O2109: The Association of Maternal Adverse Childhood Experiences with Preterm Birth of their Infants

Background: Adverse childhood experiences (ACEs) include abuse, neglect, and exposure to household dysfunction, including parental absence, mental illness, incarceration, domestic violence, and substance abuse. ACEs are common and are associated with poor long-term health and economic outcomes. However, the relationship between maternal experience of ACEs and birth outcomes among their subsequent offspring is not well understood. Therefore, we seek to: 1) Establish the relationship between maternal experience of ACEs and preterm birth in a large nationally representative dataset and 2) Examine which maternal ACEs are associated with preterm birth, in order to inform a potential clinical screening tool.

Methods: We performed secondary retrospective analysis using the Panel Study of Income Dynamics (PSID), a large nationally representative household panel survey that links mother’s and children’s outcomes. First, multivariable logistic regressions examined associations between 0-1 vs. ≥2 maternal ACEs and preterm birth ( < 37 weeks gestation) while controlling for race/ethnicity, maternal childhood SES (mothers’ mother’s education), maternal SES (education, health insurance, employment), social support during pregnancy (marriage), adverse health behaviors (late prenatal care, smoking during pregnancy, drinking during pregnancy), and maternal health conditions (advanced maternal age ≥35 years, obesity, hypertension, diabetes) and prior preterm birth. We then examined associations between each individual maternal ACE (physical abuse, emotional neglect, emotional abuse, sexual abuse, parental interpersonal violence, parental substance abuse, parental mental illness, separated/divorced parents, or absent/deceased parent) and preterm birth.

Results: Our sample contained 823 women who gave birth to 1,285 children (mean 1.6 children) between 2011-2021. 62% of mothers experienced 0-1 ACE and 38% of mothers experienced ≥2 ACEs. The prevalence of preterm birth was 6.7% among women with 0-1 ACEs vs. 12.6% among women who experienced ≥2 ACEs (Table 1). After adjustment, maternal exposure to ≥2 ACEs was significantly associated with an increased odds of preterm birth among offspring (OR 2.10 [95% CI 1.24-3.57]) (Table 2). In terms of the individual maternal ACEs, physical abuse, emotional abuse, or parental interpersonal violence was significantly associated with preterm birth among offspring (Table 2).

Conclusion: Maternal ACEs are significantly associated with preterm birth among offspring. The individual maternal ACEs associated with preterm birth appear to be the more severe ACEs including experience of physical or emotional abuse, or parental interpersonal violence. These ACEs could be included on a screening tool used in obstetric clinics to identify women who might benefit from increased social support and closer follow up. Results support the intergenerational transmission of adversity through birth outcomes of the next generation and highlight the importance of a lifecourse approach, as the maternal experience, starting in childhood, can affect the next generation.