The Relationship Between Attachment Styles and Prenatal Attachment in Iranian Pregnant Women Mediated by Body Image and Gender Roles in the Third Trimester of Pregnancy: A Structural Equation Modeling

Background: Prenatal attachment, the emotional bond a mother develops with her fetus, evolves throughout pregnancy and is affected by maternal attachment history, body image and gender role. Objectives: This study aimed to explore the relationship between attachment styles and prenatal attachment in Iranian pregnant women mediated by body image and gender roles in the third trimester of pregnancy. Methods: This cross-sectional study was undertaken in 2023, recruiting 132 Iranian pregnant women aged 15 - 45 in the third trimester of pregnancy living in Tehran, Iran. The sampling method was convenience sampling. Data collection tools included a demographic information form, Bem Sex Role Inventory (BSIR), Revised Collins and Reed's Attachment Scale (RAAS), along with questionnaires on prenatal body image (PBIQ) and prenatal attachment (MFAS). Data were analyzed using descriptive statistics (frequency, mean, standard deviation) and structural equation modeling (SEM) via partial least squares (PLS) regression. Results: The final model accounted for 21% of the variance in prenatal attachment. A significant negative relationship was found between prenatal body image and prenatal attachment (β = -0.429, P < 0.05), as well as secure attachment style and prenatal body image (β = -0.291, P < 0.05). Crucially, mediation analysis indicated that prenatal body image significantly mediated the relationship between secure attachment style and prenatal attachment (β = 0.125, P < 0.05). No direct relationships were found between any attachment style and prenatal attachment, or between any gender role and prenatal attachment. Gender roles did not serve as a significant mediator. Only a significant positive relationship was found between secure attachment style and masculine gender role (β = 0.405, P < 0.05). Conclusions: The results of the present study demonstrated that the relationship between secure attachment style and prenatal attachment in pregnant women of the third trimester is mediated by prenatal body image and not by gender roles. This highlights the importance of integrating psychological interventions aimed at improving body image into prenatal care to foster the prenatal attachment.