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Cited by 222Maternal Mental Health During Pregnancy and PostpartumAttachment and Relationship DynamicsMaternal and Perinatal Health Interventions

A systemic review of maternal wellbeing and its relationship with maternal fetal attachment and early postpartum bonding

Open access
McNamara, Josephine, Townsend, Michelle L., Herbert, Jane S.·2019·PLOS ONE
DOI 10.1371/journal.pone.0220032PMC PMC6657859
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Abstract

BACKGROUND: 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. METHOD: 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). RESULTS: 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. CONCLUSION: 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.

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Crossref · 10.1371/journal.pone.0220032

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  • Three prior narrative reviews reported that maternal depression, anxiety, and stress symptoms were associated with mother-infant bonding problems.

    “Three prior narrative reviews (Edwards, 2017; McNamara et al., 2019; Tichelman et al., 2019) reported that maternal depression, anxiety, and stress symptoms were associated with mother-infant bonding problems”

    From Associations between maternal psychological distress and mother-infant bonding: a systematic review and meta-analysis (2023) · cites this paper as McNamara et al., 2019

    The Results (page not provided) report associations of depression and anxiety with poorer early postpartum bonding. But the Results also state that no included studies investigated stress in relation to early postpartum bonding. The cited paper identifies itself as a systematic review, not a narrative review. (LLM, conf=0.91)

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  • Psychological distress is an important risk factor for poor pre- and postnatal bonding in mothers.

    “A systematic review by McNamara et al. (2019) demonstrated that psychological distress is an important risk factor for poor preand postnatal bonding in mothers.”

    From Mindfulness, Self-compassion, and Psychological Wellbeing as Correlates of Paternal Bonding in Pregnancy. (2025) · cites this paper as McNamara et al. (2019)

    The Discussion reports that depression was associated with lower maternal–fetal attachment and postpartum bonding in most included studies. It also says no consistent pattern could be identified for anxiety or stress, so the broader claim about psychological distress is not fully supported. The review primarily reports associations rather than establishing distress as a causal risk factor. (LLM, conf=0.85)

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  • A separate SA-based study found no significant associations between poor breastfeeding outcomes and mental health.

    “though a separate SA-based study found no significant associations between poor breastfeeding outcomes and mental health [45].”

    From Exploring the effects of mental health on bonding and caregiving among pregnant and postpartum persons with likely depression and/or PTSD in South Africa: a qualitative analysis (2026) · cites this paper as [45]

    The Results (Statistical analyses) discuss associations between maternal mental health and postpartum bonding, not breastfeeding outcomes. A search for breastfeeding found only a reference about breastfeeding and mother–infant sleep proximity; our copy does not report the claimed finding from a South African study. (LLM, conf=0.76)

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Cites

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4 of the 132 references couldn’t be matched to a known paper.

Research works printed but not linked: 3

  1. [35]Fleming AS, Ruble DN, Flett GL, Shaul DL. Postpartum adjustment in first time mothers: Effects of mood on maternal responsiveness. Developmental Psychology. 1988; 24: 71– 81.
  2. [39]Muller ME. The development and testing of the Muller Prenatal Attachment Inventory [Doctoral Dissertation] San Francisco: University of California; 1990.
  3. [66]Ball HL, Klingaman KP. Breastfeeding and mother-infant sleep proximity In: Smith EO, McKenna JJ, editors. Evolutionary medicine and health: New perspectives. Oxford, UK: Oxford University Press; 2007 p. 226– 41.

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Authors
McNamara, J., Townsend, M. L., & Herbert, J. S.
Affiliations
University of Wollongong (AU)
Corresponding author
McNamara, Josephine
ORCID
Venue
PLOS ONE
Publisher
Public Library of Science (PLoS)
Published
2019-07-25
Volume
14
Issue
7
Pages
e0220032
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0220032
PMC
PMC6657859
OpenAlex
W2963294809
Cited by
222
References
132
Citations by year
2026: 25 · 2025: 33 · 2024: 37 · 2023: 42 · 2022: 36 · 2021: 29 · 2020: 18 · 2019: 2
FWCI
19.56
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Figshare (acceptedVersion)
  • Research Online (University of Wollongong) (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
  • Social Sciences › Psychology › Social Psychology › Attachment and Relationship Dynamics
  • Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
Keywords
maternal well-being, maternal mental health, maternal-fetal attachment, postpartum bonding, mother-infant relationship, prenatal period, early postpartum period, construct validity
MeSH terms
Maternal Health, Female, Humans, Mother-Child Relations, Pregnancy, Prospective Studies, Pregnant People, Postpartum Period

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