The potential compounding nature of ACEs and Diabetes on Maternal Depression: An examination of the Behavioral Risk Factor Surveillance System

Background: Perinatal depression (PD), defined by the American College of Obstetrics and Gynecologists (ACOG) as a depressive episode during pregnancy and up to one year after giving birth, has significant implications. ACOG recognizes that a personal history of depression, at any point in one's life, is a susceptibility factor for PD. An additional risk factor of PD is adverse childhood experiences (ACEs), which have also been linked to diabetes in adulthood. Given the potential compounding impact of ACEs and diabetes on maternal depression, the primary objective of this study is to investigate the association between any depression diagnoses among pregnant women by diabetes status in the context of ACEs.

Methods: To examine the relationship between diagnoses of depression throughout one’s lifespan, among pregnant individuals with ACEs and diabetes, we performed a cross-sectional analysis using data from the Behavioral Risk Factor Surveillance System. We used a logistic regression model to examine the interaction of ACEs and diabetes on diagnosis of depression among pregnant women.

Results: Results showed that compared to pregnant without diabetes or a history of ACEs, the likelihood for depression was significantly increased among the following groups: Women with 1-3 ACEs, but no diabetes (OR: 1.81; 95%CI: 1.08-3.03), women with 1-3 ACEs and diabetes (OR: 4.06; 95%CI:1.06-15.58), 4+ ACEs/No Diabetes (OR: 5.94; 95%CI: 3.62-9.75), 4+ ACEs/Gestational Diabetes (OR: 3.04; 95%CI: 0.62-14.99), and were highest among those with 4+ ACEs/Diabetes (OR: 16.94; 95%CI:3.42-83.94). No significant difference in the rate of depression history was found in women with no ACEs having diabetes and was lower among those with gestational diabetes and no ACEs.

Conclusion: We found a significantly increased risk for maternal depression in pregnant individuals with 4+ ACEs and diabetes, demonstrating a dose-response relationship. In light of these results, obstetricians and other maternal healthcare providers should obtain a thorough social history including an ACEs questionnaire. Given the prevalence of perinatal depression, we recommend increasing access to mental health services for pregnant individuals with ACEs. Further, we recommend the promotion of protective and compensatory experiences (PACEs) during childhood to reduce the downstream effects of ACEs.