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The moderating effects of traumatic stress on vulnerability to emotional distress during pregnancy

Published online by Cambridge University Press:  17 June 2019

Irene Tung*
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
Kate Keenan
Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
Stephanie D. Stepp
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
Alison E. Hipwell
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
Author for Correspondence: Irene Tung, Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Suite 408, Pittsburgh, PA15213; E-mail:


Emotional distress during pregnancy is likely influenced by both maternal history of adversity and concurrent prenatal stressors, but prospective longitudinal studies are lacking. Guided by a life span model of pregnancy health and stress sensitization theories, this study investigated the influence of intimate partner violence (IPV) during pregnancy on the association between childhood adversity and prenatal emotional distress. Participants included an urban, community-based sample of 200 pregnant women (aged 18–24) assessed annually from ages 8 to 17 for a range of adversity domains, including traumatic violence, harsh parenting, caregiver loss, and compromised parenting. Models tested both linear and nonlinear effects of adversity as well as their interactions with IPV on prenatal anxiety and depression symptoms, controlling for potential confounds such as poverty and childhood anxiety and depression. Results showed that the associations between childhood adversity and pregnancy emotional distress were moderated by prenatal IPV, supporting a life span conceptualization of pregnancy health. Patterns of interactions were nonlinear, consistent with theories conceptualizing stress sensitization through an “adaptive calibration” lens. Furthermore, results diverged based on adversity subdomain and type of prenatal IPV (physical vs. emotional abuse). Findings are discussed in the context of existing stress sensitization theories and highlight important avenues for future research and practice.

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