Association Between Adverse Childhood Experiences and Adverse Pregnancy Outcomes

Abstract

OBJECTIVE: To examine the association between adverse childhood experiences and adverse pregnancy outcomes. METHODS: This cohort study included individuals who enrolled in a perinatal collaborative mental health care program (COMPASS [the Collaborative Care Model for Perinatal Depression Support Services]) between 2017 and 2021. Participants completed psychosocial self-assessments, including an adverse childhood experiences screen. The primary exposure was adverse childhood experiences measured by the ACE (adverse childhood experience) score, which was evaluated as a dichotomized variable, with a high ACE score defined as greater than three. Secondary analyses used the ACE score as a continuous variable. Adverse pregnancy outcomes including gestational diabetes, hypertensive disorders of pregnancy, preterm birth, and small-for-gestational-age (SGA) births were abstracted from the electronic health record. Bivariable and multivariable analyses were performed, including mediation analyses. RESULTS: Of the 1,274 women with a completed adverse childhood experiences screen, 904 (71%) reported one or more adverse childhood experiences, and 290 (23%) reported a high ACE score (more than three adverse childhood experiences). Adverse childhood experience scores were not associated with gestational diabetes or SGA births. After controlling for potential confounders, individuals with high ACE score had 1.55-fold (95% CI 1.06–2.26) increased odds of having hypertensive disorders of pregnancy and 2.03-fold (95% CI 1.38–2.99) increased odds of preterm birth. Each point increase in ACE score was not associated with a statistically increased odds of hypertensive disorders of pregnancy (adjusted odds ratio [aOR] 1.07, 95% CI 0.99–1.15); however, each additional point on the adverse childhood experiences screen was associated with increased odds of preterm birth (aOR 1.13, 95% CI 1.05–1.22). Mediation analyses demonstrated tobacco use, chronic medical problems, and obesity each partially mediated the observed association between high ACE scores and hypertensive disorders of pregnancy. Having chronic medical comorbidities partially mediated the observed association between high ACE scores and preterm birth. CONCLUSION: One in four individuals referred to a perinatal mental health program who were pregnant or postpartum had a high ACE score. Having a high ACE score was associated with an increased risk of hypertensive disorders of pregnancy and preterm birth. These results underscore how remote events may reverberate through the life course.

Screening for adverse childhood experiences in antenatal care settings: A scoping review

“…ACEs and adverse pregnancy outcomes such as hypertensive disorders of pregnancy and pre-term birth 6,7 ; and ACEs and mental and substance use disorders, cardiovascular disease and early mortality. 8,9 Pregnancy is an optimal time to identify existing health risks in women and provide interventions that may prevent future health problems for women, children and their families.…”

“…For example, in Australia, nearly two in three children are exposed to at least one ACE 2 . Since the landmark ACE study by Felitti and colleagues reporting a significant association between ACEs and poor physical and mental health outcomes throughout life, 3 research has expanded to additional populations providing consistent evidence of the associations between ACEs and pregnancy intentions 4,5 ; ACEs and adverse pregnancy outcomes such as hypertensive disorders of pregnancy and pre‐term birth 6,7 ; and ACEs and mental and substance use disorders, cardiovascular disease and early mortality 8,9 …”

“If I Control Your Body, I Can Fully Control You”: Interpersonal and Structural Violence Findings from the Georgia Medication Abortion Project

“…Multiple links between interpersonal violence and abortion care have been established (Basile et al, 2022; Miller et al, 2021), including pregnancy in the context of rape or incest and the association between early interpersonal trauma (e.g., childhood sexual abuse) and negative reproductive health outcomes including unwanted pregnancy. Research has also demonstrated that being denied a wanted abortion increases the likelihood of physical violence from the male-involved partner two and a half years after an unwanted pregnancy (Roberts et al, 2014).…”

Economic Burden of Health Conditions Associated With Adverse Childhood Experiences Among US Adults

“…Previous cross-sectional studies have estimated a substantial ACE-associated health economic burden in adulthood in Europe and North America, the UK, and California . To our knowledge, similar economic estimates do not yet exist for other US states or for the US in total, although the ACE-related health burden among adults is extensively documented . This study aimed to estimate the economic burden of health conditions associated with ACEs among US adults.…”