What question did this study set out to answer?

This study aims to explore how prenatal anxiety affects postpartum bonding and the psychosocial factors involved.

May 21, 2026Cambridge Prisms Global Mental Health0 citationsOpen Access

Pathways from Prenatal Anxiety to Postpartum Bonding Difficulties in Pakistan: A Prospective Longitudinal Study of Psychosocial Mediators and the Buffering Role of Social Support

RLRakhshanda LiaqatInternational Islamic University, Islamabad KAKehkashan AroujInternational Islamic University, Islamabad

Key Points

This study aims to explore how prenatal anxiety affects postpartum bonding and the psychosocial factors involved.
501 women followed from early pregnancy (15-20 weeks gestation) to 8 weeks postpartum.
Assessed prenatal anxiety (GAD-7) and depressive symptoms (PHQ-9) at T1, and psychosocial stressors and support at T1.5 (30-36 weeks).
Utilized longitudinal path analysis and mediation models to analyze the data.
Prenatal anxiety predicted postpartum bonding difficulties (β = .18, p = .001), independent of prenatal depressive symptoms.
The association was partially mediated by late-pregnancy psychosocial stressors (total indirect effect = 0.34, 95% CI [0.23, 0.46]).

Abstract

Background: Prenatal anxiety is common and potentially disruptive to the early mother-infant relationship, yet it remains less studied than perinatal depression.The psychosocial mechanisms through which prenatal anxiety influences postpartum bonding, particularly in low-resource settings, are not well understood. Methods:In this prospective longitudinal study, 501 women in Pakistan were followed from early pregnancy (T1; 15-20 weeks gestation) to postpartum (T2; 8 weeks).Prenatal anxiety (GAD-7) and depressive symptoms (PHQ-9) were assessed at T1. Late-pregnancy psychosocial stressors-pregnancy experiences, domestic violence, and perceived stress-and perceived social support were measured at T1.5 (30-36 weeks).Postpartum outcomes included mother-infant bonding (PBQ) and anxiety (GAD-7).Longitudinal path analysis, parallel mediation, and moderated mediation models were estimated.Results: Prenatal anxiety significantly predicted postpartum bonding difficulties ( = .18,p = .001),independent of prenatal depressive symptoms.This association was partially mediated by late-pregnancy psychosocial stressors (total indirect effect = 0.34, 95% CI 0.23, 0.46).Prenatal

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