Exploring factors influencing paternal-fetal attachment: A systematic review and meta-analysis

Paternal-fetal attachment contributes to positive pregnancy outcomes and early child development. Although numerous factors influencing paternal-fetal attachment have been extensively reported, these findings have not been systematically synthesized.

This study aimed to systematically evaluate the levels and influencing factors of paternal-fetal attachment, identify statistically significant determinants, and determine the effect sizes of these factors.

Medline, CINAHL, CNKI, Wanfang, Web of Science, Ovid, Scopus, PsycINFO, and Cochrane Library.

A comprehensive search was conducted across 7 English-language databases and 2 Chinese-language databases, covering the period from January 2014 to October 2024. The study included survey-based research (both cross-sectional and longitudinal studies) as well as qualitative studies. Quality assessment was performed using the Agency for Healthcare Research and Quality (AHRQ) tool, the Newcastle-Ottawa Scale (NOS), and the Critical Appraisal Skills Programme (CASP). Meta-analysis was conducted using RevMan Manager 5.4 software, and narrative synthesis was employed for data that were unsuitable or unable to undergo meta-analysis.

This systematic review and meta-analysis included 25 studies, with 17 studies (involving 2643 expectant fathers) contributing to the meta-analysis. The overall level of paternal-fetal attachment was 3.57 (95 % CI: 3.26-3.88), indicating a moderate level of attachment. Key factors influencing paternal-fetal attachment included positive emotions, partner support, and maternal-fetal attachment, which had moderate effect sizes, suggesting their substantial role in fostering paternal attachment. Other significant factors with smaller effect sizes included age (older fathers reported slightly lower attachment), pregnancy planning status (planned pregnancies were associated with stronger attachment), parity (first-time fathers showed higher attachment), and psychological factors such as anxiety, depression, and negative emotions, which were negatively associated with attachment. Additionally, marital status and marital quality were positively linked to attachment, though their effects were small. These findings highlight the importance of emotional, relational, and psychological factors in shaping paternal attachment during pregnancy.

This systematic review offers a comprehensive overview of paternal-fetal attachment and identifies key predictive factors, including positive emotions, partner support, maternal-fetal attachment, and psychological well-being. The findings underscore the importance of addressing emotional, relational, and contextual factors to enhance paternal involvement during pregnancy. These insights can guide future research and inform evidence-based practices aimed at supporting paternal emotional well-being and fostering stronger family dynamics during the prenatal period.