Teaching attachment behaviors to pregnant women: a randomized controlled trial of effects on infant mental health from birth to the age of three months

BACKGROUND: Maternal-fetal attachment, which forms as soon as pregnancy starts, is essential to an infant's mental development. OBJECTIVE: This study aimed to explore the effect of teaching attachment behaviors to pregnant women on infant mental health from birth to 3 months of age. DESIGN: Randomized controlled trial. SETTING: Hafiz Hospital, Shiraz University of Medical Sciences, Iran, from February to November 2014. PATIENTS AND METHODS: The participants were randomly divided into an intervention and a control group at 28-34 weeks gestation. The participants in the intervention group attended six educational sessions each lasting for 60-90 minutes. After delivery, the infants of mothers in each group were compared in terms of mental health indexes (total mean scores and scores derived from a checklist of questions for infant mental health with results categorized as low, average and high). Maternal anxiety levels were also recorded at birth and at 3 months. MAIN OUTCOME MEASURE(S): Infant mental health index. RESULTS: In 190 pregnant women (96 in the intervention group and 94 in the control group), the total mean (SD) scores for infant mental health at birth were 16.66 (1.51) in the intervention group and 16.07 (1.74) in the control group (P=.013). At 3 months, the total mental health scores infants were 31.05 (1.88) in the intervention group and 30.25 (2.10) in the control group (P=.007). Differences in checklist scores between the groups at 3 months were not statistically significant, except for crying intensity at 3 months (P=.021). Women in the control group had higher anxiety levels at 3 months (P=.01). CONCLUSION: Teaching attachment skills to mothers increased the attachment between the mothers and their infants, and consequently, improved infant mental health. Thus, teaching attachment skills should be incorporated into routine prenatal care. LIMITATIONS: Use of phone calls by the researcher to assess mental health.