Abstract：
BACKGROUND: Childhood maltreatment (CM) has long-term consequences for the regulation of stress biology which are particularly pronounced when mental and physical health sequelae have manifested. C-reactive protein (CRP) has been shown to be elevated in the non-pregnant state in association with CM as well as in the setting of CM-associated mental and physical health sequelae. In pregnancy, however, the association between CM and CRP is less clear. We sought to examine this association and consider the moderating role of four common health sequelae of CM (maternal depressive symptoms, overweight/obesity, smoking, and hypertensive disorders during pregnancy).
METHODS: A prospective, longitudinal study of 744 healthy pregnant participants was conducted, with analyses focusing on a sample of 643 participants. CM was assessed with the Childhood Trauma Questionnaire (CTQ) and categorized by whether no vs. one or more moderate to severe CM experiences were reported. Blood serum concentrations of CRP, maternal depression severity (continuous scores of the Center for Epidemiologic Studies Depression Scale, CES-D) and smoking during pregnancy were assessed in early (16.52 ± 2.50 weeks gestation) and late (33.65 ± 1.18 weeks gestation) pregnancy. Pre-pregnancy body mass index (BMI) was obtained at the first study visit and hypertensive disorders diagnosed during pregnancy were obtained from the medical record. Linear mixed effects models were employed to assess main effects of CM as well as interactive effects of CM and four common CM-associated sequelae as well as a sum score of these sequelae on repeatedly measured CRP concentration. In secondary analyses, we conducted latent class analyses to classify participants based on their specific experiences of childhood abuse and/or neglect and to assess the association of these CM subgroups with CM sequelae and CRP. All analyses were adjusted for potential confounders (maternal race and ethnicity and education/income).
RESULTS: CRP concentration decreased from early to late pregnancy (B = -0.06, SE = 0.01, p < 0.001). While there was no main effect of CM on CRP (p = 0.49), the interaction of CM and depressive symptoms was associated with CRP concentration (B = 0.08, SE = 0.04, p < 0.05), indicating higher CRP across pregnancy with increasing levels of depressive symptoms during pregnancy in participants with CM experience. This interaction was mainly driven by participants with co-occurring physical and emotional maltreatment. For none of the other CM-associated sequelae a statistically significant interaction with CM on CRP concentration was observed.
CONCLUSIONS: These results add to the growing empirical evidence suggesting higher inflammation during pregnancy in participants exposed to CM who experience depressive symptoms and highlight the detrimental effects of multiple co-occurring experiences of maltreatment. Given the negative consequences of chronic inflammatory state for the mother and the developing fetus, monitoring and treating psychiatric sequelae during pregnancy among participants exposed to CM is potentially an important opportunity to dampen long-term detrimental effects of CM, serving at least two generations.
METHODS: A prospective, longitudinal study of 744 healthy pregnant participants was conducted, with analyses focusing on a sample of 643 participants. CM was assessed with the Childhood Trauma Questionnaire (CTQ) and categorized by whether no vs. one or more moderate to severe CM experiences were reported. Blood serum concentrations of CRP, maternal depression severity (continuous scores of the Center for Epidemiologic Studies Depression Scale, CES-D) and smoking during pregnancy were assessed in early (16.52 ± 2.50 weeks gestation) and late (33.65 ± 1.18 weeks gestation) pregnancy. Pre-pregnancy body mass index (BMI) was obtained at the first study visit and hypertensive disorders diagnosed during pregnancy were obtained from the medical record. Linear mixed effects models were employed to assess main effects of CM as well as interactive effects of CM and four common CM-associated sequelae as well as a sum score of these sequelae on repeatedly measured CRP concentration. In secondary analyses, we conducted latent class analyses to classify participants based on their specific experiences of childhood abuse and/or neglect and to assess the association of these CM subgroups with CM sequelae and CRP. All analyses were adjusted for potential confounders (maternal race and ethnicity and education/income).
RESULTS: CRP concentration decreased from early to late pregnancy (B = -0.06, SE = 0.01, p < 0.001). While there was no main effect of CM on CRP (p = 0.49), the interaction of CM and depressive symptoms was associated with CRP concentration (B = 0.08, SE = 0.04, p < 0.05), indicating higher CRP across pregnancy with increasing levels of depressive symptoms during pregnancy in participants with CM experience. This interaction was mainly driven by participants with co-occurring physical and emotional maltreatment. For none of the other CM-associated sequelae a statistically significant interaction with CM on CRP concentration was observed.
CONCLUSIONS: These results add to the growing empirical evidence suggesting higher inflammation during pregnancy in participants exposed to CM who experience depressive symptoms and highlight the detrimental effects of multiple co-occurring experiences of maltreatment. Given the negative consequences of chronic inflammatory state for the mother and the developing fetus, monitoring and treating psychiatric sequelae during pregnancy among participants exposed to CM is potentially an important opportunity to dampen long-term detrimental effects of CM, serving at least two generations.
摘要：
背景：儿童虐待（CM）对压力生物学的调节具有长期影响，当出现精神和身体健康后遗症时，这种影响尤其明显。已显示C反应蛋白（CRP）在与CM相关的非妊娠状态以及与CM相关的身心健康后遗症中升高。在怀孕期间,然而,CM和CRP之间的关联不太清楚。我们试图检查这种关联，并考虑CM的四种常见健康后遗症（母体抑郁症状，超重/肥胖，吸烟,和怀孕期间的高血压疾病）。
方法：前瞻性，对744名健康怀孕参与者进行了纵向研究，分析集中在643名参与者的样本上。CM采用儿童创伤问卷（CTQ）进行评估，并按是否无vs.报告了一次或多次中度至重度CM经历.血清CRP浓度,产妇抑郁严重程度(流行病学研究中心抑郁量表的连续评分，在妊娠早期（16.52±2.50周）和晚期（33.65±1.18周）评估CES-D）和怀孕期间吸烟。在第一次研究访问时获得了孕前体重指数（BMI），并从医疗记录中获得了在怀孕期间诊断出的高血压疾病。线性混合效应模型用于评估CM的主要效应以及CM和四种常见CM相关后遗症的相互作用效应，以及这些后遗症对重复测量的CRP浓度的总和。在二级分析中，我们进行了潜在类别分析,根据参与者在儿童时期遭受虐待和/或忽视的具体经历对其进行分类,并评估这些CM亚组与CM后遗症和CRP的关联.所有分析均针对潜在的混杂因素（母亲种族和种族以及教育/收入）进行了调整。
结果：CRP浓度从妊娠早期到晚期降低（B=-0.06，SE=0.01，p<0.001）。虽然CM对CRP没有主要影响（p=0.49），CM与抑郁症状的交互作用与CRP浓度相关(B=0.08,SE=0.04,p<0.05),在有CM经验的参与者中，表明整个怀孕期间CRP较高，怀孕期间抑郁症状水平增加。这种互动主要是由同时发生身体和情感虐待的参与者驱动的。对于其他与CM相关的后遗症，均未观察到与CM对CRP浓度的统计学显着相互作用。
结论：这些结果增加了越来越多的经验证据，表明暴露于CM的参与者在怀孕期间经历抑郁症状并强调了多种共同发生的虐待经历的有害影响。鉴于慢性炎症状态对母亲和发育中的胎儿的负面影响，监测和治疗怀孕期间暴露于CM的参与者的精神病后遗症可能是减轻CM长期有害影响的重要机会，服务至少两代人。
方法：前瞻性，对744名健康怀孕参与者进行了纵向研究，分析集中在643名参与者的样本上。CM采用儿童创伤问卷（CTQ）进行评估，并按是否无vs.报告了一次或多次中度至重度CM经历.血清CRP浓度,产妇抑郁严重程度(流行病学研究中心抑郁量表的连续评分，在妊娠早期（16.52±2.50周）和晚期（33.65±1.18周）评估CES-D）和怀孕期间吸烟。在第一次研究访问时获得了孕前体重指数（BMI），并从医疗记录中获得了在怀孕期间诊断出的高血压疾病。线性混合效应模型用于评估CM的主要效应以及CM和四种常见CM相关后遗症的相互作用效应，以及这些后遗症对重复测量的CRP浓度的总和。在二级分析中，我们进行了潜在类别分析,根据参与者在儿童时期遭受虐待和/或忽视的具体经历对其进行分类,并评估这些CM亚组与CM后遗症和CRP的关联.所有分析均针对潜在的混杂因素（母亲种族和种族以及教育/收入）进行了调整。
结果：CRP浓度从妊娠早期到晚期降低（B=-0.06，SE=0.01，p<0.001）。虽然CM对CRP没有主要影响（p=0.49），CM与抑郁症状的交互作用与CRP浓度相关(B=0.08,SE=0.04,p<0.05),在有CM经验的参与者中，表明整个怀孕期间CRP较高，怀孕期间抑郁症状水平增加。这种互动主要是由同时发生身体和情感虐待的参与者驱动的。对于其他与CM相关的后遗症，均未观察到与CM对CRP浓度的统计学显着相互作用。
结论：这些结果增加了越来越多的经验证据，表明暴露于CM的参与者在怀孕期间经历抑郁症状并强调了多种共同发生的虐待经历的有害影响。鉴于慢性炎症状态对母亲和发育中的胎儿的负面影响，监测和治疗怀孕期间暴露于CM的参与者的精神病后遗症可能是减轻CM长期有害影响的重要机会，服务至少两代人。
