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Childhood trauma may increase depression, anxiety in pregnancy

In a new Kaiser Permanente study of pregnant patients, those with a history of adverse childhood experiences (ACEs) were more likely to develop a new diagnosis of depression or anxiety during pregnancy, as were those with low resilience.

ACEs are potentially traumatic events that occur during childhood and may include abuse, neglect, and parental divorce, substance use, or incarceration. Resilience is the ability to withstand and recover from adversity.

Carey Watson, MD.

The analysis in the journal Obstetrics & Gynecology found the odds of new depression or anxiety were even more pronounced among pregnant people with both ACEs and low resilience.

“These results are much more striking than we expected,“ said lead author Carey Watson, MD, an ob-gyn with Kaiser Permanente in Walnut Creek.

The study looked at 13,852 patients across Northern California who had been screened for both ACEs and resilience during prenatal care between October 2021 and March 2023. Screening questionnaires have routinely been given to prenatal care patients for ACEs and resilience since 2021.

The analysis found 17% of patients had a newly identified depression diagnosis during prenatal care, and 8.9% had newly identified anxiety.

The researchers found that the odds of depression were 3 times higher for patients with 4 or more ACEs, compared with those with no ACEs. Odds of depression were twice as high for those with low resilience versus high resilience.

Kelly Young-Wolff, PhD, MPH
Kelly Young-Wolff, PhD, MPH

When women had both ACEs and low resilience, they were 6.4 times more likely than those with no ACEs and high resilience to have depression.

Results were similar for anxiety.

This is the largest study of its kind, said senior author Kelly Young-Wolff, PhD, MPH, a research scientist with the Kaiser Permanente Division of Research.

“The results are particularly meaningful because these are patients who don’t have depressive or anxiety disorders prior to pregnancy,” Young-Wolff said. “ACEs and low resilience may be key factors in developing these conditions in pregnancy.”

Depression, anxiety in pregnancy are health risk factors 

The study highlights the value of screening.

“Identifying patients who may be at risk could help us intervene early or possibly prevent a mental health disorder for the patient, and thereby prevent or mitigate a potential adverse childhood experience for the newborn or other children in the family,” Dr. Watson said.

Depression and anxiety in pregnancy are risk factors for health issues in pregnancy and after giving birth.

“Perinatal mood disorders are a leading cause of medical problems in pregnancy, and even maternal mortality, so it is important to identify people at risk as early as we can,” Dr. Watson said.

Pregnancy may be a time of increased emotional vulnerability.

“Pregnancy is a really exciting time, but it can also be stressful,” Dr. Watson said. “Problems patients have experienced in the past may have more influence over their mood at this stage of life.”


anxietydepressionmaternal healthmental healthpregnancy

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