Associations Between Adverse Childhood Experiences and Prenatal Mental Health in the French EDEN Cohort: Cumulative, Person-Centered, and Dimensional Approaches
Adverse childhood experiences (ACEs), such as family conflict, abuse, or neglect, can have lasting consequences on mental health. During pregnancy, these effects may manifest as depressive or anxious symptoms, putting both maternal and child health at risk. However, using a simple cumulative ACE score may limit our understanding of the mechanisms involved, as it does not differentiate which types of adversity are most strongly linked to psychological disorders.
In this study, conducted with 1,887 pregnant women from the French EDEN cohort, we explored the association between ACEs and prenatal symptoms of depression and anxiety by comparing three approaches: the cumulative ACE score, the Dimensional Model of Adversity and Psychopathology (DMAP), and Latent Class Analysis (LCA). The LCA approach identified three exposure classes: low risk, family discordance, and multidimensional adversity.
Women who reported two or more ACEs had a significantly higher risk of depressive and comorbid symptoms. More specifically, adversities related to the family environment—such as conflict, parental separation, or lack of emotional support—were most strongly associated with mental health difficulties during pregnancy.
These findings suggest that not all forms of ACEs have the same impact, and that the qualitative nature of these experiences must be considered. Going beyond the cumulative score, the multidimensional approach offers better insight into prenatal psychological vulnerability. This opens the door to more targeted prevention and intervention strategies, tailored to each pregnant woman’s individual history.