Sense of Coherence in the Perinatal Period: A Longitudinal Growth Mixture Modeling Analysis

Previous studies have established that higher Sense of Coherence (SoC) predicts lower pregnancy-specific distress, fewer delivery complications, and increased birth satisfaction. However, less is known about how SoC typically changes over pregnancy, birth, and postnatally and the risk factors and protective factors contributing to SoC trajectory during the perinatal period. In this study, we aim to describe and predict common trajectories of SoC in the perinatal period.

680 women in the Mercy Pregnancy and Emotional Wellbeing Study completed measures of SoC on four occasions across pregnancy and the postpartum. Predictors included history of childhood trauma, expectations and outcomes from birth and the postpartum, and postpartum social support. Depression was assessed by structured clinical interview in early pregnancy. Growth mixture modeling was used to classify participants into trajectories of SoC, and multinomial logistic regression models predicted class membership.

Four trajectories were identified: (1) High (67%), (2) Low (21%), (3) Rising (8%), (4) Falling (3%). The strongest predictors of class were depression diagnosis, associated with Low and Rising trajectories, and a history of childhood trauma, associated with Low and Falling trajectories.

Childhood trauma was thus predictive of a poor SoC at 12 months postpartum, suggesting that pregnancy and birth have a negative impact on women's resilience resources, whereas depression in early pregnancy is more predictive of poorer starting point of SoC. Targeted mental health support in the perinatal period may ensure individuals have adequate coping resources.