Objectives Adverse childhood experiences (ACEs) are risk factors for health problems later in life. This study aims to 1) assess the influence of ACEs on risky health behaviors among mothers-to-be, and 2) determine whether a dose response occurs between ACEs and risky behaviors. Methods Prospective survey of women attending health centers conducted at the first prenatal care visit, and 3 and 11 months postpartum. Surveys obtained information on maternal sociodemographic and health characteristics, and 7 ACEs prior to age 16. Risky behaviors included smoking, alcohol use, marijuana use and other illicit drug use during pregnancy. Results Our sample (n=1,476) consisted of low-income (mean annual personal income: $8272), young (mean age: 24 yrs), African American (71%), single (75%) women. Twenty-three percent of women reported smoking even after finding out they were pregnant, 7% reported alcohol use, and 7% reported illicit drug use during pregnancy. Nearly three-fourths (71%) had one or more ACE(s). There was a higher prevalence of each risky behavior among those exposed to each ACE than among those unexposed. The exception was alcohol use during pregnancy where there was not an increased risk among those exposed when compared to those unexposed to witnessing a shooting or having a guardian in trouble with the law or in jail. The adjusted odds ratio for each risky behavior was greater than 2.5 for those with ≥ 3 ACEs when compared to those without. Conclusions ACEs were associated with risky health behaviors reported by mothers-to-be. Greater efforts should target the prevention of ACEs to lower the risk for adverse health behaviors that have serious consequences for adults and their children.

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