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The Association Between ACE Score and Having Pre-Pregnancy Health Conversations with a Healthcare Provider

Kyana C Martins1, Annie Gjelsvik2, Karine Monteiro3

  • 1School of Public Health, Brown University, Providence, Rhode Island, USA. Kyana_martins@alumni.brown.edu.

Maternal and Child Health Journal
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Summary

Adverse Childhood Experiences (ACEs) are linked to higher rates of pre-pregnancy health discussions. Women with high ACE scores were more likely to report these vital conversations with healthcare providers.

Keywords:
Adverse childhood experiencesPRAMSPreconception carePrevention

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Area of Science:

  • Public Health
  • Reproductive Health
  • Psychology

Background:

  • Adverse Childhood Experiences (ACEs) are associated with increased health risks and negative pregnancy outcomes.
  • Preconception care is crucial for mitigating these risks.
  • Understanding factors influencing pre-pregnancy health discussions is vital for improving maternal health.

Purpose of the Study:

  • To examine the association between the number of Adverse Childhood Experiences (ACEs) and the likelihood of women reporting pre-pregnancy health conversations with a healthcare provider.
  • To identify if a higher ACE score correlates with increased engagement in pre-pregnancy health discussions.

Main Methods:

  • Secondary analysis of Pregnancy Risk Assessment Monitoring System (PRAMS) data from 2016-2020 across three states and Washington, DC.
  • ACEs score categorized into low (0), intermediate (1-3), and high (≥4) risk groups.
  • Pre-pregnancy health conversations assessed via self-report of discussions about desire for children, birth control, or health improvement in the year prior to pregnancy.
  • Multivariate Poisson Regression adjusted for confounders including age, race/ethnicity, income, education, insurance, marital status, pregnancy intention, and parity.

Main Results:

  • Over half of the 10,448 participants reported at least one ACE (51%).
  • Women with a high ACE score (≥4) had a 1.19 times higher adjusted Prevalence Ratio (aPR) of reporting pre-pregnancy health conversations compared to those with no ACEs.
  • Women with an intermediate ACE score (1-3) showed a similar aPR (1.00) to those with no ACEs.

Conclusions:

  • The findings suggest a potential link between higher Adverse Childhood Experiences and increased likelihood of engaging in pre-pregnancy health conversations.
  • A low overall percentage of women reported receiving these crucial conversations, highlighting a need for more routine implementation in healthcare settings.
  • Integrating ACEs screening could help identify women who may benefit from proactive preconception health discussions.