they were getting used to routine ultrasounds throughout their pregnancy, and that this increased their need for another one. Conclusions Pregnant women seem to appreciate a third trimester routine ultrasound, but it does not seem to reduce anxiety or to improve bonding with their baby. Women’s appreciation of a third trimester routine ultrasound might arise from getting used to routine ultrasounds throughout pregnancy. We recommend to examine the psychological impact of third trimester routine ultrasounds in future studies. Results should be taken into consideration when balancing the gains, which are as yet not clear, of introducing a third trimester routine ultrasound against unwanted side effects and costs.

Pregnancy offers a unique period for initiating preventive parenting interventions. Disturbances in maternal-fetal bonding may indicate suboptimal parenting and a need for intervention. However, more knowledge is needed on the development of maternal-fetal bonding among at-risk groups. The study aim was to examine psychosocial correlates of maternal-fetal bonding among pregnant women identified to be at risk socially and regarding their mental health. The sample consisted of 78 at-risk pregnant women participating in a perinatal intervention study: Godt på Vej Sammen [A Good Start to Life-an Early Cross-sectorial Intervention]. This study was cross-sectional reporting on the baseline characteristics of the participants. In the beginning of the second trimester, participants completed questionnaires assessing maternal-fetal bonding (the Maternal Antenatal Attachment Scale [MAAS]), prenatal parental reflective functioning, adult attachment style, and depressive symptoms. We compared the distribution of MAAS styles with norms from a recent Dutch community sample. In addition, we tested associations between psychosocial variables and the quality and intensity of MAAS scores in regression models and performed Chi-square analyses to assess the association of MAAS styles with psychosocial variables. First, compared to women from a community sample, approximately half of the women in our sample presented lower and suboptimal MAAS scores. Second, insecure avoidant adult attachment style was negatively associated with MAAS intensity, and depressive symptoms were negatively associated with MAAS quality. Third, prenatal parental reflective functioning positively correlated with both quality and intensity of MAAS. Fourth, we found no association between insecure anxious adult attachment style and MAAS scores. Fifth, women with a negative disinterested MAAS style demonstrated the highest avoidant attachment scores, while women with a positively preoccupied MAAS style demonstrated the highest prenatal parental reflective functioning scores. The results suggest that there is a need to differentiate among at-risk pregnant woman and that prenatal screening using the MAAS may help identify those who need preventive parenting interventions and what those interventions should focus on. A main limitation of the study is the lack of a representative group of at-risk pregnant women which limits the generalizability of the study results to all risk groups.

Objective To identify trajectories of maternal–fetal attachment (MFA) in IVF mothers during the first trimester of pregnancy, and to explore categorical predictors of subgroups demonstrating MFA trajectories. Methods A prospective observational study was conducted on 495 IVF mothers. Self-report questionnaires assessing MFA, anxiety, depression, social support, and marital satisfaction were completed at three time points: 3–4 weeks (T1), 7–8 weeks (T2), and 12–14 weeks (T3) of gestation. Repeated measurement data were analyzed and growth trajectories identified. Results Three MFA trajectories were delineated in IVF mothers during the first trimester: low-attachment/slow-elevation group (30.9%), moderate-attachment/steady-elevation group (56.2%), and high-attachment/rapid-elevation group (12.9%). Secondary infertility ( OR  = 0.575, 95% CI : 0.368–0.901, p  = 0.013) and higher marital satisfaction ( OR  = 0.941, 95% CI : 0.915–0.968, p  < 0.001) were predictors for not being in the low-attachment/slow-elevation group. Conclusion Among IVF mothers with ongoing pregnancies, a subset exhibited suboptimal development of MFA during the first trimester. Marital satisfaction and infertility type may help identify those at potential risk.

IntroductionCOVID-19 is a highly infectious respiratory disease that rapidly emerged as an unprecedented epidemic in Europe, with a primary hotspot in Northern Italy during the first months of 2020. Its high infection rate and rapid spread contribute to set the risk for relevant psychological stress in citizens. In this context, mother–infant health is at risk not only because of potential direct exposure to the virus but also due to high levels of stress experienced by mothers from conception to delivery. Prenatal stress exposure associates with less-than-optimal child developmental outcomes, and specific epigenetic mechanisms (eg, DNA methylation) may play a critical role in mediating this programming association.Methods and analysisWe present the methodological protocol for a longitudinal, multicentric study on the behavioural and epigenetic effects of COVID-19-related prenatal stress in a cohort of mother–infant dyads in Northern Italy. The dyads will be enrolled at 10 facilities in Northern Italy. Saliva samples will be collected at birth to assess the methylation status of specific genes linked with stress regulation in mothers and newborns. Mothers will provide retrospective data on COVID-19-related stress during pregnancy. At 3, 6 and 12 months, mothers will provide data on child behavioural and socioemotional outcomes, their own psychological status (stress, depressive and anxious symptoms) and coping strategies. At 12 months, infants and mothers will be videotaped during semistructured interaction to assess maternal sensitivity and infant’s relational functioning.Ethics and disseminationThis study was approved by the Ethics Committee (Pavia). Results will be published in peer-reviewed journals and presented at national and international scientific conferences.Trial registration number NCT04540029; Pre-results.

Background: Pregnancy through assisted reproductive technology (ART) is a stressful experience that may affect prenatal attachment. However, maternal-fetal attachment (MFA) and anxiety in pregnancy after ART are understudied in Iran. Objective: To compare changes in MFA and pregnancy-related anxiety (PRA) in the first and third trimester of pregnancy in women who conceived through ART compared to those who conceived naturally. Materials and Methods: This longitudinal study was conducted in 2019 with 187 pregnant women (ART conception = 43, natural conception = 144). Participants were recruited using the consecutive sampling method from a prenatal clinic in Tehran. The Cranley MFA Scale and the Van Den Bergh PRA Questionnaire were used to collect the data. Results: The MFA score in the 12th wk of gestation was lower in the women who conceived with ART compared to in the women who conceived naturally, but there was no statistically significant difference between the groups in wk 36. MFA in both groups was significantly higher at gestational wk 36 than wk 12 (p ≤ 0.001). The increase in MFA score was significantly higher in the women who conceived with ART than in those who conceived naturally (p ≤ 0.001). The anxiety score declined in the two groups and no statistically significant difference was observed in the changes of anxiety scores between the two groups (p = 0.84). Conclusion: Pregnant women who conceived through ART were as attached to their fetus in the third trimester of pregnancy as other women and did not experience more PRA. Key words: Attachment, Maternal fetal relations, Assisted reproductive technology, Pregnancy, Anxiety.

Objective: to analyze maternal-fetal attachment and interrelated factors in pregnant women assisted in Primary Health Care. Method: a cross-sectional, population-based, analytical epidemiological survey. A sample of 937 participants attended by Family Health Strategy teams was investigated. Maternal-fetal attachment (outcome), sociodemographic and clinical variables, social support, family functionality, depressive symptoms and perceived stress were assessed. Multivariate analysis was adopted using structural equation modeling. Results: maternal-fetal attachment had an average of 92.6 (SD=±15.3). The adjusted structural model showed that the following factors had a direct effect on the outcome: gestational weeks (β=0.29; p<0.001), household crowding (β=-0.07; p=0.027), depressive symptoms (β=-0.11; p=0.003), social support (β=0.08; p<0.001) and family functionality (β=0.19; p<0.001). Indirect effects of social support (β=-0.29; p<0.001) and family functionality (β=-0.20; p<0.001) were identified, mediated by depressive symptoms. Conclusion: a set of interrelationships was identified between maternal-fetal attachment, gestational weeks, household crowding, depressive symptoms, social support and family functionality. It is suggested that the Family Health Strategy offer prenatal care anchored in integrality and humanization, which promotes biopsychosocial well-being during pregnancy and healthy maternal-fetal attachment. Objetivo: analizar el apego materno-fetal y los factores interrelacionados en gestantes atendidas en la Atención Primaria de Salud. Método: encuesta epidemiológica seccional, de base poblacional y analítica. Se investigó una muestra de 937 participantes atendidas por equipos de la Estrategia de Salud de la Familia. Se evaluaron apego materno-fetal (resultado), variables sociodemográficas y clínicas, apoyo social, funcionalidad familiar, síntomas depresivos y estrés percibido. Se adoptó un análisis multivariado mediante la modelización con ecuaciones estructurales. Resultados: el apego materno-fetal presentó una media de 92,6 (DE=±15,3). El modelo estructural ajustado evidenció que los siguientes factores ejercieron un efecto directo sobre el resultado: semanas gestacionales (β=0,29; p<0,001), aglomeración del domicilio (β=-0,07; p=0,027), síntomas depresivos (β=-0,11; p=0,003), apoyo social (β=0,08; p<0,001) y funcionalidad familiar (β=0,19; p<0,001). Se identificaron efectos indirectos del apoyo social (β=-0,29; p<0,001) y de la funcionalidad familiar (β=-0,20; p<0,001), mediados por los síntomas depresivos. Conclusión: se identificó un conjunto de interrelaciones entre apego materno-fetal, semanas gestacionales, aglomeración domiciliaria, síntomas depresivos, apoyo social y funcionalidad familiar. Se sugiere que la Estrategia de Salud de la Familia ofrezca una atención prenatal anclada en la integralidad y humanización, que propicie el bienestar biopsicosocial en el embarazo y un apego materno-fetal saludable. Objetivo: analisar o apego materno-fetal e os fatores inter-relacionados em gestantes assistidas na Atenção Primária à Saúde. Método: inquérito epidemiológico seccional, de base populacional e analítico. Foi investigada a amostra de 937 participantes, assistidas por equipes da Estratégia Saúde da Família. Avaliaram-se apego materno-fetal (desfecho), variáveis sociodemográficas e clínicas, apoio social, funcionalidade familiar, sintomas depressivos e estresse percebido. Foi adotada análise multivariada por meio da modelagem com equações estruturais. Resultados: o apego materno-fetal apresentou média de 92,6 (DP=±15,3). O modelo estrutural ajustado evidenciou que os seguintes fatores exerceram efeito direto sobre o desfecho: semanas gestacionais (β=0,29; p<0,001), aglomeração do domicílio (β=-0,07; p=0,027), sintomas depressivos (β=-0,11; p=0,003), apoio social (β=0,08; p<0,001) e funcionalidade familiar (β=0,19; p<0,001). Foram identificados efeitos indiretos do apoio social (β=-0,29; p<0,001) e da funcionalidade familiar (β=-0,20; p<0,001), mediados pelos sintomas depressivos. Conclusão: identificou-se um conjunto de inter-relações entre apego materno-fetal, semanas gestacionais, aglomeração domiciliar, sintomas depressivos, apoio social e funcionalidade familiar. Sugere-se que a Estratégia Saúde da Família oferte uma atenção pré-natal ancorada na integralidade e humanização, que propicie o bem-estar biopsicossocial na gravidez e o apego materno-fetal saudável.

A sufficient vascular network within the feto-maternal interface is necessary for placental function. Several pregnancy abnormalities have been associated with abnormal vascular formations in the placenta. We hypothesized that growth and expansion of the placental vascular network in the equine (Equus caballus) placenta is regulated by estrogens (estrogen family hormones), a hormone with a high circulating concentration during equine gestation. Administration of letrozole, a potent and specific inhibitor of aromatase, during the first trimester (D30 to D118), decreased circulatory estrone sulfate concentrations, increased circulatory testosterone and androstenedione concentrations, and tended to reduce the weight of the fetus (p < 0.1). Moreover, the gene expression of CYP17A1 was increased, and the expression of androgen receptor was decreased in the D120 chorioallantois (CA) of letrozole-treated mares in comparison to that of the control mares. We also found that at D120, the number of vessels tended to decrease in the CAs with letrozole treatment (p = 0.07). In addition, expression of a subset of angiogenic genes, such as ANGPT1, VEGF, and NOS2, were altered in the CAs of letrozole-treated mares. We further demonstrated that 17β-estradiol increases the expression of ANGPT1 and VEGF and increases the angiogenic activity of equine endothelial cells in vitro. Our results from the estrogen-suppressed group demonstrated an impaired placental vascular network, suggesting an estrogen-dependent vasculogenesis in the equine CA during the first trimester.