Correlations between life course trauma on perinatal outcomes of women on community supervision - a retrospective cross sectional study.

BACKGROUND

Women on probation (community supervision) report high rates of adverse childhood experiences (ACEs) and ongoing trauma, yet little research has examined how trauma across the life course relates to perinatal outcomes during community supervision. This study examined associations between lifetime trauma and perinatal violence, infant separation, and postpartum mood symptoms among women who experienced pregnancy, childbirth, and postpartum while on probation.

METHODS

We conducted a cross-sectional secondary analysis from N = 60 women in South-Central Texas who had a pregnancy within the past five years while on community supervision. Trauma exposures included selected ACEs and adulthood/perinatal trauma (domestic, intimate partner, and sexual violence). Outcomes were perinatal violence, permanent infant removal after childbirth, and postpartum mood symptoms (PHQ-2/GAD-2). We used logistic regression to examine associations between trauma exposures and outcomes; given the ordinal structure of key trauma measures, we used Kendall's tau to estimate correlations between cumulative ACEs/lifetime trauma and perinatal outcomes.

RESULTS

Participants spent an average of 5 years (SD = 3) on community supervision, and most reported partner violence (n = 52, 87%); no mental health care in the year prior to their last arrest (n = 55, 92%); and possible major depressive disorder (n = 20, 33%) and generalized anxiety disorder (n = 34, 57%). ACE prevalence included caregiver incarceration (n = 34, 56%), physical abuse (n = 25, 42%), witnessing abuse (n = 27, 45%), foster care (n = 17, 8%), and childhood sexual abuse (n = 29, 48%); 25% reported four (n = 9, 16%) or five (n = 6, 10%) ACEs. Cumulative ACE exposure was correlated with perinatal violence (p = 0.03), and childhood forced sexual intercourse was associated with perinatal violence (p = 0.04). Trauma in adulthood was associated with permanent infant removal (p = 0.003). Sexual violence in adulthood was correlated with cumulative ACE exposure and postpartum mood symptoms (p = 0.006).

CONCLUSIONS

Trauma across the life course is associated with perinatal violence, infant removal, and postpartum mood symptoms among women on community supervision. Trauma-informed, gender-responsive perinatal and community supervision interventions are needed to improve safety, mental health, and family stability.

TRIAL REGISTRATION: NA.