Impacts and mechanisms of child sexual abuse in women's impaired fecundity and pregnancy outcomes

One in four girls residing in the U.S. will be sexually abused before they turn 18. Child sexual abuse (CSA) victimization is associated with an increased risk for morbidity, including adverse reproductive health outcomes in women. In characterizing the associations between CSA and women’s reproductive health, previous work has not fully accounted for selection bias and the role of developmental timing, abuse chronicity, and co- occurrence with other child abuse types in determining outcome severity. These research limitations hinder our ability to characterize and appropriately address adverse reproductive health outcomes among women who are survivors of CSA. Moreover, the biological and psychosocial mechanisms that explain reproductive health problems among female survivors of CSA remain understudied. Chronic inflammation and psychosocial consequences of CSA, such as depression, substance use, a history of sexually transmitted infections hold promise as potential mediating factors in these associations. Our study aims to examine the impact of CSA on women’s impaired fecundity, pregnancy outcomes, and preterm delivery; and explore inflammation and psychosocial mechanisms that may mediate these associations. Specifically, the aims of this study include estimating the impact of CSA on women’s reproductive health outcomes (Aim 1); identifying patterns of child abuse based on type, developmental timing, and chronicity, and the association of these patterns with women’s reproductive health outcomes (Aim 2); and exploring inflammation and psychosocial mechanisms in the association between CSA and women’s reproductive health outcomes (Aim 3). Our proposed study is a secondary data analysis of the National Longitudinal Study of Adolescent to Adult Health (Add Health) restricted use dataset. The Add Health cohort is a nationally representative sample of adolescents recruited from grades 7-12 during the 1994-1995 school year and prospectively followed into adulthood across five waves of data collection. Add Health’s latest data collection occurred when participants were, on average, 38 years old (2016-2018; N = 6,197 women). Among women in Add Health sample, approximately 25% reported a history of CSA. This nationally representative data assesses CSA and other child abuse types, chronicity, and age of onset, allowing for a more nuanced understanding of abuse clustering. For each aim, we will investigate several adverse reproductive health outcomes, including difficulty in getting and remaining pregnant, complications during pregnancy (i.e., high blood pressure, preeclampsia, protein in urine, and diabetes), and preterm delivery. We will employ several analytical approaches for data analysis, involving propensity score matching, mixed-mode latent class modeling, mediation testing, and logistic regression analysis. The results of this study will advance strategies to prevent or mitigate impaired fecundity and pregnancy sequelae in women who have survived CSA—ultimately reducing the burden of adverse reproductive outcomes among girls who experience sexual trauma in their childhood and adolescence.