School of Psychology and Early Start, University of Wollongong, Wollongong, New South Wales, Australia.
Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia.
PLoS One. 2019 Jul 25;14(7):e0220032. doi: 10.1371/journal.pone.0220032. eCollection 2019.
An emerging body of literature suggests there is a relationship between a pregnant woman's psychological wellbeing and the development of maternal-fetal attachment (MFA) and early postpartum bonding. The nature of this relationship is not well understood because of the limited theoretical framework surrounding the construct of MFA and variations in study methods and data collection points. In this systematic review, we synthesize the published literature to determine the nature of the relationship from the antenatal to early postnatal period and to provide recommendations for future research and clinical practice.
Using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) approach, four electronic databases were searched for peer-reviewed empirical studies, published in English. Articles were considered for inclusion if data was collected on at least one domain of maternal wellbeing/mental health and MFA during pregnancy or MFA during pregnancy and the mother-infant relationship during the early postpartum period (up to 12 weeks). No date parameters were applied to the search strategy. The review was registered with PROPSERO (registration number: CRD42018096174).
25 studies examining maternal mental health and MFA/postpartum bonding were selected for inclusion in this review. Key findings identified from the review were: a need to validate existing mental health measures or develop new measures specific for use in antenatal populations; inconsistencies in data collection points throughout pregnancy and postpartum; a lack of consensus about the construct of MFA and the way it is assessed; and a continued focus on postpartum outcomes.
Scientific gaps remain in our understanding of the relationship between maternal mental health and both MFA and postpartum bonding which limit our theoretical understanding of the MFA construct. Recommendations for future research are to employ prospective longitudinal designs that span the full pregnancy and postpartum period, and for consistency in the terminology and methodology used when considering MFA. A re-focus of research attention on the theory behind MFA will allow a richer and more holistic account of the emerging relationship between mother and baby.
越来越多的文献表明，孕妇的心理健康与母婴依恋（MFA）和产后早期结合有关。由于围绕 MFA 结构的理论框架有限，以及研究方法和数据收集点的变化，这种关系的性质尚不清楚。在这项系统评价中，我们综合了已发表的文献，以确定从产前到产后早期的关系性质，并为未来的研究和临床实践提供建议。
使用系统评价和荟萃分析的首选报告项目（PRISMA）方法，在四个电子数据库中搜索了同行评审的实证研究，这些研究以英文发表。如果数据是在妊娠期间至少收集了一个母体健康/心理健康和 MFA 领域或妊娠期间的 MFA 和产后早期（最多 12 周）的母婴关系，那么文章将被考虑纳入。搜索策略没有应用日期参数。该综述已在 PROPSERO（注册号：CRD42018096174）上注册。
共有 25 项研究纳入了本综述，研究内容为母亲心理健康与 MFA/产后结合的关系。从综述中确定的主要发现包括：需要验证现有的心理健康测量方法或开发专门用于产前人群的新方法；整个妊娠和产后期间数据收集点不一致；对 MFA 的结构及其评估方式缺乏共识；以及对产后结果的持续关注。
我们对母亲心理健康与 MFA 和产后结合之间关系的理解仍存在科学差距，这限制了我们对 MFA 结构的理论理解。对未来研究的建议是采用跨整个妊娠和产后期间的前瞻性纵向设计，并在考虑 MFA 时使用术语和方法的一致性。重新关注 MFA 背后的理论将使我们能够更深入地了解母婴之间新兴关系。
