Assessing Adverse Childhood Experiences during Pregnancy: Evidence toward a Best Practice

Megan W. Nguyen; Emily Heberlein; Sarah Covington-Kolb; Anne M. Gerstner; Amber Gaspard; Kacey Y. Eichelberger

doi:10.1055/s-0039-1683407

American Journal of Perinatology Reports, Table of Contents

CC BY-NC-ND 4.0 · AJP Rep 2019; 09(01): e54-e59
DOI: 10.1055/s-0039-1683407

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Assessing Adverse Childhood Experiences during Pregnancy: Evidence toward a Best Practice

Megan W. Nguyen

¹Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of South Carolina School of Medicine Greenville/Greenville Health System, Greenville, South Carolina

,

Emily Heberlein

²Georgia Health Policy Center, Georgia State University, Atlanta, Georgia

,

Sarah Covington-Kolb

¹Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of South Carolina School of Medicine Greenville/Greenville Health System, Greenville, South Carolina

,

Anne M. Gerstner

³University of South Carolina School of Medicine Greenville/Greenville Health System, Greenville, South Carolina

,

Amber Gaspard

³University of South Carolina School of Medicine Greenville/Greenville Health System, Greenville, South Carolina

,

Kacey Y. Eichelberger

¹Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of South Carolina School of Medicine Greenville/Greenville Health System, Greenville, South Carolina

› Author Affiliations

Abstract

Objective To quantify the prevalence of adverse childhood experiences (ACEs) among a diverse urban cohort of pregnant women.

Study Design The ACE survey was self-administered to 600 women categorized evenly between the waiting room, private examination rooms, and CenteringPregnancy group spaces. The percentage of women willing to complete the survey per location was compared using chi-square tests, and the mean ACE score per arm was compared using Wilcoxon's rank–sum test.

Results Of the 660 women approached for participation, 5% declined; 67% reported ≥ 1 ACE exposure and 19% reported an ACE score of ≥ 4. By domain, 59% experienced household dysfunction, 25% abuse, and 25% neglect. Women in the waiting room were more likely to decline participation (p < 0.01), and those participating in the postpartum inpatient arm had a significantly lower proportion affirming 8 of 10 ACE questions, were less likely to report ≥1 ACE, and had a lower mean ACE score when compared with the outpatient arm (p < 0.01).

Conclusion The prevalence of ACEs in this diverse pregnant cohort was high. The ideal locations to distribute the survey are the outpatient examination rooms.

Keywords

ACE - pregnancy - adverse childhood experiences - CenteringPregnancy

Full Text

References

References
1 Felitti VJ, Anda RF, Nordenberg D. , et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med 1998; 14 (04) 245-258
2 Robert Wood Johnson Foundation. Health Policy Brief: The Relative Contribution of Multiple Determinants to Health Outcomes. August 21, 2014. http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_123.pdf . Accessed June 7, 2017
3 Hoffman MC, Mazzoni SE, Wagner BD, Laudenslager ML, Ross RG. Measures of maternal stress and mood in relation to preterm birth. Obstet Gynecol 2016; 127 (03) 545-552
4 Lilliecreutz C, Larén J, Sydsjö G, Josefsson A. Effect of maternal stress during pregnancy on the risk for preterm birth. BMC Pregnancy Childbirth 2016; 16 (01) 5
5 Brumberg HL, Shah SI. Born early and born poor: an eco-bio-developmental model for poverty and preterm birth. J Neonatal Perinatal Med 2015; 8 (03) 179-187
6 Hillis SD, Anda RF, Dube SR. , et al. The protective effect of family strengths in childhood against adolescent pregnancy and its long-term psychosocial consequences. Perm J 2010; 14 (03) 18-27
7 Hillis SD, Anda RF, Dube SR, Felitti VJ, Marchbanks PA, Marks JS. The association between adverse childhood experiences and adolescent pregnancy, long-term psychosocial consequences, and fetal death. Pediatrics 2004; 113 (02) 320-327
8 Dietz PM, Spitz AM, Anda RF. , et al. Unintended pregnancy among adult women exposed to abuse or household dysfunction during their childhood. JAMA 1999; 282 (14) 1359-1364
9 Christiaens I, Hegadoren K, Olson DM. Adverse childhood experiences are associated with spontaneous preterm birth: a case-control study. BMC Med 2015; 13 (13) 124
10 Chung EK, Nurmohamed L, Mathew L, Elo IT, Coyne JC, Culhane JF. Risky health behaviors among mothers-to-be: the impact of adverse childhood experiences. Acad Pediatr 2010; 10 (04) 245-251
11 Frankenberger DJ, Clements-Nolle K, Yang W. The association between adverse childhood experiences and alcohol use during pregnancy in a representative sample of adult women. Womens Health Issues 2015; 25 (06) 688-695
12 Bublitz MH, Stroud LR. Maternal history of child abuse moderates the association between daily stress and diurnal cortisol in pregnancy: a pilot study. Stress 2013; 16 (06) 706-710
13 Drevin J, Stern J, Annerbäck EM. , et al. Adverse childhood experiences influence development of pain during pregnancy. Acta Obstet Gynecol Scand 2015; 94 (08) 840-846
14 Smith MV, Gotman N, Yonkers KA. early childhood adversity and pregnancy outcomes. Matern Child Health J 2016; 20 (04) 790-798
15 Leeners B, Rath W, Block E, Görres G, Tschudin S. Risk factors for unfavorable pregnancy outcome in women with adverse childhood experiences. J Perinat Med 2014; 42 (02) 171-178
16 Center for Disease Control ACE Study: Data and Statistics. https://www.cdc.gov/violenceprevention/acestudy/index.html . Accessed March 5, 2016