Apego materno-fetal em gestantes: estudos psicométricos e fatores inter-relacionados

Abstract

During gestation, it starts the maternal-fetal attachment, the affective bond between the pregnant woman and the fetus that surrounds behaviors of parenthood and interaction. The maternal-fetal attachment embodies expectations, emotions, thoughts and attitudes regarding the fetus, pregnancy, and motherhood. It concerns a subjective construct that demands epidemiological evidence and should be investigated through valid and reliable instruments. This study aimed to investigate maternal-fetal attachment in pregnant women assisted by the teams of Estratégia Saúde da Família. Cross-sectional data from the study “Estudo ALGE – Avaliação das Condições de Saúde das Gestantes de Montes Claros – MG: estudo longitudinal” were used. This study was performed from October of 2018 through November of 2019 in Montes Claros’ urban area, a city located in northern Minas Gerais- Brazil. Data from the women’s second and third pregnancy trimesters were analyzed, assessing a sample of 937 participants. This thesis presents four scientific articles and one technological product. In the first article, the psychometric properties of the Brazilian version of the Maternal-Fetal Attachment Scale were examined. It was a methodological study in which psychometric sensibility, construct validity, criteria validity and reliability were analyzed. The instrument reached an appropriate psychometric sensibility. It was observed that there were reasonable indicators of model fit quality. The hypothesis’ test pointed out relations between the attachment and the analyzed variables. Significant correlations with the stress and depressive symptoms demonstrated the validity of divergent criteria. A Cronbach alpha of 0.874 was registered. In the second methodological study, an abbreviated version of the Maternal-Fetal Attachment Scale was proposed and validated. A 15-item three-factor version was obtained and showed satisfactory results in construct validation, convergent and discriminant. The reliability was appropriate. In the third study, the maternal-fetal attachment and the interrelated factors were analyzed. It was a cross sectional epidemiological survey, population-based and analytical. Modeling with structural equations was adopted. The maternal-fetal outcome had an average of 92.6 (SD=±15.3). The average level was observed in 575 (61.4%) pregnant women. The adjusted structural model showed that the following factors played a direct effect over the outcome: gestational weeks, household crowding, depressive symptoms, social support and family functionality. The indirect effects of social support and 15 family functionality mediated by depressive symptoms were verified. The fourth article consists of a technical note about the technological product: an online calculator that measures the average variance extracted and the reliability composed by psychometric instruments. The calculator website registration at the Instituto Nacional da Propriedade Industrial was the fifth product. Therefore, the Maternal Fetal Attachment Scale brought up psychometric evidence near the recommended level and been shown to be proper to use in the Primary Health Care scenario. An abbreviated Brazilian version of the instrument showed more acceptable psychometric attributes. A set of interrelationships between maternal-fetal attachment, gestational weeks, household crowding, depressive symptoms, social support and family functionality were evidenced. It is suggested that the Estratégia Saúde da Família offer a prenatal based on integrality and humanization that allow for biopsychosocial well-being during pregnancy and a healthy maternal-fetal attachment.