ANGELES UNIVERSITY FOUNDATION

COLLEGE OF NURSING

EVIDENCED BASED JOURNAL

“Is Increased Stress Affecting Prenatal

Attachment in High Risk Pregnancies?”

Submitted by:
John Patrick D. Cuenco

Submitted to:
Clinical Instructors
Is Increased Stress Affecting Prenatal Attachment in High Risk Pregnancies? Mehmet Bulbul (a), Berna
Dilbaza , Saadet Boybay Koyuncu (b) , Yurdagul Yagmur (c)
(a) Department of Obstetrics and Gynecology, Adiyaman University Faculty of Medicine, Adiyaman
(b) Department of Midwifery, Adiyaman University Health Sciences High School, Adiyaman
(c) Department of Women's Health and Disease Nursing, Inonu University Nursing Faculty, Malatya
Journal of Medical Practice and Review 2:8 (2018) Everant.in/index.php/jmpr Journal of Medical Practice
and Review Available online at http://jmpr.info/index.php/jmpr/index

Introduction
Although pregnancy is a natural phenomenon, it leads to neuroendocrine, hormonal, and
psychosocial changes that makes this period of women’s life quite different from other periods of her life.
In addition to the biological and physiological changes in pregnancy, various conflicting thoughts, hope
and expectations emerge depending on the emotional, vital and social status of the women. For this
reason, there is an escalated risk of encountering many factors that might cause anxiety and stress during
pregnancy. In high-risk pregnancies, worries about the health status of the mother and the offspring and
the outcome of the pregnancy augments the stress and the anxiety. High-risk pregnancy is defined as a
condition that affects the physiological and psychosocial health of the mother and the baby, increasing
the risk of mortality and morbidity. The increased stress experienced in high-risk pregnancies might affect
the establishment of a strong bond between the mother and the baby in the prenatal period.

Summary
The study was carried out between April 01, 2016 and July 31, 2016 in Adiyaman University Faculty
of Medicine, Training and Research Hospital, Department of Obstetrics and Gynecology. In this descriptive
study, the sample size; the 5% error level was calculated to be 282 with 0.89 representing power in the
95% confidence interval. Sample selection was performed using simple random sampling method. Among
pregnant women admitted to our clinic between the given dates 282 pregnant women who were literate,
psychologically healthy, did not have any communication difficulty and mental impairment, and accepted
to participate in the study by giving a signed informed consent and had a viable singleton pregnancy with
a gestational age > 20 week were included to the study. Following inclusion criteria out of 282 who were
eligible, 87 women were taken as normal pregnancy group and 195 were included in the high risk
pregnancy group.
 The data was obtained by a single investigator through face-to-face interviews with eligible
pregnant women who agreed to participate in the study. The interviews were conducted in a quiet room
other than the examination room and were not scheduled at the day of the antenatal examination or
medical treatment. Demographic, obstetric characteristics and the mode and delivery of the pregnant
women were recorded. Perceived Stress Scale (PSS) and Prenatal Attachment Inventory (PAI) tests were
applied to all of the patients in both groups.
The socio-demographic characteristics of the groups are given in Table 1. According to this, in the
highrisk pregnancy group, the average age, gravida, parity, abortion and number of living children were
higher than the control group. However, no statistically significant difference was found between the two
groups in terms of educational status of the women and their spouses, working rates of the pregnant
women, monthly income perception levels, planned pregnancy rates, average gestational weeks at the
time of evaluation, gender of the infants and number of ante-natal visits. When perceived stress and
prenatal attachment were assessed according to subgroups: Perceived stress was similar in women aged
≤ 35 and women > 35 but prenatal attachment was significantly lower in women > 35. Perceived stress
was statistically significantly higher and prenatal attachment statistically significantly lower in in women
with unplanned pregnancies.

Conclusion
The study perceived stress was found to be increased in high-risk pregnancies, while having a
high-risk pregnancy did not affect prenatal bonding. It was shown that the factors that increase perceived
stress in pregnancy are low educational or economic status, unemployment of the women, having an
unplanned pregnancy and increased number of pregnancies. Factors that affect the prenatal bonding
negatively are; advanced maternal age, unplanned pregnancy, and low socioeconomic level, increased
number of pregnancies, low educational status and smoking during pregnancy. The limitation of this study
is the limited number of women recruited. In order to generalize the findings of this study multicentric
studies with higher numbers of women are required.

Recommendation
I recommend this study to all health care provider especially to those who are handling obstetric
to have more or enhance their knowledge about prenatal stress and mothers who are high risk pregnancy.
This study can also strengthen the collaboration between the health care providers coming from different
professions so that they can give optimal care for their patient. I also recommend this study to my fellow
nursing students so that they may also have knowledge about the said study when they are assigned in
obstetric areas so that they may able to manage well cases like this. And lastly, this study is recommended
to all prenatal women as well as the women who are planning to become pregnant that they may be
prepared and knowledgeable on what are the possible risks and complications.