Beyond Trauma Exposure and Symptoms: Preconception Transdiagnostic Vulnerability and Postpartum Outcomes in Healthy Women.

Background: Preconception screening traditionally focuses on physical health indicators and diagnosed psychopathology, potentially overlooking subclinical psychological vulnerabilities that could predict perinatal mental health outcomes. This study examined whether transdiagnostic psychological assessment before pregnancy provides information beyond childhood adversity and current symptom severity. Methods: In this prospective cohort study, 170 healthy nulliparous women attempting natural conception underwent preconception assessment and were followed through postpartum. Preconception measures included childhood adversity, transdiagnostic psychological processes (emotional dysregulation, learned helplessness, and dissociation), and psychiatric symptoms (depression, anxiety and post-traumatic stress disorder). Postpartum outcomes included maternal bonding, birth-related trauma symptoms, depression and anxiety levels. Exploratory factor analysis (EFA), structural equation modeling (SEM), and hierarchical linear regressions were used to characterize associations between preconception dimensions and postpartum outcomes. Results: Standard trauma screening cutoffs identified 19.3% of women with significant childhood adversity, and over 90% scored below clinical thresholds for current psychopathology. Analyses identified three distinct dimensions: childhood adversity (Risk), transdiagnostic psychological processes (Vulnerability), and current symptoms (Symptoms). Risk was indirectly associated with Symptoms through Vulnerability (β = 0.24), while the direct association between Risk and Symptoms was not significant. Risk and Vulnerability were the primary predictors of maternal bonding (R2 = 0.21), whereas Symptoms was the dominant predictor of postpartum anxiety (R2 = 0.30), depression (R2 = 0.20), and birth-related trauma symptoms (R2 = 0.32). Conclusions: In a cross-sectional preconception analysis, transdiagnostic psychological vulnerability structurally linked childhood adversity to current symptoms. In a prospective analysis extending from preconception to postpartum, Vulnerability independently predicted postpartum outcomes, including maternal bonding and anxiety. These findings support further investigation of modifiable vulnerabilities, such as emotion dysregulation and learned helplessness, as potential targets for preconception assessment and preventive research.