1
|
Maeda Y, Tabuchi T, Fujiwara T. Association between adverse childhood experiences and pregnancy morbidities: A nationwide online-based cross-sectional study. J Obstet Gynaecol Res 2024. [PMID: 39414244 DOI: 10.1111/jog.16124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 10/02/2024] [Indexed: 10/18/2024]
Abstract
OBJECTIVE To examine the association between adverse childhood experiences (ACEs) and pregnancy morbidities, including preterm birth (PTB), gestational diabetes (GDM), preeclampsia, and small-for-gestational-age (SGA) among the general population in Japan. METHODS The data were from the JACSIS study, an online-based nationwide survey conducted from July to August 2021 in Japan (N = 5444). ACEs included physical, sexual, and psychological abuse, neglect, childhood poverty, bully victimization, domestic violence, parental death, and parental divorce. Pregnancy morbidities, including PTB, GDM, preeclampsia, and SGA were identified through questionnaires. A multivariable logistic regression model was applied. RESULTS Of 5444 women, 2778 (51.0%) had no ACEs, and 374 (6.9%) had four or more ACEs. A dose-response association was found between total ACE score and PTB and preeclampsia (p-value: 0.016 and 0.001). Women with four or more ACE scores showed higher risks of preeclampsia (adjusted odds ratio [aOR] [95% confidence interval, CI]: 3.06 [1.57-5.94], p-value: 0.001). Besides, those with two or three ACEs had higher risks of PTB (aOR [95%CI]: 1.42 [1.01-2.02], p-value: 0.046, and aOR [95%CI]: 1.61 [1.04-2.50], p-value: 0.041), and women with one ACE showed a higher risk of GDM (aOR [95%CI]: 1.34 [1.02-1.77], p-value: 0.035). SGA was not associated with ACEs. CONCLUSION ACEs were associated with an increased risk of PTB, preeclampsia, and GDM, but not SGA among the general population in Japan.
Collapse
Affiliation(s)
- Yuto Maeda
- Department of Public Health, Institute of Science Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Takahiro Tabuchi
- Division of Epidemiology, School of Public Health, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takeo Fujiwara
- Department of Public Health, Institute of Science Tokyo, Bunkyo-ku, Tokyo, Japan
| |
Collapse
|
2
|
Alsabti HB, Ludington-Hoe SM, Blatz MA, Johnson MW, Morgan K, Toly VB. Multiple Attempts of Peripheral Intravenous Catheter Insertion in a Preterm Infant Provoke Toxic Stress: A Case Report. Neonatal Netw 2024; 43:275-285. [PMID: 39433340 DOI: 10.1891/nn-2024-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2024]
Abstract
Premature infants admitted to the NICU often require intravenous (IV) therapy. Peripheral intravenous catheter (PIVC) insertion is a common painful/stressful/invasive procedure. Repeated exposure to stressors produces toxic stress: a prolonged, frequent activation of the body's stress response that occurs when buffering relationships, that is, mother/supportive adult, are absent. This article presents an exemplar case study of a PIVC insertion to describe toxic stress responses a premature infant experienced during the procedure. The infant was admitted for extreme prematurity and respiratory failure. Twenty-nine days later, the infant developed possible necrotizing enterocolitis that necessitated cessation of enteral feedings, gastric decompression, IV administration of fluids, parenteral nutrients, and antibiotics. The PIVC insertion procedure was monitored and observed. The infant showed physiologic dysregulation, including bradycardia, tachycardia, oxygen desaturation, and high skin conductance responses, resulting from the stress exposure and insufficient nonpharmacologic/pharmacologic stress interventions. Education and practice change are needed to promote pain/stress management.
Collapse
|
3
|
Remmers MCC, Reijs RP, Hoebe CJPA. Defining and distinguishing early life stress, trauma, adversity, toxic and chronic stress and allostatic load: a descriptive review. Scand J Public Health 2024:14034948241260105. [PMID: 39087715 DOI: 10.1177/14034948241260105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
AIMS Various concepts are used to study the impact of stress on childhood development. These concepts are often used inconsistently or interchangeably. Our main objectives were to determine how selected stress concepts (chronic stress, toxic stress, allostatic load, early life stress, childhood adversity, childhood trauma and adverse childhood experiences; ACEs) are defined, operationalized and described, and to provide a theoretical context to aid the choice for a preferred concept in public health research. METHODS For this descriptive review, we systematically searched for literature published before 4 August 2021, on PubMed, Embase and PsycInfo. Two independent reviewers included studies. Exclusion criteria were: no systematic review, not peer reviewed, not published in English, selected stress concepts were no predetermined variable or a substantial topic in the discussion, full text was unobtainable or study described non-human or non-childhood populations. Data extraction forms were used. Descriptives were gathered, publication fields were identified through Journal Citation Reports categories, and verbatim descriptions were ordered in text and Venn diagrams. RESULTS Of 264 screened studies, 124 were included. ACEs, childhood adversity and childhood trauma were used most. ACEs were the main concept used most frequently (47.6%). A total of 11 of 14 public and environmental health journals used ACEs. All concepts refer to prolonged, repeated, interpersonal stress from 0 to 18 years, that can alter physiological systems. Four concepts were stressor oriented, two concepts focused on stress response and effect and one on the state of challenged homeostasis. CONCLUSIONS ACEs seem most fitting for public health setting, due to their operationalizability, large set of core experiences and widespread use.
Collapse
Affiliation(s)
- Maarten C C Remmers
- Department of Social Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- Department of Youth Health Care, Public Health Service Limburg-North, Venlo, Netherlands
| | - Rianne P Reijs
- Department of Social Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- Department of Youth Health Care, Living Lab Public Health Mosa, Public Health Service South Limburg, Heerlen, Netherlands
| | - Christian J P A Hoebe
- Department of Social Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health Mosa, Public Health Service South Limburg, Heerlen, Netherlands
- Department of Medical Microbiology, Infectious Diseases and Infection Prevention, Care and Public Health Research Institute, Maastricht University Medical Center+, Maastricht, Netherlands
| |
Collapse
|
4
|
Zamani-Hank Y, Brincks A, Talge NM, Slaughter-Acey J, Margerison C. The Association Between Adverse Childhood Experiences and Preterm Delivery: A Latent Class Approach. J Womens Health (Larchmt) 2024; 33:522-531. [PMID: 38457646 PMCID: PMC11250838 DOI: 10.1089/jwh.2023.0196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2024] Open
Abstract
Background: Racial and socioeconomic status (SES) disparities in preterm delivery (PTD) have existed in the United States for decades. Disproportionate maternal exposures to adverse childhood experiences (ACEs) may increase the risk for adverse birth outcomes. Moreover, racial and SES disparities exist in the prevalence of ACEs, underscoring the need for research that examines whether ACEs contribute to racial and SES disparities in PTD. Methods: We examined the relationship between ACEs and PTD in a longitudinal sample of N = 3,884 women from the National Longitudinal Study of Adolescent to Adult Health (1994-2018). We applied latent class analysis to (1) identify subgroups of women characterized by patterns of ACE occurrence; (2) estimate the association between latent class membership (LCM) and PTD, and (3) examine whether race and SES influence LCM or the association between LCM and PTD. Results: Two latent classes were identified, with women in the high ACEs class characterized by a higher probability of emotional abuse, physical abuse, sexual abuse, and foster care placement compared with the low ACEs class, but neither class was associated with PTD. Race and SES did not predict LCM. Conclusions: Our findings suggest that ACEs may not impact PTD risk in previously hypothesized ways. Future research should assess the impact of ACEs on the probability of having live birth pregnancies as well as the role of potential protective factors in mitigating the impact of ACEs on PTD.
Collapse
Affiliation(s)
- Yasamean Zamani-Hank
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Ahnalee Brincks
- Department of Human Development and Family Studies, Michigan State University, East Lansing, Michigan, USA
| | - Nicole M. Talge
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Jaime Slaughter-Acey
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Claire Margerison
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
| |
Collapse
|
5
|
Espinosa Dice AL, Lawn RB, Ratanatharathorn A, Roberts AL, Denckla CA, Kim AH, de la Rosa PA, Zhu Y, VanderWeele TJ, Koenen KC. Childhood maltreatment and health in the UK Biobank: triangulation of outcome-wide and polygenic risk score analyses. BMC Med 2024; 22:135. [PMID: 38523269 PMCID: PMC10962116 DOI: 10.1186/s12916-024-03360-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 03/15/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Childhood maltreatment is common globally and impacts morbidity, mortality, and well-being. Our understanding of its impact is constrained by key substantive and methodological limitations of extant research, including understudied physical health outcomes and bias due to unmeasured confounding. We address these limitations through a large-scale outcome-wide triangulation study. METHODS We performed two outcome-wide analyses (OWAs) in the UK Biobank. First, we examined the relationship between self-reported maltreatment exposure (number of maltreatment types, via Childhood Trauma Screener) and 414 outcomes in a sub-sample of 157,316 individuals using generalized linear models ("observational OWA"). Outcomes covered a broad range of health themes including health behaviors, cardiovascular disease, digestive health, socioeconomic status, and pain. Second, we examined the relationship between a polygenic risk score for maltreatment and 298 outcomes in a non-overlapping sample of 243,006 individuals ("genetic OWA"). We triangulated results across OWAs based on differing sources of bias. RESULTS Overall, 23.8% of the analytic sample for the observational OWA reported at least one maltreatment type. Of 298 outcomes examined in both OWAs, 25% were significant in both OWAs and concordant in the direction of association. Most of these were considered robust in the observational OWA according to sensitivity analyses and included outcomes such as marital separation (OR from observational OWA, ORo = 1.25 (95% CI: 1.21, 1.29); OR from genetic OWA, ORg = 1.06 (1.03, 1.08)), major diet changes due to illness (ORo = 1.27 (1.24, 1.29); ORg = 1.01 (1.00, 1.03)), certain intestinal diseases (ORo = 1.14 (1.10, 1.18); ORg = 1.03 (1.01, 1.06)), hearing difficulty with background noise (ORo = 1.11 (1.11, 1.12); ORg = 1.01 (1.00, 1.01)), knee arthrosis (ORo = 1.13 (1.09, 1.18); ORg = 1.03 (1.01, 1.05)), frequent sleeplessness (ORo = 1.21 (1.20, 1.23); ORg = 1.02 (1.01, 1.03)), and low household income (ORo = 1.28 (1.26, 1.31); ORg = 1.02 (1.01, 1.03)). Approximately 62% of results were significant in the observational OWA but not the genetic OWA, including numerous cardiovascular outcomes. Only 6 outcomes were significant in the genetic OWA and null in the observational OWA; these included diastolic blood pressure and glaucoma. No outcomes were statistically significant in opposite directions in the two analyses, and 11% were not significant in either OWA. CONCLUSIONS Our findings underscore the far-reaching negative effects of childhood maltreatment in later life and the utility of an outcome-wide triangulation design with sensitivity analyses for improving causal inference.
Collapse
Affiliation(s)
- Ana Lucia Espinosa Dice
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA.
| | - Rebecca B Lawn
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Andrew Ratanatharathorn
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York City, NY, USA
| | - Andrea L Roberts
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Christy A Denckla
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ariel H Kim
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Molecular and Cellular Biology, Harvard University, Cambridge, MA, USA
| | - Pedro A de la Rosa
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Institute for Culture and Society, University of Navarra, Pamplona, Spain
| | - Yiwen Zhu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Tyler J VanderWeele
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Psychiatric Neurodevelopmental Genetics Unit, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
6
|
Galbally M, Watson SJ, Newnham J, White S, Watkins A, Lewis AJ. The Relationship Between Early Term Birth and the Risk of Later Childhood Mental Disorders Within a Pregnancy Cohort. Child Psychiatry Hum Dev 2024:10.1007/s10578-023-01643-5. [PMID: 38165581 DOI: 10.1007/s10578-023-01643-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2023] [Indexed: 01/04/2024]
Abstract
This study examines whether gestational age, birth weight, and early term birth is associated with childhood mental disorders in 342 pregnant women recruited at less than 20 weeks gestation and were then followed up until 4 years postpartum, including 93 children born at early term. Women were assessed at recruitment using the Structured Clinical Interview for DSM. At 4 years of age their children were assessed using the Preschool Age Psychiatric Assessment (PAPA) and the Child Behavior Checklist (CBCL). This study found earlier birth predicted an increased risk for anxiety disorders and demonstrated a significant interaction between gestational age and lower birthweight. The risk for ADHD increased with lower gestational age independent of birthweight. In contrast, gestational age was not associated with Oppositional Defiant Disorder, Conduct Disorder, internalizing or externalizing symptoms. These findings highlight the important differences in the association of early term birth and vulnerability for specific mental disorders.
Collapse
Affiliation(s)
- Megan Galbally
- School of Clinical Sciences, Monash University, Clayton, VIC, 3168, Australia.
- Health Futures Institute, Murdoch University, Perth, Australia.
| | - Stuart J Watson
- School of Clinical Sciences, Monash University, Clayton, VIC, 3168, Australia
- Health Futures Institute, Murdoch University, Perth, Australia
| | - John Newnham
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Australia
| | - Scott White
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Australia
| | | | - Andrew J Lewis
- Institute of Health and Wellbeing, Federation University, Ballarat, Australia
| |
Collapse
|
7
|
Mamun A, Biswas T, Scott J, Sly PD, McIntyre HD, Thorpe K, Boyle FM, Dekker MN, Doi S, Mitchell M, McNeil K, Kothari A, Hardiman L, Callaway LK. Adverse childhood experiences, the risk of pregnancy complications and adverse pregnancy outcomes: a systematic review and meta-analysis. BMJ Open 2023; 13:e063826. [PMID: 37536966 PMCID: PMC10401231 DOI: 10.1136/bmjopen-2022-063826] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/03/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Adverse childhood experiences (ACEs) have a profound negative impact on health. However, the strength of the association between ACEs and pregnancy complications and adverse pregnancy outcomes is not well quantified or understood. OBJECTIVE To conduct a systematic review and meta-analysis of the association between ACEs and risk of pregnancy complications and adverse pregnancy outcomes. SEARCH STRATEGY A comprehensive search was conducted using PubMed, Embase, CINAHL, PsycINFO, ClinicalTrials.gov and Google scholar up to July 2022. DATA COLLECTION AND ANALYSIS Two reviewers independently conducted the screening and quality appraisal using a validated tool. Meta-analysis using the quality-effects model on the reported odds ratio (OR) was conducted. Heterogeneity and inconsistency were examined using the I2 statistics. RESULTS 32 studies from 1508 met a priori inclusion criteria for systematic review, with 21 included in the meta-analysis. Pooled analyses showed that exposure to ACEs increased the risk of pregnancy complications (OR 1.37, 95% CI 1.20 to 1.57) and adverse pregnancy outcomes (OR 1.31, 95% CI 1.17 to 1.47). In sub-group analysis, maternal ACEs were associated with gestational diabetes mellitus (OR 1.39, 95% CI 1.11 to 1.74), antenatal depression (OR 1.59, 95% CI 1.15 to 2.20), low offspring birth weight (OR 1.27, 95% CI 1.02 to 1.47), and preterm delivery (OR 1.41, 95% CI 1.16 to 1.71). CONCLUSION The results suggest that exposure to ACEs increases the risk of pregnancy complications and adverse pregnancy outcomes. Preventive strategies, screening and trauma-informed care need to be examined to improve maternal and child health.
Collapse
Affiliation(s)
- Abdullah Mamun
- UQ Poche Centre for Indigenous Health, University of Queensland, Saint Lucia, Queensland, Australia
| | - Tuhin Biswas
- University of Queensland, Brisbane, Queensland, Australia
| | - James Scott
- University of Queensland, Brisbane, Queensland, Australia
| | - Peter D Sly
- Queensland Childrens Medical Research Instit, University of Queensland, Herston, Queensland, Australia
| | - H David McIntyre
- Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia
| | - Karen Thorpe
- University of Queensland, Brisbane, Queensland, Australia
| | | | - Marloes N Dekker
- Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia
| | - Suhail Doi
- Population Medicine, Qatar University, Doha, Ad Dawhah, Qatar
| | - Murray Mitchell
- Faculty of Health, School of Biomedical Sciences, QUT, Brisbane, Queensland, Australia
| | - Keith McNeil
- Queensland Health, Brisbane, Queensland, Australia
| | - Alka Kothari
- University of Queensland, Brisbane, Queensland, Australia
| | | | | |
Collapse
|
8
|
Swedo EA, D'Angelo DV, Fasula AM, Clayton HB, Ports KA. Associations of Adverse Childhood Experiences With Pregnancy and Infant Health. Am J Prev Med 2023; 64:512-524. [PMID: 36697281 PMCID: PMC10033436 DOI: 10.1016/j.amepre.2022.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 10/25/2022] [Accepted: 10/27/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Adverse childhood experiences are associated with a host of negative outcomes; however, few have studied cumulative adverse childhood experiences in the context of pregnancy and infant health. This study examines state-level prevalence of adverse childhood experiences and associations with pregnancy- and infant health‒related indicators. METHODS The study used 2016-2018 Pregnancy Risk Assessment Monitoring System population-based data from 5 states. Analyses were conducted for individual states and grouped states using similar adverse childhood experience items. Thirteen adverse childhood experience measures were included across 3 domains: abuse, neglect, and household challenges. Adverse childhood experience scores were calculated for the number of adverse childhood experiences experienced (0, 1, 2, ≥3) on the basis of available state measures. Fourteen pregnancy- and infant health‒related indicators were examined, including unwanted pregnancy, adequate prenatal care, experiences during pregnancy (e.g., smoking, abuse, depression), gestational diabetes, hypertensive disorders of pregnancy, birth outcomes (e.g., preterm birth), and breastfeeding. Adjusting for demographics, parity, health insurance status, and educational attainment, prevalence ratios and 95% CIs were calculated to examine the associations between pregnancy- and infant health‒related indicators and adverse childhood experience scores. RESULTS Over 50% of respondents reported at least 1 adverse childhood experience and 13%-31% reported ≥3 adverse childhood experiences, depending on the state. Significant associations were identified in all adjusted models between adverse childhood experiences and unwanted pregnancy, smoking, physical abuse, and depression during pregnancy. CONCLUSIONS Adverse childhood experiences are associated with risk factors that impact pregnancy and infant health. Preventing and mitigating adverse childhood experiences is an important strategy to improve pregnancy- and infant health‒related indicators.
Collapse
Affiliation(s)
- Elizabeth A Swedo
- From the Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Denise V D'Angelo
- From the Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amy M Fasula
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Heather B Clayton
- From the Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Katie A Ports
- and the Health Equity Research Applied, Albuquerque, New Mexico
| |
Collapse
|
9
|
Carbone JT, Hicks LM, Brown S, Saini EK, Dayton CJ. Adverse Childhood Experiences: Associations with a Blunted Cortisol Stress Response During Pregnancy. Matern Child Health J 2023:10.1007/s10995-023-03651-2. [PMID: 37000382 DOI: 10.1007/s10995-023-03651-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 04/01/2023]
Abstract
INTRODUCTION Adverse Childhood Experiences (ACEs) are associated with a range of negative physical and mental health outcomes, yet there is limited research focused on the effect of ACEs on stress responses during pregnancy. Expectant mothers experience an increase in cortisol levels as pregnancy progresses, with this increase having important implications for fetal and early infant development. Little is known about the impact of ACEs on maternal cortisol levels. This study explored the relationship between maternal ACEs and cortisol response among expectant mothers nearing or in the third trimester of pregnancy. METHODS 39 expectant mothers were exposed to a Baby Cry Protocol via an infant simulator, with salivary cortisol collected at five points in time (N = 181). Stepwise, multilevel model creation resulted in a random intercept and random slope model with an interaction term for total number of ACEs and week of pregnancy. RESULTS The repeated measures data showed that cortisol levels decreased across collection times, from arrival at the lab, through the Baby Cry Protocol, to recovery. Predictive margins for the interaction term showed that while exposure to a greater number of ACEs was associated with higher cortisol levels early in the third trimester, the expected increase in cortisol late in pregnancy was blunted for expectant mothers who were exposed to a greater number of ACEs. DISCUSSION These findings findings suggest the importance of ACEs screening and intervention efforts as part of prenatal care.
Collapse
Affiliation(s)
- Jason T Carbone
- School of Social Work, Wayne State University, 5447 Woodward Avenue, Detroit, MI, 48202, USA.
| | - Laurel M Hicks
- University of Colorado Boulder, Renée Crown Wellness Institute, Boulder, CO, USA
| | - Suzanne Brown
- School of Social Work, Wayne State University, 5447 Woodward Avenue, Detroit, MI, 48202, USA
| | | | - Carolyn J Dayton
- School of Social Work, Wayne State University, 5447 Woodward Avenue, Detroit, MI, 48202, USA
- Merrill Palmer Skillman Institute, Wayne State University, Detroit, MI, USA
| |
Collapse
|
10
|
Morse L, Paul SM, Cooper BA, Oppegaard K, Shin J, Calvo-Schimmel A, Harris C, Hammer M, Conley Y, Wright F, Levine JD, Kober KM, Miaskowski C. Higher Stress in Oncology Patients is Associated With Cognitive and Evening Physical Fatigue Severity. J Pain Symptom Manage 2023; 65:203-215. [PMID: 36423801 PMCID: PMC11189665 DOI: 10.1016/j.jpainsymman.2022.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/15/2022] [Accepted: 11/15/2022] [Indexed: 11/23/2022]
Abstract
CONTEXT Cognitive and physical fatigue are common symptoms experienced by oncology patients. Exposure to stressful life events (SLE), cancer-related stressors, coping styles, and levels of resilience may influence the severity of both dimensions of fatigue. OBJECTIVES Evaluate for differences in global, cancer-specific, and cumulative life stress, as well as resilience and coping in oncology patients (n=1332) with distinct cognitive fatigue AND evening physical fatigue profiles. METHODS Latent profile analysis, which combined the two symptom scores, identified three subgroups of patients with distinct cognitive fatigue AND evening physical fatigue profiles (i.e., Low, Moderate, High). Patients completed measures of global, cancer-specific, and cumulative life stress as well measures of resilience and coping. Differences among the latent classes in the various measures were evaluated using parametric and nonparametric tests. RESULTS Compared to Low class, the other two classes reported higher global and cancer-specific stress. In addition, they reported higher occurrence rates for sexual harassment and being forced to touch prior to 16 years of age. Compared to the other two classes, High class reported lower resilience scores and higher use of denial, substance use, and behavioral disengagement. CONCLUSION To decrease both cognitive and evening physical fatigue, clinicians need to assess for relevant stressors and initiate interventions to increase resilience and the use of engagement coping strategies. Additional research is warranted on the relative contribution of various social determinants of health to both cognitive and physical fatigue in oncology patients receiving chemotherapy.
Collapse
Affiliation(s)
- Lisa Morse
- School of Nursing (L.M.,S.M. P.,B.A.C.,K.O.,J.S.,A.C.S.,K.M.K.,C.M.), University of California, San Francisco, California
| | - Steven M Paul
- School of Nursing (L.M.,S.M. P.,B.A.C.,K.O.,J.S.,A.C.S.,K.M.K.,C.M.), University of California, San Francisco, California
| | - Bruce A Cooper
- School of Nursing (L.M.,S.M. P.,B.A.C.,K.O.,J.S.,A.C.S.,K.M.K.,C.M.), University of California, San Francisco, California
| | - Kate Oppegaard
- School of Nursing (L.M.,S.M. P.,B.A.C.,K.O.,J.S.,A.C.S.,K.M.K.,C.M.), University of California, San Francisco, California
| | - Joosun Shin
- School of Nursing (L.M.,S.M. P.,B.A.C.,K.O.,J.S.,A.C.S.,K.M.K.,C.M.), University of California, San Francisco, California
| | - Alejandra Calvo-Schimmel
- School of Nursing (L.M.,S.M. P.,B.A.C.,K.O.,J.S.,A.C.S.,K.M.K.,C.M.), University of California, San Francisco, California
| | - Carolyn Harris
- School of Nursing (C.H.,Y.C.,), University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Marilyn Hammer
- Dana Farber Cancer Institute (M.H.), Boston, Massachusetts
| | - Yvette Conley
- School of Nursing (C.H.,Y.C.,), University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Fay Wright
- Rory Meyers College of Nursing (F.W.), New York University, New York, New York
| | - Jon D Levine
- School of Medicine (J.D.L, C.M.), University of California, San Francisco, California, USA
| | - Kord M Kober
- School of Nursing (L.M.,S.M. P.,B.A.C.,K.O.,J.S.,A.C.S.,K.M.K.,C.M.), University of California, San Francisco, California
| | - Christine Miaskowski
- School of Nursing (L.M.,S.M. P.,B.A.C.,K.O.,J.S.,A.C.S.,K.M.K.,C.M.), University of California, San Francisco, California;; School of Medicine (J.D.L, C.M.), University of California, San Francisco, California, USA.
| |
Collapse
|
11
|
The association between adverse childhood experiences and peripartal pain experience. Pain 2023:00006396-990000000-00255. [PMID: 36787580 DOI: 10.1097/j.pain.0000000000002870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 01/03/2023] [Indexed: 02/16/2023]
Abstract
ABSTRACT Adverse childhood experiences (ACEs) are associated with altered ongoing and evoked pain experiences, which have scarcely been studied for the peripartum period. We aimed to investigate how ACEs affect pain experience in pregnancy and labor. For this noninterventional trial with a short-term follow-up, pregnant women were divided into a trauma group (TG) with ACEs (n = 84) and a control group (CG) without ACEs (n = 107) according to the Childhood Trauma Questionnaire. Pain experience in pregnancy and labor was recorded by self-report and the German Pain Perception Scale. Pain sensitivity prepartum and postpartum was assessed by Quantitative Sensory Testing and a paradigm of conditioned pain modulation (CPM), using pressure pain thresholds (PPTs) and a cold pressor test. The TG showed higher affective and sensory scores for back pain and a more than doubled prevalence of preexisting back pain. Pelvic pain differences were nonsignificant. The TG also exhibited increased affective scores (1.71 ± 0.15 vs 1.33 ± 0.11), but not sensory scores for labor pain during spontaneous delivery. There were no group differences in prepartum pain sensitivity. While PPTs increased through delivery in the CG (clinical CPM), and this PPT change was positively correlated with the experimental CPM (r = 0.55), this was not the case in the TG. The association of ACEs with increased peripartal pain affect and heightened risk for preexisting back pain suggest that such women deserve special care. The dissociation of impaired clinical CPM in women with ACEs and normal prepartum experimental CPM implies at least partly different mechanisms of these 2 manifestations of endogenous pain controls.
Collapse
|
12
|
Klasner C, Brown J, Gopalakrishnan M, Metwally DE, Besse M, Mark K. Effect of maternal adverse childhood experiences (ACE) and cannabis use on pregnancy outcomes. Arch Womens Ment Health 2022; 25:1097-1104. [PMID: 36203114 DOI: 10.1007/s00737-022-01269-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 09/14/2022] [Indexed: 12/14/2022]
Abstract
This study aimed to characterize the relationship between cannabis use, ACE score, and pregnancy outcomes. Pregnant patients in Baltimore, MD, completed the 17-point ACE checklist. Charts of the birth parent and neonate were reviewed for urine toxicology testing at initiation of care and delivery, prenatal care metrics, and birth statistics. Multivariable logistic regression analysis was performed to assess the relationship between ACE score, cannabis use, and pregnancy outcomes. Of 256 birth parents, 87 (34.0%) tested positive for cannabis at initial visit and 39 (15.2%) tested positive for cannabis at delivery. Testing positive for cannabis at initial visit or delivery was associated with higher ACE score (15.1 vs 13.7, p = 0.04; 16.2 vs 13.8, p = 0.01). Of those who tested positive for cannabis at initial visit, 39/87 (45.0%) tested positive at delivery. Continued cannabis use at delivery was associated with lower maternal weight gain (7.9 kg vs 13.3 kg, p = 0.003), fewer prenatal visits (7 vs 8, p = 0.010), and numerically higher mean ACE score. Cannabis use at delivery was associated with 10% lower birthweight (2665 g vs 3014 g p < 0.05) but not with pre-term birth. Total ACE score was not significantly associated with any birth outcome. Worse pregnancy outcomes were associated with cannabis use throughout pregnancy but not with cannabis use at prenatal care initiation. The interplay of ACE and continued cannabis use during pregnancy warrants further research on the physiologic effects of cannabis and interventions to decrease substance use during pregnancy.
Collapse
Affiliation(s)
- Carson Klasner
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, 11 S Paca, Suite 400, Baltimore, MD, 21201, USA
| | - Jessica Brown
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, 11 S Paca, Suite 400, Baltimore, MD, 21201, USA
| | - Mathangi Gopalakrishnan
- Department of Pharmacy Practice and Science, Center for Translational Medicine, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Dina El Metwally
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, 11 S Paca, Suite 400, Baltimore, MD, 21201, USA
| | - Margaret Besse
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, 11 S Paca, Suite 400, Baltimore, MD, 21201, USA
| | - Katrina Mark
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, 11 S Paca, Suite 400, Baltimore, MD, 21201, USA.
| |
Collapse
|
13
|
León I, Herrero Roldán S, Rodrigo MJ, López Rodríguez M, Fisher J, Mitchell C, Lage-Castellanos A. The shared mother-child epigenetic signature of neglect is related to maternal adverse events. Front Physiol 2022; 13:966740. [PMID: 36091392 PMCID: PMC9448913 DOI: 10.3389/fphys.2022.966740] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 07/13/2022] [Indexed: 11/13/2022] Open
Abstract
Studies of DNA methylation have revealed the biological mechanisms by which life adversity confers risk for later physical and mental health problems. What remains unknown is the “biologically embedding” of maternal adverse experiences resulting in maladaptive parenting and whether these epigenetic effects are transmitted to the next generation. This study focuses on neglectful mothering indexed by a severe disregard for the basic and psychological needs of the child. Using the Illumina Human Methylation EPIC BeadChip in saliva samples, we identified genes with differentially methylated regions (DMRs) in those mothers with (n = 51), versus those without (n = 87), neglectful behavior that present similar DMRs patterns in their children being neglected versus non-neglected (n = 40 vs. 75). Mothers reported the emotional intensity of adverse life events. After covariate adjustment and multiple testing corrections, we identified 69 DMRs in the mother epigenome and 42 DMRs in the child epigenome that were simultaneously above the α = 0.01 threshold. The common set of nine DMRs contained genes related to childhood adversity, neonatal and infant diabetes, child neurobehavioral development and other health problems such as obesity, hypertension, cancer, posttraumatic stress, and the Alzheimer’s disease; four of the genes were associated with maternal life adversity. Identifying a shared epigenetic signature of neglect linked to maternal life adversity is an essential step in breaking the intergenerational transmission of one of the most common forms of childhood maltreatment.
Collapse
Affiliation(s)
- Inmaculada León
- Instituto Universitario de Neurociencia, Universidad de La Laguna, San Cristóbal de la Laguna, Spain
- Facultad de Psicología, Universidad de La Laguna, San Cristóbal de la Laguna, Spain
| | - Silvia Herrero Roldán
- Instituto Universitario de Neurociencia, Universidad de La Laguna, San Cristóbal de la Laguna, Spain
- Facultad de Psicología, Universidad de La Laguna, San Cristóbal de la Laguna, Spain
- *Correspondence: Silvia Herrero Roldán,
| | - María José Rodrigo
- Instituto Universitario de Neurociencia, Universidad de La Laguna, San Cristóbal de la Laguna, Spain
- Facultad de Psicología, Universidad de La Laguna, San Cristóbal de la Laguna, Spain
| | - Maykel López Rodríguez
- Department of Pathology and Experimental Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, United States
| | - Jonah Fisher
- Institute for Social Research, University of Michigan, Ann Abor, MI, United States
| | - Colter Mitchell
- Institute for Social Research, University of Michigan, Ann Abor, MI, United States
| | - Agustín Lage-Castellanos
- Department of NeuroInformatics, Cuban Center for Neuroscience, Havana, Cuba
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| |
Collapse
|
14
|
Hardcastle K, Ford K, Bellis MA. Maternal adverse childhood experiences and their association with preterm birth: secondary analysis of data from universal health visiting. BMC Pregnancy Childbirth 2022; 22:129. [PMID: 35172776 PMCID: PMC8848970 DOI: 10.1186/s12884-022-04454-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 02/02/2022] [Indexed: 11/29/2022] Open
Abstract
Background Being born before full gestation can have short-term and life-long health implications, yet it remains difficult to determine the risk of preterm birth among expectant mothers. Across different health settings, increasing attention is given to the health and behavioural consequences of adverse childhood experiences (ACEs) such as child abuse or neglect, or exposure to harmful household environments (e.g. in which caregivers abuse alcohol), and the potential value of understanding these hidden harms when supporting individuals and families. A large international evidence base describes the association between childhood adversity and early years outcomes for mothers and children. However, the relationship between maternal ACEs and preterm birth has received far less attention. Methods Secondary analysis was carried out on anonymised cross-sectional data from health visiting services in south and west Wales that had previously captured information on mothers’ ACEs during routine contacts. Demographic data and information on mothers’ health were extracted from the Healthy Child Wales Programme. Results Half of all mothers sampled had experienced at least one ACE, with a history of ACEs more common among younger, white British mothers and those residing in deprived areas. Preterm birth was significantly independently associated with retrospective reports of childhood sexual abuse (adjusted odds ratio [AOR] = 3.83, 95% confidence interval [CI] = 1.19–12.32, p = 0.025), neglect (AOR = 7.60, 95%CI = 1.81–31.97, p = 0.006) and overall ACE exposure (AOR = 2.67, 95%CI = 1.14–6.23, p = 0.024), with one in ten mothers (10.0%) who experienced ≥4 ACEs having preterm birth. Sub-analyses revealed a more pronounced relationship among mothers with no known chronic health conditions, with those with ≥4 ACEs and no known chronic condition four times more likely to give birth preterm (AOR = 3.89, 95%CI = 1.40–10.80, p = 0.009). Conclusions Findings highlight the importance of the entire maternal experience. The experience of childhood adversity can have a lasting impact into and beyond the prenatal period, potentially increasing the risk of preterm birth, even among otherwise healthy women. Increasing our understanding of the potential perinatal outcomes associated with ACEs can help to inform how maternity services and partners offer trauma-sensitive support to mitigate some of the risks of early parturition, as well as target intergenerational cycles of adversity and poor health. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04454-z.
Collapse
Affiliation(s)
- Katie Hardcastle
- Policy and International Health, World Health Organization Collaborating Centre on Investment for Health and Well-being, Public Health Wales, Wrexham Technology Park, Wrexham, LL13 7YP, UK
| | - Kat Ford
- Public Health Collaborating Unit, School of Medical and Health Sciences, Bangor University, Wrexham Technology Park, Wrexham, LL13 7YP, UK.
| | - Mark A Bellis
- Policy and International Health, World Health Organization Collaborating Centre on Investment for Health and Well-being, Public Health Wales, Wrexham Technology Park, Wrexham, LL13 7YP, UK.,Public Health Collaborating Unit, School of Medical and Health Sciences, Bangor University, Wrexham Technology Park, Wrexham, LL13 7YP, UK
| |
Collapse
|
15
|
Nwanaji-Enwerem JC, Van Der Laan L, Kogut K, Eskenazi B, Holland N, Deardorff J, Cardenas A. Maternal adverse childhood experiences before pregnancy are associated with epigenetic aging changes in their children. Aging (Albany NY) 2021; 13:25653-25669. [PMID: 34923483 PMCID: PMC8751604 DOI: 10.18632/aging.203776] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/24/2021] [Indexed: 02/06/2023]
Abstract
Emerging research suggests associations of physical and psychosocial stressors with epigenetic aging. Although this work has included early-life exposures, data on maternal exposures and epigenetic aging of their children remain sparse. Using longitudinally collected data from the California, Salinas Valley CHAMACOS study, we examined relationships between maternal Adverse Childhood Experiences (ACEs) reported up to 18 years of life, prior to pregnancy, with eight measures (Horvath, Hannum, SkinBloodClock, Intrinsic, Extrinsic, PhenoAge, GrimAge, and DNAm telomere length) of blood leukocyte epigenetic age acceleration (EAA) in their children at ages 7, 9, and 14 years (N = 238 participants with 483 observations). After adjusting for maternal chronological age at delivery, pregnancy smoking/alcohol use, parity, child gestational age, and estimated leukocyte proportions, higher maternal ACEs were significantly associated with at least a 0.76-year increase in child Horvath and Intrinsic EAA. Higher maternal ACEs were also associated with a 0.04 kb greater DNAm estimate of telomere length of children. Overall, our data suggests that maternal preconception ACEs are associated with biological aging in their offspring in childhood and that preconception ACEs have differential relationships with EAA measures, suggesting different physiologic utilities of EEA measures. Studies are necessary to confirm these findings and to elucidate potential pathways to explain these relationships, which may include intergenerational epigenetic inheritance and persistent physical and social exposomes.
Collapse
Affiliation(s)
- Jamaji C Nwanaji-Enwerem
- Gangarosa Department of Environmental Health, Emory Rollins School of Public Health, Atlanta, GA 30322, USA.,Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA 30303, USA.,Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA 94720, USA.,Center for Computational Biology, School of Public Health, University of California, Berkeley, CA 94720, USA
| | - Lars Van Der Laan
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA 94720, USA.,Center for Computational Biology, School of Public Health, University of California, Berkeley, CA 94720, USA
| | - Katherine Kogut
- Center for Environmental Research of Community Health, CERCH, School of Public Health, University of California, Berkeley, CA 94720, USA
| | - Brenda Eskenazi
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA 94720, USA.,Center for Computational Biology, School of Public Health, University of California, Berkeley, CA 94720, USA.,Center for Environmental Research of Community Health, CERCH, School of Public Health, University of California, Berkeley, CA 94720, USA.,Community Health Sciences Division, School of Public Health, University of California, Berkeley, CA 94720, USA
| | - Nina Holland
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA 94720, USA.,Center for Computational Biology, School of Public Health, University of California, Berkeley, CA 94720, USA.,Center for Environmental Research of Community Health, CERCH, School of Public Health, University of California, Berkeley, CA 94720, USA
| | - Julianna Deardorff
- Center for Environmental Research of Community Health, CERCH, School of Public Health, University of California, Berkeley, CA 94720, USA.,Community Health Sciences Division, School of Public Health, University of California, Berkeley, CA 94720, USA
| | - Andres Cardenas
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA 94720, USA.,Center for Computational Biology, School of Public Health, University of California, Berkeley, CA 94720, USA.,Center for Environmental Research of Community Health, CERCH, School of Public Health, University of California, Berkeley, CA 94720, USA
| |
Collapse
|
16
|
Bovbjerg ML, Horan H. Current Resources for Evidence-Based Practice, January 2022. J Obstet Gynecol Neonatal Nurs 2021; 51:101-112. [PMID: 34921766 DOI: 10.1016/j.jogn.2021.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
An extensive review of new resources to support the provision of evidence-based care for women and infants. The current column includes a discussion of breastfeeding while employed and commentaries on reviews focused on mammography test characteristics and sexual health for gynecologic cancer survivors. It also includes a quick update on a USPSTF review for aspirin as pre-eclampsia prophylaxis.
Collapse
|
17
|
Characteristics of Pregnant Women and New Mothers Identified as Being At-Risk for Child Maltreatment in Early Pregnancy. WOMEN 2021. [DOI: 10.3390/women1040016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pregnant women and new mothers who have risk factors of child maltreatment are “at high risk for future child maltreatment.” Early detection of them is crucial to prevent it. This community-based, retrospective, cross-sectional, observational study aimed to identify the characteristics of pregnant women, and those in their postpartum period, identified as at-risk cases for child maltreatment. We used data from the municipal pregnancy registration system in City A and analyzed 206 cases identified as “at-risk for child maltreatment” from 1 April 2017 to 31 March 2018. They were categorized into two groups: a pregnancy group (131 cases, 63.6%) and a postpartum group (75 cases, 36.4%). Logistic regression analysis revealed that women who reported having poor relationships with their parents and participated in the interview in their early stages of their pregnancy were less likely to be registered as at-risk cases for child maltreatment after delivery. The results suggest that public health nurses (PHNs) can conduct interviews with pregnant women during the early stages of pregnancy to prevent child maltreatment in community settings. Additionally, to ensure safe delivery and childrearing environments, PHNs need to assess the family support capacity of each registered case and provide assistance to those without parental support.
Collapse
|