The Role of Maternal Attachment in Neonatal and Early Childhood Outcomes

Background: Extant research has demonstrated that compared to adults with insecure attachment styles, more securely attached parents tend to be more responsive, sensitive, and involved parents resulting in improved behavioral outcomes for their children. Whereas there is an extensive research literature on the role of maternal attachment style in early childhood behavioral outcomes, far less is known about the influence of a mother’s attachment style on her attachment to her unborn child during pregnancy and the consequent developmental outcomes of the child during early childhood.  An earlier detection of potential insecurities in attachment should guide intervention efforts to minimize the negative sequelae on both mother and child.

Aims: This prospective longitudinal study seeks to understand: a) the relationship between maternal-fetal attachment (MFA) during pregnancy and infant and toddler outcomes and b) the role of mothers’ attachment style on early childhood developmental outcomes in an economically disadvantaged sample of women and their children.

Methods: This study is an extension of a longitudinal study examining the relation between MFA and neonatal outcomes in an urban sample of 166 healthy, low-income, ethnic minority women. Initial findings demonstrated that lower MFA was associated with a greater likelihood of adverse neonatal outcomes (OR .91, Wald = 29.83, p < .05).  One to two years later, a sub-sample of these women completed a measure of maternal attachment style and maternal depressive symptoms.  A developmental assessment was completed on their toddlers.

Results: Thirty-six percent (n=29) of mothers exceeded the score for depressive symptomatology.  The developmental assessment revealed delays in each of the five domains assessed by the Ages & Stages Questionnaire. Specifically, 30% of toddler were delayed in communication, 26% delayed in problem solving, 21% delayed in gross motor, 17% delayed in fine motor, and 14% delayed in personal-social skills. Using generalized linear model with gamma distribution and log link function, MFA assessed in pregnancy, post-partum depressive symptoms, and maternal attachment style assessed post-partum were related to early childhood developmental outcomes 1-2 years later (p<0.001). Mothers’ avoidant attachment styles (Exp β=.98, p<0.001), and post-partum depressive symptoms (Exp β=.98, p=0.018) were related to poorer early childhood developmental outcomes.  

 Conclusions: This is the first study demonstrating the important role of MFA and maternal attachment style on early childhood developmental outcomes in a low-income, ethnic minority sample. Findings have implications for enhancing early intervention programs aimed at improving maternal and childhood outcomes.  An earlier identification of disruptions in attachment may be beneficial in tailoring interventions focused on the mother-child dyad.