Maternal Adverse Childhood Experiences and Perinatal Anxiety, Obsessive Compulsive Disorder, Posttraumatic Stress Disorder, and Substance Use

Abstract

Introduction: Postpartum mental health conditions including depression are a leading cause of maternal morbidity and mortality. Maternal adverse childhood experiences (ACE) have a dose-response predictive relationship to postpartum depression, highlighting mothers' own early relational trauma as an important risk factor for both mother and infant's postpartum course. Currently, far less is understood about whether maternal ACEs create risk for other postpartum mental health conditions that can negatively impact mother and baby.

Objective: This study sought to understand the relationship between maternal ACEs and the risk for development of perinatal anxiety, obsessive compulsive disorder, posttraumatic stress disorder, and substance abuse disorder via narrative review of published literature.

Methods: PubMed, PsycINFO, and Google Scholar databases were searched with terms: adverse childhood experiences or ACEs; perinatal or prenatal or pregnancy or postpartum; and either anxiety, obsessive compulsive disorder, posttraumatic stress disorder, or substance use disorder.

Results: Maternal ACEs increase risk for anxiety and posttraumatic stress disorder in pregnancy and postpartum. No studies were identified for obsessive compulsive disorder. Maternal ACEs increase the risk for substance use in pregnancy but are understudied postpartum despite risk for maternal overdose and mortality.

Conclusions: ACEs - especially those involving child maltreatment - are predictive of a wide range of perinatal mental health concerns, including anxiety, posttraumatic stress disorder, and substance use. Findings of this study support recommendations for inclusion of ACEs screening with perinatal patient populations as a component of trauma-informed care to contextualize and identify mothers who may have increased postpartum mental health risk and support needs.