Introduction
Pregnancy is one of the most sensitive periods in a woman’s life [1]. Since the mother’s emotional state significantly impacts the internal state of the uterus and the health and development of the fetus, pregnancy anxiety can have various adverse consequences on the health of the mother and fetus [2]. Maternal-fetal attachment is considered a vital emotional bond between the mother and fetus, and a vital concept in the psychological and physical well-being of the mother and child [3]. Higher levels of maternal-fetal attachment are associated with increased levels of love, happiness, peace, respect, and other positive emotions [4]. Self-compassion can be defined as a positive emotional attitude towards oneself and a non-judgmental understanding of oneself, which has a positive effect on mothers’ fear of childbirth [5] and promotes mental well-being in women with unwanted pregnancies [6] and can play a key role in improving relationships with others during important events, such as pregnancy and postpartum [7].
Increasing awareness and skills during pregnancy prepares pregnant women for childbirth, improves their health, reduces common mood disorders during and after pregnancy, and prevents mortality and complications during pregnancy [8]. The mother-child companion plan training helps mothers strengthen their self-awareness and self-compassion, which are crucial factors in attachment relationships. By developing this skill, they can better understand, seek closeness, and respond more effectively to their children [9]. Educating mothers and practicing attachment behaviors reduce anxiety and improve mothers’ mental health. This is a unique and pioneering program for increasing fetal-maternal attachment during pregnancy, which increases positive expectations before birth and reduces negative expectations and distress during pregnancy [10, 11].
Since one of the goals of motherhood is to educate a generation with humane moral principles and build a culture and pass it on from one generation to another, it is essential to implement plans and programs that focus on maternal and child health and lead to the control and reduction of harm at the community level. Considering the importance of maternal-fetal attachment in pregnant women, the high prevalence of anxiety during pregnancy, and the adverse consequences of insecure attachment and anxiety on maternal health, and considering that the mother-child companion plan in the field of attachment education is currently being implemented in Iran and no research has been conducted on the effectiveness of this program so far, the present study was conducted to determine the effect of the mother-child companion plan on maternal-fetal attachment, pregnancy anxiety, and self-compassion in pregnant mothers.

Methods
This study employed an experimental design with a pre-test-post-test format, including a control group and a one-month follow-up period. The participants were 40 pregnant women who were referred to health centers in Urmia City, Iran, in 2023. They were selected using a purposeful sampling method and randomly assigned to two experimental and control groups. The experimental group participated in thirteen 90-minute sessions weekly and received training on the mother and child assistant plan. Questionnaires on mother-fetal attachment, pregnancy anxiety, and self-compassion were completed in the pre-test, post-test, and follow-up stages for two groups. SPSS software, version 25 was used to perform repeated measures analysis of variance (RMANOVA) and Benferroni tests for data analysis. All statistical analyses were performed at a confidence interval (CI) of 0.05.

Results
The research findings show that the average age, duration of marriage, and gestational age in the two experimental and control groups distributed similarly. (Table 1) The results showed an increase in mother-fetal attachment, a decrease in pregnancy anxiety, and an increase in self-compassion in the experimental group compared to the control group (P<0.001).



Table 2 The within-subject effect indicated a significant difference between pre-test, post-test, and follow-up scores over time in all three variables. The largest difference in average scores was observed between the pre-test and follow-up periods.



Conclusion
The mother-child support program positively affects the mental health of pregnant mothers and can play an important role in reducing common mood disorders during pregnancy and improving mother-fetal attachment. The results of the study can be useful in continuing the mother-child companion plan to prevent psychosocial challenges in pregnant mothers by program staff.

Ethical Considerations

Compliance with ethical guidelines
This study was approved by the Ethics Committee of Islamic Azad University, Urmia Branch, Urmia, Iran (Code: IR.IAU.URMIA.REC.1402.115).

Funding
This article was based on a research project. This research did not receive any funding from public, commercial, or non-profit agencies. 

Authors contributions
Drafting of the manuscript: Pardis Rahmanpour; Critical revision: Farnaz Farshbaf Maneisefat and Monireh Rezae Moradali; Study supervision: Farnaz Farshbaf Maneisefat; Conceptualization, study design, data collection, and data analysis: All authors.

Conflicts of interest
The authors declared no conflicts of interest.

Acknowledgements
The authors thank the Research Vice Chancellor of Islamic Azad University, Urmia Branch, and the mothers who participated in this study.




 

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