A Biopsychosocial Model of Attachment Styles and Adverse Birth Outcomes in High-Risk Pregnancies

Because stress during pregnancy can contribute to preterm birth, low birth weight, and other adverse birth outcomes, there is a need for research on psychosocial factors that may mitigate this risk. Social support and attachment security have been shown to buffer the effects of stress in certain contexts. This study therefore evaluated the degree to which social support, attachment anxiety, and attachment avoidance affect stress-related birth outcomes in a sample of women with high-risk pregnancies. The study focused on women who had been hospitalized for pregnancy complications, as the population was identified as in need of further biopsychosocial research. The hypotheses were that women with more secure attachment would have greater social support, less stress, and therefore superior birth outcomes. Participants (N = 188) completed the 10-Item Perceived Stress Scale, Social Provisions Scale, and Experiences in Close Relationship Scale-Short Form, during their pregnancies. Birth outcome data (gestational age, birth weight, and Apgar scores) were extracted from their medical records after delivery. Biserial correlation analyses revealed that high stress levels were associated with more insecure attachment styles. Analysis of variance indicated that participants were more likely to have avoidant attachment if they were black, poorly educated, or unmarried. Hierarchical multiple regression analyses revealed that stress, social support, and attachment levels were not predictive of birth outcomes over and above the effects of physiological risk factors. This result diverges from research on low-risk pregnancies, where a clear link is observed between stress and adverse birth outcomes. By contrast, in this sample of high-risk pregnancies, psychosocial factors did not influence the profound effects of biological risk. In high-risk pregnancies, therefore, psychosocial interventions may be better suited to target psychosocial, rather than biological, outcomes. Furthermore, this study highlights a need for further research into demographic disparities in attachment styles, as well as the sociocultural factors that may impact them.