The Relationship between Spousal Support Levels in Pregnant Women Diagnosed with Threatened Preterm Labor and Prenatal Attachment: Decision Tree Model

Öz

Objective: This study aimed to examine the relationship between perceived spousal support and prenatal attachment among pregnant women diagnosed with threatened preterm labor. Materials and Methods: The sample of this cross-sectional study consisted of pregnant women hospitalized and followed in the perinatology clinic of a state hospital between May and December 2024. Data were collected using a Personal Information Form, the Spousal Support Scale, and the Prenatal Attachment Inventory. Regression tree analysis was applied, and the Chi-squared Automatic Interaction Detection (CHAID) method was employed as the decision tree technique. The study was completed with a total of 213 participants. Results: The analysis revealed statistically significant differences between educational level, number of children, planned pregnancy status, and spousal support scale scores with prenatal attachment scores (p<0.05). Findings indicated that women with higher perceived spousal support and planned pregnancies exhibited stronger prenatal attachment, highlighting the positive influence of social support on prenatal bonding. Conclusion: In women experiencing pregnancy complications such as threatened preterm labor, the importance of spousal support in promoting prenatal attachment should be emphasized. The spouse represents a critical source of social support, and both the partner’s and other social support sources’ roles should be considered during prenatal follow-up. Nurses can effectively enhance maternal-fetal bonding and improve psychosocial adaptation in high-risk pregnancies by incorporating these support mechanisms into prenatal care interventions.

Anahtar Kelimeler

• Prenatal attachment
• preterm labour
• risky pregnancy
• spousal support

Etik Beyan

Ethical approval for the study was obtained from the Van Yüzüncü Yıl University Non-Interventional Clinical Research Ethics Committee (Date: 10/05/2024; decision No: 2024/05-02), and institutional permission was obtained from the hospital where the study was conducted. Mothers were informed about the study, and their verbal consent was obtained in accordance with the principle of “Informed Consent,” stating that they were free to participate or not participate in the study, the principle of “Respect for Autonomy,” and the principle of “Confidentiality and Protection of Confidentiality,” stating that the information they provided would remain confidential. The study was conducted in accordance with the Declaration of Helsinki on Human Rights to ensure the protection of participants’ personal rights.

Teşekkür

We would like to thank all the pregnant women who participated in the study for their support.

Erken Doğum Tehdidi Tanısı Almış Gebelerin Eş Destek Düzeyleri ile Prenatal Bağlanma Arasındaki İlişki: Karar Ağacı Modeli

Öz

Amaç: Bu çalışmada, erken doğum tehdidi tanısı almış gebelerde algılanan eş desteği düzeylerinin prenatal bağlanma ile ilişkisi incelenmiştir. Materyal ve Metot: Kesitsel tasarımlı çalışmanın örneklemini, Mayıs-Aralık 2024 tarihleri arasında bir devlet hastanesinin perinatoloji kliniğinde yatarak takip edilen gebeler oluşturmuştur. Verilerin toplanmasında Kişisel Bilgi Formu, Eş Desteği Ölçeği ve Prenatal Bağlanma Envanteri kullanılmıştır. Analizlerde regresyon ağacı yöntemi uygulanmış ve karar ağacı metodu olarak Chi-squared Automatic Interaction Detection (CHAID) yöntemi tercih edilmiştir. Çalışma toplam 213 gebe ile tamamlanmıştır. Bulgular: Analiz sonuçları, eğitim düzeyi, çocuk sayısı, planlı gebelik durumu ve eş desteği ölçeği puan ortalamaları ile prenatal bağlanma puan ortalamaları arasında istatistiksel olarak anlamlı farklılıklar olduğunu göstermiştir (p<0,05). Bulgular, yüksek algılanan eş desteğine ve planlı gebeliğe sahip kadınların prenatal bağlanma düzeylerinin daha güçlü olduğunu ortaya koymakta, sosyal desteğin prenatal bağlanmayı olumlu etkilediğini vurgulamaktadır. Sonuç: Erken doğum tehdidi gibi gebelik komplikasyonları yaşayan kadınlarda, prenatal bağlanmayı desteklemek için eş desteğinin önemi öne çıkmaktadır. Eş, kritik bir sosyal destek kaynağı olarak değerlendirilmeli ve doğum öncesi izlemlerde hem eşin hem de diğer sosyal destek kaynaklarının rolü dikkate alınmalıdır. Hemşireler, prenatal bakım uygulamalarında bu desteği dahil ederek, maternal-fetal bağlanmayı güçlendirecek ve yüksek riskli gebeliklerde annenin psikososyal uyumunu artıracak müdahaleleri etkin bir şekilde sağlayabilir.

Anahtar Kelimeler

• Erken doğum
• eş desteği
• prenatal bağlanma
• riskli gebelik

Etik Beyan

Çalışma için Van Yüzüncü Yıl Üniversitesi Girişimsel Olmayan Klinik Araştırmalar Etik Kurulu'ndan etik kurul onayı (Tarih: 10/05/2024; Karar No: 2024/05-02) ve çalışmanın yürütüldüğü hastaneden kurumsal izin alınmıştır. Anneler çalışma hakkında bilgilendirilmiş; çalışmaya katılıp katılmama konusunda özgür olduklarını belirten "Bilgilendirilmiş Onam" ilkesi, "Özerkliğe Saygı" ilkesi ve sağladıkları bilgilerin gizli kalacağını ifade eden "Gizlilik ve Gizliliğin Korunması" ilkesi doğrultusunda sözlü onamları alınmıştır. Çalışma, katılımcıların kişisel haklarının korunmasını sağlamak amacıyla Helsinki Bildirgesi'ne uygun olarak yürütülmüştür.

Teşekkür

Çalışmaya katılan tüm hamile kadınlara destekleri için teşekkür ederiz.

Kaynakça

1. 1. Hanko C, Bittner A, Junge-Hoffmeister J, Mogwitz S, Nitzsche K, Weidner K. Course of mental health and mother–infant bonding in hospitalized women with threatened preterm birth. Archives of Gynecology and Obstetrics. 2020;301(1):119-128. doi:10.1007/s00404-019-05406-3
2. 2. Bedaso A, Adams J, Peng W, Sibbritt D. The relationship between social support and mental health problems during pregnancy: a systematic review and meta-analysis. Reproductive Health. 2021;18(1):162. doi:10.1186/s12978-021-01209-5
3. 3. Ahmed AM, Grandi SM, Pullenayegum E, et al. Short-term and long-term mortality risk after preterm birth. JAMA Network Open. 2024;7(11):e2445871-e2445871. doi:10.1001/jamanetworkopen.2024.45871
4. 4. Bergeron J, Avraam D, Calas L, et al. Stress and anxiety during pregnancy and length of gestation: a federated study using data from five Canadian and European birth cohorts. European journal of epidemiology. 2024;39(7):773-783. doi:10.1007/s10654-024-01126-4
5. 5. Kural B. The effect of spouse support on pregnancy and birth fear in the pregnancy period. University of Health Sciences, Hamidiye Institute of Health Sciences, Department of Midwifery, Master's Degree Thesis. Istanbul, Türkiye. 2021.
6. 6. Li M, Fang Y, Liu M, et al. Dyadic coping and associated factors in women with high-risk pregnancy and their spouses: Do they interact? Midwifery. 2024;134:104006. doi:10.1016/j.midw.2024.104006
7. 7. Küçükkaya B, Süt HK, Öz S, Sarıkaya NA. The Relatıonshıp Between Dyadıc Adjustment and Prenatal Attachment in Pregnancy. Acibadem University Journal of Health Sciences. 2020;(1):102-110. doi:10.31067/0.2020.246
8. 8. Choe JH, Yun SJ, Kim HY. High-risk pregnancy nursing: Analyzing the impact of prenatal stress, maternal-fetal attachment, and social support on prenatal depression. The Open Nursing Journal. 2024;18(1):1-10. doi:10.2174/0118744346318130240620115100

9. 9. Siebach KF, Park S, Mansoor M, et al. The association of spousal relationship quality and social support with maternal‐ınfant bonding: moderating roles of maternal age and paternal occupation. Infancy. 2025;30(1):e12647. doi:10.1111/infa.12647
10. 10. Yurdakul M, Beşen MA, Alıcı D. Development of the Perception of Spousal Support in Pregnancy Scale (PSSPS): Reliability and validity studies. Journal of Education & Research in Nursing. 2020;17(3):258-266.
11. 11. De Waal N, Boekhorst MG, Nyklíček I, Pop VJ. Maternal-infant bonding and partner support during pregnancy and postpartum: Associations with early child social-emotional development. Infant Behavior and Development. 2023;72:101871. doi:10.1016/j.infbeh.2023.101871
12. 12. Yüksekal Z, Yurdakul M. Spouse support perception of pregnants and associeted factors. Turkish Journal of Family Medicine and Primary Care. 2021;15(4):800-808.
13. 13. Yıldırım İ. Development of the Spousal Support Scale. Turkish Psychological Counseling and Guidance Journal. 2004;3(22):19-26.
14. 14. Muller ME, Mercer RT. Development of the prenatal attachment inventory. Western journal of nursing research. 1993;15(2):199-215.
15. 15. Yilmaz SD, Beji NK. Effects of perinatal loss on current pregnancy in Turkey. Midwifery. 2013;29(11):1272-1277.
16. 16. Özbek Z, Beydağ KD. The relationship between spousal support and pregnancy stress in high-risk pregnant women. Mersin University Journal of Health Sciences. 2021;15(2):144-155.
17. 17. Güleroğlu FT, Onat T. The Perception of Spousal Support in Pregnant Women and Pregnancy Symptoms. Gümüşhane University Journal of Health Sciences, 2023;12(2):416-424.
18. 18. Harpel TS, Barras KG. The impact of ultrasound on prenatal attachment among disembodied and embodied knowers. Journal of Family Issues. 2023;39(6):1523-1544.
19. 19. Uğurlu M, Arslan G, Özdemir Ö. Maternal and paternal attachment levels in the prenatal period. Gulhane Medical Journal. 2023;65(3):108-114.
20. 20. Badem A, Zeyneloğlu S. Determination of Prenatal Attachment Levels of Pregnant Women and Affecting Factors. Kırşehir Ahi Evran University Journal of Health Sciences. 2021;1(1):37-47.
21. 21. Tunçel NT, Süt HK. The Effect of Anxiety, Depression and Prenatal Distress Levels in Pregnancy on Prenatal Attachment. The Journal of Gynecology-Obstetrics and Neonatology. 2019;16(1):9-17.
22. 22. Ponti L, Smorti M, Ghinassi S, Tani F. The relationship between romantic and prenatal maternal attachment: The moderating role of social support. International Journal of Psychology. 2021;56(1):143-150.
23. 23. Ataman H, Akarsu Ö, Budak Mİ. Determining the Relationship Between Marital Adjustment and Prenatal Attachment in High-Risk Pregnants in the Third Trimester. Turkish Journal of Family Medicine and Primary Care. 2022;16(4):670-680.
24. 24. Shiraishi N, Murakami M, Goto Y, Kitamura T. Intergenerational transmission of child‐rearing styles mediated by adult attachment: A structural equation model approach. Psychiatry and Clinical Neurosciences Reports. 2022;1(3):e22. doi:10.1002/pcn5.22
25. 25. Zaki N, García AMRR, Puga JL. Attachment style and prenatal expectations from a Bayesian perspective. Psicothema. 2020;32(1):138-144.
26. 26. Nordahl D, Rognmo K, Bohne A, et al. Adult attachment style and maternal-infant bonding: the indirect path of parenting stress. BMC Psychology. 2020;8:1-11. doi:10.1186/s40359-020-00424-2