{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T17:50:31Z","timestamp":1784569831998,"version":"3.55.0"},"reference-count":59,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2023,10,19]],"date-time":"2023-10-19T00:00:00Z","timestamp":1697673600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>The process of adaptation of the woman to pregnancy seems to be influenced by many factors, such as the type of conception, the mother\u2019s age, the possible presence of other children, and socio-cultural factors. Women who conceived with an assisted reproductive technique are emotionally vulnerable; compared with pregnant women who procreated naturally, they manifest elevated anxiety, which seems to be correlated to the fright of being separated from their child. Objectives of the present research are as follows: (1) to analyze the relationship between age, gestational age, time expectancy, previous failed attempts, perception of a high-risk pregnancy, and presence of other children, with the level of maternal\u2013fetal attachment (MFA); (2) explore the level of maternal\u2013infant attachment and anxiety by comparing the control and experimental group; (3) to measure a possible relationship between anxiety levels and MFA in ART pregnant women; (4) to identify variables predictive of prenatal attachment. The study group is formed by ninety-five women aged between 18\u201342 years (M = 30.57; S.D. = 5.47), pregnant from the 23rd to the 37th week (M = 28.95; S.D. = 3.99); on which 50 women who procreate naturally and 45 pregnant women following assisted reproductive technology. They completed: Maternal\u2013Fetal Attachment Scale (MFAS), State\u2013Trait Anxiety Inventory (STAI), and ad hoc questionnaire to collect anamnestic data. The results show the presence of a correlation between gestational age and waiting period, between the number of assisted fertilization attempts with the worry about their ability to become pregnant, but a negative correlation between pregnancy weeks and the level of maternal\u2013fetal attachment. The study shows the predictive role of anxiety on the MFA. The applications and indications for future research are analyzed.<\/jats:p>","DOI":"10.3390\/ijerph20206945","type":"journal-article","created":{"date-parts":[[2023,10,19]],"date-time":"2023-10-19T11:46:26Z","timestamp":1697715986000},"page":"6945","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Precursors of Prenatal Attachment and Anxiety during Pregnancy in Women Who Procreate Naturally and Pregnant Women following Assisted Reproduction Technology"],"prefix":"10.3390","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8816-8905","authenticated-orcid":false,"given":"Monica","family":"Pellerone","sequence":"first","affiliation":[{"name":"Faculty of Human and Social Sciences, Kore University of Enna, 94100 Enna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4854-0175","authenticated-orcid":false,"given":"Juan","family":"Martinez-Torvisco","sequence":"additional","affiliation":[{"name":"Department of Cognitive, Social and Organizational Psychology, La Laguna University, 38200 Santa Cruz de Tenerife, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stesy Giuseppa","family":"Razza","sequence":"additional","affiliation":[{"name":"Faculty of Human and Social Sciences, Kore University of Enna, 94100 Enna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Commodari","sequence":"additional","affiliation":[{"name":"Department of Educational Sciences, University of Catania, 95126 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Miccich\u00e8","sequence":"additional","affiliation":[{"name":"Faculty of Human and Social Sciences, Kore University of Enna, 94100 Enna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,10,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"102","DOI":"10.5603\/GP.a2018.0017","article-title":"The phenomenon of pregnancy\u2014A psychological view","volume":"89","author":"Bjelica","year":"2018","journal-title":"Ginekol. Pol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1111\/ppc.12494","article-title":"Developing compassion and emotional intelligence in nursing students: A quasi-experimental study","volume":"56","author":"Teskereci","year":"2020","journal-title":"Perspect. Psychiatr. Care"},{"key":"ref_3","unstructured":"Stern, D.N. (1995). La Costellazione Materna. Il Trattamento Psicoterapeutico Della Coppia Madre-Bambino. [The Mother Constellation. The Psychotherapeutic Treatment of the Mother-Child Couple], Boringhieri Editore."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1017\/S0033291700013854","article-title":"The influence of childbirth on psychiatric morbidity","volume":"6","author":"Kendell","year":"1976","journal-title":"Psychol. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"653098","DOI":"10.1100\/2012\/653098","article-title":"Frequency and associated factors for anxiety and depression in pregnant women: A hospital-based cross-sectional study","volume":"2012","author":"Ali","year":"2012","journal-title":"Sci. World J."},{"key":"ref_6","first-page":"29","article-title":"Demographic andmedical consequences of the postponement of parenthood","volume":"18","author":"Schmidt","year":"2012","journal-title":"Hum. Reprod."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1093\/oxfordjournals.humrep.a019276","article-title":"Impact of the in-vitro fertilization process onemotional, physical and relational variables","volume":"11","author":"Boivin","year":"1996","journal-title":"Hum. Reprod."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/j.bpobgyn.2006.12.003","article-title":"Psychological impact of infertility","volume":"21","author":"Cousineau","year":"2007","journal-title":"Best Pract. Res. Clin. Obstet. Gynaecol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1080\/02646830802350864","article-title":"Theimpact of infertility diagnosis on psychological status of women undergoingfertility treatment","volume":"27","author":"Lykeridou","year":"2009","journal-title":"J. Reprod. Infant Psychol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1371\/journal.pone.0063743","article-title":"Stress and Anxiety Scores in First and Repeat IVF Cycles: A PilotStudy","volume":"8","author":"Turner","year":"2013","journal-title":"PLoS ONE"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1097\/00005721-200005000-00007","article-title":"Enhancing parent-child interaction with a prenatal couple intervention. MCN: The American","volume":"25","author":"Bryan","year":"2000","journal-title":"J. Matern.\/Child. Nurs."},{"key":"ref_12","unstructured":"Deutsch, H. (1945). Psicologia Della Donna Adulta E Madre. Studio Psicoanalitico. [Psychology of the Adult Woman and Mother. Psychoanalytic Study], Boringhieri."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"985173","DOI":"10.3389\/fsoc.2023.985173","article-title":"Filio-parental violence analyzed through the Spanish press (2010\u20132020). Child-to-parent violence: A case of family violence","volume":"8","author":"Torvisco","year":"2023","journal-title":"Front. Sociol."},{"key":"ref_14","unstructured":"Winnicott, D.W. (1958). Dalla Pediatria Alla Psicoanalisi. [From Pediatrics to Psychoanalysis], Martinelli."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1080\/0264683021000033174","article-title":"The role of maternal prenatal attachment in a woman\u2019s experience of pregnancy and implications for the process of care","volume":"20","author":"Slade","year":"2002","journal-title":"J. Reprod. Infant Psychol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1111\/j.1365-2648.2004.03349.x","article-title":"Maternal-fetal attachment: An integrative review","volume":"50","author":"Cannella","year":"2005","journal-title":"J. Adv. Nurs."},{"key":"ref_17","first-page":"141","article-title":"Interpersonal attachment styles and body dysmorphic symptoms in adolescent girls: The mediating role of body image","volume":"20","author":"Heshmati","year":"2023","journal-title":"Clin. Neuropsychiatry"},{"key":"ref_18","first-page":"311","article-title":"The relevance of early psychic development to pregnancy and abortion","volume":"63","author":"Pines","year":"1982","journal-title":"Int. J. Psycho-Anal."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"620942","DOI":"10.3389\/fpsyg.2021.620942","article-title":"Pre-natal attachment and parent-to-infant attachment: A systematic review","volume":"12","author":"Trombetta","year":"2022","journal-title":"Front. Psychol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1080\/02604027.2019.1654770","article-title":"The Psychosomatic Relationship As A Symbolic Circular Communication: Subjective And Transgenerational Dreams","volume":"75","author":"Mannino","year":"2019","journal-title":"World Futures"},{"key":"ref_21","unstructured":"Brazelton, T.B., and Cramer, B.G. (1991). The Earliest Relationship: Parents, Infants, and the Drama of Early Attachment, Addison Wesley Longman."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1093\/humrep\/det029","article-title":"Pregnancy specific anxiety, ART conception and infant temperament at 4 months post-partum","volume":"28","author":"McMahon","year":"2012","journal-title":"Hum. Reprod."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1389","DOI":"10.1093\/humrep\/der076","article-title":"Age at first birth, mode of conception and psychological wellbeing in pregnancy: Findings from the Parental Age and Transition to Parenthood Australia (PATPA) Study","volume":"26","author":"McMahon","year":"2011","journal-title":"Hum. Reprod."},{"key":"ref_24","first-page":"29","article-title":"Trasformazione della coppia nel percorso verso la genitorialit\u00e0 adottiva. [Transformation of the couple on the path to adoptive parenthood]","volume":"1","author":"Santona","year":"2003","journal-title":"Minor. Giust."},{"key":"ref_25","first-page":"12","article-title":"Il corpo femminile e il mondo interno [The female body and the internal world]","volume":"41","author":"Galasso","year":"2017","journal-title":"Riv. Di Sessuol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"33","DOI":"10.3280\/PSD2010-001002","article-title":"Assisted reproduction and maternal representations during pregnancy Aims","volume":"1","author":"Smorti","year":"2010","journal-title":"Psicol. Della Salut."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"96","DOI":"10.5539\/gjhs.v8n5p96","article-title":"Factors associated with marital satisfaction in infertile couple: A comprehensive literature Review","volume":"8","author":"McCarthy","year":"2015","journal-title":"Glob. J. Health Sci."},{"key":"ref_28","first-page":"109","article-title":"Strategie Di Coping Nelle Coppie Infertili. [Coping Strategies in Infertile Couples]","volume":"5","year":"2010","journal-title":"Psicoter.-Form."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1016\/j.fertnstert.2007.11.052","article-title":"Well-being and relationship satisfaction of couples dealing with an in vitro fertilization\/intracytoplasmic sperm injection procedure: A multilevel approach on the role of self-criticism, dependency, and romantic attachment","volume":"91","author":"Lowyck","year":"2009","journal-title":"Fertil. Steril."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"719","DOI":"10.2307\/3178673","article-title":"Non-motherhood: Ambivalent autobiographies","volume":"25","author":"Letherby","year":"1999","journal-title":"Fem. Stud."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"292","DOI":"10.5964\/ejop.v15i2.1736","article-title":"Extreme Desire for Motherhood: Analysis of Narratives From Women Undergoing Assisted Reproductive Technology (ART)","volume":"7","author":"Langher","year":"2019","journal-title":"Eur. J. Psychol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1034\/j.1600-0412.2003.00040.x","article-title":"Personality factors and emotional responses to pregnancy among IVF couples in early pregnancy: A comparative study","volume":"82","author":"Hjelmstedt","year":"2003","journal-title":"Acta Obstet. Et Gynecol. Scand."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1498","DOI":"10.3109\/10826084.2013.800116","article-title":"A qualitative study of treatment needs among pregnant and postpartum women with substance use and depression","volume":"48","author":"Kuo","year":"2013","journal-title":"Subst. Use Misuse"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1096","DOI":"10.1111\/j.1464-5491.2008.02533.x","article-title":"A longitudinal study of affective and anxiety disorders, depressive affect and diabetes distress in adults with Type 2 diabetes","volume":"25","author":"Fisher","year":"2008","journal-title":"Diabet. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1287","DOI":"10.1002\/pd.4688","article-title":"Anxiety, depression, and attachment before and after the first-trimester screening for Down syndrome: Comparing couples who undergo ART with those who conceive spontaneously","volume":"35","author":"Darwiche","year":"2015","journal-title":"Prenat. Diagn."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1080\/02646838.2019.1705261","article-title":"Prenatal attachment in pregnancy following assisted reproductive technology: A literature review","volume":"38","author":"Ranjbar","year":"2020","journal-title":"J. Reprod. Infant Psychol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"260","DOI":"10.30621\/jbachs.1006052","article-title":"Comparison of the Adaptation to Pregnancy in Women Who Received Infertility Treatment and Those Who Didn\u2019t","volume":"6","author":"Aksu","year":"2022","journal-title":"J. Basic Clin. Health Sci."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"McNamara, J., Townsend, M.L., and Herbert, J.S. (2019). A systemic review of maternal wellbeing and its relationship with maternal fetal attachment and early postpartum bonding. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0220032"},{"key":"ref_39","first-page":"6","article-title":"Prenatal attachment and anxiety: Women who decide to try in vitro fertilization and women who procreate naturally","volume":"4","author":"Pellerone","year":"2014","journal-title":"Psychol. Res."},{"key":"ref_40","first-page":"1","article-title":"Gebelerde depresyon ve anksiyete bozuklu\u011funun obstetrik sonu\u00e7lari ve yenido\u011fan \u00fczerine etkileri","volume":"6","author":"Eskici","year":"2012","journal-title":"Anatol. J. Clin. Investig."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"502","DOI":"10.17826\/cumj.661828","article-title":"Anxiety and prenatal attachment levels in pregnancy and influencing factors","volume":"45","year":"2020","journal-title":"Cukurova Med. J."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Bernstein, D.P., Fink, L., Handelsman, L., and Foote, J. (1994). Childhood Trauma Questionnaire (CTQ) [Database Record], APA PsycTests.","DOI":"10.1037\/t02080-000"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1007\/s00737-005-0090-z","article-title":"Neonatal outcomes in offspring of women with anxiety and depression during pregnancy","volume":"8","author":"Berle","year":"2005","journal-title":"Arch. Womens Ment. Health"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1097\/00006199-198109000-00008","article-title":"Development of a tool for the measurement of maternal attachment during pregnancy","volume":"30","author":"Cranley","year":"1981","journal-title":"Nurs. Res."},{"key":"ref_45","unstructured":"Spielberger, C.D., Gorusch, R.L., and Lushene, R. (1970). The State-Trait Anxiety Inventory: Test Manual, American Psychological Association."},{"key":"ref_46","unstructured":"Pedrabissi, L., and Santinello, M. (1989). Verifica Della Validit\u00e0 Dello STAI Forma Y di Spielberger, Giunti Organizzazioni Speciali."},{"key":"ref_47","unstructured":"Stehlik-Barry, K., and Bebinec, A.J. (2017). Data Analysis with IBM SPSS Statistics, Packt Publishing Ltd."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1080\/02646839608404510","article-title":"Pregnancy after 35 and attachment to the fetus","volume":"14","author":"Berryman","year":"1996","journal-title":"J. Reprod. Infant Psychol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1177\/105477389400300407","article-title":"Mother-daughter and husband-wife attachment as predictors of psychological well-being during pregnancy","volume":"3","author":"Zachariah","year":"1994","journal-title":"Clin. Nurs. Res."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1016\/S0029-6465(22)02505-1","article-title":"Prenatal and neonatal testing and screening: A double-edged sword","volume":"35","author":"Kenner","year":"2000","journal-title":"Nurs. Clin. N. Am."},{"key":"ref_51","first-page":"299","article-title":"Reflections about the impact of infertility on female sexual function","volume":"14","author":"Rapisarda","year":"2016","journal-title":"Kathmandu Univ. Med. J."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/j.ijgo.2015.03.044","article-title":"Anxiety and depression after failure of assisted reproductive treatment among patients experiencing infertility","volume":"130","author":"Maroufizadeh","year":"2015","journal-title":"Int. J. Gynaecol. Obstet."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1093\/humrep\/dex349","article-title":"Antenatal paternal adjustment and paternal attitudes after infertility treatment","volume":"33","author":"Pinto","year":"2018","journal-title":"Hum. Reprod."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1016\/j.rbms.2017.04.001","article-title":"Psychosocial needs of women and their partners after successful assisted reproduction treatment in Barcelona","volume":"3","author":"Crespo","year":"2016","journal-title":"Reprod. Biomed. Soc. Online"},{"key":"ref_55","first-page":"98","article-title":"The big five personality traits and dispositional mindfulness as predictors of alexithymia in college students","volume":"16","author":"Heshmati","year":"2019","journal-title":"Clin. Neuropsychiatry"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/s41043-019-0167-3","article-title":"First-time mothers\u2019 experiences of pregnancy and birth following assisted reproductive technology treatment in Taiwan","volume":"38","author":"Huang","year":"2019","journal-title":"J. Health Popul. Nutr."},{"key":"ref_57","first-page":"19","article-title":"The role of social support and emotional intelligence on negative mood states among couples during pregnancy: An actor-partner interdependence model approach","volume":"15","author":"Formica","year":"2018","journal-title":"Clin. Neuropsychiatry"},{"key":"ref_58","first-page":"125","article-title":"Relationship between parenting, alexithymia and adult attachment styles: A cross-sectional study on a group of adolescents and young adults","volume":"14","author":"Pellerone","year":"2017","journal-title":"Clin. Neuropsychiatry"},{"key":"ref_59","first-page":"141","article-title":"The role of identity development and decision making process on adult attachment: A cross-national study in Sicilian and andalusian adolescents","volume":"14","author":"Pellerone","year":"2017","journal-title":"Clin. Neuropsychiatry"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/20\/6945\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:10:00Z","timestamp":1760130600000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/20\/6945"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,19]]},"references-count":59,"journal-issue":{"issue":"20","published-online":{"date-parts":[[2023,10]]}},"alternative-id":["ijerph20206945"],"URL":"https:\/\/doi.org\/10.3390\/ijerph20206945","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,19]]}}}