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Background: Unplanned pregnancy challenges maternal adaptation process, which can disrupt Maternal Fetal Attachment and increase maternal and infant physical and mental symptoms determining the effectiveness of Cognitive Counseling on Maternal Fetal Attachment of women with unplanned pregnancy.
Methods: The study was a randomized controlled trial in health care centers in Zanjan, Iran in 2018. Among the mothers with inclusion criteria, 54 mothers were selected with convenience sampling and were divided into intervention (27 person) and control (27 person) groups with blocked randomization (combine two and four person block). The inclusion criteria comprised having unplanned pregnancy, satisfaction to participate in the study, lack of obstetric complications, psychological disease and  medication use, gestational age less than 14 weeks, lack of known psychological disease, being married and living with their husbands, having an alive mother, lack of narcotic substance abuse in women or their husbands, and at least attaining  secondary education. Exclusion criteria included the unwillingness to continue the cooperation in the study, non-participation in two or more than two sessions, occurrence of any pregnancy complications or disease, occurrence of any stressor event or accident during the study and incompleteness of the questionnaires. The intervention group received eight sessions 90-60 minute (one session per week) under cognitive group counseling based on pregnancy adaptation stages. The control group received usual care. Furthermore, this group received intervention, pamphlets, and training packages at the end of the study. Data collection tool included demographic checklists, Cranley’s Maternal Fetal Attachment questionnaire, completed at baseline, immediately after intervention, and one month after the last session by self-report method. The data of this study were analyzed by appropriate statistical tests by SPSS v.16 software.
Results: At baseline, Maternal Fetal Attachment scores did not show significant differences between the two groups (intervention group 56±6.28 and control group 57.70±3.39). Regarding post-test (intervention group 84(2) and control group 55(4.50)) and regarding the one-month follow-up period (intervention group 84(3.50) and control group 57(4.75)), median (inter quartile range) of Maternal Fetal Attachment scores were significantly higher in the intervention group than the control group (P<0.001).
Conclusions: Cognitive counseling in mothers with unplanned pregnancy improves maternal fetal attachment. Therefore, it is recommended that the maternal fetal attachment should enhance in unplanned pregnancies, followed by the child's psychological health, and educational and counseling measures. This intervention can be recommended as a striking solution that can be applied by trained midwives in developing countries.

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Background: Women have less interaction with the fetus in unplanned pregnancies. This study aimed to determine the effect of an antenatal training program on maternal-fetal attachment in unplanned pregnancies.
Methods: This single-blind clinical trial was performed in the north of Iran in 2019. By simple randomization, 76 mothers with unplanned pregnancies were allocated to the intervention and control groups. Mothers in the intervention group attended three sessions (90 minutes per session) of training based on interaction with the fetus in small groups. The control group only received routine care. Data collection instruments included a demographics checklist, London Measure of Unplanned Pregnancy, and Cranley’s Maternal-Fetal Attachment scale. Descriptive statistics, Chi-square, Fisher’s Exact test, t-test, analysis of covariance, and multivariate analysis of variance were used for data analysis.
Results: The mean difference of maternal-fetal attachment before and after training was 3.41±2.08 (P=0.112) in the intervention group and 3.96±2.17 (P=0.078) in the control group. However, the differences between and within groups were not significant. The differences in the subscales of attachment with the fetus were not also significant between the groups after the intervention. Although the post-intervention attachment score for unwanted pregnancy was lower than mistimed pregnancy in the intervention (mean difference: 14±3.61) and control groups (mean difference: 3.70±1.87), it was not significantly different based on the type of pregnancy between the groups.
Conclusion: Maternal-fetal attachment training did not boost interaction with the fetus in mothers with unplanned pregnancies; thus, deeper psychological interventions are needed.