Social Support During Pregnancy Modifies the Association Between Maternal Adverse Childhood Experiences and Infant Birth Size

  • Allison A. Appleton
  • Kevin Kiley
  • Elizabeth A. Holdsworth
  • Lawrence M. Schell


Introduction Adverse childhood experiences (ACEs) can deleteriously affect health, including pregnancy and birth outcomes occurring later in life. Identification of modifiable factors during pregnancy that buffer the ill effects of adversity is warranted. Social support during pregnancy can promote better birth outcomes, yet it is unknown whether it could also mitigate perinatal risks stemming from ACEs. Thus, this study considers multiple forms of social support in pregnancy as modifiers of an ACEs and fetal growth association. Methods Data were collected from mother and infant pairs from an ongoing prospective birth cohort. Women enrolled around 27 weeks gestation and completed gold-standard assessments of ACEs and social support. Infant cephalization index scores [(head circumference /birthweight) × 100; a marker of asymmetric fetal growth] were derived. Multivariable regression models tested main effects and interaction between ACEs and social support in relation to infant cephalization. Results Higher levels of ACEs were associated with higher cephalization scores (β = 0.01, SE = 0.01, p < 0.05) whereas higher social support was associated with lower cephalization scores (β = − 0.03, SE = 0.01, p < 0.05). A significant interaction was observed showing a protective effect of social support among those with low (0 events) and moderate (1–3 events) ACEs but not among those with high ACEs (4 + events; p < 0.05). Tangible and emotional support, but not information support, contributed to the associations. Discussion Maternal ACEs can deleteriously affect birth size, yet social support during pregnancy provides some buffer from its enduring effects. Interventions designed to enhance pregnancy social support may not only improve maternal wellbeing, but may also safeguard infant health.


Adverse childhood experiences Social support Cephalization Birth size 



This work was supported by a JPB Environmental Health Fellowship award granted by The JPB Foundation and managed by the Harvard T.H. Chan School of Public Health.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. ACOG. (2018). Committee opinion no. 729 summary: Importance of social determinants of health and cultural awareness in the delivery of reproductive health care. Obstetrics & Gynecology, 131(1), 198–199. Scholar
  2. Aiken, L. S., & West, S. G. (1991). Multiple regression: Testing and interpreting interactions. Thousand Oaks: Sage Publications.Google Scholar
  3. Berens, A. E., Jensen, S. K. G., & Nelson, C. A. 3rd (2017). Biological embedding of childhood adversity: From physiological mechanisms to clinical implications. BMC Medicine, 15(1), 135. Scholar
  4. Brunton, P. J. (2013). Effects of maternal exposure to social stress during pregnancy: Consequences for mother and offspring. Reproduction, 146(5), R175–R189. Scholar
  5. Christiaens, I., Hegadoren, K., & Olson, D. M. (2015). Adverse childhood experiences are associated with spontaneous preterm birth: A case-control study. BMC Medicine, 13, 124. Scholar
  6. Cohen, S., & Hoberman, H. (1983). Positive events and social supports as buffers of life change stress. Journal of Applied Social Psychology, 13, 99–125.CrossRefGoogle Scholar
  7. Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry, 150, 782–786.CrossRefGoogle Scholar
  8. Danese, A., Moffitt, T. E., Harrington, H., Milne, B. J., Polanczyk, G., Pariante, C. M., … Caspi, A. (2009). Adverse childhood experiences and adult risk factors for age-related disease: Depression, inflammation, and metabolic risk markers. Archives of Pediatric and Adolescent Medicine, 63(12), 1135–1143.Google Scholar
  9. Dunkel Schetter, C. (2011). Psychological science on pregnancy: Stress processes, biopsychosocial models, and emerging research issues. Annual Review of Psychology, 62, 531–558. Scholar
  10. Duthie, L., & Reynolds, R. M. (2013). Changes in the maternal hypothalamic–pituitary–adrenal axis in pregnancy and postpartum: Influences on maternal and fetal outcomes. Neuroendocrinology, 98(2), 106–115. Scholar
  11. Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., … Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The adverse childhood experiences (ACE) study. American Journal of Preventive Medicine, 14(4), 245–258. Scholar
  12. Giesbrecht, G. F., Poole, J. C., Letourneau, N., Campbell, T., & Kaplan, B. J. (2013). The buffering effect of social support on hypothalamic–pituitary–adrenal axis function during pregnancy. Psychosomatic Medicine, 75(9), 856–862. Scholar
  13. Gluckman, P. D., Hanson, M. A., & Pinal, C. (2005). The developmental origins of adult disease. Matern Child Nutrition, 1(3), 130–141. Scholar
  14. Harel, S., Tomer, A., Barak, Y., Binderman, I., & Yavin, E. (1985). The cephalization index: A screening device for brain maturity and vulnerability in normal and intrauterine growth retarded newborns. Brain and Development, 7(6), 580–584.CrossRefGoogle Scholar
  15. Hetherington, E., Doktorchik, C., Premji, S. S., McDonald, S. W., Tough, S. C., & Sauve, R. S. (2015). Preterm birth and social support during pregnancy: A systematic review and meta-analysis. Paediatric and Perinatal Epidemiology, 29(6), 523–535. Scholar
  16. Jaffee, S. R., Takizawa, R., & Arseneault, L. (2017). Buffering effects of safe, supportive, and nurturing relationships among women with childhood histories of maltreatment. Psychological Medicine, 47(15), 2628–2639. Scholar
  17. Kelly-Irving, M., Lepage, B., Dedieu, D., Bartley, M., Blane, D., Grosclaude, P., … Delpierre, C. (2013). Adverse childhood experiences and premature all-cause mortality. European Journal of Epidemiology, 28(9), 721–734. Scholar
  18. Kobau, R., Seligman, M. E. P., Peterson, C., Diener, E., Zack, M., Chapman, D., & Thompson, W. (2011). Mental health promotion in public health: Perspectives and strategies from positive psychology. American Journal of Public Health, 101(8), e1–e9.CrossRefGoogle Scholar
  19. Leitner, Y., Fattal-Valevski, A., Geva, R., Eshel, R., Toledano-Alhadef, H., Rotstein, M., … Harel, S. (2007). Neurodevelopmental outcome of children with intrauterine growth retardation: A longitudinal, 10-year prospective study. Journal of Child Neurology, 22(5), 580–587. Scholar
  20. McEwen, B. S. (1998). Stress, adaptation, and disease. Allostasis and allostatic load. Annals of the New York Academy of Sciences, 840, 33–44.CrossRefGoogle Scholar
  21. Mersky, J. P., Topitzes, J., & Reynolds, A. J. (2013). Impacts of adverse childhood experiences on health, mental health, and substance use in early adulthood: A cohort study of an urban, minority sample in the U.S. Child Abuse & Neglect, 37(11), 917–925. Scholar
  22. Michaud, D. S., Skinner, H. G., Wu, K., Hu, F., Giovannucci, E., Willett, W. C., … Fuchs, C. S. (2005). Dietary patterns and pancreatic cancer cancer risk in men and women. Journal of the National Cancer Institute, 97(7), 518–524.CrossRefGoogle Scholar
  23. Nugent, B. M., & Bale, T. L. (2015). The omniscient placenta: Metabolic and epigenetic regulation of fetal programming. Front Neuroendocrinol, 39, 28–37. Scholar
  24. Nylen, K. J., O’Hara, M. W., & Engeldinger, J. (2013). Perceived social support interacts with prenatal depression to predict birth outcomes. Journal of Behavioral Medicine, 36(4), 427–440. Scholar
  25. Quinn, G. P., & Keough, M. J. (2002). Experimental design and data analyis for biologists. New York: Cambridge University Press.CrossRefGoogle Scholar
  26. Rothman, K. J., & Greenland, S. (1998). Modern epidemiology (2nd edn.). Philadelphia: Lippincott Williams & Wilkins.Google Scholar
  27. Shonkoff, J. P., Boyce, W. T., & McEwen, B. S. (2009). Neuroscience, molecular biology, and the childhood roots of health disparities. Journal of the American Medical Association, 301(21), 2252–2259.CrossRefGoogle Scholar
  28. Smith, M. V., Gotman, N., & Yonkers, K. A. (2016). Early childhood adversity and pregnancy outcomes. Matern Child Health Journal, 20(4), 790–798. Scholar
  29. Taylor, S. E. (2011). Social support: A review. In H. S. Friedman (Ed.), The handbook of health psychology (pp. 192–217). Oxford: Oxford University Press.Google Scholar
  30. Thomas, C., Hypponen, E., & Power, C. (2008). Obesity and type 2 diabetes risk in midadult life: the role of childhood adversity. Pediatrics, 121, e1240–e1249.CrossRefGoogle Scholar
  31. Willett, W. C. (1998). Nutritional epidemiology (2nd edn.). New York: Oxford University Press.CrossRefGoogle Scholar
  32. Wosu, A. C., Gelaye, B., & Williams, M. A. (2015). Maternal history of childhood sexual abuse and preterm birth: an epidemiologic review. BMC Pregnancy Childbirth, 15, 174. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Allison A. Appleton
    • 1
  • Kevin Kiley
    • 2
  • Elizabeth A. Holdsworth
    • 3
  • Lawrence M. Schell
    • 1
    • 3
  1. 1.Department of Epidemiology and BiostatisticsUniversity at Albany School of Public HealthRensselaerUSA
  2. 2.Department of Obstetrics and GynecologyAlbany Medical CollegeAlbanyUSA
  3. 3.Department of AnthropologyUniversity at Albany College of Arts and SciencesAlbanyUSA

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