Abstract
Background
Couvade Syndrome (sympathetic pregnancy) is an involuntary disorder in which the prospective father experiences unexplainable physiological and/or psychological symptoms in the transition period to parenthood. This study aimed to determine the relationship between the incidence of Couvade syndrome and prenatal paternal attachment in prospective fathers living in Turkey and the influencing factors.
Methods
This cross-sectional study was conducted with 486 prospective fathers by simple random method through a web-based questionnaire distributed through social media and communication platforms (Facebook, Instagram, Telegram, or WhatsApp etc.) between May and August 2023. A “Participant Identification Form” and the “Prenatal Paternal Attachment Scale” were used to collect the data. Since there is no scale that quantitatively evaluates Couvade syndrome, Couvade syndrome was evaluated on the basis of symptoms through the “Personal Information Form” created by reviewing the literature. Logistic regression analysis was used to determine correlations between variables and scale scores.
Results
It was determined that 89.3% of the participants experienced at least three of the pregnancy-related complaints (such as weight gain, nausea, vomiting, edema, leg pain) during their spouse’s pregnancy. It was determined that the most frequently experienced symptoms by the prospective fathers were weight gain (59.1%), changes in sleep pattern (59.8%), increased stress (56.7%), and nausea (50.6%). The participants’ mean score on Prenatal Paternal Attachment Scale was 43.98. In the study, a statistically significant difference was found between prenatal paternal attachment levels and weight gain, loss of appetite, sensitivity to smells, changes in sleep patterns, financial worries, increased stress, and experiencing food craving (p < 0.001). Among the significant predictors related with Couvade syndrome were educational status, income status, employment status, spouse’s educational and employment status, parity and live births, infant’s gender, and planned pregnancy status (p < 0.001). In addition, experiencing Couvade syndrome according to their spouses’ pregnancy periods is also among the important predictors (p < 0.01).
Conclusion
In the study, it was seen that prenatal paternal attachment levels of the fathers was high. Couvade syndrome characteristics were found to affect prenatal paternal attachment levels.
Keywords: Couvade syndrome, Prenatal attachment, Prospective fathers; affecting factors, Frequency
Introduction
Couvade Syndrome (sympathetic pregnancy) is an involuntary disorder in which the prospective father experiences unexplainable physiological and/or psychological symptoms in the transition period to parenthood [1, 2]. Couvade syndrome symptoms generally occur in prospective fathers whose partner is pregnant in the first and third trimester of pregnancy [3]. Some of the symptoms of Couvade syndrome are anxiety, weight gain, toothache, gastrointestinal disorders, changes in sleep pattern, decreased libido, and insomnia. Although it has been well-documented that all races and socioeconomic classes are affected by Couvade syndrome, it was found to be more prevalent among ethnic minorities, African-Americans, unmarried males, and those with unplanned pregnancies [4]. It has been determined that Couvade syndrome was more frequently observed in cases where the relationship between the partners is strong. This has been supported by a very strong physical and psychological fusion between the partners. It has been reported that it is more likely for young fathers, those with unplanned pregnancies, those who are not ready for the fatherhood role, those with high levels of stress, and those with low educational level to experience Couvade syndrome [5, 6].
The incidence of Couvade syndrome in the literature has a wide range and varies between 11% and 97% [7]. The incidence of Couvade syndrome has been reported in studies conducted in the United Kingdom as 11–50%, in Sweden as 20%, in Jordanian prospective fathers as 59.1%, in Thai males as 61%, in Chinese males as 68%, and in the USA as high as 94–97% [1, 7]. There are very few studies conducted on Couvade syndrome in Turkey. In the study conducted by Kilavuz et al. (2022) [8], it was found that 52.4% of 200 prospective fathers gained weight in the pregnancy period of their partners, and 79.4% reported that their stress levels increased in that period. In a study conducted on 150 couples, it was determined that more than half of the males experienced anxiety, 28% suffered from fatigue, 26% suffered from dental problems, 23.3% had to urinate frequently, and 20% were more passive than usual [9, 10]. In another study conducted in Turkey, 15.8% of the prospective fathers were determined to experience sympathetic pregnancy symptoms [11].
While the incidence of Couvade syndrome symptoms in prospective fathers varies, one of the significant predictors of this incidence is paternal-fetal attachment. Paternal-fetal attachment forms the basis of fatherhood identity and is a type of the deep love and interest felt by the father towards the unborn child [12]. The World Health Organization (WHO) has reported that fathers should be evaluated in terms of participating in pregnancy and birth process, and that suitable strategies for this should be determined. Besides, WHO emphasizes the role of the fathers in safe motherhood programs [13]. Although it has been emphasized by the International Population and Development Conference (1994) that male participation in pregnancy should be encouraged including their fatherhood roles [14], in some cultures, there is a belief that reproductive problems are specific to women, and that male participation is not necessary to cope with this problem [15]. In fact, the main barriers to the inclusion of males in pregnancy preparation process can be listed as traditional approach to fatherhood role, lack of pattern [16], males’ little information about their roles and responsibilities, and lack of knowledge about the needs of the pregnant woman [17, 18]. The attachment process between the fetus in the mother’s womb and the father is rather sensitive and fragile, and in this process, the way the father feels himself, his harmony with the prospective mother in the pregnancy process, and incredible attachment he establishes with the fetus become all the more important.
There exists a significant lack of research on prenatal paternal attachment levels of prospective fathers, prevalence of Couvade syndrome, and effective factors [19, 20]. Due to this gap in the literature and superficial scientific data on this issue despite the fact that prospective fathers can show similar symptoms to the pregnant woman in the pregnancy process, this issue should be researched in detail. Incidence of Couvade syndrome and prenatal paternal attachment can be affected by different cultures and different variables, and these predicted differences constituted the basis for this study. In this context, it was seen that there were no studies at the national and international level which examined this issue. Hence, in this study, it was aimed to analyze the relationship between the incidence of Couvade syndrome in prospective fathers in Turkey and prenatal paternal attachment and effective factors in this regard. It is believed that the findings of the study will contribute to the relevant literature.
Methods
Research design
This cross-sectional exploratory study was conducted using a web‐based survey sent via pregnancy groups on social media (Facebook, Instagram, Telegram, or WhatsApp etc.) between May and August 2023.
Participants
The simple random method was used in this study to select participants. This method involves a researcher selecting potential respondents based solely on the convenience of their access to them [21]. In the power analysis that was conducted to determine the minimum required sample size of this study, it was determined that the sample needed to include 656 prospective fathers based on the study conducted by Kılavuz et al. (2022) [8] in a different sample in the Turkish population that used the Prenatal Paternal Attachment Scale (PPAS) for the effect size, with a 1% margin of error, 99% confidence interval, 1.21 standard deviation value, and 0.05 significance [8]. The inclusion criteria included being a prospective father with a pregnant wife who were over 18 years old, the ability to speak Turkish, being literate in Turkish, using web applications (Facebook, Instagram, or WhatsApp), being registered to pregnancy groups on social media, and agreeing to participate in the study. The exclusion criteria were having serious psychological disorders (depression, schizophrenia, personality disorders etc.), not sharing the same living space with their wife during pregnancy, being divorced with their wife and not providing consent to participate in the study. All participants who met the inclusion criteria were invited to the study, and the study was conducted with volunteers (Fig. 1).
Fig. 1.
Study flowchart
Data collection
Prospective fathers in pregnancy groups on Facebook, Instagram, Telegram, or WhatsApp were invited to participate in the study via an online survey link. They were informed about the study on the first page of the online survey. Currently, there are no standardized survey tools suitable to assess the couvade syndrome and affecting factors among prospective fathers in Türkiye. Therefore, this study was based on a new survey tool developed by the authors based on a comprehensive literature review. A researcher who develops a new measure should establish that it has “face validity” as a minimum requirement and that the new measure reflects the content of the concept in question [22]. As an essentially intuitive process, the face validity of the tool used in this study was ensured by using a mixed-methods sequential explanatory design which allowed the triangulation of quantitative and qualitative data on the same topic. The use of a mixed-methods approach assured the validation of the findings of the survey through semi-structured in-depth interviews [23]. Additionally, a pilot test performed before the main analyses to ensure the face validity of the survey (sociodemographic characteristics, evaluation of characteristics related to couvade syndrome).
Data collection tools
Prospective fathers who agreed to participate in the study administered the Participant Identification Form and the Prenatal Paternal Attachment Scale.
Participant identification form
The form consisted of two parts. The first part included questions on sociodemographic characteristics and the second part included the evaluation of characteristics related to couvade syndrome. Sociodemographic and obstetric data included age, education level, income status, working status, age of wife, education level of wife, and working status of wife [1, 8, 18, 20]. The data collected in characteristics related to couvade syndrome includes the gestational week, the number of pregnancies of the partner, the number of living children of the partner, the sex of the baby, the planning status of the current pregnancy, the problems experienced by the partner during the current pregnancy, the weight gained by your partner during pregnancy. There are also questions about whether the expectant fathers have experienced loss of appetite, sensitivity to odors, changes in sleep patterns, anxiety about earning a living, increased stress, nausea, vomiting, abdominal pain, back pain, leg pain, leg cramps, cravings, frequent urination or urinary incontinence due to couvade syndrome, and in which trimester of pregnancy their husbands had problems [1, 8, 19, 20].
Prenatal paternal attachment scale
The scale developed by Condon (1993) (Condon, 1993). Turkish validity and reliability study of the scale was conducted by Benli and Aksoy (2021) [5, 23]. PPAS consists of 16 items and has been previously validated [5, 24]. It was used to evaluate the prenatal paternal attachment of the participants in this study. The measurements are scored according a 5-point Likert-type scale. The scale consists of 2 sub-dimensions: “quality of attachment” and “time spent on attachment”. A minimum of 16 and a maximum of 80 points can be obtained from the scale. Reversed items are scored by being reversed. Higher scores indicate more positive prenatal paternal attachment. The Cronbach’s alpha coefficient of PPAS was found to be 0.82, indicating good reliability [5]. In the study, the cronbach alpha coefficient of the scale was determined as 0.96.
Ethics statement
The The Trakya University Scientific Research Ethics Committee (2023/275-24.04.2023) approved this study. An informed consent option was presented on the first page of the online survey. All participants were electronically informed on the first page of the survey that they were volunteering to participate and that they could leave the survey without completion at any time. The study was conducted in accordance with the principles of the Declaration of Helsinki.
Statistical analysis
The normality of the distribution of the data was evaluated with the Kolmogorov-Smirnov test. Descriptive statistics (mean, standard deviation, frequency, percentage, minimum, and maximum) were calculated, and the Mann-Whitney U test, the Kruskal-Wallis test, and Student’s t-test were conducted for determining the significance of the differences between the scale scores of the participants based on their descriptive characteristics. Logistic regression analysis was used to determine predictive relationships between the scale scores of the participants and other variables. The analyses were performed using IBM SPSS Statistics for Windows, Version 26.0 (IBM Corp). p < 0.05 was considered statistically significant.
Results
In the study, the mean age of the prospective mothers was 32.4 ± 6.27 years (Min:20 – Max:48) and their spouses’ mean age was 29.5 ± 5.38 (Min:18 – Max:43). It was determined that 55.5% of the prospective fathers had a university degree and above, and 91.5% were employed. 48.2% of the spouses of the prospective fathers had a university degree and above, and 44.5 were employed. It was also found that 49.4% of the pregnant women had their first pregnancy, and 49.4% did not give a live birth before. 50.6% of the fetuses were girls, and 49.4% were boys (Table 1).
Table 1.
The sociodemographic characteristics of the participants (N: 656)
| Variables |
 ±SD |
||
|---|---|---|---|
| Age (years) | 32.4 ± 6.27 (Min:20 – Max:48) | ||
| Spouse’s Age (years) | 29.5±5.38 (Min:18 – Max:43) | ||
| Gestational Week | 29.7±5.95 (Min:15 – Max:39) | ||
| n | % | ||
| Educational Status | Elementary School (Primary school and secondary school) | 16 | 2.4 |
| High School | 276 | 42.1 | |
| University and above | 364 | 55.5 | |
| Income Status | Income lower than expenses | 108 | 16.5 |
| Income equal to expenses | 416 | 63.4 | |
| Income higher than expenses | 132 | 20.1 | |
| Employment Status | Unemployed | 56 | 8.5 |
| Employed | 600 | 91.5 | |
| Spouse Education Level | Elementary School (Primary school and secondary school) | 204 | 31.1 |
| High School | 136 | 20.7 | |
| University and above | 316 | 48.2 | |
| Spouse Employment Status | Unemployed | 364 | 55.5 |
| Employed | 292 | 44.5 | |
| Number of Pregnancies | 1 | 324 | 49.4 |
| 2 | 160 | 24.4 | |
| 3 | 124 | 18.9 | |
| 4 | 32 | 4.9 | |
| 5 | 16 | 2.4 | |
| Number of live births | 0 | 324 | 49.4 |
| 1 | 168 | 25.6 | |
| 2 | 128 | 19.5 | |
| 3 | 36 | 5.5 | |
| Infant’s gender | Girl | 332 | 50.6 |
| Boy | 324 | 49.4 | |
: Mean; SS standard deviation, min Minumum, max Maxsimum
Table 2 presents the characteristics related to couvade syndrome of the participants. In the study, it was determined that 53% of the pregnancies were planned, 89.3% of the participants experienced at least three of the pregnancy-related complaints (such as weight gain, nausea, vomiting, edema, leg pain) during their spouse’s pregnancy, 99.5% of the spouses gained weight, 61% had disrupted sleep patterns, 87.8% experienced nausea, and 95.1% experienced food craving. 59.1% of the fathers gained weight in the pregnancy of their spouses, and 18.9% gained a maximum weight of 5 kg. Of the fathers, 2.4% lost their appetite, 15.2% became sensitive to smells, 59.8% experienced change in their sleep patterns, 48.8% lived financial worries, 56.7% had increased stress levels, 50.6% had nausea, 26.8% had vomiting problem, and 11% suffered from stomachache in the pregnancy period of their spouses. In addition, 32.9% of the fathers experienced food craving, 37.2% had backache, 6.1% experienced cramps in their legs, 32.3% had frequent urination need, and 1.8% had incontinence problem in the pregnancy period of their spouses. 40.9% of the fathers did not experience any problems, 27.4% of those who experienced problems lived these problems the most in the first trimester of the pregnancy period of their spouses.
Table 2.
The characteristics related to couvade syndrome of the participants (N: 656)
| Variables | n | % | |
|---|---|---|---|
| Planned Pregnancy | Yes | 348 | 53,0 |
| No | 308 | 47,0 | |
| If You Experience at Least Three of the Symptoms (weight gain, nausea, vomiting, edema, leg pain etc.) That Are Common During Your Partner’s Pregnancy (Couvade Syndrome) | Yes | 586 | 89.3 |
| No | 70 | 10.7 | |
| Problems Experienced by the Spouse in Pregnancy* | Weight Gain | 652 | 99,4 |
| Loss of Appetite | 4 | 0,6 | |
| Sensitivity to Smells | 124 | 18,9 | |
| Disrupted Sleep Pattern | 400 | 61,0 | |
| Financial Worries | 76 | 11,6 | |
| Stress | 156 | 23,8 | |
| Nausea | 576 | 87,8 | |
| Stomachache | 40 | 6,1 | |
| Food Craving | 624 | 95,1 | |
| Backache | 180 | 27,4 | |
| Feeling of Insufficiency to Take Care of the Infant | 168 | 25,6 | |
| Fathers’ Weight Gain in the Pregnancy Period | Yes | 388 | 59,1 |
| No | 268 | 40,9 | |
| Amount of Weight Gained by the Fathers in the Pregnancy Period (kg) | 1 kg | 4 | 0,6 |
| 2 kg | 8 | 1,2 | |
| 3 kg | 24 | 3,7 | |
| 4 kg | 96 | 14,6 | |
| 5 kg | 124 | 18,9 | |
| 6 kg | 84 | 12,8 | |
| 7 kg | 40 | 6,1 | |
| 8 kg | 8 | 1,2 | |
| No | 268 | 40,9 | |
| Fathers’ Loss of Appetite in the Pregnancy Process | Yes | 16 | 2,4 |
| No | 640 | 97,6 | |
| Fathers’ Sensitivity to Smells in the Pregnancy Process | Yes | 100 | 15,2 |
| No | 556 | 84,8 | |
| Fathers’ Experiencing Changes in Their Sleep Patterns in the Pregnancy Process | Yes | 392 | 59,8 |
| No | 264 | 40,2 | |
| Fathers’ Experiencing Financial Worries in the Pregnancy Process | Yes | 320 | 48,8 |
| No | 336 | 51,2 | |
| Fathers’ Experiencing Increased Stress Levels in the Pregnancy Process | Yes | 372 | 56,7 |
| No | 284 | 43,3 | |
| Fathers’ Experiencing Nausea in the Pregnancy Process | Yes | 332 | 50,6 |
| No | 324 | 49,4 | |
| Fathers’ Experiencing Vomiting in the Pregnancy Process | Yes | 176 | 26,8 |
| No | 480 | 73,2 | |
| Fathers’ Experiencing Stomachache in the Pregnancy Process | Yes | 72 | 11,0 |
| No | 584 | 89,0 | |
| Fathers’ Experiencing Food Craving in the Pregnancy Process | Yes | 216 | 32,9 |
| No | 440 | 67,1 | |
| Fathers’ Experiencing Backache in the Pregnancy Process | Yes | 244 | 37,2 |
| No | 412 | 62,8 | |
| Fathers’ Experiencing Leg Pain in the Pregnancy Process | Yes | 136 | 20,7 |
| No | 520 | 79,3 | |
| Fathers’ Experiencing Cramps in Legs in the Pregnancy Process | Yes | 40 | 6,1 |
| No | 616 | 93,9 | |
| Fathers’ Frequent Urination in the Pregnancy Process | Yes | 212 | 32,3 |
| No | 444 | 67,7 | |
| Fathers’ Experiencing Urinary Incontinence in the Pregnancy Process | Yes | 12 | 1,8 |
| No | 644 | 98,2 | |
| The Period When the Fathers Experienced the Most Problems | First Trimester | 180 | 27,4 |
| Second Trimester | 120 | 18,3 | |
| Last Trimester | 88 | 13,4 | |
| Not Experienced | 268 | 40,9 |
*More than one option is marked
The PPAS scores of the participants are shown in Table 3. The mean total PPAS score of the participants was 43.98 ± 17.07 (min:18 – max:62)
Table 3.
Prenatal paternal attachment scale total score
| Variables |
 ±SS |
|---|---|
| Prenatal Paternal Attachment Scale (PPAS) | 43.98 ± 17.07 (min:18 – max:62) |
Mean; SS standard deviation, min Minumum, max Maxsimum
Table 4 shows the results of the comparisons of the personal, and Couvade Syndrome-related characteristics of the participants and the descriptions of their prenatal paternal attachment. A significant difference was found between the fathers’ age, spouses’ age, and spouses’ number of pregnancies and prenatal paternal attachment levels (p < 0.05). Also, a significant difference was determined between the fathers’ educational status, income status, employment status, spouses’ educational status, spouses’ employment status and prenatal paternal attachment levels (p < 0.001). In addition, a significant difference was found in the study between the spouses’ number of pregnancies, number of live births, and planned pregnancy status and prenatal paternal attachment levels (p < 0.001). On the other hand, no significant difference was found between prenatal paternal attachment levels and the gender of the infants (p > 0.05).
Table 4.
Comparison of descriptive characteristics of persons and paternal attachment levels
| Variables | PPAS | ||
|---|---|---|---|
| t | p | ||
| Age | 12,821 | < 0.001 | |
| Spouse’s Age | 7,327 | < 0.001 | |
| Spouse’s Gestational Week | −2,903 | 0.004 | |
±SD
|
|||
| Educational Status | Elementary School (Primary School and Secondary School) | 22,75 ± 0,85 (min:22- max:24) | |
| High School | 29,34 ± 10,49 (min:18- max:62) | ||
| University and above | 56,01 ± 10,70 (min:22- max:62) | ||
| Test/p | 372.488K/<0.001 | ||
| Income Status | Income lower than expenses | 24,22 ± 6,38 (min:18- max: 49) | |
| Income equal to expenses | 43,73 ± 15,95 (min:22- max: 62) | ||
| Income higher than expenses | 60,93 ± 2,44 (min:52 -max: 62) | ||
| Test/p | 116.875K/< 0.001 | ||
| Employment Status | Unemployed | 23,42 ± 5,09 (min: 18– max: 41) | |
| Employed | 45,90 ± 16,52 (min:22- max: 62) | ||
| Test/p | 3872.000U/< 0.001 | ||
| Spouse’s Educational Status | Elementary School (Primary School and Secondary School) | 26,84 ± 9,01 (min:18- max:62) | |
| High School | 35,17 ± 11,50 (min:1,25- max:4,75) | ||
| University and above | 58,83 ± 7,19 (min:1,25- max: 4,75) | ||
| Test/p | 227.716K/< 0.001 | ||
| Spouse’s Employment Status | Unemployed | 32,40 ± 12,72 (min:18- max:62) | |
| Employed | 58,41 ± 8,80 (min:22- max: 62) | ||
| Test/p | 9176.000U/< 0.001 | ||
| Spouse’s Number of Pregnancies | 1 | 55,14 ± 12,96 (min:22- max: 62) | |
| 2 | 38,9 ± 14,6 (min:22- max: 62) | ||
| 3 | 27,22 ± 2,7 (min:22- max: 42) | ||
| 4 | 22,25 ± 2,14 (min:18- max: 26) | ||
| 5 | 42,0 ± 16,32 (min:22- max: 62) | ||
| Test/p | 83.356K/<0.001 | ||
| Spouse’s Number of Live Births | 0 | 54,7 ± 13,41 (min:22- max: 62) | |
| 1 | 40,16 ± 14,49 (min:22- max: 62) | ||
| 2 | 26,62 ± 5,64 (min:22- max: 42) | ||
| 3 | 26,22 ± 9,91 (min:18- max: 52) | ||
| Test/p | 280.064K/< 0.001 | ||
| Infant’s Gender | Girl | 45,26 ± 17,48(min:22- max: 62) | |
| Boy | 42,66 ± 16,55 (min:18- max: 62) | ||
| Test/p | 49696.000U/ 0.051 | ||
| Planned Pregnancy | Yes | 57,78 ± 8,1 (min:22- max: 62) | |
| No | 28,38 ± 9,37 (min:18- max: 62) | ||
| Test/p | 4728.000U/< 0.001 | ||
Mean; SS standard deviation, min Minumum, max Maxsimum
The results of the comparisons of the PPAS scores of the participants based on the Couvade Syndrome-related characteristics that they were currently using are shown in Table 5. In the study, a statistically significant difference was found between prenatal paternal attachment levels and weight gain, loss of appetite, sensitivity to smells, changes in sleep patterns, financial worries, increased stress, and experiencing food craving (p < 0.001). In addition, a statistically significant difference was found between the spouses’ experiencing nausea, vomiting, stomachache, backache, leg pain, leg cramps, frequent urination, and urinary incontinence and prenatal paternal attachment levels (p < 0.001). There was also a statistically significant difference between the period when the most problems were experienced in the pregnancy process and prenatal paternal attachment levels (p < 0.001).
Table 5.
The comparisons of the PPAS scores of the participants based on the couvade syndrome-related characteristics
| Variables | PPAS ± SD |
||
|---|---|---|---|
| n | |||
| Weight Gain | Yes | 388 | 55,88 ± 10,58 (min:22- max: 62) |
| No | 268 | 26,74 ± 6,96 (min:18- max: 62) | |
| Test/p | 4904.000U/< 0.001 | ||
| Loss of Appetite | Yes | 16 | 62,0 ± 0,0 (min:62– max:62) |
| No | 640 | 43,53 ± 17,04 (min:18– max:46) | |
| Test/p | 1568.000U/< 0.001 | ||
| Sensitivity to Smells | Yes | 100 | 58,12 ± 7,19 (min:16– max:41) |
| No | 556 | 25,8 ± 5,06 (min:11– max:46) | |
| Test/p | 13568.000U/< 0.001 | ||
| Changes in Sleep Pattern | Yes | 392 | 56,22 ± 9,87 (min:22- max: 62) |
| No | 264 | 33,1 ± 7,8 (min:18- max: 42) | |
| Test/p | 2456.000U/< 0.001 | ||
| Financial Worries Related to Income Level | Yes | 320 | 53,41 ± 13,15 (min:22- max: 62) |
| No | 336 | 35,00 ± 15,46 (min:18- max: 62) | |
| Test/p | 22512.000U/< 0.001 | ||
| Increased Stress Level | Yes | 372 | 53,58 ± 12,12 (min:22- max: 62) |
| No | 284 | 30,09 ± 11,86 (min:18- max: 62) | |
| Test/p | 162.000U/< 0.001 | ||
| Nausea | Yes | 332 | 57,33 ± 8,97 (min:22- max: 62) |
| No | 324 | 30,29 ± 11,71 (min:18- max: 62) | |
| Test/p | 7432.000U/< 0.001 | ||
| Vomiting | Yes | 176 | 58,0 ± 8,93 (min:22- max: 62) |
| No | 480 | 38,84 ± 16,45 (min:18- max: 62) | |
| Test/p | 16088.000U/< 0.001 | ||
| Stomachache | Yes | 72 | 51,66 ± 12,2 (min:22- max: 62) |
| No | 584 | 43,03 ± 17,35 (min:18- max: 62) | |
| Test/p | 15616.000U/< 0.001 | ||
| Food Craving | Yes | 216 | 57,48 ± 9,44 (min:22- max: 62) |
| No | 220 | 37,35 ± 16,04 (min:18- max: 62) | |
| Test/p | 17704.000U/< 0.001 | ||
| Backache | Yes | 244 | 57,36 ± 8,98 (min:22- max: 62) |
| No | 412 | 36,05 ± 15,73 (min:18- max: 62) | |
| Test/p | 16264.000U/< 0.001 | ||
| Leg Pain | Yes | 136 | 58,55 ± 6,51 (min:41- max: 62) |
| No | 520 | 40,16 ± 16,92 (min:18- max: 62) | |
| Test/p | 14656.000U/< 0.001 | ||
| Leg Cramps | Yes | 40 | 60,1 ± 3,96 (min:49- max: 62) |
| No | 616 | 42,93 ± 17,07 (min:18- max: 62) | |
| Test/p | 5600.000U/< 0.001 | ||
| Frequent Urination | Yes | 212 | 59,94 ± 4,26 (min:41- max: 62) |
| No | 444 | 36,36 ± 15,56 (min:18- max: 62) | |
| Test/p | 12632.000U/< 0.001 | ||
| Urinary Incontinence | Yes | 12 | 62,0 ± 0,0 (min:62– max:62) |
| No | 644 | 43,64 ± 17,05 (min:18– max:62) | |
| Test/p | 1200.00U < 0.001 | ||
| The Period When the Most Problems Were Experienced | First Trimester | 180 | 53,84 ± 12,38 (min:22- max: 62) |
| Second Trimester | 120 | 57,3 ± 8,94 (min:30- max: 62) | |
| Last Trimester | 88 | 58,59 ± 6,10 (min:39- max: 62) | |
| Not Experienced | 268 | 26,59 ± 6,73 (min:18- max: 62) | |
| Test/p | 5.937K/< 0.001 | ||
Mean; SS standard deviation, min Minumum, max Maxsimum
The results of the logistic regression analysis to determine the influencing factors associated with couvade syndrome on participants’ couvade syndrome are presented in Table 6. It was determined that the participants with a university degree and above were less inclined to experiencing Couvade syndrome compared to those with elementary education levels and high school education level by 22.576 and 8.760 times, respectively (p < 0.001). It was also found that the participants who had high income level and were employed experienced Couvade syndrome less compared to those who had income level lower than and equal to their expenses and who were unemployed by 11.332 and 23.111 times, respectively (p < 0.001). It was seen that the participants whose spouses were employed and had high educational level experienced Couvade syndrome less compared to those whose spouses had low level of education and were unemployed by 8.760 and 29.076 times, respectively (p < 0.001). As the number of pregnancies of the participants’ spouses increased, their potential for living Couvade syndrome decreased (p < 0.001). In addition, it was determined that the probability of experiencing Couvade syndrome decreased in the participants whose spouses gave more live births (p < 0.001). It was also determined that the probability of experiencing Couvade syndrome increased in the participants whose infants were girls compared to those whose infants were boys by 0.494 times (p < 0.001). The probability of experiencing Couvade syndrome was higher in the participants with unplanned pregnancy compared to those with planned pregnancy. Finally, it was found that the period when the fathers experienced Couvade syndrome the most was the first trimester, and that the probability of experiencing Couvade syndrome gradually increased in the second and last trimester (p < 0.001).
Table 6.
Logistic regression analysis to determine the influencing factors associated with couvade syndrome on participants’ couvade syndrome
| Characteristic | Group | Wald | OR | 95% Cl | p Value | |
|---|---|---|---|---|---|---|
| Lower | Upper | |||||
| Educational Status | Elementary School (Primary School and Secondary School) | 0.000 | 22.576 | 14.921 | 34.158 | < 0.001 |
| High School | ||||||
| University and above | ||||||
| Income Status | Income lower than expenses | 0.000 | 11.332 | 7.134 | 18.000 | < 0.001 |
| Income equal to expenses | ||||||
| Income higher than expenses | ||||||
| Employment Status | Unemployed | 0.000 | 23.111 | 8.246 | 64.771 | < 0.001 |
| Employed | ||||||
| Spouse’s Educational Status | Elementary School (Primary School and Secondary School) | 0.000 | 8.76 | 6.572 | 11.676 | < 0.001 |
| High School | ||||||
| University and above | ||||||
| Spouse’s Employment Status | Unemployed | 0.000 | 29.076 | 17.551 | 48.168 | < 0.001 |
| Employed | ||||||
| Spouse’s Number of Pregnancies | 1 | 0.000 | 0.285 | 0.230 | 0.352 | < 0.001 |
| 2 | ||||||
| 3 | ||||||
| 4 | ||||||
| 5 | ||||||
| Spouse’s Number of Live Births | 0 | 0.000 | 0.214 | 0.168 | 0.271 | < 0.001 |
| 1 | ||||||
| 2 | ||||||
| 3 | ||||||
| Infant’s Gender | Girl | 0.000 | 0.494 | 0.360 | 0.678 | < 0.001 |
| Boy | ||||||
| Planned Pregnancy | Yes | 0.000 | 51.469 | 31.290 | 84.661 | < 0.001 |
| No | ||||||
| The Period When the Most Problems Were Experienced | First Trimester | 0.000 | 0.99 | 0.71 | 0.139 | < 0 0.001 |
| Second Trimester | ||||||
| Last Trimester | ||||||
| Not Experienced | ||||||
OR Oddio Ratio, 95% Cl 95% Confidence Interval
Discussion
Transition to fatherhood is a period in which great changes occur in the father figure. In literature, these somatic symptoms seen in prospective fathers which are claimed to be based on unknown physical reasons and are mostly seen in the pregnancy period of their spouses are called Couvade syndrome [25]. The studies on Couvade syndrome in the literature are limited in number, and this study aimed to examine its relationship with prenatal paternal attachment levels of prospective fathers in Turkey as well as analyzing effective factors.
There are limited studies on the incidence of Couvade syndrome, and it has been stated that in the pregnancy period of their spouses, most males experience at least one of the symptoms of the syndrome defined [26]. In a study conducted, it was reported that most males experienced a minimum of 3 symptoms and a maximum of 29 symptoms in the pregnancy period of their spouses, and that 22.8% of the prospective fathers did not experience or notice these symptoms [27]. In a study conducted in Thailand with the participation of 172 prospective fathers, it was reported that they experienced loss of appetite, increased appetite, toothache, constipation, weight gain, nausea, and vomiting as well as feelings of sadness and happiness, poor concentration, and anxiety as psychological symptoms [28]. In the present study, weight gain, changes in sleep pattern, increased stress, and nausea were the symptoms experienced the most by the prospective fathers. In the study they conducted, Brennan et al. [29] reported that males who prepared themselves for the fatherhood role experienced uncertainty and stress. According to the results obtained in the present study, it is thought that regarding the inclination of the prospective fathers to experience Couvade syndrome, the fathers may have wanted to take over the problems experienced by their spouses in the pregnancy period and felt uneasy in this regard, and thus they experienced stress due to the symptoms brought about the pregnancy of their spouses. In this context, the pregnancy period should not be limited to only meeting the needs of the expectant mothers, but by considering the psychological reactions of the prospective fathers towards the pregnancy of their spouses, the needs of the prospective fathers should also be met in a holistic perspective.
It has been stated that educational level, income status, number of children, employment status, and planned pregnancy status are among the factors that are effective in the establishment of paternal-fetal attachment and fulfilling the fatherhood role [30–33]. In the present study, a statistically significant difference was found between prenatal paternal attachment levels and the fathers’ age, educational level, income status, employment status, spouse’s age, spouse’s gestational week, her educational and employment status, and planned pregnancy status. In addition, it was determined in the study that as the number of pregnancies and number of live births of the spouses increased, prenatal paternal attachment levels decreased, and the difference was statistically significant. Similarly, in studies conducted, it was seen that as the number of children increased, paternal-fetal attachment was negatively affected [28, 33]. In this regard, the results of the present study are consistent with the literature. In addition, it was determined that there was no statistically significant difference between the infant’s gender and prenatal paternal attachment levels, which was found to be consistent with the literature as well [29, 32, 34, 35].
Fathers’ attachment behaviors begin in the prenatal period. It has been emphasized in the literature that prenatal physical and psychological symptoms can affect paternal-fetal attachment [29]. Hence, in the present study, the relationship between characteristics of Couvade syndrome and prenatal paternal attachment levels was examined. As a result of the study, a statistically significant difference was found between prenatal paternal attachment levels and the prospective fathers’ physical symptoms (weight gain, loss of appetite, sensitivity to smells, nausea, vomiting, stomachache, food craving, backache, leg pain, leg cramps, frequent urination, urinary incontinence) and psychological symptoms (changes in sleep pattern, increased stress level, financial worries). It was also determined that prenatal paternal attachment levels of the fathers who experienced Couvade syndrome were higher compared to those who did not experience this syndrome. In the study by Gül and Bulut (2022) examining the factors and father-infant attachment levels in Turkish fathers of premature babies, the mean PPAS score of the fathers was found to be 62.97 ± 8.94 and at a low level [36]. In the study by Dikmen-Yıldız (2025) examining father-to-infant attachment and its associated factors during the COVID-19 pandemic, the mean PPAS score of fathers was found to be 76.92 ± 13.59 and at a low level [37]. In the study by Bulut et al. (2023) examining the father-baby attachment level and affecting factors, it was determined that the PPAS mean score was 75.22 ± 7.55 [38]. In the study by Kurtuluş et al. (2025) examining the anxiety in fathers and father infant attachment, it was determined that the PPAS mean score was 64.08 ± 6.01 [39]. Particularly, the prospective fathers use their role of taking over problems experienced by their spouses in the pregnancy period. It has also been stated that Couvade syndrome occurs in cases where the bond between the female and male is very strong as a result of psychological and physical fusion [26]. In this context, when the results of the present study are evaluated along with the literature findings, it can be stated that the prospective fathers were competent in assuming their fatherhood roles.
In the present study, it was determined that among the significant predictors related with Couvade syndrome were educational status, income status, employment status, spouse’s educational and employment status, number of pregnancies and live births, infant’s gender, and planned pregnancy status. In addition, experiencing Couvade syndrome according to their spouses’ pregnancy periods is also among the important predictors. It has been stated in the literature that Couvade syndrome occurs in the first trimester of pregnancy and gradually increases in the second and last trimesters [2, 36, 40]. In the present study, it was seen that Couvade syndrome started to be experienced by the prospective fathers in the first trimester and gradually increased into the second and third trimesters, which was statistically significant and consistent with the literature. It has been reported in the literature that as the fathers’ educational level and income level increased, they would experience Couvade syndrome less [26]. This is consistent with the findings of the present study, and it is thought that high level of education and income is effective in paternal-fetal attachment as it affects factors such as raising children and participating in infant care. In the study conducted by Evgin and Özdil (2022) examining the effect of fathers’ support for the breastfeeding process on mothers’ breastfeeding self-efficacy and father-infant bonding, it was determined that there was a relationship between fathers’ Father-Infant Bonding and the father’s educational status, family type and the number of children he had [41]. In the study conducted by Kurtuluş et al. (2025), it was determined that there was a difference between prenatal father attachment according to the parameters of education level, economic status, feeling ready for fatherhood, pregnancy planning, the feeling they experienced when they learned that they were fathers, their harmony with their spouses, the father’s accompaniment to check-ups and the negative effect of pregnancy on the change in physical appearance [39]. In addition, in this study, the attachment scores of fathers who had a university degree, had a high economic status, felt ready to be fathers, attended check-ups, were compatible with their partners and were positively affected by the physical changes during pregnancy were found to be significantly higher [39]. In addition, in cases where the number of live births, which is one of the important predictors of Couvade syndrome, increased and the pregnancy was unplanned, the fathers’ financial worries may have been effective in increasing the probability of experiencing Couvade syndrome.
Strengths and limitations
The study was conducted with the participation of prospective fathers with pregnant spouses who could use web applications (Instagram, Facebook, and WhatsApp) in Turkey. Therefore, due to traditional, social, cultural, and economic differences across the country, the results of the study cannot be generalized to the general population. Within the scope of the aim of this study, no similar study was found in the literature, and this reflects the most important strength of our study. It strengthens the literature by contributing to the literature, especially by examining the prevalence of Couvade syndrome, father-infant attachment and influencing factors. The widespread effect of the study is strengthened by reaching the targeted prospective fathers with the sample calculation.
Implications of the study
It is thought that fathers go through a process of paternal-fetal attachment similar to maternal-fetal attachment process. Whether it is psychological or physiological, fathers’ symptoms of Couvade syndrome can be a reaction to pregnancy. If necessary, support is not provided to fathers who experience Couvade syndrome, their adaptation to fatherhood role and paternal-fetal attachment will be negatively affected. In this context, there is a need for more focus on fathers’ reactions, application of intervention for their worries and physical symptoms, and supportive applications aiming at their expressing their emotions and thoughts freely. In addition, there exists a need for more research on increasing the awareness about Couvade syndrome symptoms that affect fatherhood roles. With studies to be conducted in this regard, deficiencies in the health systems will be noticed, and a contribution will be made to midwifery and nursing care.
Conclusion
The results of the present study revealed Couvade syndrome symptoms experienced by prospective fathers residing in Turkey and related factors. In addition, the relationship was demonstrated between the prospective fathers’ personal characteristics and Couvade syndrome related characteristic and their prenatal paternal attachment levels. In the study, it was observed that the prospective fathers experienced weight gain, changes in sleep pattern, and nausea the most. The limited number of studies in the literature on the relationship between the incidence of Couvade syndrome and prenatal paternal attachment levels and affective factors points to the importance of the present study. In line with these results, it should also be remembered that qualitative studies that would reveal cultural and geographical differences need to be conducted.
Acknowledgements
We would like to thank the pregnant women who participated in and completed this study.
Authors' contributions
BK and HKI were responsible for the conception and data collection processes of the study. All authors were responsible for the design, data analysis, interpretation, drafting, and critical revision of the article.
Funding
None to declare.
Data availability
No datasets were generated or analysed during the current study.
Declarations
Ethics approval and consent to participate
This study was conducted in accordance with relevant guidelines and regulations that guide ethical human research. The Trakya University Scientific Research Ethics Committee (2023/275-24.04.2023) approved this study. The authors electronically obtained informed consent from all participants.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Data Availability Statement
No datasets were generated or analysed during the current study.