Duke Health Referring Physicians


Maternal Childhood Trauma Predicts Inflammatory Imbalances During Pregnancy

Women with a history of childhood trauma are more likely to experience imbalances in inflammatory cytokines during pregnancy, according to findings from a new study. These imbalances, which are especially pronounced in late gestation, may adversely affect fetal development.

Ann E.B. Borders, MD, of the NorthShore University Health System in Chicago, IL, presented results from the prospective study at the 37th Annual Pregnancy Meeting of the Society for Maternal Fetal Medicine held January 23 to 28, 2017, in Las Vegas, NV. Douglas Williamson, PhD, of the Department of Psychiatry and Behavioral Sciences at Duke University, was a coinvestigator of the study.

“We are trying to understand the impact of stress on women’s physiology and outcomes in pregnancy,” Borders said. “With this study, we have shown that childhood trauma changes the cytokine balance during pregnancy toward a more proinflammatory state,” she explained.

Childhood trauma is known to have lasting adverse psychological and physiologic effects. However, the consequences of maternal trauma during childhood on pregnancy outcomes have not been well described.

The multicenter, prospective cohort study was designed to evaluate the interaction between maternal trauma during childhood and inflammatory abnormalities throughout pregnancy.

The study enrolled 744 patients from prenatal clinics in 3 states between June 2013 and May 2015. All women were at least 18 years of age with a singleton pregnancy of less than 21 gestational weeks.

Women treated with progesterone after 14 weeks of pregnancy were excluded from the analysis, as were those undergoing any form of long-term corticosteroid treatment. Additional exclusion criteria included the presence of major fetal congenital anomalies or known chromosomal abnormalities. In total, 521 women were included in the analysis.

All participants completed the Childhood Trauma Questionnaire during their second trimester of pregnancy. Based on their responses to the questionnaire, the participants were grouped according to the number of moderate-to-severe abuse/neglect experiences during childhood (range, 0-5). They also underwent laboratory tests for interleukin (IL) 6 and IL-10 concentrations between 12.0 and 20.6 weeks of pregnancy and again between 32.0 and 35.6 weeks of pregnancy.

Baseline characteristics suggested trends toward lower educational levels, lower income levels, a higher likelihood of exposure to trauma as an adult, and higher depressive symptom scores among women with a greater number of childhood trauma experiences (Table).

Table. Maternal Baseline Characteristics


Number of Moderate-to-Severe Childhood
Trauma Experiences

0 (n = 310)1 (n = 97)2 (n = 40)≥ 3 (n = 74)
Mean age, y29.729.627.628.9
Race/ethnicity, %
Non-Hispanic white66514841
Non-Hispanic black14181824
Education, %
Some high school or less18255543
Some college/associate's degree31412043
Bachelor’s degree or higher51342314
Annual income, $ (%)
< 15,00010142331
> 50,000-100,0002835524
> 100,0002616100
Mean adult abuse scale score1.320.410.280.10
Mean depression score9.914.220.922.6


Results showed that the balance of proinflammatory and anti-inflammatory cytokines changed throughout pregnancy for all study participants, regardless of history of childhood trauma. Concentrations of IL-6 significantly increased across the entire study cohort during the course of gestation (P < .0001). IL-10 concentrations remained stable, resulting in a significant increase in the IL-6/IL-10 ratio throughout gestation as well (P < .0001). Higher IL-6 levels and a higher IL-6/IL-10 ratio indicate a proinflammatory state.


Although cytokine levels changed during pregnancy for all study participants, the degree of change appeared to be greater in those with a history of maternal childhood trauma. On average, maternal childhood trauma was associated with significantly higher gestational IL-6 concentrations (P = .003). In addition, maternal childhood trauma did not affect the IL-6/IL-10 ratio in early pregnancy, but a significant association between maternal childhood trauma and a higher IL-6/IL-10 ratio emerged in late gestation (P = .006).

In summary, trauma occurring in childhood has lasting effects on women’s physiology, resulting in inflammatory imbalances that persist throughout pregnancy. The next step in this field of research is to assess whether these imbalances adversely affect fetal development by increasing the long-term susceptibility of disease, Borders said.

Source: Buss C, Borders A, Entringer S, et al. Maternal childhood trauma is associated with a pro-inflammatory state during pregnancy. Presented at: Society for Maternal-Fetal Medicine 37th Annual Pregnancy Meeting; January 23-28, 2017; Las Vegas, NV. Abstract 493.