Exposure to childhood maltreatment and systemic inflammation across pregnancy: The moderating role of depressive symptomatology.

BACKGROUND: Childhood maltreatment (CM) has long-term consequences for dysregulation of the immune system which is particularly pronounced when mental and physical health sequelae have manifested. Higher proinflammatory state has been shown in non-pregnant state in association with CM as well as with depression, one of the most frequent and pernicious psychiatric sequelae of CM. During pregnancy, however, this association is less clear. Given the important role of maternal inflammatory state during pregnancy for fetal, pregnancy, and birth outcomes, we sought to examine the association between CM and proinflammatory state during pregnancy considering the moderating role of maternal depressive symptoms characterized serially across pregnancy. METHODS: A prospective, longitudinal study of 180 healthy pregnant women was conducted with serial assessments in early (12.98 ± 1.71 weeks gestation), mid (20.53 ± 1.38 weeks gestation) and late (30.42 ± 1.4 weeks gestation) pregnancy. Maternal history of CM was assessed with the Childhood Trauma Questionnaire (CTQ) and the total score was used as an indicator of CM experience. Maternal depressive symptoms were assessed at each pregnancy visit with the Center for Epidemiologic Studies Depression Scale (CES-D). Serum concentrations of tumor necrosis factor (TNF)-α and interleukin (IL)-6 were obtained at each pregnancy visit and combined to a composite maternal proinflammatory score. Linear mixed effects models were employed to assess the association between CTQ score, CES-D score, and proinflammatory score during pregnancy, adjusting for potential confounders. RESULTS: Gestational age was associated with the proinflammatory score (B = 0.02; SE = 0.00; p < .001), indicating an increase in inflammation across gestation. Neither CTQ score nor depressive symptoms were independently associated with the proinflammatory score (ps > 0.28). However, the interaction between CTQ score and depressive symptoms was associated with the proinflammatory score (B = 0.03, SE = 0.01, p < .05), indicating higher inflammation across pregnancy with increasing levels of depressive symptoms during pregnancy in women with higher CTQ scores. Exploratory analyses suggested that this interaction was mainly driven by CTQ subscale scores assessing experiences of abuse rather than neglect. CONCLUSIONS: These findings suggest a moderating role of maternal depressive symptoms during pregnancy on the association of early life stress with inflammation and thus highlight the importance of the timely assessment of both CM exposure and depressive symptoms which might allow for the development of targeted and individualized interventions to impact inflammation during pregnancy and to ameliorate the detrimental long-term effects of CM. The current findings add to a better understanding of the prenatal biological pathways that may underlie intergenerational transmission of maternal CM.

Prospective association of maternal psychosocial stress in pregnancy with newborn hippocampal volume and implications for infant social-emotional development.

Maternal psychosocial stress during pregnancy can impact the developing fetal brain and influence offspring mental health. In this context, animal studies have identified the hippocampus and amygdala as key brain regions of interest, however, evidence in humans is sparse. We, therefore, examined the associations between maternal prenatal psychosocial stress, newborn hippocampal and amygdala volumes, and child social-emotional development. In a sample of 86 mother-child dyads, maternal perceived stress was assessed serially in early, mid and late pregnancy. Following birth, newborn (aged 5-64 postnatal days, mean: 25.8 ± 12.9) hippocampal and amygdala volume was assessed using structural magnetic resonance imaging. Infant social-emotional developmental milestones were assessed at 6- and 12-months age using the Bayley-III. After adjusting for covariates, maternal perceived stress during pregnancy was inversely associated with newborn left hippocampal volume (ß = -0.26, p = .019), but not with right hippocampal (ß = -0.170, p = .121) or bilateral amygdala volumes (ps > .5). Furthermore, newborn left hippocampal volume was positively associated with infant social-emotional development across the first year of postnatal life (B = 0.01, p = .011). Maternal perceived stress was indirectly associated with infant social-emotional development via newborn left hippocampal volume (B = -0.34, 95% CIBC [-0.97, -0.01]), suggesting mediation. This study provides prospective evidence in humans linking maternal psychosocial stress in pregnancy with newborn hippocampal volume and subsequent infant social-emotional development across the first year of life. These findings highlight the importance of maternal psychosocial state during pregnancy as a target amenable to interventions to prevent or attenuate its potentially unfavorable neural and behavioral consequences in the offspring.

Childhood traumatic events and loss of control eating in pregnancy: Findings from a community sample of women with overweight and obesity.

Although eating disorder symptoms generally decrease in pregnancy, loss of control eating (LOC), defined by the consumption of food accompanied by a sense of being unable to control what or how much is eaten, often persists and may develop in pregnancy. Given that LOC is associated with higher weight status and psychological distress, it is important to understand factors associated with perinatal LOC. Although childhood traumatic events have been linked to LOC in non-pregnant women, the impact of such events on LOC in pregnancy is unknown. Accordingly, the present study aimed to examine the association between a history of childhood traumatic events and LOC prior to and during pregnancy among a community sample of pregnant women with overweight or obesity. Pregnant women (N = 244) were enrolled in a longitudinal study. Women completed interviews between 12 and 20 weeks gestation to document a history of childhood traumatic events and the presence of LOC in the three months prior to and during their current pregnancy. Women were assessed for LOC monthly for the remainder of pregnancy. Results from a multinomial regression model showed that women with a history of childhood traumatic events had higher odds of engaging in LOC both prior to and during pregnancy (OR = 2.52, 95% CI [1.13, 5.64], p = 0.02) but not during pregnancy only (OR = 1.58, 95% CI [0.87, 2.89], p = 0.39). These findings indicate that women with a history of childhood traumatic events may be especially prone to LOC in the months prior to conception that continues throughout pregnancy.

Sense of coherence in long-term follow-up of adolescents with anorexia nervosa.

BACKGROUND: Sense of coherence (SOC) is a personal resource that allows people to stay healthy in spite of stressful situations. SOC is known to be low in eating disorders. We explored whether SOC correlated with anorexia nervosa (AN) symptoms several years after initial hospitalization for AN, to inform us whether AN treatment concepts could more specifically focus on increasing SOC. METHODS: Former patients were contacted 5-11 years after hospitalization for AN in a German integrative medicine hospital. Participants completed the Eating Disorder Inventory (EDI-2) and the SOC Questionnaire (SOC-13). Hospital records were reviewed. Correlations between EDI-2 subscales and SOC-13 were tested. A t-test was conducted to assess the difference between the SOC-13 and the norm. A median split was performed, dividing SOC scores into two groups and comparing these with EDI-2 subscales. RESULTS: Of 149 previously hospitalized female patients, 83 could be contacted and 68 agreed to participate (46%). 17.6% self-reported that they currently suffered from an eating disorder. The mean follow-up time was 7.2 years. All EDI-2 subscales correlated negatively with the SOC-13 score (p < .01). The mean SOC was significantly lower than the norm (p < .001). In the median split, the lower SOC group had significantly higher scores on all EDI-2 subscales. CONCLUSIONS: Amongst previously hospitalized AN patients, the SOC was lower than a normative sample and correlated with on-going eating disorder symptoms in long-term follow-up. Strengthening SOC as a personal resource should be incorporated as a specific goal in AN treatment and its impact on long-term outcomes evaluated.