Patterns of adverse childhood experiences and associations with prenatal substance use and poor infant outcomes in a multi-country cohort of mothers: a latent class analysis.

BACKGROUND: This paper enumerates and characterizes latent classes of adverse childhood experiences and investigates how they relate to prenatal substance use (i.e., smoking, alcohol, and other drugs) and poor infant outcomes (i.e., infant prematurity and low birthweight) across eight low- and middle-income countries (LMICs). METHODS: A total of 1189 mother-infant dyads from the Evidence for Better Lives Study cohort were recruited. Latent class analysis using the Bolck, Croon, and Hagenaars (BCH) 3-step method with auxiliary multilevel logistic regressions was performed. RESULTS: Three high-risk classes and one low-risk class emerged: (1) highly maltreated (7%, n = 89), (2) emotionally and physically abused with intra-familial violence exposure (13%, n = 152), (3), emotionally abused (40%, n = 474), and (4) low household dysfunction and abuse (40%, n = 474). Pairwise comparisons between classes indicate higher probabilities of prenatal drug use in the highly maltreated and emotionally abused classes compared with the low household dysfunction and abuse class. Additionally, the emotionally and physically abused with intra-familial violence exposure class had higher probability of low birthweight than the three remaining classes. CONCLUSION: Our results highlight the multifaceted nature of ACEs and underline the potential importance of exposure to childhood adversities on behaviors and outcomes in the perinatal period. This can inform the design of antenatal support to better address these challenges.

Using network analysis to illuminate the intergenerational transmission of adversity.

Objective: The effects of maternal exposure to adverse childhood experiences (ACEs) may be transmitted to subsequent generations through various biopsychosocial mechanisms. However, studies tend to focus on exploring one or two focal pathways with less attention paid to links between different pathways. Using a network approach, this paper explores a range of core prenatal risk factors that may link maternal ACEs to infant preterm birth (PTB) and low birthweight (LBW). Methods: We used data from the Avon Longitudinal Study of Parents and Children (ALSPAC) (n = 8379) to estimate two mixed graphical network models: Model 1 was constructed using adverse infant outcomes, biopsychosocial and environmental risk factors, forms of ACEs, and sociodemographic factors. In Model 2, ACEs were combined to represent a threshold ACEs score (≥4). Network indices (i.e., shortest path and bridge expected influence [1-step & 2-step]) were estimated to determine the shortest pathway from ACEs to infant outcomes, and to identify the risk factors that are vital in activating other risk factors and adverse outcomes. Results: Network analyses estimated a mutually reinforcing web of childhood and prenatal risk factors, with each risk connected to at least two other risks. Bridge influence indices suggested that childhood physical and sexual abuse and multiple ACEs were highly interconnected to others risks. Overall, risky health behaviours during pregnancy (i.e., smoking & illicit drug use) were identified as 'active' risk factors capable of affecting (directly and indirectly) other risk factors and contributing to the persistent activation of the global risk network. These risks may be considered priority candidate targets for interventions to disrupt intergenerational risk transmission. Our study demonstrates the promise of network analysis as an approach for illuminating the intergenerational transmission of adversity in its full complexity. HIGHLIGHTS: We took a network approach to assessing links between ACEs and birth outcomes.ACEs, other prenatal risk factors, and birth outcomes had complex inter-connectionsHealth behaviours in pregnancy were indicated as optimal intervention targets.

Objetivo: Los efectos de la exposición materna a experiencias adversas en la infancia (ACEs, en sus siglas en inglés) pueden ser transmitidos a las generaciones posteriores a través de varios mecanismos biopsicosociales. Sin embargo, los estudios tienden a centrarse en la exploración de una o dos vías focales, prestando menos atención a los vínculos entre diferentes vías. Utilizando un abordaje de red, este trabajo explora una serie de factores de riesgo prenatales centrales que pueden vincular las ACEs maternas con el nacimiento prematuro (PTB, en sus siglas en inglés) y el bajo peso al nacer (LBW, en sus siglas en inglés) de los bebés.Métodos: Se utilizaron datos del Estudio Longitudinal de Padres e Hijos de Avon (ALSPAC) (n = 8.379) para estimar dos modelos de red gráfica mixta: El modelo 1 se construyó utilizando los resultados adversos del lactante, los factores de riesgo biopsicosociales y ambientales, las formas de las ACE y los factores sociodemográficos. En el modelo 2, las ACEs se combinaron para representar una puntuación de ACEs umbral (≥ 4). Se estimaron los índices de red (es decir, el camino más corto y la influencia esperada del puente [1 y 2 pasos]) para determinar el camino más corto desde las ACEs hasta los resultados infantiles, y para identificar los factores de riesgo que son vitales para activar otros factores de riesgo y resultados adversos.Resultados: Los análisis de redes estimaron una red de factores de riesgo prenatales y de la infancia que se refuerzan mutuamente, y cada riesgo está conectado con al menos otros dos riesgos. Los índices de influencia de los puentes sugirieron que el abuso físico y sexual en la infancia y los múltiples ACEs estaban altamente interconectados con otros riesgos. En general, las conductas de riesgo para la salud durante el embarazo (es decir, el tabaquismo y el consumo de drogas ilícitas) se identificaron como factores de riesgo "activos" capaces de afectar (directa e indirectamente) a otros factores de riesgo y de contribuir a la activación persistente de la red de riesgo global. Estos riesgos pueden considerarse objetivos candidatos prioritarios para las intervenciones destinadas a interrumpir la transmisión intergeneracional del riesgo. Nuestro estudio demuestra la promesa del análisis de redes como abordaje para iluminar la transmisión intergeneracional de la adversidad en toda su complejidad.

Associations Between ADHD Symptoms and Maternal and Birth Outcomes: An Exploratory Analysis in a Multi-Country Cohort of Expectant Mothers.

OBJECTIVE: ADHD symptoms can adversely impact functioning in a range of domains relevant for maternal well-being and fetal development; however, there has been almost no research examining their impact during pregnancy. We aimed to address this gap. METHOD: We used data (n = 1,204) from a longitudinal birth cohort study spanning eight countries to address this gap. RESULTS: ADHD symptoms in the third trimester of pregnancy were associated with lower social support from family (b = -0.16, p = .031), friends (b = -0.16, p = .024), and significant others (b = -0.09, p = .001); higher stress (b = 0.34, p < .001) and depressive symptoms (b = 0.31, p < .001), and increased likelihood of an unwanted pregnancy (b = 0.30, p = .009). Significant associations with tobacco use (b = 0.36, p = .023) and premature birth (b = 0.35, p = .007) did not survive correction for multiple comparisons and there were no significant associations with alcohol use, low birth weight, or unplanned pregnancy. CONCLUSION: Results suggest that women with ADHD symptoms could benefit from earlier, more regular screening for mental health difficulties and greater mental health support during pregnancy.

Measuring antenatal depressive symptoms across the world: A validation and cross-country invariance analysis of the Patient Health Questionnaire-9 (PHQ-9) in eight diverse low-resource settings.

Measures that produce valid and reliable antenatal depressive symptom scores in low-resource country contexts are important for efforts to illuminate risk factors, outcomes, and effective interventions in these contexts. Establishing the psychometric comparability of scores across countries also facilitates analyses of similarities and differences across contexts. To date, however, few studies have evaluated the psychometric properties and comparability of the most widely used antenatal depressive symptom measures across diverse cultural, political, and social contexts. To address this gap, we used data from the Evidence for Better Lives Study-Foundational Research (EBLS-FR) project to examine the internal consistency reliability, nomological network validity, and cross-country measurement invariance of the nine-item version of the Patient Health Questionnaire (PHQ-9) in antenatal samples across eight low-resource contexts. We found that the PHQ-9 scores had good internal consistency across all eight countries. Correlations between PHQ-9 scores and constructs conceptually associated with depression were generally consistent, with a few exceptions. In measurement invariance analyses, only partial metric invariance held and only across four of the countries. Our results suggest that the PHQ-9 yields internally consistent scores when administered in culturally diverse antenatal populations; however, the meaning of the scores may vary. Thus, interpretation of PHQ-9 scores should consider local meanings of symptoms of depression to ensure that context-specific conceptualizations and manifestations of antenatal depressive symptoms are adequately reflected. (PsycInfo Database Record (c) 2022 APA, all rights reserved).