Open Access Research article

Pictorial representation of attachment: measuring the parent-fetus relationship in expectant mothers and fathers

Hedwig JA van Bakel123*, A Janneke BM Maas1, Charlotte MJM Vreeswijk1 and Ad JJM Vingerhoets1

Author Affiliations

1 Tilburg School of Social and Behavioral Sciences, Tilburg University, Warandelaan 2, P.O. Box 90153, Tilburg, 5000 LE, the Netherlands

2 Centre for Infant Mental Health, Dimence, Deventer, the Netherlands

3 Herlaarhof, Centre for Child and Adolescent Psychiatry, Vught, the Netherlands

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BMC Pregnancy and Childbirth 2013, 13:138  doi:10.1186/1471-2393-13-138

Published: 27 June 2013



Over the past decades, attachment research has predominantly focused on the attachment relationship that infants develop with their parents or that adults had with their own parents. Far less is known about the development of feelings of attachment in parents towards their children. The present study examined a) whether a simple non-verbal (i.e., pictorial) measure of attachment (Pictorial Representation of Attachment Measure: PRAM) is a valid instrument to assess parental representations of the antenatal relationship with the fetus in expectant women and men and b) whether factors such as gender of the parent, parity, and age are systematically related to parental bonding during pregnancy.


At 26 weeks gestational age, 352 primi- or multiparous pregnant women and 268 partners from a community based sample filled in the PRAM and the M/PAAS (Maternal/Paternal Antenatal Attachment Scale, Condon, 1985/1993).


Results show that the PRAM was significantly positively associated to a self-report questionnaire of antenatal attachment in both expectant mothers and fathers. Age and parity were both found significantly related to M/PAAS and PRAM scores.


The present findings provide support that the PRAM is as a valid, quick, and easy-to-administer instrument of parent-infant bonding. However, further research focusing on its capacity as a screening instrument (to identify parents with serious bonding problems) and its sensitivity to change (necessary for the use in evaluation of intervention studies) is needed, in order to prove its clinical value.

Antenatal; Attachment; Mother; Father; Pregnancy; Fetus