Cette étude a pour objectif d’investiguer dans quelle mesure les stratégies d’attachement des futures mères ont un impact sur leur symptomatologie dépressive, leurs représentations maternelles et leur attachement maternofœtal.

Deux cent douze femmes enceintes ont été sollicitées à participer à l’étude lors de visites prénatales dans deux maternités parisiennes. Elles ont complété des mesures permettant d’évaluer : les stratégies d’attachement (Relationship Scale Questionnaire), l’attachement prénatal (Prenatal Attachment Inventory), la dépression prénatale (Edinburgh Postnatal Depression Scale) et les représentations que les femmes enceintes ont d’elles-mêmes et de leur futur enfant (échelles de l’Entretien R).

Les stratégies d’attachement permettent de prédire une faible part, mais significative, de la variance de la symptomatologie dépressive, de la qualité plus ou moins positive des représentations maternelles et de l’intensité de l’attachement prénatal des femmes enceintes envers leur fœtus. Par ailleurs, plus les scores d’attachement sécure sont élevés, plus les représentations maternelles sont positives. L’attachement sécure est en revanche négativement corrélé aux symptômes dépressifs, alors que ces derniers sont positivement corrélés aux stratégies d’attachement insécures (craintives et préoccupées). Enfin, contrairement à des études précédentes, notre étude montre que l’attachement préoccupé est positivement corrélé à l’attachement maternofœtal.

Les stratégies d’attachement de la femme enceinte jouent un rôle dans la façon dont elle vit sa grossesse, imagine son bébé et se projette en tant que mère. Les symptômes dépressifs, les représentations maternelles et l’attachement maternofœtal sont en partie prédits par les stratégies d’attachement des femmes enceintes. En tant qu’indicateurs du type de soutien dont elles ont besoin, la prise en compte des stratégies d’attachement des femmes enceintes peut contribuer à la proposition d’un accompagnement ajusté, à prévenir des symptômes de détresse psychologique et à améliorer le vécu de la grossesse.

Pregnancy is a developmental crisis with multiple impacts on the mother-to-be and the unborn baby. The psychic dynamics of the pregnant woman can, in turn, have a considerable effect on the bond between mother and fetus, and on the mother's behavior and mental health after childbirth. A woman's bond with her child develops during pregnancy, and is accompanied by the representations she develops of herself as a future mother, and of her future baby. Pregnancy is a time of great vulnerability, as evidenced by the frequency and intensity of depressive symptoms. Because of this vulnerability, the perinatal period activates the pregnant woman's attachment system. The aim of this study is therefore to investigate the extent to which the attachment strategies of mothers-to-be have an impact on their depressive symptomatology, their maternal representations and their prenatal attachment (maternal-fetal bond). To our knowledge, no study has jointly evaluated these variables.

Two hundred and twelve pregnant women have been invited to participate in the study during their prenatal appointments in two Parisian maternities in France. They completed questionnaires and scales assessing, respectively: attachment strategies (Relationship Scale Questionnaire [RSQ]), prenatal attachment (Prenatal Attachment Inventory [PAI]), prenatal depression (Edinburgh Postnatal Depression Scale [EPDS]), and representations of themselves as future mothers and of their future children (scales from the Stern's R Interview).

Mothers mean age is 32 years. Most participants have higher education qualifications (81.13%), compared with 59.4% of women in the French general population, according to data from the latest French national perinatal survey in 2021. Overall, 84.9% of the women in our sample are employed, also a higher proportion than in the general population of French women (67.9%). Similarly, 46.23% of the women are managers, compared with 17.8% of women in the general population. With regard to obstetrical data, 38.68% of women in our sample are primiparous, compared with 41.3% in the general population. Women are at an average of 28.35 weeks’ amenorrhea at the time of their participation in the study (SD=7.88; min=12; max=42). Nearly a quarter of women (24.06%) report having experienced complications in previous pregnancies, as well as in the current pregnancy. Regarding attachment strategies, participants have a slightly higher mean than the general population in the French validation study of the RSQ for the secure strategies (m=3.2>m=3.13), and lower for fearful (m=2.6<3), preoccupied (m=2.78<2.97) and detached (m=2.87<3.22) strategies. Prenatal attachment scores range from 10 to 80, with a mean of 56.42 (SD=11.53), slightly lower than in the French validation study of the PAI (m=60.11). With regard to depressive symptomatology, EPDS scores range from 0 to 24 (m=6.99, SD=4.53) and 20.76% of women show depressive symptoms. Women's representations of their future child are globally more positive than those they elaborate of themselves as future mothers. Attachment strategies predict a small but significant proportion of the variance of depressive symptomatology, the more or less positive quality of maternal representations and the intensity of the prenatal bond of pregnant women to their fetus. The more secure the attachment is, the more positive the maternal representations are. In addition, secure attachment is negatively related to depressive symptoms, while these latter are positively correlated with insecure fearful and preoccupied attachment strategies. With regard to pregnancy term, in line with previous research, this study confirms that maternal-fetal attachment increases as pregnancy progresses. Finally, contrary to previous research, preoccupied attachment is positively correlated with prenatal attachment.

A pregnant woman's attachment strategies play a role in how she experiences her pregnancy, imagines her baby and projects herself as a mother. Depressive symptoms, maternal representations and maternal-fetal attachment are partly predicted by pregnant women's attachment strategies. As indicators of the type of support they need, taking pregnant women's attachment strategies into account can contribute to the provision of appropriate support, help prevent symptoms of psychological distress and improve the experience of pregnancy.