The Effect of Counseling on Maternal-Fetal Attachment in Mothers with Unplanned Pregnancy: a Randomized Controlled Clinical Trial

Abstract

Introduction: Unplanned pregnancies have high prevalence among women. Considering the low maternal-fetal attachment level in such pregnancies and it’s relationship with high rate of depression and anxiety,the present study aimed to determine the effect of counseling on maternal-fetal attachment (primary outcome), depression and state-trait anxiety (secondary outcomes) in mothers with unplanned pregnancy. Methods: This randomized controlled clinical trial was conducted on eighty 18-24 weeks pregnant women with unplanned pregnancy. Participants were assigned to a control (n=40) and an intervention (n=40) groups through blocked randomization design. For intervention group, 1-3 individual and 6 group counseling sessions at one-week intervals were provided and the control group received routine prenatal care. The participants completed the Maternal-Fetal Attachment Scale (MFAS), The Edinburgh Postnatal Depression Scale and State- Trait Anxiety Inventory STAI) before and four weeks after the intervention. Data analysis was performed using Chi-square, independent t and ANCOVA tests. Results: No significant difference was seen between groups in terms of socio-demographic characteristics and the baseline maternal-fetal attachment, depression and state-trait anxiety scores (P>0.05). The mean (SD= standard deviation) maternal-fetal attachment scores of the intervention group was increased from 68.2 (8.9) before the intervention to 93.2 (8.8) four weeks after the end of intervention. However, the mean (SD) maternal-fetal attachment scores of the control group were 71.6 (8.6)and 73 (5.7) before and after the intervention, respectively. Based on the results from the ANCOVA test with adjusting the baseline values, the mean maternal-fetal attachment score of the counseling group was significantly higher than control group (adjusted mean difference: 22.1; 95% Confidence Interval: 18.8 to 25.4; P<0.001). Four weeks after the end of intervention, based on the results from the ANCOVA test with adjusting the baseline values, the mean scores of depression (-4.6; -2.6 to -6.5; P<0.001), state anxiety (-7.8; 95% confidence interval: -4.5 to -11.1; P<0.001) and trait anxiety(adjusted mean difference: -8.2; 95% confidence interval: -5.4 to -10.9; P<0.001) in the counseling group was significantly lower than control group. Conclusion: Counseling has a positive effect on promoting maternal-fetal attachment and reducing of depression and also state-trait anxiety in women with unplanned pregnancies. Therefore, it is recommended that counseling and support programs to be offered to this group of women during pregnancy.