Evaluating the Impact of Music Therapy on Psychological Well-being During High-risk Pregnancy

Background and Rationale Every year, approximately 15 million children are born prematurely worldwide, with a global incidence of around 11%. Preterm birth occurs when labor takes place between the 22nd and 37th completed weeks of gestation, representing a significant public health concern. Preterm birth is associated with higher rates of infant morbidity and mortality, increased risk of long-term medical complications, impaired neurological development, family stress, and substantial social costs. Conversely, the risk of preterm birth is a stressful event for caregivers, particularly for pregnant women, potentially evolving into a traumatic experience, eliciting feelings of anxiety and depression. In cases of preterm birth risk, the initial phase of parenthood is marked by uncertainty, dominated by prevalent emotional correlates of anxiety and fear of death, which, in turn, diminish the psychological investment in the child. Many parents respond to this reality with an initial phase of rejection and ambivalence towards the child, expressing both frustration and common concerns about the infant's survival.

The risk of preterm birth falls under high-risk pregnancies, defined as "[...] any unexpected or unforeseen medical or obstetric condition associated with pregnancy with an actual or potential risk to the health or well-being of the mother or fetus...". Compared to women with low-risk pregnancies, those with high-risk pregnancies exhibit significantly higher levels of stress and anxiety, report more negative emotions when facing stress, and have a worse emotional state. Additionally, women confined due to high-risk pregnancies show predominant emotional responses of fear, anxiety, and emotional distance from the child, along with depressive symptoms and feelings of loneliness. Thus, the emotional impact of the risk of preterm birth on pregnant women demands adequate clinical attention, particularly considering that the reactive symptoms mentioned above serve as predictive factors when exploring the psychosocial determinants of preterm birth.

Furthermore, the risk of preterm birth can negatively influence the development of the mother-fetus attachment bond (or prenatal attachment), although some studies report contrasting results. Prenatal attachment, derived from John Bowlby's Attachment Theory, is defined as "the emotional bond that normally develops between the pregnant parent and their unborn child". It serves as an early indicator of the future quality of the mother-child attachment bond and is a crucial factor influencing the child's subsequent well-being. Women with high-risk pregnancies may experience guilt for their condition, and the risk of preterm birth and premature rupture of membranes can interrupt the psychological preparation process for motherhood. Negative thoughts in pregnant women related to fetal health and the possibility of fetal death can evoke fear of developing a relationship with the fetus, hindering attachment development.

Therefore, it becomes crucial to identify effective, non-invasive, and adaptable methods within the hospital setting to reduce unpleasant emotional states in pregnant women at risk of preterm birth and promote the structuring of the attachment bond. In this context, recent research has increasingly focused on music therapy as one of the potential approaches to alleviate emotional states linked to pregnancy.

The World Federation of Music Therapy defines music therapy as "[...] the professional use of music and its elements as an intervention in medical, educational, and social environments with individuals, groups, families, or communities seeking to optimize their quality of life and improve physical, social, communicative, emotional, intellectual, and spiritual health". Recent literature reviews and meta-analytical studies have documented how music therapy can be effective in reducing stress-related symptoms (both in medical and mental health contexts), decreasing depressive symptoms, and anxious symptoms. Regarding its use during pregnancy, music therapy, besides significantly reducing mental health problems such as anxiety, depressive symptoms, and perceived stress in pregnant women, can address the sensory, physical, and emotional needs of pregnant women and support the process of creating the attachment bond, promoting the development of meaningful interactions.