What factors are most important for the development of the maternal-fetal relationship? A prospective study among pregnant women in Danish general practice

Ruth Kirk Ertmann* (Corresponding Author), Christine W Bang, Margit Kriegbaum, Mette Skovgaard Væver, Jakob Kragstrup, Volkert Siersma , Philip Wilson, Melissa C Lutterodt, Johanne Smith-Nielsen

*Corresponding author for this work

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Development of the maternal antenatal attachment (MAA) constitutes an important aspect of the transition into motherhood. Early identification of women at risk of developing a poor MAA provides possibilities for preventive interventions targeting maternal mental health and the emerging mother-infant relationship. In this study, we investigate the relative importance of an extensive set of psychosocial, pregnancy-related, and physiological factors measured in the first trimester of pregnancy for MAA measured in third trimester.

A prospective study was conducted among pregnant women in Danish general practice (GP). Data were obtained in the first and the third trimester from pregnancy health records and electronic questionnaires associated with routine GP antenatal care visits. The Maternal Antenatal Attachment Scale (MAAS) was used to assess maternal antenatal attachment. The relative importance of potential determinants of maternal antenatal attachment was assessed by the relative contribution of each factor to the fit (R2) calculated from multivariable regression models.

The sample consisted of 1328 women. Low antenatal attachment (Total MAAS ≤ 75) was observed for 513 (38.6%) women. Perceived social support (having someone to talk to and having access to practical help when needed) emerged as the most important determinant. Furthermore, scores on the MAAS decreased with worse self-rated health, poor physical fitness, depression, increasing age, having given birth previously, and higher education.

Pregnant women reporting lack of social support and general low physical and mental well-being early in pregnancy may be at risk for developing a poor MAA. An approach targeting both psychosocial and physiological well-being may positively influence expectant mothers’ successful adaptation to motherhood.
Original languageEnglish
Number of pages9
JournalBMC Psychology
Issue number2
Publication statusPublished - 4 Jan 2021

Bibliographical note

The views expressed in this article are those of the authors and not necessarily those of the foundations.
Novo Nordisk Foundation, Region Zealand, Danish Research Foundation of General Practice, A.P. Moller Foundation, Lilly and Herbert Hansen’s Foundation and Jacob and Orla Madsen’s Foundation. We declare that the foundation had no input on the study design, collection, analysis, and interpretation of data and on writing the manuscript.


  • Maternal antenatal attachment
  • Pregnant, General practice
  • Cohort
  • Risk factors
  • Pregnancy-related symptoms
  • Object Attachment
  • Prospective Studies
  • Maternal-Fetal Relations/psychology
  • Humans
  • Risk Factors
  • Social Support
  • Mental Health
  • Mother-Child Relations
  • Socioeconomic Factors
  • Pregnancy
  • General Practice
  • Denmark
  • Adult
  • Female
  • Pregnant Women/psychology
  • Health Status
  • Prenatal Care


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