Using path analysis to examine the relationship between sexual abuse in childhood and diabetes in adulthood in a sample of US adults

Childhood maltreatment and the risk of impaired glucose metabolism or type 2 diabetes in young adults: Findings from the Lifelines Cohort Study

We examined the associations between childhood maltreatment and the risk of impaired glucose metabolism (IGM) or type 2 diabetes (T2D) in young adults aged 18-35. Participants (N = 8506) from the Lifelines Cohort Study without IGM or diabetes at baseline (2007-2013) were included. Childhood maltreatment was assessed by the Childhood Trauma Questionnaire (CTQ) and incident IGM/T2D was assessed by haemoglobin A1c levels (≥5.7%) in 2014-2017. There were 223 (2.6%) cases of IGM/T2D during the follow-up period. After adjusting for sociodemographic and health/lifestyle covariates and follow-up time, only the CTQ Sexual Abuse subscale was significantly associated with IGM/T2D (RR = 1.05 [95% CI = 1.01, 1.10]). The association remained when additionally accounting for depressive and anxiety symptoms (RR = 1.05 [95% CI = 1.00, 1.09]). Childhood sexual abuse was associated with an increased risk of IGM/T2D in young adults, highlighting the long-term metabolic consequences of childhood maltreatment.

Intriguing connection between diminished ovarian reserve and childhood traumatic experiences, a prospective case-control study

INTRODUCTION

Diminished ovarian reserve (DOR) presents a complex challenge in the field of infertility, with factors like age and genetics traditionally under scrutiny. However, the potential influence of adverse childhood experiences on ovarian reserve remains a relatively unexplored area. This research aims to contribute novel insights to the understanding of diminished ovarian reserve etiology, shedding light on previously unexplored risk factors and their potential implications.

DESIGN

This case-control study was conducted at an Assisted Reproductive Technology (ART) Center of a university hospital. Infertile patients admitted to the ART center were enrolled in the study. The case group consisted of 102 infertile women diagnosed with diminished ovarian reserve, and the control group consisted of 103 healthy women with male factor infertility. An interview lasting approximately 30 min was held in a separate room with those who volunteered to participate in the study. Due to the sensitivity of the research subject, the data was collected anonymously. The Childhood Trauma Questionnaire was used to measure adverse childhood experiences, and the Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety and depression in the study. The results were compared between the case and the control groups.

RESULTS

Overall, the total score of the Childhood Trauma Questionnaire and all subscale scores were higher in the case group (38.28 ± 9.86) than in the control group (35.10 ± 9.52). According to HADS, the total score was 15.92 ± 7.98 in the case group and 14.22 ± 6.87 in the control group.

CONCLUSIONS

Our pioneering study is designed to investigate a previously unexplored risk factor in low ovarian reserve. Considering our data and other studies in the literature examining childhood traumas as a risk, it makes us think that the issue is worth examining.

Trends in prevalence of adverse childhood experiences by sociodemographic factors in the United States: Behavioral Risk Factor Surveillance System 2009-2022

BACKGROUND

Limited data exists on trends in prevalence of adverse childhood experiences (ACE) at the national level and sociodemographic correlates of having ACEs. This study examined trends in ACE prevalence and sociodemographic correlates in US adults over 14 years using nationally representative data.

METHODS

Data on 447,162 adults from the Behavioral Risk Factor Surveillance System (BRFSS) across four timepoints (2009-2010; 2011-2012; 2019-2020; 2021-2022) was analyzed and weighted for population estimates. The primary outcome was ACEs with 3 groups used (0 vs. 1 + ACEs; <4 vs. 4 + ACEs; 0 vs. 1 vs. 2 vs. 3 vs. 4 + ACEs). Sociodemographic factors included age, sex, race/ethnicity, employment, education, marital status, income and insurance status. Prevalence trends were examined by estimating prevalence of ACE groupings (0/1+; <4/4+; 0,1,2,3,4+) across the four timepoints and trend analysis was performed to determine if the differences over time were statistically significant. Unadjusted and adjusted prevalence ratios were estimated using log-binomial regression models with ACE groupings as the outcome and timepoints as the primary independent variable with sociodemographic factors as covariates.

RESULTS

Across the four time points, prevalence of ACEs was higher across groupings of ACEs by time. For ACEs 1+, prevalence was 62.2% (2009-2010); 62.2% (2011-2012); 64.5% (2019-2020); and 67.2% (2021-2022). For ACEs 4+, prevalence was 17.4% (2009-2010); 18.1% (2011-2012); 20.4% (2019-2020); and 22.6% (2021-2022). Prevalence of ACE 1 + was higher for older adults, Non-Hispanic Black adults, Non-Hispanic Other adults, and those with higher education. Prevalence of 4 + ACEs was higher for females, and lower for those with higher education and those with higher annual incomes.

CONCLUSION

This study shows an increased prevalence of having ACEs over a 14-year period and identified independent sociodemographic correlates of having ACEs in a nationally representative study. Targeted interventions are needed to reduce burden of ACEs using population-based approaches.

Contextualizing risk, pathways, and solutions for the relationship between adverse childhood experiences (ACEs) and type 2 diabetes among inner-city African Americans: A qualitative analysis and development of a theoretical framework

PURPOSE

Adverse childhood experiences (ACEs) confer significant risk for diabetes in adulthood. The purpose of this study was to explore perceptions about risk, potential pathways leading to diabetes, and solutions based on the lived experience.

METHODS

Three focus groups were conducted. A semi-structured interview guide was used to explore prevalence and causes of ACEs, pathways to diabetes, and possible solutions. Grounded theory was used for analysis. Constant comparisons resulted in emergent themes that were indexed and compared with the rest of the data to establish analytical categories. Analytical categories were further refined as additional data was collected until groups of key themes or categories were identified and used to construct a theoretical framework.

RESULTS

Participants totaled 23 across 3 groups. All participants were African American. Average age was 49, average number of years living with diabetes was 13 years. Participants included both men and women. Participants experienced one or more occasions of sexual abuse, physical and verbal abuse, and neglect. The major themes can be classified as A. Cause, B. Pathway, and C. Treatment/solution.

LIMITATIONS

Findings may not generalize to the overall population with ACEs and diabetes.

CONCLUSIONS

Three major themes were identified: family instability and financial hardship as risks for ACEs, maladaptive coping leading to diabetes, and social structure as a potential solution. Future research is needed to examine quantitatively, pathways to inform prevention at the primary, secondary, and tertiary levels of care for both the prevention of ACEs, mitigating risk for diabetes, and improving overall health.

Exploring Sexual Orientation Disparities Regarding the Interplay of Childhood Sexual Abuse, Self-Reported Diabetes Status, and Depression Among Adults in the United States

Previous research has revealed a strong link between the experience of childhood sexual abuse (CSA) and diabetes in adulthood. Moreover, research has shown that sexual minorities (SM) are exposed to adverse childhood experiences (ACEs) (i.e. CSA) and experience depression at higher rates than their heterosexual counterparts. Thus, it is imperative to further investigate the role of depression and the differential associations of exposure to ACEs with diabetes prevalence by sexual orientation. We explored sexual orientation disparities regarding the relationship between CSA and diabetes and examined the moderating role of depression. A total of 29,903 participants from the 2021 Behavioral Risk Factor Surveillance System (BRFSS) were included in this study. Secondary data analysis was conducted using the survey data, and weighted logistic regression and moderation analysis were performed. Heterosexuals who experienced CSA (AOR = 1.25; p < .05) and SM who experienced CSA (AOR = 2.13; p < .05) reported higher odds of having diabetes. Among heterosexuals, depression (AOR = 1.38; p < .001) was significantly associated with having diabetes. Additionally, depression was a significant moderator among heterosexuals with and without CSA. Further understanding of the impact of ACEs on diabetes among specific subgroups of SM should be assessed in future studies.

Exposure to adverse childhood experiences and diabetes: Mediational role of short sleep duration

Adverse childhood experiences (ACEs) are associated with an increased risk of diabetes in adulthood. However, the potential mediational role of sleep duration in this association is unclear. A total of 116, 014 participants in the United States, from the Behavioral Risk Factor Surveillance System (BRFSS) survey in 2020 were involved in the study. The effects of ACE status, different ACEs, and ACE scores on short sleep duration were examined using binary logistic regression analysis, and the association of ACE status, different types of ACEs, and ACE scores with diabetes and the mediating role of short sleep duration were observed. Path analysis was used to investigate short sleep duration as pathways between different types of ACEs and diabetes in adulthood. For the different types of ACEs, alcohol abuse in the household (OR = 1.13, 95%CI 1.08; 1.18), witnessing domestic violence (OR = 1.17, 95%CI 1.11; 1.23), emotional abuse (OR = 1.11, 95%CI 1.06; 1.16), physical abuse (OR = 1.22, 95%CI 1.17; 1.28), sexual abuse (OR = 1.25, 95%CI 1.18; 1.32) and short sleep duration (OR = 1.26, 95%CI 1.21; 1.32) independently increased the odds of diabetes. There was also an indirect relationship between alcohol abuse in the household, witnessing domestic violence, physical abuse, sexual abuse, and diabetes via short sleep duration. Short sleep duration plays a partial mediating role between ACEs and diabetes, including alcohol abuse in the household, witnessing domestic violence, physical and sexual abuse.

Trauma Chronicity and the Long-Term Needs of Childhood Sexual Trauma Survivors

Research has linked childhood sexual trauma (CST) with adverse adult outcomes (AAOs) that span physical, psychological, and social domains of functioning. Differences in conceptualizing and measuring CST, however, have inhibited the examination of trauma-related variables hypothesized to impact adult outcomes. We used National Sexual Health Survey (NSHS; 1995–1996) data to examine trauma chronicity (i.e., duration) and AAOs (domains: physical and mental health, close relationships, and achievement). The NSHS (N = 6537, 18–70 years) assessed duration using perpetrator-specific CST reports. Adjusting for background characteristics, we examined CST duration in relation to AAOs and CST-related help-seeking. Approximately 8% of participants reported CST. Chronic (vs. single-exposure) CST survivors were at substantially higher risk of experiencing AAOs [i.e., mean AAOs and specific AAOs (e.g., physical and emotional health problems, divorce/separation, and poverty)]. CST had direct effects on sexual dysfunction and satisfaction, and on relationship stressors which may impact sexual relationship quality. Although 62% of CST survivors did not seek help, those with more chronic CST histories reported a higher prevalence of trauma-related help-seeking. Our work underscores the importance of examining CST chronicity in relation to long-term developmental outcomes. Chronicity assessment may be an important screening tool in the therapeutic context and in broader community screening efforts.

Relationship between social determinants of health and clinical outcomes in adults with type 2 diabetes in Lebanon

BACKGROUND

A growing number of ethnic minority populations in the United States are from the Middle East and North Africa (MENA) region, specifically Lebanon. This region is witnessing one of the highest expected increases in diabetes prevalence. However, limited data exists on how social determinants of health impact clinical care for diabetes in this population. The aim of this study was to assess the social determinants of health and their impact on clinical outcomes in Lebanese adults with type 2 diabetes (T2DM).

METHODS

A convenience sample of Lebanese patients with T2DM was recruited from primary health care centers in Lebanon. Data on demographics and social determinants of health, including socioeconomic status, neighborhood and built environment, as well as psychosocial variables were collected. Clinical outcomes including Hemoglobin A1c (A1C), systolic (SBP) and diastolic blood pressure (DBP) were measured. Unadjusted and adjusted linear regression models were used to test for associations between the independent variables and each of the outcomes.

RESULTS

Out of the 300 adults with T2DM, 52% were men, 73% were married and 64% had an education level below high school. Results from multivariate analyses showed that food insecurity (β = 0.16, p = 0.01), owning an air conditioner (β = -0.64, p = 0.01), and commuting by walking (β = -0.93, p = 0.01) were independently associated with A1C. Predictors of DBP were male gender (β = 3.59, p = 0.03), age (β = -0.19, p = 0.005) and lack of confidence in filling medical forms (β = -4.89, p = 0.007), while male gender was the only predictor of SBP (β = 7.41, p = 0.008).

CONCLUSIONS

This is the first study to examine the relationship between social determinants of health and clinical outcomes for diabetes in the MENA region. Our findings suggest that living in an underprivileged neighborhood and built environment was significantly and independently associated with poor clinical outcomes among adults with T2DM in Lebanon. Findings from this study will inform care for immigrant populations with diabetes from the MENA region.

Patterns of adverse childhood experiences and mental health outcomes among American Indians with type 2 diabetes

BACKGROUND

Extensive research demonstrates that Adverse Childhood Experiences (ACEs) are highly interconnected and have numerous health consequences well into adulthood. Yet, there is a dearth of focused research that examines ACEs and health inequities for American Indians (AIs).

OBJECTIVE

To assesses the prevalence of ten types of childhood adversities, explore constellations of exposures, and examine whether there are differential risks of mental health outcomes according to sub-group classification.

PARTICIPANTS AND SETTING

Adult AIs with type 2 diabetes from five reservation-based tribal communities in the Great Lakes region of the U.S.

METHODS

Prevalence was estimated using a modified version of the World Health Organization's ACE-International Questionnaire. To examine heterogeneity in ACEs exposures, latent class analysis was used. Risk of mental health outcomes was calculated by class.

RESULTS

The four most common ACEs reported were residing with someone who abused substances, witnessing household violence, incarceration of a household member, and sexual abuse. Three latent classes were identified: low risk (56.7%), family maladjustment with high probabilities of household violence, incarceration, and substance abuse (27.1%), and complex trauma (16.3%) with moderate to high probabilities of exposure to all ACEs. The most consistent differences in mental health outcomes were between the low risk and complex trauma classes.

CONCLUSIONS

Identification of a high number of participants in the low-risk class helps structure a more wholistic image of AI families, as negative stereotypes of AIs are abundant. For the minority of individuals in the complex trauma class, risk for chronic mental health challenges and co-morbidities appears to be high.

Sexual violence and cardiovascular disease risk: A systematic review and meta-analysis

BACKGROUND

Cardiovascular disease (CVD) is a leading cause of death among adults. Over 35% of women worldwide report lifetime exposure to sexual violence. While psychosocial factors broadly have been linked to CVD risk, it is unclear if a history of sexual violence is associated with increased risk for CVD. This study employed quantitative meta-analysis to investigate the association between sexual violence and CVD risk.

METHODS

PubMed and PsycINFO databases were searched through March 1, 2021. Included articles had a measure of sexual violence and at least one cardiovascular outcome (i.e., clinical CVD, subclinical CVD, select CVD risk factors) in women and men aged 18 years or older. Data were expressed as odds ratios (OR) or hazard ratios (HR) with 95% confidence intervals (CI) extracted from fully-adjusted models. OR and HR effects were pooled separately, given the inability to statistically harmonize these effects and differences in interpretation, using random effects meta-analysis. Heterogeneity of effects was tested using Cochran's Q test.

RESULTS

Overall, 45 articles based on 830,579 adults (77.1% women) were included (113 individual effects expressed as OR and 9 individual effects expressed as HR). Results indicated that sexual violence was related to adult CVD risk (OR [95%CI] = 1.25 [1.11-1.40]; HR [95%CI] = 1.17 [1.05-1.31]). Results varied by outcome type and measurement, and timing of violence.

CONCLUSIONS

Adults with a history of sexual violence demonstrate greater CVD risk relative to those without this history. The results highlight the importance of addressing sexual violence in CVD risk reduction efforts.

The Role of Physical and Sexual Assaults on the Ability to Complete Work Responsibilities

Sexual and physical assaults have many serious and persistent negative impacts on individual health. There is now a considerable literature base identifying and discussing these health outcomes. Less is known about the mediating mechanisms that link these types of assault with later outcomes. This study examines the role of sexual and physical assaults in self-perceptions of individual health on missing or cutting back on work responsibilities. In particular, perceptions of both mental and physical health are investigated to further refine understanding of the different impacts of assault on survivor health and behavior. Using a sample of 3,791 adults aged 30 to 84 from the Midlife in the United States (MIDUS) study, results of the analyses indicate that sexual and physical assaults do not have a direct effect on missing/cutting back on work responsibilities but do have an indirect effect through perceptions of health. The results can inform academic research, as important impacts of assault may be masked if mediating mechanisms are not investigated. In terms of policy, adults who have difficulty carrying out work responsibilities should be assessed for their overall health and survivors of violence should be offered health-related services following a victimization experience.

The early effects of cumulative and individual adverse childhood experiences on child diet: Examining the role of socioeconomic status

Adverse Childhood Experiences (ACEs) have been associated with detrimental long-term health outcomes, including obesity risk. Existing research has yet to examine whether early life ACEs are associated with diet in early childhood within socioeconomic subgroups. Data were drawn from the Early Childhood Longitudinal Study-Birth Cohort (2001-2002). Mother-child dyads (n = 7000) were recruited when children were 9-months old, and followed longitudinally at 2 years, and 4 years. Mothers reported children's exposure to five ACEs at 9-months and 2 years and children's daily intake of fruits, vegetables, sweet snacks, and sugar-sweetened beverages (SSBs) at 4 years. Weighted multiple linear regression models tested the effect of cumulative and individual ACEs on child diet in full, low-, and high-SES samples. Cumulative ACE score was inversely associated with frequency of fruit intake in full (b = -0.08, p = 0.005) and low-SES samples (b = -0.10, p < 0.001). Domestic violence was associated with less frequent fruit intake in full (b = -0.21, p = 0.01) and low-SES samples (b = -0.29 p = 0.008). In the full sample, incarceration was associated with less frequent fruit intake (b = -0.24, p = 0.02), and domestic violence was associated with higher sweet snack (b = 0.22, p = 0.01) and SSB intake (b = 0.27, p = 0.009). Results provide preliminary evidence on the association between cumulative and specific ACEs and child diet, and how this relationship varies by SES context. Future research is needed to understand the complex multi-level mechanisms operating along this pathway in order to inform interventions supporting behavior change and to build evidence for policies that may reduce diet-related disparities in ACE exposure.

Association of Adverse Childhood Experiences With Cardiovascular Disease Later in Life: A Review

Importance

Adverse childhood experiences (ACEs) are potentially harmful events that occur during childhood, spanning neglect, physical or sexual abuse, parental separation, or death, among others. At least 50% of the US adult population has experienced 1 or more ACEs before the age of 18 years, but in clinical practice, ACEs remain underrecognized. Adults who have experienced ACEs are at increased risk of developing health risk behaviors and, ultimately, cardiovascular disease (CVD). This review summarizes the evidence regarding the association of ACEs with CVD and the accompanying diagnostic and therapeutic approaches in the adult population.

Observations

ACEs are commonly classified into 3 domains: abuse (psychological, physical, or sexual), household dysfunction (eg, substance use by household members, mental illness, parental separation), and neglect. These experiences elicit chronic activation of the stress response system, leading to autonomic, neuroendocrine, and inflammatory dysfunction. The subsequent development of traditional risk factors, such as diabetes, hypertension, smoking, and obesity, results in the onset of CVD and premature mortality. Adults with 4 or more ACEs compared with those with none have a more than 2-fold higher risk of developing CVD and an almost 2-fold higher risk of premature mortality.

Conclusions and Relevance

Identifying methods of mitigating the health consequences of ACEs may lead to better cardiovascular outcomes. Inquiry into ACE exposure during clinical encounters and subsequent referral to psychological services when appropriate may be helpful, but strategies aimed at CVD prevention via management of ACEs in adults continue to lack adequate evidence.

Relationship between adverse childhood experiences and perceived discrimination in adulthood

BACKGROUND

Adverse Childhood Experiences (ACEs) and perceived discrimination impact health overtime, however little is known about their association.

METHODS

Data for 6,325 participants in the Midlife in the US (MIDUS) study were analyzed across three waves of data. ACEs included emotional or physical abuse, household dysfunction, or financial strain in childhood. Generalized Linear Models with Generalized Estimating Equation approach was used to test the unadjusted and adjusted associations for ACEs and perceived discrimination and perceived inequality.

RESULTS

Individuals with ACEs reported significantly higher perceived inequality in work (β=0.05, 95%CI 0.02-0.07), in home (β=0.06, 95%CI 0.04-0.09), in family relationships (β=0.09, 95%CI 0.06-0.11), perceived daily discrimination (β=0.77, 95%CI 0.58-0.96), and perceived lifetime discrimination (β=0.24, 95%CI 0.18-0.30). ACE types were significantly associated with more perceived inequality and perceived discrimination. . Abuse was independently associated with all outcomes after adjusting for household dysfunction, financial strain, age, sex, race/ethnicity, education, marital status, and income.

LIMITATIONS

Findings cannot speak to the temporal relationship between ACEs and discrimination. It should not be assumed that ACEs cause perceived discrimination, but rather that there is an important association that warrants further investigation.

CONCLUSIONS

These findings represent the first step in better understanding the relationship between ACEs and perceived discrimination. As both influence health across the lifespan, understanding the relationship, mechanisms, and pathways for intervening are of great importance from a population health perspective. Efforts to incorporate discussions on experiences with discrimination and inequality may be warranted as a part of treatment for ACEs to address psychosocial stressors across the lifespan.

Brain-gut-microbiome interactions in obesity and food addiction

Normal eating behaviour is coordinated by the tightly regulated balance between intestinal and extra-intestinal homeostatic and hedonic mechanisms. By contrast, food addiction is a complex, maladaptive eating behaviour that reflects alterations in brain-gut-microbiome (BGM) interactions and a shift of this balance towards hedonic mechanisms. Each component of the BGM axis has been implicated in the development of food addiction, with both brain to gut and gut to brain signalling playing a role. Early-life influences can prime the infant gut microbiome and brain for food addiction, which might be further reinforced by increased antibiotic usage and dietary patterns throughout adulthood. The ubiquitous availability and marketing of inexpensive, highly palatable and calorie-dense food can further shift this balance towards hedonic eating through both central (disruptions in dopaminergic signalling) and intestinal (vagal afferent function, metabolic endotoxaemia, systemic immune activation, changes to gut microbiome and metabolome) mechanisms. In this Review, we propose a systems biology model of BGM interactions, which incorporates published reports on food addiction, and provides novel insights into treatment targets aimed at each level of the BGM axis.

Adverse Childhood Experiences and Decreased Renal Function: Impact on All-Cause Mortality in U.S. Adults

INTRODUCTION

Evidence suggests that individuals with a history of adverse childhood experiences have higher odds of developing kidney disease than individuals with no adverse childhood experiences. However, no study has examined the influence of coexisting adverse childhood experiences and kidney disease on mortality risk. This study uses a longitudinal survey of adults to examine the influence of coexisting adverse childhood experiences and decreased renal function on all-cause mortality in a sample of U.S. adults.

METHODS

A total of 1,205 adults participating in the Midlife Development in the United States series between 1995 and 2014 were used for this analysis performed in 2019. A total of 6 types of adverse childhood experiences were available in the data set, which were combined to create a dichotomous variable with any adverse experience counted as yes. Decreased renal function was defined as an estimated glomerular filtration rate <60 milliliter/minute/1.73 m². The main outcome was all-cause mortality. Cox proportional hazards models were performed to examine 4 combinations of adverse childhood experiences and decreased renal function associated with overall survival (neither, adverse childhood experiences only, decreased renal function only, or both) controlling for covariables.

RESULTS

In fully adjusted models, adverse childhood experiences and decreased renal function were associated with increased all-cause mortality relative to neither (hazard ratio=2.85, 95% CI=1.30, 6.25). Decreased renal function only and adverse childhood experiences only were not significantly associated with all-cause mortality (hazard ratio=1.14, 95% CI=0.64, 2.04 and hazard ratio=1.55, 95% CI=0.44, 5.41, respectively). When using decreased renal function as the reference group, coexisting adverse childhood experiences and decreased renal function was associated with a 64% increased risk of all-cause mortality, though this relationship was not statistically significant.

CONCLUSIONS

Coexistence of adverse childhood experiences and decreased renal function is associated with higher all-cause mortality than seen in individuals with neither adverse childhood experiences nor decreased renal function and may be associated with higher all-cause mortality than seen in individuals with decreased renal function alone. Future research is needed to better understand this potential association.

The Role of Childhood Adversity in the Development of Gestational Diabetes

INTRODUCTION

The influence of women's childhood psychosocial environment and subsequent preconception mental health on risk of developing gestational diabetes mellitus is unclear. This study examines this relationship.

METHODS

Data from a population-based cohort study, the Australian Longitudinal Study on Women's Health, were used. A total of 6,317 women with no pre-existing diabetes were followed from 1996 (aged 18-23 years) until 2015. Gestational diabetes mellitus diagnosis was self-reported. Exposures to eight subcategories of adverse childhood experiences were recalled. Individual subcategories and total number of adverse childhood experiences were examined. Log-binomial regression models with generalized estimating equations were used to estimate RRs and 95% CIs. Analyses were adjusted for early life, preconception, and antenatal gestational diabetes mellitus risk factors. Effect modification by preconception mental health was tested using cross-product terms. Analyses were conducted in 2018.

RESULTS

Among 11,556 pregnancies, 4.7% were complicated by gestational diabetes mellitus. Compared with women not exposed to adverse childhood experiences, exposure to any three adverse childhood experiences (6% of women, adjusted RR=1.73, 95% CI=1.02, 3.01) or four or more adverse childhood experiences (7%, adjusted RR=1.76, 95% CI=1.04, 2.99) was associated with elevated gestational diabetes mellitus risk in women with preconception depressive symptoms. Among the subcategories of adverse childhood experiences, physical abuse, and household substance abuse were associated with higher gestational diabetes mellitus risk. Adverse childhood experiences were not associated with gestational diabetes mellitus in women without depressive symptoms before pregnancy (p=0.01, for interaction).

CONCLUSIONS

These findings suggest that, in addition to primary prevention of childhood adversity, strategies to curb poor mental health trajectories among women exposed to adverse childhood experiences may contribute to prevention of gestational diabetes mellitus.

The differential impact of adverse childhood experiences in the development of pre-diabetes in a longitudinal cohort of US adults

BACKGROUND

ACEs have a dose-response relationship with diabetes. The relationship between ACEs and pre-diabetes is not well known and may represent an effective area for prevention efforts.

METHODS

Data from 1054 participants from two waves of the longitudinal MIDUS study were used. Multivariate general linear regression models assessed the relationship between ACEs and biomarker outcomes. Correlation tests and mediation models investigated the relationship between ACE and pre-diabetes.

RESULTS

Individuals reporting ACEs were statistically significantly more likely to have higher BMI (1.13 (0.34-1.92)), higher waist circumference (2.74 (0.72-4.76)), elevated blood fasting insulin levels (2.36 (0.71-4.02)) and higher insulin resistance (HOMA-IR (0.57 (0.08-1.06)). BMI/waist circumference and insulin resistance did not maintain independent relationships with ACEs once HOMA-IR was included in the dichotomized ACE model (p = 0.05 and p = 0.06, respectively), suggesting the relationship between BMI and ACEs may be mediated by insulin resistance.

CONCLUSIONS

These results represent one of the first studies to examine the differential impact of ACEs on a diverse set of clinical pre-diabetes measures. Findings suggest sexual and physical abuse, and financial strain during childhood are important factors associated with higher risk for pre-diabetes, and should be considered during intervention development.