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. 2024 Jan 12;8(1):e25.
doi: 10.1017/cts.2023.704. eCollection 2024.

A role for adverse childhood experiences and depression in preeclampsia

Monica Myers #  1 , Serena Gumusoglu #  1   2 , Debra Brandt  1 , Amy Stroud  3 , Stephen K Hunter  1 , Julie Vignato  4 , Virginia Nuckols  5 , Gary L Pierce  5   6 , Mark K Santillan  1   2 , Donna A Santillan  1   2
Affiliations

A role for adverse childhood experiences and depression in preeclampsia

Monica Myers et al. J Clin Transl Sci. .

Abstract

Introduction: Adverse childhood experiences (ACEs) are a measure of childhood adversity and are associated with life-long morbidity. The impacts of ACEs on peripartum health including preeclampsia, a common and dangerous hypertensive disorder of pregnancy, remain unclear, however. Therefore, we aimed to determine ACE association with peripartum psychiatric health and prevalence of preeclampsia using a case-control design.

Methods: Clinical data were aggregated and validated using a large, intergenerational knowledgebase developed at our institution. Depression symptoms were measured by standard clinical screeners: the Patient Health Questionnaire-9 (PHQ-9) and the Edinburgh Postnatal Depression Scale (EPDS). ACEs were assessed via survey. Scores were compared between participants with (N = 32) and without (N = 46) prior preeclampsia.

Results: Participants with ACE scores ≥4 had significantly greater odds of preeclampsia than those with scores ≤ 3 (adjusted odds ratio = 6.71, 95% confidence interval:1.13-40.00; p = 0.037). Subsequent speculative analyses revealed that increased odds of preeclampsia may be driven by increased childhood abuse and neglect dimensions of the ACE score. PHQ-9 scores (3.73 vs. 1.86, p = 0.03), EPDS scores (6.38 vs. 3.71, p = 0.01), and the incidence of depression (37.5% vs. 23.9%, p = 0.05) were significantly higher in participants with a history of preeclampsia versus controls.

Conclusions: Childhood sets the stage for life-long health. Our findings suggest that ACEs may be a risk factor for preeclampsia and depression, uniting the developmental origins of psychiatric and obstetric risk.

Keywords: Preeclampsia; adverse childhood experiences; depression; neglect; trauma.

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Conflict of interest statement

None.

Figures

Figure 1.
Figure 1.
Increased adverse childhood experiences (ACEs) are associated with a history of preeclampsia. P value by one-tailed t test (A) and P value by two-sided chi-square (B).
Figure 2.
Figure 2.
Adverse childhood experiences (ACE) scores in participants with and without preeclampsia, subset by ACE category. *P < 0.05 by two-tailed t-test with correction for multiple comparisons via the Bonferroni–Dunn method.
Figure 3.
Figure 3.
Average Patient Health Questionnaire-9 (PHQ-9) and the Edinburgh Postnatal Depression Scale (EPDS) scores are increased in participants with a history of preeclampsia. P values by two-tailed t tests.
Figure 4.
Figure 4.
Adverse childhood experiences (ACEs) are increased with depression, and those with 4 or more ACEs have increased Edinburgh Postnatal Depression Scale (EPDS) and Patient Health Questionnaire-9 (PHQ-9) scores relative to those with 0-3 ACEs. P values by two-tailed t tests.
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