Perinatal Transmission of Trauma: The Association Between Adverse Childhood Experiences and Adverse Pregnancy Outcomes
Adverse childhood experiences (ACEs) have been consistently associated with chronic health conditions later in life. The relationship between ACEs in girls and adverse pregnancy outcomes is less well understood. We hypothesize that individuals with more ACEs will have a higher frequency of preterm birth (PTB). Our objective was to examine the association between ACEs and PTB.Methods: This retrospective cohort study included individuals who enrolled in the Collaborative Care Model for Perinatal Depression Support Services (COMPASS) between 1/2017 and 9/2020 and who delivered 24 weeks gestation. Upon enrollment in COMPASS, individuals complete self-reported psychosocial assessments including the ACE screen. Sociodemographic characteristics and perinatal outcomes were abstracted from the electronic health record. The number of ACEs was evaluated both dichotomized (high ACE score defined as ACE > 3) and continuously in bivariate and multivariate analyses. Results: During the study period, 1074 individuals met inclusion criteria; 242 (23%) reported a high ACE score (Table 1). Individuals with a high ACE score had a 2.3-fold increased odds of PTB (95% CI: 1.6-3.3). For each additional point on the ACE screen, the odds of preterm birth increased by 13% (95% CI: 4-23%). After controlling for medical co-morbidities and other social determinants of health, the association between a high ACE score and PTB persisted (aOR 2.0, 95% CI 1.3-3.1; Table 2). Conclusions: ACEs are associated with an increased risk of PTB. This observed relationship may be mediated by the dysregulated hypothalamic-pituitary-adrenal (HPA) axis and immune activity that have been observed in those with early life adversity. Future research should investigate interventions to mitigate these associations to reduce inter-generational cycles of disadvantage.
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