Longitudinal changes in attachment patterns of preterm infants born in a non‐Western country

Abstract

Unexpected early birth of an infant may affect the attachment formation of mother–child dyads. This longitudinal study aimed to explore mother–infant attachment patterns of very preterm (VPT) and preterm (PT) infants compared to their term‐born peers in a non‐Western country. Neurodevelopmental outcomes of infants, maternal anxiety and depressive symptoms, and sociodemographic features were evaluated to explore their effects on attachment. Eighteen VPT, 11 PT, 11 term infants and their mothers participated. Observations of attachment patterns and neurodevelopmental assessments were performed at 18 and 24 months of corrected age. This study identified a change in attachment patterns of VPT infants over time such that VPT infants tended to have less insecure attachment patterns with their mothers at the end of the infancy period. While motor and language development scores were associated with attachment patterns at 18 months, models predicting attachment patterns were no longer significant at 24 months. Therefore, change in VPT infants’ developmental outcomes and attachment patterns over time suggests that preterm birth itself is not necessarily a risk factor for developing insecure attachment patterns; yet, developmental delays may account for insecure attachment patterns. It is suggested that efforts to promote developmental outcomes of preterm infants may improve mother–child attachment.

Early life attachment in term and preterm infants

“…Our results differ from the reported higher frequencies of avoidant (Fuertes et al, 2022) and disorganized attachment style (Wolke et al, 2014), and disorganized attachment scores (Zengin Akkus et al, 2021) in preterm infants compared to term infants from 12 months of age. Since we explored attachment at nine months, our data could suggest that any impact of prematurity on attachment takes longer to manifest.…”

“…Our results do not support the reported higher frequencies of disorganized attachment style (Wolke et al, 2014), and disorganized attachment scores (Zengin Akkus et al, 2021) in preterm infants compared to term infants from 12 months of age. Additionally, more insecure resistant attachment (López-Maestro et al, 2017, Sierra-García et al, 2018) and anxious attachment scores (Zengin Akkus et al, 2021) have been found in preterm infants at 18 months of age, whereas only three infants were assigned a resistant attachment style in this study. Interestingly, most studies using the Strange Situation Procedure show that approximately two thirds of preterm infants are assigned a secure attachment style from 12 months of age (Korja et al, 2012).…”

“…Moreover, prematurity could be more likely to impact attachment when it is associated with family socioeconomic disadvantage (Fuertes et al, 2022, Wille, 1991), and the compounding effects of socioeconomic deprivation on infant attachment could also be more evident later in infancy. Additionally, more insecure resistant attachment (López-Maestro et al, 2017, Sierra-García et al, 2018) and anxious attachment scores (Zengin Akkus et al, 2021) have been found in preterm infants of GA < 32 weeks at 18 months of age, whereas only one infant was assigned a resistant attachment style in this study.…”

Parental representations after preterm birth: a narrative review

“…A meta-analysis by Korja et al (2012) on the attachment style of children born preterm has found that these children do not present more insecure attachment patterns (evaluated around one year of age) than children born full-term, in line with a recent review by Genet and Devouche (2022) . Nevertheless, a high risk of perinatal complications and developmental delays in the child can contribute to the development of an insecure attachment style ( Laganière et al, 2003 ; Brisch et al, 2005 ; Udry-Jørgensen et al, 2011 ; Korja et al, 2012 ; Zengin Akkus et al, 2021 ). Most studies have also failed to consider the role of environmental influences when studying the relationship between birth status and infant attachment style, as pointed out by Laganière et al (2003) .…”