Psychosocial Predictors of Maternal–Fetal Attachment in Anxious Pregnancies: A Study Among Women With Prior Miscarriages

Abstract

ABSTRACT Background Maternal mental health influences the key psychological process of maternal–fetal attachment (MFA) during pregnancy. Women with a history of miscarriage are at increased risk of prenatal anxiety and depression, which may affect their emotional bond with the fetus. Evidence on how anxiety and depression influence MFA in high‐risk pregnancies is inconsistent, particularly in low‐income settings such as Pakistan, where prenatal mental health research is limited. Aims This study aimed to examine the association between prenatal anxiety and prenatal depression with maternal–fetal attachment and its dimensions among pregnant women with a history of miscarriage and to explore differences based on selected demographic and psychosocial factors. Methods A cross‐sectional study was conducted at Bahawalpur Victoria Hospital, Pakistan, from October 2024 to December 2024. A total of 523 third‐trimester pregnant women with prior miscarriages were recruited using purposive sampling. Prenatal depression, anxiety, and maternal–fetal attachment were assessed using the EPDS, SAS, and MAAS, respectively. Independent sample t ‐tests, Pearson's correlations, and multiple linear regression analyses were performed using SPSS 27.0. Results Prenatal anxiety was significantly and positively associated with maternal–fetal attachment and its subdimensions, whereas prenatal depression showed no such association. Regression analysis confirmed anxiety as a significant predictor of attachment quality and total MFA scores, whereas depression was non‐significant. Planned pregnancy, marital satisfaction, employment, sleep disturbances, and younger maternal age were associated with stronger maternal–fetal attachment and higher anxiety. Conclusion Prenatal anxiety, but not depression, is positively associated with maternal–fetal attachment among women with a history of miscarriage. These findings emphasize the importance of the early identification and management of prenatal anxiety and highlight the need for culturally appropriate mental health interventions to support maternal well‐being and mother–fetus bonding in high‐risk pregnancies.