Adverse Childhood Experiences and Changing Levels of Psychosocial Distress Scores Across Pregnancy in Kenyan Women.

Pauline Samia,Ilona S Yim,Geoffrey Omuse,Sikolia Wanyonyi,Shahirose Premji,Ntonghanwah Forcheh,Mohamoud Merali,Nicole Letourneau,Might Consortium Might Consortium ,Farideh Tavangar,Aliyah Dosani,Wangira Musana

doi:10.3390/ijerph17103401

Abstract

Background: Adverse childhood experiences (ACEs) have been associated with deleterious effects on mental health in pregnancy. Methods: The ACE International Questionnaire (ACE-IQ) was used to measure neglect, abuse, and household dysfunction. Longitudinal mixed effect modelling was used to test the effect of ACEs on pregnancy-related anxiety, depressive symptoms, and perceived stress at two time points (12–19 and 22–29 weeks) during pregnancy. Results: A total of 215 women who were predominantly married (81%) and had attained tertiary education (96%) were enrolled. Total ACEs were significantly associated with depressive symptoms (r = 0.23, p < 0.05) and perceived stress (r = 0.18, p < 0.05). As depressive symptoms decreased, t (167) = −8.44, p < 0.001, perceived stress increased, t (167) = 4.60, p < 0.001, and pregnancy-related anxiety remained unchanged as pregnancy progressed. Contact sexual abuse (p < 0.01) and parental death or divorce (p = 0.01) were significantly associated with depression over time (p < 0.01). Total ACEs in this study were associated with depressive symptoms early but not late in pregnancy. Conclusions: Higher total ACEs were positively associated with depressive symptoms and perceived stress during pregnancy, suggesting that mental disorders may have an impact on pregnancy outcomes and ought to be addressed. Further validation of the Edinburgh Postnatal Depression Scale (EPDS) tool in local settings is required.

Highlights

Adverse childhood experiences (ACEs) have been associated with deleterious effects on mental health in pregnancy
A significant interaction effect between ACE International Questionnaire (ACE-IQ) and time was interpreted as evidence that the effect of ACE-IQ on the psychosocial distress changed during pregnancy
Previous research suggests that there is a window of vulnerability around 25 weeks’ gestational age (GA) in which pregnancy-related physiological changes in maternal stress hormones are predictive of maternal post-partum depressive symptoms [40,41], and that these changes can be modulated by social support [40]

Summary

Introduction

Adverse childhood experiences (ACEs) have been associated with deleterious effects on mental health in pregnancy. Longitudinal mixed effect modelling was used to test the effect of ACEs on pregnancy-related anxiety, depressive symptoms, and perceived stress at two time points (12–19 and 22–29 weeks) during pregnancy. Total ACEs were significantly associated with depressive symptoms (r = 0.23, p < 0.05) and perceived stress (r = 0.18, p < 0.05). Conclusions: Higher total ACEs were positively associated with depressive symptoms and perceived stress during pregnancy, suggesting that mental disorders may have an impact on pregnancy outcomes and ought to be addressed. Anxiety, and stress are linked to poor health outcomes in offspring [15], understanding how ACEs impact mothers’ mental health in pregnancy is an important goal with implications for understanding the risk to both mother and child.

Methods

Discussion

Conclusion