The impact of adverse childhood experiences on postpartum post-traumatic stress disorder in women: A prospective cohort study in China.

Background: Women are more prone to experience adverse childhood experiences (ACEs), placing them at higher risk of postpartum mental health disorders. However, research on ACEs, particularly their association with postpartum Post-Traumatic Stress Disorder (PTSD) in non-Western contexts, is limited.

Objective: To utilize a cumulative risk approach and latent class analysis (LCA) to operationalize ACEs among postpartum women in China and examine their association with postpartum PTSD.

Methods: In this prospective cohort study, 856 eligible participants from a tertiary hospital in Guangdong province of China between October 2022 and August 2023 completed assessments of demographic and obstetric characteristics, and ACEs within 2-3 days postpartum, followed by PTSD evaluation at 42 days postpartum. The cumulative risk approach and LCA were employed to operationalize ACEs, and their association with postpartum PTSD was assessed using log-binomial regression models, adjusting for potential confounders.

Results: Among the participants, 80.4 % (688/856) reported ACEs, with 18.2 % experiencing four or more ACEs, a threshold above which there was a particularly higher risk of postpartum PTSD in the adjusted model (OR = 8.27, 95 % CI = 3.08-22.20). LCA identified three groups: low ACEs, household and community violence, and multiple ACEs, with women in the multiple ACEs group exhibiting the most severe postpartum PTSD symptoms in the adjusted model (OR = 4.39, 95 % CI = 1.58-12.24).

Conclusions: This study demonstrates that ACEs are a significant risk factor for postpartum PTSD, especially for women who have experienced four or more ACEs, or multiple ACEs, placing them at particularly high risk for developing postpartum PTSD.