Elsevier

Women's Health Issues

Volume 10, Issue 1, January–February 2000, Pages 27-33
Women's Health Issues

Articles
Childhood sexual abuse and preterm labor in adulthood: an endocrinological hypothesis

https://doi.org/10.1016/S1049-3867(99)00038-9Get rights and content

Abstract

Anecdotal reports link adverse pregnancy outcomes, such as preterm delivery, to women with histories of childhood sexual abuse. Although little research has been conducted on this subject, we provide an overview of known health effects of violence against women and posit a biological explanation for adverse pregnancy outcomes among this population. Specifically, we hypothesize that early traumatic experiences of childhood sexual abuse may activate corticotropin releasing hormone (CRH) gene expression in the brain, and a vulnerability to elevated CRH gene expression in the placenta. Those traumatized by early abuse may be more susceptible to stress vı́s a vı́s CRH dysregulation during a major psychosocial stressor, such as pregnancy. Elevated CRH has been associated with preterm labor.

Section snippets

Intimate partner violence and pregnancy

Research suggests that there is an association between domestic violence and low birth weight infants, preterm labor, and premature delivery.2 Intimate partner violence during the perinatal period may adversely affect pregnancy outcome directly and indirectly. Some of the pregnancy effects may result from the psychosocial stress of the abuse.6 One study demonstrated that abused women who had recently experienced extremely stressful events, including domestic violence, suffered spontaneous

Definition and health consequences of childhood sexual abuse

Childhood sexual abuse may be defined as any activity that engages a child in sexual activities that are developmentally inappropriate, with or without threatened or actual violence or injury. Sexual abuse does not always involve sexual intercourse or physical force. Rather, it is characterized usually by deception and coercion. Activities may include genital or anal contact; oral–genital contact; and insertion of objects; and can encompass incest or sexual assault by a relative or stranger.

Possible effects of childhood trauma on neuroendocrine systems

Corticotropin releasing hormone (CRH) is a 41 amino acid peptide essential in the activation of the pituitary gland, and a peptide hormone linked to behavior, notably the “fight or flight” response to a perceived threat. Research on the role of CRH under conditions of extreme stress has often relied upon animal models to test empirical hypotheses, because it is both unfeasible and unethical to contrive conditions of extreme trauma in people under laboratory conditions. Studies in non-human

Clinical implications of stress-related neuroendocrine dysregulation

One result of early childhood sexual abuse is an increased risk of PTSD. Patients with current PTSD, including survivors of childhood sexual abuse, demonstrate a dysregulation of hypothalamic-pituitary-adrenal activation.18 These individuals tend to have lower basal levels of cortisol, but they hypersecrete cortisol when pharmacologically or behaviorally challenged under experimental conditions of stress.19 Importantly, PTSD is associated with elevated CRH measured in the cerebrospinal fluid

Effects of childhood sexual abuse on pregnancy and childbirth

Early traumatic events may result in long-term vulnerability to fear and anxiety related responses in a number of contexts. In an experimental context, alterations in the startle response of sexual abuse survivors have been demonstrated.24 Even without the benefit of intervention, some abuse survivors are able to maintain the appearance of psychological adjustment. Nevertheless, these individuals may be vulnerable to the lasting consequences of abuse. Certain stressful life events may trigger

Discussion

Violence against women, particularly childhood sexual abuse, may hypothetically kindle, or result in elevated CRH gene expression in the brain and in the placenta during pregnancy. There is little doubt that early traumatic experiences can have a long-term impact. Those individuals traumatized by early sexual abuse may be more susceptible to stress vı́s a vı́s CRH dysregulation during a subsequent biopsychosocial stressor, such as pregnancy. That is, certain experiences associated with

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  • Cited by (29)

    • Non-invasive biomarkers of fetal brain development reflecting prenatal stress: An integrative multi-scale multi-species perspective on data collection and analysis

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      In humans, differential methylation is associated with prenatal exposure to maternal depression (O’Connor et al., 2003; Teh et al., 2014), PS and birth weight (Filiberto et al., 2011; Mulligan et al., 2012; Vidal et al., 2014). Preconceptual or intra-gestational stress may result in increased cerebral and placental expressions of the CRH gene stimulating fetal cortisol and adrenocorticotropic hormone (ACTH) and signaling premature maturation of fetal tissue (Horan et al., 2000; Moog et al., 2016). Repeated stress exposure may dysregulate HPA axis and increase CRH and cortisol levels which in turn sensitizes women to stress experienced during pregnancy.

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      Some PAs are caused by acute trauma, but many may arise from a longer term process hypothesized to begin early in pregnancy, suggesting that prepregnancy health factors may be important to predict risk [2]. For example, stress among women who were abused in childhood has been hypothesized to manifest in increased corticotropin-releasing hormone production by the placenta (pCRH) during pregnancy [28]. Limited evidence indicates that women who experienced childhood trauma have higher pCRH levels during the second half of pregnancy [29], and placentas from abruptions express more pCRH than placentas from spontaneous preterm labors [30].

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      However, women with severe abuse more often reported an influence of CSA experiences on dental care, stress during dental visits, and preference for a female dentist to a male dentist. More severe forms of abuse are also known to increase the risk for health problems, such as mental, internal, or gynecological diseases, when compared to women with less severe forms of abuse [19–26,31,32]. While further investigations on the effect of age at the beginning of abuse or age for the duration of abuse and the number of perpetrators on specific long-term consequences of CSA are needed to confirm their unfavorable effects on long-term consequences of CSA, an increasing number of methodologically sound studies show that a combination of several types of abuse during childhood enhances the risk for health problems as adults [23,31].

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