Psychological Distress and Adverse Childhood Experiences among US Women with Concurrent Reproductive Trauma and Infertility

Abstract

Background: Adverse childhood experiences (ACEs) are traumatic events that occur during childhood, including forms of physical, emotional, or sexual abuse, neglect, and household dysfunction (i.e. divorce, parental incarceration, substance use). Previous evidence suggests that pregnancy loss may be associated with ACEs and mental health disorders; however, to our knowledge, no studies have considered the associations between ACEs and psychological distress in women with concurrent reproductive trauma (CRT), defined as pregnancy loss during infertility.

Purpose: To compare relationships between ACEs, stress, anxiety, depression, and PTSD symptoms among women with concurrent reproductive trauma and women with infertility only.

Methods: A descriptive cross-sectional study design with follow-up was used to recruit 99 U.S. women aged 18-49 with infertility through convenience and snowball sampling. Participants were recruited on infertility-related support groups on Facebook, Instagram influencers sharing the study information with followers, and at healthcare and fertility care clinics with administrator approval. A REDCap survey included demographics, an ACEs questionnaire, and measures of infertility-related stress (COMPI-FPSS), perceived stress (PSS-4), anxiety (GAD-7) depression (PHQ-8), and PTSD (PC-PTSD-5). Statistical analysis using SPSS 28 included descriptive statistics, independent t-tests, and chi-square test for independence.

Results: There were no statistically significant differences in psychological distress mean scores between CRT and infertility-only groups. Four of the 10 ACE items were statistically higher in the CRT group than the infertility-only group. Women with CRT were more likely to experience 2+ ACEs than women with infertility-only (p = .001). Infertility-only group with 2+ ACEs had significantly higher levels of stress, PTSD, anxiety, and depression, with clinically significant higher depression and PTSD symptoms, compared to those with 0-1 ACEs. CRT group with 2+ ACEs had significantly higher anxiety and depression, with clinically significant higher moderate or severe depression.

Discussion: Women with CRT and infertility-only experience similar levels of psychological distress; however psychological distress varies with the addition of an ACE history. Women with CRT were more likely to experience 2+ ACEs compared to women with infertility-only; however, women with infertility with 2+ ACE were more likely to experience clinically significant psychological distress. ACE history may be an important epigenetic factor with reproductive trauma.