Adverse childhood experiences (ACEs) may increase preeclampsia and depression risks, according to a recent study published in the Journal of Clinical and Translational Science.
Takeaways
- Adverse Childhood Experiences (ACEs) have long-term implications for health outcomes, including increased risks of conditions such as preeclampsia and depression, indicating a need to understand the connection between early-life adversity and lifelong medical issues.
- The Adverse Childhood Experiences Questionnaire is a tool used to measure abuse, neglect, and household challenges experienced during childhood. Higher ACE scores correlate with elevated risks of various health conditions, underscoring the importance of early intervention and support.
- ACEs are associated with maternal health issues such as preeclampsia and depression during and after pregnancy. Understanding this connection is crucial for developing targeted interventions to support maternal well-being.
- Preeclampsia, a condition affecting 5% to 10% of pregnancies, is linked to mood disorders such as depression, highlighting the interconnectedness of physical and mental health during pregnancy and the postpartum period.
- Research findings reveal a significant association between ACEs and preeclampsia, with higher ACE scores correlating with increased risk. This underscores the importance of identifying and addressing childhood trauma to mitigate health risks in adulthood, particularly during pregnancy.
Early childhood adversity has been linked to life-long health outcomes including metabolics, obstetric disease, and cardiovascular risk. This indicates a necessity to evaluate links between early-life exposure and life-long medical outcomes.
Abuse, neglect, and household challenges can be measured through the self-reported Adverse Childhood Experiences Questionnaire. Associations have been found between ACEs and half of the leading causes of death, and these factors may compound with other stressors such as sexism, racism, and medical comorbidities.
Depression has also been linked to increased ACEs and cardiovascular disease risk. Mental health and cardiovascular disease risk are also heightened during pregnancy.
Preeclampsia, a hypertensive disease observed in 5% to 10% of pregnancies, increases risks of mood disorders, perinatal morbidity, and perinatal mortality. However, there is little data evaluating the association between ACEs and maternal health.
Investigators conducted a study to determine if ACEs and peripartum depression are more common in patients with preeclampsia compared to those without preeclampsia. The Iowa Intergenerational Health Knowledge base, which includes electronic medical records of patient demographics, diagnoses, screenings, vitals, and other medical data, was assessed to design cohorts.
Two cohorts were developed, one including patients diagnosed with preeclampsia during pregnancy and one including patients not diagnosed. ACOG guidelines were used to diagnose preeclampsia during the third trimester.
Participants included patients aged 18 to 46 years who delivered a baby within 9 to 48 months of data extraction and were not pregnant during study inclusion. The ACE was administered between 1 and 2 years postpartum and included 10 items asking participants about specific adverse events they experienced when aged under 18 years.
Domains included abuse with physical, emotional, and sexual, neglect with abuse, physical, and emotional, and household challenges with parental separation, domestic violence, alcohol and drug use, mental illness or suicide, and incarcerated persons in family or home.
Scores ranged from 0 to 10, with higher scores indicating increased adverse experiences. Scores of 4 or greater were considered high and indicated high risks of various health conditions.
Postpartum and antepartum depression were evaluated using the EPDS and Patient Health Questionnaire-9 (PHQ-9), respectively. Three blood pressure readings were also obtained from 1 to 2 years following delivery.
There were 78 participants included in the final analysis, 32 with preeclampsia history and 46 without preeclampsia history. Patients with preeclampsia were more often Hispanic, had a higher body mass index, had chronic conditions such as hypertension and diabetes, and had higher systolic and diastolic blood pressure.
ACE scores were significantly higher in patients with prior preeclampsia than those without preeclampsia, at 1.69 and 1.02, respectively. Additionally, ACE scores of 4 or higher had a greater association with preeclampsia than scores of 3 or lower, at 80% and 35.3%, respectively.
These odds remained when adjusting for covariates, with 4 or more ACEs having an adjusted odds ratio of 6.71 for preeclampsia compared to 3 or less ACEs. Items on the ACE about abuse were more often associated with preeclampsia history, while neglect and household challenge ACEs did not differ between groups.
PHQ-9 scores were also higher among patients with preeclampsia history vs those without preeclampsia history, at 3.73 ± 4.23 and 1.87 ± 1.95, respectively. For EPDS, scores were 6.38 ± 5.51 and 3.71 ± 2.64, respectively.
These results indicated a link between ACEs with preeclampsia and depression. Investigators concluded conserved, modifiable developmental mechanisms must be identified for therapeutic targeting and prevention.
Reference
Myers M, Gumusoglu S, Brandt D, et al. A role for adverse childhood experiences and depression in preeclampsia. J Clin Transl Sci. 2024;8(1). doi:10.1017/cts.2023.704
