Pathways from Prenatal Anxiety to Postpartum Bonding Difficulties in Pakistan: A Prospective Longitudinal Study of Psychosocial Mediators and the Buffering Role of Social Support

Background: Prenatal anxiety is common and potentially disruptive to the early mother-infant relationship, yet it remains less studied than perinatal depression.The psychosocial mechanisms through which prenatal anxiety influences postpartum bonding, particularly in low-resource settings, are not well understood. Methods:In this prospective longitudinal study, 501 women in Pakistan were followed from early pregnancy (T1; 15-20 weeks gestation) to postpartum (T2; 8 weeks).Prenatal anxiety (GAD-7) and depressive symptoms (PHQ-9) were assessed at T1. Late-pregnancy psychosocial stressors-pregnancy experiences, domestic violence, and perceived stress-and perceived social support were measured at T1.5 (30-36 weeks).Postpartum outcomes included mother-infant bonding (PBQ) and anxiety (GAD-7).Longitudinal path analysis, parallel mediation, and moderated mediation models were estimated.Results: Prenatal anxiety significantly predicted postpartum bonding difficulties ( = .18,p = .001),independent of prenatal depressive symptoms.This association was partially mediated by late-pregnancy psychosocial stressors (total indirect effect = 0.34, 95% CI [0.23, 0.46]).Prenatal