Is there more to the story? The added predictive value of expanded Adverse Childhood Experiences in maternal mental health during pregnancy

Abstract

Background: Adverse Childhood Experiences (ACEs) are strongly linked to maternal mental health difficulties during pregnancy, affecting both mother and child through intergenerational transmission. Traditional ACEs frameworks have focused on family-related adversities, however, expanded models include broader social and community factors. Despite this, few studies have compared the predictive value of traditional versus expanded ACEs in pregnancy mental health. Aim: This cross-sectional study examines whether expanded ACEs improve prediction of pregnancy-related anxiety, depression, and pregnancy adaptation difficulties beyond traditional ACEs. Methods: The study included 306 pregnant women from Spain who completed assessments using the Pregnancy- Related Anxiety Questionnaire-20 (PRAQ-20), Patient Health Questionnaire-9 (PHQ-9), and Prenatal Self- Assessment Questionnaire (PSQ). Traditional ACEs and expanded ACEs (such as parental absence, unsafe neighbourhoods or financial hardship) were also measured. Findings: Hierarchical regression analyses evaluated the effects of ACEs on maternal mental health outcomes, controlling for age and socioeconomic status. Expanded ACEs significantly improved prediction of pregnancy- related anxiety, depression, and pregnancy adaptation difficulties beyond traditional ACEs. Community-level adversities, such as unsafe neighbourhoods and parental absence, were key predictors, while traditional ACEs showed weaker associations. Conclusions: Incorporating expanded ACEs in perinatal assessments enhances identification of pregnant women at risk and supports trauma-informed, context-sensitive care. Longitudinal studies are needed to explore long-term effects on maternal and child health. Statement of significance: Problem or Issue. Adverse Childhood Experiences (ACEs) are strongly associated with maternal mental health difficulties during pregnancy, which can affect both mother and child through intergenerational transmission. Traditional ACE frameworks focus primarily on family-related adversities, potentially overlooking broader social and community factors. Few studies have examined whether expanded ACEs better predict maternal mental health outcomes during pregnancy. What is Already Known. Traditional ACEs, such as abuse or neglect, are linked to depression, anxiety, and pregnancy maladjustment. Expanded ACE models, which include community-level and peer-related adversities, may provide additional predictive value, but research in pregnant populations is limited. Identifying these broader influences could improve early detection of at-risk women. What this Paper Adds. This study shows that expanded ACEs, including parental absence and unsafe neighbourhoods, significantly improve prediction of pregnancy-related anxiety, depression, and adaptation difficulties during pregnancy beyond traditional ACEs. Findings highlight the importance of incorporating broader, context-sensitive assessments in perinatal care to identify women at risk and guide trauma-informed interventions.