Childhood adversities and negative childbirth experiences: A population-based retrospective cohort study

Adverse childhood experiences (ACEs) have consistently been associated with adult health complications, including adverse mental and physical health during pregnancy. The aim of this study was to assess the relationship between ACEs and women's birthing experiences leveraging data from a large population-representative cohort of Icelandic women.

In this retrospective cohort study, we used data from 22,293 births among 10,759 women (8588 primipara, 13,705 multipara) in the Stress-And-Gene-Analysis (SAGA) with a record in the Icelandic Medical Birth Register. At baseline 2018-19, women responded to the ACE-International Questionnaire (ACE-IQ) and then in 2024 to questions on birth experiences in a follow-up questionnaire. Objective markers on birth complications were obtained from the Medical Birth Register. We used Poisson regression to assess the association between ACEs and a negative birth experience, calculating crude and adjusted prevalence ratios (PR) and 95 % confidence intervals (CI).

The prevalence of a negative birth experience was 22.5 % (n = 1717) and 8.5 % (1021) among primipara and multipara, respectively. Exposure to ACEs was associated with an increased prevalence of a negative birth experience in a dose-dependent manner: exposure to ≥4 ACEs was associated with a 2.1-fold higher prevalence of a negative birth experience (PR = 2.08, 95 %CI 1.81-2.40), with an elevated PR among women experiencing an uncomplicated birth, 3.62 (2.62-4.99), vs uncomplicated birth, 1.66 (1.42-1.95).

Women who experienced four or more ACEs had a two-fold increased prevalence of a negative birth experience compared with women with no ACEs.

Women with ACEs are a vulnerable group that may benefit from screening and trauma informed antenatal care.