Transgender and Gender Diverse Identity Development in Pediatric Populations.

Gender identity development is conceptualized as a biopsychosocial process that is influenced by broader historical, social, and cultural contextual factors. This review outlines the current understanding of the biopsychosocial and contextual factors that influence gender identity development in children and adolescents. Developmental milestones for gender identity development in youth are presented, and unique developmental needs for transgender and gender diverse (TGD) youth are reviewed. This article also reviews emerging areas of relevance for TGD populations, such as detransitioning and transition regret. Clinicians working with TGD populations should aim to develop individualized, evidence-based care plans that flexibly meet each youth's distinct developmental and contextual psychosocial and health care needs. [Pediatr Ann. 2023;52(12):e450-e455.].

Maternal Adverse Childhood Experiences and Perceived Stress During Pregnancy: The Role of Personality.

This study explores the role of personality traits in the relationship between maternal adverse childhood experiences (ACEs) and perceived stress during pregnancy. Pregnancy can be a stressful time for new mothers. ACEs have been associated with elevated levels of pregnancy stress, and have also been linked to the Big Five dimensions of personality, including a positive association with neuroticism. The Big Five have also been associated with perceptions of stress, and there is evidence to suggest that personality may be one mechanism through which ACEs disrupt psychosocial functioning during pregnancy. The sample included 177 pregnant girls and women (ages 15-40) from two prenatal clinics serving diverse and low-income patients. Participants completed online questionnaires on perceived stress, ACEs, and the Ten Item Personality Inventory. Results of a path analysis and test of mediation showed significant indirect effects from ACEs to perceived stress mediated independently by neuroticism and conscientiousness. Mothers with high ACEs reported higher neuroticism and lower conscientiousness, and in turn, experienced high levels of perceived stress during pregnancy. High neuroticism and low conscientiousness associated with early adverse experiences increase the risk for perceived stress during pregnancy. Screening for ACEs may help identify mothers at risk for perinatal stress and provide the opportunity for additional support for maternal emotion regulation and mental health.

What is already known on this subject?Research has shown that experiencing adversity during childhood is associated with higher levels of stress during pregnancy. Early life adversity has also been associated with all Big Five personality traits and personality has been implicated as an important factor contributing to psychosocial functioning and well-being.What this study adds?Findings from the current study indicated that experiences of childhood adversity were associated with perceived stress during pregnancy, with significant indirect effects through the personality dimensions of neuroticism and conscientiousness. That is, mothers with high ACEs reported higher neuroticism and lower conscientiousness, and in turn, reported experiencing high levels of perceived stress during pregnancy.

Effects of a Mindfulness-Based Parental Reflection Intervention on Pregnancy-Related Distress: A Pilot Study.

Background: Mindfulness-based interventions have been shown to be efficacious for reducing psychological distress and mental health symptoms and promoting well-being, including during pregnancy and postpartum. There is promising, though limited, evidence showing that interventions that focus on improving the mother-infant relationship are associated with improvements in both the mother-infant relationship and maternal mental health symptoms. The current study examines the effects of a prenatal mindfulness-based, reflective intervention designed to enhance maternal-fetal bonding on pregnancy-related distress and prenatal depressive symptoms. Methods: Out of a larger sample of 130 pregnant women in their second trimester, 15 women were recruited to participate in a 2-week long mindfulness-based, reflective intervention with daily short (<5-minute) activities. Multiple linear regression analyses were conducted to examine associations between the intervention and pregnancy-related distress and depression during the third trimester of pregnancy, controlling for race, age, education, union status, and first trimester depressive symptoms. Results: Results indicate that women who participated in the intervention during their second trimester reported lower pregnancy-related distress in their third trimester but no differences in depressive symptoms. Conclusions: A brief, mindfulness-based intervention delivered during pregnancy via cellphone texts can be a useful tool to reduce maternal distress related to pregnancy. Additional reflective exercises that address mood and global stress, as well as increasing the amount and/or frequency of the intervention, may be important for promoting maternal mental health more globally.

Maternal childhood adversity and pregnancy intentions as predictors of pregnancy happiness.

OBJECTIVES: Nearly half of all pregnancies in the U.S. are classified as unintended (e.g. unplanned, mistimed, or unwanted), which have been linked to numerous adverse consequences for maternal and child outcomes. Recent evidence suggests that happiness about a pregnancy is often a better predictor of maternal and infant health outcomes than pregnancy intentions, but few studies have examined maternal predictors of pregnancy happiness. METHODS: Using a clinic-based sample of pregnant women (n = 177), we apply multiple regression analysis to examine the association between maternal adverse childhood experiences and pregnancy happiness, as well as the moderating role of pregnancy intentions. RESULTS: Women with more childhood adversity and pregnancies that were unplanned and mistimed or unwanted reported lower levels of pregnancy happiness, compared with women with less childhood adversity and intended pregnancies. However, pregnancy intentions did not moderate the relationship between maternal adverse childhood experiences and pregnancy happiness. CONCLUSION: Our results suggest that pregnancy happiness is lower among mothers with a history of childhood adversity and pregnancies classified as unplanned and mistimed or unwanted. Understanding the factors that impact pregnancy happiness is critical to inform prenatal clinical practice and health policy, particularly when caring for those with a history of adversity.

Infant sleep and negative reactivity: The role of maternal adversity and perinatal sleep.

Sleep during infancy contributes to the development and maintenance of infant regulatory functioning and may be an early risk marker for more difficult temperamental traits like negative reactivity. Further, maternal adverse childhood experiences (ACEs) may predispose individuals to greater sleep disturbances in adulthood and have been linked with sleep disturbances in both mothers and infants. Thus, examining maternal history of ACEs and maternal sleep difficulties during pregnancy and postpartum may provide insight into underlying risk factors affecting infant sleep difficulties and early temperament development. Fifty-nine mothers from a diverse, community sample (44% white) completed questionnaires on ACEs, maternal sleep, infant sleep, and infant temperament at 30-weeks gestation, 6-weeks postpartum, and 16-weeks postpartum. Results indicated that maternal ACES and sleep problems during pregnancy have long term implications for infant negative reactivity at 16-weeks, with significant indirect effects through maternal and infant sleep problems at 6-weeks. Addressing psychosocial functioning and prenatal sleep during pregnancy, particularly among women with high ACEs, may be a target of intervention to improve maternal and infant sleep health during the postpartum, and reduce the risk for difficult infant temperament.

Stigma Moderates the Relation Between Peer Victimization, Thwarted Belongingness, and Depressive Symptoms in Youth with Inflammatory Bowel Disease.

PURPOSE: The stigmatizing nature of IBD symptoms may place youth at risk for being targets of peer victimization, potentially resulting in a decreased sense of social belongingness and poorer emotional adjustment. The present study tested a series of mediation and moderated mediation models examining the associations among peer victimization, thwarted social belongingness, and depressive symptoms, as well as the moderating role of IBD stigma in these associations. We hypothesized peer victimization would have an indirect effect on youth depressive symptoms through thwarted belongingness, and this effect would be amplified for youth endorsing greater IBD stigma. DESIGN AND METHODS: Seventy-five youth (10-18 yrs.) diagnosed with IBD were recruited from a pediatric gastroenterology clinic. Participants completed self-report measures of IBD stigma, peer victimization, thwarted belongingness, and depressive symptoms. RESULTS: As anticipated, mediation analyses revealed a significant peer victimization → thwarted belongingness → depressive symptoms indirect path. Moderated mediation analyses indicated that this indirect effect was moderated by IBD stigma and was significantly greater among youth reporting higher IBD stigma. CONCLUSIONS: Youth who experience higher levels of IBD-related stigma are at increased risk for depressive symptoms as a function of the socially isolating effects of peer victimization. PRACTICE IMPLICATIONS: Our findings highlight the need for routine screening and identification of the socioemotional challenges faced by youth with IBD. Clinical interventions that incorporate coping strategies aimed at minimizing youths' stigmatizing self-perceptions and improving overall social skills and social engagement may lessen the negative impact of peer victimization on youths' social and emotional adjustment.

Adverse Childhood Experiences Associated with Greater Internalization of Weight Stigma in Women with Excess Weight.

Adverse childhood experiences (ACEs) may be an early life factor associated with adult weight stigma via biological (e.g., stress response), cognitive (e.g., self-criticism/deprecation), and/or emotional (e.g., shame) mechanisms. This pilot study investigated relationships between ACEs and internalized and experienced weight stigma in adult women with overweight/obesity and explored differential relationships between weight stigma and ACE subtypes (i.e., abuse, neglect, household dysfunction). Adult women (68% white, M age = 33 ± 10 years, M BMI = 33.7 ± 7.2 kg/m2) completed measures of ACEs (ACE Questionnaire), internalized weight stigma (IWS; Weight Bias Internalization Scale-Modified; WBIS-M), and lifetime experiences of weight stigma (yes/no). Data were analyzed with linear and logistic regression (n = 46), adjusting for age, race, and body mass index (BMI). Linear regressions revealed a positive association between ACE and WBIS-M scores (ß = 0.40, p = 0.006), which was driven by Abuse-type ACEs (ß = 0.48, p = 0.009). Relationships between WBIS-M scores and Neglect- and Household-Dysfunction-type ACEs did not reach significance (ß = 0.20, p = 0.173; ß = -0.16, p = 0.273). Though descriptive statistics revealed greater rates of experienced weight stigma endorsement by those with high-3+ ACEs (81%) vs. medium-1-2 ACEs (67%) or low/no-0 ACEs (60%), ACE scores were not significantly associated with experienced weight stigma in logistic regression (Wald = 1.36, p = 0.244, OR = 1.324, 95%, CI = 0.825-2.125). ACEs may be an early life factor that increase the risk for internalizing weight stigma in adulthood. Larger studies should confirm this relationship and follow-up on descriptive findings suggesting a potential association between ACEs and experienced weight stigma.

Adverse childhood experiences and cognitive function among adults with excess adiposity.

BACKGROUND: Adverse childhood experiences (ACEs) and obesity are independently associated with brain/neurocognitive health. Despite a growing emphasis on the importance of early life adversity on health, the relationship between ACEs and neurocognition in adults with overweight/obesity is unclear. The objective was to examine associations between self-reported ACEs and measured neurocognitive domains in a sample of adults with overweight/obesity. METHODS: Participants were 95 predominantly white, highly educated adult women (76% female, 81% Caucasian, and 75% ≥ bachelor's degree) with excess adiposity enrolled in the Cognitive and Self-regulatory Mechanisms of Obesity Study. ACEs and fluid/crystallized neurocognitive domains were measured at baseline using the Adverse Childhood Experiences Scale and the NIH Toolbox Cognition Battery and Automated Neuropsychological Assessment Metric, respectively. RESULTS: Higher ACEs scores were negatively correlated with fluid cognition (r = -.34, P < .001) but not crystallized cognition (r = .01, ns). Individuals with 3 and 4+ ACEs displayed significantly lower fluid cognition scores than those with fewer ACEs F 4,89 = 3.24, P < .05. After accounting for body mass index (BMI), age, sex, race, and education, higher ACEs scores were still associated with poorer performance on overall fluid cognition (ß = -.36, P < .01), along with the following subtests: Stroop Colour/Word test (ß = -.23, P < .05), Go/No-Go omissions (ß = .29, P < .01), and Picture Sequence Memory task (ß = -.30, P < .01). CONCLUSIONS: The role of ACEs in health may be related to their associations with executive function and episodic neurocognitive domains essential to cognitive processing and self-regulation. Obesity science should further examine the role of ACEs and neurocognition in obesity prevention, prognosis, and treatment using more rigorous, prospective designs and more diverse samples.