Maternal Adverse Childhood Experiences, Postpartum Care Utilisation, and Postpartum Depressive Symptoms

Adverse childhood experiences (ACEs) are known predictors of mental health outcomes later in life. To date, few studies have examined ACEs and postpartum mental health, and data are limited on the role of ACEs in the utilisation of postpartum care, which is important for identifying women at risk of postpartum depression.

We evaluated the associations between ACEs and postpartum depressive symptoms (PDS) and utilisation of postpartum care (maternal postpartum checkup and depression screening).

We conducted a serial, cross-sectional study using the Pregnancy Risk Assessment and Monitoring System (PRAMS) data from 2016 to 2022. PRAMS is a population-based surveillance system implemented by state health departments among women who have had a recent live birth. The sample included four jurisdictions with ACE data (n = 23,913). Self-reported outcomes included receipt of a postpartum checkup, being asked about depression during the postpartum visit, and PDS. Logistic regression models accounting for complex survey weighting estimates provided confounder-adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs) for the associations of ACEs (individual and score) and outcomes.

The prevalence of 0, 1, 2-3, or ≥ 4 ACEs was 48.8%, 25.6%, 17.9%, and 7.6%, respectively. The prevalence of PDS was 15.2%. In adjusted models, ACEs were associated with increased prevalence of PDS, with PRs being 1.17 (95% CI 1.03, 1.30), 1.40 (95% CI 1.23, 1.57), and 1.86 (95% CI 1.60-2.13) for 1, 2-3, and ≥ 4 ACEs, respectively. Each individual ACE was associated with increased prevalence of PDS. ACEs were also associated with increased prevalence of no maternal postpartum checkup but were not associated with maternal depression screening.

In this large population-based study, we found that women with higher ACEs had increased prevalence of maternal PDS. Findings support the need for prenatal screening for ACEs and for providing postpartum support and resources for women with a history of ACEs.