title: A narrative review of interventions addressing the parental-fetal relationship.
abstract: BACKGROUND
  Expectant parents develop varying degrees of emotional affiliation with the unborn child. Interventions supporting this relationship may be beneficial given its link to maternal health behaviour during pregnancy, as well as the parental-infant bond after birth.
  
  
  OBJECTIVE
  To identify and describe the effects of programmes and strategies that have addressed the parental-fetal relationship.
  
  
  METHODS
  English-language primary studies, published between 2005-2015, were identified and their methodological quality was assessed. Databases used included CINAHL, Cochrane Library, MEDLINE, PsycINFO and Web of Science. Key search terms included maternal/paternal-fetal attachment, prenatal bond, parental-fetal relationship and intervention. RCTs, non-RCTs, observational and non-comparative studies, before and after studies and case studies were included.
  
  
  RESULTS
  Twenty-seven papers were included. Studies evaluated the effects of various strategies, including ultrasound and screening procedures, fetal awareness interventions, social and psychological support techniques, educational programmes and relaxation strategies. Results are inconsistent due to the diversity of interventions and significant variation in methodological quality.
  
  
  CONCLUSIONS
  There is insufficient evidence to support definitive conclusions regarding the efficacy of any included intervention. A number of limitations, such as non-probability sampling, lack of blinding, and insufficient follow-up weaken the evidence. The inclusion of fathers in only three studies reflects the overall neglect of men in research regarding the prenatal relationship. Further in-depth study of the nature of the maternal/paternal-fetal relationship may be needed in order to allow for the identification of interventions that are consistently beneficial and worthwhile.
authors.affiliation: Department of Midwifery, Faculty of Health Sciences, University of Malta, Msida MSD 2080, Malta. Electronic address: n.borg-cunen@2014.hull.ac.uk.
authors.forename: Nicole
authors.initials: N
authors.lastname: Borg Cunen
authors.affiliation: Department of Midwifery and Child Health, Faculty of Health and Social Care, University of Hull, HU6 7RX, UK.
authors.forename: Julie
authors.initials: J
authors.lastname: Jomeen
authors.affiliation: Department of Midwifery, Faculty of Health Sciences, University of Malta, Msida MSD 2080, Malta.
authors.forename: Rita
authors.initials: R
authors.lastname: Borg Xuereb
authors.affiliation: Department of Midwifery and Child Health, Faculty of Health and Social Care, University of Hull, HU6 7RX, UK.
authors.forename: Angela
authors.initials: A
authors.lastname: Poat
mesh_terms: D000328:Adult; D004644:Emotions; D005260:Female; D005333:Fetus; D006801:Humans; D008297:Male; D008875:Middle Aged; D009769:Object Attachment; D010287:Parent-Child Relations; D010290:Parents / Q000523:psychology*; D011247:Pregnancy
keywords: Interventions; Maternal–fetal relations; Paternal–fetal attachment; Psychological bonding; Review