Influence of Age, Planned Pregnancy, Stress and Marital Relationship on Maternal-Infant Attachment in Postpartum Mothers with Inadequate Prenatal Care

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Saowaros Pangzup Wanna Phahuwatanakorn Chaweewan Yusamran Dittakarn Boriboonhirunsarn


         Purpose: To determine predictive power of age, planned pregnancy, stress and marital relationship on maternal-Infant attachment during postpartum in mothers with inadequate prenatal care.
         Design: A correlational predictive design.
         Methods: The samples consisted of 134 postpartum mothers who delivered at a university hospital in Bangkok. The data were collected through questionnaires: the personal information, Stress Inventory, the Dyadic Adjustment Scale, and the Maternal Attachment Inventory. Descriptive statistics and logistic regression analysis were used for the analyses.
         Main findings: The result of the study shows that 65.7 percent of the subjects has a medium score of maternal-infant attachment. Age, planned pregnancy, stress, and marital relationship together predicted maternal-infant attachment, which accounted for 28% (Nagelkerke R2 = .280) of variance of maternal-infant attachment during postpartum in mothers with inadequate prenatal care. Particularly, age and stress significantly predicted maternal-infant attachment at p < .01. Teenage mothers were 4.19 times more likely to have low maternal-infant attachment than mothers who are 20 years old and older. Stressful mothers were 3.81 times more likely to have low maternalinfant attachment than mothers with no stress (OR = 4.19; 95%CI [1.57, 11.17], and OR = 3.81; 95%CI [1.67, 8.67], respectively). 
         Conclusion and recommendations: Age and stress can influence maternal-infant attachment. Therefore, nurses and midwives should concern and  promote attachment-bonding to teenage mothers, especially those with stress during postpartum period.


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How to Cite
Pangzup, S., Phahuwatanakorn, W., Yusamran, C., & Boriboonhirunsarn, D. (2018). Influence of Age, Planned Pregnancy, Stress and Marital Relationship on Maternal-Infant Attachment in Postpartum Mothers with Inadequate Prenatal Care. Nursing Science Journal of Thailand, 36(3), 34-45. Retrieved from
Research Papers


1. Dexter CA, Wong K, Stacks AM, Beeghly M, Barnett D. Parenting and attachment among
low-income African American and Caucasian preschoolers. J Fam Psychol. 2013;27(4):629-38.
2. Klaus M, Kennell J. Parental - infant bonding. 2nd ed. St. Louis: Mosby; 1982.
3. Ross E. Maternal—fetal attachment and engagement with antenatal advice. Br J Midwifery. 2012;20(8):566-75.
4. Browne K, Whitfield K, Jackson V, Anaut M, Daniunaite I, Herczog M, et al. Child abandonment and its prevention in Europe [internet]. Nottingham: The University of Nottingham; 2012 [cited 2018 Jul 14]: Available from:
5. Wu M, Lagasse LL, Wouldes TA, Arria AM, Wilcox T, Derauf C, et al. Predictors of inadequate prenatal care in methamphetamine-using mothers in New Zealand and the United States. Matern Child Health J. 2013;17(3):566-75.
6. Landry SH, Smith KE, Swank PR. Responsive parenting: establishing early foundations
for social, communication, and independent problem-solving skills. Dev Psychol. 2006;42(4):627-42.
7. Gilbert NL, Casapía M, Joseph SA, Ryan JA, Gyorkos TW. Inadequate prenatal care and
the risk of stillbirth in the Peruvian Amazon. Int J Gynecol Obstet. 2010;109(2):155-6.
8. Lumnium T, Serisathien Y, Pariyaruk P, Phahuwatanakorn W. The study of prevalence of no antenatal care and factors associated with no antenatal care among mothers who delivered at hospitals of Bangkok Metropolitan Administration. Vajira Nursing Journal. 2011;13(1):1-13. (in Thai).
9. Department of Health. Annual report 2. Nonthaburi: Department of Health, Ministry of Public Health; 2014. (in Thai).
10. Debiec KE, Paul KJ, Mitchell CM, Hitti JE. Inadequate prenatal care and risk of preterm delivery among adolescents: a retrospective study over 10 years. Am J Obstet Gynecol. 2010;203(2):122.e1-6.
11. Heaman MI, Gupton AL, Moffatt ME. Prevalence and predictors of inadequate prenatal care: a comparison of aboriginal and non-aboriginal women in Manitoba. J Obstet Gynaecol Can. 2005;27(3):237-46.
12. Ratchaputi A, Chareonsanti J, Kantaruksa K. Situational analysis of inadequate antenatal visits among pregnant women, Ranong Hospital. Nursing Journal. 2011;38(3):20-9. (in Thai).
13. Paredes I, Hidalgo L, Chedraui P, Palma J, Eugenio J. Factors associated with inadequate prenatal care in Ecuadorian women. Int J Gynaecol Obstet. 2005;88(2):168-72.
14. Department of Mental Health, Ministry of Public Health. Relaxation guide. Bangkok: Design Studio; 1998. (in Thai).
15. Sookkavanawat V. Self esteem, maternal perception of newborn behavior, marital relationship and maternal role performance in adolescent mothers during postpartum period [master’ thesis]. Bangkok: Mahidol University; 1998. 126 p. (in Thai).
16. Jongpranee P. Selected factors for social support and maternal-infant attachment in adolescent mothers [master’ thesis]. Bangkok: Mahidol University; 1997. 161 p. (in Thai).
17. Sieger K, Renk K. Pregnant and parenting adolescents: a study of ethnic identity, emotional and behavioral functioning, child characteristics, and social support. J Youth Adolesc. 2007;36(4):567-81.
18. Jaffee S, Caspi A, Moffitt TE, Belsky J, Silva P. Why are children born to teen mothers at risk for adverse outcomes in young adulthood? Results from a 20-year longitudinal study. Dev Psychopathol. 2001;13(2):377-97.
19. Riva Crugnola C, Ierardi E, Gazzotti S, Albizzati A. Motherhood in adolescent mothers: maternal attachment, motherinfant styles of interaction and emotion regulation at three months. Infant Behav Dev. 2014;37(1):44-56.
20. Esma G, Oznur K, Kamile K. Identification of factors affecting mother-infant bonding in advanced maternal age. Lupine Online Journal of Nursing & Health Care [Internet]. 2018 Feb 6 [cite 2018 May 11];1(1):1-8. Available from
21. Kwon MK, Bang KS. Relationship of prenatal stress and depression to maternal-fetal attachment and fetal growth. J Korean Acad Nurs. 2011;41(2):276-83.
22. Kinsey CB, Baptiste-Roberts K, Zhu J, Kjerulff KH. Birth-related, psychosocial, and emotional correlates of positive maternal-infant bonding in a cohort of first-time mothers. Midwifery. 2014;30(5):188-94.
23. Reeder S, Martin L, Koniak-Griffin D. Maternity nursing: family newborn and women’s health care. 18th ed. Philadelphia: Lippincott Williams and Wilkins; 1996.