A Role for Adverse Childhood Experiences and Depression in Preeclampsia

Early Human Development, 2019

Introduction: There are contradicting findings in the current literature regarding the association between inutero exposure to preeclampsia and the long-term neuropsychiatric health of the offspring. The objective of this study is to assess whether prenatal exposure to preeclampsia increases the risk of long-term neuropsychiatric morbidity. Methods: A retrospective population-based cohort study compared neuropsychiatric morbidity between singletons exposed and unexposed to preeclampsia. The study included all the singletons that were born between 1991 and 2014 in a single regional tertiary medical center. A generalized estimating equation (GEE) model was used to control for confounders and maternal clusters. Results: Of the 253,808 singletons that met the inclusion criteria; 3.0% were born to mothers diagnosed with mild preeclampsia (n = 7660), 0.9% with severe preeclampsia (n = 2366) and 0.03% with eclampsia (n = 81). A significant linear association was noted between the severity of the preeclampsia (no preeclampsia, mild, severe preeclampsia and eclampsia) and the incidence of neuropsychiatric morbidity of the offspring (1.0%, vs. 1.2% vs. 1.9% vs. 1.2% respectively, p = 0.003). In a GEE model which was used to control for maternal clusters, gestational diabetes, maternal age, gestational age and time-to-event preeclampsia was found to be an independent risk factor for neuropsychiatric morbidity in the offspring (adjusted OR = 1.36; 95% CI 1.14-1.63). Conclusion: Offspring exposed prenatally to preeclampsia have a significantly higher risk of developing a neuropsychiatric morbidity during childhood.

The British Journal of Psychiatry, 2011

Background Antenatal depression and childhood maltreatment have each been associated with offspring psychopathology, but have never been examined in the same sample. Aims To determine whether childhood maltreatment influences the association between antenatal depression and offspring psychopathology. Method Prospectively collected data on antenatal depression, offspring maltreatment (age 11) and offspring psychopathology (age 11 and 16) were analysed in 120 mother–offspring dyads from the community-based South London Child Development Study. Results Antenatal depression increased the risk of maltreatment in the offspring by almost four times. Children exposed only to antenatal depression or only to childhood maltreatment were no more at risk of developing psychopathology; however, children exposed to both antenatal depression and childhood maltreatment were at almost 12 times greater risk of developing psychopathology than offspring not so exposed. Conclusions Research investigating...

Journal of Women's Health, 2019

Introduction: Little is known about how exposure to adverse childhood experiences (ACEs) and protective factors, such as resilience, influence prenatal mental and behavioral health. This study examined associations between exposure to ACEs and mental and behavioral health during pregnancy overall and among women with high versus low levels of resilience. Materials and Methods: Women in two Kaiser Permanente Northern California medical centers were screened for ACEs and resilience during prenatal care (*14-23 weeks of gestation; N = 355). Multivariable logistic regression analyses examined associations between ACEs and prenatal mental and behavioral health conditions overall and for women with low (£32) versus high (>32) resilience on the 10-item Connor-Davidson Resilience Scale. Results: Overall, 54% of women reported 0 ACEs, 28% 1-2 ACEs, and 18% 3+ ACEs. Relative to women with 0 ACEs, those with 1-2 ACEs had higher odds of an anxiety or depressive disorder and intimate partner violence (IPV) (odds ratios [ORs] 2.42-3.12, p < 0.05), and those with 3+ ACEs had higher odds of an anxiety or depressive disorder, depression symptoms, and IPV (ORs 3.08-4.71, p < 0.05). In stratified analyses by high (56%) and low (44%) resilience, having one or more ACEs (vs. 0 ACEs) was only associated with worse mental and behavioral health in women with low resilience. Conclusions: ACEs predicted mental and behavioral health conditions among pregnant women, and associations were the strongest among women with low levels of current resilience. Longitudinal research is needed to understand the causal mechanisms underlying these associations.

Psychological medicine, 2007

Perinatal problems may be associated with an increased risk for psychological and physical health problems in adulthood, although it is unclear which perinatal problems (low birthweight, preterm birth, low Apgar scores, and small head circumference), or what clusters of problems, are more likely to be associated with later health problems. It is also not known whether perinatal problems (singly or together) are associated with co-morbidity between psychological and physical health problems.

Journal of Perinatal Medicine, 2014

Aims: To explore the association between childhood sexual abuse (CSA), physical abuse, as well as other adverse childhood experiences (ACE), and different obstetrical risk factors/behaviors. Methods: In this cohort study, obstetrical risk factors and perinatal outcome in 85 women exposed to CSA were compared to 170 matched unexposed women. CSA, physical abuse, and ACE were explored by face-to-face interviews and by questionnaire. Data on perinatal outcome were extracted from medical charts. Fisher's exact, χ 2-test, and multiple logistic regression were used for statistical analysis. Results: During pregnancy women with CSA experiences were significantly more often smoking (31.7%/9.4%; P < 0.0001), had partners abusing drugs (10.6%/1.2%; P < 0.0005), experienced physical (16.5%/0; P < 0.0001), sexual (12.9%/0; P < 0.0001), and emotional abuse (44.7%/1.7%; P < 0.0001), reported depression (24.7%/1.8%; P < 0.0001), and suicidal ideation (10.6%/0; P < 0.0001) than women without CSA experiences. Differences in risk factors were more often correlated with physical than with sexual abuse during childhood. The probability for premature delivery was associated with CSA, physical abuse and ACE as well as with several of the risk factors investigated. Conclusion: Women with CSA, physical, and ACE present with a variety of abuse-associated obstetrical risk factors and an increased risk for premature delivery. Therefore, all types of abusive and other ACE should be considered in prenatal care.

American journal of hypertension, 2009

Mood and anxiety disorders are common, debilitating psychiatric illnesses that disproportionally affect women of childbearing age. Relatively few studies have evaluated the extent to which, if at all, maternal mood and anxiety disorders are risk factors for preeclampsia, and results from available studies are inconsistent. We examined the risk of preeclampsia in relation to maternal medical history of mood and anxiety disorders. We used data from a cohort study of 2,601 pregnant women. Maternal pregestational and early pregnancy (before completion of 20 weeks gestation) psychiatric diagnoses were ascertained from medical records. Generalized linear regression procedures were used to derive relative risk (RR) estimates and 95% confidence intervals (CIs). A positive history of maternal mood or anxiety disorder was associated with a 2.12-fold increased risk of preeclampsia after adjustment for age, race/ethnicity, and pre-pregnancy body mass index (95% CI 1.02-4.45). The risk of preecl...

Hormones and Behavior

American Psychologist, 2021

The Adverse Childhood Experiences (ACEs) study (Felitti et al., 1998) has led to an understanding of how exposure to abuse, neglect, and family dysfunction in childhood are related to subsequent physical and mental health problems. These issues are important to consider during the perinatal period, with studies indicating that pregnant women who report adverse experiences in childhood may be at risk of experiencing mental health and substance use problems. This study examined the association of pregnant women's ACEs with symptoms of depression, anxiety, posttraumatic stress, and substance use, and examined the potential buffering effect of women's resilience against the deleterious effects of ACES on mental health and substance use. Women reported on ACES, mental health symptoms, substance use, and resilience when they were screened for participation in a perinatal psychosocial support intervention, which was integrated into obstetrical clinics in a Southern academic medical center. Almost a quarter of the 303 women in this sample reported four or more ACEs, indicating significant risk. Those reporting more overall ACEs also reported more symptoms of depression, posttraumatic stress, and increased risk of tobacco use. Unique effects of specific ACEs subtypes were also found. Women exposed to child maltreatment reported more anxiety, depression, and posttraumatic stress symptoms, and were at risk for tobacco, cannabis, or opioid use during pregnancy. Women exposed to household dysfunction reported more posttraumatic stress symptoms and were at increased risk of tobacco and alcohol use during pregnancy. Women's resilience attenuated effects of household dysfunction on posttraumatic stress symptoms. Public Significance Statement This study demonstrates the importance of including adverse childhood experiences in evaluating and treating mental health symptoms and substance use during pregnancy.

Women's Health Reports

Background: Although there is scientific literature supporting an association between depression and preeclampsia (PE), little is known about the underlying mechanistic pathways that may explain these observed associations. Thus, this study aimed to outline the relationship between depression and PE, and to highlight the underlying cardiovascular and metabolic risk factors that are common to both. Methods: A scoping review of the literature was conducted in Medline, Scopus, and Web of Science. Results: From 706 articles initially identified, 23 articles met the inclusion criteria and were included in this review. Although some studies reported a positive association between PE and postpartum depressive symptoms, challenges comparing different methodologies, measurement instruments and when measurements were administered, and patient populations do not permit a decisive conclusion. In addition, very few studies addressed potential underlying mechanisms that may be contributing to observed associations; thus, a secondary search was conducted to identify cardiovascular and metabolic risk factors that are common to both depression and PE. Conclusion: The cardiovascular and metabolic risk factors (i.e., increased inflammation and oxidative stress and decreased vascular and endothelial function) common to both depression and PE suggest that these factors may contribute as underlying mechanisms in both conditions. These similarities underscore the importance to better understand these mechanisms so preventative and therapeutic strategies could be developed to improve maternal health.

The Egyptian Journal of Hospital Medicine, 2017

Handling depression is one of the greatest challenges facing pregnant women across the globe. The level of antenatal depression and anxiety has a prevalence rate of above five percent but less than twelve. Escalated depression has been associated with increasing maternal and infant mortality because of the development of secondary disorders such as preeclampsia and other obstetric-related conditions. The objective of this review was to determine the relationship that exists between depression and anxiety and preeclampsia in early pregnancy. The present paper draws conclusions on the etiology and potential predisposing factors of preeclampsia based on the studies consulted which ascertained the existence of a correlation between antenatal anxiety and depression and preeclampsia which should serve as the baseline for the assessment of the pathogenesis and future direction, the existing literature has

2012

We evaluated the relationship between antenatal depressive symptoms and preterm birth. STUDY DESIGN: Patients completed the Edinburgh Postnatal Depression Scale between 24-28 weeks of gestation. A score Ն12 (or thoughts of self-harm) indicated an at-risk woman. Symptomatic women were compared to risk-negative patients for relevant demography, historical variables, and pregnancy outcome.

The Journal of Maternal-Fetal & Neonatal Medicine, 2015

To examine whether a pre-gestational diagnosis of depression is a risk factor for adverse obstetric and neonatal outcome.

JAMA network open, 2022

IMPORTANCE Maternal preeclampsia has been reported to increase the risk of autism spectrum disorder, attention-deficit/hyperactivity disorder (ADHD), and intellectual disability in offspring. However, the association between maternal preeclampsia combined with perinatal complications and neurodevelopmental and psychiatric disorders in offspring is less well documented. OBJECTIVE To examine the association of maternal preeclampsia, separately and together with perinatal complications, with neurodevelopmental and psychiatric disorders in offspring.

Journal of Child Psychology and Psychiatry, 2008

Background: Postpartum depression (PPD) is considered a major public health problem that conveys risk to mothers and offspring. Yet PPD typically occurs in the context of a lifelong episodic illness, and its putative effects might derive from the child's exposure to other episodes, in pregnancy or later childhood. The aim of the study is to test two hypotheses: (1) that the effects of PPD on adolescent outcomes are partly explained by antepartum depression (APD) and (2) that the effects of APD and PPD are both explained by later exposure to the mother's depression. Method: A random sample of 178 antenatal patients was drawn from two general medical practices in South London; 171 gave birth to live infants, and 150 (88%) were assessed at 3 months post partum, with 121 of their offspring (81%) assessed for emotional disorders (ED), disruptive behaviour disorders (DBD) and IQ, at 11 and 16 years of age. Results: When APD and subsequent episodes of depression were taken into account, PPD had a significant effect on adolescent IQ, especially for boys, but did not predict psychopathology. ED and DBD in adolescence were predicted by the extent of exposure to maternal depression after 3 months post partum; a significant effect of APD on ED in girls was accounted for by later exposure to the mother's illness. Mothers' symptoms of anxiety, smoking and alcohol use in pregnancy did not predict adolescent outcomes, once maternal depression was taken into account. Conclusions: Some effects attributed to mothers' mental health problems in pregnancy or post partum may be mediated by cumulative exposure to maternal illness, probably reflecting genetic influence and gene-environment correlation. However, PPD has a direct effect on cognition. Clinicians should endeavour to identify women with depression in pregnancy (31% of this sample) and help them to manage their lifelong illness.

Journal of Psychiatric Research, 2012