Exposure to childhood maltreatment and systemic inflammation across pregnancy: The moderating role of depressive symptomatology

Theresa S Kleih; Sonja Entringer; Laura Scholaske; Norbert Kathmann; Karin DePunder; Christine M Heim; Pathik D Wadhwa; Claudia Buss

doi:10.1016/j.bbi.2022.02.004

Exposure to childhood maltreatment and systemic inflammation across pregnancy: The moderating role of depressive symptomatology

Brain Behav Immun. 2022 Mar:101:397-409. doi: 10.1016/j.bbi.2022.02.004. Epub 2022 Feb 5.

Authors

Theresa S Kleih¹, Sonja Entringer², Laura Scholaske³, Norbert Kathmann⁴, Karin DePunder⁵, Christine M Heim⁶, Pathik D Wadhwa⁷, Claudia Buss⁸

Affiliations

¹ Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Medical Psychology, 10117 Berlin, Germany; Humboldt-Universität zu Berlin, Institute of Psychology, 12489 Berlin, Germany.
² Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Medical Psychology, 10117 Berlin, Germany; Department of Pediatrics, University of California, Irvine, CA 92617, USA; Development, Health and Disease Research Program, University of California, Irvine, CA 92617, USA.
³ Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Medical Psychology, 10117 Berlin, Germany; German Center for Integration and Migration Research (DeZIM), Mauerstr. 76, 10117 Berlin, USA.
⁴ Humboldt-Universität zu Berlin, Institute of Psychology, 12489 Berlin, Germany.
⁵ Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Medical Psychology, 10117 Berlin, Germany.
⁶ Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Medical Psychology, 10117 Berlin, Germany; Department of Biobehavioral Health, College of Health & Human Development, The Pennsylvania State University, University Park, PA, USA.
⁷ Department of Psychiatry & Human Behavior, University of California, Irvine, CA 92617, USA; Department of Pediatrics, University of California, Irvine, CA 92617, USA; Department of Obstetrics & Gynecology, University of California, Irvine, CA 92617, USA; Department of Epidemiology, University of California, Irvine, CA 92617, USA; Development, Health and Disease Research Program, University of California, Irvine, CA 92617, USA.
⁸ Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Medical Psychology, 10117 Berlin, Germany; Department of Pediatrics, University of California, Irvine, CA 92617, USA; Department of Epidemiology, University of California, Irvine, CA 92617, USA. Electronic address: claudia.buss@charite.de.

Abstract

Background: Childhood maltreatment (CM) has long-term consequences for dysregulation of the immune system which is particularly pronounced when mental and physical health sequelae have manifested. Higher proinflammatory state has been shown in non-pregnant state in association with CM as well as with depression, one of the most frequent and pernicious psychiatric sequelae of CM. During pregnancy, however, this association is less clear. Given the important role of maternal inflammatory state during pregnancy for fetal, pregnancy, and birth outcomes, we sought to examine the association between CM and proinflammatory state during pregnancy considering the moderating role of maternal depressive symptoms characterized serially across pregnancy.

Methods: A prospective, longitudinal study of 180 healthy pregnant women was conducted with serial assessments in early (12.98 ± 1.71 weeks gestation), mid (20.53 ± 1.38 weeks gestation) and late (30.42 ± 1.4 weeks gestation) pregnancy. Maternal history of CM was assessed with the Childhood Trauma Questionnaire (CTQ) and the total score was used as an indicator of CM experience. Maternal depressive symptoms were assessed at each pregnancy visit with the Center for Epidemiologic Studies Depression Scale (CES-D). Serum concentrations of tumor necrosis factor (TNF)-α and interleukin (IL)-6 were obtained at each pregnancy visit and combined to a composite maternal proinflammatory score. Linear mixed effects models were employed to assess the association between CTQ score, CES-D score, and proinflammatory score during pregnancy, adjusting for potential confounders.

Results: Gestational age was associated with the proinflammatory score (B = 0.02; SE = 0.00; p < .001), indicating an increase in inflammation across gestation. Neither CTQ score nor depressive symptoms were independently associated with the proinflammatory score (ps > 0.28). However, the interaction between CTQ score and depressive symptoms was associated with the proinflammatory score (B = 0.03, SE = 0.01, p < .05), indicating higher inflammation across pregnancy with increasing levels of depressive symptoms during pregnancy in women with higher CTQ scores. Exploratory analyses suggested that this interaction was mainly driven by CTQ subscale scores assessing experiences of abuse rather than neglect.

Conclusions: These findings suggest a moderating role of maternal depressive symptoms during pregnancy on the association of early life stress with inflammation and thus highlight the importance of the timely assessment of both CM exposure and depressive symptoms which might allow for the development of targeted and individualized interventions to impact inflammation during pregnancy and to ameliorate the detrimental long-term effects of CM. The current findings add to a better understanding of the prenatal biological pathways that may underlie intergenerational transmission of maternal CM.

Keywords: Childhood maltreatment; Depression; Inflammation; Pregnancy.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adult Survivors of Child Abuse* / psychology
Child
Child Abuse* / psychology
Depression
Female
Humans
Inflammation
Interleukin-6
Longitudinal Studies
Pregnancy
Prospective Studies
Tumor Necrosis Factor-alpha

Substances

Interleukin-6
Tumor Necrosis Factor-alpha

Abstract

Publication types

MeSH terms

Substances

Grants and funding