Chapter 9 244 vulnerability that include women with social risk factors, UP rates may be attributed (partially) to those factors. In prospective cohort data, it was shown that social and psychiatric risk factors clustered in the prediction of UPs, supporting the hypothesis that UPs occur in women with psychiatric vulnerability who also present with social risk factors2. Contrary to this hypothesis, the results from the retrospective MoMentUM dataset show a robust association between psychiatric vulnerability and UPs even after adjustment for social factors such as employment status, age, parity and ethnical background (Chapter 4). Figure 9.2 - Hypothesis 2: there is overlap between social and psychiatric risk factors. Hypothesis 3: Adverse childhood experiences indirectly attribute to risk of UPs through psychiatric vulnerability Based on qualitative findings from this thesis we pose a third hypothesis. In women with psychiatric vulnerability, the adverse childhood experiences (ACE) predominantly impacted pregnancy decision-making by installing ambivalence towards motherhood, as opposed to the psychiatric symptoms as posed in hypothesis 1. A body of evidence confirms that ACE are related to sexual risk behavior, resulting in teenage birth, rapid repeat pregnancies and unwanted pregnancies in samples of women without mentioned psychiatric history45-48. Moreover, one study suggests a ‘doseresponse’ relationship between exposure to childhood adverse events such as abuse and household dysfunction, and subsequent UPs49. Aside from ACE, varying types of adverse life events (e.g. forms of violence, economic hardship, death (by suicide), and disrupted family/social networks) put women at risk for UPs by imposing stress50.
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