Reviewer's report
Title:Effect of previous perinatal loss on maternal-infant bonding during the first
year postpartum in the First Baby Study: A longitudinal cohort study
Version:3Date:12 April 2014
Reviewer: Denise Cote-Arsenault
Reviewer's report:
BMC Women’s Health
Effect of previous perinatal loss on maternal-infant bonding during the first year
postpartum in the First Baby Study: A longitudinal cohort study
This study addresses an important question of the impact of prior perinatal loss
on maternal-infant bonding after a successful subsequent pregnancy. Through a
secondary data analysis of an existing longitudinal data set, The First Baby
Study, attachment was compared between women with and without a history of
miscarriage (pregnancy loss prior to 20 weeks gestation). Excluded from the
original study were women with a history of perinatal loss beyond 20 weeks
gestation and those with a history of elective abortion. These exclusions do make
for a homogenous sample which adds to our knowledge base. The finding that
those White, married, educated women with a history of miscarriage went on to
have healthy babies that they felt equally emotionally connected to is very clear.
1) Of concern is that the 10-item Postpartum Bonding Score had low internal
validity in this sample, and that this instrument is not well validated. That is, this
expert reviewer has never heard of it or seen it used. This major limitation of this
analysis needs to be addressed in the Discussion; if postpartum bonding was an
important outcome in the original study well-established and multiple measures
of maternal-infant attachment should have been used. A single, new, 10-item
scale cannot adequately measure the complex concept of maternal-infant
bonding (much discussed, and with controversy of what should be measured).
This concern needs to be addressed in the Discussion. [Major compulsory
revision]
2) Use of the broad term, history of perinatal loss, is inaccurately used. Instead, it
should be “history of miscarriage” or “history of early perinatal loss.” As currently
stated, the focus is misunderstood. While the authors include this issue as a
limitation of their study, this could be easily rectified by changing the title of this
article, and the wording throughout the manuscript. [minor essential revision]
Background & Significance is well written, provides a solid rationale for the
current study. Appropriate reference sources are cited.
3) This section could be strengthened with attention drawn to the difficulty of
measuring the concept of prenatal attachment/postnatal attachment of mother to
infant vs. Bowlby and Ainsworth’s infant to mother process. [Discretionary
revision]
This manuscript is well-organized and written.
4) The sample size appears to be more than accurate but a post hoc power
analysis for the analyses done here is needed to provide support for its
adequacy. The rest of the analysis is well described, and seems appropriate.
[major compulsory revisions]
The Discussion generally includes conclusions that are within the design and
methods of the study, except for the issues noted to be included, above.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I declare that I have no competing interests.