Mothers’ exposure to early life adversity and mental health and childbirth related outcomes during the perinatal period

The research reported in this thesis is concerned with the impact of exposure to early life adversity on childbirth and mental health outcomes during the perinatal period with a particular focus on Post Traumatic Stress Disorder (PTSD) and Complex Post Traumatic Stress Disorder (CPTSD). A systematic review of this literature in Chapter 2 highlighted that exposure to maltreatment-based early life adversity is associated with a range of negative perinatal outcomes, including lower birthweight, increased preterm birth, and poorer maternal mental health, but findings were inconsistent and further research warranted. Subsequent chapters aimed to address the evidence gaps identified in Chapter 2. Chapter 3 used data from an existing cohort of participants collected prior to the COVID-19 pandemic and found that exposure to early life adversity was associated with women entering parenthood, doing so younger, and giving birth to more children. Additionally, maltreatment based early life adversities predicted episodes of mental ill-health during the perinatal period among women already diagnosed with a mental health condition. Chapters 4, 5, and 6 report data drawn from an on-going cohort study (the Maternal Wellbeing, Mental Health, and Life Events study), which began following the onset of the COVID-19 pandemic. Chapter 4 established the current perinatal frequency of probable PTSD, CPTSD, and clinically significant Disturbances in Self-Organisation (DSO) symptoms in both a clinical and non-clinical population, concluding that trauma related stress disorders are under-detected, especially in the clinical subsample of women accessing mental health services. Further, maltreatment-based early life adversity predicted the PTSD, DSO, and CPTSD symptom clusters. Chapter 5 demonstrated that early life adversity predicted poorer childbirth outcomes, whilst PTSD, and CPTSD symptoms predicted more negative perceptions of the birth. Chapter 6 highlighted moderate to good symptom identification similarity between the International Trauma Questionnaire (ITQ), and the clinical interview of the International Trauma Interview (ITI). Some crossovers in symptoms between trauma related stress disorders and borderline personality disorder (BPD) were further identified. Collectively, the studies presented in these chapters show that early life adversity, particularly maltreatment-based adversities, predict 19 poorer perinatal outcomes, and as such should be screened for early in pregnancy so that appropriate treatments, interventions, and support can be provided