What tools should be used to identify women in need of additional support in pregnancy?

Objective: This study aimed to identify and inform recommendation of self-report and interview-based instruments that are feasible, reliable and valid to evaluate the quality of the maternal-fetal relationship (MFR).

Background: Several constructs predicting parent-infant interaction and later infant adjustment are used to assess mothers' thoughts and feelings towards their unborn baby, including reflective functioning, mind-mindedness, representation, and fetal attachment. As yet, there is no existing review comparing the quality and accessibility of instruments across each of these constructs.

Methods: A systematic literature review was undertaken to synthesise psychometric information on measures reporting on the MFR. Searches of six databases were conducted. English articles were selected based on inclusion and exclusion criteria. The QATSDD checklist was used to assess study quality.

Results:  Of 669 studies identified, 28 met inclusion criteria. Thirteen different instruments were identified for evaluation. Reported reliability and validity varied significantly across instruments, as well as availability for research and/or clinical use.

Conclusion: Suggestions for research and clinical practice include further evaluation of the psychometric properties of tools, particularly for self-report measures of reflective functioning, use of interviews to scaffold reflexivity, and development of clinical policies and procedures to clarify care pathways for expectant mothers needing further support.