Associations between adverse childhood experiences and perinatal outcomes

To determine the frequency of adverse childhood experiences (ACE) among a cohort of pregnant women (primary outcome) and explore their association with prematurity, pre-eclampsia, and fetal growth restriction (secondary outcomes).

The Adverse Childhood Experiences International Questionnaire - ACE-IQ was applied to patients during prenatal visits. Information on perinatal outcomes was collected from medical records. The proportion of total ACE and its different domains was estimated. Multiple logistic regressions were performed to assess the association between ACE and outcomes, after adjusting for possible confounding factors.

A cohort of 307 pregnant women completed the ACE-IQ. The results in the binary and frequency versions were, respectively: mean (SD) scores of 5.84 (2.87) and 3.55 (2.73); the proportion of ACE 4 of 75% and 44%; the most prevalent ACE domains were home dysfunction (89.6 and 86.6%) and exposure to community violence (76.5 and 50%). For fetal growth restriction, pregnant women with ACE ≥ 4 had 2.32 times (95% CI: 1.04-5.37; p = 0.042) higher chance of this outcome. For preterm birth, the odds ratio was 1.1 (95% CI: 0.5-2.6; p = 0.886), indicating no statistically significant association. There was no significant association between the total ACE score, or its domains, and the other perinatal outcomes studied.

The frequency of ACE was high in this cohort of pregnant women, and exposure to community violence was associated with fetal growth restriction. The investigation of the association with other perinatal outcomes should be extended to a general population of pregnant women.