Associations of Childhood Sexual Maltreatment and Negative Birth Experiences: Mediating Role of Posttraumatic Stress in Late Pregnancy

Purpose Childhood sexual maltreatment is a well-documented risk factor for adverse perinatal physical and mental health outcomes, which are worse in women of color compared to white women. Yet, the pathways through which early sexual trauma influences childbirth experiences and the role of ethnicity/race in these associations are insufficiently understood. This study examined the relationship between childhood sexual maltreatment and negative childbirth experiences, with a focus on the potential mediating roles of late-pregnancy posttraumatic stress symptoms (PTSS) and fear of childbirth. Ethnic/racial group differences were also evaluated. Methods Women (N = 433) were drawn from the Michigan Prenatal Stress Study, a large longitudinal, prospective study of the influence of prenatal stressors on mother and infant outcomes. Participants reported on childhood sexual maltreatment, PTSS, fear of giving birth (third trimester), negative childbirth experiences, and ethnic/racial identity. Results Childhood sexual maltreatment was significantly associated with more negative childbirth experiences, and late-pregnancy PTSS mediated this association. Although this PTSS-mediated pathway did not significantly differ by race/ethnicity, it was only significant among women of color. Conclusions Findings highlight the importance of addressing trauma-related stress during pregnancy to improve perinatal outcomes for all women with a history of childhood sexual maltreatment. Targeted interventions aimed at reducing PTSS in pregnancy may mitigate the impact of childhood sexual trauma on childbirth experiences and promote maternal and infant well-being.