童年虐待与中年期妊娠相关生殖健康：一项前瞻性研究

原文

BACKGROUND: Childhood maltreatment is a major public health concern in the U.S. and globally with long-term consequences for physical and mental health. Whether childhood maltreatment predicts problematic reproductive health outcomes is unknown as the existing literature reveals mixed results with a heavy reliance on retrospective studies, and of the very few prospective studies, follow-up does not extend beyond 21 years of age. This study leveraged a unique prospective cohort with court documented cases of childhood abuse and neglect and 30-years follow-up in middle adulthood on pregnancy-related reproductive health outcomes. OBJECTIVE: Conduct a rigorous, prospective study of associations between childhood maltreatment and reproductive health in middle adulthood, leveraging a unique prospective cohort, to overcome methodological weaknesses in previous studies that rely primarily on retrospective reports of childhood maltreatment. STUDY DESIGN: A prospective longitudinal follow-up of children aged 0-11 years with court documented cases of physical abuse, sexual abuse, and neglect, from a U.S. Midwestern County (1967-1971) and a demographically matched comparison group (original study of 1575 children). At 30-years follow-up (2003-2005), 807 adult participants completed medical status examinations and comprehensive health interviews; the final sample includes N=426 (52.7%) females, based on biological sex at birth, who responded to a module on reproductive health. In regression analyses, we investigated whether childhood maltreatment (any exposure) and subtypes of childhood maltreatment (physical abuse, sexual abuse, and neglect) affected giving birth preterm or to low birth weight infants, infertility, teen pregnancy, and breastfeeding, and explored gravidity (number of pregnancies) and parity (number of live births). Covariates considered were demographic factors and physical health indicators previously associated with childhood maltreatment and reproductive health, including poor glycemic control (indicator of risk for diabetes), high body mass index (BMI), sexually transmitted infections and diseases (STIs and STDs), hepatitis C, human immunodeficiency virus (HIV), and smoking. RESULTS: At 30-years follow-up, participants were mean age=41.39 years (SD=3.58, range 32-49). Adjusting for age, race, employment, marital status, and high school education (selected based on group differences P<.05), the childhood maltreatment group had increased odds of giving birth to low birth weight infants (<5.5lbs; P<.05) and significantly higher gravidity (P<.05). By maltreatment subtype, the sexual abuse subgroup had increased odds for infertility (P<.05) and engagement with breastfeeding (P<.05), and the neglect subgroup had increased odds of giving birth to low birth weight infants (P<.01) and significantly higher gravidity (P<.05). Sensitivity analyses adjusting for poor glycemic control attenuated the associations. CONCLUSION: Childhood maltreatment influences reproductive health, in some instances leading to increased risk, such as infants born low birth weight, and in others leading to a positive health behavior, greater breastfeeding engagement. Maltreatment also led to higher gravidity (pregnancies) but not parity (live births), possibly indicating increased pregnancy loss. Poor glycemic control played an important role in understanding these associations, interpreted as possible chronic alterations in stress hormones affecting reproductive health. Findings suggest opportunity for trauma-responsive preventive interventions for individuals exposed to childhood maltreatment. Future research directions are the systematic examination of biological and behavioral mechanisms in these associations.