599 Associations between adverse childhood experiences and obstetrical outcomes in an urban underserved population

Abstract

Adverse childhood experiences (ACEs) such as abuse, neglect, and household dysfunction are strongly associated with poor adult health outcomes in a dose-dependent manner. Less is known about the impact of ACEs on pregnancy, especially in vulnerable populations. The objective of this study was to examine the relationship between ACEs and obstetric outcomes. This is a single-center retrospective cohort study of pregnant women referred to a mental health care coordinator due to elevated psychosocial risks and/or behavioral concerns. Women younger than age 18 and those who did not speak English were excluded. Patients completed validated mental and behavioral health screening tools including the ACE questionnaire. Medical charts were reviewed for obstetric outcomes. The associations between ACE score and adverse obstetric outcomes including preterm birth (<37 weeks), low birth weight (<2500 g), and hypertensive disorders of pregnancy (gestational hypertension and preeclampsia), were analyzed using bivariate analysis and multivariate logistic regression, adjusting for confounding factors (significant at p< 0.1 in bivariate analysis). Our cohort included 92 women of whom 49% had elevated cumulative ACE score ≥ 4 and 26% had a cumulative ACE score ≥ 6. Women with elevated ACE score were significantly more likely to have chronic hypertension; otherwise there were no differences on demographic characteristics or potential obstetric confounds between groups (Table 1). In univariate analysis, ACE score ≥ 4 was not associated with adverse obstetric outcomes, however a score ≥ 6 was associated with an increased risk of preterm birth (OR 3.7, 95% CI 1.2-11.4) and low birth weight (OR 4.9, 95% CI 1.4-17.2). This association did not remain statistically significant after controlling for chronic hypertension. A high level of childhood adversity was associated with chronic hypertension and both prematurity and low birth weight. Future studies should examine whether chronic illnesses help account for poor obstetric outcomes in pregnant women with high childhood adversity.View Large Image Figure ViewerDownload Hi-res image Download (PPT)