Mapping links between childhood maltreatment and biopsychosocial health in pregnancy: a network analysis

PURPOSE: Child maltreatment experiences may impact both mental and physical health in pregnancy and are associated with increased interpersonal difficulties. However, facets of psychosocial and physical health are interrelated, making it difficult to identify effects of maltreatment experiences. Therefore, this study aims to improve our understanding of how experiences of childhood maltreatment are associated with perinatal bio-psycho-social health employing an exploratory network approach. The analysis focused on whether there are differential effects of maltreatment subtypes, namely physical, sexual and emotional abuse as well as physical and emotional neglect. METHOD: N = 131 pregnant women (gestational age of 10-20 weeks) answered questionnaires on their own child maltreatment experiences, depressive and anxiety symptoms, maternal-foetal attachment, social support and couple relationship quality. Additionally, medical information was collected from their maternity passports. We estimated a regularized partial correlation network to model the associations between these variables. RESULTS: Maltreatment experiences were associated with lower prenatal social support and higher prenatal depression scores, but not with pregnancy-related anxiety, maternal-foetal attachment and prenatal relationship quality. A link between maltreatment and medical risk emerged only in a reduced network model including only emotional child maltreatment subtypes, but not physical or sexual maltreatment. Among subtypes, emotional abuse and emotional neglect emerged as most central in the network. CONCLUSION: Emotional abuse and neglect experiences may function as risk factors for biopsychosocial health in early pregnancy. Thus, maltreatment experiences should be examined carefully in medical history. Their effects, especially regarding perceived social support, need to be addressed in prenatal care by gynaecologists and midwives.