Understanding the impact of psychosocial risk factors on the maternal-fetal/infant relationship in the perinatal period
Marsh, Imogen Charlotte
BACKGROUND: Maternal-fetal relationship quality is a known predictor of maternal infant relationship quality. Maternal-infant relationship quality is associated with infant attachment style, and both are predictive of long-term physical and mental health and developmental outcomes. Maternal-fetal/infant relationship quality is known to be influenced by psychosocial factors such as maternal mental health, social support, and socio-economic status. The systematic review component of this thesis aimed to synthesise and evaluate existing research regarding the relationships between maternal-fetal/infant relationship and maternal substance misuse, to ascertain whether women with substance misuse difficulties are at risk of developing poorer quality maternal-fetal/infant relationships. The empirical research component of this thesis aimed to better understand the relationships between the cognitive (maternal caregiving representations) and affective aspects of maternal-fetal relationship quality, within the context of a range of psychosocial risk factors. METHOD: The systematic review identified 15 studies reporting outcomes pertaining to maternal-fetal/infant relationship quality within the perinatal period (pregnancy and the first year postpartum) in the context of current/historical maternal substance misuse. The cross-sectional research study recruited n = 172 women in the second trimester of pregnancy from the general population. Participants completed a range of self-report questionnaires regarding demographic factors, caregiving representations, affective quality of the maternal-fetal relationship, psychosocial risk, alcohol and substance misuse, depressive symptoms, and adult attachment style. RESULTS: The findings of the systematic review suggest that, rather than substance misuse being a unique risk factor, women who misuse substances might be at greater risk of developing poor maternal-fetal/infant relationship quality because of their increased likelihood of experiencing a constellation of inter-related psychosocial risk factors such as mental health difficulties, experience of interpersonal trauma, poor social support, low socio-economic status, and low educational attainment. The review highlighted the paucity of research regarding the adversities faced by women with current or historical substance misuse difficulties within the perinatal period. The findings of the original research study indicated that the quality of caregiving representations (how a woman thinks about her fetus) is significantly predictive of the quality of her affect towards her unborn child. Disorganised and secure organised caregiving representations were found to mediate the significant relationship between maternal avoidant attachment style maternal-fetal affect. CONCLUSION: Greater efforts are required to understand the impact of psychosocial risks on maternal-fetal/infant relationship quality, particularly for women experiencing multiple adversities. Caregiving representations are highlighted as a possible method of screening for risk of poor maternal-fetal/infant relationship quality, and as a potential point of intervention.