Patterns of adverse childhood experiences and associations with prenatal substance use and poor infant outcomes in a multi-country cohort of mothers: a latent class analysis

Abstract

Background This paper enumerates and characterizes latent classes of adverse childhood experiences and investigates how they relate to prenatal substance use (i.e., smoking, alcohol, and other drugs) and poor infant outcomes (i.e., infant prematurity and low birthweight) across eight low- and middle-income countries (LMICs). Methods A total of 1189 mother-infant dyads from the Evidence for Better Lives Study cohort were recruited. Latent class analysis using the Bolck, Croon, and Hagenaars (BCH) 3-step method with auxiliary multilevel logistic regressions was performed. Results Three high-risk classes and one low-risk class emerged: (1) highly maltreated (7%, n = 89), (2) emotionally and physically abused with intra-familial violence exposure (13%, n = 152), (3), emotionally abused (40%, n = 474), and (4) low household dysfunction and abuse (40%, n = 474). Pairwise comparisons between classes indicate higher probabilities of prenatal drug use in the highly maltreated and emotionally abused classes compared with the low household dysfunction and abuse class. Additionally, the emotionally and physically abused with intra-familial violence exposure class had higher probability of low birthweight than the three remaining classes. Conclusion Our results highlight the multifaceted nature of ACEs and underline the potential importance of exposure to childhood adversities on behaviors and outcomes in the perinatal period. This can inform the design of antenatal support to better address these challenges.

A Scoping Review on Adverse Childhood Experiences Studies Using Latent Class Analysis: Strengths and Challenges

“…However, several studies showed that it was a particular ACEs class, but not the high/ multiple ACEs group, that was associated with the worst outcomes. For example, infants of mothers in the emotionally and physically abused group with intrafamilial violence exposure showed significantly low birth weight (Hemady et al, 2022); the class of household poverty and child discrimination showed the highest unmet care coordination needs (Anyigbo et al, 2021); children in the class of parental mental illness and poverty demonstrated the highest chronic condition and special healthcare needs (Lanier et al, 2018); adolescents experiencing neighborhood violence had the most severe chronic school absenteeism (Stempel et al, 2017); women in the sexual abuse/household dysfunction ACEs class had the weakest partner social support network during pregnancy (Napier et al, 2023); and adults experiencing sexual abuse were most vulnerable to developing diabetes (Salas et al, 2019).…”

“…F. Wang, Yuan, et al, 2022; Xiao et al, 2023; Yuan et al, 2022; Zhang et al, 2020), Cambodia (Miedema et al, 2023), Germany (Turner et al, 2021; Witt et al, 2019), Korea (Kim, Park, et al, 2022), Singapore (Liu et al, 2022), Spain (Aizpurua et al, 2023), Switzerland (Barra et al, 2018), Tanzania (Zietz et al, 2020), and the United Kingdom (Iob et al, 2021; Lacey, Bartley, et al, 2020; Lacey, Pinto Pereira, et al 2020; Lacey et al, 2022; MacLochlainn et al, 2022; Ross et al, 2022). Interestingly, one study sampled eight country sites across the Latin-American and Caribbean region, Europe, Africa, the Indian Subcontinent, and Asia (Hemady et al, 2022).…”

“…The scales included the Maltreatment and Abuse Chronology of Exposure Scale and Childhood Sexual Abuse Questionnaire (Barra et al, 2018), the Adverse Childhood Experiences—International Questionnaire (ACE-IQ; S. S. Chen, He, et al, 2022; Hemady et al, 2022; Ho et al, 2019; Li et al, 2022; Liu et al, 2022; Miedema et al, 2023; L. Wang, Yu, et al, 2022; Xiao et al, 2023; Yuan et al, 2022; Zietz et al, 2020), the Childhood Trauma Questionnaire (S.…”

“…In addition to the original ACEs questionnaire developed from the Kaiser-CDC ACEs study (Felitti et al, 1998), researchers used the following scales to collect primary ACEs data. The scales included the Maltreatment and Abuse Chronology of Exposure Scale and Childhood Sexual Abuse Questionnaire (Barra et al, 2018), the Adverse Childhood Experiences-International Questionnaire (ACE-IQ; S. S. Chen, He, et al, 2022;Hemady et al, 2022;Ho et al, 2019;Li et al, 2022;Liu et al, 2022;Miedema et al, 2023;L. Wang, Yu, et al, 2022;Xiao et al, 2023;Yuan et al, 2022;Zietz et al, 2020), the Childhood Trauma Questionnaire (S. S. Chen, He, et al, 2022;M.…”

“…Other non-maltreatment family adversities were expanded such as (a) parental/guardian death (studies based on NSCH; studies using ACE-IQ; Aizpurua et al, 2023;Hemady et al, 2022;Lacey, Pinto Pereira, et al, 2020;Lacey et al, 2022;MacLochlainn et al, 2022;Miedema et al, 2023;Smith et al 2023;G. F. Wang, Yuan, et al, 2022;Xiao et al, 2023;Yu et al, 2022;Yuan et al, 2022 also added sibling death; Zhang et al, 2020;Zietz et al, 2020); (b) disadvantaged household socioeconomic status such as poverty/material hardship/financial struggles (studies based on FFCWS, NSCH; S. S. Chen, He, et al, 2022;Heidinger & Willson, 2022;Kim, Lee, et al, 2020;Yu et al, 2022), parents' unemployment (Heidinger & Willson, 2022;Zhang et al, 2020), and low maternal education (Zhang & Monnat, 2022); (c) illness/ disability/accident experienced by a family member (S. S. Chen, He, et al, 2022;MacLochlainn et al, 2022;G.…”