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BACKGROUND: In France, miscarriage affects nearly 200,000 women every year. This life event may generate negative effects on the mother-child relationship and the mother's mental health in the following pregnancy. OBJECTIVES: To investigate the influence of body satisfaction, partner support, resilience and previous experience of a miscarriage on prenatal attachment in pregnant women. DESIGN: This is a cross-sectional mixed-methods study. Women answered an online questionnaire in the period between November 2022 to April 2023. PARTICIPANTS: 267 French pregnant women who had previously experienced a miscarriage were recruited for this study. MEASUREMENTS: Study outcomes included prenatal attachment, resilience, partner support, history of previous pregnancies and miscarriages, the current pregnancy, and questions relating to body experience. FINDINGS: Participants who reported a high investment in the current pregnancy, high partner support and a positive image of their body had higher levels of prenatal attachment. The experience of miscarriage also seems to influence prenatal attachment: pregnancy investment at the time of miscarriage had a positive influence, while medical experience had no significant impact. While the global resilience score was not related to prenatal attachment, sense of control was positively linked to prenatal attachment. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: These results highlight the importance of considering miscarriage as a perinatal loss with potential for long-lasting impact on women, which deserves particular attention from professionals. Enhancing partner support and helping women build a positive image of their pregnant body can also have a role in fostering prenatal attachment to the foetus.

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Attachment is one of the foundational themes in the history of the psychological development of human beings. For this reason, we assume that it must be approached by taking into account multiple scientific perspectives. The present review aims at analyzing the state of the art regarding the genetic, neurobiological and cognitive mechanisms underlying the development of attachment bonding, considering the child as the frame of reference. We hypothesize that attachment may be present in prototypical forms even in the prenatal period, thus our analysis has a temporal origin in the intrauterine period preceding birth. The intrauterine period is assumed to be a period of maximum sensitivity to stimuli and in particular to those coming from a potential primary caregiver: the biological mother. We conclude with a reframing of the state of the art and propose that future research work would benefit from a superordinate model of attachment, capable of containing and regulating all its components and variables.

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The aim of the study is to examine the relationship between spiritual well-being, prenatal stress and attachment level of Turkish women conceiving spontaneously or with assisted reproductive techniques (ART). The comparative descriptive study type was conducted between November 2021 and June 2022 with 202 pregnant women, including 87 women conceiving with ART and 115 women conceiving spontaneously, who applied for routine prenatal care checkup in a state hospital in the west of Turkey. Both groups have a high level of spiritual well-being. Pregnant women in the ART group experience higher prenatal distress (9.6% for spontaneous, 12.6% for ART, p = 0.487) and low level of attachment (69.72 ± 7.98 for spontaneous, 66.24 ± 8.88 for ART, p = 0.006) compared to the other group. Additionally, as insufficient partner involvement in the prenatal process increases in pregnant women in both groups, prenatal attachment decreases. It is extremely important that midwives and nurses evaluate the spiritual well-being of pregnant women and provide holistic care in line with their spiritual needs.

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Background The COVID-19 pandemic has posed significant threats to global physical and mental health, notably impacting the psychological management of pregnancy. The mental health of parents plays a critical role in fostering the emotional bond with their unborn child, referred to as prenatal attachment. Despite the significance of this bond, research has primarily concentrated on maternal outcomes, often neglecting the paternal aspect during the pandemic. This study investigates the correlation between coronavirus disease 2019 (COVID-19) risk perception and paternal prenatal attachment, further exploring the mediating role of well-being within this association. Methods A total of 141 expectant fathers attending the gynecology and obstetrics outpatient clinic with their partners were recruited. Participants completed measures including the Paternal Antenatal Attachment Scale (PAAS), the World Health Organization Well-being Index (WHO-5), and the COVID-19 Perceived Risk Scale (CPRS). Results Data analysis revealed a significant negative correlation between COVID-19 risk perception and well-being (ß = -.34, p < .001). There was a positive correlation between well-being and prenatal attachment (ß = .37, p = .002). The prenatal attachment was also positively linked to COVID-19 risk perception (ß = .20, p = .047). Furthermore, well-being mediated the relationship between COVID-19 risk perception and prenatal attachment. Conclusion The findings underscore the potential of the COVID-19 risk perception to disrupt the prenatal attachment process for expectant fathers by interfering with psychological well-being. However, it can also promote prenatal attachment through various mechanisms. Consequently, acknowledging and understanding the experiences of fathers during pregnancy is of paramount importance. Future longitudinal studies are necessitated to examine the parent-child relationship dynamics that have evolved under the influence of the pandemic.

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The process of adaptation of the woman to pregnancy seems to be influenced by many factors, such as the type of conception, the mother's age, the possible presence of other children, and socio-cultural factors. Women who conceived with an assisted reproductive technique are emotionally vulnerable; compared with pregnant women who procreated naturally, they manifest elevated anxiety, which seems to be correlated to the fright of being separated from their child. Objectives of the present research are as follows: (1) to analyze the relationship between age, gestational age, time expectancy, previous failed attempts, perception of a high-risk pregnancy, and presence of other children, with the level of maternal-fetal attachment (MFA); (2) explore the level of maternal-infant attachment and anxiety by comparing the control and experimental group; (3) to measure a possible relationship between anxiety levels and MFA in ART pregnant women; (4) to identify variables predictive of prenatal attachment. The study group is formed by ninety-five women aged between 18-42 years (M = 30.57; S.D. = 5.47), pregnant from the 23rd to the 37th week (M = 28.95; S.D. = 3.99); on which 50 women who procreate naturally and 45 pregnant women following assisted reproductive technology. They completed: Maternal-Fetal Attachment Scale (MFAS), State-Trait Anxiety Inventory (STAI), and ad hoc questionnaire to collect anamnestic data. The results show the presence of a correlation between gestational age and waiting period, between the number of assisted fertilization attempts with the worry about their ability to become pregnant, but a negative correlation between pregnancy weeks and the level of maternal-fetal attachment. The study shows the predictive role of anxiety on the MFA. The applications and indications for future research are analyzed.

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Exposure of pregnant women to physical and emotional violence during pregnancy adversely affects the health of the mother and the fetus. This study aimed to assess the effects of emotional and physical partner violence on prenatal attachment and depression levels in pregnant women. Five-hundred and ten pregnant women in the second and third trimesters were included in the study. A personal information form, the Epidemiological Research Center Depression Scale, and the prenatal attachment inventory (PAI) were used for data collection. Although 7.5% of the pregnant women were exposed to physical partner violence during pregnancy, 24.3% were exposed to emotional partner violence. Depression was observed in 86.9% of the pregnant women, whereas the mean PAI score was 37.29 ± 10.504. There was a statistically significant relationship between the pregnant women's exposure to physical (p = .046) and emotional partner violence (p < .001) and depression. In this study, it was determined that pregnant women's exposure to emotional partner violence poses a risk for depression during pregnancy (p < .002; odds ratio = .143). As professionals working with pregnant women, obstetricians and maternity nurses should inquire about the exposure of pregnant women to partner violence during antenatal follow-ups.

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BACKGROUND: Evidence about effective psychoeducational interventions to improve prenatal attachment, anxiety and depression has been increasing, but it lacks a complete synthesis of the results. The aim of this study is to evaluate the effect of psychoeducational intervention on prenatal attachment and anxiety/depression in pregnant women and their partners. METHODS: Ten databases were systematically searched to identify randomized controlled trials (RCTs) on the effectiveness of psychoeducational interventions on prenatal attachment from inception to March 2023, then manually screened to include studies of anxiety or depression. Two researchers assessed the methodological quality of the included studies using the Cochrane risk-of-bias tool and meta-analysis was performed using RevMan 5.4 software. RESULTS: Ten RCTs with a total of 700 pregnant women and 399 partners were included. Prenatal attachment scores after the intervention (standardized mean difference = 1.10, 95 % CI 0.65 to 1.55, P <.00001) was significantly increased and anxiety scores (standardized mean difference = -0.99, 95 % CI -1.18 to -0.80, P <.00001) was significantly lower. The subgroup analysis showed that the different prenatal attachment assessment tools were the source of heterogeneity in the combined results. The sensitivity analysis results showed reliable pooled results except for the studies using the self-made anxiety scale. CONCLUSION: This review suggests that psychoeducational interventions can effectively enhance prenatal attachment, reduce anxiety and depression, providing reference for the promotion of evidence-based practice of psychoeducational interventions in perinatal pregnant women and their partners.

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High-risk pregnant women experience stress and anxiety. Anxiety may affect prenatal attachment. This study aimed to examine the effect of anxiety on prenatal attachment in high-risk pregnant women. The study was cross-sectional and conducted on 290 high-risk pregnant women who applied to the perinatology outpatient clinic of a university hospital between February and July 2022. The data were collected with the descriptive information sheet, Prenatal Attachment Inventory (PAI), and Perinatal Anxiety Screening Scale (PASS). Mann-Whitney U, Kruskal Wallis-H, and Spearman's Correlation tests were used to analyze the data. The mean age of the examined pregnant women was 28.12 ± 5.36, and most of them were multigravida (65.5 percent) and in the third trimester (80.7 percent). The PAI and PASS mean scores were 64.09 ± 11.31 and 27.98 ± 16.52, respectively. There was a weak positive correlation between anxiety and prenatal attachment (r = .227, p < .001). The levels of prenatal attachment were higher in primigravidas and women with no children. Also, the anxiety levels of pregnant women in the third trimester were lower. Health professionals should evaluate the prenatal attachment and anxiety levels of high-risk pregnant women, and consider obstetrical factors that may influence both prenatal attachment and anxiety levels.

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Pregnancy is an important period in which mother-infant attachment begins, includes bio-psychological changes, and has physical and psychological effects on the future life of the fetus. This study aims to evaluate the prenatal attachment levels of Syrian refugee and Turkish mothers in Turkey and to determine the variables that affect these. This cross-sectional study conducted in the obstetric outpatient clinics with 397 pregnant women 197 Syrian and 200 native women. Inclusion criteria were a pregnancy of at least 20 weeks, no communication or mental disorders, no chronic diseases, no diagnosis of high-risk pregnancy, literacy in the pregnant Turkish women, Turkish language proficiency in the pregnant Syrian women, and residence in Turkey for at least three years. Data were collected using a Sociodemographic form and The Prenatal Attachment Inventory (PAI). The data were analyzed by conducting independent t-tests, and hierarchical multiple linear regression analysis. The mean prenatal attachment score of Turkish pregnant women (61.79 ± 8.55) was higher than Syrian women (48.38 ± 10.39) (p < .05). Education level, pre-pregnancy counseling, regular checkup, support from spouses, relatives, and friends, and being a refugee of pregnant women were determined as predictors of prenatal attachment. The results showed that 67 percent of the total variance in the prenatal attachment levels could be explained in model 2 (F = 35.524, R2 variation = .673, p = .001). The low prenatal attachment level of Syrian pregnant women was a result of the detrimental impacts of being a refugee on pregnancy. The integration of transcultural knowledge, culture-specific perspectives, and cross-cultural theories into clinical practices is essential for immigrant women.

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Pregnant women have faced novel physical and mental health risks during the pandemic. This situation is remarkable because a parent's emotional bond with their unborn baby (also known as prenatal attachment) is related to the parent's mental state. Prenatal attachment helps parents psychologically prepare for the transition into parenthood. Moreover, it plays a pivotal role in the future parentchild relationship and psychosocial development of the baby. Based on the available literature, the current study integrated risk perception theories with mental health indicators to examine maternal prenatal attachment during the pandemic. Pregnant women (n = 258) completed the Pregnancy-Related Anxiety Questionnaire-Revision 2 (PRAQ-R2), the WHO Well-being Index (WHO-5), the Prenatal Attachment Inventory (PAI), and answered questions about COVID-19 risk perception. The findings illustrated that pregnancy-related anxiety was positively associated with maternal prenatal attachment. Moreover, COVID-19 risk perception and well-being mediated this relationship. In other words, the higher levels of pregnancy-related anxiety were associated with increased COVID-19 risk perception and decreased well-being, inhibiting prenatal attachment in pregnant women. Considering the importance of prenatal attachment, it is crucial to understand the experiences of pregnant women and develop policies for promoting prenatal attachment, especially during challenging times such as the COVID-19 pandemic.

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OBJECTIVES: To investigate maternal prenatal anxiety and depression in high-risk pregnancies and examine their influence on maternal-fetal attachment. METHODS: We included 95 hospitalized high-risk pregnant women. The Hospital Anxiety and Depression Scale (HADS) and the Prenatal Attachment Inventory (PAI) were used to assess the primary objective. Internal consistency and construct validity of the PAI were investigated. RESULTS: The average age was 31 years and gestational age ranged from 26 to 41 weeks. Prevalence of depressive symptoms was 20% and anxiety symptoms 39%. Cronbach alpha coefficient of the PAI Tunisian version was 0.8 and the construct validity in favour of one factor model. PAI scores correlated negatively and significatively with the HADS total score (r = - 0.218, p = 0.034) and was attributed to the depression dimension only (r = - 0.205, p = 0.046). CONCLUSIONS FOR PRACTICE: Emotional wellbeing of pregnant women especially in high-risk pregnancies should be explored in order to prevent consequences on women, their growing fetus, and prenatal attachment.

What is already known? Maternal prenatal emotional well-being influences maternal­fetal attachment which has important implications on postnatal bonding. Anxiety and depression disorders during pregnancy could affect women's attachment to their unborn child in a negative way. Research has largely been conducted with the general pregnant population with little focus on at-risk pregnancies, which are associated with increased levels of mood disorders. What this paper adds? This study highlights the impact of depression but not situational anxiety on maternal­fetal attachment in women with high-risk pregnancies, highlighting the importance of assessing and managing psychological disorders during pregnancy to enhance the quality of prenatal bonding.

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OBJECTIVE: The present research aims to adapt the Body Understanding Measure for Pregnancy Scale (BUMPs) to Turkish, determine its psychometric properties, and examine the correlation between prenatal attachment and body image perception of pregnant women. METHODS: Three hundred seventy-one pregnant women were enrolled in the research. The original English version of the BUMPs was translated into Turkish using forward-backward translation logic. The scale's reliability was evaluated with item analysis, internal consistency analysis, and test-retest reliability. Turkish version of the BUMPs and Prenatal Attachment Inventory (PAI) were filled out by pregnant women. The relationship between them was evaluated by correlation analysis. RESULTS: The mean week of gestation was 25.25 ± 8.26 (min: 12, max: 41). The Turkish version of the BUMPs exhibited satisfactory psychometric properties. The t-values, factor loadings, and fit indices of the scale items of the Turkish version were at an acceptable and excellent level. As a result of confirmatory factor analysis, the 18-item, three-factor construct was confirmed for the Turkish version of the scale. In the Turkish version of the scale, there are three subscales, including satisfaction with appearing pregnant, weight gain concerns, and physical burdens of pregnancy. Cronbach's alpha internal consistency coefficient of the overall scale was 0.84. A significant correlation was determined between the scores of the Turkish version of the BUMPs and the PAI (r = -0.263; p < 0.001). CONCLUSION: The Turkish version of the BUMPs is a valid and reliable measurement tool for determining pregnant women's body image perception. Prenatal attachment increases with the increasing body image perception of pregnant women.

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BACKGROUND: The COVID-19 pandemic has led to exceptional stress in pregnant women. The aim of the present study was to investigate associations of maternal stress (pandemic-related and -unrelated), anxiety, and relationship satisfaction experienced during the COVID-19 pandemic with prenatal mother-infant attachment. METHODS: An online study was conducted evaluating pandemic-related stress, pregnancy-specific stress (unrelated to the pandemic), anxiety, partnership satisfaction, and maternal-fetal attachment in German-speaking women during the second COVID-19 lockdown between January and March 2021. In total, 431 pregnant women (349 lived in Germany and 82 in Switzerland) filled in the questionnaires and gave information on demographic and pregnancy-related variables (i.e. age, gestational age, parity). Bivariate correlations were calculated in order to investigate associations between the different variables and additionally, a hierarchical regression model was conducted in order to evaluate the influence of the independent variables on prenatal attachment. RESULTS: The hierarchical regression analysis revealed that after controlling for age, gestational age, and parity higher pandemic-related stress, namely stress associated with feeling unprepared for birth, higher partnership satisfaction as well as higher positive appraisal (considered as a way of coping with pandemic-related stress) was associated with stronger maternal-fetal attachment, whereas associations of anxiety and other forms of stress were non-significant. CONCLUSIONS: The study highlights interesting associations between maternal pandemic-related preparedness stress and positive appraisal of the pregnancy as well as partnership satisfaction and prenatal attachment in women pregnant during the COVID-19 pandemic.

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BACKGROUND: While twin pregnancy (TP) is associated with increased maternal physical and psychological risks, little is known about how this context interferes with prenatal attachment. AIMS: To compare the level of prenatal attachment between women with TP and singleton pregnancy (SP), and to investigate socio-demographic, maternal mental health and pregnancy-related predictors. STUDY DESIGN: Case-control study in a university hospital. SUBJECTS: 119 women with TP during their last trimester of pregnancy versus 103 women with SP. OUTCOME MEASURES: The Prenatal Attachment Inventory (PAI), the Edinburgh Postnatal Depression Scale (EPDS), in addition to the collection of general socio-demographic and medical data. RESULTS: The mean PAI total score did not significantly differ between the two groups. In the group of women with TP, low but statistically significant correlations were found between the PAI total score and the EPDS total score (r = -0.21) and with maternal age (r = -0.20). CONCLUSIONS: No major difference in prenatal attachment was found in women TP compared to those with SP. A higher level of depressive symptoms is worth considering to explore the risk of suboptimal attachment in this population. Questions were raised about the applicability of usual measures of prenatal attachment in this context.

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AIM: The aim of this study was to determine prenatal attachment and foetal health locus of control in pregnant women and factors affecting these parameters. METHODS: This cross-sectional study was conducted with 156 pregnant women (77 low-risk and 79 high-risk pregnancies). The study was carried out between August 2015 and February 2016. The data collection instruments included a Participant Information Form, the Prenatal Attachment Inventory and the Foetal Health Locus of Control Scale. RESULTS: Pregnant women's education and foetal health locus of control levels had positive and significant effects on prenatal attachment, and education had an effect on foetal health locus of control. Foetal health locus of control explained 6.3% of the total variance in prenatal attachment levels. CONCLUSION: As the educational statuses of pregnant women affected their prenatal attachment and foetal health locus of control, information, counselling and care should be prioritized for women with low education levels, in line with their needs. This is particularly important in terms of improving the control of pregnant women with lower prenatal attachment levels or internal locus of control over foetal health.

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OBJECTIVES: To determine the effect of self-evaluation of foetal movement and position tracking on prenatal attachment and distress. METHODS: The study was a randomised controlled study . The study included women who came to the Kahramanmaras Maternity and Children's Hospital for prenatal examination. The data were collected using a questionnaire form, the prenatal attachment inventory (PAI), and the Tilburg pregnancy distress scale (TPDS). The pregnant women in the intervention group were trained to count the foetal movements and track the position of the foetus. Data were evaluated using paired samples t-test, independent samples t-test, chi-square test, Pearson correlation analysis, and linear regression analysis. This trial was registered at ClinicalTrials.gov under the process NCT05313113. RESULTS: Although the mean PAI pre-test scores were similar in the intervention and control groups (t = -0.811; p = 0.420), a significant difference was observed in the mean post-test scores between the two groups (t = 6.404; p < 0.001). The mean TPDS pre-test scores were similar in both groups (t = 0.933; p = 0.453), but a significant difference was observed in the mean post-test scores (t = -3.345; p < 0.001). CONCLUSION: Thus, self-evaluation of foetal movement and foetal position tracking increased the prenatal attachment.

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This study aimed to assess the impact of the COVID-19 stress and anxiety on prenatal attachment during the second trimester of gestation. Pregnancy is an important stage for mothers-to-be in creating representations of themselves as a "mother", with the developing attachment relationship to the unborn child considered as a milestone in the future parent's developmental trajectory. The outbreak of the COVID-19 pandemic and the national health measures installed can hence have consequences on these representations and on prenatal attachment. Our sample consisted of 95 mothers that were recruited from a prenatal ultrasound screening center. Results suggested that the COVID-19 pandemic significantly affected prenatal attachment (PAI) with significant correlations between PAI total score and age, anxiety (DASS) and stress (IES-R). When entered in one model looking for predictors of PAI total score, age and COVID-19 stress were the only variables found to significantly predict prenatal attachment. We argue for a cultural component in explaining these results, hypothesizing that stress could trigger defensive strategies, leading to more investment in the attachment relationship, potentially playing the role of a protective factor.

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This study was conducted to determine the effect of haptonomy applied to pregnant women on perceived stress, fear of childbirth, and prenatal attachment. The population of the randomized controlled experimental study consisted of 72 primiparous pregnant women within the gestational weeks 22-28 who presented to the Obstetrics and Gynecology Polyclinic of a state hospital in Turkey for check-up (36 experimental subjects, 36 control subjects). A home visit was made to the experimental group, and haptonomy was applied for at least 30 min, once a week, for 7 weeks (with the researcher for 3 weeks, with the husband by providing the training brochure and video that will help the practice for the next 4 weeks). The control group did not receive any treatment. After the haptonomy application, the stress levels and fears of childbirth of the pregnant women in the experimental group decreased, and their attachment levels with their babies increased.

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Given the positive impact of high-quality mother-infant interaction on child development, and that such relationship might be hindered by maternal stresses such past cancer, research is needed to understand protective and risk factors in this clinical population. As almost no data is available on the impact of history of cancer on the quality of mother-infant interaction, a multicentric and longitudinal pilot study was conducted. Differences in women's prenatal psychological well-being and attachment (T1, third trimester), and postnatal quality of mother-infant interaction (T2, 2-5 months) were assessed in a sample of Italian mothers with (N = 11) or without cancer history (N = 13). Results showed that women did not differ significantly in their prenatal well-being (assessed with the Profile of Mood States questionnaire) and levels of attachment (assessed with the Prenatal Attachment Inventory). Looking at mother-infant interactions (assessed using the Global Rating Scale at T2), while maternal sensitivity, warmth and intrusiveness, and infant distress and attentiveness did not differ between the two groups, in the clinical group, mothers were more remote and less absorbed in the infant, and infants showed fewer positive communications. These findings might shed light on potential protective and risk factors for early parenting and later child outcomes in this clinical population.

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PURPOSE: To evaluate emotional distress and prenatal attachment throughout a subsequent pregnancy after Termination of Pregnancy (TOP) for fetal abnormality. METHODS: Observational study, in a French Tertiary Maternity. POPULATION: 25 women in a subsequent pregnancy after a medical termination of pregnancy for foetal abnormality, 18-year-old and older. Prenatal Interviews at 20 Gestationnal weeks (GW), 27 GW and 35 GW and Postnatal at 3 months and at each time self-administered questionnaires of anxiety, post-traumatic stress syndrome (PCLS) depressive symptoms (EPDS), prenatal attachment (PAI) and Perinatal Grief Scale (PGS). RESULTS: Pregnancy onset, i.e. before 20 GW, showed increased prevalence of anxiety (16/23, 66.7%), depression (7/23, 30.4%) and post-traumatic stress symptoms (4/16, 25%). Total score on PGS is higher in onset of pregnancy than in the third trimester (p = 0.005). Prenatal attachment was lower during early pregnancy (p = 0.003) and correlated inversely with grief intensity (p = 0.022). During late pregnancy, emotional symptoms decrease, and prenatal attachment stopped increase positively, specifically among women whose foetal abnormality in previous pregnancies were diagnosed late, at an average of 25 GW. CONCLUSION: This research shows the specific dynamics of pregnancies following TOP and highlights the necessity for early prenatal psychological support. One should also pay special attention to prenatal attachment during late pregnancy even after knowing that the fetus is healthy.

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