Exploring Psychological Distress and Adverse Childhood Experiences Among U.S. Women with Concurrent Reproductive Trauma and Infertility: A Secondary Analysis of a Cross-Sectional Study

Abstract

Background: Adverse childhood experiences (ACEs) are traumatic events that occur during childhood. Previous evidence suggests that pregnancy loss may be associated with ACEs and mental health disorders; however, to our knowledge, no studies have considered these associations in women with concurrent reproductive trauma (CRT), defined as pregnancy loss during infertility. Purpose: To compare ACEs, stress, anxiety, depression, and post-traumatic stress disorder (PTSD) symptoms among women with CRT and women with infertility only. Methods: A descriptive cross-sectional study design was used to recruit 99 U.S. women with infertility through convenience and snowball sampling on Facebook, Instagram, and at fertility clinics. A REDCap survey included demographics, ACEs questionnaire, infertility-related stress (COMPI-FPSS), perceived stress (PSS-4), anxiety (GAD-7), depression (PHQ-8), and PTSD (PC-PTSD-5). Statistical analysis using SPSS 28 included descriptive statistics, independent t-tests, and chi-square test for independence. Results: Women with CRT were more likely to experience 2+ ACEs than women with infertility-only (p = 0.001), with four ACEs occurring more often. Infertility-only group with 2+ ACEs had significantly higher levels of stress, PTSD, anxiety, and depression, with clinically significant higher depression and PTSD symptoms. CRT group with 2+ ACEs had significantly higher anxiety and depression, with clinically significant higher moderate or severe depression. Discussion: Although women with CRT and infertility experienced similar levels of psychological distress, having an ACE history worsened their mental health symptoms. ACE history may be associated with reproductive traumas, though further studies are needed. Trauma-informed care should be implemented for women with ACEs, infertility, and CRT.