RESUMO
Objectives Although maternal attachment is an important predictor of infant developmental outcomes, little is known about its pre- and postnatal predictors. The purpose of this secondary data analysis is to assess several risk factors for maternal attachment at 6 months postpartum in a sample of Mexican women at risk of depression. The predictors included were prenatal depressive symptoms, pregnancy intendedness, partner relationship, social support, maternal history of childhood sexual abuse, and postpartum depressive symptoms. Methods A total of 156 pregnant women seeking antenatal care at three health centers were selected because they displayed depressive symptoms (CES-D ≥ 16) or had previously suffered depression. Women were interviewed during pregnancy and at 6 months postpartum. A step-wise multivariate logistic regression was conducted to evaluate the pre- and postpartum risk factors for postpartum depression related to low maternal attachment. Results Pre- and postpartum depressive symptoms increased the risk of low maternal attachment by factors of 3.00 and 3.97, respectively, compared with women who did not present these symptoms; low level of adjustment with the partner increased the risk by a factor of 3.11, low social support by a factor of 2.90, and CSA by a factor of 2.77. Conclusions for practice Prevention programs during pregnancy to reduce depressive symptoms should strengthen strategies to promote maternal attachment by improving partner relations and increasing social support. However, evidence shows that such programs alone are insufficient, so direct interventions should also be implemented. Women with a history of childhood sexual abuse should be given additional attention during prenatal care.
Assuntos
Depressão Pós-Parto/diagnóstico , Depressão/diagnóstico , Apego ao Objeto , Cuidado Pré-Natal/métodos , Parceiros Sexuais , Depressão/etnologia , Depressão Pós-Parto/etnologia , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , México , Gravidez , Complicações na Gravidez , Apoio Social , População Urbana , Adulto JovemRESUMO
Various authors support the theory that the mother-child bond begins in gestation, through a mental representation which the mother constructs during pregnancy. This image would be based on their own childhood experience, which lays the foundation for the transgenerational transmission of the attachment relationship type that will be formed. Objective: To study the relationship between the pregnant mother's history of attachment and her attachment style during pregnancy, including the types of images formed about her future son or daughter as well as herself as a mother. Patients and Method: Three first time pregnant women with different attachment styles were identified through the Parental Bonding Instrument. An in-depth interview was performed with each individual. Flick's adaptation of Grounded Theory was applied during data analysis. Results show that differences exist both in the thematic contents as in the quality, quantity and coherence of their representations depending upon the attachment style. Discussion: These results contribute to the knowledge of the representational world of the pregnant woman, allowing for improved prenatal interventions that will promote secure mother-child attachment.
De acuerdo a diversos autores, el vínculo madre-hijo se inicia desde la gestación, a través de las representaciones que la madre va construyendo durante el embarazo. Dichas representaciones estarían ancladas en su propia experiencia de apego en la infancia, lo que sentaría las bases de la transmisión transgeneracional de los vínculos de apego. Objetivo: Determinar la relación entre el estilo de apego de la madre y el tipo de representaciones que ésta construye acerca del hijo en gestación, de sí misma como madre y de su propia historia de apego, durante el embarazo. Pacientes y Método: Estudio cualitativo con análisis interpretativo de los datos. Se seleccionaron 3 mujeres primigestas, con distintos estilos vinculares, identificados a través del Parental Bondig Instrument, a las cuales se les realizó una entrevista semi-estructurada, en función de una pauta guía que contenía los principales ejes teóricos del estudio. Para el análisis de los datos, se utilizó la adaptación de Flick de la Grounded Theory. Resultados: Los resultados muestran que existen diferencias tanto en los contenidos temáticos, como en la calidad, cantidad y coherencia de las representaciones maternas, dependiendo del estilo vincular. Conclusión: Los resultados aportan al conocimiento del mundo representacional de la mujer embarazada, lo cual permite el desarrollo de intervenciones prenatales para promover el establecimiento apego seguro madre-hijo.