From the Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
From the Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
Am J Prev Med. 2023 Apr;64(4):512-524. doi: 10.1016/j.amepre.2022.10.017. Epub 2023 Jan 23.
Adverse childhood experiences are associated with a host of negative outcomes; however, few have studied cumulative adverse childhood experiences in the context of pregnancy and infant health. This study examines state-level prevalence of adverse childhood experiences and associations with pregnancy- and infant health‒related indicators.
The study used 2016-2018 Pregnancy Risk Assessment Monitoring System population-based data from 5 states. Analyses were conducted for individual states and grouped states using similar adverse childhood experience items. Thirteen adverse childhood experience measures were included across 3 domains: abuse, neglect, and household challenges. Adverse childhood experience scores were calculated for the number of adverse childhood experiences experienced (0, 1, 2, ≥3) on the basis of available state measures. Fourteen pregnancy- and infant health‒related indicators were examined, including unwanted pregnancy, adequate prenatal care, experiences during pregnancy (e.g., smoking, abuse, depression), gestational diabetes, hypertensive disorders of pregnancy, birth outcomes (e.g., preterm birth), and breastfeeding. Adjusting for demographics, parity, health insurance status, and educational attainment, prevalence ratios and 95% CIs were calculated to examine the associations between pregnancy- and infant health‒related indicators and adverse childhood experience scores.
Over 50% of respondents reported at least 1 adverse childhood experience and 13%-31% reported ≥3 adverse childhood experiences, depending on the state. Significant associations were identified in all adjusted models between adverse childhood experiences and unwanted pregnancy, smoking, physical abuse, and depression during pregnancy.
Adverse childhood experiences are associated with risk factors that impact pregnancy and infant health. Preventing and mitigating adverse childhood experiences is an important strategy to improve pregnancy- and infant health‒related indicators.
不良的童年经历与许多负面后果有关；然而，很少有人研究过在怀孕和婴儿健康背景下的累积不良童年经历。本研究调查了州级不良童年经历的流行率及其与妊娠和婴儿健康相关指标的关联。
本研究使用了来自 5 个州的 2016-2018 年妊娠风险评估监测系统人群为基础的数据。对个别州和使用类似不良童年经历项目的分组州进行了分析。纳入了 3 个领域的 13 个不良童年经历指标：虐待、忽视和家庭挑战。根据可用的州级措施，计算了经历的不良童年经历数量（0、1、2、≥3）的不良童年经历得分。检查了 14 个与妊娠和婴儿健康相关的指标，包括意外怀孕、充分的产前护理、妊娠期间的经历（例如吸烟、滥用、抑郁）、妊娠期糖尿病、妊娠高血压疾病、分娩结局（例如早产）和母乳喂养。调整人口统计学、产次、医疗保险状况和教育程度后，计算了妊娠和婴儿健康相关指标与不良童年经历得分之间的患病率比和 95%置信区间，以检验两者之间的关联。
超过 50%的受访者报告至少有 1 次不良童年经历，13%-31%的受访者报告有≥3 次不良童年经历，具体取决于州。在所有调整后的模型中，不良童年经历与意外怀孕、吸烟、身体虐待和怀孕期间抑郁之间都存在显著关联。
不良的童年经历与影响妊娠和婴儿健康的风险因素有关。预防和减轻不良的童年经历是改善妊娠和婴儿健康相关指标的重要策略。
