Maternal attachment state of mind and perinatal emotional wellbeing: Findings from a pregnancy cohort study

Objectives: Maternal attachment state of mind is an important potential predictor of risk and resilience to perinatal emotional wellbeing and early parenting. To explore maternal attachment in relation to perinatal depression and emotional wellbeing. Methods: This study drew on data collected within an ongoing cohort from 170 women recruited in early pregnancy, including 67 who met criteria for Major Depression. Maternal attachment state of mind was assessed with the Adult Attachment Interview (AAI) in pregnancy. Additional measures included the Structured Clinical Interview for the DSM (SCID), at 12 months the Strange Situation Procedure (SSP), Child Trauma Questionnaire (CTQ), Parenting Stress Index, and antenatal maternal hair cortisol concentrations (HCC). Limitations: Sample size to be able to undertake all analyses using the 4 way classifications, cortisol measurement is limited to hair only and there is no prospectively collected measure of childhood trauma in mothers. Conclusions: This study found that maternal attachment, specifically the Non-Autonomous states of mind, adjusted for clinical depression, was associated with higher cortisol in pregnancy and higher depressive symptoms across pregnancy and the postpartum. Furthermore, separately those with depression and Non-Autonomous states of mind also had higher postpartum parenting stress. There was no significant intergenerational concordance between AAI and SSP attachment classifications. Our findings support future research exploring the role of maternal attachment state of mind in understanding perinatal depression and emotional wellbeing.