Introduction
Adverse childhood experiences are associated with a host of negative outcomes; however,
few have studied cumulative adverse childhood experiences in the context of pregnancy
and infant health. This study examines state-level prevalence of adverse childhood
experiences and associations with pregnancy- and infant health‒related indicators.
Methods
The study used 2016–2018 Pregnancy Risk Assessment Monitoring System population-based
data from 5 states. Analyses were conducted for individual states and grouped states
using similar adverse childhood experience items. Thirteen adverse childhood experience
measures were included across 3 domains: abuse, neglect, and household challenges.
Adverse childhood experience scores were calculated for the number of adverse childhood
experiences experienced (0, 1, 2, ≥3) on the basis of available state measures. Fourteen
pregnancy- and infant health‒related indicators were examined, including unwanted
pregnancy, adequate prenatal care, experiences during pregnancy (e.g., smoking, abuse,
depression), gestational diabetes, hypertensive disorders of pregnancy, birth outcomes
(e.g., preterm birth), and breastfeeding. Adjusting for demographics, parity, health
insurance status, and educational attainment, prevalence ratios and 95% CIs were calculated
to examine the associations between pregnancy- and infant health‒related indicators
and adverse childhood experience scores.
Results
Over 50% of respondents reported at least 1 adverse childhood experience and 13%–31%
reported ≥3 adverse childhood experiences, depending on the state. Significant associations
were identified in all adjusted models between adverse childhood experiences and unwanted
pregnancy, smoking, physical abuse, and depression during pregnancy.
Conclusions
Adverse childhood experiences are associated with risk factors that impact pregnancy
and infant health. Preventing and mitigating adverse childhood experiences is an important
strategy to improve pregnancy- and infant health‒related indicators.
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References
- Social and structural determinants of health inequities in maternal health.J Womens Health (Larchmt). 2021; 30: 230-235https://doi.org/10.1089/jwh.2020.8882
- Maternal health and non-communicable disease prevention: an investment case for the post COVID-19 world and need for better health economic data.Int J Gynaecol Obstet. 2020; 150: 151-158https://doi.org/10.1002/ijgo.13198
- Economic burden of maternal morbidity - a systematic review of cost-of-illness studies.PLoS One. 2020; 15e0227377https://doi.org/10.1371/journal.pone.0227377
- The frequency of maternal morbidity: a systematic review of systematic reviews.Int J Gynaecol Obstet. 2018; 141: 20-38https://doi.org/10.1002/ijgo.12468
- Vital signs: pregnancy-related deaths, United States, 2011–2015, and strategies for prevention, 13 states, 2013–2017.MMWR Morb Mortal Wkly Rep. 2019; 68: 423-429https://doi.org/10.15585/mmwr.mm6818e1
- Racial/ethnic inequities in low birth weight and preterm birth: the role of multiple forms of stress.Matern Child Health J. 2018; 22: 1154-1163https://doi.org/10.1007/s10995-018-2500-7
- Medical, psychosocial, and behavioral risk factors do not explain the increased risk for low birth weight among black women.Am J Obstet Gynecol. 1996; 175: 1317-1324https://doi.org/10.1016/s0002-9378(96)70048-0
- Maternal healthcare in migrants: a systematic review.Matern Child Health J. 2013; 17: 1346-1354https://doi.org/10.1007/s10995-012-1149-x
- Racial and ethnic disparities in birth outcomes: a life-course perspective.Matern Child Health J. 2003; 7: 13-30https://doi.org/10.1023/a:1022537516969
- Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study.Am J Prev Med. 1998; 14: 245-258https://doi.org/10.1016/s0749-3797(98)00017-8
- Improving the adverse childhood experiences study scale.JAMA Pediatr. 2013; 167: 70-75https://doi.org/10.1001/jamapediatrics.2013.420
CD Bethell, MB Davis, N Gombojav, S Stumbo and K Powers, Issue Brief: adverse childhood experiences among U.S. children, Child and Adolescent Health Measurement Initiative, 2017, Johns Hopkins Bloomberg School of Public Health; Baltimore, MDhttps://www.cahmi.org/docs/default-source/resources/issue-brief-adverse-childhood-experiences-among-us-children-(2017).pdfhttps://www.publicschoolsfirstnc.org/wp-content/uploads/2018/08/ACEs-Fact-Sheet.pdf, pdf. Published October 2017. Accessed January 21, 2021.
- Vital Signs: estimated proportion of adult health problems attributable to adverse childhood experiences and implications for prevention – 25 States, 2015–2017.MMWR Morb Mortal Wkly Rep. 2019; 68: 999-1005https://doi.org/10.15585/mmwr.mm6844e1
- Adverse childhood experiences and life opportunities: shifting the narrative.Child Youth Serv Rev. 2017; 72: 141-149https://doi.org/10.1016/j.childyouth.2016.10.021
- Capitalizing on advances in science to reduce the health consequences of early childhood adversity.JAMA Pediatr. 2016; 170: 1003-1007https://doi.org/10.1001/jamapediatrics.2016.1559
- Adverse childhood experiences and the risk of premature mortality.Am J Prev Med. 2009; 37: 389-396https://doi.org/10.1016/j.amepre.2009.06.021
- Stressors across the life-course and preterm delivery: evidence from a pregnancy cohort.Matern Child Health J. 2017; 21: 648-658https://doi.org/10.1007/s10995-016-2151-5
- Childhood maltreatment and inflammation among pregnant women with gestational diabetes mellitus: a pilot study.Obstet Med. 2017; 10: 120-124https://doi.org/10.1177/1753495×17701320
- Pregnancy and delivery for women with a history of child sexual abuse.Child Abuse Negl. 1999; 23: 81-90https://doi.org/10.1016/s0145-2134(98)00113-6
- Childhood stress and birth timing among African American women: cortisol as biological mediator.Psychoneuroendocrinology. 2017; 84: 32-41https://doi.org/10.1016/j.psyneuen.2017.06.009
- Maternal adverse childhood experiences and their association with preterm birth: secondary analysis of data from universal health visiting.BMC Pregnancy Childbirth. 2022; 22: 129https://doi.org/10.1186/s12884-022-04454-z
- Intergenerational effects of childhood trauma: evaluating pathways among maternal ACEs, perinatal depressive symptoms, and infant outcomes.Child Maltreat. 2016; 21: 317-326https://doi.org/10.1177/1077559516659556
- Early childhood adversity and pregnancy outcomes.Matern Child Health J. 2016; 20: 790-798https://doi.org/10.1007/s10995-015-1909-5
- Adverse childhood experiences are associated with spontaneous preterm birth: a case-control study.BMC Med. 2015; 13: 124https://doi.org/10.1186/s12916-015-0353-0
- The prevalence of adverse childhood experiences, nationally, by state, and by race or ethnicity.Child Trends, Bethesda, MD2018 (Published February 12, 2018. Accessed January 21, 2021.)
- Adverse childhood experiences and poor birth outcomes in a diverse, low-income sample.BMC Pregnancy Childbirth. 2019; 19: 387https://doi.org/10.1186/s12884-019-2560-8
- Maternal adverse childhood experiences and pregnancy intentions.Ann Epidemiol. 2021; 64: 47-52https://doi.org/10.1016/j.annepidem.2021.09.011
- Adverse childhood experiences and pregnancy intentions among pregnant women seeking prenatal care.Womens Health Issues. 2021; 31: 100-106https://doi.org/10.1016/j.whi.2020.08.012
- Depressive symptoms in disadvantaged women receiving prenatal care: the influence of adverse and positive childhood experiences.Ambul Pediatr. 2008; 8: 109-116https://doi.org/10.1016/j.ambp.2007.12.003
- Adverse childhood experiences and prenatal mental health: type of ACEs and age of maltreatment onset.J Fam Psychol. 2019; 33: 304-314https://doi.org/10.1037/fam0000510
- Adverse childhood experiences and mental and behavioral health conditions during pregnancy: the role of resilience.J Womens Health (Larchmt). 2019; 28: 452-461https://doi.org/10.1089/jwh.2018.7108
- Asking about childhood adversity in the prenatal care setting: cross-sectional associations with maternal health and mental health outcomes.Matern Child Health J. 2022; 26: 994-1004https://doi.org/10.1007/s10995-021-03301-5
- Maternal substance use in pregnancy: differential prediction by childhood adversity subtypes.Prev Med. 2020; 141106303https://doi.org/10.1016/j.ypmed.2020.106303
- Pathways from maternal adverse childhood experiences to substance use in pregnancy: findings from the all our families cohort.J Womens Health (Larchmt). 2021; 30: 1795-1803https://doi.org/10.1089/jwh.2020.8632
- Association between adverse childhood experiences and adverse pregnancy outcomes.Obstet Gynecol. 2021; 138: 770-776https://doi.org/10.1097/AOG.0000000000004570
- MiGHT. Total adverse childhood experiences and preterm birth: A systematic review.Matern Child Health J. 2021; 25: 1581-1594https://doi.org/10.1007/s10995-021-03176-6
- Maternal childhood adversity as a risk for perinatal complications and NICU hospitalization.J Pediatr Psychol. 2021; 46: 801-813https://doi.org/10.1093/jpepsy/jsab027
- Rethinking the measurement of adversity.Child Maltreat. 2017; 22: 58-68https://doi.org/10.1177/1077559516679513
- The Pregnancy Risk Assessment Monitoring System (PRAMS): overview of design and methodology.Am J Public Health. 2018; 108: 1305-1313https://doi.org/10.2105/AJPH.2018.304563
- Behavioral risk factor surveillance system survey ACE data. U.S. Department of Health and Human Services.Centers for Disease Control and Prevention. 2022; (Updated April 3, 2020. Accessed September 9, 2021.)
- 2020 National Survey of Children’s Health: methodology report.U.S. Census Bureau, Suitland-Silver Hill, MD2021 (Published September 30, 2021. Accessed December 2, 2021)
- The adequacy of prenatal care utilization index: its U.S. distribution and association with low birthweight.Am J Public Health. 1994; 84: 1486-1489https://doi.org/10.2105/ajph.84.9.1486
- Infant Death: an Analysis by Maternal Risk and Health Care.(Chapter 2) Institute of Medicine and National Academy of Scientists, Washington, DC1973
Birth certificate variables. Atlanta, GA: Centers for Disease Control and Prevention. https://www.cdc.gov/prams/pdf/pramsresearchdatasetcodebook_3-2012.pdf. Published March 23, 2012. Accessed January 4, 2023.
PRAMS Phase 8 topic reference document. Centers for Disease Control and Prevention. https://www.cdc.gov/prams/pdf/questionnaire/Phase-8-Topics-Reference_508tagged.pdf. Published May 8, 2018. Accessed December 2, 2021.
J Parker, M Talih, D Malec, et al., National Center for Health Statistics data presentation standards for proportions, Vital Health Stat 2, 175, 2017, 1–22, https://www.cdc.gov/nchs/data/series/sr_02/sr02_175.pdf, Published August 2017. Accessed August 24, 2022.
- Reliability of estimates.National Center for Health Statistics, 2021 (Centers for Disease Control and Prevention.) (Updated December 2021. Accessed August 24, 2022)
SAS [computer program]. Version 9.4. Cary, NC: SAS Institute Inc; 2017.
- Environment for Statistical Computing [computer program]. Version 4.2.0. R Foundation for Statistical Computing, Vienna, Austria2022
- Unintended pregnancy among adult women exposed to abuse or household dysfunction during their childhood.JAMA. 1999; 282: 1359-1364https://doi.org/10.1001/jama.282.14.1359
- Adverse childhood experiences and intimate partner violence during pregnancy and their association to postpartum depression.J Affect Disord. 2018; 229: 159-163https://doi.org/10.1016/j.jad.2017.12.036
- Risky health behaviors among mothers-to-be: the impact of adverse childhood experiences.Acad Pediatr. 2010; 10: 245-251https://doi.org/10.1016/j.acap.2010.04.003
- Adverse childhood experiences and depressive symptomatology among pregnant women.Acta Obstet Gynecol Scand. 2018; 97: 701-708https://doi.org/10.1111/aogs.13327
- Adverse childhood experiences and changing levels of psychosocial distress scores across pregnancy in Kenyan women.Int J Environ Res Public Health. 2020; 17: 3401https://doi.org/10.3390/ijerph17103401
- Perinatal depression: the role of maternal adverse childhood experiences and social support.J Affect Disord. 2020; 263: 576-581https://doi.org/10.1016/j.jad.2019.11.030
- Adverse childhood experiences and lifetime adverse maternal outcomes (gestational diabetes and hypertensive disorders of pregnancy) in the Hispanic Community Health Study/Study of Latinos.Ann Epidemiol. 2020; 50: 1-6https://doi.org/10.1016/j.annepidem.2020.08.004
- Intergenerational continuity of adverse childhood experiences in homeless families: unpacking exposure to maltreatment versus family dysfunction.Am J Orthopsychiatry. 2017; 87: 3-14https://doi.org/10.1037/ort0000133
- Intergenerational continuity in adverse childhood experiences and rural community environments.Am J Public Health. 2018; 108: 1148-1152https://doi.org/10.2105/AJPH.2018.304598
- Safe, stable, nurturing relationships as a moderator of intergenerational continuity of child maltreatment: a meta-analysis.J Adolesc Health. 2013; 53: S32-S38https://doi.org/10.1016/j.jadohealth.2013.05.004
- Association of parental adverse childhood experiences and current child adversity.JAMA Pediatr. 2015; 169: 786-787https://doi.org/10.1001/jamapediatrics.2015.0269
- Expanding our understanding of intergenerational exposure to adversity.Child Youth Serv Rev. 2020; 118105369https://doi.org/10.1016/j.childyouth.2020.105369
- Environmental influences on health and development: nutrition, substance exposure, and adverse childhood experiences.Dev Med Child Neurol. 2019; 61: 1008-1014https://doi.org/10.1111/dmcn.14149
- A new framework for addressing adverse childhood and community experiences: the building community resilience model.Acad Pediatr. 2017; 17: S86-S93https://doi.org/10.1016/j.acap.2016.12.011
- Maternal adverse childhood experiences and antepartum risks: the moderating role of social support.Arch Womens Ment Health. 2018; 21: 663-670https://doi.org/10.1007/s00737-018-0826-1
- Section on Adolescent Health, Council on Community Pediatrics, Committee on Adolescence. The impact of racism on child and adolescent health.Pediatrics. 2019; 144e20191765https://doi.org/10.1542/peds.2019-1765
- Investigating racial differences in clusters of adverse childhood experiences.Am J Orthopsychiatry. 2020; 90: 106-114https://doi.org/10.1037/ort0000405
Article info
Publication history
Published online: January 23, 2023
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In Press Journal Pre-ProofIdentification
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Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine.
