When Life Deals ACEs: The Association Between Adverse Childhood Experiences and Reproductive, Prenatal, and Perinatal Health Outcomes among Women

Nearly 65% of adults report experiencing at least one adverse childhood experience (ACEs). Women are more likely to report experiencing 4 or more ACEs. While the association between ACEs and adverse physical and mental health outcomes in adulthood is well supported, few studies have examined the impact of ACEs on reproductive, prenatal, and perinatal health. Women with a history of ACEs have increased odds of unintended pregnancy, pregnancy complications, and delivering infants who are low birth weight and preterm birth. The purpose of this dissertation was to assess the associations between ACEs and contraceptive use, early initiation of prenatal care (PNC), and delivering a small for gestational age (SGA) infant.
Three separate population-based studies were conducted to investigate these associations using Add Health Public-Use Data, which is a subset of publicly available data from the full National Longitudinal Study of Adolescent Health dataset. The first study assessed the association between ACEs and contraceptive use. The second study evaluated the association between ACEs and early initiation of PNC. The third study examined the ACEs-SGA association as well as examined race/ethnicity as an effect modifier of this association. Logistic regression and multivariate logistic regression were used to calculate the unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (CIs), respectively. Stratified analysis by race/ethnicity was conducted on the ACEs-SGA association. Given the complex sampling design of Add Health Public-Use Data, all analyses were performed using SAS survey procedures (version 9.4, SAS Institute Inc. Cary, NC).
Across all studies, ACEs were associated with adverse health outcomes. In the first study, women with a family history of suicidal behavior had statistically significant decreased odds of contraceptive use (AOR=0.69, 95% CI: 0.51-0.96). Findings from the second study demonstrated that women who experienced parental alcoholism had 82% statistically significant decreased odds of early initiation of PNC (AOR=0.18, 95% CI: 0.06-0.55). In the third study on ACEs and birth outcomes, women who experienced parental alcoholism had statistically significant increased odds of delivering an SGA infant (AOR=4.11, 95% CI: 1.09-15.52). When stratified by race/ethnicity, among Non-Hispanic White women, those who experienced parental alcoholism had 7-fold statistically significant increased odds of delivering an SGA infant (AOR=7.39, 95% CI: 1.44-37.88). Among Non-Hispanic Black/Hispanic/Other women, those who experienced parental alcoholism had 1.6-fold increased odds of delivering an SGA infant (AOR=1.55, 95% CI: 0.22-10.84).
This dissertation addresses existing gaps in the literature on the impact of ACEs on women’s reproductive, prenatal, and perinatal health. Study results highlight the importance of integrating mental health and reproductive health care services. By implementing trauma-informed care practices such as ACEs screening during reproductive health and PNC visits, healthcare providers may provide additional support for this high-risk population of women. In addition, healthcare providers should underscore the importance of PNC during preconception reproductive health counseling as these visits may serve as an opportunity to engage these women before a pregnancy. By doing so, early PNC may reduce and prevent SGA births.