The impact of maternal adverse childhood experiences and prenatal depressive symptoms on foetal attachment: Preliminary evidence from expectant mothers across eight middle-income countries

Mothers from middle-income countries (MIC) are estimated to have higher rates of adverse childhood experiences (ACEs) and depression during pregnancy compared to mothers from high income countries. Prenatal depression can adversely impact on a mother's feelings towards her foetus and has thus been hypothesised to be partially responsible for intergenerational transmission of risk associated with maternal ACEs. However, the extent to which prenatal depressive symptoms mediate the association between maternal ACEs and foetal attachment is unknown. The current study investigated this question in a multi-country sample of mothers in their third trimester of pregnancy. Expectant mothers (n = 1,185) from eight MICs completed measures of foetal attachment, ACEs and prenatal depression. Full-sample path mediation analyses, adjusting for relevant covariates, suggested an overall full mediating effect of prenatal depression, as the relationship between ACEs and foetal attachment became non-significant when adding maternal depression as a mediator. However, at the individual-country level, both positive and negative effects of ACEs on foetal attachment were observed after the inclusion of depressive symptoms as a mediator, suggesting that cultural and geographical factors may influence a mother’s empathic development after ACE exposure. The findings reinforce the importance of screening for prenatal depression during antenatal care in MICs. Addressing prenatal depression within maternal health care may support foetal attachment and contribute to reducing the intergenerational transmission of disadvantage.