Screening for Childhood Trauma in Adult Primary Care Patients

Weinreb, Linda; Savageau, Judith A.; Candib, Lucy M.; Reed, George W.; Fletcher, Kenneth E.; Hargraves, J. Lee

doi:10.4088/pcc.10m00950blu

Cited by 63 publications

(87 citation statements)

References 25 publications

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“…Primary care physicians, obstetrician–gynecologists, and pediatricians are well positioned to identify exposure to childhood adversity in women of childbearing age as part of their delivery of care, with the goal of preventing unhealthy weight gain and promoting health for women and their children. 31–33 Though a recent study suggests that tools are available to make prenatal screening for psychosocial risks achievable, 34 less than one third of physicians screen female patients for childhood abuse. 31 This suggests that additional awareness, training, and support are needed to help providers to engage with their patients on this sensitive issue.…”

Section: Discussionmentioning

confidence: 99%

Maternal Childhood Adversity, Prepregnancy Obesity, and Gestational Weight Gain

Ranchod

Headen

Petito

et al. 2016

American Journal of Preventive Medicine

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Introduction Growing evidence suggests that exposure to childhood adversity may influence obesity across the life course. High maternal weight complicates pregnancy and increases the risk of child obesity. This study examined the association between maternal childhood adversity and pregnancy-related weight in a large U.S. sample. Methods Data on 6,199 pregnancies from 2,873 women followed from 1979 to 2012 by the National Longitudinal Survey of Youth 1979 were analyzed in 2014. Associations between three adversity exposures before age 18 years (history of physical abuse, alcohol problems, or mental illness in the household) and two maternal weight outcomes (prepregnancy obesity and excessive gestational weight gain) were modeled separately using survey-adjusted log-binomial models. Results After adjusting for race/ethnicity and early life socioeconomic factors, childhood physical abuse was associated with a 60% increase in the risk of prepregnancy obesity (adjusted risk ratio [RR]=1.6, 95% CI=1.1, 2.2). Household alcohol abuse was associated with a 30% increase in prepregnancy obesity (RR=1.3, 95% CI=1.0, 1.7), as was household mental illness (RR=1.3, 95% CI=0.8, 1.9), but the mental illness exposure was not significant. Physical abuse and household alcohol abuse were associated with a significant 20% increase in the risk of excessive gestational weight gain; mental illness was not. Conclusions Adversity in early life may affect maternal weight before and during pregnancy. Screening and treating women of reproductive age for childhood adversity and its negative effects could significantly reduce obesity-related health outcomes for women and their children.

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Section: Discussionmentioning

confidence: 99%

Maternal Childhood Adversity, Prepregnancy Obesity, and Gestational Weight Gain

Ranchod

Headen

Petito

et al. 2016

American Journal of Preventive Medicine

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“…In contrast to screening for intimate partner violence, screening for ACEs has received little attention in medical education (Weinreb, Savageau, Candib, Reed, Fletcher & Hargraves, 2010). There is a need to increase provider awareness about the impact of ACEs on health outcomes across the lifespan, including the preconception, pregnancy and post-partum period.…”

Section: Implications For Practice And/or Policymentioning

confidence: 99%

“…There is a need to increase provider awareness about the impact of ACEs on health outcomes across the lifespan, including the preconception, pregnancy and post-partum period. In addition, training programs to increase provider confidence in asking sensitive questions about childhood are warranted (Weinreb et al, 2010). Finally, for ACEs screening to have an impact on improving maternal and infant health outcomes, it must be coupled with appropriate referrals to evidence-based interventions that are designed to build resilience among women and families who have experienced childhood adversity.…”

Section: Implications For Practice And/or Policymentioning

confidence: 99%

The Association between Adverse Childhood Experiences and Alcohol Use during Pregnancy in a Representative Sample of Adult Women

Frankenberger

Clements-Nolle

Wang

2015

Women's Health Issues

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Background The impact of adverse childhood experiences (ACEs) on adult alcohol consumption is well-established, but little is known about the association with alcohol use during pregnancy. Methods Using data from the 2010 Nevada Behavioral Risk Factor Surveillance System (BRFSS), we assessed the relationship between ACEs and alcohol use during pregnancy in a representative sample of 1,987 adult women. An established ACEs scale was used to assess a range of childhood physical, emotional, and sexual abuse and household dysfunction (range 0–8). Weighted logistic regression was used to assess the relationship between ACE scores and alcohol use during pregnancy after controlling for drinking before pregnancy and other covariates. Results Six percent of participants reported drinking alcohol during pregnancy. After controlling for race/ethnicity, age, employment status, smoking status, and pre-pregnancy alcohol use, increasing ACEs were positively associated with higher odds of alcohol use during pregnancy (1 ACE: AOR= 2.92; 95% CI= 1.08, 7.87), (2–3 ACEs: AOR=3.52; 95% CI=1.46, 8.48), and (4 or more ACEs: AOR= 4.79; 95% CI=2.14, 10.72). Pre-pregnancy drinking was also strongly associated with alcohol use during pregnancy (AOR= 11.95; 95% CI=5.02, 28.43). Conclusions We found evidence of a dose-response relationship between ACEs and alcohol use during pregnancy that remained even after controlling for pre-pregnancy drinking and other covariates. Screening women of childbearing age as well as pregnant women for ACEs may be an effective way to identify and address many of the emotional, behavioral, and physical sequelae of childhood adversity.

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“…Currently, less than one third of clinicians usually or always screen for childhood abuse or correctly estimate its prevalence. 6 Although physicians may be trying to be sensitive and may worry about reopening old wounds, published studies indicate that most patients with abuse histories who have not voluntarily disclosed that history to health professionals would like to be asked about abuse. 7 Some studies suggest that when physicians ask about abuse, there is a greater likelihood that patients will pursue interventions, thereby leading to improved health outcomes.…”

mentioning

confidence: 99%

“…8 The key obstacles to asking about abuse include clinician discomfort, gaps in knowledge about abuse prevalence, a lack of time and resources, a lack of confidence or preparation, and a lack of training. 6,9,10 For instance, in one survey of 313 primary care physicians, 40% reported no formal training in screening adults for childhood abuse histories, and 33.6% were themselves survivors of abuse. So, how should we ask?…”

mentioning

confidence: 99%