Psychological functioning in pregnant women who experienced complex trauma

The concept of complex trauma, which has been operationalized by the diagnosis of developmental trauma disorder (DTD) in children and adolescents, may contribute to our understanding of the large interindividual variability in maternal health and functioning among pregnant women who experienced childhood maltreatment. The study examines whether three groups of pregnant women (one including women who experienced childhood maltreatment and suffered from DTD, a second including women who experienced childhood maltreatment but did not suffer from DTD, and a third group including women who did not report experiencing childhood maltreatment) differ on mental health and functioning during the prenatal period. Several markers associated with the intergenerational trajectories of childhood maltreatment were examined: severity of PTSD symptoms, quality of prenatal attachment, perception of maternal competence, reflective functioning, disruptions in mentalization of trauma and adverse relationships, intimate partner violence, and mental health disorders.

The study includes 373 pregnant women who participated in a comprehensive diagnostic assessment of current and lifetime psychiatric disorders conducted by two blinded and independent clinical psychologists. The women also completed self-report measures of symptoms and functioning.

Women with DTD (n = 26) had more severe symptoms of PTSD, lower quality of prenatal attachment to the fetus, lower perceptions of maternal competence, less curiosity about mental states, and more severe disruptions in mentalizing trauma and adverse relationships than women who experienced childhood maltreatment but never met the diagnostic criteria for a DTD (n = 99) and women not exposed to childhood maltreatment (n = 248). In contrast, women who experienced childhood maltreatment but did not develop a DTD did not differ from women not exposed to maltreatment on all domains except the level of disruptions in mentalizing trauma and adverse relationships. Women who had a DTD in childhood or adolescence also had an 18.5-fold and 25.4-fold increased risk of having a mental health disorder during pregnancy compared, respectively, to women who had experienced maltreatment without DTD and women who had not experienced maltreatment. Persistent complex trauma, defined as the presence of a diagnosis of Complex PTSD during pregnancy, was present in over a third (34.6%) of women with DTD.