Maternal Childhood Adversity as a Risk for Perinatal Complications and NICU Hospitalization

Abstract

Objective To examine maternal childhood adversity in relation to increased risk for maternal and infant perinatal complications and newborn Neonatal Intensive Care Unit (NICU) admittance. Methods A sample of 164 women recruited at their first prenatal appointment participated in a longitudinal study through 6 weeks postdelivery. Participants self-reported on their adverse childhood experiences (ACEs), negative health risks (overweight/obesity, smoking, and alcohol use), adverse infant outcomes, NICU admittance, and maternal perinatal complications across three pregnancy assessments and one post-birth assessment. Logistic binomial regression analyses were used to examine associations between maternal ACEs and adverse infant outcomes, NICU admittance, and maternal perinatal complications, controlling for pregnancy-related health risks. Results Findings showed that women with severe ACEs exposure (6+ ACEs) had 4 times the odds of reporting at least one adverse infant outcome (odds ratio [OR] = 4.33, 95% CI: 1.02–18.39), almost 9 times the odds of reporting a NICU admission (OR = 8.70, 95% CI: 1.34–56.65), and 4 times the odds of reporting at least one maternal perinatal outcome (OR = 4.37, 95% CI: 1.43–13.39). Conclusions The findings demonstrate the extraordinary risk that mothers’ ACEs pose for infant and maternal health outcomes over and above the associations with known maternal health risks during pregnancy, including overweight/obesity, smoking, and alcohol use. These results support a biological intergenerational transmission framework, which suggests that risk from maternal adversity is perpetuated in the next generation through biophysical and behavioral mechanisms during pregnancy that negatively affect infant health outcomes.

Application of the Adverse Childhood Experiences Framework to the NICU

“…In the NICU, many infants and families requiring care will experience both physiological and psychosocial stress and trauma, 12 resulting in what could be considered the first ACE, or potentially an additional ACE, given the maternal perinatal environment. 13,14 While in the NICU, infants experience a multitude of stressors that may accumulate and overwhelm their ability to maintain physiological stability. Common stressful stimuli include high levels of noise, excessive light exposure, painful procedures, frequent assessments, social isolation, and separation from parents.…”

“…13 Furthermore, structural racism experienced both in and out of the NICU is associated with ACEs and poor health outcomes. 13,14 For example, emerging literature suggests that quality of NICU care for Black infants and other infants is lacking and contributes to greater disparities in health outcomes for infants born preterm. 19 Although survival rates of extremely premature infants are steadily improving, the incidence of later developmental disabilities for these infants remains high.…”

“…Researchers recently found that women who report 6 or more ACEs are 9 times more likely to have an infant requiring NICU hospitalization 13. Furthermore, structural racism experienced both in and out of the NICU is associated with ACEs and poor health outcomes 13,14. For example, emerging literature suggests that quality of NICU care for Black infants and other infants is lacking and contributes to greater disparities in health outcomes for infants born preterm 19…”

Maternal childhood adversity and infant epigenetic aging: Moderation by restless sleep during pregnancy

“…Extant evidence supports the notion that children are affected by parental exposure to environmental cues, including adversity and trauma occurring before birth, and possibly even prior to conception (Yehuda & Lehrner, 2018). Specifically, maternal exposure to adverse childhood experiences (ACEs) is linked to pregnancy complications and poorer infant health (Ciciolla et al., 2021; Racine et al., 2018; Smith et al., 2016). Epigenetic alterations are a potential mechanism through which maternal exposure to adversity may influence phenotypic variation in health and developmental outcomes in infants (Moore et al., 2022).…”

Child protection pathways for newborn infants: A multi‐disciplinary retrospective chart review of an Irish maternity hospital’s records

“…A growing body of international research is drawing attention to the importance of safeguarding infants during the perinatal period given the specific nature of their physical vulnerability and developmental needs; the consequence of prenatal maternal drug use (Peterson et al, 2020); and the link between maternal childhood adversity and perinatal complications (Ciciolla et al, 2021). Research has examined the characteristics of women whose infants are subject to child protection investigations (Taplin, 2017), identified a recent rapid increase in newborn removals to care in England (Bilson & Bywaters, 2020) and examined the role of hospital‐level factors in the reporting of drug‐related concerns (Rebbe et al, 2019).…”