Abstract
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.
Highlights
Over the last 20 years, it has become widely accepted that experiences of adversity in childhood, including abuse, neglect, and household dysfunction, set the stage for poor physical and mental health across the lifespan [1,2,3,4]
The goal of the current study was to evaluate whether the implementation of a traumainformed care (TIC) approach, which included asking about maternal Adverse Childhood Experiences (ACEs) and maternal mental health in a low-risk maternity clinic, was associated with differences in pregnancy health and infant birth outcomes, for better or for worse, as compared to standard care
In the current study we found that asking about ACEs in the prenatal care setting in the context of a broader trauma-informed care (TIC) initiative as compared to standard care was not associated with differences in maternal pregnancy health and only modestly associated with better infant birth outcomes
Summary
Over the last 20 years, it has become widely accepted that experiences of adversity in childhood, including abuse, neglect, and household dysfunction, set the stage for poor physical and mental health across the lifespan [1,2,3,4]. Exposure to adverse childhood experiences (ACEs) is an international problem, with two thirds of children exposed to some form of adverse experience prior to the age of 18 years worldwide [5] This is concerning as exposure to these experiences disrupt the core cognitive, affective, relational, and behavioral skills that are critical for mental and physical health [6]. Women and girls are disproportionately impacted by exposure to adversity, sexual abuse and exposure to domestic violence [7,8] These experiences have long term implications for their health [9] and mental health [10], as well as having consequences for fetal and infant health and development [11]. Future research examining other potential benefits of TIC approaches are needed including among women of high socio-demographic and medical risk
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