Asking About Childhood Adversity in the Prenatal Care Setting: Cross-Sectional Associations with Maternal Health and Mental Health Outcomes

Objectives Adverse childhood experiences (ACEs) are associated with poor physical and mental health outcomes in pregnancy, prompting many care agencies to ask about ACEs as part of routine care. However, limited research has been conducted in the clinical setting to demonstrate associations between ACEs and maternal health (i.e., pregnancy complications and birth outcomes) and mental health in pregnancy (i.e., depression, anxiety, and substance use). The aims of the current study were to: (1) examine the prevalence of ACEs reported by patients attending a maternity clinic for medically low-risk patients, and (2) evaluate whether these reports were associated with prenatal health and mental health. Methods Participants included pregnant women (n = 338) receiving prenatal care at a low-risk outpatient medical clinical from June 2017 to December 2018. Total ACE scores, pregnancy complications (e.g., gestational hypertension, preeclampsia), birth outcomes (e.g., Apgar scores, preterm birth), and mental health outcomes (i.e., anxiety, depression, and substance use) were extracted from electronic medical records. Results The majority of women (67.8%) reported experiencing no ACEs, 16.0% reported one ACE, 10.1% reported two ACEs, and 6.2% reported three or more ACEs. ACEs were associated with increased odds of prenatal depression, anxiety, and substance use in a dose-response fashion, but not pregnancy health or birth outcomes. Conclusions for Practice Prevalence rates of maternal ACEs obtained in the prenatal care setting were low compared to the general population. While ACEs were positively associated with maternal mental health and substance use in pregnancy, they were not associated with pregnancy complications.