Prenatal Trauma Research Articles

Examining implications of the developmental timing of maternal trauma for prenatal and newborn outcomes

Separate literatures have demonstrated that mothers’ experiences with trauma during childhood or pregnancy are associated with maternal prenatal health risks, adverse childbirth outcomes, and offspring internalizing and externalizing disorders. These literatures largely align with the intergenerational transmission or fetal programming frameworks, respectively. However, few studies have tested the effects of maternal childhood and prenatal trauma simultaneously on mothers’ and infants’ health outcomes, and no studies have examined these effects on newborn neurobehavioral outcomes. Thus, in the present study, we examined how the developmental timing of pregnant women’s traumatic life experiences associated with their physical health and psychopathology (Aim 1) as well as their newborns’ birth and neurodevelopmental outcomes (Aim 2; for pre-registered aims and hypotheses, see https://osf.io/ygnre/?view_only=cbe17d0ac7f24af5a4d3e37e24eebead). One hundred and fifty-two 3rd trimester pregnant women (Mage = 29 years; 17.1% Hispanic/Latina) completed measures of trauma history and psychopathology. Then, 24–48 h after birth, trained clinicians conducted newborn neurobehavioral exams (n = 118 newborns; 52.6% female). Results indicated that lifetime traumatic experiences associated with multiple prenatal maternal health outcomes, including depression, anxiety, emotion dysregulation, and pregnancy complications. Pregnant women’s experiences with childhood trauma, but not adulthood or prenatal trauma, predicted higher neurobehavioral attention scores among female newborns. Our discussion highlights the importance of considering the developmental timing of maternal trauma on perinatal outcomes and contextualizes our findings within the intergenerational transmission and fetal programming literatures. Data AvailabilityData pertaining to R01MH119070 (MPIs Crowell & Conradt) and that support these findings are uploaded to the NIMH repository.

The mental health crisis of expectant women in the UK: effects of the COVID-19 pandemic on prenatal mental health, antenatal attachment and social support

BackgroundPregnancy has been shown to be times in a woman’s life particularly prone to mental health issues, however a substantial percentage of mothers report subclinical perinatal mental health symptoms that go undetected. Experiences of prenatal trauma, such as the COVID-19 pandemic, may exacerbate vulnerability to negative health outcomes for pregnant women and their infants. We aimed to examine the role of: 1) anxiety, depression, and stress related to COVID-19 in predicting the quality of antenatal attachment; 2) perceived social support and COVID-19 appraisal in predicting maternal anxiety and depression.MethodsA sample of 150 UK expectant women were surveyed during the COVID-19 pandemic. Questions included demographics, pregnancy details, and COVID-19 appraisal. Validated measures were used to collect self-reported maternal antenatal attachment (MAAS), symptoms of anxiety (STAI), depression (BDI-II), and stress related to the psychological impact of COVID-19 (IES-r).ResultsWe found that the pandemic has affected UK expectant mothers’ mental health by increasing prevalence of depression (47%), anxiety (60%) and stress related to the psychological impact of COVID-19 (40%). Women for whom COVID-19 had a higher psychological impact were more likely to suffer from depressive (95% HDPI = [0.04, 0.39]) and anxiety symptoms (95% HPDI = [0.40, 0.69]). High depressive symptoms were associated with reduced attachment to the unborn baby (95% HPDI [-0.46, -0.1]). Whilst women who appraised the impact of COVID-19 to be more negative showed higher levels of anxiety (HPDI = [0.15, 0.46]), higher social support acted as a protective factor and was associated with lower anxiety (95% HPDI = [-0.52, -0.21]).ConclusionsThe current findings demonstrate that direct experience of prenatal trauma, such as the one experienced during the COVID-19 pandemic, significantly amplifies mothers’ vulnerability to mental health symptoms and impairs the formation of a positive relationship with their unborn baby. Health services should prioritise interventions strategies aimed at fostering support for pregnant women.

Prenatally traumatized mice reveal hippocampal methylation and expression changes of the stress-related genes Crhr1 and Fkbp5

In our previous study, we found that prenatal trauma exposure leads to an anxiety phenotype in mouse pups, characterized by increased corticosterone levels and increased anxiety-like behavior. In order to understand the mechanisms by which aversive in utero experience leads to these long-lasting behavioral and neuroendocrine changes, we investigated stress reactivity of prenatally traumatized (PT) mice, as well as the expression and methylation levels of several key regulatory genes of the stress axis in the dorsal hippocampus (dHPC) of the PT embryo and adult mice. We detected increased corticotropin-releasing hormone receptor 1 (Crhr1) and decreased FK506 binding protein 5 (Fkbp5) mRNA levels in the left dHPC of adult PT mice. These alterations were accompanied by a decreased methylation status of the Crhr1 promoter and an increased methylation status of the Fkbp5 promoter, respectively. Interestingly, the changes in Fkbp5 and Crhr1 mRNA levels were not detected in the embryonic dHPC of PT mice. Together, our findings provide evidence that prenatal trauma has a long-term impact on stress axis function and anxiety phenotype associated with altered Crhr1 and Fkbp5 transcripts and promoter methylation.

Neonatal minimal invasive management of a prenatal gunshot trauma: case report

BackgroundPrenatal penetrating gunshot trauma represents a challenging scenario for healthcare providers. Trauma is the leading non-obstetric cause of morbidity and mortality during pregnancy, and even though rare, firearm injuries have the most fatal outcomes and higher fetus mortality rates. Understanding the mechanism of injury in order to identify the possible injuries and adequate management is essential. In this paper, we discuss the case of a newborn with prenatal gunshot trauma, the treatment used, and the outcome of conservative and minimally invasive management.Case presentationWe present the case of a male newborn, 37 weeks of gestational age and weighing 3050 g, delivered through an emergency cesarean section with prenatal gunshot trauma. Two skin wounds were found, one in the arm and another in the left thoracic region. The patient presented with respiratory distress, bilateral pneumothorax, and pneumoperitoneum, requiring high-frequency mechanical ventilation and the placement of bilateral thoracic drains. The pneumoperitoneum was attributed to pulmonary barotrauma, with no suspicion of abdominal hollow viscera lesion. A right thoracoscopy was performed after 24 h of conservative management for the removal of the foreign body. Both the mother and the baby had a positive outcome, with no further treatment needed.ConclusionsFor the improvement in the result of trauma events, an adequate intervention and coordinated efforts from multidisciplinary clinical and surgical teams are required. For gunshot wounds, entry, trajectory, the final position of the bullet, and pathological findings in images need to be analyzed before taking the patient to the operative room. Chosen with strict selection criteria, some patients could benefit from conservative management.

Adopted and permanently placed children in education: from rainbows to reality

Children who leave care into adoption and special guardianship are often considered by schools and local authorities to have found their “happy ending.” Yet there is growing evidence that the impact of prenatal and early trauma, abuse and neglect does not disappear upon placement in a permanent family. Rates of social, emotional and mental health difficulties remain high, and the group has pronounced educational needs. Whilst having high levels of involvement with education and health services, families report significant difficulties in mobilising understanding, support and provision. In the context of growing numbers of children in England finding permanence through adoption and special guardianship, and the Department for Education’s increasing focus on addressing the needs of this group, this paper highlights the key role of Educational Psychology Services in supporting adopted and other permanently placed children by providing training, consultation, assessment, intervention and research for children and their families, their schools, and the local authorities.

‘It’s silly these doors don’t open’: a six-year-old girl emerges from a chronic state of emotional withdrawal

This clinical paper explores the way in which the first two years of a long-term psychotherapy helped six-year-old Anna to lessen her retreat into a chronic withdrawn emotional state. Over the course of the first year she would occasionally pick up the fridge from the doll’s house and try to open the doors, but because the fridge was actually a block of wood the doors could not open. In treatment, this inquiry came to represent the difficulties of engaging and making contact with a baby who found it very hard to feed. The author describes how, as Anna entered into a therapeutic relationship, it slowly became clear that there was an inner world jam-packed with persecutory anxieties and a family history of unmourned loss and trauma. Through fear Anna slammed the doors to her mind – to knowing herself – and by not feeding, Anna starved herself of opportunities for mental growth. It took some time for her to state, “it’s silly these doors don’t open, they should”. In the discussion of this clinical material the author draws on the work of Francis Tustin, Alessandra Piontelli and Marguerite Reid to consider the link between intergenerational and prenatal trauma and subsequent emotional disturbance in the child.

Effects of In utero environment and maternal behavior on neuroendocrine and behavioral alterations in a mouse model of prenatal trauma.

Maternal posttraumatic stress disorder (PTSD) following trauma exposure during pregnancy is associated with an increased risk of affective disorders in children. To investigate the mechanisms by which prenatal trauma and/or maternal PTSD affect brain development and behavior we established a mouse model of prenatal traumatic (PT) experience based on the application of an electric foot shock to C57Bl/6N female mice on the gestational day 12 during their pregnancy. The model is based on a previously validated animal model of PTSD. We found high anxiety levels and poor maternal care along with reduced serum prolactin and increased corticosterone levels in dams following maternal trauma (MT). PT-pups were born smaller and stayed smaller throughout their life. We show increased time and frequency of ultrasonic calls in PT-pups when separated from the mothers on the postnatal day (PND) 9. Cross-fostering experiments reveal lower anxiety levels in PT pups raised by healthy mothers as compared to trauma-naive pups raised by MT-dams. Importantly, the combination of prenatal trauma and being raised by a traumatized mother leads to: (1) the highest corticosterone levels in pups, (2) longest USV-call time and (3) highest anxiety levels in comparison to other experimental groups. Our data indicates a distinct change in maternal care following MT which is possibly associated with trauma-induced decrease in prolactin levels. Furthermore, we show that maternal behavior is crucial for the development of the offspring anxiety and specific aspects in maternal care overwrite to a significant extend the effects of in utero and postnatal environment. © 2016 Wiley Periodicals, Inc. Develop Neurobiol 76: 1254-1265, 2016.

Addiction: the Burden of Cyclothymic Temperament

Disorders of the bipolar spectrum (e.g. cyclothymic disorder) and subthreshold manifestations of mood disorders (such as temperamental traits) have been suggested to influence the course of psychiatric diseases. Cyclothymic temperament (as described by Kraepelin and as measured by Akiskal's temperament scale, the TEMPS) has been suggested to be the most morbid and prodromal element in the pathogenic chain of personal disposition to behavioural and emotional problems. We studied the effects of affective temperaments on psychoactive substance use, on alcohol dependence and opioid dependence. In particular, we wanted to test the hypothesis whether cyclothymic temperament mediates a deleterious effect. 1380 inhabitants of residential student homes in Austria, 116 alcohol dependent patients at the Medical University of Vienna and 101 opioid dependent patients at the Oum El Nour rehabilitation center in Lebanon were investigated. Temperament was assessed using the briefTEMPS-M auto-questionnaire. In opioid dependence, subtypes were assessed according to the LAT interview (www.lat-online.at). In the college student group, cyclothymic (and irritable) temperament serves as predictor of self-reported nicotine dependence, alcohol abuse and cannabis use. In alcohol dependent patients, cyclothymic temperament influenced the age of onset of alcohol abuse and the age of onset of alcohol dependence. In the opioid dependence group, patients exhibiting symptoms of severe negative childhood development according to the LAT interview (e.g. prenatal trauma, cerebral trauma before the age of 14) showed the highest percentage of cyclothymic temperament. Our data show that cyclothymic temperament as measured by the briefTEMPS-M is an important negative pathoplastic factor for substance-related addictive disorders.

Fetus nasal injury after maternal blunt trauma during pregnancy, a case report

Introduction: Neonatal period damages occur due to mechanical forces (compression, stretching) during the birth process are classified as birth trauma. Various maternofetal factors, such as maternal diabetes, breech or other noncephalic presentations and birth weight might have been effective in developing prenatal trauma. Shoulder dystocia, which is common in neonates` of diabetic mothers, usually occurs in term neonates and associated with birth trauma and complications such as brachial plexus palsy. A higher rate of trauma was reported in neonates with birth weight more than 4500 gram. Recently, incidence of birth trauma was decreased, because of better prenatal care. Fetus face trauma might happen due to maternal blunt trauma. Although this type of fetus injuries are rare, they could be life threatening. In this article we report a neonate with nasal trauma.

Nasal septum morphology in human fetuses in computed tomography images

ObjectivesNasal septum deformation (NSD) may cause breathing dysfunction. The reason for a septal deviation is the developmental anomaly in growth of the elastic septum or its skeleton. Such a type of deviation is called physiological. Some deviations can result from the prenatal trauma. The aim of the work was the analysis of the anatomy of the nasal cavity with a special interest focused on the nasal septum and its deviation.Materials and methodsThe nasal cavity with its bones and septum was analyzed in CT images of 105 spontaneously aborted fetuses (57 males and 48 females) aged 12 and 40 weeks of gestation. We attempted to assess the morphometric development of the nasal cavity with tomographic scanning methods and to detect anatomical variations.ResultsIn 15 (14.3%) fetuses, NSD were detected on radiological sections. The angle between the virtual line from the sphenoid sinus ostium through limen nasi and the horizontal plane was 33.6 ± 2.3°, on average.ConclusionsNSD may already be found in fetuses. The observation of the nasal cavity development enables to evaluate the growth and symmetry of the nasal septum and to foretell predispositions for dysfunction in the upper respiratory tract.

Effects of Intimate Partner Violence on Pregnancy Trauma and Placental Abruption

Intimate partner violence (IPV) during pregnancy increases women's risk of pregnancy complications and adverse birth outcomes. The goal of this study was to examine the association between IPV and prenatal trauma and placental abruption during pregnancy. Prenatal and hospital obstetrical charts were reviewed for 2873 women who gave birth between January 2000 and March 2002 in a Northeastern city. We examined associations among sociodemographic characteristics, health-related variables, IPV, and pregnancy trauma and placental abruption using univariate and multivariate logistic regression. Of the 2873 women in the analyses, 105 (3.7%) reported IPV during prenatal care. After controlling for sociodemographic variables; tobacco, alcohol, and drug use; preeclampsia; and gestational diabetes during pregnancy, women who reported IPV also had higher odds of pregnancy trauma and placental abruption (adjusted odds ratio [OR] 32.08, 95% confidence interval [CI] 14.33-71.80, p < 0.01, and OR 5.17, 95% CI 1.37-19.51, p < 0.05, respectively). This study found that IPV is a significant and independent risk factor for pregnancy trauma and placental abruption after controlling for factors typically associated with these outcomes. This study has implications for partner violence screening and intervention policies among pregnant women and highlights the importance of making distinctions about the type of IPV that women experience.

The Influence of Prenatal Trauma, Stress, Social Support, and Years of Residency in the US on Postpartum Maternal Health Status Among Low-Income Latinas

This study examined the associations of prenatal psychosocial factors, including depressive symptoms, post-traumatic stress disorder symptoms, trauma exposure including intimate partner violence, perceived stress, and social support, with perceived postpartum health status. Low-income Latinas (N = 203) were recruited from two health plans within the first 12 weeks of their pregnancies and followed through 3 months after birth. Participants completed semi-structured interviews conducted in English or Spanish within the first 12 weeks of pregnancy, and again at 12 weeks postpartum. Perceived health status was measured by the SF-12. Participants with complete follow-up data (n = 193) were used in data analysis. Women were mostly foreign-born (75%) with low-incomes (59%) and reported postpartum health status in the average range (M = 102.5; SD = 12.2). Overall health status was positively associated with decreased levels of perceived stress (P < .0001), being foreign-born and having resided in the US <10 years (P = .003). Emotional well-being was positively linked with being foreign-born and having resided in the US <10 years (P = .002), increased levels of social support (P = .01), and decreased levels of perceived stress (P < .001). Exposure to non-specific IPV trauma (P = .01) and health problems experienced during pregnancy or delivery (P = .05) were negatively associated with physical health status. Prenatal psychosocial factors and length of residency in the US are differentially predictive of overall postpartum health status and emotional well-being, and have less impact on physical well-being after birth. Health professionals are encouraged to assess these factors in early pregnancy.

Severe subdural hemorrhage due to minimal prenatal trauma

The authors report a case of minimal prenatal trauma producing a large subdural hematoma in the fetus, which was diagnosed in utero by MR imaging. The occurrence of such a complication is extremely rare in the absence of significant maternal trauma. Prenatally diagnosed intracranial hemorrhages, particularly those that are subdural in origin, have a poor prognosis in most cases. After birth, brain compression required a complex neurosurgical intervention because simple hematoma evacuation was not possible. The clinical and neurological outcome at 6 months was excellent, as confirmed by the neuroimaging findings.

Regional Odontodysplasia: Report of a Case in the Mandible Crossing the Midline

This report presents an unusual case of regional odontodysplasia (RO) in the mandible which crosses the midline along with its clinical management. RO is an uncommon, nonhereditary unilateral developmental anomaly involving the dental hard tissues, most frequently affecting the maxillary teeth. RO was diagnosed in a 12-year-old. The dysplastic teeth were the mandibular canines, lateral incisors, central incisors, and the right premolars. The treatment was extraction of the affected teeth followed by provisory prosthetic rehabilitation. The etiology of RO remains obscure. In this case a possible association with pre-natal trauma is suspected. The literature is not unanimous as to the management of RO. Nevertheless, the presence of a dental abscess is an indication for extraction. Since general bone quality is not affected, a provisory prosthesis was fabricated as the patient waits for future implant rehabilitation. The executed treatment met the expectations of the patient and her mother as it improved the patient's masticatory function, esthetics, and quality of life. The general practitioner must be prepared to deal with different situations in the dental office. The diagnosis of RO relies mainly on clinical and radiographic findings, and its treatment depends on the affected teeth, the severity of the dysplasia, the presence of infection, and the patient's age.

Characteristics of the Population of Deaf and Hard of Hearing Students With Emotional Disturbance in Illinois

The study summarizes a database for the years 1994-1999 on deaf and hard of hearing students in Illinois with a diagnosis of emotional disturbance (N = 115). Data are reported on the group's demographic, domestic, etiologic, communication-related, and intervention-related characteristics. These dually diagnosed students differed from Illinois's general population of deaf and hard of hearing students in many ways, including higher incidences of prematurity, prenatal trauma, and perinatal trauma. They were more likely to have had a later onset of hearing loss, to live in single-parent homes, to belong to an ethnic minority, to live in an urban or suburban area, and to qualify for low-income health care. Many had histories of abuse, 50% were regularly medicated, and 15% were assigned to surrogate parents.

Neonatal renovascular hypertension due to prenatal traumatic retroperitoneal hematoma

This report describes severe hypertension in a 7-week-old male infant found to have renovascular disease from an organized hematoma due to prenatal trauma. As such, this case illustrates a novel acquired, congenital mechanism of renovascular hypertension. The importance of considering prenatal as well as postnatal etiologies of acquired renovascular hypertension in neonates is emphasized. Likewise, attention must be drawn to the classic presentation of congestive heart failure in a child with severe hypertension.

Prenatal trauma and autism

Through the clinical history of a little girl, this paper explores some possible traumatic prenatal experiences of children who have autistic features from birth. It establishes a tentative connection between the precocity of the onset of pathology and potentially traumatic prenatal situations such as threats of miscarriage or pathological mental states in the pregnant mother. It is suggested that a psycho-physical retreat from the auditory experience of the mother's voice, which normally stimulates foetal proto-mental activity and may lead to the development of a 'sound-object', might contribute to the later autistic child's isolation and non-mental clinging to tactile sensations.

Prenatal trauma and autism

Through the clinical history of a little girl, this paper explores some possible traumatic prenatal experiences of children who have autistic features from birth. It establishes a tentative connection between the precocity of the onset of pathology and potentially traumatic prenatal situations such as threats of miscarriage or pathological mental states in the pregnant mother. It is suggested that a psycho-physical retreat from the auditory experience of the mother's voice, which normally stimulates foetal proto-mental activity and may lead to the development of a 'sound-object', might contribute to the later autistic child's isolation and non-mental clinging to tactile sensations.

Neonatal Circumcision Reconsidered

This article discusses the present status of neonatal circumcision in the United States and presents clinical findings regarding the long-term somatic, emotional, and psychological consequences of this procedure in adult men. These consequences are seen as typical of complex posttraumatic stress disorder. They emerged during psychotherapy focused on the resolution of prenatal, perinatal, and developmental trauma and shock experiences. Their relationship to phenomena such as trauma, shock, somatic decisions, discounting, and scripting is described.

Dissociation Between Startle and Prepulse Inhibition in Rats Exposed to γ Radiation at Day 15 of Embryogeny

The role of prenatal trauma in disordered sensory gating was explored in albino rats of the Sprague-Dawley strain. Pregnant rats were exposed to 1.5 Gy (0.15 Gy/min) of the whole-body γ radiation on days 15, 17, or 19 of gestation. Controls were sham-exposed during 10 min in the same conditions. Exposed and control offsprings were evaluated for the auditory startle response (ASR) and its gating by either the habituation process or by the preceding weak sensory stimulus in the prepulse inhibition of startle (PPI) procedure. The tests were conducted when the animals reached 27 and 57 days of age. A noticeable hyperresponding and delayed habituation of startle were found in rats exposed at E15, with meager effects in rats exposed at E17 and E19. Maximal deficit was obtained on tests conducted on P57 but not on P27. However, in rats pretreated with amphetamine, dysfunctional startle was unmasked already on the P27 test. By contrast, PPI was insensitive to the damaging effect of prenatal irradiation at either period. This dissociation is reminiscent of one observed in patients with posttraumatic stress disorder (PTSD).