Childhood Adversity, Benevolent Experiences, and Perceived Stress Among Pregnant Women in Mexico: Psychosocial Determinants of Maternal Well-Being in a Middle-Income Setting

Background Adverse childhood experiences (ACEs) are strongly associated with poor physical and mental health across the life course. Maternal ACEs have been linked to prenatal stress, hypertensive disorders, gestational diabetes, shorter gestation, lower infant birth weight, and increased risk of prenatal and postpartum depression. Benevolent childhood experiences (BCEs) and social support may buffer these effects; however, ACE-informed perinatal care remains uncommon in low- and middle-income settings. This study aimed to estimate the prevalence of ACEs and BCEs among pregnant women in Mexico and to examine their associations with perceived stress and depressive symptoms during pregnancy. Methods We conducted a cross-sectional observational study at a large public maternity hospital ( Hospital Materno Infantil y de Especialidades de Nuevo León ) in Monterrey, Mexico, between September 2023 and March 2024. Pregnant women receiving prenatal care were invited to participate; of 400 eligible women, 368 consented, and 330 provided complete data for analysis. Participants completed the WHO Adverse Childhood Experiences International Questionnaire (ACE-IQ), the Benevolent Childhood Experiences (BCE) Scale, the Perceived Stress Scale (PSS-10), the Edinburgh Postnatal Depression Scale (EPDS), and the Social Support Questionnaire (SSQ-6). Sociodemographic and pregnancy-related variables were self-reported. Descriptive statistics summarized sample characteristics. Bivariate associations were assessed using chi-square tests and Spearman correlations. Structural equation modeling (SEM) was used to evaluate hypothesized pathways linking ACEs, BCEs, social support, perceived stress, and depressive symptoms. Model fit was evaluated using the comparative fit index (CFI), root mean square error of approximation (RMSEA), and χ²/df. Results Overall, 90% of participants reported at least one ACE, and 45.2% reported four or more ACEs. The most prevalent ACE domains were violence and neglect. Social support levels were moderate to high, and BCE scores were high (mean = 8.55). Perceived stress levels were moderate (mean = 17.87), and 13% of participants screened positive for depressive symptoms. SEM analyses indicated that higher ACE exposure was associated with lower benevolence and social support and with increased perceived stress. Both benevolence and social support were associated with lower stress and fewer depressive symptoms, with perceived stress acting as a central mediator. Overall model fit was acceptable (CFI = 0.93; RMSEA = 0.06). Conclusions Pregnant women in this public-sector Mexican sample experienced high levels of childhood adversity alongside substantial protective factors. ACE exposure was associated with increased perceived stress and depressive symptoms during pregnancy, while benevolent childhood experiences and social support appeared to mitigate these associations. These findings underscore the importance of integrating trauma- and resilience-informed approaches into prenatal care in low- and middle-income settings.