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The Effects of Adverse Childhood Experiences on Prenatal and Postnatal Distress during the COVID-19 Pandemic

Wed, April 7, 10:15 to 11:15am EDT (10:15 to 11:15am EDT), Virtual

Abstract

Maternal mental health during the prenatal and postnatal periods is a critical component in understanding the children’s developmental trajectories (Kingston & Tough, 2014). Adverse Childhood Experiences (ACEs) have detrimental effects on individuals, increasing their susceptibility to future stress, and likely influence women’s mental health and vulnerability to distress during the pre- and postnatal periods (Hammen et al., 2000). Moreover, ACEs may convey additive impact during times of significant stress such as the COVID-19 pandemic. The current study investigates how ACEs relate to prenatal and postpartum distress as well as maternal-infant bonding during a global pandemic. Since Black mothers are at a greater disadvantage than White mothers regarding the negative mental health effects of the pandemic (Gur et al., 2020) and the experience of ACEs, perhaps due to systemic racism in America, we specifically aim to understand how ACEs may disproportionately affect Black women and their children.

Pregnant women (N=819, mean age 32.7, 20.6% non-Hispanic Black, 70.1% non-Hispanic White women, mean GA 24.7 weeks) were assessed during a stay-at-home mandate in the region. Assessments were completed via online surveys. During pregnancy, women reported on: ACEs, anxiety (Generalized Anxiety Disorder-7), depression (Patient Health Questionnaire-2), and general and pregnancy specific pandemic-related worries. Post-partum data collection at 8-15 weeks postpartum is ongoing (completion date is February 2021, current n=418). During the postpartum assessment, women report on their depression (Edinburgh Postnatal Depression Scale) and mother-infant bonding (Postpartum Bonding Questionnaire).

Results revealed that 56.3% of the women reported 1 or more ACEs. The average total number of ACEs was significantly higher in Black women (Mean=2.22) than White women (Mean=1.03), t(704)=6.61,p<.001). Partial correlations, controlling for SES, gestational age, maternal age, marital status, and parity, revealed a small, but significant relation between total ACEs and total COVID-19 worries during pregnancy (r(812) = .09, p = .008). When examining race differences between correlations of total ACEs and specific worry items, many of the correlations were significantly stronger in Black women (i.e., worries about contracting COVID-19 for family and self, dying from COVID-19, and having a good birthing experience during COVID-19; all Fishers Zs>1.7, ps<.04). Report of total ACEs was associated with prenatal anxiety (Wald 2(1)=4.55, p=.03) and depression (Wald 2(1)=26.48, p<.001); this pattern did not differ by race (ps>.31).

Preliminary analysis of available post-partum data showed that ACEs had persistent, significant association with postpartum reports of anxiety, depression, and loneliness, above and beyond depression and anxiety reported during pregnancy (all rs>.19, ps<.001). ACEs did not predict mother-infant bonding. Interactions with race and postpartum variables will be examined at data collection completion.

Stress and depression during pregnancy and postpartum periods has detrimental effects on child outcomes (Glover, 2014); this link appears stronger in women with more ACEs. Given the prevalence of high numbers of ACEs in Black women coupled with the disproportionate negative effects of COVID-19 pandemic on the Black community and the prevalence of anti-Black racism in America, it is important to examine pregnancy and postpartum mental health in Black women.

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