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Liu W, Sun W, Yang L, Huang Y, Zhu S, Xiao W, Cheng S, Hao J, Ying J, Chen H, Ren Z, Wang S, Song P. Paternal and maternal exposures to adverse childhood experiences and spontaneous fetal loss: a nationwide cross-sectional analysis. BMC Public Health 2024; 24:1047. [PMID: 38622567 PMCID: PMC11020413 DOI: 10.1186/s12889-024-18477-y] [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] [Received: 03/25/2023] [Accepted: 03/28/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Adverse childhood experiences (ACEs) might be associated with maternal spontaneous fetal loss, while evidence among Chinese population is limited. This study aims to explore the associations of adverse childhood experiences (ACEs) among women and their spouses with the risk of spontaneous abortion and stillbirth. METHOD Data were from the China Health and Retirement Longitudinal Study (CHARLS) 2014 survey. ACEs were categorized into intra-familial ACEs and extra-familial ACEs. The associations of maternal and paternal ACEs with women's history of spontaneous abortion and stillbirth were investigated by logistic regression. RESULTS 7,742 women were included with 9.05% and 2.47% experiencing at least one spontaneous abortion or stillbirth, respectively. Women exposed to 2, 3, and ≥ 4 ACEs were at significantly higher odds of spontaneous abortion, with adjusted odds ratios (ORs) of 1.52 (95% [CI, Confidence Interval] 1.10-2.10), 1.50 (95% CI 1.07-2.09) and 1.68 (95% CI 1.21-2.32), respectively. A significant association between ≥ 4 maternal intra-familial ACEs and stillbirth (OR 2.23, 95% CI 1.12-4.42) was also revealed. Furthermore, paternal exposures to 3 and ≥ 4 overall ACEs were significantly associated with their wives' history of spontaneous abortion, with adjusted ORs of 1.81 (95% CI 1.01-3.26) and 1.83 (95% CI 1.03-3.25), respectively. CONCLUSION Both maternal and paternal ACEs were associated with spontaneous abortion, and potential mediators might need to be considered to further explore impacts of maternal and paternal ACEs on maternal reproductive health.
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Affiliation(s)
- Wen Liu
- School of Public Health and the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Weidi Sun
- School of Public Health and the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Lili Yang
- Department of Nursing, The Fourth Affiliated Hospital, International institutes of Medicine, Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Yizhou Huang
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Siyu Zhu
- School of Public Health and the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Wenhan Xiao
- School of Public Health and the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Siqing Cheng
- International School of Medicine, Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Jiajun Hao
- School of Public Health and the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Center for Global Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jiayao Ying
- School of Public Health and the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Hanlu Chen
- School of Public Health and the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Ziyang Ren
- Institute of Reproductive and Child Health / Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Peking University, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Shuhui Wang
- School of Public Health and the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Peige Song
- School of Public Health and the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
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Ding W, Xu Y, Kondracki AJ, Sun Y. Childhood adversity and accelerated reproductive events: a systematic review and meta-analysis. Am J Obstet Gynecol 2024; 230:315-329.e31. [PMID: 37820985 DOI: 10.1016/j.ajog.2023.10.005] [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] [Received: 05/08/2023] [Revised: 09/18/2023] [Accepted: 10/02/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE Accelerated female reproductive events represent the early onset of reproductive events involving puberty, menarche, pregnancy loss, first sexual intercourse, first birth, parity, and menopause. This study aimed to explore the association between childhood adversity and accelerated female reproductive events. DATA SOURCES PubMed, Web of Science, and Embase were systematically searched from September 22, 2022 to September 23, 2022. STUDY ELIGIBILITY CRITERIA Observational cohort, cross-sectional, and case-control studies in human populations were included if they reported the time of reproductive events for female individuals with experience of childhood adversity and were published in English. METHODS Two reviewers independently screened studies, obtained data, and assessed study quality, and conflicts were resolved by a third reviewer. Dichotomous outcomes were evaluated using meta-analysis, and pooled odds ratios and 95% confidence intervals were generated using random-effects models. Moderation analysis and meta-regression were used to investigate heterogeneity. RESULTS In total, 21 cohort studies, 9 cross-sectional studies, and 3 case-control studies were identified. Overall, female individuals with childhood adversity were nearly 2 times more likely to report accelerated reproductive events than those with no adversity exposure (odds ratio, 1.91; 95% confidence interval, 1.33-2.76; I2=99.6%; P<.001). Moderation analysis indicated that effect sizes for the types of childhood adversity ranged from an odds ratio of 1.61 (95% confidence interval, 1.23-2.09) for low socioeconomic status to 2.13 (95% confidence interval, 1.14-3.99) for dysfunctional family dynamics. Among the 7 groups based on different reproductive events, including early onset of puberty, early menarche, early sexual initiation, teenage childbirth, preterm birth, pregnancy loss, and early menopause, early sexual initiation had a nonsignificant correlation with childhood adversity (odds ratio, 2.70; 95% confidence interval, 0.88-8.30; I2=99.9%; P<.001). Considerable heterogeneity (I2>75%) between estimates was observed for over half of the outcomes. Age, study type, and method of data collection could explain 35.9% of the variance. CONCLUSION The literature tentatively corroborates that female individuals who reported adverse events in childhood are more likely to experience accelerated reproductive events. This association is especially strong for exposure to abuse and dysfunctional family dynamics. However, the heterogeneity among studies was high, requiring caution in interpreting the findings and highlighting the need for further evaluation of the types and timing of childhood events that influence accelerated female reproductive events.
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Affiliation(s)
- Wenqin Ding
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Yuxiang Xu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Anthony J Kondracki
- Department of Community Medicine, Mercer University School of Medicine, Macon, GA
| | - Ying Sun
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China; Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, Ministry of Education of the People's Republic of China, Hefei, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei, China.
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3
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Taylor K, Demakakos P. Adverse childhood experiences and trajectories of multimorbidity in individuals aged over 50: Evidence from the English Longitudinal Study of Ageing. CHILD ABUSE & NEGLECT 2024; 149:106653. [PMID: 38277873 DOI: 10.1016/j.chiabu.2024.106653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 01/04/2024] [Accepted: 01/10/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND Adverse childhood experiences (ACE) are important for chronic diseases yet their association with multimorbidity remains understudied. Few studies consider the complexity of multimorbidity or observe multimorbidity development over time. OBJECTIVE We investigated whether ACE were associated with multimorbidity at baseline and over a 12-year follow-up period. PARTICIPANTS AND SETTING 5326 participants aged over 50 were obtained from the English Longitudinal Study of Ageing (ELSA). METHODS An ACE summary score was derived using eight ACE items measuring abuse, social care, and household dysfunction. From repeated measurements of 29 chronic conditions over a 12-year period (2008-2019) we derived two multimorbidity measures: number of chronic diseases and number of chronic disease categories. We used multinomial logistic regression to assess associations between ACE and both measures. Mixed effects models were estimated to examine trajectories of multimorbidity by ACE over time. RESULTS Graded associations between ACE and multimorbidity were observed. Compared to those without ACE, participants with ≥3 ACE had three times the risk of having ≥3 chronic diseases (RRR 3.06, 95 % CI 1.85-5.05) and falling into ≥3 chronic disease categories (RRR 2·93 95 % CI 1·74-4·95). Graded associations persisted during 12-year follow-up, though differences in multimorbidity between those with ≥3 ACE and those without ACE remained constant (B 0.02, 95 % CI 0·01-0·03, and B -0·01, 95 % CI -0·02-0·00, number of chronic conditions and chronic condition categories respectively). CONCLUSION ACE are associated with multimorbidity risk and complexity, associations arising before the age of 50. Early intervention amongst those with ACE could attenuate this association.
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Affiliation(s)
- Katherine Taylor
- Division of Biosciences, Medical Sciences Building, University College London, Gower Street, London WC1E 6BT, United Kingdom of Great Britain and Northern Ireland.
| | - Panayotes Demakakos
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 7HB, United Kingdom of Great Britain and Northern Ireland
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4
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Swift A, Berry M, Fernandez-Pineda M, Haberstroh A. An Integrative Review of Adverse Childhood Experiences and Reproductive Traumas of Infertility and Pregnancy Loss. J Midwifery Womens Health 2024; 69:258-278. [PMID: 38013638 DOI: 10.1111/jmwh.13585] [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: 11/29/2023]
Abstract
INTRODUCTION Adverse childhood experiences (ACEs) can lead to chronic diseases and mental health conditions; however, less is known about the associations of ACEs to the reproductive traumas of infertility and pregnancy loss. The purpose of this integrative review was to explore relationships between ACEs and the reproductive traumas of infertility and pregnancy loss. METHODS We searched PubMed, SocINDEX, PsycINFO, and CINAHL databases in December 2021 and 2022. Inclusion criteria were qualitative or quantitative research, systematic or integrative reviews, or meta-analysis articles in English that were peer-reviewed and full-text, addressing any ACE from the ACE Checklist and infertility or pregnancy loss. A total of 20 articles were included in the review. We used Whittemore and Knafl's integrative review framework, Preferred Reporting Items for Systematic Reviews and Meta-analyses for reporting, and Covidence software for data management. A quality appraisal using Joanna Briggs Institute critical appraisal tools was performed. Relevant data were extracted into a matrix for iterative comparison. RESULTS Twenty studies were included in the review. Results support there may be an association between pregnancy loss and infertility in women with a history of ACE, although results are mixed between infertility and ACEs. We also identified other concepts related to ACEs and the reproductive traumas of infertility and pregnancy loss and include racial and ethnically diverse populations, social determinants of health, modifiable risk factors, and stress appraisals. DISCUSSION Midwives and other women's health care providers should be aware that ACEs may be associated with pregnancy loss and infertility, although additional research is needed to further explore the relationships with infertility, mental health, and hypothalamic-pituitary-adrenal axis dysregulation from allostatic load. Trauma-informed care and the development of effective interventions are warranted for women who experience ACEs. Providers should consider earlier interventions, including emotional services, for women with a history of ACE or reproductive trauma.
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Affiliation(s)
- Alison Swift
- Department of Advanced Nursing Practice and Education, East Carolina University, Greenville, North Carolina
| | - Madison Berry
- Cardiac Intensive Care Unit, ECU Health Medical Center, Greenville, North Carolina
| | | | - Amanda Haberstroh
- Laupus Health Sciences Library, East Carolina University, Greenville, North Carolina
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Spencer CN, Khalil M, Herbert M, Aravkin AY, Arrieta A, Baeza MJ, Bustreo F, Cagney J, Calderon-Anyosa RJC, Carr S, Chandan JK, Coll CVN, de Andrade FMD, de Andrade GN, Debure AN, Flor LS, Hammond B, Hay SI, Knaul FN, Lim RQH, McLaughlin SA, Minhas S, Mohr JK, Mullany EC, Murray CJL, O'Connell EM, Patwardhan V, Reinach S, Scott D, Sorenson RJD, Stein C, Stöckl H, Twalibu A, Vasconcelos N, Zheng P, Metheny N, Chandan JS, Gakidou E. Health effects associated with exposure to intimate partner violence against women and childhood sexual abuse: a burden of proof study. Nat Med 2023; 29:3243-3258. [PMID: 38081957 PMCID: PMC10719101 DOI: 10.1038/s41591-023-02629-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 10/04/2023] [Indexed: 12/17/2023]
Abstract
The health impacts of intimate partner violence against women and childhood sexual abuse are not fully understood. Here we conducted a systematic review by comprehensively searching seven electronic databases for literature on intimate partner violence-associated and childhood sexual abuse-associated health effects. Following the burden of proof methodology, we evaluated the evidence strength linking intimate partner violence and/or childhood sexual abuse to health outcomes supported by at least three studies. Results indicated a moderate association of intimate partner violence with major depressive disorder and with maternal abortion and miscarriage (63% and 35% increased risk, respectively). HIV/AIDS, anxiety disorders and self-harm exhibited weak associations with intimate partner violence. Fifteen outcomes were evaluated for their relationship to childhood sexual abuse, which was shown to be moderately associated with alcohol use disorders and with self-harm (45% and 35% increased risk, respectively). Associations between childhood sexual abuse and 11 additional health outcomes, such as asthma and type 2 diabetes mellitus, were found to be weak. Although our understanding remains limited by data scarcity, these health impacts are larger in magnitude and more extensive than previously reported. Renewed efforts on violence prevention and evidence-based approaches that promote healing and ensure access to care are necessary.
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Affiliation(s)
- Cory N Spencer
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Mariam Khalil
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Molly Herbert
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Aleksandr Y Aravkin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Applied Mathematics, University of Washington, Seattle, WA, USA
| | - Alejandra Arrieta
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - María Jose Baeza
- School of Medicine, The Pontifical Catholic University of Chile, Santiago, Chile
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | - Flavia Bustreo
- Fondation Botnar, Basel, Switzerland
- Partnership for Maternal, Newborn and Child Health, Geneva, Switzerland
| | - Jack Cagney
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Sinclair Carr
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jaidev Kaur Chandan
- Warwick Medical School, University of Warwick, Coventry, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Carolina V N Coll
- Department of Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- Human Development and Violence Research Center, Federal University of Pelotas, Pelotas, Brazil
| | | | | | - Alexandra N Debure
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | - Luisa S Flor
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Ben Hammond
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Felicia N Knaul
- Institute for the Advanced Study of the Americas, University of Miami, Coral Gables, FL, USA
| | - Rachel Q H Lim
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Susan A McLaughlin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Sonica Minhas
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jasleen K Mohr
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Erin C Mullany
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Christopher J L Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Erin M O'Connell
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Vedavati Patwardhan
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Center on Gender Equity and Health, UC San Diego School of Medicine, San Diego, CA, USA
| | | | - Dalton Scott
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | - Reed J D Sorenson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Caroline Stein
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Heidi Stöckl
- Institute of Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians-University Munich, Munich, Germany
| | - Aisha Twalibu
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | | | - Peng Zheng
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Nicholas Metheny
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | - Joht Singh Chandan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Emmanuela Gakidou
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA.
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Jasthi DL, Lappen JR, Garber S, Kennedy S, McCarther N, Nagle-Yang S, Moore T, Frank S, Huth-Bocks A. Associations between adverse childhood experiences and obstetrical outcomes in a predominantly Black-identifying and low-income pregnant population. Am J Obstet Gynecol MFM 2023; 5:101008. [PMID: 37156467 DOI: 10.1016/j.ajogmf.2023.101008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/29/2023] [Accepted: 05/02/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Recent literature indicates that adverse childhood experiences have been associated with poor obstetrical outcomes, including pregnancy loss, preterm birth, and low birthweight. Several studies have been conducted in primarily self-identified White individuals who report middle to high income levels. Less is known about the impact of adverse childhood experiences on obstetrical outcomes in minority-identifying and low-income populations, who are known to experience a greater number of adverse childhood experiences and are at higher risk of maternal morbidity. OBJECTIVE This study aimed to examine associations between adverse childhood experiences and a broad range of obstetrical outcomes among predominantly Black-identifying pregnant persons who have low income and live in an urban area. STUDY DESIGN This is a single-center retrospective cohort study of pregnant persons referred to a mental healthcare manager because of elevated psychosocial risks identified by screening tools or provider concerns during the study period from April 2018 to May 2021. Pregnant persons aged <18 years and those who did not speak English were excluded. Patients completed validated mental and behavioral health screening tools including the Adverse Childhood Experiences Questionnaire. Medical charts were reviewed for obstetrical outcomes, including preterm birth, low birthweight, hypertensive disorders of pregnancy, gestational diabetes mellitus, chorioamnionitis, sexually transmitted infection, maternal group B streptococcus carrier status, type of delivery, and attendance of a postpartum visit. Associations between high (≥4) and very high (≥6) of 10 adverse childhood experience score and obstetrical outcomes were analyzed using bivariate analysis and multivariate logistic regression, adjusting for confounding factors (significant at P<.05 in bivariate analysis). RESULTS Our cohort included 192 pregnant persons, of whom 176 (91.7%) self-identified as Black or African American and 181 (94.8%) had public insurance (used as a proxy for low income). Adverse childhood experience score ≥4 was reported by 91 (47.4%) individuals and score ≥6 by 50 (26%). On univariate analysis, adverse childhood experience score ≥4 was associated with preterm birth (odds ratio, 2.17; 95% confidence interval, 1.02-4.61). Adverse childhood experience score ≥6 was associated with hypertensive disorders of pregnancy (odds ratio, 2.09; 95% confidence interval, 1.05-4.15) and preterm birth (odds ratio, 2.29; 95% confidence interval, 1.05-4.96). After accounting for chronic hypertension, associations between adverse childhood experience score and obstetrical outcomes were no longer significant. CONCLUSION Approximately half of the pregnant persons referred to a mental healthcare manager had a high adverse childhood experience score, underscoring the high burden of childhood trauma on populations facing long-standing systemic racism and barriers to healthcare access. High and very high adverse childhood experience score may be associated with chronic health conditions that predate pregnancy and can alter obstetrical outcomes. Obstetrical care providers have a unique opportunity to mitigate risk of associated poor health outcomes during preconception and prenatal care by screening for adverse childhood experiences.
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Affiliation(s)
- Divya L Jasthi
- Case Western Reserve University School of Medicine, Cleveland, OH (Ms Jasthi and Drs Frank and Huth-Bocks)
| | - Justin R Lappen
- Ob/Gyn and Women's Health Institute, Cleveland Clinic, Cleveland, OH (Dr Lappen)
| | - Sarah Garber
- Department of Obstetrics and Gynecology, University Hospitals, Cleveland, OH (Drs Garber, Kennedy, McCarther, and Ms Moore)
| | - Sarah Kennedy
- Department of Obstetrics and Gynecology, University Hospitals, Cleveland, OH (Drs Garber, Kennedy, McCarther, and Ms Moore)
| | - Noria McCarther
- Department of Obstetrics and Gynecology, University Hospitals, Cleveland, OH (Drs Garber, Kennedy, McCarther, and Ms Moore)
| | - Sarah Nagle-Yang
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Denver, CO (Dr Nagle-Yang)
| | - Tamika Moore
- Department of Obstetrics and Gynecology, University Hospitals, Cleveland, OH (Drs Garber, Kennedy, McCarther, and Ms Moore)
| | - Scott Frank
- Case Western Reserve University School of Medicine, Cleveland, OH (Ms Jasthi and Drs Frank and Huth-Bocks)
| | - Alissa Huth-Bocks
- Case Western Reserve University School of Medicine, Cleveland, OH (Ms Jasthi and Drs Frank and Huth-Bocks); Merrill Palmer Skillman Institute, Wayne State University, Detroit, MI (Dr Huth-Bocks).
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7
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Iob E, Ajnakina O, Steptoe A. The interactive association of adverse childhood experiences and polygenic susceptibility with depressive symptoms and chronic inflammation in older adults: a prospective cohort study. Psychol Med 2023; 53:1426-1436. [PMID: 37010219 DOI: 10.1017/s0033291721003007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) and genetic liability are important risk factors for depression and inflammation. However, little is known about the gene-environment (G × E) mechanisms underlying their aetiology. For the first time, we tested the independent and interactive associations of ACEs and polygenic scores of major depressive disorder (MDD-PGS) and C-reactive protein (CRP-PGS) with longitudinal trajectories of depression and chronic inflammation in older adults. METHODS Data were drawn from the English longitudinal study of ageing (N~3400). Retrospective information on ACEs was collected in wave3 (2006/07). We calculated a cumulative risk score of ACEs and also assessed distinct dimensions separately. Depressive symptoms were ascertained on eight occasions, from wave1 (2002/03) to wave8 (2016/17). CRP was measured in wave2 (2004/05), wave4 (2008/09), and wave6 (2012/13). The associations of the risk factors with group-based depressive-symptom trajectories and repeated exposure to high CRP (i.e. ⩾3 mg/L) were tested using multinomial and ordinal logistic regression. RESULTS All types of ACEs were independently associated with high depressive-symptom trajectories (OR 1.44, 95% CI 1.30-1.60) and inflammation (OR 1.08, 95% CI 1.07-1.09). The risk of high depressive-symptom trajectories (OR 1.47, 95% CI 1.28-1.70) and inflammation (OR 1.03, 95% CI 1.01-1.04) was also higher for participants with higher MDD-PGS. G×E analyses revealed that the associations between ACEs and depressive symptoms were larger among participants with higher MDD-PGS (OR 1.13, 95% CI 1.04-1.23). ACEs were also more strongly related to inflammation in participants with higher CRP-PGS (OR 1.02, 95% CI 1.01-1.03). CONCLUSIONS ACEs and polygenic susceptibility were independently and interactively associated with elevated depressive symptoms and chronic inflammation, highlighting the clinical importance of assessing both ACEs and genetic risk factors to design more targeted interventions.
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Affiliation(s)
- Eleonora Iob
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Healthcare, University College London, London, UK
| | - Olesya Ajnakina
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Healthcare, University College London, London, UK
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Andrew Steptoe
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Healthcare, University College London, London, UK
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Demakakos P, Steptoe A, Mishra GD. Adverse childhood experiences are associated with increased risk of hysterectomy and bilateral oophorectomy: A national retrospective cohort study of women in England. BJOG 2022; 129:1481-1489. [PMID: 34978369 PMCID: PMC9250543 DOI: 10.1111/1471-0528.17088] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 12/16/2021] [Accepted: 12/22/2021] [Indexed: 11/29/2022]
Abstract
Objective To examine the associations between adverse childhood experiences (ACE) and the risk of hysterectomy and bilateral oophorectomy in a national sample of women in England. Design Retrospective cohort study. Setting A stratified random sample of households across England. Population 2648 women aged ≥55 years in 2007 from the English Longitudinal Study of Ageing (ELSA) were included in the bilateral oophorectomy analyses and 2622 in the hysterectomy analyses. Methods Logistic and multinomial logistic regression analyses of the associations between categories of the ACE summary score (0, 1, 2, ≥3 ACE), eight individual ACE, and hysterectomy and bilateral oophorectomy. Results 615 women had undergone hysterectomy and 259 women bilateral oophorectomy. We found graded associations between the summary ACE score and risk of hysterectomy and bilateral oophorectomy. In the fully adjusted model, compared with women with no ACE, those with ≥3 ACE had double the odds of hysterectomy (odds ratio [OR] 2.01, 95% confidence interval [CI] 1.30–3.11) and more than double the odds of bilateral oophorectomy (OR 2.61, 95% CI 1.54–4.42). The exclusion of women with cancer history made the associations stronger, especially in women who underwent hysterectomy at age <40 years or bilateral oophorectomy at age ≤44 years. Several individual ACE were positively associated with both outcomes. Conclusions ACE are associated with increased risk of hysterectomy and bilateral oophorectomy. Individual‐level covariates did not explain these associations. Our findings highlight the importance of a life course approach to understanding surgical menopause and add to our knowledge of the societal and public health impact of ACE. Tweetable abstract Adverse childhood experiences are associated with increased risk of hysterectomy and bilateral oophorectomy in a national sample of women in England. Adverse childhood experiences are associated with increased risk of hysterectomy and bilateral oophorectomy in a national sample of women in England. Linked article: This article is commented on by Walter A. Rocca, pp. 1491–1492 in this issue. To view this minicommentary visit https://doi.org/10.1111/1471-0528.17105.
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Affiliation(s)
- Panayotes Demakakos
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Andrew Steptoe
- Department of Behavioural Sciences and Health, University College London, London, UK
| | - Gita D Mishra
- School of Population Health, University of Queensland, Brisbane, Queensland, Australia
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Yuan J, Yu Y, Liu D, Sun Y. Associations between distinct dimensions of early life adversity and accelerated reproductive strategy among middle-aged women in China. Am J Obstet Gynecol 2022; 226:104.e1-104.e14. [PMID: 34384774 DOI: 10.1016/j.ajog.2021.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/21/2021] [Accepted: 07/27/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Life history theory argues that unpredictable and harsh conditions such as early life adversity tends to produce a fast life history strategy, characterized by early sexual maturation and less parenting of offspring. It remains unclear whether all forms of early life adversity are associated with accelerated reproductive strategy, and most previous studies predominantly focused on single form of reproductive strategy indicators. OBJECTIVE To examine the associations between 2 distinct dimensions of early life adversity (ie, threat and deprivation) and reproductive strategies across global metrics. STUDY DESIGN We used data from 9674 middle-aged women of the China Health and Retirement Longitudinal Study. The experiences of threat and deprivation were assessed using the Life History Survey Questionnaire in 2014. Reproductive strategy information was assessed via self-report from the follow-up of 2013, 2015 and 2018, including age at menarche, age at natural menopause, age at first birth, total number of children, and number of abortions. Multivariate linear regression analyses were performed to assess the associations between distinct dimensions of early life adversity and multiple reproductive strategy indicators, adjusting for age, Hukou location, family socioeconomic status in adulthood and body mass index. RESULTS Of the 9674 women (mean [standard deviation] age at baseline, 55.89 [10.23] years), 4084 (42.20%) reported exposure to threat-related early life adversity and 7332 (75.79%) reported exposure to deprivation-related early life adversity. Early life adversity characterized by threat was associated with accelerated reproductive strategy. Compared with women who have no experiences of threat-related early life adversity, ≥3 threat-related early life adversity was associated with 3.7-month earlier age at menarche (β=-0.31, 95% confidence interval, -0.53 to -0.08; P=.007), 8.6-month earlier age at natural menopause (β=-0.72, 95% confidence interval, -1.29 to -0.15; P=.013), >1-year earlier age at first birth (β=-1.14, 95% confidence interval, -1.58 to -0.71; P<.0001), and an increased total number of children (β=0.25, 95% confidence interval, 0.10-0.41; P=.002). In contrast, experiences of deprivation were associated with delayed age at natural menopause (β=.50, 95% confidence interval, 0.06-0.94; P=.025) and increased number of abortions (β=.17, 95% confidence interval, 0.01-0.34, P=.037), in models adjusting for co-occurring threat exposures. CONCLUSION This study suggests that early life adversity characterized by threat was associated with accelerated reproductive strategy, whereas deprivation was associated with slower reproduction strategy. Future research should clarify the biological pathways between different dimensions of early life adversity and reproductive strategies and further determine whether accelerated reproduction is an adaptive response to early life adversity in humans.
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O'Shea BQ, Demakakos P, Cadar D, Kobayashi LC. Adverse Childhood Experiences and Rate of Memory Decline From Mid to Later Life: Evidence From the English Longitudinal Study of Ageing. Am J Epidemiol 2021; 190:1294-1305. [PMID: 33534903 DOI: 10.1093/aje/kwab019] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 01/14/2021] [Accepted: 01/28/2021] [Indexed: 01/07/2023] Open
Abstract
Evidence on the role of early-life adversity in later-life memory decline is conflicting. We investigated the relationships between adverse childhood experiences (ACEs) and memory performance and rate of decline over a 10-year follow-up among middle-aged and older adults in England. Data were from biennial interviews with 5,223 participants aged 54 years or older in the population-representative English Longitudinal Study of Ageing from 2006/2007 to 2016/2017. We examined self-reports of 9 ACEs prior to age 16 years that related to abuse, household dysfunction, and separation from family. Memory was assessed at each time point as immediate and delayed recall of 10 words. Using linear mixed-effects models with person-specific random intercepts and slopes and adjusted for baseline age, participants' baseline age squared, sex, ethnicity, and childhood socioeconomic factors, we observed that most individual and cumulative ACE exposures had null to weakly negative associations with memory function and rate of decline over the 10-year follow-up. Having lived in residential or foster care was associated with lower baseline memory (adjusted β = -0.124 standard deviation units; 95% confidence interval: -0.273, -0.025) but not memory decline. Our findings suggest potential long-term impacts of residential or foster care on memory and highlight the need for accurate and detailed exposure measures when studying ACEs in relation to later-life cognitive outcomes.
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Thomas JL, Lewis JB, Ickovics JR, Cunningham SD. Associations between Adverse Childhood Experiences and Sexual Risk among Postpartum Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073848. [PMID: 33917634 PMCID: PMC8038841 DOI: 10.3390/ijerph18073848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/31/2021] [Accepted: 04/04/2021] [Indexed: 11/16/2022]
Abstract
Epidemiological evidence suggests that exposure to adverse childhood experiences (ACEs) is associated with sexual risk, especially during adolescence, and with maternal and child health outcomes for women of reproductive age. However, no work has examined how ACE exposure relates to sexual risk for women during the postpartum period. In a convenience sample of 460 postpartum women, we used linear and logistic regression to investigate associations between ACE exposure (measured using the Adverse Childhood Experiences Scale) and five sexual risk outcomes of importance to maternal health: contraceptive use, efficacy of contraceptive method elected, condom use, rapid repeat pregnancy, and incidence of sexually transmitted infections (STIs). On average, women in the sample were 25.55 years of age (standard deviation = 5.56); most identified as Black (60.4%), White (18%), or Latina (14.8%). Approximately 40% were exposed to adversity prior to age 18, with the modal number of experiences among those exposed as 1. Women exposed to ACEs were significantly less likely to use contraception; more likely to elect less-efficacious contraceptive methods; and used condoms less frequently (p = 0.041 to 0.008). ACE exposure was not associated with rapid repeat pregnancy or STI acquisition, p > 0.10. Screening for ACEs during pregnancy may be informative to target interventions to reduce risky sexual behavior during the postpartum period.
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Affiliation(s)
- Jordan L. Thomas
- Department of Psychology, University of California Los Angeles (UCLA), Los Angeles, CA 90095, USA;
| | - Jessica B. Lewis
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT 06510, USA;
| | - Jeannette R. Ickovics
- Yale-NUS College, Singapore 138527, Singapore;
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT 06510, USA
| | - Shayna D. Cunningham
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT 06032, USA
- Correspondence: ; Tel.: +1-860-679-7642
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