Maternal exposure to adverse childhood experiences are associated with an increased risk of preterm birth

DENVER — Preterm birth, or birth before 37 weeks' gestation, can in some cases be linked to the mother’s exposure to adverse childhood experiences, or ACE’s, according to research presented during the American Academy of Pediatrics 2025 National Conference & Exhibition at the Colorado Convention Center from Sept. 26-30.

The research, “The Association of Maternal Adverse Childhood Experiences with Preterm Birth of their Infants,” studied 823 mothers who gave birth to 1,285 children from 2011 to 2021. A majority, or 62%, of the mothers had zero to one adverse childhood experience, with the other 38% experiencing two or more.

Data showed that among mothers with two or more adverse childhood experiences, 12.6% had a preterm birth, approaching double the rate of mothers who experienced zero to one adverse childhood experience (6.7%).

Adverse childhood experiences are defined by the Centers for Disease Control and Prevention as potentially traumatic incidents that happen during childhood such as abuse, neglect, and household instability. Children don’t necessarily need to be the direct victim of these incidents in order for them to be traumatic, as witnessing them can be just as damaging.

Molly Easterlin, MD, MS, FAAP, research author and neonatologist at Children’s Hospital Los Angeles and assistant professor of clinical pediatrics, Keck School of Medicine of USC, said the research exemplifies the impact that adverse childhood experiences can have well beyond a person’s youth.

“These findings provide further evidence that the effects of adverse childhood experiences may be passed from generation to generation and support action through public health and policy initiatives and clinical care to prevent and mitigate childhood trauma,” said Easterlin.

In addition, mothers who experienced specific traumas – physical abuse, emotional abuse, and exposure to parental interpersonal violence - had a higher chance of giving birth prematurely.

Researchers state that obstetrics offices should consider including screenings for adverse childhood experiences to help better inform patients and clinicians on how to best serve and prepare patients for birth. This could also help target families that may be in need of additional social support or require closer follow-up.

The authors received financial support for this research from the Keck School of Medicine of USC Dean’s Pilot Funding Program.

Dr. Molly Easterlin is scheduled to present her research, which is below, from 2:50 p.m. to 3 p.m. on Saturday, Sept. 27 in the Colorado Convention Center, Mile High Ballroom 2A-3A. To request an interview with the authors, contact Kelly Carolipio at kcarolipio@chla.usc.edu.

In addition, Dr. Easterlin will be among highlighted abstract authors who will give a brief presentation and be available for interviews during a press conference from noon-1:30 p.m. Saturday, Sept. 27, in the National Conference Press Room, CCC 705/707. During the meeting, you may reach AAP media relations staff at 303-228-8338. 

Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal. 

# # #

The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org. Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at http://www.aapexperience.org/

Program Name: 2025 Call for Abstracts

Submission Type: Section on Neonatal-Perinatal Medicine

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

Molly Easterlin

Santa Monica, CA, United States

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.

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.

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).

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.

Table 1. Descriptive Statistics for Maternal Sample with 0-1 ACEs vs ≥2 ACEs

ACEs=Adverse Childhood Experiences. Diabetes and very preterm category not shown due to low sample size.

Table 2. Regression Results for Preterm Birth and 0-1 vs ≥2 ACEs and Preterm Birth and Each Individual Adverse Childhood Experience

*All regressions adjusted 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.