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ACEs Risk Factor #1: Difficult Pregnancy

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Anxiety or Depression

Anxiety in pregnancy is associated with shorter gestation causing a premature risk and low birth weight. Adverse child outcomes include altered brain development, cognitive delays, learning problems, as well as, later diagnosed anxiety or aggression disorders Schetter (2012).

The negative effects of prenatal depression include postpartum depression, paternal depression, and prematurity. Negative effects on infants include greater right frontal EEG [or activity in the brain], amygdala connectivity, cortical thinning, and more difficult temperament Field (2017).

Right frontal EEG asymmetry is a pattern that typically accompanies greater negative affect and less empathic responses to emotion-inducing stimuli, such as, a crying infant or parental distress. Children of depressed mothers spent more time asking for help than did children of non-depressed mothers when completing a teaching task Jones (2000). The depressed mothers voiced their approval less often and ultimately spent less time helping their child complete the task.

Abusive Relationship (Physical Violence)

Women who experience violence during pregnancy from an intimate partner (or IPV), are more likely to have a preterm delivery (or before 37 completed weeks gestation) and low birth weight (<2,500g/5.5pounds). Previously, the US Surgeon General identified partner violence as a public health problem of “epidemic” proportions Bailey (2010).

Abused women were more likely to begin prenatal care during their third trimester, suffer from repeated episodes, and have a significant risk for low birth weight McFarlane (1996). Abuse during pregnancy is associated with low weight gain for the mother, infections, anemia, smoking, use of alcohol and drugs.

Late Prenatal Care

Three main reasons for seeking delayed prenatal care are Haddrill (2014):

1. Not knowing

  • Absence of classic symptoms, Misinterpretation; Didn't realize
  • Using contraception, age, subfertility; Not believing it to be true

2. Knowing

  • Mixed feelings, fear, self-care, postponement; Avoidance

3. Delayed

  • Professional/System Failures; Doctors & Healthcare
  • Knowledge/Empowerment Issues; "Pregnancy Mindset"

Some perceived benefits of receiving Prenatal Care include:

  • Improving pregnancy outcomes
  • Receiving regular checkups
  • Hearing the baby's heartbeat
  • Baby's health - gender, learning good habits, preparing for labor
  • Opportunity to socialize
  • Reduced stress
ACE Risk Factor #1 - Difficult Pregnancy

Although some women feared tests and exams, disliked "constant checkups", or felt prenatal care was unnecessary; a belief in the value of prenatal care was associated with higher satisfaction with care Novick (2009).


The nutritional needs of a pregnant woman are different when compared to those of a non-pregnant woman. Malnutrition and inflammation (i.e. infection, leaky gut, etc.) are forms of prenatal stress that can result in a poor birth outcome, such as prematurity or growth restriction.

Fetal growth restriction in both term and preterm infants is associated with a wide variety of behavioral and psychological diagnoses in childhood and adolescence, including attention-deficit/hyperactivity disorder, anxiety, depression, internalizing and thought problems, poor social skills, and autism spectrum disorder Vohr (2017).


Gestational stress is believed to increase the risk of pregnancy miscarriages and predisposes the mother to perinatal infections, premature labor, hemorrhages, and preeclampsia González-Ochoa (2018). Children are also presumed to be negatively affected by prenatal stress since it predisposes them to develop mood disorders, attention deficit disorder, perinatal infections, and obesity at early ages and cancer and/or degenerative disorders in adulthood (e.g., cardiovascular disease, cancer, diabetes, obesity, and behavioral, cognitive, and mood disorders).

Stress can be defined as a physical, mental, or emotional factor that causes bodily or mental tension:

  • External - Environment, psychological, social situations
  • Internal - Illness or recent medical procedure

The "fight or flight" response system is activated by stress which causes your body to prepare for muscular action Shiel (2018). Your heart/lungs accelerate into action, digestion slows down or stops, blood vessels/pupils dilate, tear production/salivation are inhibited by the lacrimal gland, bladder relaxes, loss of hearing, tunnel vision, and shaking. Many health conditions can result from prolonged stress, such as: poor healing, IBS, hypertension.


Bailey, B. (2010). Partner violence during pregnancy: prevalence, effects, screening, and management. International Journal of Women's Health, 2, 183-197. doi: 10.2147/ijwh.s8632

Field, T. (2017). Prenatal Depression Risk Factors, Developmental Effects and Interventions: A Review. Journal of Pregnancy and Child Health, 4, 301. doi:10.4172/2376-127X.1000301

González-Ochoa, R., Sánchez-Rodríguez, E. N., Chavarría, A., Gutiérrez-Ospina, G., & Romo-González, T. (2018). Evaluating Stress during Pregnancy: Do We Have the Right Conceptions and the Correct Tools to Assess It?. Journal of pregnancy, doi: 10.1155/2018/4857065

Haddrill, R., Jones, G.L., Mitchell, C.A. et al. (2014). Understanding delayed access to antenatal care: a qualitative interview study. BMC Pregnancy Childbirth 14, 207.       doi:

Jones, N. A., Field, T. & Davalos, M. (2000). Right Frontal EEG Asymmetry and Lack of Empathy in Preschool Children of Depressed Mothers. Child Psychiatry Hum Dev, 30, 189–204 doi:

McFarlane, J., Parker, B., & Soeken, K. (1996). Abuse During Pregnancy: Associations with Maternal Health And Infant Birth Weight. Nursing Research, 45(1), 37-42. 

Novick G. (2009). Women's experience of prenatal care: an integrative review. Journal of midwifery & women's health, 54(3), 226–237. doi:

Schetter, C. D., & Tanner, L. (2012). Anxiety, depression and stress in pregnancy: implications for mothers, children, research, and practice. Current Opinion in Psychiatry, 25(2), 141–148. doi:10.1097/YCO.0b013e3283503680

Shiel, W. C. (2018, December 11). Medical Definition of Stress. MedicineNet.

Vohr, B. R., Davis, E. P., & Wanke, C. A. (2017). Neurodevelopment: The Impact of Nutrition and Inflammation During Preconception and Pregnancy in Low-Resource Settings. Krebs Pediatrics, 139, (Supplement 1) S38-S49; doi:

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