Maternal-Fetal Attachment and Health Behaviors Among Women with HIV/AIDS

Background: Mothers with HIV often face personal and environmental risks for poor maternal health behaviors and infant neglect, even when HIV transmission to the infant was prevented. Maternal-fetal attachment (MFA), the pre-birth relationship of a woman with her fetus, may be the precursor to maternal caregiving. Using the strengths perspective that embeds MFA within the socio-ecological model, it is hypothesized that high levels of MFA protect mothers and infants against poor maternal health behaviors. Objective: To assess whether MFA together with history of drug use, marital relationship status, planned pregnancy status, and timing of HIV diagnosis predict three desirable maternal health behaviors (pregnancy care, prenatal HIV medication adherence, and infant’s screening clinic care) among pregnant women with HIV/AIDS. Method: Prospective observation and hypothesis-testing multivariate analyses. Over 17 consecutive months, all eligible English- or Spanish-speaking pregnant women with HIV (n=110) were approached in the principal HIV obstetrical and infant clinics in Miami-Dade County, Florida at ≥ 24 weeks’ gestation; 82 agreed to enroll. During three data collections from enrollment until 16 weeks after childbirth (range: 16 to 32 weeks), participants reported on socio-demographic and predictor variables, MFA, and pregnancy care. Measures of medication adherence and infant care were extracted from medical records. Findings: Socio-demographic, pregnancy, and HIV disease characteristics in this sample suggest changes in the makeup of HIV-infected pregnant women parallel to the evolution of the HIV epidemic in the USA over the past two decades. The MFA model predicted maternal health behaviors for pregnancy care (R² = .37), with MFA, marital living status, and planned pregnancy status independently contributing (  = .50,  = .28,  = .23, respectively). It did not predict medication adherence or infant care. Relevance: These findings provide the first focused evidence of the protective role of MFA against poor maternal health behaviors among pregnant women with HIV, in the presence of adverse life circumstances. Social desirability biases in some self-report measures may limit the findings. Suggestions are made to orient future inquiry on maternal health behaviors during childbirth toward relationship and protection.