The impact of maternal ACEs on obstetric outcomes and psychosocial wellbeing during pregnancy

Abstract

Adverse childhood experiences (ACE) are traumatic events, such as physical or emotional abuse/neglect, sexual abuse, and household dysfunction, that confer an increased lifetime risk of chronic disease. We examined the relationship between maternal ACEs and adverse obstetric and psychosocial outcomes. This is a secondary analysis of a larger clinical trial (CRADLE study) that compared group vs individual prenatal care on pregnancy outcomes. The Behavioral Risk Factor Surveillance System ACE questionnaire and psychosocial measures (Center for Epidemiological Studies-Depression Screen, Prenatal Anxiety Screen, and Prenatal Distress Questionnaire) were administered to all participants. Pregnancy outcomes were obtained via chart abstraction; the primary outcome was a composite of preterm birth (PTB, < 37 weeks), low birth weight (LBW, < 2,500g), and intrauterine fetal demise (IUFD). Secondary outcomes included 1) composite of maternal morbidity (BMI >35, hypertensive disorders of pregnancy, gestational diabetes), 2) NICU admission, and 3) psychosocial measures or new diagnosis of anxiety/depression. Multivariable logistic regression models were performed. 2221 patients were included; 40.1% Black, 36.5% White, 21.4% Hispanic, and 1.3% Other. 96.4% were Medicaid eligible and 65.9% reported an unintended pregnancy. There was no relationship between ACE scores and PTB, LBW, IUFD, or the composite (p >0.10). Higher ACE scores were associated with increased risk of composite maternal morbidity (p< 0.01) and NICU admission (p< 0.01). Higher ACE scores were also associated with positive CES-D, prenatal anxiety, prenatal distress, and a new depression and/or anxiety diagnosis during the study (p< 0.01). We did not identify an increased risk of PTB or LBW with ACE >5. Higher ACE scores were associated with maternal morbidity, NICU admission, and psychosocial stress during pregnancy. Future projects should seek avenues by which screening, supportive treatment or counseling could improve outcomes for women identified at risk, specifically those with ACE >5 at entry to prenatal care.View Large Image Figure ViewerDownload Hi-res image Download (PPT)