Psychometric Properties of the Prenatal Opioid Use Perceived Stigma Scale and Its Use in Prenatal Care

ObjectiveTo examine the psychometric properties of the Prenatal Opioid Use Perceived Stigma (POPS) scale and to assess the relationship of POPS scores to adequate prenatal care.DesignProspective cohort study.SettingMedical centers in Alabama, Ohio, and Pennsylvania (N = 4).ParticipantsWomen (N = 127) who took opioids during pregnancy and whose infants participated in the Outcomes of Babies With Opioid Exposure Study.MethodsParticipants reported their perceptions of stigma during pregnancy by responding to the eight items on the POPS scale. We evaluated the instrument’s internal consistency reliability (Cronbach’s alpha), structural validity (factor analysis), and convergent validity (relationship with measures of similar constructs). In addition, to assess construct validity, we used logistic regression to examine the relationship of POPS scores to the receipt of adequate prenatal care.ResultsThe internal consistency of the POPS scale was high (Cronbach’s α = .88), and all item-total correlations were greater than 0.50. The factor analysis confirmed that the items cluster into one factor. Participants who reported greater perceived stigma toward substance users and everyday discrimination in medical settings had higher POPS scores, which supported the convergent validity of the scale. POPS scores were significantly associated with not receiving adequate prenatal care, adjusted OR = 1.47, 95% confidence interval [1.19, 1.83], p < .001.ConclusionThe psychometric testing of the POPS scale provided initial support for the reliability and validity of the instrument. It may be a useful tool with which to assess perceived stigma among women who take opioids, a potential barrier to seeking health care during pregnancy.     

Prenatal Depressive Symptoms and Postpartum Sexual Risk Among Young Urban Women of Color

Study ObjectiveTo determine whether prenatal depressive symptoms are associated with postpartum sexual risk among young, urban women of color.DesignParticipants completed surveys during their second trimester of pregnancy and at 1 year postpartum. Depressive symptoms were measured using the Center for Epidemiologic Studies-Depression Scale, excluding somatic items because women were pregnant. Logistic and linear regression models adjusted for known predictors of sexual risk and baseline outcome variables were used to assess whether prenatal depressive symptoms make an independent contribution to sexual risk over time.SettingFourteen community health centers and hospitals in New York City.ParticipantsThe participants included 757 predominantly black and Latina (91%, n = 692) pregnant teens and young women aged 14-21 years.Interventions and Main Outcome MeasuresThe main outcome measures were number of sex partners, condom use, exposure to high-risk sex partners, diagnosis of a sexually transmitted disease, and repeat pregnancy.ResultsHigh levels of prenatal depressive symptoms were significantly associated with increased number of sex partners (β = 0.17; standard error, 0.08), decreased condom use (β = −7.16; standard error, 3.08), and greater likelihood of having had sex with a high-risk partner (odds ratio = 1.84; 95% confidence interval, 1.26-2.70), and repeat pregnancy (odds ratio = 1.72; 95% confidence interval, 1.09-2.72), among participants who were sexually active (all P < .05). Prenatal depressive symptoms were not associated with whether participants engaged in postpartum sexual activity or sexually transmitted disease incidence.ConclusionScreening and treatment for depression should be available routinely to women at risk for antenatal depression.     

Maternal-fetal attachment and its correlates in a sample of Italian women: a study using the Prenatal Attachment Inventory

Background: Maternal–fetal attachment (MFA) is considered to be related to the quality of subsequent maternal care of the infant and maternal health behaviour during pregnancy. Objective: The aims of the present study were to investigate the internal structure of a questionnaire used for assessing MFA, the Prenatal Attachment Inventory (PAI), and to address the role of gestational age, couple adjustment and depressive symptomatology on MFA, on a sample of women from suburban areas. Method: A cross-sectional study using self-report questionnaires was conducted to address these two aims on 130 women attending prenatal care services. Results: A five-factor solution emerged for the PAI questionnaire. MFA levels were comparable to those found in previous studies using PAI, whereas depressive symptoms were higher than those reported in previous studies with normative pregnant women. Couple adjustment and gestational age significantly increased MFA. Among the MFA dimensions, Affect and Interaction were mainly affected by gestational age; Maternal–fetal differentiation was associated with gestational age and couple adjustment. Depressive symptoms were associated with an increase in Fantasy and Sensitivity factor scores. Conclusion: Prenatal attachment increased as gestational age advanced and as mothers perceived greater levels of couple adjustment, which promoted MFA strength, positive affect and MFA interaction and differentiation. The internal structure of PAI and its association with specific correlates are discussed.     

Perceived Discriminatory Factors that Impact Prenatal Care Satisfaction and Attendance Among Adolescent and Young Adult Couples

ObjectiveTo identify possible discriminatory factors that lead to prenatal care dissatisfaction and disengagement from prenatal care among young, expecting couples with a focus on exploring the experiences of Black and Latinx participants.MethodsA total of 296 young adolescent couples were recruited. Each couple consisted of an expecting female (ExpF) and an expecting male (ExpM). Participants were asked to give responses to a survey, and data was collected at 3 different time points.ParticipantsThe sample consisted of 296 expecting young couples.SettingParticipants were recruited from obstetrics and gynecology clinics and ultrasound clinics from 4 university-affiliated hospitals in southern Connecticut.Outcome MeasuresThe main outcome measure was prenatal care satisfaction. The secondary outcome was number of prenatal care visits that were attended by each member of the couple dyad. Both of these outcomes were assessed to evaluate whether discriminatory factors that participants experienced in healthcare had an effect on each outcome.ResultsA total of 51 males (17.5%) and 36 females (12.4%) reported a perception of experiencing discrimination in the healthcare system a few times a year or more. Those who believed that race contributed to discrimination in the healthcare system were 2.45 times more likely to have an unpleasant prenatal visit (P = .018). Those who believed that age contributed to discrimination in the healthcare system were 2.74 times more likely to have an unpleasant prenatal visit (P = .001). Participants who believed that physical appearance contributed to discrimination in the healthcare system were 2.83 times more likely to have an unpleasant prenatal visit (P = .01).ConclusionBlack and Latinx young expecting couples are not exempt from discriminatory experiences during prenatal care. Recommendations for quality improvement in prenatal healthcare settings include implementation of standard evaluative measures specific to personal treatment and supportiveness of the medical team.     

Maternal depressive symptomatology during pregnancy is a risk factor affecting newborn’s health: a longitudinal study

ABSTRACT

Background: Depression symptomatology in pregnant women is a condition that represents an important risk factor for the health of both women and children.

Objectives: The aim of this study was to investigate the influence of women’s depression symptomatology on the clinical aspects of their delivery, both directly and indirectly, through mothers’ prenatal attachment to their unborn children. Moreover, we analysed whether these aspects affect the well-being of the newborn, assessed through the Apgar score.

Methods: A longitudinal design was carried out on a total of 203 pregnant women. At weeks 31–32 of gestation, women filled out the Beck Depression Inventory and the Prenatal Attachment Inventory. The day of childbirth, hospital healthcare staff registered the clinical data of childbirth.

Results: A woman’s depressive symptomatology negatively affects prenatal attachment to her unborn child and positively affects the clinical aspects of the delivery, both directly and mediated by the quality of prenatal attachment. Moreover, the Apgar score was negatively influenced by the clinical aspects of the delivery and, indirectly, by the depressive symptomatology.

Conclusion: Depressive symptomatology during pregnancy has negative outcomes, affecting the delivery experience of women, the first emotional bond with the child, and the well-being of the newborn.     

Randomized Controlled Trial of the Effects of 3D-Printed Models and 3D Ultrasonography on Maternal–Fetal Attachment

ObjectiveTo determine whether the addition of 3D-printed models improves maternal–fetal attachment in healthy pregnancies more than 3D ultrasonography alone.DesignRandomized, parallel-group, controlled trial.SettingUniversity- and clinic system–affiliated locations in Omaha, Nebraska.ParticipantsBetween May 2018 and February 2019, 857 pregnant women were screened for inclusion in the study, and 96 women (11%) were randomly assigned to an ultrasonography group (n = 48) or to an ultrasonography plus 3D-printed model group (n = 48).MethodsParticipants completed the Maternal Antenatal Attachment Scale (MAAS) questionnaire before they received third trimester 3D ultrasonography. Participants were randomly allocated to receive 3D ultrasonography only or 3D ultrasonography plus 3D-printed models of the fetus’s face. All participants completed a second MAAS questionnaire approximately 14 days after the study ultrasonography. The primary outcome was the global MAAS score. Secondary outcomes included the MAAS subscale scores.ResultsThe time-by-group interaction effect indicated that change in MAAS global score from baseline for the 3D-printed model group was 3.75 points greater than the score for the ultrasonography only group (95% confidence interval [1.40, 6.10], p = .002). Similar results were observed for the subscales with regard to quality of attachment and time spent thinking about the fetus.ConclusionsThe use of fetal facial models resulted in greater increases in maternal–fetal attachment than the use of ultrasonography only. Future research into this new technology to enhance pregnancy outcomes is clearly warranted.     

Impact of a Pediatric and Adolescent Gynecology Curriculum on an Obstetrics and Gynecology Residency

Study ObjectiveTo determine the effectiveness of a new pediatric and adolescent gynecology (PAG) curriculum for improving obstetrics/gynecology resident physician knowledge and comfort level in patient management and to describe the current deficiencies in resident physician knowledge and comfort level in PAG.DesignA PAG curriculum was implemented for the obstetrics/gynecology resident physicians (n = 20) at the University of South Florida in July 2013. Before and after the curriculum was introduced, resident physicians and recent graduates of the residency program completed a survey to assess their comfort level and a knowledge assessment consisting of 20 case-based questions.SettingUniversity-based residency program.ParticipantsResident physicians and recent resident physician graduates in the Department of Obstetrics and Gynecology.InterventionsIntroduction of a PAG curriculum during the 2013-2014 academic year.Main Outcome MeasuresImprovement in resident physicians' comfort level and knowledge in PAG.ResultsAfter the curriculum was introduced, comfort increased in examining the genitals of a pediatric gynecology patient (median difference = 1.5; P = .003) and history-taking, physical examination skills, and management (median difference = 1; P = .002) compared with before the curriculum. There was no significant difference in overall quiz score (15.5 ± 1.87 vs 15.8 ± 1.3; P = .78).ConclusionA curriculum in PAG did improve resident comfort level in managing PAG patients, but did not significantly improve knowledge of this topic.     

Psychological Correlates of Prenatal Attachment in Women Who Conceived After In Vitro Fertilization and Women Who Conceived Naturally

ABSTRACT: Background: Investigators have pointed out that long‐awaited pregnancies, such as those after in vitro fertilization (IVF), are emotionally vulnerable. In addition, higher pregnancy‐related distress has been found among women pregnant after in vitro fertilization compared with women with “naturally” achieved pregnancy. The aim of this study was to compare prenatal attachment among IVF mothers and control mothers (women who conceived naturally), and to study relationships between prenatal attachment and psychosocial variables. Methods : Fifty‐six IVF women from IVF clinics and 41 control women from antenatal clinics in Stockholm were assessed in gestational weeks 26 and 36. They completed self‐rating scales measuring prenatal attachment, personality, marital relationship, anxiety, and depression. Results: Prenatal attachment increased as the pregnancy progressed in both groups. Prenatal attachment rated in gestational week 26 was significantly associated with that in gestational week 36. Multiple regression analyses showed that, in gestational week 26, prenatal attachment was explained by satisfaction with the partner relationship, whereas in gestational week 36 the factors contributing to high prenatal attachment were low scores of the personality trait detachment, low ambivalence, and younger age. Method of conception was unrelated to prenatal attachment at either assessment time point. Conclusions: In vitro fertilization mothers are attached to their unborn children to the same extent as other mothers. Prenatal attachment increases during pregnancy. At the same time, however, individual scores on prenatal attachment seem to be relatively stable. Significant contributors to prenatal attachment are marital satisfaction, age, ambivalence, and detachment. (BIRTH 33:4 December 2006)     

Mentors Offering Maternal Support: A Support Intervention for Military Mothers

ObjectiveTo evaluate the effectiveness of the Mentors Offering Maternal Support (MOMS) program to promote maternal fetal attachment, maternal adaptation to pregnancy, self‐esteem, and perceived community support in women within a military environment.DesignA randomized, controlled, repeated measured pilot study compared two groups of pregnant military wives, a control group receiving standard prenatal care and an intervention group receiving a structured eight‐session MOMS program.SettingThe study was conducted at two Air Force installations in Florida having joint (Air Force, Army, and Navy) operations and high deployment requirements.ParticipantsSixty‐five military wives in their first trimester of pregnancy (control group, n = 36 and intervention group, n = 29) completed all aspects of the study.MethodsWomen randomized to the MOMS program received eight structured classes starting in the first trimester of pregnancy and occurring every other week until the third trimester. Outcome measures were obtained in each trimester. The women in the control group received usual prenatal care.ResultsNo statistically significant differences were found between the two groups for any of the outcome variables. The interaction of the amount of contact the women had with their deployed husbands and group assignment was statistically different for two variables, the Relationship with Husband Scale and the Rosenberg Self‐Esteem Inventory.     

A Longitudinal Survey of Childbirth‐Related Fear and Associated Factors

ObjectiveTo investigate the prevalence of childbirth‐related fear from pregnancy to one year after childbirth and to identify factors associated with being cured of childbirth‐related fear.DesignA longitudinal regional survey.SettingThree hospitals in a northern part of Sweden.ParticipantsSix hundred ninety‐seven (697) women who completed four questionnaires.MethodsData were collected by questionnaires in mid and late pregnancy and at 2 months and one year after birth. Childbirth related fear was measured 3 times.ResultsThere was a statistically significant increase in childbirth fear from 12.4% in mid‐pregnancy to 15.1% one year after childbirth (p < .001). Women who were cured of childbirth fear reported a better birth experience and would prefer a vaginal birth in a subsequent pregnancy. These women were also more likely to experience a feeling of control during birth and were more satisfied with information about the progress of labor, but there was no difference in prenatal counseling or having an elective cesarean between the groups.ConclusionWomen with prenatal fear of childbirth may be cured of this fear by having a better birth experience. If women feel in control of their bodies and are well informed about the progress of labor, the chances of being cured will increase. Prenatal counseling or having an elective cesarean birth does not seem to be a solution for relieving childbirth fear.     

Is prenatal bonding enhanced by prenatal education courses?

AIM: Prenatal education courses (PEC) are a way of allaying anxiety in pregnancy. PEC consist of a series of five 1-hour lessons in the first and second trimesters of pregnancy. Conducted by nurses or midwives, the course syllabus includes the basics of fetal physiology and development, singing sessions, dance sessions, massage-through-the-womb sessions. Here we investigated whether they can enhance feto-maternal bonding. METHODS: We studied 77 pregnant women (mean age: 31.5+/-4.1 years), 36 of whom attended PEC. We used the Prenatal Attachment Inventory (PAI), a validated 21-item questionnaire, to score prenatal bonding and compared the scores of the two groups. Three months after delivery, we asked the mothers to fill in another questionnaire to assess infant and maternal well-being. RESULTS: The PEC group showed a higher PAI score than the control group (65.5+/-6.9 vs. 59.9+/-6.1; P<0.05). Babies born to the PEC group had a higher frequency of unexplained crying. CONCLUSION: PEC positively influenced prenatal attachment. More studies are needed to assess whether this may be useful for the development of the mother-infant relationship.     

Underrepresented minority representation trends in gynecologic oncology fellowships in the United States

ObjectiveTo evaluate representation trends of historically underrepresented minority (URM) groups in gynecologic oncology fellowships in the United States using a nationwide database collected by the Accreditation Council for Graduate Medical Education (ACGME).MethodsData on self-reported ethnicity/race of filled residency positions was collected from ACGME Database Books across three academic years from 2016 to 2019. Primary chi-square analysis compared URM representation in gynecologic oncology to obstetrics and gynecology, other surgical specialties, and other medical specialties. Secondary analysis examined representation of two URM subgroups: 1) Asian/Pacific Islander, and 2) Hispanic, Black, Native American, Other (HBNO), across specialty groups.ResultsA total of 528 gynecologic oncology positions, 12,559 obstetrics and gynecology positions, 52,733 other surgical positions, and 240,690 other medical positions from ACGME accredited medical specialties were included in analysis. Primary comparative analysis showed a statistically significant lower proportion (P < 0.05) of URM trainees in gynecologic oncology in comparison to each of obstetrics and gynecology, other surgical fields, and other medical fields. Secondary analysis also demonstrated a significantly lower proportion (P < 0.05) of HBNO physicians in gynecologic oncology in comparison to obstetrics and gynecology, as well as all other medical and surgical specialties.ConclusionsThis study illustrates the disparities in URM representation, especially those who identify as HBNO, in gynecologic oncology fellowship training in comparison to obstetrics and gynecology as well as other medical and surgical fields. Improvements to the current recruitment and selection practices in gynecologic oncology fellowships in the United States are necessary in order to ensure a diverse and representative workforce.     

Remembrance of Dr Deborah Rosenblatt,a friend and perinatal researcher

Objective: To explore the underlying structure of the Prenatal Attachment Inventory (PAI) and to assess the psychometric properties of the subscales. Background: The establishment of the mother–fetus relationship is an important developmental task for successful adaption to pregnancy, with implications for the well-being of mother and child. The PAI was developed to measure the relationship between a women and her fetus. Although originally developed as a single dimension, other researchers have suggested alternative factor structures. Methods: A self-report questionnaire, including the PAI, was administered to 775 Swedish women in late pregnancy. Psychometric assessment of the PAI was undertaken using exploratory (EFA) and confirmatory factor analysis (CFA), and Rasch analysis. Results: EFA indicated a three-factor solution, which was confirmed by CFA. The previously reported single-factor and five-factor solutions were not supported. Rasch analysis was used to form three 6-item PAI-Revised subscales (Anticipation, Interaction, Differentiation). All subscales showed good overall fit to the Rasch model and good internal consistency. The three subscales were moderately intercorrelated, sharing between 23% and 42% of their variance, suggesting they should be used separately, pending further research concerning their unique predictive power. Conclusion: These results suggest that PAI-Revised is a psychometrically sound tool, suitable for use in research and clinical settings. It can be used to guide the identification, support, and follow-up of pregnant women with low attachment. The three subscales, although related, may tap different aspects of the attachment construct, with different antecedents and consequences for the well-being of mother and child.     

The Growth of Maternal-Fetal Emotional Attachment in Pregnant Adolescents: A Prospective Cohort Study

Study ObjectiveTo describe self-reported maternal-fetal emotional attachment in adolescent women over the course of pregnancy, compare it with adult pregnant women, and identify risk factors for poor attachment.DesignA prospective cohort study.SettingYoung mothers' clinics in 2 public hospitals in metropolitan Melbourne, Australia.ParticipantsEnglish-speaking young women aged 20 years and under attending their first antenatal visit.MethodsSelf-report questionnaires were completed in each trimester. Validated measures were used to assess anxiety and depression symptoms and maternal-fetal emotional attachment. Data were analyzed with existing data from pregnant adults. Regression analyses were conducted to establish factors independently associated with higher mean first-trimester attachment score and lowest-quartile third trimester score adjusting for confounding variables.Main Outcome MeasureMaternal-fetal emotional attachment, assessed by the Quality and Intensity subscales and Global score on Maternal Antenatal Attachment Scale (MAAS).Results165/194 (85%) completed the first questionnaire; 130/165 (79%) provided complete data. Mean anxiety but not depression scores were significantly higher in adolescents than adults across pregnancy. Mean (95%CI) first-trimester adolescent Global MAAS was significantly lower than adults (70.3 (68.4, 72.2) vs 76.8 (75.4, 78.2) P < .01), but there were no significant second- or third-trimester between-group differences. Adjusted odds of a lowest-quartile third-trimester MAAS score was significantly associated with lower first-trimester score (P < .001), previous abortion (P = .02) and being born overseas (P = .002).ConclusionAdolescents report slower development of antenatal emotional attachment than adults. Women with risk factors for poor attachment in late pregnancy are identifiable in early pregnancy and may benefit from additional multidisciplinary care.     

Screening for At-Risk Alcohol and Drug Use in the Antenatal Period: How Do Young Women Compare with Older Adult Women?

Study ObjectiveIn the present study we compared results of standardized screening tools for problem alcohol and other drug use in younger (ages 18-24 years) and older (ages 25 and older) women attending the same clinic. We separately investigated pregnant and nonpregnant women.Design, Setting, Participants, Interventions, and Main Outcome MeasuresThis was a cross-sectional study of women attending an urban, university-affiliated obstetrics and gynecology clinic. Women were recruited while awaiting appointments with their providers. In total, 3317 provided consent and completed a brief anonymous survey with standardized questions about alcohol and other drug problems. Measures included the T-ACE (acronym for Tolerance, Annoyed when others express concern, Cut down on drinking, Eye-opener) for alcohol and CAGE for other drugs (CAGE is a mnemonic for the following items: (1) Have you ever felt you should cut down on your use of other drugs? (2) Have people annoyed you by criticizing your use of other drugs? (3) Have you ever felt bad or guilty about your use of other drugs? and (4) Have you ever used drugs first thing in the morning to steady your nerves, avoid withdrawal, or get rid of a hangover [eye opener]?). Individual item responses and screener summary scores were compared separately for pregnant and nonpregnant younger (ages 18-24 years) and older adult (25 years of age or older) women using χ² for categorical and t tests for continuous variables.ResultsFor pregnant women, 386/1460 (26%) of older women screened at-risk for problem drinking compared to 250/1203 (21%) of younger women (P = .001). For other drugs, however, 192/1203 (16%) of younger pregnant women screened at risk compared to 186/1461 (13%) of older adult pregnant women (P = .02). For nonpregnant women, screen positive rates for at-risk drug use were nearly 2 times higher among older compared with younger women, with 48/321 (15%) of older women screening at risk compared to 28/332 (8%) of younger women (P < .01).ConclusionThe present findings affirm the need for routine screening for alcohol and drug problems in women of all ages, regardless of pregnancy status.     

Life Course Pathways to Prenatal Maternal Stress

ObjectiveTo evaluate the impact of childhood stressors, recalled childhood stress, and stressors in adulthood on perceived stress in pregnancy.DesignProspective cohort study.SettingPregnant women were recruited from pre‐birth clinics in two communities.ParticipantsFour‐hundred and twenty‐one pregnant women.ResultsPerceived prenatal maternal stress was the main outcome measure. Recalled childhood stress was positively associated with prenatal stress (β = .54) after adjusting for other child and adult factors. Low family cohesion during childhood was indirectly associated with prenatal stress through its effects on recalled childhood stress, current family cohesion, and current subjective socioeconomic position (SEP). Low levels of adult subjective SEP (β = −.44) and family cohesion (β = −.25) were directly associated with prenatal stress. Perceived social support during childhood was indirectly associated with prenatal stress through its effect on recalled childhood stress and perceived social support in adulthood. Childhood subjective SEP indirectly influenced prenatal stress through its effect on adult subjective SEP and recalled childhood stress.ConclusionsPrenatal stress is a result of the interplay between factors from childhood and adulthood. The study findings can be used to inform psychosocial risk assessment and interventions across the lifespan to decrease prenatal stress and its adverse outcomes.     

Does an Advanced Pelvic Simulation Curriculum Improve Resident Performance on a Pediatric and Adolescent Gynecology Focused Objective Structured Clinical Examination? A Cohort Study

Study ObjectiveTo determine the effect of an advanced pelvic simulation curriculum on resident performance on a pediatric and adolescent gynecology (PAG) focused objective structured clinical examination (OSCE).DesignObstetrics and gynecology residents in a single academic Canadian center participated in a PAG simulation curriculum. An OSCE on prepubertal vaginal bleeding was administered at the biannual OSCE examination 2 months before the simulation curriculum and again 3 months after the simulation curriculum.SettingAcademic half-day at the University of Ottawa Skills and Simulation Centre.ParticipantsObstetrics and gynecology residents from the University of Ottawa.InterventionsParticipants completed 4 stations teaching PAG-appropriate history-taking, genital examination, Tanner staging, vaginal sampling and flushing, hymenectomy, vaginoscopy, laparoscopic adnexal detorsion, and approach to the child and/or adolescent. Advanced pelvic models were used for procedure-specific stations.Main Outcome MeasuresThe primary outcome measure was change in mean score on a prepubertal vaginal bleeding OSCE station. Secondary outcome measures were changes in individual component scores.ResultsFourteen residents completed the simulation curriculum and the PAG OSCE at the 2 separate time points (before and after simulation curriculum). The mean OSCE score before the simulation curriculum was 54.6% (20.5 of 37) and mean score after the curriculum was 78.1% (28.9 of 37; P < .001). Significant score increases were found in history-taking, examination, differential diagnosis, identification of organism, surgical procedures, and identification of foreign body (P < .01 for all).ConclusionThis innovative PAG simulation curriculum significantly increased residents' knowledge in PAG history-taking, examination skills, operative procedures, and approach to the child and/or adolescent. Obstetrics and Gynecology Program Directors should consider incorporating PAG simulation training into their curriculum to ensure that residents meet their learning objectives and increase their knowledge and confidence, which will ultimately benefit patient care.     

Assessing prenatal attachment in a sample of Italian women

The term prenatal attachment refers to the affective investment that parents develop towards the unborn baby during the gestation period. Recent research supports the idea that the early relationship between the woman and the child she's bearing is related to the quality of postnatal mother–infant interaction and to the improvement of the woman's health behaviour in pregnancy. This study focuses on the process of the woman's bonding with her foetus and aims to assess the psychometric properties of the Italian translation of Prenatal Attachment Inventory (PAI). The PAI was translated into Italian and administered to a sample of 214 low‐risk pregnant women. As prenatal attachment is supposed to measure the mother's capability to emotionally invest in the foetus, the Toronto Alexithymia Scale was also administered to assess the pregnant women's alexithymia level. The results illustrate that the Italian version of the PAI maintains the main psychometric characteristics of the original version. Explorative factor analysis suggested a five‐factor structure. The association between low level prenatal attachment and high level alexithymia may be of interest in mother–infant wellbeing promotion programmes.