Emily S Miller1, Oriana Fleming, Etoroabasi E Ekpe, William A Grobman, Nia Heard-Garris. 1. Division of Maternal-Fetal Medicine, the Department of Obstetrics and Gynecology, the Department of Psychiatry and Behavioral Sciences, the Institute for Public Health and Medicine, and the Department of Pediatrics, Northwestern University Feinberg School of Medicine, the Division of Advanced General Pediatrics and Primary Care, Ann & Robert H. Lurie Children's Hospital of Chicago, the Mary Ann & J. Milburn Smith Child Health Outreach, Research, and Evaluation Center, the Stanley Manne Children's Research Institute, and the Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
Abstract
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.
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.
Authors: Paul A Harris; Robert Taylor; Robert Thielke; Jonathon Payne; Nathaniel Gonzalez; Jose G Conde Journal: J Biomed Inform Date: 2008-09-30 Impact factor: 6.317
Authors: Mary E Coussons-Read; Marci Lobel; J Chris Carey; Marianne O Kreither; Kimberly D'Anna; Laura Argys; Randall G Ross; Chandra Brandt; Stephanie Cole Journal: Brain Behav Immun Date: 2012-03-07 Impact factor: 7.217
Authors: Lucilla Poston; Natalia Igosheva; Hiten D Mistry; Paul T Seed; Andrew H Shennan; Sarosh Rana; S Ananth Karumanchi; Lucy C Chappell Journal: Am J Clin Nutr Date: 2011-05-25 Impact factor: 7.045
Authors: Kaitlyn K Stanhope; Alison L Cammack; Krista M Perreira; Lindsay Fernández-Rhodes; Christina Cordero; Linda C Gallo; Carmen R Isasi; Sheila F Castañeda; Martha L Daviglus; Michelle A Kominiarek; Shakira F Suglia Journal: Ann Epidemiol Date: 2020-08-11 Impact factor: 3.797
Authors: Melissa T Merrick; Derek C Ford; Katie A Ports; Angie S Guinn; Jieru Chen; Joanne Klevens; Marilyn Metzler; Christopher M Jones; Thomas R Simon; Valerie M Daniel; Phyllis Ottley; James A Mercy Journal: MMWR Morb Mortal Wkly Rep Date: 2019-11-08 Impact factor: 17.586