Search Results (99)

Background: Transgenerational trauma (TT)/Intergenerational trauma (IT) is the transmission of the effects of traumatic experiences of parents to their children, who have not themselves experienced traumatic events. This transmission occurs through neurobiological and metabolic changes and the environment in which they were raised. Methods: A systematic review was conducted in accordance with the PRISMA 2020 guidelines. PubMed and Google Scholar databases were searched from 2005 to 2025. Studies focusing on adult offspring, exposure to ancestral trauma, biological markers (DNA methylation, cortisol), and psychological outcomes were included. Results: The main study results are as follows: identification of sex-specific DNA methylation patterns in the NR3C1 gene and accelerated biological aging (GrimAge) in offspring; role of parental reflective functioning (PRF) and impaired mentalization as major psychological channels of trauma transmission; and evidence confirming the impact on three generations, manifested by treatment-resistant depressive disorders, anxiety, and neuroendocrine dysregulation (low cortisol levels). Conclusions: This article highlights the intergenerational impact of trauma and highlights its epigenetic significance. The primary goal was to explore universal epigenetic mechanisms. Early understanding of ancestral history is crucial for personalized psychiatric care. Full article

Maternal stress during lifetime and pregnancy may influence offspring epigenetic age, impacting long-term health. We conducted a systematic review and meta-analysis of associations between maternal stress and epigenetic aging markers: telomere length (TL) and DNA methylation (DNAm) age acceleration. The systematic search was performed according to PRISMA guidelines and registered on PROSPERO (ref. CRD42023474640). Fixed and random effect meta-analyses were carried out, stratified by stress type and marker type (TL, DNAm). Sixteen studies met inclusion criteria; 12 were meta-analyzed (10 TL, 2 DNAm). Due to high heterogeneity, restricted maximum likelihood meta-analysis suggested significant inverse associations between maternal stress and offspring TL. Perceived stress was associated with shorter TL (p-value = 7 × 10⁻⁴, β = −0.085, 95%CI [−0.135, −0.036]), as was lifetime stress/trauma (p-value = 0.01, β = −0.209, 95%CI [−0.370, −0.049]). In contrast, maternal stress showed no significant associations with DNAm age acceleration (p-value = 0.32). Both perceived maternal stress and maternal stress were associated with shorter offspring TL, suggesting that stress exposure across the maternal lifespan influences offspring biological aging markers. No significant association was observed with DNAm-based aging clocks. Further studies with larger sample sizes and more homogeneous settings are needed to confirm and expand upon our observations. Full article

Operative vaginal delivery (OVD) via vacuum extraction is a fundamental component of modern obstetric management, yet it carries specific risks of failure and maternal–fetal complications, such as cup detachment, cephalohematoma, and intracranial hemorrhage. The success and safety of the procedure rely heavily on the correct application of the vacuum cup over the “flexion point” of the fetal head. Traditional identification of this landmark via digital examination is often hindered by caput succedaneum and cranial molding, leading to high rates of diagnostic error, particularly in dystocic labor, due to fetal head malpositions and malpresentation. Intrapartum ultrasound (ITU) has demonstrated superior accuracy compared to clinical examination in assessing fetal head position and station and internal rotation. This expert commentary and technical proposal analyzes the current literature regarding vacuum extraction application and failures, focusing on the predictive value of ITU parameters (e.g., Angle of Progression, Midline Angle, Head-Symphysis Distance) and the impact of ITU on cup placement and delivery outcomes. Furthermore, we propose a novel technique: the “Ultrasound Flexion Point” (UFP). This method utilizes translabial ultrasound to identify the specific intersection of the fetal midline and the biparietal diameter as an objective sonographic proxy for the classical flexion point. By providing spatial orientation guidance immediately before the procedure, this technique aims to guide the operator in aligning the cup’s notch with the sonographically identified target zone, using the midline angle as orientation reference, thereby potentially minimizing paramedian or deflexing applications and reducing the incidence of vacuum detachment and associated neonatal trauma. This expert commentary and technical proposal synthesizes current evidence and proposes a protocol requiring prospective validation through randomized controlled trials. Full article

Breastfeeding is a complex biopsychosocial process influenced not only by biological mechanisms but also by a woman’s previous psychological experiences and past traumas. The aim of this review was to analyze current research on the impact of early traumatic experiences, perinatal trauma, psychological difficulties, and previous interpersonal stressors on the initiation, continuation, and emotional course of breastfeeding. Women with a history of trauma are more likely to struggle with emotional regulation difficulties, increased stress, depressed mood, and problems bonding with their child. These factors translate into an increased risk of discontinuing lactation, discomfort during feeding, and reduced self-esteem regarding maternal competence. The literature also emphasizes the role of psychological and social support, which can help mothers cope with emotional tension and promote a positive breastfeeding experience. Consideration of the mother’s previous psychological and traumatic experiences is crucial for a more complete understanding of lactation difficulties and the development of effective forms of support for women in the perinatal period. Full article

Intergenerational trauma significantly affects the health and mental health of African American families, particularly women whose lives are shaped by systemic inequities and historical oppression. This scoping review examines how trauma and resilience are transmitted across generations in African American communities, with a focus on dyads such as mother–child and mother–daughter relationships and a conceptual grandmother–mother–daughter triad. The review aims to identify mechanisms of trauma transmission and resilience and to inform culturally responsive, multigenerational interventions. Peer-reviewed studies published between 2012 and 2025 were identified that included African American caregivers and children and addressed biological, psychological, social, cultural, and resilience dimensions of intergenerational processes. Data were synthesized using a dimensional conceptual analysis approach. Findings indicate that intergenerational trauma is perpetuated through chronic stress and discrimination, maternal mental health challenges, family structure and caregiving strain, and cultural narratives about strength and self-reliance. At the same time, resilience is transmitted through sensitive caregiving, spirituality and faith, social and kin support, racial socialization, and economic survival strategies that draw on cultural and historical knowledge. These results underscore the importance of addressing intergenerational trauma holistically by integrating dyadic evidence within a broader conceptual triadic framework. Culturally responsive, multigenerational interventions that leverage family and community strengths and make space for emotional vulnerability are essential for interrupting cycles of trauma and fostering healing within African American families. Full article

Child sexual abuse (CSA) has consequences beyond the direct victim, affecting non-offending mothers, who may experience psychological, physical, and social symptoms after disclosure. This systematic review examined the impact of CSA on these mothers and the variables that influence coping and recovery. Searches were run in EBSCOhost (MEDLINE, PsycInfo, CINAHL) following PRISMA 2020 and a PEO framework. Three reviewers screened 128 records in Rayyan (Cohen’s κ = 0.73), and 17 empirical studies met the inclusion criteria. Risk of bias was appraised with ROBINS-E. Distress, anxiety, depression, and secondary traumatic stress were the most frequently reported symptoms. These consequences were associated with factors such as maternal history of abuse, perceived social support, coping style, and cultural or religious beliefs, highlighting potentially modifiable cognitive and contextual targets for support. A key contribution of this review is the identification of modifiable cognitive variables that are clinically relevant. Methodological limitations of the evidence base warrant cautious interpretation–comprising seven qualitative, nine quantitative cross-sectional, and one mixed-methods study, with heterogeneity that precluded meta-analysis and limited causal inference. Overall, the findings highlight the need for comprehensive, trauma-informed interventions that address not only the child’s recovery but also the well-being and resilience of their mothers. Full article

Perineal tears are common during vaginal delivery and are associated with significant maternal morbidity. While chorioamnionitis and intrapartum fever are known to affect labor dynamics and perineal tissue integrity, their relationship with perineal trauma in spontaneous vaginal deliveries has not been established. This study aimed to evaluate the prevalence of perineal tears among women with intrapartum fever who delivered spontaneously. This retrospective cohort study included women who underwent spontaneous vaginal delivery during 2013–2021 in Israel. The study group comprised women diagnosed with intrapartum fever (≥38 °C), while afebrile women served as controls in a 1:2 ratio matched by age (<35 or ≥35 years) and gestational age (preterm/term). Perineal tears were classified according to the Royal College of Obstetricians and Gynaecologists (RCOG) criteria. Multivariable logistic regression was performed to adjust for statistically significant variables including obesity, induction of labor, epidural analgesia, amniotomy, delivery week, gestational diabetes, birth number, duration of the second stage of labor, and episiotomy. The cohort included 373 women with intrapartum fever and 746 controls. The overall rate of perineal tears was similar between febrile and afebrile women (42% vs. 40%; adjusted odds ratio [aOR] 0.99, 95% confidence interval [CI] 0.72–1.36). However, the rate of obstetric anal sphincter injury (OASIS) was lower among women with intrapartum fever (0.5% vs. 2.0%; aOR 0.10, 95% CI 0.02–0.52). Intrapartum fever was associated with higher rates of postpartum hemorrhage, manual exploration of the uterus, endometritis, anemia, and blood transfusion. Bacterial cultures were positive in 31% of febrile women, predominantly Escherichia coli and Group B Streptococcus, without association with perineal trauma. Alltogether, Intrapartum fever did not increase the risk of perineal tears in spontaneous vaginal deliveries and was paradoxically associated with a lower rate of OASIS. Further studies are warranted to explore the underlying physiological mechanisms linking temperature and perineal tissue resilience. Full article

Background/Objectives: Emergency department (ED) physicians may hesitate to order medically indicated imaging (MI) for pregnant patients, potentially delaying or omitting necessary diagnostic procedures. This study aimed to assess the attitudes and practices of ED physicians regarding MI procedures in pregnant patients, considering their level of training. Methods: A total of 300 physicians participated, including ED general practitioners (n = 100), emergency medicine (EM) residents (n = 100), and EM specialists (n = 100). The first section of the questionnaire collected demographic data, professional experience, and previous training related to the subject. The second section included questions based on a modified version of the American College of Radiology (ACR) Appropriateness Criteria to assess attitudes and behaviors. Results: A majority (88.7%) of participants found the management of pregnant trauma patients challenging and expressed a preference to avoid such cases. A statistically significant difference was observed between physician groups regarding the approach to unstable pregnant patients, with EM specialists and residents more likely to disregard gestational age when deciding on imaging (p < 0.001). Physicians who had received relevant training were significantly more likely to advocate immediate imaging regardless of gestational age in unstable patients (p = 0.001). Conclusions: This study highlights the diversity and statistical heterogeneity in ED physicians’ attitudes and behaviors toward MI use in pregnant patients. These variations are influenced by training, clinical experience, and accessibility of updated guidelines. Enhancing education and standardizing procedural guidance may improve decision-making and ultimately reduce maternal and fetal morbidity and mortality. Based on these findings, we propose a clinical algorithm to support imaging decisions in emergency settings. Full article

Background/Objectives: Childbirth, although generally a positive life event, can sometimes be experienced as traumatic, leading to postpartum post-traumatic stress disorder. Emergency caesarean section and operative vaginal delivery are associated with elevated psychological distress, while factors such as lifetime trauma, domestic violence, anxiety, and coping strategies may further increase vulnerability. Methods: This prospective cohort study included 113 postpartum women who delivered via emergency caesarean section (73.5%) or operative vaginal delivery (26.5%) in two tertiary hospitals in Athens, Greece (March–July 2023). Data were collected at three time points: the second postpartum day, six weeks postpartum, and three months postpartum. Descriptive statistics were used to summarize sample characteristics. Chi-square tests were performed for categorical variables and independent sample t-tests for continuous variables. Multivariate logistic regression analyses were conducted to identify predictors of postpartum post-traumatic stress disorder, with results expressed as odds ratios (OR) and 95% confidence intervals (CI). Results: At six weeks postpartum, 14.2% of participants met full diagnostic criteria for P-PTSD. Postpartum post-traumatic stress was strongly associated with higher state and trait anxiety, fewer positive coping strategies, and exposure to domestic violence (lifetime, during pregnancy, and in the past year). Women with traumatic childbirth experiences had a 14.7-fold higher risk of developing P-PTSD. Lifetime trauma, particularly physical or sexual abuse and exposure to disasters, further increased vulnerability. Over the last three months, 50% of those initially diagnosed continued to meet the diagnostic criteria. Multivariate analysis identified traumatic childbirth, state anxiety, and domestic violence during pregnancy as significant predictors of postpartum post-traumatic stress. Conclusions: Postpartum post-traumatic stress is a significant and underestimated consequence of high-risk deliveries. Screening for domestic violence and trauma history during pregnancy, assessing perinatal anxiety, and providing trauma-informed psychological support are critical to reducing maternal psychiatric morbidity and promoting maternal-infant well-being. Full article

Introduction: Neurodevelopmental disorders (NDs), including autism spectrum disorder and related conditions, are increasingly recognized among women of reproductive age, yet their unique needs during pregnancy and childbirth remain poorly studied. Communication differences, sensory sensitivities, and co-occurring psychiatric conditions may complicate maternity care, leading to higher risks of adverse outcomes and ethical challenges in clinical practice. This study aimed to examine pregnancy complications, delivery outcomes, and postpartum characteristics in women with NDs, compared with a control group, and to identify specific barriers in perinatal care. Methods: A retrospective observational study was conducted at the National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, including 18 pregnant women with confirmed NDs and 21 matched controls with uncomplicated pregnancies. Data were extracted from medical records and included demographic parameters, pregnancy course, complications, labor management, neonatal outcomes, and documented communication or ethical issues. Comparative analyses were performed using chi-square or Fisher’s exact tests for categorical variables and Student’s t-test or Mann–Whitney U test for continuous variables. Results: Pregnant women with NDs had significantly higher rates of pelvic girdle pain (66.7% vs. 23.8%, p = 0.01), vaginal bleeding (44.4% vs. 14.3%, p = 0.04), anxiety (61.1% vs. 19.0%, p = 0.007), and depression (50.0% vs. 14.3%, p = 0.02) compared with controls. Persistent daily nausea was also more common (50.0% vs. 14.3%, p = 0.03). Attendance of prenatal physician visits was lower in the ND group (66.7% vs. 95.2%, p = 0.02). Cesarean delivery occurred in 83.3% of ND women versus 23.8% of controls (p < 0.001), with psychiatric recommendations often cited as the indication. Breastfeeding was declined in 94.4% of ND cases versus 4.8% of controls. Labor duration was prolonged, and neonatal anthropometrics were lower in the ND group. Communication difficulties were documented in 83.3% of ND participants, and postpartum depressive symptoms were identified in 77.8%. Conclusions: Pregnant women with NDs face a multidimensional vulnerability in maternity care, including higher frequencies of pain, bleeding, nausea, anxiety, and depression, prolonged labor, markedly increased cesarean rates, reduced breastfeeding initiation, and smaller neonatal anthropometrics. Frequent communication barriers, guardian decision-making, and postpartum separation further complicate care. These findings underscore the necessity of neurodiversity-informed, individualized perinatal strategies, integrating sensory accommodations, trauma-informed communication, and proactive mental health support to improve both clinical outcomes and patient experiences. Full article

Objective: This pilot study assessed the psychological and physical impact of the COVID-19 pandemic on postpartum women that gave birth during the pandemic, and evaluated the feasibility of remote monitoring for maternal mental health. The study also proposes a conceptual framework to strengthen remote maternal care in future public health emergencies. Methods: Conducted between 2020 and 2021 in Reggio Emilia, one of Italy’s ten hardest-hit provinces during the early COVID-19 outbreak, this study enrolled 21 pregnant women (10 COVID-19-positive at delivery, 11 COVID-19-negative controls). Psychological and physical health were assessed using validated instruments: the Beck Depression Inventory (BDI) and Edinburgh Postnatal Depression Scale (EPDS) for depression, the State-Trait Anxiety Inventory (STAI) for anxiety, the Impact of Event Scale–Revised (IES-R) for trauma-related stress, and the SF-36 for physical functioning. Additional measures included breastfeeding experience and resilience. Remote assessments were conducted between 6 and 12 months postpartum to evaluate psychological recovery and satisfaction with perinatal care. C test was used to compare the two groups of women. Results: COVID-19-positive women reported significantly higher depressive symptoms (BDI: 13.50 ± 8.14 vs. 6.73 ± 4.73; U = 27, p = 0.048), and elevated state anxiety levels (STAI-S: 41.60 ± 10.23 vs. 33.64 ± 10.15; U = 27, p = 0.048) compared to controls. Post-traumatic stress symptoms were also higher among COVID-positive participants (IES-R total: 41.10 ± 19.33 vs. 30.64 ± 7.99; U = 24.5, p = 0.029). No significant differences emerged in EPDS or trait anxiety scores. Conclusions: Remote data collection proved feasible for postpartum women during the pandemic and highlighted elevated depressive, anxiety, and trauma-related symptoms in COVID-19-positive mothers. These findings support the development of flexible digital care frameworks for maternal well-being in crises. The introduction of the “10 Gold Rules for Remote Maternal Healthcare in Critical Situations” offers a forward-looking, expert-informed conceptual framework to guide the development of scalable, trust-based digital care models that go beyond monitoring to include proactive, patient-centred support. Full article

Intimate partner violence (IPV) and life stressors, such as housing instability, unsafe neighborhoods, and lack of support, significantly impact maternal and fetal health, potentially leading to perinatal loss. This qualitative study explored the lived experiences of 22 Black women in the United States who identified IPV and other stressors as contributing factors to their perinatal loss. Semi-structured interviews were carried out with women who had experienced perinatal loss and were either pregnant or had given birth after a loss. Descriptive coding and thematic analysis were used in analyzing the data, revealing three main themes: pregnancy in the context of IPV, unsafe and unstable living environments, and challenges in finding support. Women perceived IPV and life stressors as direct causes of their loss, complicating their ability to heal and increasing their anxiety about future pregnancies. This study underscores the importance of addressing IPV and related stressors within maternity care. Maternity care providers should recognize signs of IPV and significant life stressors, provide trauma-informed, culturally responsive care, and facilitate access to supportive services. These insights inform perinatal public health strategies, including surveillance, prevention, and responsive policy. Full article

Psychopathy in women remains understudied, particularly regarding the role of early relational experiences such as attachment. This systematic review aims to synthesize the current evidence on the association between attachment-related factors and psychopathic traits in women. A structured search following PRISMA guidelines across multidisciplinary databases (Scopus-Elsevier^®, ESBCO^®, Pubmed^®, Sage Publishing^®, B-On, and Web of Science-Core Collection^®) yielded 147 articles, of which eight met the inclusion criteria. The majority of the studies met three to four out of the five methodological quality criteria. Findings indicate that insecure attachment styles are differentially associated with psychopathy. Avoidant attachment is positively linked to callous-unemotional traits, whereas the role of anxious attachment appears more heterogeneous. Some studies associate it with higher levels of affective traits and secondary psychopathy, while others identify it as a negative predictor of callous-unemotional features in women. Avoidant attachment was also negatively correlated with empathy and positively related to maladaptive emotion regulation strategies, particularly among women with secondary psychopathic traits. Negative maternal parenting was associated with elevated psychopathic traits, whereas positive parental involvement acted as a protective factor. Additional predictors included early maladaptive schemas and childhood risk factors such as parental criminality and poor supervision. These findings highlight the relevance of early intervention and attachment-informed approaches in forensic risk assessment, trauma-informed care, and prevention programs targeting women with psychopathic traits. Full article

Background/Objectives: Infant feeding is critical for health and development, yet the influence of maternal psychosocial factors on its timing is not fully understood. While maternal adverse childhood experiences (ACEs) are known to affect perinatal outcomes, their impact on the specific timing of initiating formula and complementary foods remains under-investigated. We hypothesized that maternal ACEs are associated with delayed initiation of infant formula and complementary foods and that this association is mediated by postpartum depression (PPD). This study aimed to examine the link between maternal ACEs and delayed infant feeding, and to assess the mediating role of PPD using data from a large nationwide Japanese database. Methods: This cross-sectional study utilized data from the Japan COVID-19 and Society Internet Survey (JACSIS), conducted between July and August 2021. The analysis included 3446 postpartum mothers. Maternal ACEs were assessed using a 9-item questionnaire, and a cumulative score was categorized as high (≥4 ACEs) versus low (0–3 ACEs). The primary outcomes were infant feeding behavior including breastfeeding, formula feeding and complementary foods. We used logistic regression analysis with inverse probability of treatment weighting (IPTW) to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). A mediation analysis was conducted to evaluate the role of smoking, alcohol and PPD. Results: High ACE exposure (≥4) was present in 221 mothers (6.4%). A high maternal ACE score was significantly associated with delayed initiation of formula feeding (≥7 days) (Adjusted OR: 2.12, 95% CI: 1.12–4.01, p = 0.02) and late initiation of complementary foods (≥7 months) (Adjusted OR: 2.27, 95% CI: 1.38–5.01, p = 0.03); no significant associations were observed for ever/late/continued breastfeeding or ever/continued formula feeding. These associations attenuated to non-significance after adjusting for PPD. Conclusions: Maternal ACEs are associated with delayed initiation of complementary foods and formula, largely through PPD. Perinatal services should combine ACE/PPD screening with trauma-informed mental health and nutrition support to promote timely infant feeding. Full article

Background: Motor vehicle accidents account for the majority of abdominal trauma in pregnancy and can result in fetal morbidity and mortality. With advancing gestation, the fetus becomes more vulnerable to injury. Case presentation: A preterm neonate is born at 32 weeks’ gestation via cesarean section due to placental abruption after maternal motor vehicle accident. Initially, the infant presented with anemia, thrombocytopenia, and acute kidney injury in the setting of renal contusions. Results: Hyponatremia, acidosis, oliguria, and uremia progressed to frank anuric renal failure, requiring several months of hemodialysis before transition to peritoneal dialysis for chronic renal replacement therapy at home. Conclusions: Fetal renal injury resulting in postnatal renal failure is a rare but potentially devastating complication of blunt abdominal injury during pregnancy. Sonographic and laboratory evaluation of a neonate with suspected in utero injury after maternal motor vehicle accident is imperative, as is a high index of suspicion for neonatal renal injury. Full article