title: Prenatal attachment and other correlates of postnatal maternal attachment to twins.
abstract: OBJECTIVE
  To determine the relationship of prenatal attachment and other selected perinatal contextual variables (method of delivery, maternal self-reported health, depression, infant birthweight, need for neonatal intensive care unit [NICU] admission) to postnatal attachment in mothers of twins.
  
  
  METHODS
  Two hundred fourteen women were initially recruited from a national mothers of twins support group for a study of maternal prenatal attachment. Of the 168 women who agreed to be contacted after delivery, 142 returned completed questionnaires (82.7% response rate), with 139 study-eligible women included in the analysis for this report.
  
  
  METHODS
  Correlational design with longitudinal follow-up at 1 month after expected delivery date.
  
  
  METHODS
  Self-administered, mailed questionnaires completed by women with twin gestations prenatally and postnatally 1 month after their expected delivery dates. Descriptive analysis, correlations, and regression equations were performed.
  
  
  METHODS
  The Maternal Attachment Inventory.
  
  
  RESULTS
  A modest correlation was found between prenatal and postnatal attachment ( r = 0.38, P < 0.001). Prenatal attachment and postpartum depression explained 26.1% of the variance in postnatal attachment ( F = 5.06, P < 0.001). Depression, method of delivery, and need for admission to the NICU had moderator effects on the relationship between prenatal attachment and postnatal attachment. The addition of these interaction terms nominally increased the adjusted R 2 to explain 27.9% to 29.6% of the variance in postnatal attachment.
  
  
  CONCLUSIONS
  Although the study findings support a modest relationship between prenatal and postnatal attachment in mothers of twins, maternal depression was also significant in explaining postnatal attachment. Postpartum depression, having a cesarean delivery, and the experience of a NICU admission for 1 or both twins further influenced the relationship between prenatal attachment and postnatal attachment. When fostering attachment in mothers of twins, nurses should assess for symptoms of depression and pay particular attention to those women who have an infant requiring a NICU admission.
authors.affiliation: Acute Care Division, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Ind, USA. egd@cwru.edu
authors.forename: Elizabeth G
authors.initials: EG
authors.lastname: Damato
mesh_terms: D000328:Adult; D019052:Depression, Postpartum / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008425:Maternal Behavior / Q000523:psychology*; D009034:Mother-Child Relations; D009035:Mothers / Q000523:psychology*; D015404:Nursing Methodology Research; D009769:Object Attachment; D011181:Postnatal Care / Q000523:psychology; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods; D012044:Regression Analysis; D012107:Research Design; D011795:Surveys and Questionnaires; D013997:Time Factors; D014427:Twins