Abstract
Introduction
Stress exposure during a woman’s own childhood and adulthood likely elevate risk of prenatal depression (PND). However, most PND screening tools fail to assess for events prior to conception. This study examined the differential effects of adverse childhood experiences (ACE) and adult life stressors on PND.
Methods
This cross-sectional study was conducted among 199 racially diverse pregnant women, ages 18 to 43, recruited from clinics and ongoing university-based studies between 2012 and 2018. The ACE Scale assessed maternal childhood trauma exposure. Validated scales examining subjective stressors assessed for chronic adult stressors. PND was assessed with the Edinburgh Depression Scale, with the Rini Pregnancy-Related Anxiety Scale as a covariate. Associations were measured using multivariable linear regression modeling. Results were stratified by self-identified Black or white race.
Results
Among 199 participants, mean age was 26.8 years and 67.8% were Black. Controlling for age, race, education, and prenatal anxiety, all participants reporting both childhood trauma and adult stressors were at increased risk for PND (p < 0.0001). PND risk was increased among Black women with childhood stressors (p < 0.01) or three or more adult stressors (p < 0.0001) and among White women following any number of adult stressors (p < 0.001).
Discussion
These findings highlight the importance of cumulative exposure to stress and trauma across the life span as indicators of risk for PND. Black and white participants had differential development of risk, depending on timing and number of exposures. Prenatal depression risk screening during routine prenatal care should include an assessment of current and historical trauma and stressors.
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Data Availability
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Acknowledgements
The authors would like to acknowledge key staff members, Kyle Esteves, Christopher Jones, and Marni Jacobs, for their dedication to the study implementation. We would also like to thank all of the families who volunteered for their selfless contributions to the Infant Development Study.
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This research was supported by the National Institutes of Health (NIH) R01MH101533.
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Dr. KT and Dr. SD conceptualized, designed, and provided oversight for the study and analyses. Material preparation, data collection, and data anlysis was performed by CJ. The draft preparation, review, and editing was led by Dr. MGE with contributions from all authors. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
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Evans, M.G., Theall, K.P., Jackson, C. et al. Racial Differences in the Risk of Prenatal Depression Among Women Experiencing Childhood and Adult Stressors. Matern Child Health J 26, 614–622 (2022). https://doi.org/10.1007/s10995-021-03322-0
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DOI: https://doi.org/10.1007/s10995-021-03322-0