How do Social Inequities get
Under the Skin in the Perinatal Period?
Photo by Andrae Ricketts on Unsplash
Research has shown that maternal adverse childhood experiences (ACEs) like abuse and neglect have a profound and long-lasting effect on development and health across generations. And we know that ACEs are not randomly distributed but affect individuals inequitably the context of racism, colonialism, and other forms of structural violence.
Yet, much remains to be known about how these social inequities become biologically embedded and transmitted intergenerationally during the perinatal period. One proposed method is through epigenetic changes, which alter not the sequence of DNA but rather how DNA is expressed. The most studied epigenetic mechanism to date is DNA methylation. We are working on better understanding DNA methylation changes that occur during the perinatal period in the context of adversity. Through our work, we intend to help elucidate biological processes that connect social inequities and health across generations in order to use biomarkers to evaluate perinatal interventions that aim to redress these health inequities.
Can Interventions Meant to
Redress Social Inequities
Get Back “Under the Skin”?
Across the globe, interventions in pregnancy and early childhood have been developed that aim to accompany families facing social inequities, particularly those living in poverty and improve health outcomes.
Perinatal RISE aims to use biological markers to evaluate the effectiveness of these interventions. Traditionally, evaluating interventions solely based on behavioral outcomes can take years, especially when it comes to assessing impacts on children. However, incorporating biological markers in the perinatal period, could provide more immediate feedback on interventions’ effectiveness while helping researchers gain insights into the underlying mechanisms of how interventions work.
By leveraging perinatal biological markers, we aim to not only improve outcomes for families facing social inequities but also contribute to the broader understanding of how interventions can effectively address complex social challenges.
Trauma-Informed Care
In women with trauma histories, obstetric procedures through the perinatal period tend to be experienced as particularly invasive, often triggering hyperarousal and symptoms of post-traumatic stress such as fear, shame, or anger. Triggers in obstetric care are not limited to intrusive contact; power dynamics and lack of control can be activating for a trauma survivor. These reactions can contribute to sustained high levels of stress, anxiety, and depression, which are associated with negative outcomes for pregnant women and their babies. A novel avenue for improving outcomes for women with trauma histories and their children is to develop models of obstetric care that are attuned to the unique needs of women with trauma histories.
Trauma-informed care responds to the high prevalence and sequelae of trauma by acknowledging the impact that traumatic events have on patients’ lives and health and actively resisting retraumatizing patients. Recognizing the importance of trauma-informed care for patients, in 2021, the American College of Obstetricians and Gynecologists (ACOG) recommended implementing a trauma-sensitive approach in all obstetric/gynecologic healthcare visits.
Despite the ACOG’s recommendations that all healthcare should be trauma informed, there is no consensus on how principles of trauma-informed care should be incorporated into the obstetric setting, and there is no evidence of the effects of trauma-informed obstetric care on maternal and child health.
Perinatal RISE is working to co-create trauma-informed obstetric care models with patients, clinicians and policymakers and test their effectiveness in improving maternal and child health.
