PMID- 37032357 OWN - NLM STAT- MEDLINE DCOM- 20230519 LR - 20230903 IS - 1435-1102 (Electronic) IS - 1434-1816 (Print) IS - 1434-1816 (Linking) VI - 26 IP - 3 DP - 2023 Jun TI - Pathways to adverse pregnancy outcomes: exploring the mediating role of intimate partner violence and depression: results from a South African rape cohort study. PG - 341-351 LID - 10.1007/s00737-023-01312-5 [doi] AB - Adverse pregnancy outcomes (APOs) are common occurrences that contribute to negative maternal and child health outcomes. Our aim was to test the hypothesis that trauma exposure and depression are drivers of the better-recognised risk factors for miscarriage, abortion and stillbirths. Our comparative cohort study based in Durban, South Africa recruited women who reported a recent rape (n = 852) and those who had never experienced rape (n = 853), with follow-up for 36 months. We explored APOs (miscarriage, abortion or stillbirth) among those having a pregnancy during follow-up (n = 453). Potential mediators were baseline depression, post-traumatic stress symptoms, substance abuse, HbA1C, BMI, hypertension and smoking. A structural equation model (SEM) was used to determine direct and indirect paths to APO. Overall, 26.6% of the women had a pregnancy in the follow-up period and 29.4% ended in an APO, with miscarriage (19.9%) the most common outcome, followed by abortion (6.6%) and stillbirths (2.9%). The SEM showed two direct pathways from exposure to childhood trauma, rape and other trauma, to APO which were ultimately mediated by hypertension and/or BMI, but all paths to BMI were mediated by depression and IPV-mediated pathways from childhood and other trauma to hypertension. Food insecurity mediated a pathway from experiences of trauma in childhood to depression. Our study confirms the important role of trauma exposure, including rape, and depression on APOs, through their impact on hypertension and BMI. It is critical that violence against women and mental health are more systematically addressed in antenatal, pregnancy and postnatal care. CI - (c) 2023. The Author(s). FAU - Abrahams, N AU - Abrahams N AUID- ORCID: 0000-0002-6138-6256 AD - Gender & Health Research Unit, South African Medical Research Council, Francie Van Zijl Dr, Parow Valley, Cape Town, 7501, South Africa. naeemah.abrahams@mrc.ac.za. AD - School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, 7935, Cape Town, South Africa. naeemah.abrahams@mrc.ac.za. FAU - Chirwa, E AU - Chirwa E AD - Gender & Health Research Unit, South African Medical Research Council, Francie Van Zijl Dr, Parow Valley, Cape Town, 7501, South Africa. AD - School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa. FAU - Mhlongo, S AU - Mhlongo S AD - Gender & Health Research Unit, South African Medical Research Council, Francie Van Zijl Dr, Parow Valley, Cape Town, 7501, South Africa. FAU - Seedat, S AU - Seedat S AD - Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Dr, Parow, Cape Town, 7505, South Africa. AD - Department of Psychiatry, Faculty of Medicine and Health Sciences, South African Research Chair in Posttraumatic Stress Disorder, Stellenbosch University, Cape Town, South Africa. AD - Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa. FAU - Myers, B AU - Myers B AD - Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Francie van Zijl Dr, Parow Valley, 7501, Cape Town, South Africa. AD - Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, 6102, Australia. AD - Department of Psychiatry and Mental Health, University of Cape Town, Rondebosch, Cape Town, 7700, South Africa. FAU - Peer, N AU - Peer N AD - Non-Communicable Diseases Research Unit, South African Medical Research Council, Francie van Zijl Dr, Parow Valley, 7501, Cape Town, South Africa. AD - Department of Medicine, University of Cape Town, Rondebosch, Cape Town, 7700, South Africa. FAU - Kengne, A P AU - Kengne AP AD - Non-Communicable Diseases Research Unit, South African Medical Research Council, Francie van Zijl Dr, Parow Valley, 7501, Cape Town, South Africa. AD - Department of Medicine, University of Cape Town, Rondebosch, Cape Town, 7700, South Africa. FAU - Garcia-Moreno, C AU - Garcia-Moreno C AD - HRP (The UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction), Department of Sexual and Reproductive Health and Research, World Health Organization (WHO), 1211, Geneva, Switzerland. FAU - Lombard, C AU - Lombard C AD - Biostatistics Unit, South African Medical Research Council, Francie van Zijl Dr, Parow Valley, 7501, Cape Town, South Africa. AD - Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa. FAU - Jewkes, R AU - Jewkes R AD - Gender & Health Research Unit, South African Medical Research Council, Francie Van Zijl Dr, Parow Valley, Cape Town, 7501, South Africa. AD - Office of the Executive Scientist, South African Medical Research Council, Pretoria, 0001, South Africa. LA - eng GR - 001/WHO_/World Health Organization/International PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20230410 PL - Austria TA - Arch Womens Ment Health JT - Archives of women's mental health JID - 9815663 SB - IM MH - Child MH - Humans MH - Female MH - Pregnancy MH - Cohort Studies MH - *Abortion, Spontaneous/epidemiology MH - South Africa/epidemiology MH - Stillbirth MH - *Rape MH - Depression/epidemiology MH - *Intimate Partner Violence/psychology PMC - PMC10191987 OTO - NOTNLM OT - Abortion OT - Adverse pregnancy outcomes OT - Intimate partner violence OT - Mental health OT - Miscarriage OT - Stillbirths OT - Trauma COIS- The authors declare no competing interests. EDAT- 2023/04/10 06:00 MHDA- 2023/05/19 06:42 PMCR- 2023/04/10 CRDT- 2023/04/09 23:15 PHST- 2023/02/08 00:00 [received] PHST- 2023/03/23 00:00 [accepted] PHST- 2023/05/19 06:42 [medline] PHST- 2023/04/10 06:00 [pubmed] PHST- 2023/04/09 23:15 [entrez] PHST- 2023/04/10 00:00 [pmc-release] AID - 10.1007/s00737-023-01312-5 [pii] AID - 1312 [pii] AID - 10.1007/s00737-023-01312-5 [doi] PST - ppublish SO - Arch Womens Ment Health. 2023 Jun;26(3):341-351. doi: 10.1007/s00737-023-01312-5. Epub 2023 Apr 10.