Maternal History of Adverse Childhood Experiences and Ambulatory Blood Pressure in Pregnancy

Abstract

Objective This study aimed to study the association between maternal history of childhood adversity and blood pressure in pregnancy. Methods A total of 127 pregnant women completed measures of adverse childhood experiences (ACE) and prenatal stress between June 2015 and April 2019. At 11 weeks’ gestation (range, 6–17 weeks), we measured 24-hour ambulatory blood pressure. All women were considered to be at risk for pregnancy complications due to elevated body mass index and self-reporting snoring in pregnancy. Results Women were, on average, 30 years old (range, 19–40 years), and average (standard deviation) body mass index in this sample was 34 (7) kg/m2 (range, 27–55 kg/m2). Higher ACE scores were associated with higher nighttime blood pressure (systolic blood pressure: β = 0.23, p = .013; diastolic blood pressure: β = 0.22, p = .028). There were no significant associations between the ACE score and daytime blood pressure. Women with four or more ACEs were more likely to display nocturnal blood pressure nondipping (odds ratio = 3.97, 95% confidence interval = 1.38–11.40). Associations between ACE and nocturnal blood pressure remained significant after adjusting for symptoms of prenatal stress. Conclusions Results indicate that experiences of childhood adversity are associated with elevated nocturnal blood pressure and loss of a typical decline in blood pressure between day and night.

Maternal exposure to childhood maltreatment and adverse birth outcomes

“…Mental health was indexed by presence of depressive symptoms in mid pregnancy based on a score of 16 or greater on the CES-D, a widely used tool designed to evaluate depressive symptomatology 32 , 47 , 48 . Hypertensive disorders of pregnancy included gestational hypertension, pre-eclampsia, or eclampsia diagnosed during pregnancy and documented in the medical record 25 , 49 . Any substance use during pregnancy was defined as any alcohol consumption, recreational drug use (marijuana, cocaine, heroin), or smoking since becoming pregnant.…”

“…Depression 17 – 19 , substance abuse 20 – 22 , obesity 23 , 24 , and hypertension 25 – 27 are common CM-associated sequelae that increase risk for adverse birth outcomes 28 – 32 and may thus mediate the association of CM with preterm birth and SGA. It is also possible that these sequelae may moderate these associations because CM-associated variation in maternal-placental-fetal stress biology has been shown to be especially pronounced in the presence of such sequelae 11 , 33 .…”