Prenatal couple relationship satisfaction, romantic attachment, and childbirth-related posttraumatic stress symptoms

Stephanie Alves; Margarida Pratas; Matilde Sousa; Daniela Fidalgo; Ana Morais; Inês Jongenelen; Diogo Lamela; Tiago Miguel Pinto; Raquel Costa

doi:10.1080/02646838.2025.2452908

Prenatal couple relationship satisfaction, romantic attachment, and childbirth-related posttraumatic stress symptoms

Stephanie Alves, Margarida Pratas, Matilde Sousa, Daniela Fidalgo, Ana Morais, Inês Jongenelen, Diogo Lamela, Tiago Miguel Pinto, Raquel Costa

HEI-LAB - Human Environment Interaction Lab

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Traumatic childbirth can lead to childbirth-related posttraumatic stress symptoms (CB-PTSS). Although underexplored, prenatal couple relationship satisfaction and romantic attachment orientations are modifiable factors that may increase or mitigate the risk of CB-PTSS after a traumatic childbirth experience. Objectives: This study examined (1) the associations between prenatal couple relationship satisfaction and romantic attachment, traumatic childbirth and CB-PTSS; (2) whether prenatal couple relationship satisfaction moderates the association between traumatic childbirth and CB-PTSS; and (3) whether the interaction between prenatal couple relationship satisfaction and romantic attachment moderates the association between traumatic childbirth and CB-PTSS. Method: The sample included 162 mothers from a Portuguese longitudinal cohort who completed self-report questionnaires at the third trimester of pregnancy (T1) and at two months postpartum (T2), on sociodemographic, mental health-related, and obstetric data (T1 and T2), couple relationship satisfaction (T1), romantic attachment (T1), traumatic childbirth experience (T2) and CB-PTSS (T2). Hierarchical regression analyses and moderated moderation models were performed. Results: Lower prenatal couple relationship satisfaction predicted greater CB-PTSS severity, before accounting for attachment-related anxiety and avoidance. Attachment-related anxiety predicted greater CB-PTSS severity. The association between traumatic childbirth experience and CB-PTSS severity was only significant at low levels of prenatal couple relationship satisfaction and medium or high levels of attachment-related anxiety. Conclusions: Especially in mothers reporting higher attachment-related anxiety, lower prenatal couple relationship satisfaction seems to increase the risk of CB-PTSS following the experience of a traumatic childbirth. Couple relationship satisfaction and romantic attachment orientations should be assessed during routine prenatal screenings, along with childbirth experiences.

Original language	English
Pages (from-to)	1-17
Journal	Journal of Reproductive and Infant Psychology
DOIs	https://doi.org/10.1080/02646838.2025.2452908
Publication status	Published - 19 Jan 2025

Bibliographical note

Publisher Copyright:
© 2025 Society for Reproductive & Infant Psychology.

Funding

This work was funded by Fundação para a Ciência e Tecnologia (FCT), under HEI-Lab R&D Unit[UIDB/05380/2020], https://doi.org/10.54499/UIDB/05380/2020) and project 2022.01825.PTDC(http://doi.org/10.54499/2022.01825.PTDC). This research was funded by”la Caixa’’ Foundation’sSocial Research Call 2023 under the project code [LCF/PR/SR23/57000014]. Raquel Costa wasfunded by the FSE and FCT – Fundação para a Ciência e a Tecnologia, I.P. (Individual CEEC[2023.06934.CEECIND]). The funders had no role in study design; in the collection, analysis, andinterpretation of data; in the writing of the report; or in the decision to submit the article forpublication.

Keywords

Traumatic childbirth
childbirth-related posttraumatic stress disorder
couple relationship satisfaction
mothers
romantic attachment

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10.1080/02646838.2025.2452908

Cite this

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title = "Prenatal couple relationship satisfaction, romantic attachment, and childbirth-related posttraumatic stress symptoms",

abstract = "Background: Traumatic childbirth can lead to childbirth-related posttraumatic stress symptoms (CB-PTSS). Although underexplored, prenatal couple relationship satisfaction and romantic attachment orientations are modifiable factors that may increase or mitigate the risk of CB-PTSS after a traumatic childbirth experience. Objectives: This study examined (1) the associations between prenatal couple relationship satisfaction and romantic attachment, traumatic childbirth and CB-PTSS; (2) whether prenatal couple relationship satisfaction moderates the association between traumatic childbirth and CB-PTSS; and (3) whether the interaction between prenatal couple relationship satisfaction and romantic attachment moderates the association between traumatic childbirth and CB-PTSS. Method: The sample included 162 mothers from a Portuguese longitudinal cohort who completed self-report questionnaires at the third trimester of pregnancy (T1) and at two months postpartum (T2), on sociodemographic, mental health-related, and obstetric data (T1 and T2), couple relationship satisfaction (T1), romantic attachment (T1), traumatic childbirth experience (T2) and CB-PTSS (T2). Hierarchical regression analyses and moderated moderation models were performed. Results: Lower prenatal couple relationship satisfaction predicted greater CB-PTSS severity, before accounting for attachment-related anxiety and avoidance. Attachment-related anxiety predicted greater CB-PTSS severity. The association between traumatic childbirth experience and CB-PTSS severity was only significant at low levels of prenatal couple relationship satisfaction and medium or high levels of attachment-related anxiety. Conclusions: Especially in mothers reporting higher attachment-related anxiety, lower prenatal couple relationship satisfaction seems to increase the risk of CB-PTSS following the experience of a traumatic childbirth. Couple relationship satisfaction and romantic attachment orientations should be assessed during routine prenatal screenings, along with childbirth experiences.",

keywords = "Traumatic childbirth, childbirth-related posttraumatic stress disorder, couple relationship satisfaction, mothers, romantic attachment",

author = "Stephanie Alves and Margarida Pratas and Matilde Sousa and Daniela Fidalgo and Ana Morais and In{\^e}s Jongenelen and Diogo Lamela and Pinto, {Tiago Miguel} and Raquel Costa",

note = "Publisher Copyright: {\textcopyright} 2025 Society for Reproductive & Infant Psychology.",

year = "2025",

month = jan,

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doi = "10.1080/02646838.2025.2452908",

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T1 - Prenatal couple relationship satisfaction, romantic attachment, and childbirth-related posttraumatic stress symptoms

AU - Alves, Stephanie

AU - Pratas, Margarida

AU - Sousa, Matilde

AU - Fidalgo, Daniela

AU - Morais, Ana

AU - Jongenelen, Inês

AU - Lamela, Diogo

AU - Pinto, Tiago Miguel

AU - Costa, Raquel

PY - 2025/1/19

Y1 - 2025/1/19

N2 - Background: Traumatic childbirth can lead to childbirth-related posttraumatic stress symptoms (CB-PTSS). Although underexplored, prenatal couple relationship satisfaction and romantic attachment orientations are modifiable factors that may increase or mitigate the risk of CB-PTSS after a traumatic childbirth experience. Objectives: This study examined (1) the associations between prenatal couple relationship satisfaction and romantic attachment, traumatic childbirth and CB-PTSS; (2) whether prenatal couple relationship satisfaction moderates the association between traumatic childbirth and CB-PTSS; and (3) whether the interaction between prenatal couple relationship satisfaction and romantic attachment moderates the association between traumatic childbirth and CB-PTSS. Method: The sample included 162 mothers from a Portuguese longitudinal cohort who completed self-report questionnaires at the third trimester of pregnancy (T1) and at two months postpartum (T2), on sociodemographic, mental health-related, and obstetric data (T1 and T2), couple relationship satisfaction (T1), romantic attachment (T1), traumatic childbirth experience (T2) and CB-PTSS (T2). Hierarchical regression analyses and moderated moderation models were performed. Results: Lower prenatal couple relationship satisfaction predicted greater CB-PTSS severity, before accounting for attachment-related anxiety and avoidance. Attachment-related anxiety predicted greater CB-PTSS severity. The association between traumatic childbirth experience and CB-PTSS severity was only significant at low levels of prenatal couple relationship satisfaction and medium or high levels of attachment-related anxiety. Conclusions: Especially in mothers reporting higher attachment-related anxiety, lower prenatal couple relationship satisfaction seems to increase the risk of CB-PTSS following the experience of a traumatic childbirth. Couple relationship satisfaction and romantic attachment orientations should be assessed during routine prenatal screenings, along with childbirth experiences.

AB - Background: Traumatic childbirth can lead to childbirth-related posttraumatic stress symptoms (CB-PTSS). Although underexplored, prenatal couple relationship satisfaction and romantic attachment orientations are modifiable factors that may increase or mitigate the risk of CB-PTSS after a traumatic childbirth experience. Objectives: This study examined (1) the associations between prenatal couple relationship satisfaction and romantic attachment, traumatic childbirth and CB-PTSS; (2) whether prenatal couple relationship satisfaction moderates the association between traumatic childbirth and CB-PTSS; and (3) whether the interaction between prenatal couple relationship satisfaction and romantic attachment moderates the association between traumatic childbirth and CB-PTSS. Method: The sample included 162 mothers from a Portuguese longitudinal cohort who completed self-report questionnaires at the third trimester of pregnancy (T1) and at two months postpartum (T2), on sociodemographic, mental health-related, and obstetric data (T1 and T2), couple relationship satisfaction (T1), romantic attachment (T1), traumatic childbirth experience (T2) and CB-PTSS (T2). Hierarchical regression analyses and moderated moderation models were performed. Results: Lower prenatal couple relationship satisfaction predicted greater CB-PTSS severity, before accounting for attachment-related anxiety and avoidance. Attachment-related anxiety predicted greater CB-PTSS severity. The association between traumatic childbirth experience and CB-PTSS severity was only significant at low levels of prenatal couple relationship satisfaction and medium or high levels of attachment-related anxiety. Conclusions: Especially in mothers reporting higher attachment-related anxiety, lower prenatal couple relationship satisfaction seems to increase the risk of CB-PTSS following the experience of a traumatic childbirth. Couple relationship satisfaction and romantic attachment orientations should be assessed during routine prenatal screenings, along with childbirth experiences.

KW - Traumatic childbirth

KW - childbirth-related posttraumatic stress disorder

KW - couple relationship satisfaction

KW - mothers

KW - romantic attachment

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DO - 10.1080/02646838.2025.2452908

M3 - Article

AN - SCOPUS:85215302740

SN - 0264-6838

SP - 1

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JO - Journal of Reproductive and Infant Psychology

JF - Journal of Reproductive and Infant Psychology

ER -

Prenatal couple relationship satisfaction, romantic attachment, and childbirth-related posttraumatic stress symptoms

Abstract

Bibliographical note

Funding

Keywords

Access to Document

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