Abstract
BackgroundIt has been proposed that adverse childhood experiences (ACEs) can put women at risk for mental illness in the pregnancy and postpartum periods. While some studies have found strong support for this proposition, others have found weak or no support. This study is a meta-analysis of the association between ACEs and maternal mental health to resolve between-study discrepancies, and to examine potential moderators of associations.MethodsThree electronic databases (i.e., MEDLINE, Embase, and PsycINFO) were searched up to November 2018 by a health sciences librarian. A hand search was conducted in January 2020 and relevant studies were added. Included studies reported on associations between ACEs and maternal depression and/or anxiety in the perinatal period (pregnancy to 1-year postpartum). Pregnancy and postpartum outcomes were examined separately for both depression and anxiety. Random-effect meta-analyses were conducted. Moderator analyses were conducted using meta-regression. Study quality was evaluated using a 15-point scale.ResultsThe initial search yielded 4646 non-duplicate records and full text review occurred for 196 articles. A total of 15 studies (N = 7788) were included in the meta-analyses, of which 2 were also described narratively. Publication year ranged from 1998 to 2019. Mothers were approximately 28.93 years of age when they retrospectively reported on their ACEs. All studies had maternal self-report questionnaires for the mental health outcomes. Study quality ranged from 7 to 12. The pooled effect sizes between ACEs and prenatal (N = 12; r = .19; 95% CI= .13, .24) and postpartum (N = 7; r = .23; 95% CI = .06 to .39) depressive symptoms were significant. The pooled effect size between ACEs and prenatal anxiety was also significant (N = 5; r = .14; 95% CI= .07, .21). Moderator analyses indicated that timing of depressive and anxiety symptoms may be important for understanding associations.ConclusionsACEs confer risk to maternal mental health, albeit effect sizes are small to moderate in magnitude. Trauma-informed approaches, as well as increased mental health support during and after pregnancy, may help to offset the relative risk of ACEs on maternal mental health.
Highlights
It has been proposed that adverse childhood experiences (ACEs) can put women at risk for mental illness in the pregnancy and postpartum periods
A recent prevalence study in the UK found that anxiety and depression are the most common maternal mental illnesses and that 53% of children are at risk of being exposed to maternal mental illness prior to age 16 years [10]
Perinatal depression and perinatal anxiety referred to measurements of anxiety and depression that occurred in both pregnancy and the postpartum period
Summary
It has been proposed that adverse childhood experiences (ACEs) can put women at risk for mental illness in the pregnancy and postpartum periods. It is well established that maternal mental health difficulties are common. 20–30% of women in low- and middle-income countries and 10% of women in high-income countries have a mental illness, such as anxiety or depression, during pregnancy or in the postpartum period [1, 2]. A recent prevalence study in the UK found that anxiety and depression are the most common maternal mental illnesses and that 53% of children are at risk of being exposed to maternal mental illness prior to age 16 years [10]. Understanding and mitigating the precursors to maternal mental illness in pregnancy and after childbirth are critical for reducing this large-scale public health burden
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