Adverse childhood experiences, resilience screening may ID pregnancy depression, anxiety

Key takeaways:

• Adverse childhood experiences and low resilience were independently tied to depression and anxiety in pregnancy.
• Four or more adverse childhood experiences and low resilience led to greater odds of each outcome.

Routine screening for adverse childhood experiences and resilience may identify women at risk for developing depression or anxiety during pregnancy, according to a retrospective cohort study published in Obstetrics & Gynecology.

“Pregnant patients who have a history of adverse childhood experiences and low resilience were more likely to develop a new diagnosis of depression or anxiety during pregnancy,” Carey R. Watson, MD, FACOG, an OB/GYN with The Permanente Medical Group, told Healio. “Identifying patients who may be at risk could help us intervene early or possibly prevent a mental health disorder for the patient, and thereby potentially prevent or mitigate future adverse childhood experiences for the newborn or other children in the family.”

Watson and colleagues conducted a retrospective cohort study with data from 14,625 pregnant women from the Kaiser Permanente Northern California system. At 16 weeks gestation, all women were screened for adverse childhood experiences and resilience, defined as the ability to resist and recover from adversity, during a standard prenatal care visit from October 2021 to March 2023.

Researchers identified adverse childhood experiences using the California ACEs Aware 10-item screening questionnaire and assessed resilience with an 8-item validated screening tool. New depression or anxiety diagnoses were based on prenatal ICD-10 codes without diagnosed depression or anxiety within 2 years of pregnancy and new depressive symptoms were prenatal depressive symptoms based on routine prenatal care screening without diagnosed depression within 2 years of pregnancy.

Overall, 65.1% of women had no adverse childhood experiences, 13.8% had one, 11.8% had two or three and 9.3% had four or more adverse childhood experiences, and 28.9% of women had low resilience. In addition, 17% of women had newly identified depression, 9.8% had newly identified depressive symptoms and 8.9% had newly identified anxiety during pregnancy.

Adverse childhood experiences and low resilience were independently associated with higher odds of newly identified depression, depressive symptoms and anxiety in pregnancy. Women with four or more vs. no adverse childhood experiences had higher odds of depression (adjusted OR = 3.18; 95% CI, 2.74-3.69), depressive symptoms (aOR = 3.03; 95% CI, 2.52-3.66) and anxiety (aOR = 2.57; 95% CI, 2.16-3.06). Women with low vs. high resilience had higher odds of depression (aOR = 2.13; 95% CI, 1.93-2.36), depressive symptoms (aOR = 3.1; 95% CI, 2.71-3.54) and anxiety (aOR = 2.02; 95% CI, 1.79-2.29).

When combining adverse childhood experiences and resilience, women with four or more adverse childhood experiences and low resilience had higher odds of depression (aOR = 6.43; 95% CI, 5.23-7.9), depressive symptoms (aOR = 9.49; 95% CI, 7.5-12) and anxiety (aOR = 4.79; 95% CI, 3.81-6.02) compared with women with no adverse childhood experiences and high resilience.

According to Watson, these results suggest that early life experiences and the ability to withstand and “bounce back” from adversity may impact emotional health in adulthood.

“We are seeking funding to carry out similar research to explore other health outcomes, and to identify which support mechanisms and referrals best support pregnant patients who have experienced adverse childhood experiences and/or who have low resilience,” Watson said.