Adverse childhood experiences and poor birth outcomes in a diverse, low-income sample

Association between adverse childhood experiences and pregnancy morbidities: A nationwide online-based cross-sectional study

OBJECTIVE

To examine the association between adverse childhood experiences (ACEs) and pregnancy morbidities, including preterm birth (PTB), gestational diabetes (GDM), preeclampsia, and small-for-gestational-age (SGA) among the general population in Japan.

METHODS

The data were from the JACSIS study, an online-based nationwide survey conducted from July to August 2021 in Japan (N = 5444). ACEs included physical, sexual, and psychological abuse, neglect, childhood poverty, bully victimization, domestic violence, parental death, and parental divorce. Pregnancy morbidities, including PTB, GDM, preeclampsia, and SGA were identified through questionnaires. A multivariable logistic regression model was applied.

RESULTS

Of 5444 women, 2778 (51.0%) had no ACEs, and 374 (6.9%) had four or more ACEs. A dose-response association was found between total ACE score and PTB and preeclampsia (p-value: 0.016 and 0.001). Women with four or more ACE scores showed higher risks of preeclampsia (adjusted odds ratio [aOR] [95% confidence interval, CI]: 3.06 [1.57-5.94], p-value: 0.001). Besides, those with two or three ACEs had higher risks of PTB (aOR [95%CI]: 1.42 [1.01-2.02], p-value: 0.046, and aOR [95%CI]: 1.61 [1.04-2.50], p-value: 0.041), and women with one ACE showed a higher risk of GDM (aOR [95%CI]: 1.34 [1.02-1.77], p-value: 0.035). SGA was not associated with ACEs.

CONCLUSION

ACEs were associated with an increased risk of PTB, preeclampsia, and GDM, but not SGA among the general population in Japan.

Improving birth experiences and provider interactions: Expert opinion on critical links in Maternity care

This article explores the Quality of Provider Interaction (QPI) within maternity care, spotlighting its crucial role in positive childbirth experiences. It emphasizes the need for trust-based relationships between women and their care providers, a necessity amplified by the profound neurohormonal sensitivities experienced during labor. Drawing from the 'Optimizing the birth environment' COST DEVOTION CA18211 Working Group, this article aims to provide insights and stimulate discussion on how to mitigate birth trauma and improve childbirth experiences. The study evolved through discussions on QPI, engagement with the group, a review of COST Action research, and conference contributions, leading to essential recommendations. From our dialogue and evaluation of existing literature, we identified four pivotal aspects critical to enhancing QPI: 1) Empathy and emotional availability, 2) Trauma-informed maternity care, 3) Integrating woman-centered individual and institutional attitudes, and 4) Empowering language use. We examine how these elements influence women's emotional and psychological well-being throughout childbirth and beyond, underscoring their critical contribution. This article proposes a framework to improve maternity care by enhancing the Quality of Provider Interaction (QPI). It offers practical recommendations for refining care protocols and language guidelines, emphasizing the importance of respectful, secure birthing environments. Adopting care models that prioritize high-quality provider interactions is crucial for the well-being of women and their families.

How do Differences in Adolescent and Caregiver Reports of Adolescent Adverse Childhood Experiences Relate to Adolescent Depression?

Objective

To compare adolescent and caregiver reports of adolescent adverse childhood experiences (ACEs) and their relationship with current adolescent depression and to analyze the relationship between ACEs and depression.

Methods

We recruited 46 adolescent-caregiver dyads from a large, inner-city medical center's adolescent medicine clinic. Adolescents and caregivers completed the Center for Youth Wellness ACE questionnaire, encompassing traditional ACEs (eg, abuse, neglect, household dysfunction) and nontraditional ACEs (eg, foster care, parental death, exposure to community violence). Adolescents also completed the Patient Health Questionnaire-9A (PHQ-9A) depression screening tool.

Results

Among adolescents, 14 (30%) reported no traditional ACEs, 11 (24%) reported 1, and 21 (46%) reported more than 1. Regarding nontraditional ACEs, 16 (35%) reported none, 11 (24%) reported 1, and 19 (41%) reported more than 1. Caregiver reports consistently indicated lower ACEs compared with adolescent self-reports (P < .005). For the PHQ-9A scores, 26 (57%) of adolescents showed no or minimal depression, 14 (30%) mild, and 6 (13%) moderate depression. A moderate positive correlation emerged between PHQ-9A scores and self-reported traditional ACEs (rs = 0.5, P < .001) and nontraditional ACEs (rs = 0.49, P < .001). In addition, a positive correlation was observed between the absolute differences in adolescent and caregiver reports of traditional ACEs and PHQ-9A scores (n = 46, ρ = 0.51, P < .001).

Conclusions

As the differences in ACE reports between adolescents and caregivers increased, there was a corresponding increase in adolescent depression scores. It is essential to incorporate comprehensive ACE screening and encourage open communication between adolescents and caregivers, which may improve mental health outcomes.

Paternal and maternal exposures to adverse childhood experiences and spontaneous fetal loss: a nationwide cross-sectional analysis

BACKGROUND

Adverse childhood experiences (ACEs) might be associated with maternal spontaneous fetal loss, while evidence among Chinese population is limited. This study aims to explore the associations of adverse childhood experiences (ACEs) among women and their spouses with the risk of spontaneous abortion and stillbirth.

METHOD

Data were from the China Health and Retirement Longitudinal Study (CHARLS) 2014 survey. ACEs were categorized into intra-familial ACEs and extra-familial ACEs. The associations of maternal and paternal ACEs with women's history of spontaneous abortion and stillbirth were investigated by logistic regression.

RESULTS

7,742 women were included with 9.05% and 2.47% experiencing at least one spontaneous abortion or stillbirth, respectively. Women exposed to 2, 3, and ≥ 4 ACEs were at significantly higher odds of spontaneous abortion, with adjusted odds ratios (ORs) of 1.52 (95% [CI, Confidence Interval] 1.10-2.10), 1.50 (95% CI 1.07-2.09) and 1.68 (95% CI 1.21-2.32), respectively. A significant association between ≥ 4 maternal intra-familial ACEs and stillbirth (OR 2.23, 95% CI 1.12-4.42) was also revealed. Furthermore, paternal exposures to 3 and ≥ 4 overall ACEs were significantly associated with their wives' history of spontaneous abortion, with adjusted ORs of 1.81 (95% CI 1.01-3.26) and 1.83 (95% CI 1.03-3.25), respectively.

CONCLUSION

Both maternal and paternal ACEs were associated with spontaneous abortion, and potential mediators might need to be considered to further explore impacts of maternal and paternal ACEs on maternal reproductive health.

Impact of sex, race, and social determinants of health on neonatal outcomes

Despite the global improvements in neonatal outcomes, mortality and morbidity rates among preterm infants are still unacceptably high. Therefore, it is crucial to thoroughly analyze the factors that affect these outcomes, including sex, race, and social determinants of health. By comprehending the influence of these factors, we can work towards reducing their impact and enhancing the quality of neonatal care. This review will summarize the available evidence on sex differences, racial differences, and social determinants of health related to neonates. This review will discuss sex differences in neonatal outcomes in part I and racial differences with social determinants of health in part II. Research has shown that sex differences begin to manifest in the early part of the pregnancy. Hence, we will explore this topic under two main categories: (1) Antenatal and (2) Postnatal sex differences. We will also discuss long-term outcome differences wherever the evidence is available. Multiple factors determine health outcomes during pregnancy and the newborn period. Apart from the genetic, biological, and sex-based differences that influence fetal and neonatal outcomes, racial and social factors influence the health and well-being of developing humans. Race categorizes humans based on shared physical or social qualities into groups generally considered distinct within a given society. Social determinants of health (SDOH) are the non-medical factors that influence health outcomes. These factors can include a person's living conditions, access to healthy food, education, employment status, income level, and social support. Understanding these factors is essential in developing strategies to improve overall health outcomes in communities.

The Association Between Adverse Childhood Experiences and Preterm Delivery: A Latent Class Approach

Background: Racial and socioeconomic status (SES) disparities in preterm delivery (PTD) have existed in the United States for decades. Disproportionate maternal exposures to adverse childhood experiences (ACEs) may increase the risk for adverse birth outcomes. Moreover, racial and SES disparities exist in the prevalence of ACEs, underscoring the need for research that examines whether ACEs contribute to racial and SES disparities in PTD. Methods: We examined the relationship between ACEs and PTD in a longitudinal sample of N = 3,884 women from the National Longitudinal Study of Adolescent to Adult Health (1994-2018). We applied latent class analysis to (1) identify subgroups of women characterized by patterns of ACE occurrence; (2) estimate the association between latent class membership (LCM) and PTD, and (3) examine whether race and SES influence LCM or the association between LCM and PTD. Results: Two latent classes were identified, with women in the high ACEs class characterized by a higher probability of emotional abuse, physical abuse, sexual abuse, and foster care placement compared with the low ACEs class, but neither class was associated with PTD. Race and SES did not predict LCM. Conclusions: Our findings suggest that ACEs may not impact PTD risk in previously hypothesized ways. Future research should assess the impact of ACEs on the probability of having live birth pregnancies as well as the role of potential protective factors in mitigating the impact of ACEs on PTD.

Personalized Mobile Health-Enhanced Cognitive Behavioral Intervention for Maternal Distress: Examining the Moderating Role of Adverse Childhood Experiences

BACKGROUND

Maternal history of trauma is a risk factor for distress during pregnancy. The purpose of this paper was to examine the theorized differential impact of a cognitive behavioral intervention (Mothers and Babies Personalized; MB-P) on maternal distress and emotional regulation for those with ≥ 1 adverse childhood experiences (ACEs; vs no ACEs) from pregnancy to 3 months postpartum.

METHODS

Between August 2019 and August 2021, eligible pregnant individuals aged ≥ 18 years, < 22 weeks' gestation, and English-speaking were recruited from 6 university-affiliated prenatal clinics. Participants (N = 100) were randomized to MB-P (n = 49) or control (n = 51). Analyzable data were collected for 95 participants. Analyses tested progression of change (slope) and at individual timepoints (panel analysis) for perinatal mental health outcomes.

RESULTS

The majority of participants (n = 68, 71%) reported experiencing > 1 ACE (median = 1, range: 0-11). Participants demonstrated significant differential effects for depressive symptoms in absence of ACEs (standardized mean differences [SMD] = 0.82; 95% confidence interval [CI] = [0.13-1.51]) vs in presence of ACEs (SMD = 0.39; 95% CI = [-0.20 to 0.97]) and perceived stress in absence of ACEs (SMD = 0.92; 95% CI = [0.23-1.62]) vs in presence of ACEs (SMD = -0.05; 95% CI = [-0.63 to 0.53]). A panel analysis showed significantly reduced depressive symptoms postintervention and increased negative mood regulation at 3 months postpartum for individuals with ACEs.

CONCLUSIONS

Findings support effectiveness of the MB-P intervention to reduce prenatal distress for all pregnant individuals. Preliminary exploration suggests the possibility that individuals with ACEs may benefit from enhanced trauma-informed content to optimize the effects of a perinatal intervention.

Childhood adversity and accelerated reproductive events: a systematic review and meta-analysis

OBJECTIVE

Accelerated female reproductive events represent the early onset of reproductive events involving puberty, menarche, pregnancy loss, first sexual intercourse, first birth, parity, and menopause. This study aimed to explore the association between childhood adversity and accelerated female reproductive events.

DATA SOURCES

PubMed, Web of Science, and Embase were systematically searched from September 22, 2022 to September 23, 2022.

STUDY ELIGIBILITY CRITERIA

Observational cohort, cross-sectional, and case-control studies in human populations were included if they reported the time of reproductive events for female individuals with experience of childhood adversity and were published in English.

METHODS

Two reviewers independently screened studies, obtained data, and assessed study quality, and conflicts were resolved by a third reviewer. Dichotomous outcomes were evaluated using meta-analysis, and pooled odds ratios and 95% confidence intervals were generated using random-effects models. Moderation analysis and meta-regression were used to investigate heterogeneity.

RESULTS

In total, 21 cohort studies, 9 cross-sectional studies, and 3 case-control studies were identified. Overall, female individuals with childhood adversity were nearly 2 times more likely to report accelerated reproductive events than those with no adversity exposure (odds ratio, 1.91; 95% confidence interval, 1.33-2.76; I2=99.6%; P<.001). Moderation analysis indicated that effect sizes for the types of childhood adversity ranged from an odds ratio of 1.61 (95% confidence interval, 1.23-2.09) for low socioeconomic status to 2.13 (95% confidence interval, 1.14-3.99) for dysfunctional family dynamics. Among the 7 groups based on different reproductive events, including early onset of puberty, early menarche, early sexual initiation, teenage childbirth, preterm birth, pregnancy loss, and early menopause, early sexual initiation had a nonsignificant correlation with childhood adversity (odds ratio, 2.70; 95% confidence interval, 0.88-8.30; I2=99.9%; P<.001). Considerable heterogeneity (I2>75%) between estimates was observed for over half of the outcomes. Age, study type, and method of data collection could explain 35.9% of the variance.

CONCLUSION

The literature tentatively corroborates that female individuals who reported adverse events in childhood are more likely to experience accelerated reproductive events. This association is especially strong for exposure to abuse and dysfunctional family dynamics. However, the heterogeneity among studies was high, requiring caution in interpreting the findings and highlighting the need for further evaluation of the types and timing of childhood events that influence accelerated female reproductive events.

Associations between early child adversity and lifetime suicide attempts among gender diverse individuals: A moderated mediation

BACKGROUND

This study examines the effect of adverse childhood experiences (ACEs) on lifetime suicide attempts (LSA) across five gender subgroups (i.e., transgender men, transgender women, transgender non-binary, cisgender men and cisgender women).

OBJECTIVE

To examine (1) the prevalence of LSA across gender identity subgroups; (2) whether the association between ACEs and LSA is moderated by gender identity subgroup; (3) depressive symptoms, alcohol use disorder, social support, and social well-being as mechanisms linking ACEs with LSA; and (4) the moderating role of gender identity on the four putative mediators.

PARTICIPANTS AND SETTINGS

We used nationally representative data from a population-based survey of N = 1368 transgender and cisgender individuals collected between 2016 and 2019.

METHODS

Structural equation modeling was used to explore the indirect effect of depressive symptoms on the relation between ACEs and LSA, and the moderating impact of gender identity.

RESULTS

LSA was significantly more prevalent among transgender respondents (cisgender man = 5 %; cisgender woman = 9 %; transgender man = 42 %; transgender woman = 33 %; transgender non-binary = 37 %; p < 0.001). Individuals with more ACEs had a greater risk of engaging in LSA regardless of gender identity; however, moderation results showed that the impact of each additional ACE on LSA was stronger for individuals with transgender identities: the likelihood of engaging in LSA was statistically similar for transgender men with no ACEs and cisgender men with all 8 ACEs. Indirect effects of ACEs on LSA via depressive symptoms were also observed, and the mediating effect was moderated by gender identity.

CONCLUSIONS

By examining the mechanisms linking childhood adversity to LSA, this study demonstrates that not all ACEs impact gender minority subgroups equally.

Maternal and Paternal Adverse Childhood Experiences (ACEs) and Offspring Health and Wellbeing: A Scoping Review

BACKGROUND

Adverse childhood experiences (ACEs) are common, often co-occur, and are associated with poor health outcomes across the life course. Emerging research has emphasized the lasting consequences of ACEs across generations, suggesting parental ACEs are associated with poor physical and mental health outcomes in children. However, the individual effects of fathers' ACEs and pathways of transmission remain unclear. A scoping review was conducted to summarize the current knowledgebase of the intergenerational consequences of parental ACEs on offspring health, clarify pathways of transmission, understand how ACEs are operationalized in the intergenerational literature, and identify gaps in knowledge.

METHODS

Six electronic databases were searched for articles published in English from 1995 to 2022 relating to the long-term consequences of parental ACEs on offspring physical and mental health. Articles underwent title, abstract, and full-text review by two investigators. Content analysis was performed to integrate findings across the included studies.

RESULTS

The search yielded 14,542 unique articles; 49 met the inclusion criteria. Thirty-six articles focused exclusively on mothers, one solely on fathers, and 12 included both mothers and fathers in their analyses. Six studies used an expanded definition of ACEs. Both direct and indirect associations between parental ACEs and poor offspring outcomes were identified, primarily through biological and psychosocial pathways.

CONCLUSIONS

Findings underscore the importance and oversight of fathers and the need to solidify a unified definition and measure of ACEs. This review identified modifiable protective factors (social support, father involvement) and pathways of transmission (parental mental health, parenting); both having important implications for intervention development.

Intergenerational Transmission of Parental Adverse Childhood Experiences and Children's Outcomes: A Scoping Review

Adverse childhood experiences (ACEs) are among the leading environmental causes of morbidity and mortality. Extending research on within-generation effects, more recent scholarship has explored between-generation consequences of ACEs. Despite growing interest in the intergenerational effects of parents' ACEs on children's outcomes, this line of scholarship has yet to be coalesced into a comprehensive review. The current study is a scoping review on the intergenerational transmission of parental ACEs and children's outcomes. Ten databases such as PubMed, APA PsycArticles, and Social Work Abstracts were searched. To be included, empirical studies must have been published in English and analyzed associations between a cumulative measure of at least four parental ACEs and children's outcomes. Sixty-eight studies qualified for the review and, among these, 60 were published in the most recent 5 years (2018-2022). Fifty-one studies had sample sizes smaller than 500, and 55 focused on the effect of maternal ACEs. Nearly all studies demonstrated that parental ACEs could affect children's outcomes directly or indirectly via mechanisms like maternal mental health problems or parenting-related factors. By scoping the extant literature, this review advances the knowledge base regarding the intergenerational impacts of parental childhood trauma and children's outcomes. It also reveals methodological limitations that should be addressed in future research to strengthen causal inferences along with practical implications for interventions that aim to interrupt the intergenerational transmission of trauma.

The role of childhood adversity and prenatal mental health as psychosocial risk factors for adverse delivery and neonatal outcomes

OBJECTIVE

Exposure to adverse childhood experiences (ACEs) is a significant predictor for physical and mental health problems later in life, especially during the perinatal period. Prenatal common mental disorders (PCMDs) are well-established as a risk for obstetric interventions but knowledge on combined effects of multiple psychosocial risk factors is sparse. We aim to examine a comprehensive model of ACEs and PCMDs as risk factors for poor delivery and neonatal outcomes.

METHOD

With structural equation modeling, we examined direct and indirect pathways between psychosocial risk and delivery and neonatal outcomes in a prospective cohort from pregnancy to birth in Iceland.

RESULTS

Exposure to ACEs increased risk of PCMDs [β = 0.538, p < .001, CI: 0.195-1.154] and preterm delivery [β = 0.768, p < .05, CI: 0.279-1.007)]. An indirect association was found between ACEs and increased risk of non-spontaneous delivery [β = 0.054, p < .05, CI: 0.004-0.152], mediated by PCMDs. Identical findings were observed for ACEs subcategories.

CONCLUSION

ACEs are strong predictors for mental health problems during pregnancy. Both ACEs and PCMDs diagnosis are associated with operative delivery interventions and neonatal outcomes. Findings underscore the importance of identifying high-risk women and interventions aimed at decreasing psychosocial risk during the prenatal period.

Influence of Maternal Adverse Childhood Experiences on Birth Outcomes in American Indian and non-Hispanic White Women

PURPOSE

Maternal adverse childhood experiences (ACEs) are an antecedent risk during prenatal and postpartum periods. We examined race-based differences of the mediating influences of antepartum health risks (prenatal depression, high blood pressure, gestational diabetes) on associations between ACEs and maternal and birth outcomes (postpartum depression, preterm birth, low birthweight) among American Indian and non-Hispanic White women.

METHODS

Public use data from the South Dakota Pregnancy Risk Assessment Monitoring System PRAMS (2017-2019) were used for this secondary analysis of postpartum women. ACEs and depression were measured based on self-report survey results. Antepartum risks and birth outcomes were extracted from birth certificate data. A moderated mediation logit model estimated direct, indirect, and moderating effects by race, controlling for maternal characteristics and perinatal risks to understand ACEs' impact on pregnancy and birth outcomes between groups.

RESULTS

The sample included 2,343 postpartum women. American Indian versus non-Hispanic White women had a higher mean ACE score (3.37 vs. 1.64) and substantial disparities. Race-based differences were attributed to social, economic, and health-related factors. Adjusting for proportional differences, members of both groups with ACEs demonstrated significantly increased odds of prenatal and postpartum depression. ACEs influenced postpartum depression and preterm birth through the indirect effect of prenatal depression in both races. Prenatal depression indirectly influenced the relationship between ACEs and low birthweight in non-Hispanic White women.

CLINICAL IMPLICATIONS

ACEs were associated with higher levels of prenatal depression, which may negatively influence maternal and birth outcomes in American Indian and non-Hispanic White women. Improving perinatal outcomes must emphasize psychosocial care along with medical care to address the high burden of maternal ACEs in the United States.

Adverse childhood experiences, the risk of pregnancy complications and adverse pregnancy outcomes: a systematic review and meta-analysis

BACKGROUND

Adverse childhood experiences (ACEs) have a profound negative impact on health. However, the strength of the association between ACEs and pregnancy complications and adverse pregnancy outcomes is not well quantified or understood.

OBJECTIVE

To conduct a systematic review and meta-analysis of the association between ACEs and risk of pregnancy complications and adverse pregnancy outcomes.

SEARCH STRATEGY

A comprehensive search was conducted using PubMed, Embase, CINAHL, PsycINFO, ClinicalTrials.gov and Google scholar up to July 2022.

DATA COLLECTION AND ANALYSIS

Two reviewers independently conducted the screening and quality appraisal using a validated tool. Meta-analysis using the quality-effects model on the reported odds ratio (OR) was conducted. Heterogeneity and inconsistency were examined using the I2 statistics.

RESULTS

32 studies from 1508 met a priori inclusion criteria for systematic review, with 21 included in the meta-analysis. Pooled analyses showed that exposure to ACEs increased the risk of pregnancy complications (OR 1.37, 95% CI 1.20 to 1.57) and adverse pregnancy outcomes (OR 1.31, 95% CI 1.17 to 1.47). In sub-group analysis, maternal ACEs were associated with gestational diabetes mellitus (OR 1.39, 95% CI 1.11 to 1.74), antenatal depression (OR 1.59, 95% CI 1.15 to 2.20), low offspring birth weight (OR 1.27, 95% CI 1.02 to 1.47), and preterm delivery (OR 1.41, 95% CI 1.16 to 1.71).

CONCLUSION

The results suggest that exposure to ACEs increases the risk of pregnancy complications and adverse pregnancy outcomes. Preventive strategies, screening and trauma-informed care need to be examined to improve maternal and child health.

Modeling the Likelihood of Low Birth Weight: Findings from a Chicago-Area Health System

OBJECTIVE

This study presents a statistical model of the incidence of low birth weight (LBW) births in a large, Chicago-area hospital system. The study was undertaken to provide a strategic framework for future health system interventions.

METHODS

Administrative and electronic health records were matched to census Zip Code Tabulation Area (ZCTA) household poverty data for 42,681 births in 2016-2019 at seven system hospitals, serving a diverse patient population. A logistic regression model of LBW incidence was estimated to test the independent significance of maternal sociodemographic characteristics after controlling for clinical risk factors.

RESULTS

The incidence of LBW was 6.3% overall but 11.3% among non-Hispanic Black patients as compared to 5.1% among non-Hispanic White patients. LBW incidence ranged from 9.2% for patients from the poorest ZCTA (20% + poor households) compared to 5.6% of patients from the most affluent (< 5% poor) ZCTA. Nulliparous patients, patients with pre-existing chronic conditions, and patients with hypertensive disorders of pregnancy were significantly more likely to have LBW births. After controlling for clinical risk factors and poverty level, non-Hispanic Black patients were still over 80% more likely and to have a LBW birth.

DISCUSSION

Study findings reveal the joint effects of social and clinical risk factors. Findings profile our highest-risk populations for targeted interventions. Promising prenatal care redesign programs include pregnancy patient navigators, home and group visits, eHealth telemonitoring, improved mental health screening, and diversification of the maternity care workforce. Decreasing LBW births should be a national public health policy priority and will require major investments in the most impacted communities.

Parental Preconception Adversity and Offspring Health in African Americans: A Systematic Review of Intergenerational Studies

Background: This systematic review explores the empirical literature addressing the association between parental preconception adversity and offspring physical health in African-American families. Method: We conducted a literature search in PubMed, Web of Science, PsycINFO, CINAHL, and Scopus through June 2021. Articles were included if they: reported data about at least two generations of African-American participants from the same family; measured parental preconception adversity at the individual level; measured at least one offspring physical health outcome; and examined associations between parental adversity and child health. Results: We identified 701 unique articles; thirty-eight articles representing 30 independent studies met inclusion criteria. Twenty-five studies (83%) reported that parental preconception adversity was associated with child health; six studies (20%) reported that parental preconception adversity was not associated with at least one offspring outcome; several studies reported both. Only six studies (20%) reported an association specific to African Americans. Conclusion: Empirical evidence linking parental preconception adversity with offspring physical health in African Americans is limited and mixed. In the current literature, very few studies report evidence addressing intergenerational associations between parental preconception adversity and offspring physical health in the African-American population, specifically, and even fewer investigate forms of parental preconception adversity that have been shown to disproportionately affect African Americans (e.g., racism). To better understand root causes of racial health disparities, more rigorous systematic research is needed to address how intergenerational transmission of historical and ongoing race-based trauma may impact offspring health among African Americans.

Understanding the Mental Health Impact of Previous Pregnancy Loss Among Currently Pregnant Veterans

BACKGROUND

Pregnancy loss, including miscarriage and stillbirth, is common and associated with an increased risk for prenatal and postnatal depression, as well as posttraumatic stress disorder (PTSD). Racial disparities have been observed in pregnancy loss, with Black women having higher rates of pregnancy loss and postnatal depression. However, no research to date has examined the mental health and demographic correlates of pregnancy loss within a veteran population.

METHOD

The current study examined associations between pregnancy loss and mental health and demographic correlates among 1,324 pregnant veterans, of which 368 had a history of at least one stillbirth and/or miscarriage.

RESULTS

Veterans with a history of pregnancy loss, compared with those without, were more likely to have a diagnosis of anxiety (52.7% vs. 46.4%, p = .04), depression (62.5% vs. 50.8%, p = .0001), or PTSD (46.5% vs. 37.6%, p = .003); were more likely to report receiving mental health care during pregnancy (23.1% vs. 16.8%, p = .01); and were more likely to have experienced military sexual trauma (harassment: 56.5% vs. 49.9%, p = .04; rape: 38.9% vs. 29.3%, p = .0004). Results also indicated that Black veterans were more likely to report a history of pregnancy loss (32.1% vs. 25.3%, p = .01). Further, Black veterans were more likely to experience clinically meaningful prenatal depression symptoms (adjusted odds ratio: 1.90; 95% confidence interval: 1.42-2.54) after accounting for past loss and age in logistic regression models.

DISCUSSION

Taken together, findings from the present investigation corroborate previous research highlighting the deleterious impact of pregnancy loss and extend prior work by examining these associations among a diverse sample of pregnant veterans.

Associations between adverse childhood experiences and obstetrical outcomes in a predominantly Black-identifying and low-income pregnant population

BACKGROUND

Recent literature indicates that adverse childhood experiences have been associated with poor obstetrical outcomes, including pregnancy loss, preterm birth, and low birthweight. Several studies have been conducted in primarily self-identified White individuals who report middle to high income levels. Less is known about the impact of adverse childhood experiences on obstetrical outcomes in minority-identifying and low-income populations, who are known to experience a greater number of adverse childhood experiences and are at higher risk of maternal morbidity.

OBJECTIVE

This study aimed to examine associations between adverse childhood experiences and a broad range of obstetrical outcomes among predominantly Black-identifying pregnant persons who have low income and live in an urban area.

STUDY DESIGN

This is a single-center retrospective cohort study of pregnant persons referred to a mental healthcare manager because of elevated psychosocial risks identified by screening tools or provider concerns during the study period from April 2018 to May 2021. Pregnant persons aged <18 years and those who did not speak English were excluded. Patients completed validated mental and behavioral health screening tools including the Adverse Childhood Experiences Questionnaire. Medical charts were reviewed for obstetrical outcomes, including preterm birth, low birthweight, hypertensive disorders of pregnancy, gestational diabetes mellitus, chorioamnionitis, sexually transmitted infection, maternal group B streptococcus carrier status, type of delivery, and attendance of a postpartum visit. Associations between high (≥4) and very high (≥6) of 10 adverse childhood experience score and obstetrical outcomes were analyzed using bivariate analysis and multivariate logistic regression, adjusting for confounding factors (significant at P<.05 in bivariate analysis).

RESULTS

Our cohort included 192 pregnant persons, of whom 176 (91.7%) self-identified as Black or African American and 181 (94.8%) had public insurance (used as a proxy for low income). Adverse childhood experience score ≥4 was reported by 91 (47.4%) individuals and score ≥6 by 50 (26%). On univariate analysis, adverse childhood experience score ≥4 was associated with preterm birth (odds ratio, 2.17; 95% confidence interval, 1.02-4.61). Adverse childhood experience score ≥6 was associated with hypertensive disorders of pregnancy (odds ratio, 2.09; 95% confidence interval, 1.05-4.15) and preterm birth (odds ratio, 2.29; 95% confidence interval, 1.05-4.96). After accounting for chronic hypertension, associations between adverse childhood experience score and obstetrical outcomes were no longer significant.

CONCLUSION

Approximately half of the pregnant persons referred to a mental healthcare manager had a high adverse childhood experience score, underscoring the high burden of childhood trauma on populations facing long-standing systemic racism and barriers to healthcare access. High and very high adverse childhood experience score may be associated with chronic health conditions that predate pregnancy and can alter obstetrical outcomes. Obstetrical care providers have a unique opportunity to mitigate risk of associated poor health outcomes during preconception and prenatal care by screening for adverse childhood experiences.

Associations of Adverse Childhood Experiences With Pregnancy and Infant Health

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.

Intimate partner violence, adverse childhood experiences and prenatal substance use in South Africa

Background

Intimate partner violence (IPV) is one of the most pressing public health conditions among women worldwide, particularly in sub-Saharan Africa. Intimate partner violence in South Africa, along with human immunodeficiency virus (HIV), is an epidemic that is closely linked to trauma and substance use in women.

Aim

This study aimed to identify factors associated with IPV among pregnant women, with a specific focus on adverse childhood experiences (ACE), prenatal substance use, and HIV status.

Setting

A large public general hospital in the KwaZulu-Natal province.

Methods

The sampled study participants included 223 adult postpartum women (18 - 45 years) based on convenience sampling who recently gave birth. Four separate logistic regression models were fitted to examine the role of ACE, perinatal substance abuse and HIV against threat (model 1), physical violence (model 2), sexual violence (model 3) and any IPV (model 4) outcomes (threat and/or physical and/or sexual violence).

Results

The prevalence of threat, physical violence, sexual violence and any IPV were 19.7%, 16.6%, 1.8% and 20.2%, respectively. The total ACE scores ranged from 0 to 11 (of 13 possible events) with a mean of 3.28 (standard deviation [s.d.] = 2.76), where 14.4% reported using substances during pregnancy (n = 32) as well as 47.1% (n = 105) of participants living with HIV. The authors found that the presence of family support was protective against IPV physical.

Conclusion

It is essential that obstetric services screen and address potential risk factors along the life course pathways from early adversity to adult maternal health that drive IPV, particularly in young women who may lack family support during pregnancy.

Contribution

This research gives insight into the dynamics between IPV, HV, ACE and perinatal substance use facing young women in South Africa.

Effect of maternal adverse childhood experiences (ACE) and cannabis use on pregnancy outcomes

This study aimed to characterize the relationship between cannabis use, ACE score, and pregnancy outcomes. Pregnant patients in Baltimore, MD, completed the 17-point ACE checklist. Charts of the birth parent and neonate were reviewed for urine toxicology testing at initiation of care and delivery, prenatal care metrics, and birth statistics. Multivariable logistic regression analysis was performed to assess the relationship between ACE score, cannabis use, and pregnancy outcomes. Of 256 birth parents, 87 (34.0%) tested positive for cannabis at initial visit and 39 (15.2%) tested positive for cannabis at delivery. Testing positive for cannabis at initial visit or delivery was associated with higher ACE score (15.1 vs 13.7, p = 0.04; 16.2 vs 13.8, p = 0.01). Of those who tested positive for cannabis at initial visit, 39/87 (45.0%) tested positive at delivery. Continued cannabis use at delivery was associated with lower maternal weight gain (7.9 kg vs 13.3 kg, p = 0.003), fewer prenatal visits (7 vs 8, p = 0.010), and numerically higher mean ACE score. Cannabis use at delivery was associated with 10% lower birthweight (2665 g vs 3014 g p < 0.05) but not with pre-term birth. Total ACE score was not significantly associated with any birth outcome. Worse pregnancy outcomes were associated with cannabis use throughout pregnancy but not with cannabis use at prenatal care initiation. The interplay of ACE and continued cannabis use during pregnancy warrants further research on the physiologic effects of cannabis and interventions to decrease substance use during pregnancy.

The intergenerational transmission of maternal adverse childhood experiences on offspring's psychiatric disorder and the mediating role of maternal depression: Results from a cross sectional study

Maternal adverse childhood experiences (ACEs) may negatively affect the mental health and development of their offspring. The purpose of this study was to investigate the association of maternal ACE and offspring's psychiatric disorder and the mediating effect of maternal depression. The subjects included 463 mothers (42.78 ± 5.68 years) and their offspring aged 6-18 years (13.26 ± 3.90 years). Mothers reported their ACE before age 18 and completed the Beck Depression Inventory-II and Diagnostic Predictive Scales (DPS), a screening tool for offspring's psychiatric disorder. 35.42% of subjects had at least one ACE, and 11.0% reported three or more ACEs. Higher maternal ACE scores were associated with a significantly higher prevalence of offspring's psychiatric disorders (p < 0.001). Household dysfunction of maternal ACE (OR = 2.263, p < 0.001) is significantly associated with offspring's psychiatric disorder. In the mediation model in which the household dysfunction affects the number of offspring's psychiatric disorders, the partial mediation model through maternal depression was significant. The mother's experience of household dysfunction before the age of 18 has a significant impact on her offspring's psychiatric disorder and supported significant mediation through maternal depression. Further research is needed to determine the mechanisms of intergenerational transmission of ACE and offspring's psychopathology.

Pregnancy Outcomes of Women Hospitalized for Physical Assault, Sexual Assault, and Intimate Partner Violence

Pregnancy outcomes of women with serious injuries due to violence receive limited attention. We examined the association of assault before and during pregnancy with maternal and infant outcomes at delivery. We performed a retrospective cohort study of 2,193,711 births in Quebec, Canada between 1989 and 2016. We identified women who were hospitalized for physical assault, sexual assault, and assault with documented intimate partner violence before and during pregnancy. We examined adverse outcomes at delivery, including preeclampsia, placental abruption, antepartum hemorrhage, stillbirth, preterm birth, low birthweight, and other disorders. In log-binomial regression models, we estimated risk ratios (RR) and 95% confidence intervals (CI) for the association between violence hospitalization and adverse birth outcomes, adjusted for potential confounders. Compared with no exposure, violence before or during pregnancy was associated with the future risk of placental abruption (RR 1.49, 95% CI 1.23-1.82), antepartum hemorrhage (RR 1.43, 95% CI 1.19-1.71), stillbirth (RR 1.83, 95% CI 1.27-2.63), preterm birth (RR 1.70, 95% CI 1.54-1.87), and low birthweight (RR 1.78, 95% CI 1.58-2.00). Physical assault, sexual assault, and assault with documented intimate partner violence were all associated with adverse outcomes. The risk of adverse outcomes was elevated regardless of timing and number of violence admissions, although associations were stronger for women hospitalized twice or more. Physical assault, sexual assault, and intimate partner violence are important risk factors for adverse pregnancy outcomes. Screening for violence in women of childbearing age and closer follow-up during pregnancy may help improve birth outcomes.

The influence of maternal and paternal education on birth outcomes: an analysis of the Ottawa and Kingston (OaK) birth cohort

BACKGROUND

Education is considered one of the most robust determinants of health. However, it is unclear whether maternal education and paternal education have differential impacts on perinatal health outcomes. We assess maternal and paternal education differences and their association with adverse birth outcomes in a large birth cohort from Ontario, Canada.

METHODS

The OaK Birth Cohort recruited patients from Ontario, Canada, between October 2002 and April 2009. We recruited mothers were recruited between 12 and 20 weeks' gestation and collected both mother and infant data. The final sample size of the cohort was 8,085 participants. We use logistic regression to model the probability of preterm birth (less than 34 and 37 weeks' gestation), small-for-gestational-age (SGA), or stillbirth as a function of maternal and paternal educational attainment. We adjust for household-level income, maternal and paternal race and ethnicity, and compare the strength of the association between maternal and paternal education on outcomes using Wald tests.

RESULTS

7,928 mother-father-offspring triads were available for the current analysis. 75% of mothers and fathers had college or university level education, and 8.7% of mothers experienced preterm delivery. Compared to mothers with college or university education, mothers with a high school education had an odds ratio of 1.37 (95% CI: 1.01-1.87) for SGA. Paternal education was not associated with infant outcomes. Comparing the odds ratios for maternal education and paternal education showed a stronger association than paternal education at the high school level for SGA birth (difference in odds ratio: 1.95, 95% CI: 1.13-3.36, p = .016) among women at least 25 years old.

CONCLUSION

Maternal education was associated with SGA, and this effect was more robust than paternal education, but both associations were weaker than previously reported.

Nursing students' adverse childhood experience scores: a national survey

OBJECTIVES

To determine the adverse childhood experience scores (ACES) of nursing students in the United States.

METHODS

Utilized the standardized Family Health History Questionnaire to determine the ACES of a national sample of nursing students. Simple descriptive statistics were used to analyze the findings.

RESULTS

Nursing students ACES indicate that they enter academia with a much higher baseline of childhood trauma versus the general population. Over 40% of nursing students surveyed had an ACES of 4 or more versus the national average of 12.5-13.3% of the general population having an ACES of 4 or more.

CONCLUSIONS

This data provides support for Conti-O'Hare's theory of nurses as wounded healer. Nursing faculty should consider nursing students to be members of a vulnerable population and revise curricula to support nursing students stress resileince.

Maternal-Child Health Outcomes from Pre- to Post-Implementation of a Trauma-Informed Care Initiative in the Prenatal Care Setting: A Retrospective Study

Background: There has been an increase in use of trauma-informed care (TIC) approaches, which can include screening for maternal Adverse Childhood Experiences (ACEs) during prenatal care. However, there is a paucity of research showing that TIC approaches are associated with improvements in maternal or offspring health outcomes. Using retrospective file review, the current study evaluated whether differences in pregnancy health and infant birth outcomes were observed from before to after the implementation of a TIC approach in a low-risk maternity clinic, serving women of low medical risk. Methods: Demographic and health data were extracted from the medical records of 601 women (n = 338 TIC care, n = 263 pre-TIC initiative) who received prenatal care at a low-risk maternity clinic. Cumulative risk scores for maternal pregnancy health and infant birth outcomes were completed by health professionals. Results: Using independent chi-squared tests, the proportion of women without pregnancy health risks did not differ for women from before to after the implementation of TIC, χ2 (2, 601) = 3.75, p = 0.15. Infants of mothers who received TIC were less likely to have a health risk at birth, χ2 (2, 519) = 6.17, p = 0.046. Conclusion: A TIC approach conveyed modest benefits for infant outcomes, but not maternal health in pregnancy. Future research examining other potential benefits of TIC approaches are needed including among women of high socio-demographic and medical risk.

Association Between Adverse Childhood Experiences and Adverse Pregnancy Outcomes

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.

Charting a Course towards Resilience Following Adverse Childhood Experiences: Addressing Intergenerational Trauma via Strengths-Based Intervention

Early research on adverse childhood experiences (ACEs) provided staggering evidence of the significant ramifications of ACEs on physical health and functioning. It brought to the forefront the importance of addressing trauma and family dysfunction to enhance public health. Over the past several decades, the study of childhood adversity has blossomed, with expanded conceptualizations and assessments of ACEs. This review brings together various biological, psychological, and sociological principles that inform our understanding of ACEs and our approach to treatment. Specifically, we document the evolution of ACEs research, focusing on the intergenerational impact of ACEs, the importance of incorporating a resilience framework when examining ACEs, and implementing interventions that address adversity across generations and at multiple levels of the social ecology. Evidence is provided to support the evolving perspective that ACEs have long-lasting effects beyond the ACE(s)-exposed individual, with significant attention to the impact of parental ACEs on child development. An intergenerational and multilevel approach to understanding and addressing ACEs offers specific areas to target in interventions and in public policy.

Maternal Adverse Childhood Experiences, Paternal Involvement, and Infant Health

OBJECTIVES

To assess the interplay between maternal exposure to adverse childhood experiences (ACEs) and father's acknowledgment of paternity (AOP; a proxy for paternal involvement) in the risk of low birth weight (<2500 grams) and preterm birth (<37 weeks) among offspring.

STUDY DESIGN

Data come from the 2018 North Dakota and South Dakota Pregnancy Risk Assessment Monitoring System (n = 1896). Logistic regression models were used to assess low birth weight and preterm birth outcomes. Moderation analyses are conducted to assess the interaction between maternal ACEs and father's AOP.

RESULTS

Moderation analyses demonstrated a positive interaction between an accumulating number of maternal ACEs and being unmarried without AOP for low birth weight and preterm birth. Upon comparing newborns of unmarried women without AOP, those whose mothers were exposed to 4 or more ACEs had a 3.74 times greater probability of low birth weight (0.050 vs 0.187) and a 1.74 times greater probability of preterm birth (0.085 vs 0.148) than those whose mothers reported no ACE exposure.

CONCLUSIONS

Exposure to accumulating ACEs substantially increases the risk of deleterious infant health outcomes, but only for newborns of unmarried women without AOP. Future research should assess the efficacy of interventions that can mitigate the impact of maternal ACEs in the absence of father's AOP.

Biopsychosocial Factors during the Perinatal Period: Risks, Preventative Factors, and Implications for Healthcare Professionals

Women face risks to their wellbeing during the perinatal period of pregnancy. However, there is a dearth of information on perinatal risk factors within the biopsychosocial paradigm. Emphasis is often placed on biological components associated with pregnancy and women's health. However, psychological and social determinants of health are integral during the perinatal period, and mental wellness is often a determinant for positive maternal and neonatal health outcomes. This article reviews risk factors of perinatal wellness (e.g., physical and nutritional concerns, trauma, discrimination, adverse childhood events) and highlights protective factors for women in their perinatal period. Healthcare professionals can support perinatal health by focusing on culturally and contextually appropriate research and prevention, providing equal access to sexual and reproductive healthcare information and services, providing quality education and training for helping professionals, and supporting policies for positive sexual and reproductive women's healthcare.

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

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.

Association of Mercury Exposure and Maternal Sociodemographics on Birth Outcomes of Indigenous and Tribal Women in Suriname

Information regarding adverse birth outcomes (ABO) of Indigenous and Tribal women living in the remote tropical rainforest of Suriname, where mercury (Hg) use is abundant in artisanal gold mining, is not available. In the context of a health system analysis, we examined the association between Hg exposure, maternal sociodemographics on the ABO of Indigenous and Tribal women living in Suriname’s interior and its capital, Paramaribo. ABO were determined in pregnant women enrolled from December 2016 to July 2019 in the Caribbean Consortium for Environmental and Occupational Health prospective environmental epidemiologic cohort study. Associations were explored using Pearson’s χ²-test and the Mann–Whitney U-test. Among 351 singleton participants, 32% were Indigenous, residing mainly in the interior (86.8%), and 23.1% had ABO. Indigenous participants had higher rates of ABO (29.8% vs. 19.8%) and preterm birth (PTB) (21.2% vs. 12.4%), higher Hg levels, delivered at a younger age, were less educated, and had lower household income compared to Tribal participants. Multivariate logistic regression models revealed that Indigenous participants had higher odds of ABO (OR = 3.60; 95% CI 1.70–7.63) and PTB (OR = 3.43; 95% CI 1.48–7.96) compared with Tribal participants, independent of Hg exposure and age at delivery. These results highlight the importance of effective risk reduction measures in support of Indigenous mothers, families, and communities.

Total Adverse Childhood Experiences and Preterm Birth: A Systematic Review

INTRODUCTION

Total adverse childhood experiences (ACEs) are gaining prominence as a risk factor for preterm birth (PTB). The emerging literature examining this relationship reports inconsistent findings. The purpose of this systematic review was to summarize the available evidence exploring whether total ACEs predict PTB.

METHODS

A total of 386 studies were returned from searches on PubMed, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Nine studies were selected for final analysis and synthesis based on reporting of total ACEs and preterm birth gestational weeks or standard definition of birth before 37 weeks' gestational age. A systematic review rather than meta-analysis was selected to present the findings given the clinical and methodological (e.g., sample studied, measurement tools) heterogeneity of the retrieved studies and pregnancy outcomes measured.

RESULTS

The nine studies report on birth outcomes for 6,087 women from a range of sociodemographic and ethnic backgrounds. Despite a wide range of study designs, measurement tools, and timings of ACEs exposure across studies, seven of the nine included studies showed significant relationships between ACEs and PTB.

CONCLUSION

Systematic review of the literature suggests that total ACEs are associated with PTB and provides an overview on the known associations. However, to date only nine studies have assessed this link, and more studies are needed, to explore the associations between ACEs and PTB using appropriate and valid instruments and doing so among more diverse populations. Future research should also explore possible biological mechanisms (allostatic load), and moderating and mediating variables.

Pregnancy and obstetric complications in women with a history of childhood maltreatment: Results from a nationally representative sample

INTRODUCTION

A history of childhood maltreatment is associated with increased risk of perinatal complications, with research primarily focused on childhood sexual abuse. Limited research has examined the relationship between different types of childhood maltreatment on perinatal complications, particularly in population-based samples.

METHODS

This study examined the association between childhood maltreatment and self-reported perinatal complications in a sample of pregnant and postpartum women (n = 1279) drawn from the 2012-2013 NESARC-III, a nationally representative survey of United States adults.

RESULTS

Nearly half (45%) of pregnant or postpartum women reported at least one form of childhood maltreatment and a quarter (24.6%) of these women experienced a perinatal complication compared to 13.5% of women without a history of childhood maltreatment. Exposure to any childhood maltreatment, childhood sexual abuse and intimate partner violence (IPV) during childhood were significantly associated with increased odds of perinatal complications after adjusting for sociodemographic characteristics and lifetime psychiatric disorders (AOR ranged from 1.87 to 2.09). Experiencing two or more types of childhood maltreatment (compared to none) was also associated with increased odds of perinatal complications (AOR 2.18 [99% CI = 1.22, 3.90]).

CONCLUSIONS

This association may be explained by vulnerability to physical diseases/complications due to persistent changes in biological stress systems, physical injuries from abuse, or as a result of traumatic memories triggered by pregnancy and childbirth. Findings highlight one of many negative sequelae of childhood maltreatment and the importance of promoting healthcare provider awareness of this association so they can provide appropriate interventions when needed.

Racial Disparities in Mental Health Outcomes Among Women With Early Pregnancy Loss

The risk for major depression is common 30 days after treatment for early pregnancy loss, especially among Black women.

OBJECTIVE:

To explore the relationship between race and depression symptoms among participants in an early pregnancy loss clinical trial.

METHODS:

We performed a planned secondary analysis of a randomized trial by comparing treatments for medical management of early pregnancy loss. We hypothesized that Black participants would have higher odds of risk for major depression (measured with the CES-D [Center for Epidemiological Studies-Depression] scale) 30 days after early pregnancy loss treatment when compared with non-Black participants. We analyzed the data as a cohort, with the primary exposure being race and secondary exposure being high adverse childhood experience scores (measured with the Adverse Childhood Experience scale). Our primary outcome was risk for major depression (score of 21 or higher on the CES-D scale) 30 days after early pregnancy loss treatment.

RESULTS:

Three hundred participants diagnosed with a nonviable intrauterine pregnancy from 5 to 12 weeks of gestation were randomized as part of the original trial from May 2014 to April 2017. Of 275 respondents included in this analysis, 120 [44%] self-identified as Black and 155 [56%] self-identified as non-Black. After early pregnancy loss treatment, 65 [24%] participants were at risk for major depression. Black participants had an increased risk for major depression (57%) after early pregnancy loss treatment compared with non-Black participants (43%; odds ratio [OR] 2.02; 95% CI 1.15–3.55). After adjustment for risk for baseline depression, adverse childhood experience score, and parity, the odds of risk for major depression 30 days after pregnancy loss treatment remained higher for Black participants when compared with non-Black participants (OR 2.02; 95% CI 1.15–3.55; adjusted OR 2.48; 95% CI 1.28–4.81).

CONCLUSION:

Overall, approximately one quarter of women who experience an early pregnancy loss are at an increased risk for major depression 30 days after treatment. This risk is about twice as high for Black women compared with non-Black women. There is a need for appropriate mental health resources for women undergoing early pregnancy loss care.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT02012491.

Associations between Adverse Childhood Experiences and Sexual Risk among Postpartum Women

Epidemiological evidence suggests that exposure to adverse childhood experiences (ACEs) is associated with sexual risk, especially during adolescence, and with maternal and child health outcomes for women of reproductive age. However, no work has examined how ACE exposure relates to sexual risk for women during the postpartum period. In a convenience sample of 460 postpartum women, we used linear and logistic regression to investigate associations between ACE exposure (measured using the Adverse Childhood Experiences Scale) and five sexual risk outcomes of importance to maternal health: contraceptive use, efficacy of contraceptive method elected, condom use, rapid repeat pregnancy, and incidence of sexually transmitted infections (STIs). On average, women in the sample were 25.55 years of age (standard deviation = 5.56); most identified as Black (60.4%), White (18%), or Latina (14.8%). Approximately 40% were exposed to adversity prior to age 18, with the modal number of experiences among those exposed as 1. Women exposed to ACEs were significantly less likely to use contraception; more likely to elect less-efficacious contraceptive methods; and used condoms less frequently (p = 0.041 to 0.008). ACE exposure was not associated with rapid repeat pregnancy or STI acquisition, p > 0.10. Screening for ACEs during pregnancy may be informative to target interventions to reduce risky sexual behavior during the postpartum period.

Pathways from Maternal Adverse Childhood Experiences to Substance Use in Pregnancy: Findings from the All Our Families Cohort

Background: Exposure to adverse childhood experiences (ACEs) is a risk factor for maternal substance use in pregnancy, however, mechanisms by which maternal ACEs may influence substance use in pregnancy have not been fully explored. The current study examines the association between maternal ACEs and substance use in pregnancy (i.e., alcohol, smoking, and drug use) and explores mediating pathways. Methods: A community sample of 1,994 women as part of the All Our Families Cohort were recruited in pregnancy in Calgary, Canada, between 2008 and 2011. Women provided retrospective reports of ACE exposure before age 18 as well as reports of demographic information, substance use (i.e., moderate-to-high alcohol use, any smoking, or any drug use), a previous history of substance use difficulties, and depressive symptoms during pregnancy. Path analyses were used to examine maternal income, education, depression, and previous substance use as mediating variables. Results: There were significant indirect associations between maternal ACEs and maternal substance use in pregnancy via maternal education (β = 0.05, p < 0.001), previous substance use (β = 0.01, p = 0.001), and depression (β = 0.02, p = 0.02). The direct effect of maternal ACEs on maternal substance in pregnancy remained significant after accounting for the indirect effects (β = 0.22, 95% CI = 0.15-0.29, p < 0.001). Conclusions: Exposure to adversity in childhood can lead to socioeconomic and mental health difficulties that increase risk for substance use in pregnancy. Addressing these difficulties before pregnancy may help to reduce the potential for substance use in pregnancy.

Acknowledging and Addressing Allostatic Load in Pregnancy Care

The USA is one of the few countries in the world in which maternal and infant morbidity and mortality continue to increase, with the greatest disparities observed among non-Hispanic Black women and their infants. Traditional explanations for disparate outcomes, such as personal health behaviors, socioeconomic status, health literacy, and access to healthcare, do not sufficiently explain why non-Hispanic Black women continue to die at three to four times the rate of White women during pregnancy, childbirth, or postpartum. One theory gaining prominence to explain the magnitude of this disparity is allostatic load or the cumulative physiological effects of stress over the life course. People of color disproportionally experience social, structural, and environmental stressors that are frequently the product of historic and present-day racism. In this essay, we present the growing body of evidence implicating the role of elevated allostatic load in adverse pregnancy outcomes among women of color. We argue that there is a moral imperative to assign additional resources to reduce the effects of elevated allostatic load before, during, and after pregnancy to improve the health of women and their children.

Exploring maternal adversity and childhood outcomes among low-income rural families

BACKGROUND

Research has linked adversity among mothers to poorer outcomes among their offspring. However, additional inquiry is warranted particularly in rural communities where risk factors for adversity are prevalent.

OBJECTIVE

This study had two objectives: (1) to describe and compare relationships between individual and cumulative maternal adversity with childhood outcomes; and, (2) to determine if mother-child attachment mediated the relationship between maternal adversity and childhood outcomes.

PARTICIPANTS AND SETTING

A convenient sample of 140 women with low socio-economic status (SES) were recruited through Head Start programs in the rural Midwest.

METHODS

Data was gathered using a survey comprised of multiple measures to assess maternal adversity and childhood outcomes (i.e. behavior and attachment). Data were analyzed in SPSS using bivariate and multivariate analyses, including stepwise regression.

RESULTS

Nearly 80 % of respondents experienced at least one adverse childhood experience (ACE) and 48 % reported having one or more traumatic experiences. Higher levels of adversity were associated with increased attention problems, increased emotional reactivity, and decreased harmonious attachment (p < .05, d = 0.37-0.38). Maternal experiences of childhood physical abuse and sexual abuse, as well as witnessing trauma, significantly predicted childhood outcomes, however, the variance accounted for by each type of adversity was small (4%-6%). Maternal adversity was unrelated to mother-child attachment.

CONCLUSIONS

Low-SES mothers in rural communities have significant histories of adversity. It is important to consider individual and cumulative adverse experiences, as well as the mother's perception of events as traumatic. Factors associated with rural communities and Head Start programming, as well as implications for research and practice surrounding maternal adversity and childhood outcomes, are discussed.

Adverse childhood experiences and lifetime adverse maternal outcomes (gestational diabetes and hypertensive disorders of pregnancy) in the Hispanic Community Health Study/Study of Latinos

PURPOSE

Childhood adversity is associated with increased risk of adult disease, including type II diabetes and hypertension. However, little is known about potential associations between childhood adversity and adverse pregnancy outcomes. The goal of this study was to examine the relationship between adverse childhood experiences (ACEs) and ever experiencing gestational diabetes mellitus (GDM) or a hypertensive disorder of pregnancy (HDP) in a cohort of Hispanic or Latina women.

METHODS

We analyzed data from 2319 women from the Hispanic Community Health Study/Study of Latinos who had ever given birth to a liveborn infant. We fit separate logistic regression models accounting for sample weights to examine the association between ACEs and risk of GDM and HDP adjusting for Hispanic/Latino background, age at immigration to the United States, and education.

RESULTS

Women who reported four or more ACEs did not show increased odds of GDM or HDP compared with those who reported three or fewer (GDM adjusted odds ratio: 0.8 [0.5, 1.3]; HDP adjusted OR: 1.0 [0.7, 1.5]).

CONCLUSIONS

Unlike previous research with majority non-Hispanic White cohorts, there was no association between ACEs and GDM or HDP. Future research should explore if this relationship varies by race/ethnicity in multiethnic cohorts.