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Kern A, Khoury B, Frederickson A, Langevin R. The associations between childhood maltreatment and pregnancy complications: A systematic review and meta-analysis. J Psychosom Res 2022; 160:110985. [PMID: 35816769 DOI: 10.1016/j.jpsychores.2022.110985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/28/2022] [Accepted: 06/28/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Childhood maltreatment is associated with pregnancy complications. This study aimed to systematically review and quantitatively synthesize the strength of the associations between maternal histories of childhood maltreatment and the risk of preterm delivery, low birth weight, and gestational diabetes. METHODS Subject Headings and keywords for childhood maltreatment and the pregnancy outcomes were searched in MEDLINE (Ovid; 1946-Present), PsycINFO (Ovid; 1806-Present), and Web of Science Core Collection. Original studies or dissertations that reported quantitative associations between childhood maltreatment and any of the pregnancy outcomes of interest were included. Two independent reviewers selected the pertinent studies, assessed the risk of bias, and extracted data. Pooled effect sizes were calculated for the three outcomes. RESULTS Twenty-eight studies were reviewed and 22 were meta-analysed. Maternal childhood maltreatment was associated with preterm birth (OR = 1.27 95% CI: 1.06-1.52, p = 0.001), low birth weight (OR = 1.42 95% CI: 1.10-1.83, p = 0.001), and gestational diabetes (RR = 1.37 95% CI: 1.02-1.83, p = 0.030), however high levels of heterogeneity were found. Findings were insignificant for studies examining gestational age and birth weight as continuous variables. DISCUSSION Findings confirm that under certain conditions, childhood maltreatment is associated with pregnancy outcomes. Future research should prioritize mediation and moderation models to clarify the mechanisms underlying these relationships. Trauma-informed care is needed to tailor the appropriate care for expecting mothers.
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Affiliation(s)
- Audrey Kern
- Department of Educational and Counselling Psychology, McGill University, 3700 McTavish St, Montreal, Quebec H3A 1Y2, Canada
| | - Bassam Khoury
- Department of Educational and Counselling Psychology, McGill University, 3700 McTavish St, Montreal, Quebec H3A 1Y2, Canada
| | - Alesha Frederickson
- Department of Educational and Counselling Psychology, McGill University, 3700 McTavish St, Montreal, Quebec H3A 1Y2, Canada
| | - Rachel Langevin
- Department of Educational and Counselling Psychology, McGill University, 3700 McTavish St, Montreal, Quebec H3A 1Y2, Canada.
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Fuchs A, Resch F, Kaess M, Moehler E. Early Parenting Stress Links Obstetric Complications and Child Psychopathology in Middle Childhood in an At-Risk Sample. J Dev Behav Pediatr 2022; 43:e48-e55. [PMID: 33908374 DOI: 10.1097/dbp.0000000000000960] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 03/03/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Obstetric complications (OCs) are adverse events during pregnancy, birth, or immediately after birth. Evidence on cumulative OC and longitudinal associations with child psychopathology is sparse. Prospective studies testing mediating pathways such as parenting stress are needed. This study aimed to investigate the impact of OC on child psychopathology in middle childhood and to highlight whether and which type of parenting stress specifically mediates this association. METHODS We investigated n = 54 mother-child dyads from 5 months to 8 years of age. Child psychopathology at 8 years and parenting stress at 12 months were assessed using the Child Behavior Checklist (CBCL) and the Parenting Stress Index. OCs were evaluated by the Steinhausen Questionnaire and through access to official pregnancy records at the 5-month visit. Half of the mothers had experienced early-life maltreatment (ELM), assessed with the Childhood Trauma Questionnaire. RESULTS There was a significant indirect effect of maternal parenting stress at 12 months mediating the association between OC and child psychopathology at 8 years (β = 0.26; p < 0.01; 95% [0.35-1.83]). A significant proportion of 35% of CBCL-variance was explained. The significant effect remained even when maternal ELM and maternal psychological distress were controlled for. On the subscale level, only the "Difficult Child" subscale was a significant mediator. CONCLUSION Our findings suggest that parenting stress should be targeted to prevent adverse effects of OC on child psychopathology. More research focusing on families subjected to OC is needed to highlight how maternal parenting stress and child regulatory functioning interact to affect child development longitudinally.
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Affiliation(s)
- Anna Fuchs
- Centre for Psychosocial Medicine, Department of Child and Adolescent Psychiatry, University Hospital Heidelberg, Heidelberg, Germany
- Department of Psychology, Pennsylvania State University, University Park, PA
| | - Franz Resch
- Centre for Psychosocial Medicine, Department of Child and Adolescent Psychiatry, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Kaess
- Centre for Psychosocial Medicine, Department of Child and Adolescent Psychiatry, University Hospital Heidelberg, Heidelberg, Germany
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Eva Moehler
- Centre for Psychosocial Medicine, Department of Child and Adolescent Psychiatry, University Hospital Heidelberg, Heidelberg, Germany
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Saarland, Homburg, Germany
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Fuchs A, Dittrich K, Neukel C, Winter S, Zietlow AL, Kluczniok D, Herpertz SC, Hindi Attar C, Möhler E, Fydrich T, Bermpohl F, Kaess M, Resch F, Bödeker K. Hair cortisol moderates the association between obstetric complications and child wellbeing. Psychoneuroendocrinology 2020; 121:104845. [PMID: 32861165 DOI: 10.1016/j.psyneuen.2020.104845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 06/25/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022]
Abstract
Obstetric complications (OC) may have implications for later health outcomes. However, there is a lack of research examining the association between OC and behavior problems or quality of life (HRQoL). We aimed to close this gap and further investigate functioning of the hypothalamus-pituitary-adrenal (HPA)-axis as a potential physiological vulnerability moderating the association between OC and behavior problems and HRQoL. We investigated 232 mothers and their five to 12-year-old children. Presence of OC during the pre-, peri-, and postnatal phases was determined by interviewing mothers. Children's behavior problems (CBCL, TRF) and HRQoL (Kidscreen rated by mothers and children) were assessed. Children gave 3 cm strands of hair for analysis of hair cortisol (HC). Structural equation modeling analyses with a latent variable of child outcome ("distress"), OC as predictor and HC as a potential moderator were conducted. OC significantly predicted distress (β = .33, p < .01). The model showed a good fit to the data: χ2(14)=15.66, p < .33, CFI=.99, TLI=.99, RMSEA=.02, 90 %CI [.00, .06], SRMR=.04. In addition, HC moderated the association between OC and distress (β=-.32, p < .01). The moderation model also showed a good fit: χ2(14) =7.13, p = .93, CFI=1.00, TLI=1.06, RMSEA=.00, 90 %CI [.00, .02], SRMR=.03. Results indicated that the association between OC and distress was significant only when children had low HC-levels. This was also the case for both externalizing and internalizing behavior problems. Our results underline the notion of OC as a risk factor for child behavior problems and wellbeing and point to an important role of the children's physiological set-up such as HPA-functioning.
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Affiliation(s)
- Anna Fuchs
- University Hospital Heidelberg, Centre for Psychosocial Medicine, Department of Child and Adolescent Psychiatry, Heidelberg, Germany; Department of Psychology, Pennsylvania State University, University Park, PA, USA.
| | - Katja Dittrich
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), Campus Virchow-Klinikum, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Berlin, Germany
| | - Corinne Neukel
- University Hospital Heidelberg, Centre for Psychosocial Medicine, Department of General Psychiatry, Heidelberg, Germany
| | - Sibylle Winter
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), Campus Virchow-Klinikum, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Berlin, Germany
| | - Anna-Lena Zietlow
- University Hospital Heidelberg, Centre for Psychosocial Medicine, Institute of Medical Psychology, Heidelberg, Germany
| | - Dorothea Kluczniok
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), Campus Charité Mitte, Department of Psychiatry and Psychotherapy, Berlin, Germany
| | - Sabine C Herpertz
- University Hospital Heidelberg, Centre for Psychosocial Medicine, Department of General Psychiatry, Heidelberg, Germany
| | - Catherine Hindi Attar
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), Campus Charité Mitte, Department of Psychiatry and Psychotherapy, Berlin, Germany
| | - Eva Möhler
- University Hospital Heidelberg, Centre for Psychosocial Medicine, Department of Child and Adolescent Psychiatry, Heidelberg, Germany
| | - Thomas Fydrich
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Felix Bermpohl
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), Campus Charité Mitte, Department of Psychiatry and Psychotherapy, Berlin, Germany
| | - Michael Kaess
- University Hospital Heidelberg, Centre for Psychosocial Medicine, Department of Child and Adolescent Psychiatry, Heidelberg, Germany; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Franz Resch
- University Hospital Heidelberg, Centre for Psychosocial Medicine, Department of Child and Adolescent Psychiatry, Heidelberg, Germany
| | - Katja Bödeker
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), Campus Virchow-Klinikum, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Berlin, Germany
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Ben Salah A, Lemieux A, Mlouki I, Amor I, Bouanene I, Ben Salem K, al'Absi M, El Mhamdi S. Impact of social violence and childhood adversities on pregnancy outcomes: a longitudinal study in Tunisia. J Glob Health 2020; 9:020435. [PMID: 31893035 PMCID: PMC6925971 DOI: 10.7189/jogh.09.020435] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Accumulating research suggests that exposure to intra-familial adversities are significant risk factors for adverse pregnancy outcomes. However, the relationship between social violence (peer violence, witnessing community violence and exposure to collective violence) and pregnancy outcomes has not been extensively investigated. Our study aims to examine the association between social Adverse Childhood Experiences (ACEs) and pregnancy outcomes and to explore the role of depression during pregnancy as a mediator of this association. Methods We performed a prospective follow-up study of pregnant women in five Primary Health care Centers (PHC) in the region of Monastir (Tunisia) from September 2015 to August 2016. Enrolled women were followed during the second trimester, third trimester of pregnancy and during the postnatal period. Exposure to violence was assessed retrospectively using the validated Arabic version of the World Health Organization (WHO) ACE questionnaire. The Self Reporting Questionnaire 20-Item (SRQ-20) was used as a screening tool for depression during pregnancy. Results We recruited and followed a total of 593 women during the study period. Witnessing community violence was the most frequently reported social ACE among pregnant women (237; 40%), followed by peer violence (233; 39.3%). After adjustment for high risk pregnancies, environmental tobacco smoke, and intra-familial ACEs, the risk of premature birth was significantly associated with exposure to collective violence (P < 0.001) and witnessing community violence (P < 0.05). The risk of low birth weight was significantly associated with witnessing community violence (P < 0.001). In the mediation analysis, depression mediated significant proportions of the relationship between the cumulative number of ACEs and pregnancy outcomes. Conclusions Social ACEs may have a long-term effect on maternal reproductive health, as manifested by offspring that were of reduced birth weight and shorter gestational age. A public health framework based on the collaboration between pediatric, psychiatric obstetrical health professionals, education professionals and policy makers could be applied to ensure primary prevention of childhood adversities and pay attention to expected mothers with history of exposure to such adversities.
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Affiliation(s)
- Arwa Ben Salah
- Department of Community Medicine, Faculty of Medicine, University of Monastir, Monastir, Tunisia.,Research laboratory "Epidemiology Applied to Maternal and Child Health", Monastir, Tunisia
| | - Andrine Lemieux
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minnesota, USA
| | - Imen Mlouki
- Department of Community Medicine, Faculty of Medicine, University of Monastir, Monastir, Tunisia.,Research laboratory "Epidemiology Applied to Maternal and Child Health", Monastir, Tunisia.,Department of Preventive and Community Medicine, University Hospital Tahar Sfar, Mahdia Tunisia
| | - Ines Amor
- Department of Community Medicine, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Ines Bouanene
- Department of Community Medicine, Faculty of Medicine, University of Monastir, Monastir, Tunisia.,Research laboratory "Epidemiology Applied to Maternal and Child Health", Monastir, Tunisia
| | - Kamel Ben Salem
- Department of Community Medicine, Faculty of Medicine, University of Monastir, Monastir, Tunisia.,Research laboratory "Epidemiology Applied to Maternal and Child Health", Monastir, Tunisia
| | - Mustafa al'Absi
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minnesota, USA
| | - Sana El Mhamdi
- Department of Community Medicine, Faculty of Medicine, University of Monastir, Monastir, Tunisia.,Research laboratory "Epidemiology Applied to Maternal and Child Health", Monastir, Tunisia.,Department of Preventive and Community Medicine, University Hospital Tahar Sfar, Mahdia Tunisia
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Finy MS, Christian LM. Pathways linking childhood abuse history and current socioeconomic status to inflammation during pregnancy. Brain Behav Immun 2018; 74:231-240. [PMID: 30217532 PMCID: PMC6289854 DOI: 10.1016/j.bbi.2018.09.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 09/04/2018] [Accepted: 09/10/2018] [Indexed: 12/12/2022] Open
Abstract
Women who have experienced significant adversities during childhood and adulthood are at risk for excessive inflammation during pregnancy, but the mechanisms are unclear. Using structural equation modeling, we examined pathways from childhood abuse history and current socioeconomic status (SES) to inflammatory markers through indicators of health risk, recent stressors, and psychological distress in 214 women assessed at mid-pregnancy (5-31 weeks gestation). Self-reported data on socioeconomic indicators, childhood trauma history, pre-pregnancy body mass index (BMI), smoking, sleep quality, interpersonal conflict, recent life events, perceived stress, and depressive symptoms were collected, and serum levels of C-reactive protein (CRP) and interleukin (IL)-6 were determined. In separate models, pre-pregnancy BMI, sleep quality, and interpersonal conflict statistically explained the relationship between adversity and inflammation. These three intermediate variables were then entered into a multiple mediation analysis to examine unique effects. Childhood abuse history and current SES both demonstrated significant indirect effects on CRP through pre-pregnancy BMI, and current SES showed a significant indirect effect on IL-6 through all intermediate variables. When examining each indirect pathway individually, pre-pregnancy BMI and interpersonal conflict emerged as parallel pathways by which low current SES leads to elevated IL-6; the indirect pathway through sleep quality was no longer significant. Pre-pregnancy BMI and interpersonal conflict are two independent mechanisms by which adversity is associated with increased inflammation during pregnancy. Women who have been exposed to significant adversity may be at particular risk for obesity, sleep disruption, and interpersonal conflict, with implications for immune dysregulation during pregnancy.
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Affiliation(s)
- M. Sima Finy
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH 43210,Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH 43210
| | - Lisa M. Christian
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH 43210,Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH 43210,Department of Psychology, The Ohio State University, Columbus, OH 43210,Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH 43210
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Stephenson LA, Beck K, Busuulwa P, Rosan C, Pariante CM, Pawlby S, Sethna V. Perinatal interventions for mothers and fathers who are survivors of childhood sexual abuse. CHILD ABUSE & NEGLECT 2018; 80:9-31. [PMID: 29558671 DOI: 10.1016/j.chiabu.2018.03.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 03/04/2018] [Accepted: 03/12/2018] [Indexed: 06/08/2023]
Abstract
Childhood sexual abuse (CSA) is a worldwide problem with severe long-term consequences. A history of CSA can impact the childbearing experience of mothers and fathers; affecting their mental health, parenting skills and compromising infant development. Nonetheless, the perinatal period offers huge opportunity for intervention and hope. This literature review collates evidence for perinatal psychosocial interventions targeting both mothers and fathers who are survivors of CSA. Publications dating from 1970 to June 2016 were searched using Medline, Maternity and Infant Health, PsychINFO, PsychArticles, PubMed and the International Bibliography of the Social Sciences (IBSS). There were no perinatal interventions that considered the needs of survivor fathers. Sixteen publications on 9 psychosocial perinatal interventions for CSA survivors were identified. However, no sub-analyses specific to CSA survivors were reported. Trauma-specific perinatal interventions drew from a range of theoretical models and varied widely in format. Generally interventions were associated with improvements in maternal mental health, parenting competence, infant attachment security and positive public health outcomes. They were safe and feasible to implement, acceptable to parents and therapist, and therapists were able to implement protocols with adequate fidelity. Yet current data is hampered by small sample size, inconsistent reporting of CSA rates and outcome measures, scarcity of observational data and longer-term follow-up. Intervention modifications are proposed for CSA survivors in view of their unique childbearing experiences.
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Affiliation(s)
- Lucy A Stephenson
- South London and the Maudsley NHS Foundation Trust/Institute Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Katherine Beck
- Department of Psychosis Studies, Institute Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Paula Busuulwa
- GKT School of Medical Education, King's College London, UK
| | - Camilla Rosan
- National Society for the Prevention of Cruelty to Children, UK
| | - Carmine M Pariante
- Stress, Psychiatry and Immunology Lab. & Perinatal Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Susan Pawlby
- Stress, Psychiatry and Immunology Lab. & Perinatal Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Vaheshta Sethna
- Stress, Psychiatry and Immunology Lab. & Perinatal Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Sackler Institute for Translational Neurodevelopment, Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.
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Racine NM, Madigan SL, Plamondon AR, McDonald SW, Tough SC. Differential Associations of Adverse Childhood Experience on Maternal Health. Am J Prev Med 2018; 54:368-375. [PMID: 29306559 DOI: 10.1016/j.amepre.2017.10.028] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 10/03/2017] [Accepted: 10/30/2017] [Indexed: 01/21/2023]
Abstract
INTRODUCTION The current study examined whether three distinct antecedent factors related to maternal adverse childhood experiences were differentially associated with maternal health and psychosocial outcomes in the antepartum period. It was hypothesized that all three adverse childhood experience factors would be positively associated with poor health prior to pregnancy, poor reproductive health history, and health complications and psychosocial difficulties during pregnancy. METHODS Data from 1,994 women (mean age=30.87 years) and their infants were collected from a prospective longitudinal cohort from 2008 to 2011. Pregnant women completed self-report questionnaires and a healthcare professional assessed the mothers' health prior to pregnancy, reproductive history, and pregnancy complications. RESULTS Data analyses were conducted from December 2016 to March 2017. Path analysis demonstrated that women who had experience with physical/emotional abuse in childhood were significantly more likely to enter pregnancy with a chronic health condition (AOR=1.25, 95% CI=1.02, 1.54) and to have psychosocial difficulties in their pregnancy (AOR=1.60, 95% CI=1.34, 1.89). Women who were exposed to household dysfunction in childhood were also significantly more likely to experience psychosocial difficulties during pregnancy (AOR=2.33, 95% CI=1.49, 3.65). There was no association between exposure to sexual abuse and maternal health or mental health outcomes. CONCLUSIONS Adverse childhood experience categories differentially predicted maternal health and psychosocial outcomes prior to and during pregnancy. The overall variance accounted for by adverse childhood experiences was small (3%-19%), suggesting that factors other than childhood adversity likely contribute to maternal health.
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Affiliation(s)
- Nicole M Racine
- Department of Psychology, Faculty of Arts, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Sheri L Madigan
- Department of Psychology, Faculty of Arts, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.
| | - Andre R Plamondon
- Département des fondements et pratiques en éducation, Université Laval, Québec, Québec, Canada
| | - Sheila W McDonald
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Suzanne C Tough
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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Mitchell AM, Porter K, Christian LM. Examination of the role of obesity in the association between childhood trauma and inflammation during pregnancy. Health Psychol 2017; 37:114-124. [PMID: 28967771 DOI: 10.1037/hea0000559] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Childhood trauma is associated with negative perinatal health outcomes including mood disorders and shorter gestation. However, effects of early life exposures on maternal biology are poorly delineated. This study examined associations between childhood trauma and inflammation, as well as the mediating role of obesity in this relationship. METHOD This study examined a racially diverse sample of 77 pregnant women assessed in early, mid, and late pregnancy. Assessments included the Childhood Trauma Questionnaire, Center for Epidemiologic Studies-Depression Scale, serum CRP, IL-6, and TNF-α, and prepregnancy BMI. RESULTS Per linear mixed models, while no direct relationships were observed between childhood trauma with IL-6 or TNF-α, physical (95% CI: 0.007, 0.080) and emotional (95% CI: 0.005, 0.046) abuse as well as emotional neglect (95% CI: 0.010, 0.051) predicted elevated CRP. Effects remained after adjustment for race, income, education, smoking status, medical conditions, and depressive symptoms. PROCESS analyses showed BMI mediated the relationship between physical abuse and both serum CRP (95% CI: 0.014, 0.062) and IL-6 (95% CI: 0.009, 0.034). CONCLUSIONS Exposure to childhood trauma, particularly emotional abuse, physical abuse, and emotional neglect, is associated with inflammation in pregnant women. Obesity served as 1 pathway by which physical abuse contributed to elevations in serum CRP and IL-6. Interventions targeting maternal obesity prior to pregnancy may help mitigate the effects of childhood trauma on perinatal health. These findings have relevance for understanding biological and behavioral pathways by which early life exposures contribute to maternal health. (PsycINFO Database Record
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Affiliation(s)
- Amanda M Mitchell
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center
| | - Kyle Porter
- Center for Biostatistics, The Ohio State University
| | - Lisa M Christian
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center
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Abstract
OBJECTIVES To examine the association between adverse childhood experiences (ACEs) and pregnancy outcomes; to explore mediators of this association including psychiatric illness and health habits. METHODS Exposure to ACEs was determined by the Early Trauma Inventory Self Report Short Form; psychiatric diagnoses were generated by the Composite International Diagnostic Interview administered in a cohort of 2303 pregnant women. Linear regression and structural equation modeling bootstrapping approaches tested for multiple mediators. RESULTS Each additional ACE decreased birth weight by 16.33 g and decreased gestational age by 0.063. Smoking was the strongest mediator of the effect on gestational age. CONCLUSIONS ACEs have an enduring effect on maternal reproductive health, as manifested by mothers' delivery of offspring that were of reduced birth weight and shorter gestational age.
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10
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Inter-relationships between sexual abuse, female sexual function and childbirth. Midwifery 2015; 31:1087-95. [DOI: 10.1016/j.midw.2015.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 06/13/2015] [Accepted: 07/20/2015] [Indexed: 12/31/2022]
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Hoffman ER, Zerwas SC, Bulik CM. Reproductive issues in anorexia nervosa. ACTA ACUST UNITED AC 2014; 6:403-414. [PMID: 22003362 DOI: 10.1586/eog.11.31] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite a high prevalence of menstrual irregularities, women with anorexia nervosa are becoming pregnant. The physical and psychological demands of pregnancy and motherhood can represent an immense challenge for women already struggling with the medical and psychological stress of an eating disorder. This article summarizes key issues related to reproduction in women with anorexia nervosa, highlighting the importance of preconception counseling, adequate gestational weight gain, and sufficient pre- and post-natal nutrition. Postpartum issues including eating disorder symptom relapse, weight loss, breastfeeding, and risk of perinatal depression and anxiety are also discussed.
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Affiliation(s)
- Elizabeth R Hoffman
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB #7160, 101 Manning Drive, Chapel Hill, NC 27599-7160, USA
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The perinatal self-care index: development of an evidence-based assessment tool for use with child sexual abuse survivors. J Perinat Neonatal Nurs 2012; 26:319-26. [PMID: 23111720 DOI: 10.1097/jpn.0b013e318252dd9a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Every ninth woman presenting for prenatal care reports having experienced childhood sexual abuse. Many develop mental health disorders, including posttraumatic stress disorder (PTSD). In response to PTSD, pregnant women survivors of childhood sexual abuse engage in negative perinatal self-care behaviors that can lead to adverse perinatal outcomes. Currently, promotion of perinatal self-care does not consider childhood sexual abuse or PTSD. This study aimed to develop a Perinatal Self-Care Index, determine sensitivity of the index to differences in behaviors of childhood sexual abuse survivors (PTSD-affected and PTSD-resilient), and validate usefulness in relation to birth weight. Secondary analysis was conducted using data from a prospective cohort study of the effects of PTSD on pregnancy outcomes. The index explained 6.5% of variance in birth weight. Prediction improved to 9.4% once PTSD and socioeconomic status were considered. The index is sensitive to differences in PTSD-affected versus PTSD-resilient survivors of childhood sexual abuse and a useful predictor of birth weight in this analysis.
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Meltzer-Brody S, Zerwas S, Leserman J, Holle AV, Regis T, Bulik C. Eating disorders and trauma history in women with perinatal depression. J Womens Health (Larchmt) 2011; 20:863-70. [PMID: 21671774 DOI: 10.1089/jwh.2010.2360] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Although the prevalence of perinatal depression (depression occurring during pregnancy and postpartum) is 10%, little is known about psychiatric comorbidity in these women. We examined the prevalence of comorbid eating disorders (ED) and trauma history in women with perinatal depression. METHODS A research questionnaire was administered to 158 consecutive patients seen in a perinatal psychiatry clinic during pregnancy (n=99) or postpartum (n=59). Measures included Structured Clinical Interview for DSM (SCID) IV-based questions for lifetime eating psychopathology and assessments of comorbid psychiatric illness including the State/Trait Anxiety Inventory (STAI), Patient Health Questionnaire (PHQ-9), Edinburgh Postnatal Depression Scale (EPDS), and Trauma Inventory. RESULTS In this cohort, 37.1% reported a putative lifetime ED history; 10.1% reported anorexia nervosa (AN), 10.1% reported bulimia nervosa (BN), 10.1% reported ED not otherwise specified-purging subtype (EDNOS-P), and 7.0% reported binge eating disorder (BED). Women with BN reported more severe depression (EPDS score, 19.1, standard deviation [SD 4.3], p=0.02; PHQ-severity 14.5, SD 7.4, p=0.02) than the referent group of women with perinatal depression and no ED history (EPDS 13.3, SD=6.1; PHQ 9.0, SD=6.2). Women with AN were more likely to report sexual trauma history than the referent group (62.5% vs. 29.3%, p<0.05), and those with BN were more likely report physical (50.0%, p<0.05) and sexual (66.7%, p<0.05) trauma histories. CONCLUSIONS ED histories were present in over one third of admissions to a perinatal psychiatry clinic. Women with BN reported more severe depression and histories of physical and sexual trauma. Screening for histories of eating psychopathology is important in women with perinatal depression.
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Roller CG. Moving Beyond the Pain: Women's Responses to the Perinatal Period After Childhood Sexual Abuse. J Midwifery Womens Health 2011. [DOI: 10.1111/j.1542-2011.2011.00051.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
AIM This paper is a report of a study of the relationship of post-traumatic stress symptoms, depression, and health status to high risk pregnancy status in survivors of childhood sexual abuse. BACKGROUND Studies examining the long-term effects of childhood sexual abuse have delineated diverse psychological, cognitive, and social difficulties in adult survivors that often manifest somatically. METHODS A random sample of 1835 mid-pregnant Jewish women was recruited in Israel over an 18-month period in 2005-2007. Participants were divided into three sub-groups consisting of the different combinations between pregnancy at risk (yes/no), childhood sexual abuse (yes/no), other than childhood sexual abuse trauma (yes no), and no trauma (yes/no). They completed a self-administered questionnaire consisting of five scales: a demographic variables scale, the Post-traumatic Stress Disorder Symptom Scale, Center for Epidemiologic Studies Depression Scale, Traumatic Events Questionnaire, and Childhood Sexual Experiences Scale. FINDINGS Pregnant survivors of childhood sexual abuse suffered higher distress levels which heightened poor health, hence increasing the probability of high risk pregnancy compared to women who had had other than sexual abuse trauma or reported no trauma. Post traumatic stress symptoms and avoidance (a sub-category) were found to explain chronic illnesses, whereas depression was found to explain gynecological problems in pregnant sexually-abused survivors. CONCLUSION Healthcare workers need to recognize and address the psychological state of pregnant child sexual abuse survivors. Screening of pregnant women for child sexual abuse is needed to assess survivors' psychological well-being and recognize their unique concerns during pregnancy monitoring.
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PTSD and postpartum mental health in a sample of Caucasian, Asian, and Pacific Islander women. Arch Womens Ment Health 2009; 12:393-400. [PMID: 19565327 DOI: 10.1007/s00737-009-0087-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2009] [Accepted: 06/12/2009] [Indexed: 02/03/2023]
Abstract
To better understand the role of posttraumatic stress disorder (PTSD) in postpartum health, this study investigates the relationship of PTSD and associated perinatal behavioral risk factors in a sample of Caucasian, Asian, and Pacific Islander women. As part of a larger longitudinal study, 54 women (18-35 years of age) were interviewed at their postpartum clinic visit for PTSD, anxiety, depression, and alcohol and substance use. PTSD and subclinical PTSD during the postpartum period were associated with behavioral health risks, with PTSD at the onset of pregnancy being a predictor of postpartum PTSD by a factor of three. Women with PTSD and subclinical PTSD were more likely to also experience stress (73%), anxiety (64%), and depression (73%) during the postpartum period compared to those without PTSD. No significant differences were found by ethnicity for postpartum PTSD, depression, or anxiety. Regardless of ethnicity or PTSD status, one in four women in the sample had a probable mental health disorder or risk behavior of some type during the postpartum period. Given the rates of associated mental health risks with PTSD, these findings suggest further research examining the fluctuations of PTSD symptomatology throughout each pregnancy trimester to determine its role as a potential mediator during the perinatal period. Further research is also needed to elucidate the role of ethnic or cultural differences in trauma and PTSD and perinatal health.
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