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Lee and Park: Relationship among Emotional Clarity, Maternal Identity, and Fetal Attachment in Pregnant Women with Gestational Diabetes Mellitus
Original Article

Korean Journal of Women Health Nursing 2017; 23(2): 99-108.

Published online: 27 June 2017

DOI: https://doi.org/10.4069/kjwhn.2017.23.2.99

Relationship among Emotional Clarity, Maternal Identity, and Fetal Attachment in Pregnant Women with Gestational Diabetes Mellitus

Su Min Lee1, Hye-Ja Park2

1Bundang CHA Hospital, Seongnam, Korea.

2College of Nursing, CHA University, Pocheon, Korea.

Corresponding author: Park, Hye-Ja. College of Nursing, CHA University, 120 Haeryong-ro, Pocheon 11160, Korea. Tel: +82-31-850-9395, Fax: +82-31-8017-5853, clara@cha.ac.kr

Received 4 February 2017       Revised 11 April 2017       Accepted 19 April 2017

© 2017 Korean Society of Women Health Nursing

(open-access):

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to examine the relationship among emotional clarity in emotional intelligence, maternal identity, and fetal attachment to measure how emotional clarity and maternal identity impact on fetal attachment and to determine mediating effects of maternal identity in pregnant women at the time of diagnosis with gestational diabetes mellitus (GDM).

Methods

This study used a correlational survey design. 88 pregnant women with GDM completed a study questionnaire of emotional clarity, maternal identity, and fetal attachment immediately after the diagnosis of GDM. Data were analyzed Mann-Whitney U test, and ANOVA with Duncan test, Pearson correlation, three-step regressions to test mediating effect, and Sobel test.

Results

The emotional clarity was positively related with maternal identity and fetal attachment. It affected maternal identity with 21.9% of explained variance. The emotional clarity and the maternal identity were significant predictors of fetal attachment by 57.7% of explained variance. The maternal identity mediated the relationship between emotional clarity and fetal attachment.

Conclusion

The results suggest that a nursing program to enhance the emotional clarity and the maternal identity needs to be developed as an effective strategy to improve fetal attachment.

Keywords: Emotional clarity, Identity, Attachment, Gestational diabetes mellitus

Figures and Tables

Figure 1

Mediating effects of maternal identity in the relationship between emotional clarity and fetal attachment.

kjwhn-23-99-g001
Table 1

Demographic and Clinical Characteristics of Subjects (N=88)

kjwhn-23-99-i001
Variables Categories n (%)or M±SD
Age (yr) 33.91±3.61
21~34 53 (60.2)
35~42 35 (39.8)
Education <College 16 (18.2)
≥College 72 (81.8)
Job Yes 44 (50.0)
No 44 (50.0)
Religion Yes 40 (45.5)
No 48 (54.5)
Economic status High 4 (4.5)
Middle 82 (93.2)
Low 2 (2.3)
Child care assistant Yes 52 (59.1)
No 36 (40.9)
Gestational age (weeks) 27.64±1.81
24~28 61 (69.3)
29~33 27 (30.7)
Parity Primipara 52 (59.1)
Multipara 36 (40.9)
Smoking Yes 9 (10.2)
No 79 (89.8)
Drinking Yes 46 (52.3)
No 42 (47.7)
Eating habits Regular 54 (61.4)
Irregular 34 (38.6)
Exercise habits Regular 37 (42.0)
BMI change Obese (BMI≥25) → Obese 21 (23.9)
Non-obese (BMI<25) → Obese 27 (30.7)
Non-obese → Non-obese 40 (45.5)
Family history of type 2 DM Yes 40 (45.5)
No 48 (54.5)
GDM history Yes 12 (13.6)
No 76 (86.4)
Blood sugar by 50 g OGCT (1 hour) 167.96±21.70
Blood sugar by 100 g OGTT Baseline 95.73±15.58
1 hour 196.51±24.55
2 hours 174.26±26.00
3 hours 141.01±38.80
FBS (mg/dL) before treatment 90.27±9.43
71~95 61 (69.3)
96~126 27 (30.7)
2PPS (mg/dL) before treatment 127.00±21.40
≤120 51 (58.0)
121≥ 37 (42.0)
HbA1c (%) before treatment 5.34±0.41
4.4~6.4 75 (85.2)
6.5~6.8 13 (14.8)

GDM=gestational diabetes mellitus; DM=diabetes mellitus;

BMI=body mass index; ; OGCT=oral glucose challenge test;

FBS=fasting blood sugar; 2PPS=2 hours post prandial sugar;

HbA1c=glycated hemoglobin

Table 2

Emotional Clarity, Maternal Identity, and Fetal Attachment according to Subjects' Characteristics (N=88)

kjwhn-23-99-i002
Characteristics Categories Fetal Attachment Fetal Attachment Fetal Attachment
M±SD z or F (p) M±SD z or F (p) M±SD z or F (p)
Age (yr) 21~34 37.87±4.72 −0.77
(.444)		 128.91±17.10 −0.69
(.490)		 75.00±12.22 −0.24
(.814)
35~42 39.89±5.08 126.17±19.54 74.29±12.77
Gestational age (weeks) 24~28 37.98±5.16 −0.97
(.334)		 129.23±17.34 −0.95
(.342)		 74.97±12.32 −0.26
(.796)
29~33 38.93±4.11 124.63±19.52 74.15±12.71
GDM history Yes 40.17±3.27 −1.63
(.104)		 130.17±19.11 −0.37
(.715)		 78.25±14.31 −1.16
(.245)
No 37.97±5.02 127.45±17.98 74.16±12.05
Parity Primipara 37.69±5.03 −1.56
(.119)		 128.38±18.67 −0.55
(.581)		 74.92±11.74 −0.05
(.959)
Multipara 39.11±4.54 127.00±17.35 74.42±13.40
DM Family Hx Yes 38.60±4.67 −0.50
(.614)		 131.43±19.84 −2.02
(.042)		 75.35±13.28 −0.60
(.549)
No 38.00±5.05 124.81±16.01 74.19±11.68
Smoking Yes 39.00±6.02 −0.66
(.512)		 130.44±14.70 −0.46
(.649)		 77.00±9.19 −0.28
(.778)
No 38.19±4.75 127.52±18.45 74.46±12.70
Drinking Yes 37.72±4.90 −1.34
(.182)		 126.15±18.52 −1.12
(.265)		 74.22±13.77 −0.18
(.857)
No 38.88±4.80 129.64±17.56 75.26±10.77
Eating habits Regular 38.13±4.61 −0.31
(.757)		 128.22±19.05 −0.53
(.598)		 75.13±13.40 −0.76
(.448)
Irregular 38.50±5.30 127.18±16.61 74.06±10.70
Exercise habits Regular 38.22±5.20 −0.25
(.803)		 126.24±18.34 −0.71
(.478)		 74.78±12.18 −0.24
(.813)
Irregular 38.31±4.65 128.96±17.94 74.67±12.63
BMI change Ob → Ob 38.19±4.72 1.55
(.219)		 128.95±17.45 0.18
(.837)		 74.95±10.40 0.07
(.935)
Non-Ob → Ob 37.04±4.96 128.81±16.02 75.30±11.77
Non-Ob → Non-Ob 39.15±4.80 126.55±19.91 74.20±13.90
Child care assistant Yes 38.02±4.46 −0.86
(.390)		 130.33±18.14 −1.89
(.059)		 75.52±12.39 −0.95
(.344)
No 38.64±5.44 124.19±17.54 73.56±12.43
Education <College 37.38±5.46 −0.71
(.481)		 122.38±15.20 −1.62
(.106)		 73.63±11.61 −0.40
(.689)
≥College 38.47±4.74 129.03±18.50 74.96±12.60
Job Yes 38.50±5.13 −0.49
(.628)		 129.98±16.66 −1.19
(.233)		 77.18±11.60 −1.76
(.078)
No 38.05±4.63 125.66±19.29 72.25±12.75
Religion Yes 38.90±4.33 −1.33
(.183)		 132.48±16.38 −2.25
(.024)		 77.35±12.08 −1.79
(.073)
No 37.75±5.25 123.94±18.62 72.52±12.31
Economic status High 37.75±2.22 2.08
(.131)		 123.75±18.41 0.76
(.469)		 65.50±21.83 1.17
(.316)
Middle 38.46±4.85 128.37±18.18 75.15±11.93
Low 31.50±6.36 113.50±7.78 75.50±0.71
FBS (mg/dL) 71~95 38.43±4.72 −0.55
(.583)		 129.20±18.00 −0.97
(.333)		 75.13±12.83 −0.72
(.474)
96~126 37.93±5.25 124.70±18.11 73.78±11.44
2PPS (mg/dL) ≤120 38.25±4.88 −0.14
(.889)		 129.08±17.19 −0.58
(.562)		 76.53±12.28 −1.84
(.066)
121≥ 38.30±4.90 126.08±19.28 72.22±12.22
HbA1c (%) 4.4~6.4 38.27±4.86 −0.30
(.768)		 127.71±18.66 −0.09
(.930)		 74.89±12.61 −0.43
(.667)
6.5~6.8 38.31±5.09 128.46±14.65 73.69±11.30

z by Mann-Whitney test; GDM=gestational diabetes mellitus; BMI=body mass index; Ob=obese (BMI≥25); Nob=non-obese (BMI<25);

FBS=fasting blood sugar; 2PPS=2 hours postprandial blood sugar; HbA1c=glycated hemoglobin.

Table 3

Relationships among Emotional Clarity, Maternal Identity, and Fetal Attachment (N=88)

kjwhn-23-99-i003
Variables M±SD Range (min~max) Emotional clarity Maternal identity Fetal attachment
r p r p r p
Emotional clarity 38.27±4.86 27.0~49.0 − −
Maternal identity 127.82±18.05 73.0~159.0 .430 <.001 − −
 Behavior factor 60.50±12.09 26.0~80.0 .355 .001 .907 <.001 .654 <.001
 Emotional factor 67.32±8.72 47.0~80.0 .398 <.001 .821 <.001 .678 <.001
Fetal attachment 74.72±12.37 38.0~96.0 .362 .001 .766 <.001 − −
 Differentiation 8.89±1.90 4.0~12.0 .298 .005 .646 <.001 .711 <.001
 Interaction 16.47±3.22 6.0~20.0 .325 .002 .715 <.001 .866 <.001
 Attributing and intention 18.11±3.42 10.0~24.0 .309 .003 .516 <.001 .835 <.001
 Giving of self 19.85±3.74 10.0~24.0 .265 .013 .676 <.001 .917 <.001
 Role taking 11.40±2.51 6.0~16.0 .325 .002 .660 <.001 .776 <.001

r by Pearson's correlation coefficient; Differentiation=differentiation of self from fetus; Interaction=interaction with fetus; Attributing and intention=attributing characteristics and intention to the fetus.

Table 4

Mediating Effects of Maternal Identity in the Relationship between Emotional Clarity and Fetal Attachment (N=88)

kjwhn-23-99-i004
Factors Step 1 (EC→MI) Step 2 (EC→FA) Step 3 (EC, MI→FA)
B β t p VIF B β t p VIF B β t p VIF
Family history 5.784 .160 1.690 .095 1.004 0.673 .027 0.271 .787 1.004 −2.36 −.096 −1.345 .182 1.038
Religion 6.887 .191 2.002 .049 1.014 3.835 .155 1.537 .128 1.014 0.223 .009 0.126 .900 1.063
EC 1.477 .398 4.159 <.001 1.018 0.869 .342 3.375 .001 1.018 0.095 .037 0.482 .631 1.228
MI 0.524 .765 9.533 <.001 1.326
R2 .246 .155 .597
Adj. R2 .219 .125 .577
F (p) 9.126 (<.001) 5.141 (.003) 30.701 (<.001)
d (du) 1.872 (1.668) 2.314 (1.696) 2.299 (1.693)
4-du 2.332 2.332 2.307
K-S (p) .078 (.200) .080 (.200) .083 (.182)
Breusch-Pagan x2 (p) 4.306 (.230) 2.627 (.453) 4.311 (.366)
Sobel test z (p) z=3.813 (<.001)

EC=emotional clarity; MI=maternal identity; FA=fetal attachment; d (du)=Durbin-Watson's upper bound; K-S=Kolmogorov-Smirnov's normality test; χ2 by Breusch-Pagan's equal variance test; Adjusted by DM family history, religion; DM family history=dummy variable (No=0, Yes=1), Religion=dummy variable (No=0, Yes=1).

Notes

This article is a revision of the first author's master's thesis from CHA University.

Summary Statement

▪ What is already known about this topic?
Adaptation to motherhood roles and the fetal attachment were positive predictors of prenatal health practices. The emotional intelligence could impact on health outcomes positively in diabetes mellitus patients, while evidence is limited with gestational diabetes mellitus.
▪ What this paper adds?
The emotional clarity was newly identified as a positive predictor of maternal identity and the fetal attachment with the mediating effect of maternal identity for pregnant women in gestational diabetes mellitus.
▪ Implications for practice, education and/or policy
An emotional intelligence program combined with diabetic nursing education may be helpful for pregnant women in gestational diabetes millitus to achieve better health outcomes of glycemic management, maternal identity, and fetal attachment.

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