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    Rights statement: This is the peer reviewed version of the following article: Speyer, LG, Hall, HA, Ushakova, A, et al. Links between perinatal risk factors and maternal psychological distress: A network analysis. Acta Obstet Gynecol Scand. 2021; 100: 917– 926. https://doi.org/10.1111/aogs.14056 which has been published in final form at https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/aogs.14056 This article may be used for non-commercial purposes in accordance With Wiley Terms and Conditions for self-archiving.

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Links between Perinatal Risk Factors and Maternal Psychological Distress: A Network Analysis

Research output: Contribution to Journal/MagazineJournal articlepeer-review

  • Lydia Grabriela Speyer
  • Hildigunnur Anna Hall
  • Anastasia Ushakova
  • Aja Louise Murray
  • Michelle Luciano
  • Bonnie Auyeung
<mark>Journal publication date</mark>31/05/2021
<mark>Journal</mark>Acta Obstetricia et Gynecologica Scandinavica
Issue number5
Number of pages10
Pages (from-to)917-926
Publication StatusPublished
Early online date30/11/20
<mark>Original language</mark>English


This paper explores a range of perinatal risk factors that may increase maternal vulnerability to postnatal psychological distress in a sample of 17 531 women participating in the Millennium Cohort Study, a diverse British, longitudinal birth cohort study.

Material and methods
Using a graphical network modeling framework, this study models the links between postnatal psychological distress and perinatal risk factors, while controlling for sociodemographic factors and history of depression and anxiety. Postnatal psychological distress was assessed at 9 months postpartum using the Rutter Malaise Inventory.

Results of the graphical network models indicate that lower levels of happiness about the pregnancy (Edge weight [w] = 0.084, 95% CI = 0.069‐0.100, b = 0.095), smoking during pregnancy (w = 0.026, 95% CI = −0.009‐0.060, b = 0.029), infection during pregnancy (w = 0.071, 95% CI = 0.024‐0.118, b = 0.090), hyperemesis gravidarum (w = 0.068, 95% CI = 0.013‐0.123, b = 0.083), baby in special care (w = 0.048, 95% CI = −0.004‐0.099, b = 0.062), not being white (w = 0.101, 95% CI = 0.062‐0.140, b = 0.118), being from a more deprived area (w = −0.028, 95% CI = −0.051 to −0.005, b = −0.039), lower income (w = −0.025, 95% CI = −0.055‐0.005, b = −0.036), and history of depression or anxiety (w = 0.574, 95% CI = 0.545‐0.603, b = 0.764) were associated with increased psychological distress.

Some perinatal risk factors may be directly associated with postnatal psychological distress, but many risk factors appear to be primarily associated with demographic factors. This emphasizes the importance of taking a holistic approach when evaluating an individual's risk of developing postnatal psychological distress.