Impact of Maternal Childhood Adversity on the Psycho-Neuroendocrine-Inflammatory Profile during Pregnancy

Saturday, 7 November 2015

Karen J. Kotz, MSN, BSN, RN, NNP-BC1
Dina Tell Cooper, PhD, BA2
Herbert L. Mathews, PhD3
Linda Witek Janusek, PhD, BS, RN, FAAN1
(1)Niehoff School of Nursing, Loyola University Chicago, Maywood, IL, USA
(2)Schools of Nursing and Medicine, Loyola University Chicago, Maywood, IL, USA
(3)Microbiology and Immunology, School of Medicine, Loyola University Chicago, Maywood, IL, USA

Background: Pregnancy is accompanied by a multitude of physical and psychological changes.  Adaptation to these changes through reduced anxiety and attenuated stress responsiveness is necessary across gestation for optimal maternal infant health.  Ample evidence demonstrates that perception of high levels of psychosocial stress and/or mood disturbance during pregnancy can disrupt neuroendocrine-inflammatory processes required for successful pregnancy outcomes. In particular, precise regulation of circulating proinflammatory cytokines across gestation is critical for the maintenance of pregnancy; lower levels during mid gestation keep the uterus in a quiescent state, whereas, near term levels of proinflammatory cytokines increase to initiate birth.

Purpose: The primary aim was to examine the relationship between maternal childhood adversity and prenatal levels of stress, depression, and proinflammatory cytokines; and, secondly, to explore the relationship of these variables with neonatal birth outcomes. 

Significance/Rationale: Increased proinflammatory cytokines during pregnancy are linked to maternal depressive risk and poor birth outcomes. Maternal exposure to  childhood adversity and poverty may intensify each of these, predisposing to health disparity in birth outcomes.

Methods/Analysis: During their second (16-24 weeks gestation) and third trimester (28-32 weeks) of pregnancy, women (N=64), 18-39 years old, provided a blood sample to measure the proinflammatory cytokine, TNF-alpha; and completed instruments measuring childhood adversity (Child Trauma Questionnaire), perceived stress (Perceived Stress Scale), depression (Center for Epidemiologic Studies-Depression and Edinburgh Depression Scale) and social support (Social Provisions Scale). Childhood adversity assessed: emotional neglect/abuse, physical neglect/abuse and sexual abuse. Poverty was determined by current household income and number in the household per federal guidelines. Correlations among variables were evaluated and moderation analysis explored interaction effects.

Results: Nearly 25% of the sample reported exposure to childhood adversity, and women with greater childhood adversity had increased perceived stress and increased depressive symptoms. Also, women reporting greater depressive symptoms had higher plasma TNF-alpha levels. Moderation analysis revealed that women exposed to childhood adversity, together with current household poverty, had higher levels of TNF-alpha. Evaluation of relationships with birth outcomes revealed that women with greater childhood adversity and higher TNF-alpha delivered lower birth weight infants.  Also, exposure to childhood adversity was associated with lower infant gestational age; however, higher levels of social support moderated (attenuated) this relationship.

Conclusion:Maternal childhood adversity associates with greater psychological morbidity during pregnancy and poorer neonatal outcomes.

Implications. Findings emphasize the need for prenatal psychosocial screening to include assessment of childhood adversity and the encouragement of social support to buffer negative effects of childhood adversity on birth outcomes.