Past wounds, present bonds, future mothers: item-level analysis of perinatal risk profiles

Background Perinatal depression is shaped by interacting psycho-relational risk factors—childhood adversity, current relational functioning, perceived social support, and prenatal attachment. Variable-centered approaches focused on isolated predictors may obscure how these dimensions combine within individuals to generate distinct vulnerability configurations. Objective To identify person-centered profiles of psychosocial functioning during pregnancy and to examine their association with depressive symptoms across the perinatal period. Participants and setting A sample of 774 pregnant women was recruited from full-term and high-risk pregnancy clinics at one of the largest birth centers in Southern Italy. A subsample of 200 women (25.8%) completed the postpartum follow-up at 6 months (T1). Methods An item-level k-means cluster analysis ( k = 3) was performed on 44 items from the CTQ-SF, DAS-7, MSSS, and MAAS. Cluster differences in EPDS scores were tested cross-sectionally with one-way ANOVA and a covariate-adjusted model (T0), and longitudinally with a repeated-measures ANOVA (T0–T1). A formal attrition analysis and domain-level sensitivity analyses were also conducted. Results Three profiles emerged: Low-Risk (53.7%), Moderately Adjusted (31.7%), and High-Adversity (14.6%). Between-cluster differences in depressive symptoms were significant at T0 ( F (2, 771) = 62.52, p < 0.001, η 2 = 0.140), were essentially unchanged after adjustment for sociodemographic and obstetric covariates ( F (2, 747) = 58.15, p < 0.001, partial η 2 = 0.135), and persisted across the perinatal period (main effect of cluster: F (2, 197) = 22.74, p < 0.001, partial η 2 = 0.188), with no significant Time effect ( F (1, 197) = 0.38, p = 0.54) or Cluster × Time interaction ( F (2, 197) = 1.40, p = 0.25). At T0, 11.1, 35.9, and 44.2% of the Low-Risk, Moderately Adjusted, and High-Adversity profiles, respectively, scored above the EPDS clinical cut-off (≥ 9; p < 0.001). Conclusion Item-level cluster analysis reveals clinically significant heterogeneity in perinatal risk. Between-profile differences in depressive symptoms persisted across the perinatal period and may inform stratified, trauma-informed prevention strategies.