MATERNAL PHYSICAL TRAUMA AND PSYCHOLOGICAL DISTRESS DURING PREGNANCY: ASSOCIATIONS WITH PSYCHOTROPIC MEDICATION EXPOSURE, PLACENTAL PATHOLOGY, AND ADVERSE PREGNANCY OUTCOMES

Abstract

Background: Maternal physical trauma and prenatal psychological distress are important yet frequently underrecognized contributors to adverse maternal and fetal outcomes. These conditions may coexist with psychotropic medication exposure and biological and placental changes with potential clinical and medico-legal relevance. An integrated obstetric, psychological, and forensic assessment may provide a more comprehensive understanding of these interrelated factors. Objective: To assess the clinical characteristics of maternal physical trauma and psychological distress during pregnancy, examine their associations with psychotropic medication exposure and selected biological and placental findings, and evaluate their relationship with adverse pregnancy outcomes. Methods: A hospital-based observational analytical study was conducted over six months, from October 2025 to March 2026, among 200 pregnant women with a documented history of physical trauma, intimate partner violence, or severe psychological distress. Participants underwent comprehensive obstetric and clinical evaluation, standardized psychometric assessment, and toxicological screening for psychotropic and analgesic medication exposure. Forensic assessment included systematic documentation and mapping of physical injuries. Biological assessment included serum cortisol and selected inflammatory markers. Following delivery, placentas were macroscopically examined and sampled for histopathological assessment of retroplacental hematoma, ischemic changes, microvascular injury, and villous abnormalities. Associations among trauma, psychological distress, medication exposure, biological findings, placental pathology, and pregnancy outcomes were evaluated using appropriate statistical methods. Results: Among the 200 participants, maternal physical trauma and higher levels of psychological distress were associated with adverse obstetric and fetal outcomes (p < 0.05). Physical trauma was predominantly associated with acute obstetric complications, including placental abruption and preterm delivery, whereas severe psychological distress was associated with intrauterine growth restriction, lower birth weight, and preeclampsia. Placental histopathological examination demonstrated a higher frequency of microvascular and hypoxic-ischemic changes among women with greater documented trauma or psychological distress. Higher psychotropic medication exposure was associated with a greater frequency of neonatal adaptation difficulties. Severe untreated psychological distress was also associated with adverse pregnancy outcomes, particularly spontaneous preterm delivery. Conclusion: Maternal physical trauma and prenatal psychological distress were associated with adverse maternal, placental, and neonatal outcomes in this hospital-based study. An integrated obstetric, psychological, and forensic medical assessment may assist in identifying high-risk pregnancies and may provide objective clinical and pathological documentation relevant to patient management and medico-legal evaluation. Prospective studies are needed to clarify the temporal and causal relationships among maternal trauma, psychological distress, medication exposure, biological stress responses, placental pathology, and pregnancy outcomes.