Maternal-fetal attachment and neonatal outcomes: The role of emotional health and intimate partner violence in a sample of low income African American women

Background. Disparate neonatal outcomes between African Americans and non-Hispanic White Americans are one of the most troublesome and persistent disparities affecting our nation. Poor mental health is a known risk factor for poor pregnancy outcomes, and may compromise a woman's ability to emotionally attach to her unborn child. Diminished maternal-fetal attachment (MFA), in turn, may lead to less investment in health promoting practices thus increasing the likelihood of adverse neonatal outcomes. However, beyond cross-sectional studies, the literature to date on MFA has not examined these relationships in vulnerable populations of low income, minority women.;Objectives. (a) To examine the influence of MFA on health practices during pregnancy and neonatal outcomes, (b) to analyze the influence of maternal emotional health, intimate partner violence (IPV), and MFA on health practices during pregnancy and neonatal outcomes, and (c) to explore African American women's perceptions of MFA including factors thought to influence the relationship a woman has with her unborn child.;Design and methods. A prospective, longitudinal concurrent mixed methods design was employed. Quantitative and qualitative data were collected between 24--28 weeks gestation. Multiple linear and logistic regressions were used to examine the relationships of interest in the first two aims, while conventional content analysis was used for the third aim.;Sample. 166 low-income women and their neonates (quantitative sample; 93% African American) recruited from three urban OB/GYN clinics and 12 African American women (qualitative sample) participated in the study.;Findings. 44% of neonates were classified as having an adverse neonatal outcome as measured by the presence of small for gestational age, low birth weight or preterm birth. Participants reported high rates of depressive symptoms (59%), post-traumatic stress (48%), and IPV during pregnancy (19%). MFA was related to health practices during pregnancy and adverse neonatal outcomes. Health practices mediated the influence of MFA on adverse neonatal outcomes. A lower level of emotional health and IPV were independently associated with lower MFA. Qualitative participants identified the strong links between emotional health and MFA.;Conclusions. This study provides strong support for the role that MFA plays in health practices, and more importantly, in neonatal outcomes in a highly vulnerable sample of low-income, African American women. Our findings support the validity of MFA as an important health construct for this population.