The role of childhood adversity and prenatal mental health as
psychosocial risk factors for adverse delivery and neonatal outcomes: a
prospective cohort study
Objective. To examine the association between adverse childhood
experiences (ACE), prenatal common mental disorders (PCMDs) and delivery
and neonatal outcomes. Also, to examine the overall effect of ACE and
individual ACE subcategories on PCMD diagnosis and obstetric outcomes.
Design. Prospective cohort study from pregnancy to birth. Setting. The
study was based on an Icelandic cohort study and supplemented with
maternal childbirth records from three hospitals in Iceland. Sample.
Women recruited in the cohort study who had accessible childbirth
records and singleton births (N = 522). Methods. Bayesian SEM was used
to test pathways between ACE, PCMD and delivery and neonatal outcomes
with probit regression models. Main outcome measures. ACE was assessed
with a semi-structured interview. PCMD was diagnosed with the MINI+.
Delivery outcomes were defined as pain management during labor and mode
of delivery. Neonatal outcomes were defined as small for gestational age
(SGA), preterm delivery (PD), Apgar score, fetal distress, and newborn
intensive care unit (NICU) admissions. Results. Women having experienced
ACE were at increased risk of PCMD [β=.538, p < .001, CI:
.195-1.154] and PD [β=.768, p < .05, CI: .279 - 1.007)].
An indirect association was found between ACE and increased risk of
non-spontaneous delivery [β=.054, p < .05, CI: .004 -
.152], mediated by PCMD. Identical findings were observed for
individual ACE subcategories. Conclusion. The negative impact of ACE on
non-spontaneous delivery is mediated by the impact of ACE on PCMD
diagnosis suggesting that interventions aimed at decreasing PCMD may
reduce the risk of non-spontaneous delivery.