Adverse childhood experiences and prenatal depression in the maternal and development risks from environmental and social stressors pregnancy cohort

The aim of this study was to examine the association between adverse childhood experiences (ACEs) and risk for depression among 480 predominantly low-income Hispanic/Latina women in the Maternal and Development Risks from Environmental and Social Stressors pregnancy cohort. Models were fitted to evaluate associations between ACEs and prenatal probable depression measured by the Center for Epidemiologic Studies-Depression Scale adjusting for recruitment site, age, income, race/ethnicity, marital status and parity. The ACEs Questionnaire parameterised experiences as counts (0–10), categories (0, 1–3 and 4+ ACEs) and domains. Participants had a significantly higher likelihood of prenatal probable depression per unit increase in ACEs count or if they reported 4+ ACEs relative to 0 ACEs. Higher likelihood of probable depression was also associated with higher counts of each ACEs domains: abuse, neglect and household dysfunction. Findings suggest systematic screening for depressive symptoms in those with a history of childhood adversities may be important in prenatal care practice.Impact Statement<b>What is already known on this subject?</b> Experiencing depression during pregnancy has been associated with later adverse maternal mental and physical health outcomes. Emerging studies indicate that adverse childhood experiences (ACEs) may maintain or increase the predisposition to prenatal depression.<b>What do the results of this study add?</b> Although prenatal depressive symptoms are prevalent among racial/ethnic minority samples including Hispanic/Latinas, research determining whether the association between ACEs and prenatal depression varies by nativity is scarce. Overall, ACEs were common among Maternal and Developmental Risks from Environmental and Social Stressors (MADRES) participants and were associated with a higher likelihood of probable depression during pregnancy. These patterns did not significantly differ among the foreign-born versus U.S.-born Hispanic/Latina women, although the associations were stronger among U.S.-born Hispanic/Latina women.<b>What are the implications of these findings for clinical practice and/or further research?</b> Research should continue to focus on the effects of ACEs in communities that have been historically excluded in perinatal mental health services such as pregnant women from racial and ethnic minority groups. It may be important for clinicians to routinely screen for mental health during pregnancy as an adverse, psychological environment may impact both women and children. These findings suggest a need for improvement in systematic screening for depressive symptoms in those with a history of childhood adversities. <b>What is already known on this subject?</b> Experiencing depression during pregnancy has been associated with later adverse maternal mental and physical health outcomes. Emerging studies indicate that adverse childhood experiences (ACEs) may maintain or increase the predisposition to prenatal depression. <b>What do the results of this study add?</b> Although prenatal depressive symptoms are prevalent among racial/ethnic minority samples including Hispanic/Latinas, research determining whether the association between ACEs and prenatal depression varies by nativity is scarce. Overall, ACEs were common among Maternal and Developmental Risks from Environmental and Social Stressors (MADRES) participants and were associated with a higher likelihood of probable depression during pregnancy. These patterns did not significantly differ among the foreign-born versus U.S.-born Hispanic/Latina women, although the associations were stronger among U.S.-born Hispanic/Latina women. <b>What are the implications of these findings for clinical practice and/or further research?</b> Research should continue to focus on the effects of ACEs in communities that have been historically excluded in perinatal mental health services such as pregnant women from racial and ethnic minority groups. It may be important for clinicians to routinely screen for mental health during pregnancy as an adverse, psychological environment may impact both women and children. These findings suggest a need for improvement in systematic screening for depressive symptoms in those with a history of childhood adversities.

本研究旨在探究环境与社会应激源母婴发育风险（Maternal and Developmental Risks from Environmental and Social Stressors, MADRES）妊娠队列中480名以低收入西班牙裔/拉丁裔女性群体为主体的研究对象，其童年不良经历（Adverse Childhood Experiences, ACEs）与抑郁风险之间的关联。本研究构建回归模型，以评估童年不良经历与采用流调中心抑郁量表（Center for Epidemiologic Studies-Depression Scale）评定的产前疑似抑郁之间的关联，并校正招募地点、年龄、收入、种族/族裔、婚姻状况以及产次等混杂因素。童年不良经历调查问卷将暴露情况量化为计数得分（0~10分）、类别分组（0、1~3、4+个童年不良经历）以及维度得分。研究对象的产前疑似抑郁发生风险随童年不良经历计数得分每增加1个单位均显著升高；相较于0个童年不良经历者，报告有4个及以上童年不良经历者的抑郁风险显著更高。此外，各童年不良经历维度（虐待、忽视与家庭功能失调）的得分越高，研究对象出现疑似抑郁的概率也越高。本研究结果提示，在产前诊疗实践中，对有童年逆境经历的女性系统筛查抑郁症状或具有重要临床意义。

### 影响声明
#### 该领域已有研究基础
妊娠期抑郁与产妇后续不良精神及躯体健康结局存在关联。现有新兴研究表明，童年不良经历（ACEs）可能维持或升高个体罹患产前抑郁的易感性。
#### 本研究新增的研究发现
尽管包括西班牙裔/拉丁裔在内的少数族裔群体中产前抑郁症状普遍存在，但探究童年不良经历与产前抑郁之间的关联是否因出生出生地而异的研究仍较为匮乏。总体而言，环境与社会应激源母婴发育风险（MADRES）队列的研究对象中童年不良经历十分常见，且该经历与妊娠期更高的疑似抑郁风险相关。虽然在美国出生的西班牙裔/拉丁裔女性中二者的关联更强，但外国出生与美国出生的西班牙裔/拉丁裔女性之间，上述关联模式并未出现显著差异。
#### 本研究结果对临床实践及后续研究的启示
未来研究应持续关注童年不良经历在历史上被围产期心理健康服务排除在外的群体中的影响，例如少数种族/族裔的妊娠女性。临床医师在妊娠期常规开展心理健康筛查或具有重要意义，因为不良心理环境可能同时对母婴双方造成影响。本研究结果提示，亟需改进对有童年逆境经历的女性的抑郁症状系统筛查工作。

#### 该领域已有研究基础
妊娠期抑郁与产妇后续不良精神及躯体健康结局存在关联。现有新兴研究表明，童年不良经历（ACEs）可能维持或升高个体罹患产前抑郁的易感性。
#### 本研究新增的研究发现
尽管包括西班牙裔/拉丁裔在内的少数族裔群体中产前抑郁症状普遍存在，但探究童年不良经历与产前抑郁之间的关联是否因出生出生地而异的研究仍较为匮乏。总体而言，环境与社会应激源母婴发育风险（MADRES）队列的研究对象中童年不良经历十分常见，且该经历与妊娠期更高的疑似抑郁风险相关。虽然在美国出生的西班牙裔/拉丁裔女性中二者的关联更强，但外国出生与美国出生的西班牙裔/拉丁裔女性之间，上述关联模式并未出现显著差异。
#### 本研究结果对临床实践及后续研究的启示
未来研究应持续关注童年不良经历在历史上被围产期心理健康服务排除在外的群体中的影响，例如少数种族/族裔的妊娠女性。临床医师在妊娠期常规开展心理健康筛查或具有重要意义，因为不良心理环境可能同时对母婴双方造成影响。本研究结果提示，亟需改进对有童年逆境经历的女性的抑郁症状系统筛查工作。