Abstract
Adverse childhood experiences (ACEs) have been found to be associated with various health conditions; however, there is dearth of evidence on the relationship between ACEs and prenatal depression. This study was conducted to determine the association between overall ACE score and prenatal depression symptoms, assess the moderating effect of social support and partner support on this relationship, and determine the association between individual ACE scores and prenatal depression. A secondary analysis was conducted of data from an RCT that assessed the feasibility of e-screening for maternal mental health among 636 pregnant women recruited from antenatal clinics. Two logistic regression models were built to reach our objectives. Over 80% of the participants were older than 25 years and had education beyond high school. Eighteen percent of the women had an ACE score of four or more. Univariable analysis found a 2.5-fold increase in the odds of prenatal depression for women with an ACEs score of ≥ 4. When examining the overall ACE score, lack of social support during pregnancy [AOR = 4.16; 95%CI (2.10–10.35)] and partner’s relationship [AOR = 2.23; 95%CI (1.12–4.44)] were associated with prenatal depression while among the individual ACE scores, living with a person who went to prison was found to be associated with prenatal depression even when controlled for all variables. No moderating effect was found. These findings suggest for the improvement of partner’s relationship and provision of social support before women conceive, in order to mitigate the effect of these adversities.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Ahmed A, Feng C, Bowen A, Muhajarine N (2018) Latent trajectory groups of perinatal depressive and anxiety symptoms from pregnancy to early postpartum and their antenatal risk factors. Arch Womens Ment Health 21:689–698. https://doi.org/10.1007/s00737-018-0845-y
Andersson L, Sundström-Poromaa I, Wulff M, Åström M, Bixo M (2006) Depression and anxiety during pregnancy and six months postpartum: a follow-up study. Acta Obstet Gynecol Scand 85:937–944. https://doi.org/10.1080/00016340600697652
Ångerud K, Annerbäck E-M, Tydén T, Boddeti S, Kristiansson P (2018) Adverse childhood experiences and depressive symptomatology among pregnant women. Acta Obstet Gynecol Scand 97:701–708. https://doi.org/10.1111/aogs.13327
Bayrampour H, Tomfohr L, Tough S (2016) Trajectories of perinatal depressive and anxiety symptoms in a community cohort. J Clin Psychiatry 77:e1467–e1473. https://doi.org/10.4088/JCP.15m10176
Bennett HA, Einarson A, Taddio A, Koren G, Einarson TR (2004) Prevalence of depression during pregnancy: systematic review. Obstet Gynecol 103:698–709. https://doi.org/10.1097/01.AOG.0000116689.75396.5f
Bergman K, Sarkar P, O’Connor T, Modi N, Glover V (2007) Maternal stress during pregnancy predicts cognitive ability and fearfulness in infancy. J Am Acad Child Adolesc Psychiatry [WWW Document] http://www.jaacap.com/article/S0890-8567(09)62042-6/pdf. Accessed 12.20.17
Biaggi A, Conroy S, Pawlby S, Pariante CM (2016) Identifying the women at risk of antenatal anxiety and depression: a systematic review. J Affect Disord 191:62–77. https://doi.org/10.1016/j.jad.2015.11.014
Bick J, Nelson CA (2016) Early adverse experiences and the developing brain. Neuropsychopharmacology 41:177–196
Bowen A, Stewart N, Baetz M, Muhajarine N (2009) Antenatal depression in socially high-risk women in Canada |. J Epidemiol Community Health [www document] http://jech.bmj.com/content/63/5/414.long. Accessed 12.21.17
Byatt N, Cox L, Moore Simas TA, Biebel K, Sankaran P, Swartz HA, Weinreb L (2018) Access to pharmacotherapy amongst women with bipolar disorder during pregnancy: a preliminary study. Psychiatric Quarterly 89(1):183–190
Buist A, Ellwood D, Brooks J, Milgrom J, Hayes BA, Sved-Williams A, Barnett B, Karatas J, Bilszta J (2007) National program for depression associated with childbirth: the Australian experience. Best Pract Res Clin Obstet Gynaecol 21:193–206. https://doi.org/10.1016/j.bpobgyn.2006.11.003
Chan CY, Lee AM, Lam SK, Lee CP, Leung KY, Koh YW, Tang CSK (2013) Antenatal anxiety in the first trimester: risk factors and effects on anxiety and depression in the third trimester and 6-week postpartum. Open J Psychiatry 03:301–310. https://doi.org/10.4236/ojpsych.2013.33030
Chapman DP, Whitfield CL, Felitti VJ, Dube SR, Edwards VJ, Anda RF (2004) Adverse childhood experiences and the risk of depressive disorders in adulthood. J Affect Disord 82:217–225. https://doi.org/10.1016/j.jad.2003.12.013
Cheong EV, Sinnott C, Dahly D, Kearney PM (2017) Adverse childhood experiences (ACEs) and later-life depression: perceived social support as a potential protective factor. BMJ Open 7:e013228. https://doi.org/10.1136/bmjopen-2016-013228
Choi KW, Houts R, Arseneault L, Pariante C, Sikkema KJ, Moffitt TE (2018) Maternal depression in the intergenerational transmission of childhood maltreatment and its sequelae: testing postpartum effects in a longitudinal birth cohort. Dev Psychopathol:1–14. https://doi.org/10.1017/S0954579418000032
Colemen VH, Carter MM, Morgan MA, Schulkin J (2008) Obstetrician-gynecologists' screening patterns for anxiety during pregnancy. Depression and Anxiety 25(2):114–123
Cookson H, Granell R, Joinson C, Ben-Shlomo Y, Henderson AJ (2009) Mothers’ anxiety during pregnancy is associated with asthma in their children. J Allergy Clin Immunol 123:847–853.e11. https://doi.org/10.1016/j.jaci.2009.01.042
Cox JL, Holden J, Sagovsky R (1987) Detection of postnatal depression 5.
Dayan J, Creveuil C, Dreyfus M, Herlicoviez M, Baleyte J-M, O’Keane V (2010) Developmental model of depression applied to prenatal depression: role of present and past life events, past emotional disorders and pregnancy stress. PLoS One 5. https://doi.org/10.1371/journal.pone.0012942
De Brito SA, Viding E, Sebastian CL, Kelly PA, Mechelli A, Maris H, McCrory EJ (2013) Reduced orbitofrontal and temporal grey matter in a community sample of maltreated children: reduced in maltreated children grey matter. J Child Psychol Psychiatry 54:105–112. https://doi.org/10.1111/j.1469-7610.2012.02597.x
Dong M, Giles WH, Felitti VJ, Dube SR, Williams JE, CHapman DP, Anda RF (2004) Insights into causal pathways for ischemic heart disease: adverse childhood experiences study. Circulation 110:1761–1766. https://doi.org/10.1161/01.CIR.0000143074.54995.7F
Dunkel Schetter C, Tanner L (2012) Anxiety, depression and stress in pregnancy: implications for mothers, children, research, and practice. Curr Opin Psychiatry 25:141–148. https://doi.org/10.1097/YCO.0b013e3283503680
Essex MJ, Thomas Boyce W, Hertzman C, Lam LL, Armstrong JM, Neumann SMA, Kobor MS (2013) Epigenetic vestiges of early developmental adversity: childhood stress exposure and DNA methylation in adolescence: epigenetic vestiges of early adversity. Child Dev 84:58–75. https://doi.org/10.1111/j.1467-8624.2011.01641.x
Faisal-Cury A, Menezes PR (2007) Prevalence of anxiety and depression during pregnancy in a private setting sample. Arch Womens Ment Health 10:25–32. https://doi.org/10.1007/s00737-006-0164-6
Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS (1998) Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. Am J Prev Med 14:245–258. https://doi.org/10.1016/S0749-3797(98)00017-8
Field T, Diego M, Hernandez-Reif M (2006) Prenatal depression effects on the fetus and newborn: a review. Infant Behav Dev 29:445–455. https://doi.org/10.1016/j.infbeh.2006.03.003
Finkelhor D (2018) Screening for adverse childhood experiences (ACEs): cautions and suggestions. Child Abuse Negl 85:174–179. https://doi.org/10.1016/j.chiabu.2017.07.016
Gaynes BN, Gavin N, Meltzer-Brody S, Lohr KN, Swinson T, Gartlehner G, Brody S, Miller WC (2005) Perinatal depression: prevalence, screening accuracy, and screening outcomes. Agency for Healthcare Research and Quality (US), Rockville
Glover V, Barlow J (2014) Psychological adversity in pregnancy: what works to improve outcomes? J Child Serv 9:96–108. https://doi.org/10.1108/JCS-01-2014-0003
Gurung RAR, Dunkel-Schetter C, Collins N, Rini C, Hobel CJ (2005) Psychosocial predictors of prenatal anxiety. J Soc Clin Psychol 24:497–519. https://doi.org/10.1521/jscp.2005.24.4.497
Hamirani MM, Sultana A, Ibrahim Z, Iqbal H, Sultana S (2006) Frequency of prenatal depression in second and third trimesters of pregnancy in Karachi: a hospital based study. J Liaquat Univ Med Health Sci 5:106–109
Hanson JL, Adluru N, Chung MK, Alexander AL, Davidson RJ, Pollak SD (2013) Early neglect is associated with alterations in white matter integrity and cognitive functioning. Child Dev 84:1566–1578. https://doi.org/10.1111/cdev.12069
Hanson JL, Nacewicz BM, Sutterer MJ, Cayo AA, Schaefer SM, Rudolph KD, Shirtcliff EA, Pollak SD, Davidson RJ (2015) Behavioral problems after early life stress: contributions of the hippocampus and amygdala. Biol Psychiatry 77:314–323. https://doi.org/10.1016/j.biopsych.2014.04.020
Hashemieh C, Neisani Samani L, Taghinejad H (2013) Assessment of anxiety in pregnancy following assisted reproductive technology (ART) and associated infertility factors in women commencing treatment. Iran Red Crescent Med J 15. https://doi.org/10.5812/ircmj.14465
Heaman M, Kingston D, Chalmers B, Sauve R, Lee L, Young D (2013) Risk factors for preterm birth and small-for-gestational-age births among Canadian women: risk factors for PTB and SGA births. Paediatr Perinat Epidemiol 27:54–61. https://doi.org/10.1111/ppe.12016
Hosmer D, Lemeshow S (2000) Applied logistic regression, Wiley Series in Probability and Statistics, 2nd edn. Wiley, New York
Howell KH, Miller-Graff LE, Schaefer LM, Scrafford KE (2017) Relational resilience as a potential mediator between adverse childhood experiences and prenatal depression. J Health Psychol. https://doi.org/10.1177/1359105317723450
Hughes K, Bellis MA, Hardcastle KA, Sethi D, Butchart A, Mikton C, Jones L, Dunne MP (2017) The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. Lancet Public Health 2:e356–e366. https://doi.org/10.1016/S2468-2667(17)30118-4
Huot RL, Brennan PA, Stowe ZN, Plotsky PM, Walker EF (2004) Negative affect in offspring of depressed mothers is predicted by infant cortisol levels at 6 months and maternal depression during pregnancy, but not postpartum. Ann N Y Acad Sci 1032:234–236. https://doi.org/10.1196/annals.1314.028
Husain N, Rahman A, Husain M, Khan SM, Vyas A, Tomenson B, Cruickshank KJ (2014) Detecting depression in pregnancy: validation of EPDS in British Pakistani mothers. J Immigr Minor Health 16:1085–1092. https://doi.org/10.1007/s10903-014-9981-2
IBM SPSS Software/IBM Analytics (n.d.) [www document] https://www.ibm.com/analytics/data-science/predictive-analytics/spss-statistical-software. Accessed 5.12.18
Jaffee SR (2017) Child maltreatment and risk for psychopathology in childhood and adulthood. Annual Review of Clinical Psychology 13(1):525-551
Jha S, Salve HR, Goswami K, Sagar R, Kant S (2018) Burden of common mental disorders among pregnant women: a systematic review. Asian J Psychiatr 36:46–53. https://doi.org/10.1016/j.ajp.2018.06.020
Kingston D, Heaman M, Fell D, Dzakpasu S, Chalmers B (2012) Factors associated with perceived stress and stressful life events in pregnant women: findings from the Canadian maternity experiences survey. Matern Child Health J 16:158–168. https://doi.org/10.1007/s10995-010-0732-2
Kingston D, McDonald S, Biringer A, Austin M-P, Hegadoren K, McDonald S, Giallo R, Ohinmaa A, Lasiuk G, MacQueen G, Sword W, Lane-Smith M, van Zanten S (2014) Comparing the feasibility, acceptability, clinical-, and cost-effectiveness of mental health e-screening to paper-based screening on the detection of depression, anxiety, and psychosocial risk in pregnant women: a study protocol of a randomized, parallel-group, superiority trial. Trials 15(3). https://doi.org/10.1186/1745-6215-15-3
Kingston D, Biringer A, Veldhuyzen van Zanten S, Giallo R, McDonald S, MacQueen G, Vermeyden L, Austin M-P (2017) Pregnant women’s perceptions of the risks and benefits of disclosure during web-based mental health e-screening versus paper-based screening: randomized controlled trial. JMIR Ment Health 4:e42. https://doi.org/10.2196/mental.6888
Matijasevich A, Munhoz TN, Tavares BF, Barbosa APPN, da Silva DM, Abitante MS, Dall’Agnol TA, Santos IS (2014) Validation of the Edinburgh postnatal depression scale (EPDS) for screening of major depressive episode among adults from the general population. BMC Psychiatry 14. https://doi.org/10.1186/s12888-014-0284-x
Matthey S, Henshaw C, Elliott S, Barnett B (2006) Variability in use of cut-off scores and formats on the Edinburgh postnatal depression scale – implications for clinical and research practice. Arch Womens Ment Health 9:309–315. https://doi.org/10.1007/s00737-006-0152-x
McDonald S, Kingston D, Bayrampour H, Tough S (2015) Adverse childhood experiences in Alberta, Canada: a population based study. Med Res Arch 3:1-18.
Miller L, Shade M, Vasireddy V (2009) Beyond screening: assessment of perinatal depression in a perinatal care setting. Arch Womens Ment. Health 12:329–334. https://doi.org/10.1007/s00737-009-0082-5
Muzik M, Borovska S (2010) Perinatal depression: implications for child mental health. Ment Health Fam Med 7:239
Nasreen HE, Kabir ZN, Forsell Y, Edhborg M (2011) Prevalence and associated factors of depressive and anxiety symptoms during pregnancy: a population based study in rural Bangladesh. BMC Womens Health 11(22). https://doi.org/10.1186/1472-6874-11-22
O’hara MW, Swain AM (1996) Rates and risk of postpartum depression—a meta-analysis. Int Rev Psychiatry 8:37–54. https://doi.org/10.3109/09540269609037816
Patten SB, Wilkes TCR, Williams JVA, Lavorato DH, el-Guebaly N, Schopflocher D, Wild C, Colman I, Bulloch AGM (2015) Retrospective and prospectively assessed childhood adversity in association with major depression, alcohol consumption and painful conditions. Epidemiol Psychiatr Sci 24:158–165. https://doi.org/10.1017/S2045796014000018
Racine N, Madigan S, Plamondon A, Hetherington E, McDonald S, Tough S (2018) Maternal adverse childhood experiences and antepartum risks: the moderating role of social support. Arch Womens Ment Health 21:663–670. https://doi.org/10.1007/s00737-018-0826-1
Rahman A, Bunn J, Lovel H, Creed F (2007) Association between antenatal depression and low birthweight in a developing country. Acta Psychiatr Scand 115:481–486. https://doi.org/10.1111/j.1600-0447.2006.00950.x
REDCap (n.d.) https://www.project-redcap.org/. Accessed 5.12.18
Reuben A, Moffitt TE, Caspi A, Belsky DW, Harrington H, Schroeder F, Hogan S, Ramrakha S, Poulton R, Danese A (2016) Lest we forget: comparing retrospective and prospective assessments of adverse childhood experiences in the prediction of adult health. J Child Psychol Psychiatry 57:1103–1112. https://doi.org/10.1111/jcpp.12621
Robertson-Blackmore E, Putnam FW, Rubinow DR, Matthieu M, Hunn JE, Putnam KT, Moynihan JA, O’Connor TG (2013) Antecedent trauma exposure and risk of depression in the perinatal period. J Clin Psychiatry 74:942–948. https://doi.org/10.4088/JCP.13m08364
Rubertsson C, Börjesson K, Berglund A, Josefsson A, Sydsjö G (2011) The Swedish validation of Edinburgh postnatal depression scale (EPDS) during pregnancy. Nord J Psychiatry 65:414–418. https://doi.org/10.3109/08039488.2011.590606
Sanchez SE, Puente GC, Atencio G, Qiu C, Yanez D, Gelaye B, Williams MA (2013) Risk of spontaneous preterm birth in relation to maternal depressive, anxiety and stress symptoms. J Reprod Med 58:25–33
Scott KM, McLaughlin KA, Smith DAR, Ellis PM (2012) Childhood maltreatment and DSM-IV adult mental disorders: comparison of prospective and retrospective findings. Br J Psychiatry 200:469–475. https://doi.org/10.1192/bjp.bp.111.103267
Shah S, Bowen A, Afridi I, Nowshad G, Muhajarine N (2011) Prevalence of antenatal depression: comparison between Pakistani and Canadian women [www document]. http://jpma.org.pk/full_article_text.php?article_id=2641. Accessed 12.20.17
Sheehan DV (1998) The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 12
Soares ALG, Howe LD, Matijasevich A, Wehrmeister FC, Menezes AMB, Gonçalves H (2016) Adverse childhood experiences: prevalence and related factors in adolescents of a Brazilian birth cohort. Child Abuse Negl 51:21–30. https://doi.org/10.1016/j.chiabu.2015.11.017
Tupler LA, De Bellis MD (2006) Segmented hippocampal volume in children and adolescents with posttraumatic stress disorder. Biol Psychiatry 59:523–529. https://doi.org/10.1016/j.biopsych.2005.08.007
Using the ACE Questionniare in Practice » Alberta Family Wellness Initiative [WWW Document] (2014) Alberta Family Wellness. https://www.albertafamilywellness.org/what-we-know/aces. Accessed 11 Feb 2019
Weder N, Zhang H, Jensen K, Yang BZ, Simen A, Jackowski A, Lipschitz D, Douglas-Palumberi H, Ge M, Perepletchikova F, O’Loughlin K, Hudziak JJ, Gelernter J, Kaufman J (2014) Child abuse, depression, and methylation in genes involved with stress, neural plasticity, and brain circuitry. J Am Acad Child Adolesc Psychiatry 53:417–424.e5. https://doi.org/10.1016/j.jaac.2013.12.025
Westdahl C, Milan S, Magriples U, Kershaw TS, Rising SS, Ickovics JR (2007) Social support and social conflict as predictors of prenatal depression. Obstet Gynecol 110:134–140. https://doi.org/10.1097/01.AOG.0000265352.61822.1b
Wolbers M, Heemskerk D, Chau TTH, Yen NTB, Caws M, Farrar J, Day J (2011) Sample size requirements for separating out the effects of combination treatments: randomised controlled trials of combination therapy vs. standard treatment compared to factorial designs for patients with tuberculous meningitis. Trials 12. https://doi.org/10.1186/1745-6215-12-26
Young-Wolff KC, Alabaster A, McCaw B, Stoller N, Watson C, Sterling S, Ridout KK, Flanagan T (2018) Adverse childhood experiences and mental and behavioral health conditions during pregnancy: the role of resilience. J Women’s Health. https://doi.org/10.1089/jwh.2018.7108
Acknowledgments
E-screening was funded by CIHR Canadian Institutes of Health Research. Dr. Dawn Kingston (PI: e-screening project) holds a CIHR new investigator award. The funder had no role in the study design, data collection and/or analyses, interpretation of data, writing of the manuscript, nor in decisions regarding submission for publication.
We are grateful to all the women who took part in this research. We are also thankful to the research team and staff.
Funding
This study was funded by CIHR Canadian Institutes of Health Research.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Dawn Kingston is a Senior author.
Rights and permissions
About this article
Cite this article
Wajid, A., van Zanten, S.V., Mughal, M.K. et al. Adversity in childhood and depression in pregnancy. Arch Womens Ment Health 23, 169–180 (2020). https://doi.org/10.1007/s00737-019-00966-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00737-019-00966-4