Tehran University of Medical Sciences Iranian Journal of Psychiatry 1735-4587 0 0 2026 08 15 1 9 Wafaa Ahmed Ameen Maternal and Neonate Nursing, College of Nursing, University of Babylon, Babylon province, Iraq. Maryam Abd Al-Kareem Maternal and Neonate Nursing, College of Nursing, University of Babylon, Babylon province, Iraq. Hayder M. Obaid Adult Nursing, Anesthesia Techniques Department, Ishtar University College, Babylon province, Iraq. Abbas Fadhel Jassim Pediatric Nursing, Nursing Department, Ishtar University College, Babylon province, Iraq. Hassanain M. Kadhim AL-Mamoori Adult Nursing, Anesthesia Techniques Department, Ishtar University College, Babylon province, Iraq. Ahmed Sh Alzuheri Family and Community Nursing, Higher Health Institute of Babylon, Babylon province, Iraq. 2026 06 02 2026 07 22 Objective: This cross-sectional study examined maternal role adaptation among mothers of preterm infants in Neonatal Intensive Care Units (NICUs), and assessed whether self-efficacy and social support explain additional variance in adaptation beyond global self-esteem. Method: A cross-sectional correlational design was employed with a convenience sample of 350 mothers of preterm infants (gestational age < 37 weeks) admitted to the NICU at Imam Al-Sadiq Teaching Hospital in Hilla city, Iraq. Participants completed validated Arabic versions of the Rosenberg Self-Esteem Scale, the Arabic Parental Self-Efficacy Scale (APSES), the Multidimensional Scale of Perceived Social Support (MSPSS), and a Maternal Role Adaptation Questionnaire. Data were analyzed using descriptive statistics, Pearson correlations, and hierarchical linear regression. Results: Overall maternal role adaptation was poor in 61.4% of mothers (mean score 23.72 ± 5.31). Self-efficacy showed the strongest correlation with adaptation (r = 0.56, P < 0.001), followed by social support (r = 0.51, P < 0.001) and self-esteem (r = 0.44, P < 0.001). Hierarchical regression revealed that after controlling for demographic covariates, self-efficacy (β = 0.41, 95% CI: 0.31-0.50, P < 0.001) and social support (β = 0.33, 95% CI: 0.23-0.42 P < 0.001) were independently associated with adaptation, while self-esteem was not significant in the final model (β = 0.08, 95% CI: -0.03-0.19, P = 0.14). The full model explained 44% of the variance in adaptation scores (R² = 0.44). Conclusion: Maternal self-efficacy and perceived social support demonstrate stronger associations with adaptation to motherhood than global self-esteem among mothers of preterm infants in NICUs. Interventions to enhance NICU mothers' adaptation should prioritize skill-based self-efficacy building and social support mobilization. https://ijps.tums.ac.ir/index.php/ijps/article/view/4642 https://ijps.tums.ac.ir/index.php/ijps/article/download/4642/1349