The Effect of Adverse Childhood Events on Prenatal Attachment

Introduction: Adverse childhood events (ACEs) profoundly affect psychological health, yet their influence on maternal-fetal attachment remains unclear. This study investigates how childhood trauma impacts prenatal bonding, with two aims: (1) to clarify the ACEs-attachment relationship during pregnancy, and (2) to guide preventive interventions by assessing how trauma may disrupt early mother-infant bonding.
Methods: Pregnant women (aged 18-35) receiving care at a state hospital in Istanbul (January-December 2024) were attended the study. Data were collected using: (1) a demographic questionnaire, (2) the Adverse Childhood Events-Turkish Scale (ACE), and (3) the Prenatal Attachment Inventory (PAI). Statistical analyses included descriptive statistics, nonparametric tests (Mann-Whitney U, Kruskal-Wallis), parametric tests (t-tests, ANOVA with post-hoc analyses), and linear regression to examine ACEs' predictive effect on attachment.
Results: The study included 602 pregnant women. The mean age of participants was 25.67 (±3.81) years old, with a mean gestational age of 31.07 (±7.15) weeks; 77.6% had at least a high school education. Smoking and psychiatric history correlated strongly with ACEs (p<0.001). Marriage type, pregnancy planning, and fetal gender significantly affected attachment (p<0.005). Notably, women with divorced parents had higher attachment scores (p=0.006). Contrary to expectations, ACE-exposed women showed stronger prenatal attachment (66.81±10.23) versus non-exposed women (64.60±11.39; p=0.036). Regression analysis showed that ACEs minimally predicted attachment (R²=0.007, p=0.036), and this association was no longer significant after adjusting for psychosocial factors (p=0.079). Planned pregnancy, love marriage and knowledge of fetal gender were associated with higher attachment. Discussion and Conclusion: Regression models showed ACEs had a minimal and clinically negligible effect on prenatal attachment, which became non-significant when psychosocial factors were included.

Keywords: Childhood trauma; Mother-fetus relationship; Post-traumatic growth