Maternal attachment styles and maternal-fetal attachment: The serial mediation role of alexithymia and depressive symptoms
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Keywords

maternal-fetal attachment
maternal attachment styles
alexithymia
depressive symptoms

How to Cite

Nowicki, P. (2025). Maternal attachment styles and maternal-fetal attachment: The serial mediation role of alexithymia and depressive symptoms. Quarterly Journal Fides Et Ratio, 62(2), 76-85. https://doi.org/10.34766/1pb4hw72

Abstract

Maternal-fetal attachment refers to the emotional and cognitive bond a pregnant woman develops with her unborn child. This bond plays a significant role in prenatal care behaviors and the later formation of the mother-infant relationship. The aim of the present study was to identify the psychological mechanisms underlying maternal-fetal attachment, with particular emphasis on maternal attachment styles, alexithymia, and depressive symptoms, using a serial mediation model. The study sample consisted of 173 women in their second and third trimesters of pregnancy. The findings indicated that maternal attachment styles – secure, anxious, and avoidant – significantly influenced emotional bonding with the unborn child. Alexithymia and depressive symptoms functioned as successive mediators in this process. A secure attachment style was associated with lower levels of alexithymia and depressive symptoms, which in turn facilitated stronger maternal-fetal attachment. Conversely, anxious and avoidant attachment styles were linked to higher levels of alexithymia and depressive symptoms, which weakened maternal-fetal attachment.

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References

Abasi, E., Keramat, A., Borghei, N.S., Goli, S., & Farjamfar, M. (2021). Evaluating the effect of prenatal interventions on maternal–foetal attachment: A systematic review and meta-analysis. Nursing Open, 8(1), 4-16. https://doi.org/10.1002/nop2.648

Barberis, N., Cannavò, M., Calaresi, D., & Verrastro, V. (2023). Reflective functioning and Alexithymia as mediators between attachment and psychopathology symptoms: Cross-sectional evidence in a community sample. Psychology, Health & Medicine, 28(5), 1251-1262. https://doi.org/10.1080/13548506.2022.2045331

Bernard-Bonnin, A.C., Canadian Paediatric Society, & Mental Health and Developmental Disabilities Committee. (2004). Maternal depression and child development. Paediatrics & Child Health, 9(8), 575-583. https://doi.org/10.1093/pch/9.8.575

Bielawska-Batorowicz, E. (1995). Determinanty spostrzegania dziecka przez rodziców w okresie poporodowym. Wydawnictwo Uniwersytetu Łódzkiego.

Borchers, L.R., Dennis, E.L., King, L.S., Humphreys, K.L., & Gotlib, I.H. (2021). Prenatal and postnatal depressive symptoms, infant white matter, and toddler behavioral problems. Journal of Affective Disorders, 282, 465-471. https://doi.org/10.1016/j.jad.2020.12.075

Bowlby, J. (1979). The Bowlby-Ainsworth attachment theory. Behavioral and Brain Sciences, 2(4), 637-638. https://doi.org/10.1017/S0140525X00064955

Branjerdporn, G., Meredith, P., Wilson, T., & Strong, J. (2021). Maternal-fetal attachment: Associations with maternal sensory processing, adult attachment, distress and perinatal loss. Journal of Child and Family Studies, 30, 528-541. https://doi.org/10.1007/s10826-020-01876-1

Cox, J.L., Holden, J.M., & Sagovsky, R. (1987). Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression Scale. The British Journal of Psychiatry, 150(6), 782-786. https://doi.org/10.1192/bjp.150.6.782

Cranley, M.S. (1981). Development of a tool for the measurement of maternal attachment during pregnancy. Nursing Research, 30, 281-284. https://doi.org/10.1097/00006199-198109000-00008

Dagan, O., Facompré, C.R., & Bernard, K. (2018). Adult attachment representations and depressive symptoms: A meta-analysis. Journal of Affective Disorders, 236, 274-290. https://doi.org/10.1016/j.jad.2018.04.091

Dadi, A.F., Miller, E.R., Bisetegn, T.A., & Mwanri, L. (2020). Global burden of antenatal depression and its association with adverse birth outcomes: An umbrella review. BMC Public Health, 20, 1-16. https://doi.org/10.1186/s12889-020-8293-9

Dias, C.C., & Figueiredo, B. (2020). Mother’s prenatal and postpartum depression symptoms and infant’s sleep problems at 6 months. Infant Mental Health Journal, 41(5), 614-627. https://doi.org/10.1002/imhj.21869

Ferraro, I.K., & Taylor, A.M. (2021). Adult attachment styles and emotional regulation: The role of interoceptive awareness and alexithymia. Personality and Individual Differences, 173, 110641. https://doi.org/10.1016/j.paid.2021.110641

Hayes, A.F. (2018). Partial, conditional, and moderated moderated mediation: Quantification, inference, and interpretation. Communication Monographs, 85(1), 4-40. https://doi.org/10.1080/03637751.2017.1352100

Ierardi, E., Bottini, M., Facchinetti, M., & Crugnola, C.R. (2022). Maternal anxiety, depression, alexithymia, and social support: Association with maternal-fetal attachment in pregnancy. International Journal of Childbirth, 12(2). https://doi.org/10.1891/IJC-2021-0047

Jones, J.D., Cassidy, J., & Shaver, P.R. (2015). Parents’ self-reported attachment styles: A review of links with parenting behaviors, emotions, and cognitions. Personality and Social Psychology Review, 19(1), 44-76. https://doi.org/10.1177/1088868314541858

Koppelberg, P., Kersting, A., & Suslow, T. (2023). Alexithymia and interpersonal problems in healthy young individuals. BMC Psychiatry, 23(1), 688. https://doi.org/10.1186/s12888-023-05191-z

Kossakowska, K. (2013). Edynburska Skala Depresji Poporodowej – właściwości psychometryczne i charakterystyka. Acta Universitatis Lodziensis. Folia Psychologica, 17, 39-50. https://doi.org/10.18778/1427-969X.17.03

Kucharska, M. (2021). Selected predictors of maternal-fetal attachment in pregnancies with congenital disorders, other complications, and in healthy pregnancies. Health Psychology Report, 9(3), 193-206.

Lutkiewicz, K., & Bidzan, M. (2022). Maternal adult attachment and maternal-fetal attachment in the context of romantic relationship quality after premature birth – a cross sectional study. Frontiers in Psychiatry, 13, 935871. https://doi.org/10.3389/fpsyt.2022.935871

Mangialavori, S., Fontana, A., Terrone, G., Topino, E., Trani, L., Trincia, V., & Cacioppo, M. (2024). Maternal Perinatal Depression, Alexithymia, and Couple Functioning: Which Relationship Exists with Prenatal Attachment. Behavioral Sciences, 14(9), 773. https://doi.org/10.3390/bs14090773

Matthies, L.M., Müller, M., Doster, A., Sohn, C., Wallwiener, M., Reck, C., & Wallwiener, S. (2020). Maternal-fetal attachment protects against postpartum anxiety: The mediating role of postpartum bonding and partnership satisfaction. Archives of Gynecology and Obstetrics, 301, 107-117. https://doi.org/10.1007/s00404-019-05402-7

McDonald, H. (2021). Mindful awareness, emotion regulation, and attachment style in the experience of psychological distress during pregnancy and the postpartum. (Doctoral dissertation, Macquarie University).

McFarland, J., Salisbury, A.L., Battle, C.L., Hawes, K., Halloran, K., & Lester, B.M. (2011). Major depressive disorder during pregnancy and emotional attachment to the fetus. Archives of Women’s Mental Health, 14, 425-434. https://doi.org/10.1007/s00737-011-0237-z

McNamara, J., Townsend, M.L., & Herbert, J.S. (2019). A systemic review of maternal wellbeing and its relationship with maternal-fetal attachment and early postpartum bonding. PloS One, 14(7). https://doi.org/10.1371/journal.pone.0220032

Messina, A., Beadle, J.N., & Paradiso, S. (2014). Towards a classification of alexithymia: Primary, secondary and organic. Journal of Psychopathology, 20, 38-49.

Montebarocci, O., Codispoti, M., Baldaro, B., & Rossi, N. (2004). Adult attachment style and alexithymia. Personality and Individual Differences, 36(3), 499-507. https://doi.org/10.1016/S0191-8869(03)00110-7

Muris, P., Meesters, C., Van Melick, M., & Zwambag, L. (2001). Self-reported attachment style, attachment quality, and symptoms of anxiety and depression in young adolescents. Personality and Individual Differences, 30(5), 809-818. https://doi.org/10.1016/S0191-8869(00)00074-X

Parker, J.D., Michael Bagby, R., Taylor, G.J., Endler, N.S., & Schmitz, P. (1993). Factorial validity of the 20-item Toronto Alexithymia Scale. European Journal of Personality, 7(4), 221-232.

Pisoni, C., Garofoli, F., Tzialla, C., Orcesi, S., Spinillo, A., Politi, P., ... & Stronati, M. (2014). Risk and protective factors in maternal-fetal attachment development. Early Human Development, 90, S45-S46? https://doi.org/10.1016/S0378-3782(14)50012-6

Plopa, M. (2008). Więzi w małżeństwie i rodzinie. Metody badań. Kraków: Oficyna Wydawnicza Impuls.

Preece, D.A., Mehta, A., Becerra, R., Chen, W., Allan, A., Robinson, K., & Gross, J.J. (2022). Why is alexithymia a risk factor for affective disorder symptoms? The role of emotion regulation. Journal of Affective Disorders, 296, 337-341. https://doi.org/10.1016/j.jad.2021.09.085

Preece, D.A., & Gross, J.J. (2023). Conceptualizing alexithymia. Personality and Individual Differences, 215, 112375. https://doi.org/10.1016/j.paid.2023.112375

Quinto, R.M., De Vincenzo, F., Graceffa, D., Bonifati, C., Innamorati, M., & Iani, L. (2022). The relationship between alexithymia and mental health is fully mediated by anxiety and depression in patients with psoriasis. International Journal of Environmental Research and Public Health, 19(6), 3649.

Rahimi, T., Sedghi, R., Yousefi, S., & Sarikhani, Y. (2025). The association between maternal-fetal attachment and adherence to health behaviors among pregnant women. BMC Research Notes, 18(1), 16. https://doi.org/10.1186/s13104-024-07071-5

Rodriguez, N., Tun, H.M., Field, C.J., Mandhane, P.J., Scott, J.A., & Kozyrskyj, A.L. (2021). Prenatal depression, breastfeeding, and infant gut microbiota. Frontiers in Microbiology, 12, 664257. https://doi.org/10.3389/fmicb.2021.664257

Rollè, L., Giordano, M., Santoniccolo, F., & Trombetta, T. (2020). Prenatal attachment and perinatal depression: A systematic review. International Journal of Environmental Research and Public Health, 17(8), 2644. https://doi.org/10.3390/ijerph17082644

Sacchi, C., Miscioscia, M., Visentin, S., & Simonelli, A. (2021). Maternal-fetal attachment in pregnant Italian women: Multidimensional influences and the association with maternal caregiving in the infant’s first year of life. BMC Pregnancy and Childbirth, 21, 1-8. https://doi.org/10.1186/s12884-021-03964-6

Sánchez-Polán, M., Franco, E., Silva-José, C., Gil-Ares, J., Pérez-Tejero, J., Barakat, R., & Refoyo, I. (2021). Exercise during pregnancy and prenatal depression: A systematic review and meta-analysis. Frontiers in Physiology, 12, 640024. https://doi.org/10.3389/fphys.2021.640024

Shaver, P.R., Mikulincer, M., Sahdra, B., & Gross, J. (2016). Attachment security as a foundation for kindness toward self and others. The Oxford Handbook of Hypo-Egoic Phenomena, 10. https://doi.org/10.1093/oxfordhb/9780199328079.013.15

Sifneos, P.E. (1973). The prevalence of ‘alexithymic’ characteristics in psychosomatic patients. Psychotherapy and Psychosomatics, 22(2-6), 255-262. https://doi.org/10.1159/000286529

Simpson, J.A., Rholes, W.S., Campbell, L., Tran, S., & Wilson, C.L. (2003). Adult attachment, the transition to parenthood, and depressive symptoms. Journal of Personality and Social Psychology, 84(6), 1172. https://doi.org/https://doi.org/10.1037/0022-3514.84.6.1172

Ścigała, D.K., Zdankiewicz-Ścigała, E., Bedyńska, S., & Kokoszka, A. (2020). Psychometric properties and configural invariance of the Polish – Language Version of the 20-Item Toronto Alexithymia Scale in non-clinical and alcohol addict persons. Frontiers in Psychology, 11, 1241. https://doi.org/10.3389/fpsyg.2020.01241

Walsh, J., Hepper, E.G., & Marshall, B.J. (2014). Investigating attachment, caregiving, and mental health: A model of maternal-fetal relationships. BMC pregnancy and childbirth, 14, 1-9. https://doi.org/10.1186/s12884-014-0383-1

Walsh, J. (2010). Definitions matter: If maternal-fetal relationships are not attachment, what are they?. Archives of Women’s Mental Health, 13, 449-451. https://doi.org/10.1007/s00737-010-0152-8

Zdolska-Wawrzkiewicz, A., Chrzan-Dętkoś, M., & Bidzan, M. (2018). Maternal attachment style during pregnancy and becoming a mother in Poland. Journal of Reproductive and Infant Psychology, 36(1), 4-14. https://doi.org/10.1080/02646838.2017.1395400

Zhang, J., Zhang, Y., Mao, Y., & Wang, Y. (2024). The relationship between insecure attachment and alexithymia: A meta-analysis. Current Psychology, 43(7), 5804-5825. https://doi.org/10.1007/s12144-023-04749-0

Zhang, L., Wang, L., Yuan, Q., Huang, C., Cui, S., Zhang, K., & Zhou, X. (2021). The mediating role of prenatal depression in adult attachment and maternal-fetal attachment in primigravida in the third trimester. BMC Pregnancy and Childbirth, 21, 1-9. https://doi.org/10.1186/s12884-021-03779-5