Early Childhood Adversity and Pregnancy Outcomes
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ORIGINAL PAPER
Early Childhood Adversity and Pregnancy Outcomes Megan V. Smith1 • Nathan Gotman1 • Kimberly A. Yonkers1
Published online: 14 January 2016 Ó Springer Science+Business Media New York 2016
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. Keywords Maternal mental health Trauma Adverse childhood experiences Pregnancy outcomes Smoking
Significance There is little prospective information available on whether and how traumatic experiences prior to the age of 18 influence pregnancy outcomes. This report provides such
& Megan V. Smith [email protected] 1
Department of Psychiatry, Yale School of Medicine, 142 Temple Street, Suite #301, New Haven, CT 06510, USA
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information on a well-articulated, longitudinal cohort of pregnant women.
Background Adverse childhood experiences that occur prior to the age of 18 have been associated with unfavorable future health outcomes [e.g. chronic obstructive pulmonary disorder, ischemic heart disease, tumor growth, major depressive disorder, post-traumatic stress disorder (PTSD)] [1–5], risky health behaviors (illicit drug abuse, alcohol abuse and early initiation of sexual activity) [6–9] and neurodevelopmental deficits [10]. Typically, adverse child experiences are divided into three classes of events occurring prior to the child’s 18th birthday: (1) abuse, including emotional, physical and sexual; (2) neglect, including emotional and physical and (3) household dysfunction, including interpersonal violence, household substance abuse, household mental illness, parental separation or divorce and incarceration of a household member [11]. Numerous investigators have examined the impact of major life events, including severe trauma experienced in pregnancy and chronic stress, on risk of low birth weight and preterm birth (see recent reviews by Dunkel Schetter) [12, 13]. The preponderance of evidence suggests that major life events and traumatic events that occur during pregnancy predict birth weight and preterm birth, with even more robust effects observed for chronic stressors. However, there is little prospective information available on whether and how traumatic experiences prior to the age of 18 influence pregnancy out
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