The effects of adverse childhood experiences on pregnancy loss and mental health outcomes among rural Chinese women: A causal machine learning approach.

BACKGROUND

Adverse childhood experiences (ACEs) are linked to poor long-term health. However, the potential causal impacts of ACEs on pregnancy loss and mental health outcomes, and their mediating pathways, remain underexplored, particularly among vulnerable populations.

OBJECTIVE

To investigate the potential causal effects of ACEs on pregnancy loss, depression, anxiety, and comorbidity, and to evaluate the mediating role of pregnancy loss.

METHODS

This cross-sectional study was conducted among rural Chinese women between June and July 2024. Structured face-to-face interviews collected self-reported ACEs, pregnancy loss histories, and symptoms of depression and anxiety using the 10-item Center for Epidemiologic Studies Depression scale (CES-D-10) and the 7-item Generalized Anxiety Disorder scale (GAD-7). Double Machine Learning was applied to estimate potential causal effects. Subgroup and heterogeneity analyses were conducted. Causal mediation analysis was performed to assess the mediating role of pregnancy loss.

RESULTS

A total of 2880 rural Chinese women participated in the study. Overall, 38.2 % reported experiencing at least one ACE. The median number of pregnancy losses was 1.00 (interquartile range (IQR): 0.00-1.00). The prevalence of depression, anxiety, and comorbidity was 10.0 %, 21.5 %, and 7.3 %, respectively. ACE exposure significantly increased pregnancy loss (average treatment effect (ATE) = 0.133; 95 % confidence intervals (CI): 0.054-0.213), and probabilities of depression (ATE = 0.064; 95 % CI: 0.041-0.088), anxiety (ATE = 0.055; 95 % CI: 0.024-0.087), and comorbidity (ATE = 0.060; 95 % CI: 0.039-0.081). Effects were stronger in less-educated groups and varied by age. Pregnancy loss mediated a small proportion of the associations, strongest for anxiety (4.96 %).

CONCLUSIONS

ACEs significantly increase pregnancy loss and risks of depression, anxiety, and comorbidity among rural Chinese women. Trauma-informed interventions integrating reproductive and mental health support are needed.