Types and timing of trauma exposure across the life course and maternal hypertension.

Background: Exposure to trauma across the life course may be associated with cardio-metabolic dysfunction during pregnancy; however, previous research has been inconsistent, particularly in highly exposed populations.

Objectives: To estimate associations between types and timing (first occurrence) of trauma exposure and hypertension experienced during pregnancy in a safety-net hospital in Atlanta, Georgia, 2011-2022.

Methods: Participants completed a 14-item trauma screener. We linked that information to data from the medical record on hypertension (including chronic hypertension, gestational hypertension or preeclampsia). We fit logistic regression models and used the estimates to calculate risk ratios for each trauma type and each critical window (0-9 years, 10-19 and 20+). We fit unadjusted models and adjusted for age, parity and education.

Results: We included 704 individuals with a delivery within 12 months following screening. The majority (94%, 661) reported at least one traumatic event, most commonly witnessing violence (79.4%). Overall, 18% experienced gestational hypertension, 10.8% chronic hypertension and 11.9% preeclampsia. Among individuals who reported trauma, 31.5% screened positive for probable posttraumatic stress disorder and 30.9% for probable depression, compared to 0 and 2.3% among those without reported trauma. No trauma type (violence, witnessing violence, non-interpersonal or sexual assault) was associated with increased hypertensive risk, regardless of timing.

Conclusions: In this sample with a high trauma and hypertension burden, trauma was not associated with an elevated risk of hypertension during pregnancy, despite a high burden of PTSD and depressive symptoms among people with trauma exposure.