UQ Poche Centre for Indigenous Health, University of Queensland, Saint Lucia, Queensland, Australia
University of Queensland, Brisbane, Queensland, Australia.
BMJ Open. 2023 Aug 3;13(8):e063826. doi: 10.1136/bmjopen-2022-063826.
Adverse childhood experiences (ACEs) have a profound negative impact on health. However, the strength of the association between ACEs and pregnancy complications and adverse pregnancy outcomes is not well quantified or understood.
To conduct a systematic review and meta-analysis of the association between ACEs and risk of pregnancy complications and adverse pregnancy outcomes.
A comprehensive search was conducted using PubMed, Embase, CINAHL, PsycINFO, ClinicalTrials.gov and Google scholar up to July 2022.
Two reviewers independently conducted the screening and quality appraisal using a validated tool. Meta-analysis using the quality-effects model on the reported odds ratio (OR) was conducted. Heterogeneity and inconsistency were examined using the I statistics.
32 studies from 1508 met a priori inclusion criteria for systematic review, with 21 included in the meta-analysis. Pooled analyses showed that exposure to ACEs increased the risk of pregnancy complications (OR 1.37, 95% CI 1.20 to 1.57) and adverse pregnancy outcomes (OR 1.31, 95% CI 1.17 to 1.47). In sub-group analysis, maternal ACEs were associated with gestational diabetes mellitus (OR 1.39, 95% CI 1.11 to 1.74), antenatal depression (OR 1.59, 95% CI 1.15 to 2.20), low offspring birth weight (OR 1.27, 95% CI 1.02 to 1.47), and preterm delivery (OR 1.41, 95% CI 1.16 to 1.71).
The results suggest that exposure to ACEs increases the risk of pregnancy complications and adverse pregnancy outcomes. Preventive strategies, screening and trauma-informed care need to be examined to improve maternal and child health.
不良童年经历（ACEs）对健康有深远的负面影响。然而，ACEs 与妊娠并发症和不良妊娠结局之间的关联强度尚未得到很好的量化或理解。
系统评价和荟萃分析 ACEs 与妊娠并发症和不良妊娠结局风险之间的关系。
使用 PubMed、Embase、CINAHL、PsycINFO、ClinicalTrials.gov 和 Google Scholar 进行全面检索，检索时间截至 2022 年 7 月。
两位审查员使用经过验证的工具独立进行筛选和质量评估。使用报告的比值比（OR）的质量效应模型进行荟萃分析。使用 I 统计量检查异质性和不一致性。
32 项研究来自 1508 项符合系统评价预先设定纳入标准的研究，其中 21 项研究纳入荟萃分析。汇总分析表明，暴露于 ACEs 会增加妊娠并发症（OR 1.37，95%CI 1.20 至 1.57）和不良妊娠结局（OR 1.31，95%CI 1.17 至 1.47）的风险。在亚组分析中，母体 ACEs 与妊娠期糖尿病（OR 1.39，95%CI 1.11 至 1.74）、产前抑郁（OR 1.59，95%CI 1.15 至 2.20）、低出生体重儿（OR 1.27，95%CI 1.02 至 1.47）和早产（OR 1.41，95%CI 1.16 至 1.71）有关。
结果表明，暴露于 ACEs 会增加妊娠并发症和不良妊娠结局的风险。需要研究预防策略、筛查和创伤知情护理，以改善母婴健康。
