Association between adverse childhood experiences and unintended pregnancy: A systematic review and meta-analysis

At present, the research results on the relationship between adverse childhood experiences (ACEs) and unplanned pregnancy (UP) are inconsistent, likely due to variations in sample characteristics and measurement methods.

To comprehensively evaluate the strength of the association between different subtypes of ACEs and UP, as well as the cumulative effects of these experiences on UP, a meta-analysis was conducted.

This present meta-analysis included 16 studies with 151,089 participants.

Five English and three Chinese databases were searched on empirical studies that reported the association between ACEs and UP. This study employed Agency for Healthcare Research and Quality (AHRQ) and Newcastle-Ottawa Scale (NOS) tools for quality assessment. Effect sizes were pooled using random/fixed-effects models per heterogeneity results. Sensitivity/subgroup analyses addressed heterogeneity, while dose-response curves evaluated ACEs cumulative effects. Publication bias was examined via funnel plots and Egger's test.

ACEs significantly increased UP odds (OR = 1.57, 95 %CI:1.35-1.83) with a dose-response pattern: each additional ACE raised odds by 31.8 %, reaching 73.9 % (2.5 ACEs) and 144.3 % (4 ACEs). Sexual abuse showed strongest association (OR = 1.45, 95 %CI:1.23-1.70) versus physical and psychological abuse. Geographically, Africa exhibited the highest odds, with Asia, Europe and North America following in descending order. LI countries demonstrated markedly elevated odds(OR = 2.92, 95 % CI: 1.87-4.55) compared to HI nations (OR = 1.36, 95 %CI:1.29-1.44).

ACEs exhibited a significant dose-response relationship with UP odds, with variations across geographic regions and economic groups. These findings highlight the need for early, integrated interventions combining child protection, mental health, and reproductive care to reduce long-term health impacts.