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A systemic review of maternal wellbeing and its relationship with maternal fetal attachment and early postpartum bonding
Open accessAbstract
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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“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
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“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)
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“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]
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Grandparental support and maternal postpartum mental health: A review and meta-analysisPreprint
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Doğum Sonrası Maternal Anksiyete ve Bağlanmayı Etkileyen Faktörler
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“Moreover, premature infants, infants with difficult temperament, emotional dysregulation, and excessive clinging were more likely to have difficulties in bonding with their mothers (Adama et al., 2018; McNamara et al., 2019).”
BackgroundImage du corps, vécu corporel et bonding chez les femmes dans les six mois suivant l’accouchement
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What tools should be used to identify women in need of additional support in pregnancy?
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“Recent reviews have highlighted a lack of consensus around definitions of constructs related to the maternal-fetal relationship, as well as heterogeneity across instruments (Cataudella et al., 2016; McNamara et al., 2019).”
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“Estimates suggest approximately 20% of women will experience a mental health problem during the first year postpartum (Public Health England, 2019), the consequences of which may include reduced maternal-infant bonding (McNamara et al., 2019), and insecure attachments (Slomian et al., 2019).”
BackgroundMaternal-fetal attachment and interrelated factors in pregnant women assisted in Primary Health Care
Lima, C. D. A., Brito, M. F. S. F., de PINHO, L., Ruas, S. J. S., Messias, R. B., & Silveira, M. F. (2024) · Revista Latino-Americana de Enfermagem · doi:10.1590/1518-8345.7104.4404 · Cited by 3
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“However, as disordered eating has rarely been studied in relation to MFA [11], further studies are needed to identify broader trends.”
InfluentialGestações na adolescência e adesão à consulta puerperal
Pinto, I. R., da Silva, J. A., Parra, P. C., Wernet, M., Fonseca, L. M. M., & Ruiz, M. T. (2022) · Revista Latino-Americana de Enfermagem · doi:10.1590/1518-8345.6269.3703 · Cited by 3
“A maioria das adolescentes (81,8% – 18) eram primíparas, embora 13,6% (03) estivessem gestantes pela segunda vez e uma (4,5%) encontrava-se na terceira gestação; 13,6% (03) tiveram experiência de abortamento prévio; todas (22) fizeram o pré-natal com número adequado de consultas (seis ou mais consultas) e 77,3% (17) d…”
BackgroundMackness, J., Gallis, J. A., Owusu, R. K., Ali, M., Abubakr-Bibilazu, S., Adam, H., Aborigo, R., Awoonor‐Williams, J. K., Lillie, M., McEwan, E., et al. (2021) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-020-03476-9 · Cited by 3
Hubungan Dukungan Suami dengan Kondisi Fisik dan Kondisi Psikososial Ibu Primigravida
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COVID-19 Public Health Restrictions and New Mothers’ Mental Health: A Qualitative Scoping Review
Abdul‐Fatah, A., Bezanson, M., Steven, S. L., Tippins, E., Jones, S., MacDonald, H. R., & Ysseldyk, R. (2024) · Qualitative Health Research · doi:10.1177/10497323241251984 · Cited by 3
“The stress related to the pressures of work – life balance, loss of autonomy, and changing societal roles, potentially leading to a lack of bonding with one ’ s child, can also have negative effects on maternal well-being (McNamara et al., 2019).”
Lima, C. D. A., Brito, M. F. S. F., de PINHO, L., Ruas, S. J. S., Messias, R. B., & Silveira, M. F. (2024) · Revista Latino-Americana de Enfermagem · doi:10.1590/1518-8345.7104.4403 · Cited by 2
Effects of maternal depression and self-efficacy during pregnancy on postpartum bonding
Bergmann, R., Märthesheimer, S., Hagenbeck, C., Balan, P., Fehm, T. N., & Schaal, N. K. (2025) · Journal of Reproductive and Infant Psychology · doi:10.1080/02646838.2025.2541078 · Cited by 2
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“A number of adverse psychosocial and obstetric factors that are difficult to modify (i.e., prior mis - carriages, obstetric complications, congenital defects, and intimate partner violence) can impair parent–child attachment (Cataudella et al. 2016; McNamara et al. 2019).”
Smith, M., Brunton, R., Watson, B., & Dryer, R. (2025) · Acta Psychologica · doi:10.1016/j.actpsy.2025.106025 · Cited by 3
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“The emphasis on maternal health is shifting beyond survival to overall health and well-being throughout the life course [ 22 – 24 ].”
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“The World Health Organization (WHO) claims that approximately 10% of pregnant women suffer from mental disorders, particularly anxiety and depression (McNamara et al., 2019).”
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“A previous review indicated that maternal distress was associated with maternal fetal bonding [19].”
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“These fi ndings were in line with previous research in fathers (De Cock et al., 2016) and mothers (McNamara et al., 2019), but not with other studies that did not associate psychological problems with poor bonding (Dayton et al., 2019; Gobel et al., 2019).”
A Perinatal Psychiatry Service in Bangalore, India: Structure and Function
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When a Parent Is Born: An Integrated Approach to Perinatal Mental Health and Early Risk Screening
Guarneri, C., Sottile, J., Bevacqua, E., Leone, M. C., Mineo, R., Rini, C., Riolo, M., Maiorana, A., & Infurna, M. R. (2025) · European Journal of Investigation in Health Psychology and Education · doi:10.3390/ejihpe15100193 · Cited by 2
“…awareness and emotional connection to the fetus facilitates the establishment of a secure attachment bond, which plays a crucial protective role in safeguarding both maternal mental health and the child’s emotional development from the risk of psychological distress (McNamara et al., 2019).”
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Embarazos en adolescentes y adherencia a la consulta puerperal
Pinto, I. R., da Silva, J. A., Parra, P. C., Wernet, M., Fonseca, L. M. M., & Ruiz, M. T. (2022) · Revista Latino-Americana de Enfermagem · doi:10.1590/1518-8345.6269.3701 · Cited by 1
“Resultados: se entrevistaron a 121 puérperas, el 18,2% (22) eran adolescentes, siendo confirmado entre ellas una baja escolaridad (p<0,001); menor número de embarazos con patologías (p = 0,016); predominando las primíparas (p<0,001) y mayores tasas de parto normal (p = 0,032).”
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“Several factors can also contribute to this, including the dearth of emotional resources, self-perceived parenting inadequacies, and negative attitudes toward caregiving responsibilities [13].”
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“A systematic review by McNamara J et al. [38] included 11 studies examining the relationship between parity and MIB, all conducted outside Japan, and reported that five studies identified primiparas as at risk for MIB failure.”
BackgroundApego materno-fetal e fatores inter-relacionados em gestantes assistidas na Atenção Primária à Saúde
Lima, C. D. A., Brito, M. F. S. F., de PINHO, L., Ruas, S. J. S., Messias, R. B., & Silveira, M. F. (2024) · Revista Latino-Americana de Enfermagem · doi:10.1590/1518-8345.7104.4405 · Cited by 1
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“The nature of depression symptomatology, such as a lack of pleasure and emotional unavailability due to a limitation to a negative range of emotion seem to hinder the development of a strong positive emotional bond toward the child even more strongly than prenatal anxiety symptoms [121, 132, 133].”
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“For example, maternal postpartum distress is suggested to have negative effects on a mother-infant bonding, a mother’s attachment style, as well as her sensitivity and attunement towards a child’s needs, which are all crucial in supporting child socio-emotional development [ 21–23 ].”
Mokhtarian-Gilani, T., Kariman, N., Nia, H. S., Doulabi, M. A., & Nasiri, M. (2021) · Research Square · doi:10.21203/rs.3.rs-152709/v1 · Cited by 1
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“In addition, prenatal depression symptoms were found to be negatively correlated with prenatal MFA [31, 32].”
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Aestheticization of Ultrasound ImagesPreprint
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Maternal Attachment and Preventive Intervention Methods in Mothers Under Covid19 Stress
Kurt, A., & Söyler, H. Ç. (2021) · doi:10.35365/ctjpp.21.4.32
Aestheticization of Ultrasound ImagesPreprint
Pal, P., Vago, D. R., Ghosh, A., & Brewer, J. A. (2021) · doi:10.36227/techrxiv.16543488
“There is ample evidence that better mother-child emotional bonding lead to healthier grown of the fetus [25], [26], [27].”
BackgroundMedical complication of pregnancy at Bent-Al-Huda teaching hospital in Al-Nasiriyah City
Bkhebukh, S. B., Malik, F. H., Aate, D. S., & Hasan, A. A. (2022) · International Journal of Health Sciences · doi:10.53730/ijhs.v6ns1.8501
“Table (2) Summary Statistical of Sample Regarding Determination Medical Complication of Pregnancy by Frequency and percent:”
BackgroundRandomized Controlled Trial to Prevent Postpartum Depression: An Infant Carrier InterventionPreprint
Little, E., Bain, L., & Hahn‐Holbrook, J. (2023) · doi:10.22541/au.167845088.87835810/v1
Mother-infant bonding and its predictors among pregnant women in Saudi Arabia
Academic Affairs and Training Administration, M. O. H., Oraybi, L. A., Yanbaawi, L. O., & Primary and Preventive Health Care, M. O. H. (2023) · International Journal of ADVANCED AND APPLIED SCIENCES · doi:10.21833/ijaas.2023.03.009
البقمي, ن. س. (2023) · مجلة الإرشاد النفسی · doi:10.21608/cpc.2023.291489
Staite, E., Summers, S. J., Pawlby, S. J., Ismail, K., Wilson, C., & Wloszek, M. (2023) · Global Pediatrics · doi:10.1016/j.gpeds.2023.100076
Topal, S., & Çaka, S. Y. (2024) · Research Square · doi:10.21203/rs.3.rs-3899493/v1
RetractedMaternal Prenatal Attachment: An Early Intergenerational Intervention for Child Psychiatry
Gao, L., Givrad, S., & Rutherford, H. J. V. (2023) · JAACAP Connect · doi:10.62414/001c.92191
Bakhshi, M., Stein, L. A. R., Lalooha, F., Sarichloo, M. E., & Oveisi, S. (2024) · Research Square · doi:10.21203/rs.3.rs-4206119/v1
Technology, intimacy and motherhood
Ferrarello, S. (2024) · New Techno Humanities · doi:10.1016/j.techum.2024.05.001
Røhder, K., Baumann, M. V., Karstoft, K., Schleicher, I., George, C. C., & Harder, S. K. (2024) · Infant Mental Health Journal · doi:10.1002/imhj.22128
Maternal-fetal attachment during pregnancy at the Public Health Center
Suryaningsih, E. K., Aryudaningrum, N., & Linh, N. D. (2024) · International Journal of Health Science and Technology · doi:10.31101/ijhst.v6i1.3720
Kıyak, S., & Koçoğlu, D. (2024) · Sağlık Bilimlerinde Değer · doi:10.33631/sabd.1381046 · Cited by 1
Psychometric evaluation of the Brazilian version of the Maternal-Fetal Attachment Scale
Lima, C. D. A., Brito, M. F. S. F., de PINHO, L., Andrade, J. S., Santos, V. M., Marôco, J. P., & Silveira, M. F. (2024) · Estudos de Psicologia (Campinas) · doi:10.1590/1982-0275202441e210144
Alavala, V., & Genna, N. M. D. (2025) · medRxiv · doi:10.1101/2025.02.05.25321721
Application of Three-Dimensional Printing in Maternity and Pediatric Nursing Care
Ahmad, S., & Dreisbach, C. (2024) · MCN The American Journal of Maternal/Child Nursing · doi:10.1097/nmc.0000000000001084
“Maternal fetal attachment is a special relationship be-tween the mother and the fetus that can relate to strong maternal bond that has been correspondingly reported to be the basis for growth of pregnancy behaviors that include fetal care and protection (McNamara et al., 2019).”
Clusters and case vignettes of impaired maternal–fetal bonding in pregnancy: A mixed method approach
Kitamura, T., Hada, A., Usui, Y., & Ohashi, Y. (2025) · Psychiatry and Clinical Neurosciences Reports · doi:10.1002/pcn5.70127
Nepomuceno, M. I., Branquinho, M., Canavarro, M. C., & Fonseca, A. (2025) · Journal of Reproductive and Infant Psychology · doi:10.1080/02646838.2025.2520514
“It has been linked to difficulties in mother-infant bonding (MIB) (McNamara et al., 2019), a crucial process for both maternal well-being and child development.”
Rahimi, A., Kiani, Z., Kariman, N., Rousta, F., Lotfi, R., Borzu, Z. A., Fakari, F. R., & Simbar, M. (2025) · Current Women s Health Reviews · doi:10.2174/0115734048365938250712060650
Sleep Health During Pregnancy: A Focus on Prevention
Meneo, D., Baldi, E., Cascone, R., & Baglioni, C. (2025) · Springer eBooks · doi:10.1007/978-3-031-95948-6_11
Prenatal Attachment Inventory: Adaptation and Validation in the Indian Context
Rajitha, K., Verma, M. K., & Mohan, V. A. (2025) · The Journal of Obstetrics and Gynecology of India · doi:10.1007/s13224-025-02210-9
“According to a systematic review, the MFAS is considered the most widely used tool [1], but the PAI is regarded as a promising and psychometrically sound instrument [2].”
La importancia del vínculo y el apego entre madre e hijo
Díaz-Ogallar, M. A., Martínez, A., Galiano, J. M. M., & Abad., M. (2024) · doi:10.64628/aao.vegdpsmmx
Barut, S., Kurt, N., & Baransel, E. S. (2025) · Revista da Associação Médica Brasileira · doi:10.1590/1806-9282.20250040
“Other studies have shown that negative emotional states during pregnancy, such as unhappiness, may lead to difficulties bonding with the child both during and after birth, ultimately reducing overall well-being 26-28 .”
Akdağ, B., Kopuz, H. Y., Günenç, M., & Taşkum, İ. (2025) · Current Psychology · doi:10.1007/s12144-025-08473-9
“Affected parents may struggle to connect emotionally with their unborn child (Brandão et al., 2019; Rubertsson et al., 2015), potentially due to a scarcity of emotional resources, perceived inadequacies in parenting abilities, or negative views toward caregiving (McNamara et al., 2019 ).”
Sansone, A., Stapleton, P., Patching, A., & Lawrence, Z. (2025) · OBM Integrative and Complementary Medicine · doi:10.21926/obm.icm.2504046
From maternal melodies to prenatal attachment: A qualitative study on expressive songwriting
Uyanık, A., & Demirdil, G. (2025) · Infant Mental Health Journal · doi:10.1002/imhj.70054
McNab, S., Dryer, S., Fitzgerald, L., Gomez, P., Bhatti, A. M., Kenyi, E., Somji, A., Khadka, N., & Stalls, S. (2022) · Figshare · doi:10.6084/m9.figshare.19625394
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McNab, S., Dryer, S., Fitzgerald, L., Gomez, P., Bhatti, A. M., Kenyi, E., Somji, A., Khadka, N., & Stalls, S. (2022) · Figshare · doi:10.6084/m9.figshare.19625391
Meneo, D., Baldi, E., Cerolini, S., Curati, S., Bastianini, S., Berteotti, C., Simonazzi, G., Manconi, M., Zoccoli, G., Bartolo, P. D., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26011968
Meneo, D., Baldi, E., Cerolini, S., Curati, S., Bastianini, S., Berteotti, C., Simonazzi, G., Manconi, M., Zoccoli, G., Bartolo, P. D., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26011844
Maternal-Fetal Attachment Among Pregnant Women in Primary Health Care and Associated Variables
Gowert, M. S., Macedo, A. P., & Trettim, J. P. (2025) · Paidéia (Ribeirão Preto) · doi:10.1590/1982-4327e3530 · Cited by 1
Tanaka, Y., Araki, T., & Fukushima, H. (2026) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-025-08199-3
“Previous research on maternal-fetal attachment has mainly focused on psychosocial factors such as maternal mental health and social support during pregnancy [25, 32, 33].”
Metadata
- Authors
- McNamara, J., Townsend, M. L., & Herbert, J. S.
- Affiliations
- University of Wollongong (AU)
- Corresponding author
- McNamara, Josephine
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2019-07-25
- Volume
- 14
- Issue
- 7
- Pages
- e0220032
- ISSN
- 1932-6203 (ISSN-L)
- 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
- gold
- doi.org
- 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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