Child Abuse and Neglect, Preterm Birth, and Associated Mediators Open Access

Cammack, Alison Leigh (2017)

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Psychosocial stress has emerged as an important risk factor for preterm birth, but maternal exposure to child abuse and neglect remain understudied with respect to preterm birth and associated mediators. In the context of perinatal outcomes, maltreatment is typically measured via retrospective self-report, which may be prone to measurement error and selective recall. The goals of this dissertation were to explore bias in reporting of history of child maltreatment around the time of pregnancy and to understand links between maltreatment, preterm birth, and smoking, a common and modifiable risk factor for preterm birth.

Using original data from the Emory Women's Mental Health Program, history of childhood maltreatment was measured before and after delivery for each woman, using the Childhood Trauma Questionnaire. Overall test-retest reliability was at least moderate for all trauma types except physical neglect. However, for those experiencing certain adverse pregnancy outcomes, there was a tendency to report trauma after delivery but not before. Further, associations of physical neglect with low birth weight and preterm birth indicated an inverse relationship when neglect was measured before delivery and a positive relationship when measured after delivery.

In the National Longitudinal Study of Adolescent to Adult Health, non-parental/caregiver sexual abuse by physical force was associated with very preterm birth. This association was limited to women whose abuse started after age nine. Non-parental/caregiver sexual abuse by physical force was also associated with continued smoking into pregnancy among women with a history of regular smoking. When stratified by depressive symptoms, associations of physical abuse and non-parental/caregiver sexual abuse with continued smoking were limited to women with depressive symptomatology, and depressive symptoms significantly modified the effect of parental/caregiver sexual and physical abuse.

This dissertation shows that maternal exposure to abuse, particularly sexual abuse, is associated with early preterm birth and is a determinant of modifiable behaviors in pregnant women. It also shows that misclassification and recall bias may be present for specific forms of maltreatment, namely physical neglect. These findings suggest that future research into effective screening and interventions involving clinic populations, including well-woman, prenatal, and postpartum care, may be important.

Table of Contents

Chapter 1: Introduction and Motivation...1

Chapter 2: Literature Review..22

Chapter 3: Description of Study Samples...84

Chapter 4: Test-Retest Reliability of Retrospective Self-Reported Maternal Exposure to Childhood Abuse and Neglect...92

Chapter 5: An Exploratory Study of Whether Pregnancy Outcomes Influence Maternal Self-Reported History of Child Maltreatment...110

Chapter 6: The Association Between Maternal Exposure to Child Abuse, Preterm Birth, and Very Preterm Birth in Nulliparous Women...153

Chapter 7: Maternal History of Child Abuse and Continued Smoking Through Pregnancy...186

Chapter 8: Supplementary Analyses...213

Chapter 9: Summary, Implications, and Future Directions...234

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