The association between adverse childhood experiences and postpartum post-traumatic stress disorder among women in China: A moderated mediation model of childbirth experiences and social support.

BACKGROUND

Adverse Childhood Experiences (ACEs) are significant risk factors for postpartum Post-Traumatic Stress Disorder (PTSD), yet the mechanisms linking them remain poorly understood. This study aimed to explore the mediating role of childbirth experiences and the moderating role of social support in the relationship between ACEs and postpartum PTSD.

METHODS

A prospective cohort study was conducted at a tertiary hospital in China between November 2023 and October 2024. Eligible postpartum women completed assessments of demographic and obstetric characteristics, ACEs, childbirth experiences, and social support at 3 days postpartum. Postpartum PTSD was assessed at 42 days postpartum. Mediation and moderation analyses were performed using the SPSS PROCESS macro.

RESULTS

A total of 528 postpartum women were enrolled. ACEs were positively associated with postpartum PTSD (β = 0.19, t = 4.50, p < 0.001). Childbirth experiences significantly mediated this relationship (β = 0.06, SE = 0.01, p < 0.001). Additionally, social support moderated the indirect effect of childbirth experiences on postpartum PTSD (β = -0.08, t = -2.03, p < 0.05), suggesting a buffering role.

LIMITATIONS: The single-site, homogeneous sample may limit the generalizability of the findings.

CONCLUSIONS

This study provides novel insights into the underlying mechanisms of ACEs on postpartum PTSD, identifying childbirth experiences as a mediating factor and social support as a moderating factor. These findings provide a new perspective for interventions aimed at preventing the occurrence of postpartum PTSD in women with ACEs.