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Maternal-Fetal Bonding: Ultrasound Imaging's Role in enhancing This Important Relationship

Authors:
Aparna Atluru
Aparna Atluru
Aparna Atluru
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Kallie Appleton
Kallie Appleton
Kallie Appleton
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Sanja Kupesic Plavsic at Texas Tech University Health Sciences Center
Sanja Kupesic Plavsic
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Abstract

New technology in ultrasound imaging is allowing women to view more visually precise images of their fetuses than ever before. Maternal-fetal bonding describes the attachment interaction that forms between a mother and her unborn child. Ultrasound diagnosis modalities including two-dimensional (2D), three-dimensional (3D) and four-dimensional (4D) may create differences in the amount of maternal-fetal bonding, depending on the modality used. When relevant literature was reviewed on this topic, no significant difference between maternal-fetal bonding was found when comparing 2D vs 3D vs 4D ultrasound. However, certain measures such as a perceived feeling of closeness to the baby were higher with 3D and 4D ultrasounds as compared with 2D ultrasound. Further exploration is needed to ascertain whether different ultrasound modalities have an effect on maternal-fetal bonding in multigestational pregnancies, pregnancies in which there is fetal demise, and to overall examine the effects of using ultrasound for nonmedical ‘entertainment’ purposes by prospective mothers. How to cite this article Atluru A, Appleton K, Kupesic Plavsic S. Maternal-Fetal Bonding: Ultrasound Imaging's Role in enhancing This Important Relationship. Donald School J Ultrasound Obstet Gynecol 2012;6(4):408-411.
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408 JAYPEE
Aparna Atluru et al
REVIEW ARTICLE
Maternal-Fetal Bonding: Ultrasound Imaging’s Role in
enhancing This Important Relationship
Aparna Atluru, Kallie Appleton, Sanja Kupesic Plavsic
10.5005/jp-journals-10009-1263
ABSTRACT
New technology in ultrasound imaging is allowing women to
view more visually precise images of their fetuses than ever
before. Maternal-fetal bonding describes the attachment
interaction that forms between a mother and her unborn child.
Ultrasound diagnosis modalities including two-dimensional (2D),
three-dimensional (3D) and four-dimensional (4D) may create
differences in the amount of maternal-fetal bonding, depending
on the modality used. When relevant literature was reviewed
on this topic, no significant difference between maternal-fetal
bonding was found when comparing 2D vs 3D vs 4D ultrasound.
However, certain measures such as a perceived feeling of
closeness to the baby were higher with 3D and 4D ultrasounds
as compared with 2D ultrasound. Further exploration is needed
to ascertain whether different ultrasound modalities have an
effect on maternal-fetal bonding in multigestational pregnancies,
pregnancies in which there is fetal demise, and to overall
examine the effects of using ultrasound for nonmedical
‘entertainment’ purposes by prospective mothers.
Keywords: Maternal-fetal bonding, Two-dimensional
ultrasound, Three-dimensional ultrasound, Four-dimensional
ultrasound, Attachment.
How to cite this article: Atluru A, Appleton K, Kupesic Plavsic
S. Maternal-Fetal Bonding: Ultrasound Imaging’s Role in
enhancing This Important Relationship. Donald School J
Ultrasound Obstet Gynecol 2012;6(4):408-411.
Source of support: Nil
Conflict of interest: None declared
INTRODUCTION
Advances in ultrasound imaging technology are allowing
women visually-precise glimpses of their babies months
before delivery. The function of these imaging modalities
including two-dimensional (2D), three-dimensional (3D)
and four-dimensional (4D) ultrasound is three-fold. Not only
are such advances in ultrasound technology allowing
expectant mothers to see details of their baby’s physique,
but also such modalities allow a better visual understanding
of the fetal structures and growth. Ultrasound imaging is
also able to aid physicians in early diagnosis of birth defects
and abnormalities. Maternal-fetal bonding is a complex
interaction which begins prenatally and past studies been
shown to increase, when the expectant mother is able to see
ultrasound images of her fetus before birth.1 While
ultrasound has traditionally been used in evaluating
pregnancies, the question remains: does a 2D vs 3D or even
4D ultrasound affect this maternal-fetal bonding
relationship? Health care professionals need to understand
the important relationships between 2D, 3D and 4D
ultrasound imaging modalities, as these can be used to
potentially nurture the psychological relationship between
the expecting parents and the fetus.
MATERNAL-FETAL BONDING
The significance of the relationship between mother and
fetus is called ‘prenatal attachment’. Further defined by
Cranley in 1981, maternal fetal attachment (MFA) is ‘the
extent to which women engage in behaviors that represent
an affiliation and interaction with their unborn child’.2
Maternal-fetal attachment is positively influenced by
many factors including the mother’s state of mind,
surroundings and environment, social support system, as
well as negatively influenced by factors, such as substance
abuse and anxiety.2
Prenatal studies have been shown to be powerful tools
in nurturing the MFA between an expectant mother and her
unborn fetus. While there has been little difference on the
MFA in visual prenatal studies such as ultrasound vs
nonvisual studies, it is important to recognize the positive
effects a prenatal ultrasound can have on this important
relationship.1 Ultrasound has been shown to give parents a
confirmation of a new life, through two components:
ultrasound provides a visualization of the baby, and a
realization that the unit will soon become a family.
Ultrasound is also known to be a reassuring tool, showing
that the life-form carried inside the expectant mother is
indeed a baby.3 It has been shown that ultrasound decreases
maternal partaking in risky behaviors during pregnancy,
such as alcohol intake.4 Such positive attributes of
ultrasound in pregnancy should not be overlooked. The bond
that has been shown to start before birth of the baby is
enhanced when the mother can be aware of the growing
baby inside her.1
One expectant mother remarks that, ‘…there actually is
something so almost completely developed it just has to
grow. That such good technology exists—it’s
unbelievable…they can see so much’.3 Whatever, the draw
for a mother to desire to see her fetus, there is no denying
that ultrasound techniques in the obstetric field can be
powerful in enhancing and shaping the maternal-fetal
bonding and attachment that is underway.
Donald School Journal of Ultrasound in Obstetrics and Gynecology, October-December 2012;6(4):408-411 409
DSJUOG
Maternal-Fetal Bonding: Ultrasound Imaging’s Role in enhancing This Important Relationship
OVERVIEW OF 2D, 3D AND 4D ULTRASOUND
MODALITIES ON MATERNAL-FETAL BONDING
Currently, 2D, 3D and 4D ultrasound modalities can be
offered to expectant mothers for imaging. Much research
has gone into the development of theories regarding which
ultrasound technique is most effective in nurturing and
enhancing MFA.
Despite the fact that the most basic ultrasound, 2D,
cannot show surface rendering and definite physique as 3D
imaging, as 3D allows multiplanar evaluation, and
assessment of spatial, and volumetric relationships,5 there
has been little difference shown between the relationship
or feelings expressed by the expectant mother after viewing
their baby on a 2D vs 3D ultrasound. Mothers and fathers
found both imaging modalities helpful in knowing that baby
was real and healthy.6 However, one study shows that 82%
of mothers would chose 3D ultrasound over 2D ultrasound
because of the sense of closeness they feel due to the
enhanced images.7
2D ultrasound can be difficult for the mother and father
to interpret and understand. However, 3D ultrasound
provides clear imaging of important anatomical landmarks
such as the skull and face.6 It has also been shown that
families can experience some disappointment with 3D
ultrasound, as the imaging’s capabilities may leave them
disappointed with the quality of 3D images they receive.7
One study gave women a 2D ultrasound followed by a 3D
ultrasound weeks later. There was found to be no difference
between the bonding. It has been suggested that this lack of
difference can be attributed to the ‘ceiling effect’ of a 2D
ultrasound. By the time the mother has experienced a 2D
ultrasound, she has already maximally felt bonding and
attachment.4
3D ultrasound has been shown to more positive effect
the parents’ enthusiasm over the pregnancy, especially in
social situations (showing off the 3D images to the family
and friends, etc.).7,8 3D ultrasound has been very popular
in the media, as the fetal face can be very closely identified.9
Leung et al8 assessed 124 women attending prenatal
ultrasound clinic.8 Maternal anxiety levels were compared
between two groups of patients (intervention group, in which
2D ultrasound was followed by 3D ultrasound, and control
group, in which 2D ultrasound alone was performed) at
patient’s first visit, 18 and 28 weeks’ gestation. This study
demonstrated a short-term reduction of the anxiety score
after the first visit, and no significant difference between
the groups. However, about 80% of women reported being
able to tell that the baby was more real in 3D ultrasound
over 2D ultrasound.8
In comparing 2D and 4D ultrasound fathers have
experienced more bonding with their future babies with 4D
ultrasound. Paternal attachment even decreased after
viewing a 2D ultrasound, whereas it inevitably increased
after viewing a 4D ultrasound. However, maternal
attachment was always shown to increase after 4D and 2D
ultrasound.10 It has been suggested that men are more
concerned with the technique.3 Perhaps men are more
visually stimulated by high-tech and detailed graphics.
Fathers have also been shown to be more excited about the
prospects of 3D ultrasound over 2D.11
Tables 1 and 2 demonstrate ultrasound characteristics
and comparison between 2D, 3D and 4D ultrasound in MFA.
Overall, ultrasound imaging was shown to be ‘less real’ for
women who had yet to feel quickening or movement of the
baby. Women in their second pregnancy were able to
appreciate ultrasound more as showing a ‘real’ baby, as they
have previously experienced all sensations associated with
Table 1: Ultrasound imaging characteristics in maternal-fetal attachment
Imaging modality Image quality, limitations and advantages Maternal preference Paternal preference
2D US JI et al6—difficult to understand image Sedgmen et al4 suggest Righetti et al10—attachment has
‘ceiling effect’ after 2D US actually decreased after 2D US
for mothers
3D US Timor-Tritsch and Platt5—multiplanar JI et al6—mothers had higher Jl et al6—overall more enthusiastic
evaluation, spatial and volumetric expectations that were not feelings toward fetus
relationships met; overall more enthusiastic
feelings
Jl et al6 allow physicians and patients
to see facial features
Goncalves et al10 popular due to the
ability to see facial features
4D US Righetti et al10—paternal
attachment has increased after
4D US
2D: Two-dimensional; 3D: Three-dimensional; 4D: Four-dimensional; US: Ultrasound
410 JAYPEE
Aparna Atluru et al
pregnancy. Fathers and mothers alike have remarked that
after ultrasound imaging they feel more like parents. One
woman even remarked that her partner acted more gentle
and kind toward her after ultrasound imaging.3
Many have been concerned over the morality of
ultrasound. Does entertaining the mother and father with
images of their baby outweigh the risks of finding fetal
abnormalities? Could ultrasound even cause more
abortions? Is ultrasound a ‘weapon of morality’?12 It is
important that parents be well-informed about the potential
implications of ultrasound in medical diagnosis. Educating
parents can help reduce possible shock associated with
identifying fetal abnormalities and/or other adverse
outcomes.13
CONCLUSION
Maternal-fetal bonding is a very complex concept that at
its simplest describes the emotional attachment between an
expectant mother and her growing fetus. There are many
components that contribute to parental bonding, which
include environmental factors, such as social support and
prenatal screening. It seems that 3D and 4D ultrasound may
change the parental attitude toward pregnancy and may
contribute to an increase in bonding to fetus. While studies
have not shown any explicit difference in the level of
bonding with the use of 2D vs 3D vs 4D ultrasound, after
reviewing the effects of various types of ultrasound on
maternal-fetal bonding, it is evident that there is a wide
range of associated topics that may prove fruitful if further
explored. These topics include examining the effects of
different ultrasound modalities in multiple pregnancies and
the effects of different ultrasound modalities in instances
of fetal demise. Some findings suggest that experiencing a
miscarriage in a previous pregnancy does not necessarily
affect a woman’s psychological mindset in a following
pregnancy.14 However, examining the role of various
ultrasound modalities in pregnancies in which fetal demise
occurs is warranted, as the type of ultrasound may impact
maternal perception to varying degrees during a subsequent
pregnancy. Examining the role of different ultrasound
modalities and the effect they may have on maternal-fetal
bonding in multiple pregnancies is also warranted. For
instance, one study suggested that mothers felt more
attachment to twin B in a twin pregnancy as twin B may be
easier to see or touch.16 By comparing 2D vs 3D vs 4D
ultrasound, we may be able to ascertain if these disparate
ultrasound types may favor equal MFA among fetuses in
multiple pregnancies, may favor increased MFA to one of
the fetuses, or may change the quality or characteristics of
MFA as a whole.
Additionally, previous research has found that higher
maternal education levels correlated with larger head
growth.15 More research is warranted in examining, if
maternal prenatal education (including the effect of
ultrasound different types of ultrasound) has any correlation
to both physical and psychological factors involving the
fetus. In some areas and in certain demographics, 3D and
4D ultrasounds have become largely employed for
nonmedical entertainment reasons, i.e. ‘boutique’
ultrasounds that parents desire as keepsakes.17 According
to one study, no significant harm has been found in children
who had multiple prenatal ultrasounds, as compared with
children who had minimal ultrasound imaging prior to
birth.18 However, the use of 3D and 4D ultrasounds for
Table 2: Two-dimensional vs three-dimensional vs four-dimensional ultrasound imaging comparisons in maternal-fetal attachments
2D vs 4D ultrasound
Lapaire et al7—82% of expectant mothers preferred 3D over 2D due to ‘closeness’; however, there was no difference between
relationship and expressed feelings
Sedgmen et al4—no difference between the two; perhaps 2D ultrasound has ‘ceiling effect.’
JI et al6—both are helpful in helping mothers feel close and experience the reality of their baby; parents were found to be more
excited to show off 3D US images.
Leung et al8—80% of women had better understanding that their baby was ‘normal’ with 3D over 2D US
2D vs 4D ultrasound
Righetti et al10—little difference between the two ultrasound modalities. Mothers had increased MFA with 2D and 4D. Father’s felt
decreased attachment after 2D but increased after 4D US
3D vs 4D ultrasound
Pretorius et al11—both 3D and 4D US have positive change in parent's feelings toward the fetus
2D vs 3D/4D ultrasound
Leung et al8—at risk pregnancies did not have decreased anxiety with 3D/4D ultrasound compared with 2D. A total of 80% of
women thought that following 3D/4D US, they had better understanding that their baby was normal
2D: Two-dimensional; 3D: Three-dimensional; 4D: Four-dimensional; MFA: Maternal-fetal attachment; US: Ultrasound
Donald School Journal of Ultrasound in Obstetrics and Gynecology, October-December 2012;6(4):408-411 411
DSJUOG
Maternal-Fetal Bonding: Ultrasound Imaging’s Role in enhancing This Important Relationship
nonmedical purposes remains controversial. Further research
is warranted on whether mothers who have been screened
using different ultrasound modalities have different attitudes
toward their fetuses, their health and future pregnancies.
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Kate LP. Does offering and performing prenatal screening
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2. Alhusen J. A literature update on maternal-fetal attachment.
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The impact of two-dimensional versus three-dimensional
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6. JI EK, Pretorius DH, Newton R, Uyan K, Hull AD, Hollenbach
K, et al. Effects of ultrasound on maternal-fetal bonding: A
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7. Lapaire O, Alder J, Peukert R, Holzgreve W, Tercanli S. Two-
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2007 Nov; 276(5):475-79.
8. Leung KY, Ngai CSW, Lee A, Chan HY, Leung WC, Lee CP,
et al. The effects on maternal anxiety of two-dimensional versus
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Obstet Gynecol 2006;28:249-54.
9. Goncalves L, Lee W, Espinoza J, Romero R. Three- and
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Ultrasound Med 2005;24:1599-624.
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11. Pretorius D, Gattu S, Ji EK, Hollenbach K, Newton R, Hull A,
et al. Preexamination and postexamination assessment of
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obstetric ultrasonography. J Ultrasound Med 2006;25:
1411-21.
12. Fletcher J, Evans M. Sounding boards: Maternal bonding in
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13. Garcia J, Bricker L, Henderson J, Martin MA, Mugford M,
Nielson J, et al. Women’s views of pregnancy ultrasound: A
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14. Tsartsara E, Johnson MP. The impact of miscarriage on women’s
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Tiemeier H, et al. Mother’s educational level and fetal growth:
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ABOUT THE AUTHORS
Aparna Atluru
Student Physician, Department of Medical Education, Paul L Foster
School of Medicine, Texas Tech University, El Paso, Texas, USA
Kallie Appleton
Student Physician, Department of Medical Education, Paul L Foster
School of Medicine, Texas Tech University, El Paso, Texas, USA
Sanja Kupesic Plavsic (Corresponding Author)
Professor, Department of Obstetrics/Gynecology and Radiology, Paul
L Foster School of Medicine, Texas Tech University, El Paso, Texas
USA, Phone: +1 (915)783-1700, e-mail: sanja.kupesic@ttuhsc.edu
... Studies do not show differences in parental attachment depending on the advancement of the ultrasound technology used (Atluru et al., 2012;Benzie et al., 2018). However, the very inclusion of ultrasound technology is considered as one that may directly promote attachment in the womb, or indirectly affect the bond between the mother and the child, by influencing emotions or maternal attitudes (Atluru et al., 2012;Denbow, 2019). ...
... Studies do not show differences in parental attachment depending on the advancement of the ultrasound technology used (Atluru et al., 2012;Benzie et al., 2018). However, the very inclusion of ultrasound technology is considered as one that may directly promote attachment in the womb, or indirectly affect the bond between the mother and the child, by influencing emotions or maternal attitudes (Atluru et al., 2012;Denbow, 2019). Therefore, modern man interacts with technology before he is able to fully consciously use it. ...
View
... Studies do not show differences in parental attachment depending on the advancement of the ultrasound technology used (Atluru et al., 2012;Benzie et al., 2018). However, the very inclusion of ultrasound technology is considered as one that may directly promote attachment in the womb, or indirectly affect the bond between the mother and the child, by influencing emotions or maternal attitudes (Atluru et al., 2012;Denbow, 2019). ...
... Studies do not show differences in parental attachment depending on the advancement of the ultrasound technology used (Atluru et al., 2012;Benzie et al., 2018). However, the very inclusion of ultrasound technology is considered as one that may directly promote attachment in the womb, or indirectly affect the bond between the mother and the child, by influencing emotions or maternal attitudes (Atluru et al., 2012;Denbow, 2019). Therefore, modern man interacts with technology before he is able to fully consciously use it. ...
View
... Studies do not show differences in parental attachment depending on the advancement of the ultrasound technology used (Atluru et al., 2012;Benzie et al., 2018). However, the very inclusion of ultrasound technology is considered as one that may directly promote attachment in the womb, or indirectly affect the bond between the mother and the child, by influencing emotions or maternal attitudes (Atluru et al., 2012;Denbow, 2019). ...
... Studies do not show differences in parental attachment depending on the advancement of the ultrasound technology used (Atluru et al., 2012;Benzie et al., 2018). However, the very inclusion of ultrasound technology is considered as one that may directly promote attachment in the womb, or indirectly affect the bond between the mother and the child, by influencing emotions or maternal attitudes (Atluru et al., 2012;Denbow, 2019). Therefore, modern man interacts with technology before he is able to fully consciously use it. ...
View
... Studies do not show differences in parental attachment depending on the advancement of the ultrasound technology used (Atluru et al., 2012;Benzie et al., 2018). However, the very inclusion of ultrasound technology is considered as one that may directly promote attachment in the womb, or indirectly affect the bond between the mother and the child, by influencing emotions or maternal attitudes (Atluru et al., 2012;Denbow, 2019). ...
... Studies do not show differences in parental attachment depending on the advancement of the ultrasound technology used (Atluru et al., 2012;Benzie et al., 2018). However, the very inclusion of ultrasound technology is considered as one that may directly promote attachment in the womb, or indirectly affect the bond between the mother and the child, by influencing emotions or maternal attitudes (Atluru et al., 2012;Denbow, 2019). Therefore, modern man interacts with technology before he is able to fully consciously use it. ...
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... Also, the raw-image is often completely devoid of any kind of aesthetics whatsoever. On the other hand, maternal bonding is a very important emotional aspect of fetal ultrasound imaging [11], [14], [15], particularly the very first few ones, where these images often play the role of being the only visual proof of the existence of the fetus. Beyond everything, it plays a very significant role of being an emotional connector for parents to be able observe the signature of something very precious to their lives. ...
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div> Ultrasound imaging is one of the most versatile imaging method in order to observe inner workings of human- body. Due to its simplicity, cost-effectiveness, easy availability and portability, a diverse set of applications are influenced by this very popular imaging modality. Despite its popularity as one of the most widely used imaging techniques, it has some serious limitations including lack of image clarity as well as complete absence of any visual aesthetics. Although, commonplace data filters can potentially make ultrasound images smoother looking, however, there is a significant loss of information introduced by the smoothing filters. In this article, we developed a method to enhance the image clarity as well as a protocol for enhancing image aesthetics for ultrasound modality using modern data-curation tool SOCKS. We performed few case studies using various color schemas applied on a publicly available fetal ultrasound image. The outlined technique can be easily generalized to any other kind of ultrasound images. We hypothesize that, our method would not only provide us with enhanced scientific accuracy, visual clarity of ultrasound images but also add additional layers of visual clarity coupled with artistic and aesthetic values. Our method calls for an complete rethinking of how we present ultrasound images </div
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... Also, the raw-image is often completely devoid of any kind of aesthetics whatsoever. On the other hand, maternal bonding is a very important emotional aspect of fetal ultrasound imaging [11], [14], [15], particularly the very first few ones, where these images often play the role of being the only visual proof of the existence of the fetus. Beyond everything, it plays a very significant role of being an emotional connector for parents to be able observe the signature of something very precious to their lives. ...
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Full-text available
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div> Ultrasound imaging is one of the most versatile imaging method in order to observe inner workings of human- body. Due to its simplicity, cost-effectiveness, easy availability and portability, a diverse set of applications are influenced by this very popular imaging modality. Despite its popularity as one of the most widely used imaging techniques, it has some serious limitations including lack of image clarity as well as complete absence of any visual aesthetics. Although, commonplace data filters can potentially make ultrasound images smoother looking, however, there is a significant loss of information introduced by the smoothing filters. In this article, we developed a method to enhance the image clarity as well as a protocol for enhancing image aesthetics for ultrasound modality using modern data-curation tool SOCKS. We performed few case studies using various color schemas applied on a publicly available fetal ultrasound image. The outlined technique can be easily generalized to any other kind of ultrasound images. We hypothesize that, our method would not only provide us with enhanced scientific accuracy, visual clarity of ultrasound images but also add additional layers of visual clarity coupled with artistic and aesthetic values. Our method calls for an complete rethinking of how we present ultrasound images </div
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Background: Parents exposed to psychosocial adversities often experience challenges which, combined with the needs of a new-born infant, can be difficult to manage and increase the risk of poor outcomes for both parents and infants. Psychosocial adversity can disrupt the development of parental-foetal attachment to the baby during pregnancy, which can have a negative effect on parental care and quality of interaction during the postnatal period. This intervention is based on the proposition that enhanced parental capacity to mentalise and emotionally connect to unborn children during pregnancy, and better understanding about how to manage distressing infant behaviour (i.e., persistent crying and sleep problems) will: (i) promote the development of secure parent-infant attachment; (ii) improve antenatal bonding and postnatal parenting; and, (ii) reduce parental distress. Method: This protocol is for a pilot randomised control trial evaluating a new intervention, which makes use of innovative technologies to support parents experiencing moderate psychosocial adversity (Australian New Zealand Clinical Trials Registry: ACTRN12622000287730). The New Technology for New Parents (NTNP) intervention provides support using antenatal ultrasound scans and 'virtual home visits' during the perinatal period. Quantitative outcomes include mentalising capacity, parental-foetal/infant attachment, and parental competence. Conclusion: To the best of our knowledge, no study has evaluated the combined effectiveness of two novel technologies (3D/4D ultrasound scans and virtual home visits) to support parents across the antenatal and postnatal periods. This protocol, which includes the rationale for this innovative intervention, addresses a gap in services for parents experiencing moderate psychosocial adversity.
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  • Oct 2010
  • INT J EPIDEMIOL
Women of low socio-economic status (SES) give birth to lighter babies. It is unknown from which moment during pregnancy socio-economic differences in fetal weight can be observed, whether low SES equally affects different fetal-growth components, or what the effect of low SES is after taking into account mediating factors. In 3545 pregnant women participating in the Generation R Study, we studied the association of maternal educational level (high, mid-high, mid-low and low) as a measure of SES with fetal weight, head circumference, abdominal circumference and femur length. We did this before and after adjusting for potential mediators, including maternal height, pre-pregnancy body mass index and smoking. In fetuses of low-educated women relative to those of high-educated women, fetal growth was slower, leading to a lower fetal weight that was observable from late pregnancy onwards. In these fetuses, growth of the head [-0.16 mm/week; 95% confidence interval (CI): -0.25 to -0.07; P = 0.0004], abdomen (-0.10 mm/week; 95% CI: -0.21 to 0.01; P = 0.08) and femur (-0.03 mm/week; 95% CI: -0.05 to -0.006; P = 0.01) were all slower; from mid-pregnancy onwards, head circumference was smaller, and from late pregnancy onwards, femur length was also smaller. The negative effect of low education was greatest for head circumference (difference in standard deviation score in late pregnancy: -0.26; 95% CI: -0.36 to -0.15; P < 0.0001). This effect persevered even after adjustment for the potential mediators (adjusted difference: -0.14; 95% CI: -0.25 to -0.03; P = 0.01). Low maternal education is associated with a slower fetal growth and this effect appears stronger for growth of the head than for other body parts.
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Maternal-Fetal Attachment in Twin Pregnancies
Article
  • Nov 2000
To describe maternal attachment to twin fetuses and determine whether such attachment differs between the twins. A descriptive, correlational, nonexperimental design was used to collect data on a convenience sample of high-risk and low-risk women pregnant with twins. Questionnaires were distributed or mailed by presidents of parents of multiples clubs to interested participants. Participants mailed the questionnaires back to the researcher via stamped return envelope. During a 14-month period, 214 eligible women from 41 states and the District of Columbia completed the survey instruments. The Prenatal Attachment Inventory. Pregnant women reported greater attachment to Twin B than to Twin A. Pregnant women may be more attached to Twin B (typically the nonpresenting fetus) because this twin may be easier to see and touch. While the mean attachment scores between twins differed, the size of the difference was small. Further study is needed to determine the predictive value and clinical significance of this finding for future mother-infant relationships.
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Women's Views of Pregnancy Ultrasound: A Systematic Review
Article
  • Jan 2003
Ultrasound has become a routine part of care for pregnant women in most countries with developed health services. It is one of a range of techniques used in screening and diagnosis, but it differs from most others because of the direct access that it gives parents to images of the fetus. A review of women's views of ultrasound was commissioned as part of a larger study of the clinical and economic aspects of routine antenatal ultrasound use. Studies of women's views about antenatal screening and diagnosis were searched for on electronic databases. Studies about pregnancy ultrasound were then identified from this material. Further studies were found by contacting researchers, hand searches, and following up references. The searches were not intentionally limited by date or language. Studies that reported direct data from women about pregnancy ultrasound were then included in a structured review. Studies were not excluded on the basis of methodological quality unless they were impossible to understand. They were read by one author and tabulated. The review then addressed a series of questions in a nonquantitative way. The structured review included 74 primary studies represented by 98 reports. Studies from 18 countries were included, and they employed methods ranging from qualitative interviewing to psychometric testing. The review included studies from the very early period of ultrasound use up to reports of research on contemporary practice. Ultrasound is very attractive to women and families. Women's early concerns about the safety of ultrasound were rarely reported in more recent research. Women often lack information about the purposes for which an ultrasound scan is being done and the technical limitations of the procedure. The strong appeal of diagnostic ultrasound use may contribute to the fact that pregnant women are often unprepared for adverse findings. Despite the highly varied study designs and contexts for the research included, this review provided useful information about women's views of pregnancy ultrasound. One key finding for clinicians was the need for all staff, women, and partners to be well informed about the specific purposes of ultrasound scans and what they can and cannot achieve.
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A qualitative study of mothers’ and fathers’ experiences of routine ultrasound examination in Sweden
Article
  • Jan 2005
  • MIDWIFERY
to conceptualise mothers' and fathers' thoughts and feelings before, during and after the routine ultrasound examination during the second trimester of pregnancy. a grounded theory study. Two to four weeks after their ultrasound examination, 22 Swedish mothers and 22 fathers were interviewed in their homes. the basic social process was confirmation of a new life. The four categories, visualising-the evident option, overwhelming to see life; becoming a family and reassuring, all represent a time span in the parents' process towards confirmation of a new life. The caregivers' way of assisting and supporting the process by information and treatment was very important to parents. as the ultrasound examination is perceived as a confirmation of a new life it is an extremely important milestone for both parents so the father should be encouraged to participate. It is an important and unique event for both women and men in their process towards becoming parents. This process was largely dependent on the treatment the parents had received during the examination and the information given. The findings of this study are of interest to midwives and others who perform ultrasound examinations as it explains why adequate time must be allowed for the examination and the importance of the information given before hand. When introducing new forms of fetal diagnosis in the future it should be kept in mind that this might irrevocably be accepted by parents who long for confirmation of a new life.
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Effects of repeated prenatal ultrasound examinations on childhood outcome up to 8 years of age: Follow-up of a randomised controlled trial
Article
  • Dec 2004
  • LANCET
Background: Despite the widespread use of prenatal ultrasound studies, there are no published data from randomised controlled trials describing childhood outcomes that might be influenced by repeated ultrasound exposures. We previously undertook a randomised controlled trial to assess the effects of multiple studies on pregnancy and childhood outcomes and reported that those pregnancies allocated to receive multiple examinations had an unexplained and significant increase in the proportion of growth restricted newborns. Our aim was to investigate the possible effects of multiple prenatal ultrasound scans on growth and development in childhood. Here, we provide follow-up data of the childrens' development. Methods: Physical and developmental assessments were done on children whose pregnant mothers had been allocated at random to a protocol of five studies of ultrasound imaging and umbilical artery Doppler flow velocity waveform between 18 and 38 weeks' gestation (intensive group n=1490) or a single imaging study at 18 weeks' gestation (regular group n=1477). We used generalised logistic and linear regression models to assess the group differences in developmental and growth outcomes over time. Primary data analysis was done by intention-to-treat. Findings: Examinations were done at 1, 2, 3, 5, and 8 years of age on children born without congenital abnormalities and from singleton pregnancies (intensive group n=1362, regular group n=1352). The follow-up rate at 1 year was 85% (2310/2714) and at 8 years was 75% (2042/2714). By 1 year of age and thereafter, physical sizes were similar in the two groups. There were no significant differences indicating deleterious effects of multiple ultrasound studies at any age as measured by standard tests of childhood speech, language, behaviour, and neurological development. Interpretation: Exposure to multiple prenatal ultrasound examinations from 18 weeks' gestation onwards might be associated with a small effect on fetal growth but is followed in childhood by growth and measures of developmental outcome similar to those in children who had received a single prenatal scan.
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Maternal/paternal antenatal attachment and fourth-dimensional ultrasound technique: A preliminary report
Article
  • Feb 2005
The purpose of the present research was to investigate the role of the fourth dimensional (4D) ultrasound scanning on the antenatal attachment development, in pregnant women (19-23 weeks of gestation) and their partners. A total of 44 couples were asked to complete questionnaires about maternal and paternal antenatal attachment, before the two-dimensional (2D; control group) and 4D (experimental group) ultrasound scanning and 2 weeks later. In the groups of women, our findings underline the progressive increase in antenatal attachment throughout gestation: the mean level of antenatal attachment was significantly different between the first and the second assessment. No significant differences are shown between 2D and 4D ultrasound scanning groups. We do not eliminate the possibility that ultrasound scanning practice would be a helpful and crucial means of investigation for a complete explanation of prenatal attachment (Ainsworth, Blehar, Waters, & Wall, 1978; Fivaz-Depeursinge & Corboz-Warney, 2000) and parental mental representations (Stern, 1987, 1997).
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Effects of ultrasound on maternal-fetal bonding: A comparison of two- and three-dimensional imaging
Article
  • May 2005
The purpose of this study was to evaluate the effect of two-dimensional (2DUS) compared to three-dimensional ultrasound (3DUS) imaging on the maternal-fetal bonding process. Fifty mothers who had 2DUS and 50 who had 2DUS and 3DUS were included in the study. A postpartum survey by telephone interview was carried out to assess maternal-fetal bonding. Bonding was evaluated by analysis of extent of prenatal image sharing, maternal ability to form a mental picture of the baby and mother's comments about their ultrasound images. Data were analyzed using the independent t-test, Chi-square and Mann-Whitney U-tests. Mothers who received 3DUS showed their ultrasound images to more people (median, 27.5; interquartile range, 14.5-40.0) than mothers receiving 2DUS alone (median, 11.0; interquartile range, 5.0-25.5) (P < 0.001, Z = -3.539). Eighty-two percent of the subjects screened with 3DUS had a greater tendency to form a mental picture of the baby postexamination compared to 39% of the 2DUS subjects (P < 0.001, Z = -3.614). Mothers receiving a 3DUS study were more likely to receive comments on the similarities/differences of the neonate compared to those having 2DUS studies. Furthermore, 70% of the mothers receiving 3DUS felt they 'knew' the baby immediately after birth vs. 56% of the mothers receiving 2DUS (P = 0.009, Z = -2.613). Both 2DUS and 3DUS experiences were positive, however, the comments made by the mothers undergoing 3DUS (n = 18) were more exclamatory (amazed, wonderful, fabulous) than those undergoing 2DUS (n = 4). Patients having a 3DUS examination consistently scored higher than those having a 2DUS examination alone for all categories of maternal-fetal bonding. 3DUS appears to more positively influence the perceptions of mothers to their babies postbirth compared to 2DUS. Specifically, mothers who had 3DUS showed their ultrasound images to a greater number of people compared to mothers who had 2DUS alone and this may represent mother's social support system. 3DUS may have a greater impact on the maternal-fetal bonding process.
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Three-dimensional ultrasound experience in obstetrics. Curr Opin Obstet Gynecol 14(6):569
Article
  • Jan 2003
Three-dimensional (3D) ultrasound is a natural development of the imaging technology. Fast computers are essential to enable 3D and four-dimensional (4D) ultrasound pictures. A short review of the technical points and clinical aspects is presented. Our purpose is to acquaint the reader with the possibilities of this new technology and to increase awareness of its present clinical usefulness. A short review of technical information is provided. The advantages of 3D and 4D ultrasound in certain areas are unequivocal. Its use in the workup of fetal anomalies involving the face, limbs, thorax, spine and the central nervous system are already applied by most centers. The use of this technology in applying color Doppler, in guiding needles for different puncture procedures as well in evaluating the fetal heart are under close research scrutiny. The bonding effect between the parents and their future offspring is becoming evident as 3D ultrasound is used. Consulting specialists understand fetal pathology better and can better plan postnatal interventions. 4D or real time 3D ultrasound was developed and is expected to achieve new meaning with the planned introduction of electronic transducer multilinear arrays. 3D ultrasound is an extremely promising imaging tool to image the fetus. In spite of the scant outcome studies the potential of 3D ultrasound is understood by a large number of obstetricians, maternal fetal specialists and imaging specialists.
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