School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.
Tulane University School of Medicine, New Orleans, LA, USA.
Matern Child Health J. 2022 Mar;26(3):614-622. doi: 10.1007/s10995-021-03322-0. Epub 2021 Dec 1.
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.
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.
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).
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.
女性在自己的童年和成年期经历压力可能会增加产前抑郁症（PND）的风险。然而，大多数 PND 筛查工具都无法评估受孕前的事件。本研究探讨了不良童年经历（ACE）和成年生活应激源对 PND 的不同影响。
本横断面研究于 2012 年至 2018 年在来自诊所和正在进行的大学研究的 199 名不同种族的孕妇中进行，年龄在 18 至 43 岁之间。ACE 量表评估了母亲的童年创伤暴露情况。经过验证的评估慢性成年应激源的主观应激源量表也用于评估。PND 采用爱丁堡抑郁量表进行评估，Rini 妊娠相关焦虑量表作为协变量。使用多变量线性回归模型测量关联。结果按自我认定的黑人和白人种族进行分层。
在 199 名参与者中，平均年龄为 26.8 岁，67.8%为黑人。控制年龄、种族、教育程度和产前焦虑后，所有报告童年创伤和成年应激源的参与者发生 PND 的风险均增加（p<0.0001）。有童年应激源的黑人女性（p<0.01）或有三个或更多成年应激源的黑人女性（p<0.0001）以及有任何数量成年应激源的白人女性（p<0.001），PND 风险增加。
这些发现强调了一生中累积暴露于压力和创伤作为 PND 风险指标的重要性。黑人和白人参与者的风险发展存在差异，取决于暴露的时间和数量。在常规产前保健期间进行产前抑郁症风险筛查时，应评估当前和历史上的创伤和应激源。
