Abstract 11891: Adverse Childhood Experiences are Associated With Elevated Blood Pressure and Disturbed Sleep in the First Trimester of Pregnancy in Apparently Healthy, Young Adult Women

Abstract

Introduction: Adverse childhood experiences (ACEs) are potentially traumatic psychosocial stressors that occur in early life, such as abuse, neglect, and household dysfunction. We hypothesize that ACEs are an underlying risk factor for disturbed sleep and hypertension in pregnancy, which is a major cause of maternal-fetal morbidity and mortality. Hypothesis: In young adult women, ACE exposure will be positively associated with first trimester systolic (SBP), diastolic blood pressure (DBP), and wakefulness after sleep onset (WASO), and inversely associated with sleep efficiency (SE). Further, ACE exposure will be associated with greater odds of first trimester elevated or stage 1 hypertension (ES1H). Methods: Data were obtained at 10-12 weeks of gestation from 142 pregnant women who were enrolled in an ongoing, clinical cohort study in Iowa City and Pittsburgh. Participants were 18-45 y of age, had a BMI <40 kg/m 2 , and could not be taking medications or receiving treatment for sleep or cardiometabolic disorders such as chronic hypertension or diabetes. BP was assessed in accordance with AHA recommendations. Actigraphy was used to assess WASO and SE over ≥5 nights. ACE scores were log transformed and correlations were used to examine associations between ACE exposure and SBP, DBP, WASO and SE. Logistic regression was used to examine the association of ACE exposure with the probability of ES1H in an unadjusted model (model 1) and a model adjusted for age, race, ethnicity, BMI, and depressive symptoms (model 2). Results: 56% reported exposure to ≥1 ACE, and 28% reported exposure to ≥3. ACE exposure was positively related to SBP (r = 0.17, p = 0.04), DBP (r = 0.21, p = 0.01), and WASO (ρ = 0.21, p = 0.01), and negatively associated with SE (ρ = -0.22, p = 0.009). ACE exposure was associated with greater odds of first trimester ES1H in model 1 (OR = 2.73, 95% CI = 1.36 - 5.50; p = 0.005) and model 2 (OR = 2.44, 95% CI = 1.07 - 5.56; p = 0.03). Conclusions: ACEs represent an important risk factor for elevated BP and disturbed sleep in pregnancy. Large cohort studies are needed to understand the links among ACE exposure, sleep, resilience factors and hypertensive risk in pregnancy to provide information for developing targeted interventions to improve maternal-fetal cardiovascular health.