The structure and correlates of the 20-item Maternal-Fetal Attachment Scale in a population-based sample of Hungarian expectant women

Abstract

Objective: This study aimed at analysing the structure and reliability of the modified, 20-item Hungarian version of the Maternal-Fetal Attachment Scale (MFAS-HU-20), and to investigate its associations with certain demographic, pregnancy-related and psychosocial characteristics.

Design: A socio-demographically diverse sample of Hungarian women completed interviews in middle or late pregnancy, as part of the countrywide Cohort '18 Growing Up in Hungary study.

Setting: Data collection was carried out by local health visitors either at the family home or at the health visitor's office.

Participants: In total, 7,315 pregnant women were included in the study; they were aged between 13 and 49, and had a mean gestational age of 30 weeks.

Measurements: In addition to the MFAS-HU-20, other paper-and-pencil scales were applied to measure perceived social support, partnership interactions, depressive and generalized anxiety symptoms, and pregnancy-related anxiety. Socio-demographic and pregnancy-related data were collected through personal interviews.

Findings: Exploratory and confirmatory factor analyses supported an oblique two-factor model, consisting of factors that were renamed 'Attunement' and 'Interaction'. Cronbach's alphas for these two subscales confirmed their adequate internal consistency. The age of the expectant women, their partnership status, level of education, equivalized household income and parity all had a small effect on their bonding, while gestational age and multiple pregnancy had no meaningful impact on prenatal attachment in the present study. The psychosocial characteristics of the pregnant women were weakly associated with their attachment to the fetus, regardless of the mother's level of education.

Conclusions: This study suggests a two-factor structure of maternal-fetal attachment that reflects the distinction between the mental and behavioural aspects of this relationship. Socio-demographic background and psychosocial characteristics have a small impact on women's attachment to their fetus.

Implications for practice: The MFAS-HU-20 seems to be a reliable and valid scale that could be utilized in prenatal research and pregnancy care. Its correlates highlight the importance of interventions aimed at providing social support for pregnant women.

Keywords: Growing up in Hungary; Maternal-Fetal Attachment Scale (MFAS); Pregnancy; Psychometric properties; Socio-demographic background.