Longitudinal Changes in Fear Learning across Pregnancy: Moderation by Sexual Trauma.

BACKGROUND

Black pregnant individuals are at increased risk for posttraumatic stress disorder (PTSD), symptoms that may be exacerbated by histories of sexual trauma. Disruptions in fear learning are central to the development and maintenance of PTSD. The present study examined longitudinal changes in fear acquisition and extinction over pregnancy, and the moderating role of sexual trauma in fear learning trajectories, in a sample of under-resourced Black pregnant persons.

METHODS

Participants (N = 116) completed an enrollment interview in which the Trauma Exposure Inventory was used to assess lifetime sexual trauma. Fear-potentiated startle was administered in up to three physiological assessments over pregnancy.

RESULTS

Linear mixed models showed that percent potentiation to the danger cue during acquisition increased over pregnancy in the general sample (B = 1.85, SE = 0.94, p = 0.049). Conditional models showed that this increase was observed among participants with no (B = 4.49, SE = 1.39, p = 0.001) and mean (B = 2.07, SE = 0.95, p = 0.029) levels of sexual trauma exposure, but not in individuals with high (mean + 1 SD) sexual trauma exposure (B = -0.34, SE = 1.35, p = 0.80). Percent potentiation to the safety cue during acquisition did not change over gestation (B = 0.55, SE = 0.94, p = 0.56), and there were no significant changes in percent potentiation to either the danger (B = 0.23, SE = 0.63, p = 0.716) or safety cue (B = -0.011, SE = 0.63, p = 0.966) during extinction.

CONCLUSIONS

These findings suggest that pregnancy progression is adaptive by enhancing startle responses to danger cues during fear acquisition, and that high levels of sexual trauma exposure may attenuate typical changes in threat sensitivity that occur during pregnancy.