Healthy maternal–infant attachment is the foundation on which a child’s physical, cognitive, psychological, and emotional development rests. This relationship between the dyad does not begin at birth but rather prior to conception or any time throughout pregnancy. Our understanding of how this relationship develops between a mother and her fetus remains largely intangible for researchers and clinicians alike as it is a highly complex process with many variables influencing the evolving bond. Situated within a poststructural critical feminist framework, the purpose of this qualitative study using a grounded theory approach was to gain a better understanding of how women who use substances during pregnancy experience the process of a developing relationship with their fetuses, and to identify intersecting variables that may influence their health behaviours. Five main categories emerged including choosing the mothering path, balancing the risks, needing safe passage, breaking the cycle, and mothering against all odds. All of the women in the study described feeling an increase in maternal–fetal attachment as the pregnancy progressed and demonstrated efforts to reduce substance use, engage with the health care system, and improve dietary choices to limit negative consequences for their developing fetuses. Barriers to changing health behaviours were identified by the participants as well as by health care providers working with this population. In gaining a deeper understanding of the variables that influence maternal–fetal attachment in women who use substances and development of a substantive theory, nursing practice may be informed by providing direction around how best to support harm reduction approaches in this population.

Existing commonly used maternal-fetal attachment instruments have not been thoroughly tested for reliability and validity; criticism can be levelled for a variety of problems ranging from lack of reliability due to an inadequate underpinning framework to facilitate objective interpretation to limited generalizability due to the sample. The aim of this study is to acknowledge the centrality of the mother, to use the experiences of pregnant women to generate a definition of maternalfetal attachment and ultimately create a tool that will act as a reliable, valid and simple measurement. A mixed method framework utilising a sequential exploratory strategy has allowed qualitative exploration of the phenomenon under investigation followed by quantitative testing of the emerging theory on a much larger and different sample. Phase 1 involved face to face open structured interviews on an opportunity sample of 10 (5 primigravid; 5 multiparous) women in the final trimester of pregnancy followed by 3 focus groups targeting specific groups – primigravid women (6 participants); multiparous women (7 participants) and teenagers (4 participants). Data analysis was through constant comparative methodology. A multidimensional, psycho-biological definition of attachment was generated from the women’s own perception of their attachment to their fetus. This was used as a framework to design a questionnaire for the measurement of maternal-fetal attachment. Phase 2 involved the validation of the questionnaire and further testing of the definition. Cohort 1 tested for reliability with 200 participants within their second or third trimester of pregnancy. Following modification of the questionnaire, Cohort 2 a sample of 150 women within the final trimester of pregnancy tested the tool for internal reliability and validity. The generated Maternal-Fetal Attachment Tool (MFAT) following rigorous testing proved both reliable and valid. Maternal fetal attachment is founded in psycho-biological theory and is a complex multi-dimensional construct. Central to the definition is the woman’s need to protect her fetus, attachment develops as the fetus becomes more tangible, it is facilitated through the woman’s intergenerational experience of attachment and through appropriate social support. Maternal-fetal attachment facilitates behavioural change to ensure a favourable intra-uterine environment.

The Breech Baby Study is a mixed methods study which combines qualitative and quantitative inquiry. This study explores psycho-social-cultural risk factors for breech presentation from an evolutionary perspective. The quantitative component of the study uses Florida birth certificate and Medicaid data sets from 1992-2003 to evaluate the influence of ethnicity and socio-economic status on breech presentation. Ethnicity and socio-economic status account for less than two percent of the variance of risk factors for breech presentation. The qualitative study includes 114 mothers of breech and cephalic presentation babies who completed the State Trait Personality Inventory and a socio-demographic survey. Of these, 52 mothers of cephalic presentation babies and 23 mothers of breech presentation also participated in an in-depth interview about formative life experiences and peri-conception through delivery. The primary data analysis found mothers of breech presentation babies exhibit psycho-social-cultural characteristics unlike those found in mothers of cephalic presentation babies. These characteristics include being idealistic, analytical, polished, overextended, and fearful. Mothers of cephalic presentation babies were better equipped to adapt to unexpected situations and to be pragmatic in the face of unresolvable circumstances. Mothers of breech presentation babies were further separated into two categories. One category is achievement focused woman while the other is non-present focused woman. While both sets of breech presentation mothers were idealistic, the achievement focused mothers were more likely to be analytical, polished, and overextended. In contrast, the non-present focused mothers had a history of abuse and were more likely to have an unresolved pregnancy outcome or to be fearful. Breech presentation is interpreted by attachment theory, evolutionary ecological reproductive theory, and developmental plasticity theory as a fetal strategy to adapt to the intra-uterine relationship environment and an attempt to predict the extra-uterine relationship environment.

Background: Mothers with HIV often face personal and environmental risks for poor maternal health behaviors and infant neglect, even when HIV transmission to the infant was prevented. Maternal-fetal attachment (MFA), the pre-birth relationship of a woman with her fetus, may be the precursor to maternal caregiving. Using the strengths perspective in social work, which embeds MFA within a socio-ecological conceptual framework, it is hypothesized that high levels of maternal-fetal attachment may protect mothers and infants against poor maternal health behaviors. Objective: To assess whether MFA together with history of substance use, living marital status, planned pregnancy status, and timing of HIV diagnosis predict three desirable maternal health behaviors (pregnancy care, adherence to prenatal antiretroviral therapy–ART, and infant’s screening clinic care) among pregnant women with HIV/AIDS. Method: Prospective observation and hypothesis-testing multivariate analyses. Over 17 consecutive months, all eligible English- or Spanish-speaking pregnant women with HIV ( n = 110) were approached in the principal obstetric and screening clinics in Miami-Dade County, Florida at 24 weeks’ gestation; 82 agreed to enroll. During three data collection periods from enrollment until 16 weeks after childbirth (range: 16 to 32 weeks), participants reported on socio-demographic and predictor variables, MFA, and pregnancy care. Measures of adherence to ART and infant care were extracted from medical records. Findings: Sociodemographic, pregnancy, and HIV disease characteristics in this sample suggest changes in the makeup of HIV-infected pregnant women parallel to the evolution of the HIV epidemic in the USA over the past two decades. The MFA model predicted maternal health behaviors for pregnancy care (R2 = .37), with MFA, marital living status, and planned pregnancy status independently contributing ( = .50, = .28, = .23, respectively). It did not predict adherence to ART medication or infant care. Relevance: These findings provide the first focused evidence of the protective role of MFA against poor maternal health behaviors among pregnant women with HIV, in the presence of adverse life circumstances. Social desirability biases in some self-report measures may limit the findings. Suggestions are made for orienting future inquiry on maternal health behaviors during childbirth toward relationship and protection.

A gravidez é um evento que envolve adaptações físicas e emocionais na vida de qualquer gestante, sendo um período em que indicadores emocionais, como a ansiedade e a depressão, podem-se alterar. É também neste período que a vinculação da mãe com seu bebê, que vai nascer, começa a ser estabelecida. Esta vinculação, chamada de apego materno-fetal, é importante para a qualidade de todos os laços afetivos futuros de qualquer indivíduo. Assim, o objetivo deste estudo foi verificar as possíveis diferenças nos comportamentos de apego materno-fetal apresentados por gestantes normais e com gravidez de risco. Para tanto, participaram desta pesquisa gestantes que realizaram exames ultrassonográficos na Escola de Ultra-Sonografia e Reciclagem Médica de Ribeirão Preto, sendo 25 com gravidez normal e 23 que apresentaram gravidez de risco. Entre estas, com gravidez de risco, quatro tiveram fetos malformados. Este estudo foi longitudinal e contou com três etapas de coleta de dados: a primeira, antes da realização do exame de ultrassonografia durante o segundo trimestre gestacional; a segunda, até dois meses após o exame e a terceira, até seis meses após o nascimento dos bebês. Utilizaram-se a Escala de Apego Materno-fetal, os Inventários de Ansiedade e Depressão de Beck e três roteiros de entrevista, um para cada fase de coleta, elaborados para atender aos objetivos desta pesquisa. Os dados obtidos foram analisados quantitativamente, de acordo com as normas estabelecidas de cada um deles, e os dados das entrevistas foram transcritos na íntegra e explorados a partir do sistema quantitativointerpretativo. Posteriormente, os dados foram correlacionados entre si, através de testes estatísticos não paramétricos. Assim, obteve-se que não há diferenças entre o apego maternofetal dos dois grupos estudados, sendo que este índice aumentou à medida que a gestação avançava, apresentando-se valores máximos desde antes da ultrassonografia, no segundo trimestre gestacional. O aumento do apego foi confirmado pelo relato das gestantes, ao demonstrarem a intensificação dos comportamentos que apresentavam em relação a seus bebês, conforme a gravidez evoluía e também depois do nascimento deles. Os índices de ansiedade e depressão mostraram-se mais elevados, durante todo o período pré-natal e também depois do nascimento, entre as participantes cujas gestações foram de risco, principalmente para aquelas que tiveram filhos malformados. Estas gestantes, especialmente, sofreram o impacto da notícia de uma malformação em seus filhos ainda intraútero e quando os mesmos nasceram, apresentando reações de choque, negação, tristeza e equilíbrio na busca por adaptação à situação que vivenciavam. Conclui-se que a gravidade da realidade vivida por estas mães implica em níveis mais elevados de ansiedade e depressão, porém, não impede a formação da relação de apego entre elas e seus filhos. Enfatiza-se, portanto, a necessidade de programas de saúde com profissionais especializados que visem a assistência pré-natal emocional a todas as gestantes, de um modo geral, e principalmente àquelas que apresentam condições adversas durante a gestação. / Pregnancy is an event which involves physical and emotional adaptation in any pregnant woman\'s life. It is also a period in which emotional indicators, such as anxiety and depression, can be altered. Besides that, this is the period in which the mother and her unborn child begin to establish an attachment. This attachment, named maternal-fetal attachment, is important for the quality of all future affective bonds of any person. Therefore, the objective of this study is to find possible differences in the maternal-fetal attachment behaviour shown by normal pregnant women and the ones with risk pregnancies. For that, pregnant women who underwent ultrasound exams in the School of Ultrasound and Medical Recycling of Ribeirão Preto (Escola de Ultra-Sonografia e Reciclagem Médica de Ribeirão Preto) participated in this study. Of this group, 25 had normal pregnancies and 23 presented highrisk pregnancies. Among the latter, 4 had malformed fetuses. This is a longitudinal study, with three data collection phases: the first one was done before the ultrasound exam during the second gestational trimester; the second, up to two months after the exam and the third, up to six months after the children\'s birth. The Maternal-Fetal Attachment Scale, the Beck Anxiety and Depression Inventories and three interview scripts, one for each phase of the collection, specially designed to meet the objectives of this research, were used during the study. The information obtained was analysed quantitatively, according to each set of established rules and the data from the interviews were transcribed in full and explored using the quantitative-interpretative system. Posterior to that, the data was correlated through nonparametric static tests. It was, then, established that there are no differences between the maternal-fetal attachment of the two groups. The index, however, increased as the gestation progressed, with higher numbers since before the ultrasound, in the second gestational trimester. The growth of the attachment was confirmed by the pregnant women\'s report, when they showed the intensification of the behaviours which were presented in relation to their babies, as the pregnancies evolved and also after the babies\' birth. The levels of anxiety and depression were higher during all prenatal period and also after birth, among the participants whose gestations were of higher risk, mainly for those who had malformed babies. These pregnant women, particularly, suffered the impact of the news of a malformation in their children still intrauterine and when these children were born, they still presented reactions of shock, denial, sadness and balance when trying to adapt to their new situation. To conclude, the seriousness of the reality lived by these mothers implicate in higher levels of anxiety and depression, although it does not prevent the formation of an attachment relationship between them and their children. It is emphasised, therefore, the need of health programmes with specialised professionals which aim at emotional prenatal assistance to all pregnant women, in general, and mainly to those who go through adverse conditions during pregnancy.

Submitted by Oliveira Santos Dilzaná (dilznana@yahoo.com.br) on 2016-05-05T19:16:22Z No. of bitstreams: 1 Dissertação de Aline Carvalho Alves Peixoto.pdf: 1268291 bytes, checksum: 91d76cfbdad65ef2dc76a55c0af3db9c (MD5) / Approved for entry into archive by Oliveira Santos Dilzaná (dilznana@yahoo.com.br) on 2016-05-11T16:39:50Z (GMT) No. of bitstreams: 1 Dissertação de Aline Carvalho Alves Peixoto.pdf: 1268291 bytes, checksum: 91d76cfbdad65ef2dc76a55c0af3db9c (MD5) / Made available in DSpace on 2016-05-11T16:39:51Z (GMT). No. of bitstreams: 1 Dissertação de Aline Carvalho Alves Peixoto.pdf: 1268291 bytes, checksum: 91d76cfbdad65ef2dc76a55c0af3db9c (MD5) / Este estudo possui caráter pioneiro por explorar a relação mãe-feto em gestantes que sofrem violência. O constructo do apego materno-fetal tem sido amplamente estudado, em pesquisas nacionais e internacionais, assim como seus preditores, contudo existe uma carência de literatura que explore esse tema no contexto da violência. O presente estudo comparou o apego materno-fetal em um grupo de gestantes que nunca havia sofrido violência pelo parceiro íntimo durante a gestação (grupo comparação), e um grupo de gestantes que sofreu violência psicológica ou física pelo parceiro, durante a gestação (grupo de risco). Participaram deste estudo 32 mulheres que tinham idade entre 19 e 44 anos, e estavam no terceiro trimestre de gestação, no momento da coleta de dados. As gestantes foram convidadas a participar da pesquisa em duas maternidades públicas de Salvador e em um ambulatório de uma instituição filantrópica. Durante as entrevistas, as gestantes responderam a Escala de Apego Materno-fetal, o Questionário Nuclear WorldSAFE, e uma ficha de dados sociodemográficos. Não foram encontradas diferenças significativas entre os grupos de risco e comparação, em relação ao escore de apego materno-fetal contudo, foi verificado que o apego materno-fetal foi significativamente menor no subgrupo que sofreu violência física quando comparado ao subgrupo que sofreu unicamente violência psicológica. Discutem-se os comportamentos do apego que possivelmente foram prejudicados pela situação de violência, especificamente a física, a importância da saúde mental da mulher nesse contexto, as características metodológicas do estudo e características dos instrumentos utilizados nesta investigação. This study was pioneer in the discussion of mother-fetus relationship in pregnant women who suffer violence. The construct of maternal-fetal attachment has been widely studied in national and international research, as well as its predictors, however there is a lack of literature that explores this theme in the context of violence. This study compared the maternal-fetal attachment in a group of pregnant women who had never experienced violence by an intimate partner during pregnancy (comparison group), and a group of pregnant women who have suffered violence, psychological or physical by the partner, during pregnancy (risk group). The study included 32 women who were aged between 19 and 44, and were in the third trimester of pregnancy at the time of data collection. Pregnant women were invited to participate in the study in two public hospitals of Salvador and at a clinic belonging to a philanthropic institution. During the interviews, the mothers answered the Maternal-fetal Attachment Scale (MFAS), the WorldSAFE Nuclear Quiz, and finally a sociodemographic data sheet. There were no significant differences among risk group and comparison group, in relation to to the score of maternal-fetal attachment, but it was found that the maternal-fetal attachment was significantly lower in the subgroup that suffered physical violence when compared to the subgroup that underwent only psychological violence. It is discussed the attachment behaviors that were possibly affected by the situation of violence - specifically physical, the importance of women's mental health in this context, the methodological characteristics of the study and the characteristics of the instruments used on this research.

A gravidez é um evento que envolve adaptações físicas e emocionais na vida de qualquer gestante, sendo um período em que indicadores emocionais, como a ansiedade e a depressão, podem-se alterar. É também neste período que a vinculação da mãe com seu bebê, que vai nascer, começa a ser estabelecida. Esta vinculação, chamada de apego materno-fetal, é importante para a qualidade de todos os laços afetivos futuros de qualquer indivíduo. Assim, o objetivo deste estudo foi verificar as possíveis diferenças nos comportamentos de apego materno-fetal apresentados por gestantes normais e com gravidez de risco. Para tanto, participaram desta pesquisa gestantes que realizaram exames ultrassonográficos na Escola de Ultra-Sonografia e Reciclagem Médica de Ribeirão Preto, sendo 25 com gravidez normal e 23 que apresentaram gravidez de risco. Entre estas, com gravidez de risco, quatro tiveram fetos malformados. Este estudo foi longitudinal e contou com três etapas de coleta de dados: a primeira, antes da realização do exame de ultrassonografia durante o segundo trimestre gestacional; a segunda, até dois meses após o exame e a terceira, até seis meses após o nascimento dos bebês. Utilizaram-se a Escala de Apego Materno-fetal, os Inventários de Ansiedade e Depressão de Beck e três roteiros de entrevista, um para cada fase de coleta, elaborados para atender aos objetivos desta pesquisa. Os dados obtidos foram analisados quantitativamente, de acordo com as normas estabelecidas de cada um deles, e os dados das entrevistas foram transcritos na íntegra e explorados a partir do sistema quantitativointerpretativo. Posteriormente, os dados foram correlacionados entre si, através de testes estatísticos não paramétricos. Assim, obteve-se que não há diferenças entre o apego maternofetal dos dois grupos estudados, sendo que este índice aumentou à medida que a gestação avançava, apresentando-se valores máximos desde antes da ultrassonografia, no segundo trimestre gestacional. O aumento do apego foi confirmado pelo relato das gestantes, ao demonstrarem a intensificação dos comportamentos que apresentavam em relação a seus bebês, conforme a gravidez evoluía e também depois do nascimento deles. Os índices de ansiedade e depressão mostraram-se mais elevados, durante todo o período pré-natal e também depois do nascimento, entre as participantes cujas gestações foram de risco, principalmente para aquelas que tiveram filhos malformados. Estas gestantes, especialmente, sofreram o impacto da notícia de uma malformação em seus filhos ainda intraútero e quando os mesmos nasceram, apresentando reações de choque, negação, tristeza e equilíbrio na busca por adaptação à situação que vivenciavam. Conclui-se que a gravidade da realidade vivida por estas mães implica em níveis mais elevados de ansiedade e depressão, porém, não impede a formação da relação de apego entre elas e seus filhos. Enfatiza-se, portanto, a necessidade de programas de saúde com profissionais especializados que visem a assistência pré-natal emocional a todas as gestantes, de um modo geral, e principalmente àquelas que apresentam condições adversas durante a gestação. / Pregnancy is an event which involves physical and emotional adaptation in any pregnant woman\'s life. It is also a period in which emotional indicators, such as anxiety and depression, can be altered. Besides that, this is the period in which the mother and her unborn child begin to establish an attachment. This attachment, named maternal-fetal attachment, is important for the quality of all future affective bonds of any person. Therefore, the objective of this study is to find possible differences in the maternal-fetal attachment behaviour shown by normal pregnant women and the ones with risk pregnancies. For that, pregnant women who underwent ultrasound exams in the School of Ultrasound and Medical Recycling of Ribeirão Preto (Escola de Ultra-Sonografia e Reciclagem Médica de Ribeirão Preto) participated in this study. Of this group, 25 had normal pregnancies and 23 presented highrisk pregnancies. Among the latter, 4 had malformed fetuses. This is a longitudinal study, with three data collection phases: the first one was done before the ultrasound exam during the second gestational trimester; the second, up to two months after the exam and the third, up to six months after the children\'s birth. The Maternal-Fetal Attachment Scale, the Beck Anxiety and Depression Inventories and three interview scripts, one for each phase of the collection, specially designed to meet the objectives of this research, were used during the study. The information obtained was analysed quantitatively, according to each set of established rules and the data from the interviews were transcribed in full and explored using the quantitative-interpretative system. Posterior to that, the data was correlated through nonparametric static tests. It was, then, established that there are no differences between the maternal-fetal attachment of the two groups. The index, however, increased as the gestation progressed, with higher numbers since before the ultrasound, in the second gestational trimester. The growth of the attachment was confirmed by the pregnant women\'s report, when they showed the intensification of the behaviours which were presented in relation to their babies, as the pregnancies evolved and also after the babies\' birth. The levels of anxiety and depression were higher during all prenatal period and also after birth, among the participants whose gestations were of higher risk, mainly for those who had malformed babies. These pregnant women, particularly, suffered the impact of the news of a malformation in their children still intrauterine and when these children were born, they still presented reactions of shock, denial, sadness and balance when trying to adapt to their new situation. To conclude, the seriousness of the reality lived by these mothers implicate in higher levels of anxiety and depression, although it does not prevent the formation of an attachment relationship between them and their children. It is emphasised, therefore, the need of health programmes with specialised professionals which aim at emotional prenatal assistance to all pregnant women, in general, and mainly to those who go through adverse conditions during pregnancy.

Submitted by Cristiane Chim (cristiane.chim@ucpel.edu.br) on 2018-04-17T16:40:01Z No. of bitstreams: 1 Bárbara Borges Rubin_ok.pdf: 2368899 bytes, checksum: 497278bc48e1249b965937422adc4f01 (MD5) / Made available in DSpace on 2018-04-17T16:40:01Z (GMT). No. of bitstreams: 1 Bárbara Borges Rubin_ok.pdf: 2368899 bytes, checksum: 497278bc48e1249b965937422adc4f01 (MD5) Previous issue date: 2017-12-14 / Introduction: In general, child neurodevelopment can be determined by genetic, social and environmental factors that interact in complex ways. In addition, the development of the fetus is considered the most vulnerable period in this process. Risk behaviors during pregnancy are often observed in women who are not affectively bonding with the fetus, and there is evidence that the relationship of the pregnant woman with the fetus during pregnancy tends to remain stable after birth. It is known that early mother-infant bonding may influence the child's future social, cognitive and emotional development. Objective: To evaluate the relationship between maternal-fetal attachment and child development in children at three months of age. Method: This is a longitudinal study nested in a cohort of pregnant women in the city of Pelotas, Brazil, with pregnant that were evaluated at up to 24 weeks of pregnancy, 60 days after the first assessment and at 90 days postpartum with the children. A questionnaire that contains sociodemographic variables, questions related to the health of the pregnant, the relationship with the child’s father and data on the pregnancy were used; the Maternal-Fetal Attachment Scale to evaluate the quality of the relationship between the pregnant and the fetus; and the Bayley Scales of Infant Development III to assess child development. Results: The main result indicated that, at each increment of 1 point in the Maternal-Fetal Attachment, there was an increase of 0.03 (95% CI 0.0; 0.5) in the mean of the social-emotional scale and 0.02 (95% CI 0.0; 0.5) in the adaptive behavior scale score. Discussion: Our results suggest the influence of the early bond in the socioemotional and adaptive behavior domains, highlighting the importance of prenatal aspects in child development. / Introdução: Em geral, o neurodesenvolvimento infantil pode ser determinado por fatores genéticos, sociais e ambientais que interagem de forma complexa entre si. Além disso, o desenvolvimento do feto é considerado o período mais vulnerável neste processo. Comportamentos de risco durante a gestação são frequentemente observados em mulheres que não estão vinculadas afetivamente com o feto e, ainda, há evidências de que a relação da gestante com feto durante a gravidez tende a manter-se estável após o nascimento. Sabe-se que a vinculação precoce mãe-bebê pode influenciar o futuro desenvolvimento social, cognitivo e emocional da criança. Objetivo: Avaliar a relação entre Apego Materno-Fetal e Desenvolvimento Infantil em bebês aos três meses de vida. Método: Trata-se de um estudo longitudinal aninhado a uma coorte de gestantes da cidade de Pelotas/RS, no qual as gestantes foram avaliadas com até 24 semanas de gestação, 60 dias após a primeira avaliação e aos 90 dias após o parto junto com os bebês. Foram utilizados um questionário contendo variáveis sociodemográficas, questões relacionadas à saúde da gestante, à relação com o pai do bebê e dados sobre a gestação; a Escala de Apego Materno-Fetal para avaliar a qualidade da relação da gestante com o feto; e as Bayley Scales of Infant Development para avaliar o desenvolvimento infantil. Resultados: O principal resultado indicou que, a cada incremento de 1 ponto na escala de Apego Materno-Fetal, houve um aumento de 0,03 (IC95% 0,0;0,5) pontos na média da escala socioemocional e 0,02 (IC95% 0,0;0,5) na pontuação da escala de comportamento adaptativo. Discussão: Nossos resultados sugerem a influência do vínculo precoce nos domínios socioemocional e comportamento adaptativo, ressaltando a importância dos aspectos pré-natais no desenvolvimento infantil.

Introdução: Atualmente, estima-se que uma em cada mil mulheres grávidas sejam portadoras de câncer. A associação do diagnóstico de câncer ao de gestação coloca a mulher numa condição vulnerável para o desenvolvimento de transtornos psicológicos. Objetivo: Comparar e avaliar a associação entre sintomatologia de depressão, ansiedade, autoestima e vínculo materno-fetal entre gestantes com diagnóstico de câncer e gestantes sem diagnóstico de câncer. Propõe-se também a realizar a análise do discurso da vivência do período gestacional com e sem o diagnóstico de câncer. Método: Foi realizado estudo transversal com 63 gestantes com diagnóstico de câncer atendidas no Ambulatório de Tumores na Gestação de um hospital universitário terciário e 72 gestantes sem diagnóstico de câncer atendidas no Ambulatório de Pré-Natal de baixo risco do mesmo serviço. Foram utilizadas as escalas de Apego Materno-Fetal (MFAS), Hospital Anxiety and Depression (HAD), Subescala de Autoestima do Prenatal Psychosocial Profile (PPP) e entrevista semidirigida que investigou questões relacionadas à gravidez e ao adoecimento por câncer. Os testes Mann-Whitney, Kruskal-Wallis, de Dunn, qui-quadrado de Pearson e o teste exato de Fisher foram utilizados. O nível de significância adotado foi de 5%. A análise qualitativa foi realizada por meio da Técnica de Análise de Conteúdo. Resultados: Neste estudo constatou-se presença de sintomatologia depressiva em 33,3% das gestantes com câncer e em 18,1% nas gestantes sem câncer. Observou-se que as gestantes com diagnóstico de câncer quando comparadas às gestantes sem diagnóstico de câncer apresentaram menor renda per capita (p > 0,001), menor escolaridade (p=0,001), maior paridade (p < 0,001), menor trabalho remunerado (p=0,015), maior prevalência de depressão (p=0,041), ansiedade (p=0,039) e autoestima rebaixada (p < 0,001). Na análise feita por meio da combinação de diagnóstico de câncer e de depressão, evidenciou-se que a ansiedade estava associada à depressão e não com o diagnóstico de câncer. Com relação à autoestima, na combinação dos grupos evidenciou-se que o rebaixamento da autoestima estava relacionado à presença de câncer e não com a depressão. Aos resultados qualitativos foram atribuídas categorias em ambos os grupos: Descoberta da gestação, Vivência pré-natal, Relacionamento com o feto e Significado da gravidez. Em relação às entrevistas somente com as gestantes com câncer foram definidas as categorias: Como foi a descoberta da doença, Vivência do tratamento do câncer, Adaptação ao adoecimento, Crenças sobre o relacionamento com o feto, Vivência do câncer na gestação e Significado atribuído ao câncer. Conclusão: Este estudo evidenciou diferenças significativas entre presença de sintomatologia depressiva, ansiosa e baixa autoestima entre gestantes com diagnóstico de câncer quando comparadas com as sem o diagnóstico. Na análise qualitativa, constatou-se que com relação ao relacionamento com o feto foram identificadas as seguintes categorias: Conversa, Bom relacionamento, Medo, Alegria, Milagre e Não se relaciona. Com relação à Vivência do câncer na gestação foram evidenciadas as categorias: Enfoque negativo, Enfoque positivo, Dualidade e Normal. Sobre o significado da gravidez, as categorias foram: Enfoque positivo, Responsabilidade e Não sabe explicar. Em relação ao significado atribuído ao câncer, as categorias demonstradas foram: Morte/sofrimento, Cura/tratamento, Superação e Causa / Introduction: Currently, it is estimated that one in every thousand pregnant women are suffering from cancer. The association of the diagnosis of cancer with that of pregnancy puts a woman in a vulnerable condition for the development of psychological disorders. Objective: This Doctoral thesis aimed to evaluate and verify the association between symptoms of depression, anxiety, self-esteem and maternal-fetal bond among pregnant women diagnosed with cancer and pregnant women without a cancer diagnosis. It also proposed to understand the discourse of the experience of the gestational period with and without the diagnosis of cancer. Method: A cross-sectional study was performed with 63 pregnant women diagnosed with cancer, assisted at the Clinic of Tumors in Pregnancy of a tertiary university hospital and 72 pregnant women without a cancer diagnosis, assisted at the Clinic of Low-risk Prenatal care of the same service. These scales were used: MFAS for maternal-fetal bonding, Hospital Anxiety and Depression (HAD), self-esteem sub-scale of Prenatal Psychosocial Profile (PPP) and a semi-structured interview that investigated issues related to pregnancy and illness due to cancer. The Mann-Whitney, Kruskal-Wallis, Dunn, Pearson\'s chi-square and Fisher\'s exact tests were used. The level of significance was 5%. The qualitative analysis was performed by means of the Content Analysis Technique. Results: In this study, the presence of depressive symptoms was found in 33.3% of pregnant women with cancer and in 18.1% pregnant women without cancer. It was observed that the pregnant women diagnosed with cancer when compared to pregnant women without a cancer diagnosis presented lower per capita income (p > .001), lower level of schooling (p=0.001); higher number of pregnancies (p < 0.001), lower paid job (p=0.015), higher prevalence of depression (p=0.041), anxiety (p=0.039) and lowered self-esteem (p < 0.001). In the analysis made through the combination of cancer diagnosis and depression, it was shown that anxiety was associated with depression and not with the diagnosis of cancer. Regarding the self-esteem, the combination of the groups showed that the lowering of self-esteem is related to the presence of cancer and not with depression. These categories were attributed to the qualitative results in both groups: Pregnancy discovery, Prenatal experience, Relationship with the fetus and Meaning of pregnancy. With respect to the interviews only with the pregnant women with cancer, the following categories were defined: How was the discovery of the disease, Cancer treatment experience, Adaptation to the illness, Beliefs about the relationship with the fetus, Cancer experience during pregnancy and Meanings attributed to cancer. Conclusion: This study showed significant differences between the presence of depressive symptomatology, anxiety and low self-esteem among pregnant women diagnosed with cancer when compared to those without the diagnosis. In the qualitative analysis, it was found that with regard to the relationship with the fetus the following categories were identified: Chatting, Good relationship, Fear, Joy, Miracle and Not related. Regarding the Cancer experience during pregnancy, the following categories were highlighted: Negative focus, Positive focus, Duality and Normal. About the meaning of pregnancy, the categories were: Positive focus, Responsibility and Cannot explain. In relation to the meaning attributed to cancer, the categories shown were: Death/suffering, Healing/treatment, Overcoming and Cause

Introdução: Atualmente, estima-se que uma em cada mil mulheres grávidas sejam portadoras de câncer. A associação do diagnóstico de câncer ao de gestação coloca a mulher numa condição vulnerável para o desenvolvimento de transtornos psicológicos. Objetivo: Comparar e avaliar a associação entre sintomatologia de depressão, ansiedade, autoestima e vínculo materno-fetal entre gestantes com diagnóstico de câncer e gestantes sem diagnóstico de câncer. Propõe-se também a realizar a análise do discurso da vivência do período gestacional com e sem o diagnóstico de câncer. Método: Foi realizado estudo transversal com 63 gestantes com diagnóstico de câncer atendidas no Ambulatório de Tumores na Gestação de um hospital universitário terciário e 72 gestantes sem diagnóstico de câncer atendidas no Ambulatório de Pré-Natal de baixo risco do mesmo serviço. Foram utilizadas as escalas de Apego Materno-Fetal (MFAS), Hospital Anxiety and Depression (HAD), Subescala de Autoestima do Prenatal Psychosocial Profile (PPP) e entrevista semidirigida que investigou questões relacionadas à gravidez e ao adoecimento por câncer. Os testes Mann-Whitney, Kruskal-Wallis, de Dunn, qui-quadrado de Pearson e o teste exato de Fisher foram utilizados. O nível de significância adotado foi de 5%. A análise qualitativa foi realizada por meio da Técnica de Análise de Conteúdo. Resultados: Neste estudo constatou-se presença de sintomatologia depressiva em 33,3% das gestantes com câncer e em 18,1% nas gestantes sem câncer. Observou-se que as gestantes com diagnóstico de câncer quando comparadas às gestantes sem diagnóstico de câncer apresentaram menor renda per capita (p > 0,001), menor escolaridade (p=0,001), maior paridade (p < 0,001), menor trabalho remunerado (p=0,015), maior prevalência de depressão (p=0,041), ansiedade (p=0,039) e autoestima rebaixada (p < 0,001). Na análise feita por meio da combinação de diagnóstico de câncer e de depressão, evidenciou-se que a ansiedade estava associada à depressão e não com o diagnóstico de câncer. Com relação à autoestima, na combinação dos grupos evidenciou-se que o rebaixamento da autoestima estava relacionado à presença de câncer e não com a depressão. Aos resultados qualitativos foram atribuídas categorias em ambos os grupos: Descoberta da gestação, Vivência pré-natal, Relacionamento com o feto e Significado da gravidez. Em relação às entrevistas somente com as gestantes com câncer foram definidas as categorias: Como foi a descoberta da doença, Vivência do tratamento do câncer, Adaptação ao adoecimento, Crenças sobre o relacionamento com o feto, Vivência do câncer na gestação e Significado atribuído ao câncer. Conclusão: Este estudo evidenciou diferenças significativas entre presença de sintomatologia depressiva, ansiosa e baixa autoestima entre gestantes com diagnóstico de câncer quando comparadas com as sem o diagnóstico. Na análise qualitativa, constatou-se que com relação ao relacionamento com o feto foram identificadas as seguintes categorias: Conversa, Bom relacionamento, Medo, Alegria, Milagre e Não se relaciona. Com relação à Vivência do câncer na gestação foram evidenciadas as categorias: Enfoque negativo, Enfoque positivo, Dualidade e Normal. Sobre o significado da gravidez, as categorias foram: Enfoque positivo, Responsabilidade e Não sabe explicar. Em relação ao significado atribuído ao câncer, as categorias demonstradas foram: Morte/sofrimento, Cura/tratamento, Superação e Causa / Introduction: Currently, it is estimated that one in every thousand pregnant women are suffering from cancer. The association of the diagnosis of cancer with that of pregnancy puts a woman in a vulnerable condition for the development of psychological disorders. Objective: This Doctoral thesis aimed to evaluate and verify the association between symptoms of depression, anxiety, self-esteem and maternal-fetal bond among pregnant women diagnosed with cancer and pregnant women without a cancer diagnosis. It also proposed to understand the discourse of the experience of the gestational period with and without the diagnosis of cancer. Method: A cross-sectional study was performed with 63 pregnant women diagnosed with cancer, assisted at the Clinic of Tumors in Pregnancy of a tertiary university hospital and 72 pregnant women without a cancer diagnosis, assisted at the Clinic of Low-risk Prenatal care of the same service. These scales were used: MFAS for maternal-fetal bonding, Hospital Anxiety and Depression (HAD), self-esteem sub-scale of Prenatal Psychosocial Profile (PPP) and a semi-structured interview that investigated issues related to pregnancy and illness due to cancer. The Mann-Whitney, Kruskal-Wallis, Dunn, Pearson\'s chi-square and Fisher\'s exact tests were used. The level of significance was 5%. The qualitative analysis was performed by means of the Content Analysis Technique. Results: In this study, the presence of depressive symptoms was found in 33.3% of pregnant women with cancer and in 18.1% pregnant women without cancer. It was observed that the pregnant women diagnosed with cancer when compared to pregnant women without a cancer diagnosis presented lower per capita income (p > .001), lower level of schooling (p=0.001); higher number of pregnancies (p < 0.001), lower paid job (p=0.015), higher prevalence of depression (p=0.041), anxiety (p=0.039) and lowered self-esteem (p < 0.001). In the analysis made through the combination of cancer diagnosis and depression, it was shown that anxiety was associated with depression and not with the diagnosis of cancer. Regarding the self-esteem, the combination of the groups showed that the lowering of self-esteem is related to the presence of cancer and not with depression. These categories were attributed to the qualitative results in both groups: Pregnancy discovery, Prenatal experience, Relationship with the fetus and Meaning of pregnancy. With respect to the interviews only with the pregnant women with cancer, the following categories were defined: How was the discovery of the disease, Cancer treatment experience, Adaptation to the illness, Beliefs about the relationship with the fetus, Cancer experience during pregnancy and Meanings attributed to cancer. Conclusion: This study showed significant differences between the presence of depressive symptomatology, anxiety and low self-esteem among pregnant women diagnosed with cancer when compared to those without the diagnosis. In the qualitative analysis, it was found that with regard to the relationship with the fetus the following categories were identified: Chatting, Good relationship, Fear, Joy, Miracle and Not related. Regarding the Cancer experience during pregnancy, the following categories were highlighted: Negative focus, Positive focus, Duality and Normal. About the meaning of pregnancy, the categories were: Positive focus, Responsibility and Cannot explain. In relation to the meaning attributed to cancer, the categories shown were: Death/suffering, Healing/treatment, Overcoming and Cause