Adverse childhood experiences and adverse community environments among maternal mortality cases in Arizona

Adverse childhood experiences (ACE) and adverse community environments (ACoE) can have negative impacts on adult health and lead to premature death. Their association within the maternal mortality (MM) population remains unknown.

This study aimed to assess the association between ACEs and ACoEs with pregnancy outcomes and MM variables within the Arizona MM population.

A secondary review of 146 maternal deaths in Arizona (2018-2019), originally reviewed by the Arizona Maternal Mortality Review Committee, was conducted to identify ACE and ACoE exposure, adverse pregnancy outcomes, and maternal medical and social comorbidities. Descriptive statistics examined the distribution of demographic characteristics. Bivariate analyses were completed to assess the relationship of ACEs and ACoEs with maternal co-morbidities and MM variables, and logistic regression models examined the exposure of ACE and ACoE with maternal co-morbidities and MM variables.

Exposure to ≥1 ACE or ACoE was associated with increased likelihood of prior incarceration, history of homelessness, mental health diagnosis (MHD), substance use disorder (SUD), intimate partner violence and involvement with child protective services (p < 0.001) in the MM population. When controlled for age, race/ethnicity, and insurance type, exposure to ≥1 ACE, increased odds of mental health-related death (21.6 OR; 95% CI 5.01, 93.17), substance use-related death (5.16 OR; 95% CI 1.96, 12.6), accidental death (2.78 OR; 95% CI 1.15, 6.73) and death by suicide (22.43 OR, 95% CI 1.99, 252.74). Additionally, when examining exposure to ACE and ACoE by race/ethnicity, over half of the study population (56%) had evidence of community adversity with an ACoE score ≥1. Black, non-Hispanic decedents had the highest exposure to ACEs (50%) among the study population.

Exposure to ≥1 ACE has significant associations with MHD, SUD, accidental death, and suicide within the Arizona MM population. MHD and SUD are growing co-morbidities within the pregnancy population and specifically large contributors to MM. ACE and ACoE exposure highlights risk factors and associations within this population.