There is evidence that throughout pregnancy mothers and fathers develop mental representations (ideas and emotions) and behaviors related to their unborn child and thus establish the precursors of attachment and relationship (Ilicali & Fisek, 2004). These manifestations develop as pregnancy progresses and increase in the presence of fetal movements, the use of ultrasound, and gestational age (Grace, 1989; Leifer, 1980; Lumley, 1982; Mikhail et al., 1991; Righetti et al., 2005; Trombetta et al., 2021).

Research in this area has focused on different constructs that represent the bond parents begin to establish with the unborn. The term maternal-fetal attachment, proposed by Cranley (1981, p. 282), was defined as “the extent to which women engage in behaviors that represent an affiliation and interaction with their unborn child.” Several factors affect maternal-fetal attachment. Among these, depressive symptoms and perceived stress have consistently been associated with lower fetal attachment quality in pregnant women (Condon & Corkindale, 1997; Cranley, 1981; Hart & McMahon, 2006; Nieto et al., 2017; Perry et al., 2011).

The translated Maternal Antenatal Attachment Scale—Spanish version for Mexican women (MAAS-Spanish version) is a self-applied questionnaire that assesses attachment precursors and guides pre- and postnatal interventions aimed at the caregiver-infant dyad. The original scale was a proposal to improve the internal consistency of previous instruments, such as Cranley’s (1981) Maternal-Fetal Attachment Scale (Condon, 1993).

The MAAS (Condon, 1993) is one of the most widely used instruments that assess maternal antenatal attachment (Della Vedova et al., 2019). Ossa et al. (2011) used a hetero-applied version of the MAAS translated into Spanish. They reported a Cronbach alpha for the global scale of .72 in a sample of 244 Chilean pregnant women. In Mexico, Castro et al. (2015) used a previous translation of the MAAS in a sample of 169 pregnant women. They found a Cronbach alpha of .69 for the Global scale, .77 for the Quality subscale, and .55 for the Intensity subscale. Their results showed a slight decrease in the instrument’s internal consistency compared to that reported in the original study by Condon (1993). Another study on Spanish speakers was that of Navarro-Aresti et al. (2016) in Spain, in which the original version of the MAAS (Condon, 1993) was translated and back-translated. An internal consistency of .74 Cronbach alpha was reported for the global scale, .67 for the Intensity subscale, and .63 for the Quality subscale with this version.

The objective of this study was to obtain the psychometric parameters of the internal validity of the Maternal Antenatal Attachment Scale—Spanish version for Mexican women (MAAS—Spanish version) using the version translated and adapted for this population.

The aim of this study was to evaluate the consistency and concurrent validity of the Maternal Antenatal Attachment Scale-Spanish Version for Mexican women (MAAS-Spanish version). According to Tsang et al. (2017), the instrument was used with a translation and adaptation process that ensured that the measurement of the constructs was consistent with the original scale, maintained the theoretical perspective of attachment, and considered the cultural context. Like other Latin American contexts, the study sample consisted of women with high psychosocial vulnerability, where 16% were single and 56% were in a consensual union. Also, the maximum degree of education of the majority (75%) was middle school, and 88% were economically dependent and dedicated to housework.

In this socioeconomic environment, the MAAS-Spanish version showed adequate internal consistency for its total score with a Cronbach alpha of .79 according to Nunnally and Bernstein (1995) criteria, similar to that reported by Condon (1993). However, the internal consistency of the subscales was slightly below the recommended level. This finding was expected since, in the MAAS-Spanish version, the two-factor structure proposed by Condon (1993) was not replicated. Thus, both the Intensity and Quality scales obtained a Cronbach alpha of .69. However, Cronbach alphas of the total and two factor scales of the MAAS in Spanish exceeded most of those reported in other populations. In contexts such as Spain, Mexico, and Chile, the global scale has shown Cronbach alphas in a range of .70 to .87; the Intensity scale of .56 to .77, and the Quality scale of .57 to .88 (Mako and Deak, 2014; Mata et al., 2015; Navarro-Aresti et al., 2016; Ossa et al., 2011; Van Bussel et al. al., 2010). Accordingly, the overall internal consistency of the MAAS-Spanish version shows that its items have the desirable homogeneity.

The two-factor confirmatory factor analysis partially replicated the model proposed by Condon (1993) since the first factor contained items from both factors. This finding was consistent with discrepancies reported between other Spanish versions of the MAAS with respect to the original instrument (Navarro Aresti et al., 2016). Thus, the MAAS in this study showed an explained variance of 32.9% in the two-factor confirmatory analysis, 6.1% lower than that of the original model by Condon (1993). In the exploratory factorial analysis and in the confirmatory two-factor analysis, a factor was found that explained most of the variance and had most of the items. Taking this data into account and that the correlation between the subscales was high (higher than that of previous studies), it is suggested that the global score is a significant measure of attachment referents in the prenatal stage (Busonera et al., 2015; Condon and Corkindale, 1997; Van Bussel et al., 2010; Mako and Deak, 2014).

Regarding the concurrent validity of the MAAS-Spanish version, as expected, a significant negative relationship was found between the risk factors for perinatal depression and the low Quality of the maternal representations of the infant. As has been described in the literature, pregnant women with a higher risk of suffering perinatal depression showed representations of the infant of lower Quality and Intensity (Condon & Corkindale, 1997).

This finding is relevant from two perspectives. On the one hand, it shows the concurrent validity of the MAAS-Spanish version and the usefulness of its global score and the two subscales proposed by Condon (1993) in the original instrument. On the other hand, the results corroborate the importance of evaluating and considering the risk factors that interfere with bonding processes to prevent or treat them in the prenatal stage.

The presence of depressive symptoms during pregnancy and its impact on attachment processes is relevant in the Mexican context (Lara et al., 2006; Nieto et al., 2017). It is estimated that between 9% and 14% of pregnant women in Mexico are diagnosed with depression when evaluated with clinical interviews, while between 8% and 31% are diagnosed through self-reports (Ibarra-Yruegas et al., 2016). On the other hand, Ibarra (2015) identified that up to 21% of pregnant women were at risk of postpartum depression in a similar Mexican population. This risk has been associated with various psychosocial factors such as problems in the social and economic support network and anxiety produced by the challenge of parenting (Albuja et al., 2017; Cutrona, 1984; García et al., 1991; Lara et al., 2006). In this study, the presence of depressive symptoms and risk factors for postpartum depression confirmed their association with lower-quality referents of prenatal bonding.

The manifestations of difficulties in bonding processes, identified through prenatal attachment referents and the presence of perinatal depression, have been associated with negative consequences. For example, both reduce adherence to pregnancy check-ups and enjoying motherhood (Bennett et al., 2004). They have also been linked to an increased risk of non-term pregnancies, low birth weight, breastfeeding difficulties, and parental sensitivity to the infant’s needs (Kaydirak et al., 2021; Schaffir, 2018; Steer et al., 1992). On the other hand, better quality in prenatal attachment referents has been related to the development of adaptive, emotional, and proximity parental behaviors in the postnatal stage, such as smiling at the baby, hugging, and kissing him, as well as prompt, consistent, and affectionate responses to the baby’s call (Lara et al., 2013; Taffazoli et al., 2015).

Motherhood is a complex phenomenon that implies significant challenges in the Latin American context. On the one hand, it is a moment of assuming female identity as a source of value, power, and social prestige. On the other hand, motherhood can diminish labor competition and complicate access to a better socioeconomic position and quality of life (Gajardo, 2021).

Mota et al. (2019) mention that in current Mexican culture, the meaning of motherhood and the attitudes and beliefs about it differ according to specific social groups. The relevance of motherhood in this country and other Latin American countries as a source of personal fulfillment is high in socioeconomically vulnerable groups (Gajardo & Oteíza, 2017; Mota et al., 2019). Concerning this, in the studied sample, it was striking that despite socioeconomic adversity, low educational background, unemployment, and marital status as single and living consensually, most pregnancies were reported as wanted, although a high percentage were unplanned. Factors to consider in this phenomenon include the high proportion of Catholic participants and the impact of the traditional role of Mexican women, associated with qualities of passivity and dependence (Albuja et al., 2017; Lara, 1998; Lara et al., 1994). From this perspective, duty and sacrifice are inherent to the maternal role (Gajardo and Oteíza, 2017). However, in contexts of low social support, this traditional role can act as a risk factor for developing postpartum depression (Albuja et al., 2017).

Latin women still face rigid models of ideals about motherhood that can lead to negative effects on physical and mental health (Gajardo and Oteíza, 2017; Lara, 1998). In addition to this, before 2021, in most of the states of Mexico, voluntary termination of pregnancy was not decriminalized, and there were constitutional reforms that guaranteed protection of the right to live from the moment of conception (Wójtowicz-Wcisło, 2020), which were politically motivated by religious institutions (Blofield 2008). In contrast, sex education in Mexico is very deficient, where 20% of annual pregnancies correspond to teenage mothers (Cancino & Valencia, 2015).