Impacto das experiências adversas na infância nos cuidados maternos e na saúde de lactentes no primeiro ano de vida e efeito protetor do suporte social

Abstract

Introduction: Events such as physical, sexual, and emotional abuse, neglect, family dysfunction are known as adverse childhood experiences (ACEs) and can negatively impact the child's health since the beginning of life. These negative impacts can be minimized by the presence of protective factors, such as social support. Objectives: To analyze the impact of adverse childhood experiences (ACEs) on maternal care and health of infants in the first year of life and the protective effect of social support. Methods: This is a retrospective cohort study involving children followed up at Hospital Sofia Feldman and Hospital das Clínicas-UFMG in the first year of life. Children who completed the follow-up for 12 months during the research period and with the complete dataset were eligible. The Physical Health and Maternal Care Indicator (ISCM) was used to assess child health and maternal care, which gathers information such as vaccination, nutrition, growth, diseases, and accidents. The impact of ACEs on the ISCM was analyzed by multiple linear regression, and the d-Cohen test estimated the effect size (d). The cumulative effect of ACEs on ISCM was analyzed using Spearman's correlation based on a score that reflects family dysfunction, maternal mental health, poverty, and exposure to violence. We used a structural equation model to analyze the relations between the ISCM, intrafamilial context, maternal depression, and social support. Results: Most children were born preterm and with low weight. The ISCM was lower in children exposed to maternal depression (p<0.001; d=0.08), substance abuse by family members (p=0.02; d=0.6) and marital conflicts (p=0.03; d=0.7). Spearman's correlation showed that the greater the exposure to ACE, the lower the ISCM (r = -0.40, p<0.0001). Contexts characterized by single mothers, non-nuclear families, and conflicts between parents were related to a higher occurrence of maternal depression (b=1.20; p = 0.027) and worse results in the ISCM (b = -0.24; p = 0.027). Maternal depression also negatively affected the ISCM (b=0.02, p=0.003). Social support decreased maternal depressive symptoms and indirectly improved the ISCM results (b=0.28; p=0.04). Conclusion: Exposure to ACEs, especially familiar dysfunction and maternal depression, negatively impacted maternal care and child health. The social support perceived by the mother acted as a protective factor for the health of the dyad by reducing maternal depressive symptoms and improving the care offered and the health of the child.