An intervention to address prenatal anxiety improves maternal-infant bonding, with effects mediated by maternal-infant responsiveness, maternal self-efficacy, and postpartum depression

Prenatal anxiety is associated with poor postpartum infant-child relationships. Thus strategies that improve prenatal anxiety could also affect this relationship. We investigated the effects of an intervention to address prenatal anxiety on maternal-infant bonding and examined the potential mediating roles of maternal self-efficacy, maternal-infant responsiveness, and postpartum depression. Data were collected between 2019 and 2022 as part of a randomized controlled trial to treat prenatal anxiety using cognitive behavioral therapy. Participants included 701 pregnant women aged 18 or older with symptoms of anxiety, but not depression, attending a tertiary hospital in Rawalpindi, Pakistan. Women randomized to the intervention arm demonstrated significantly lower scores on the postpartum bonding questionnaire (B = -3.05, 95% CI: -4.98, -1.12), indicating stronger bonding. Responsiveness, self-efficacy, and postpartum depression significantly mediated 38%, 66%, and 95% of the association between the intervention and bonding, respectively. These mediators may be useful targets to improve maternal-infant bonding among women with prenatal anxiety.