Elsevier

Academic Pediatrics

Volume 10, Issue 4, July–August 2010, Pages 245-251
Academic Pediatrics

Child and Adolescent Mental Health
Risky Health Behaviors Among Mothers-to-Be: The Impact of Adverse Childhood Experiences

Presented at the Pediatric Academic Societies' Annual Meeting, Toronto, Canada, May 5–8, 2007.
https://doi.org/10.1016/j.acap.2010.04.003Get rights and content

Objectives

Adverse childhood experiences (ACEs) are risk factors for health problems later in life. This study aims to assess the influence of ACEs on risky health behaviors among mothers-to-be and determine whether a dose response occurs between ACEs and risky behaviors.

Methods

A prospective survey of women attending health centers was conducted at the first prenatal care visit, and at 3 and 11 months postpartum. Surveys obtained information on maternal sociodemographic and health characteristics, and 7 ACEs prior to age 16. Risky behaviors included smoking, alcohol use, marijuana use, and other illicit drug use during pregnancy.

Results

Our sample (N = 1476) consisted of low-income (mean annual personal income, $8272), young (mean age, 24 years), African American (71%), single (75%) women. Twenty-three percent of women reported smoking even after finding out they were pregnant, 7% reported alcohol use, and 7% reported illicit drug use during pregnancy. Nearly three fourths (72%) had one or more ACEs. There was a higher prevalence of each risky behavior among those exposed to each ACE than among those unexposed. The exception was alcohol use during pregnancy, where there was not an increased risk among those exposed when compared with those unexposed to witnessing a shooting or having a guardian in trouble with the law or in jail. The adjusted odds ratio for each risky behavior was >2.5 for those with >3 ACEs when compared with those without.

Conclusions

ACEs were associated with risky health behaviors reported by mothers-to-be. Greater efforts should target the prevention of ACEs to lower the risk for adverse health behaviors that have serious consequences for adults and their children.

Section snippets

Methods

The study is part of a larger prospective cohort study on maternal stress, birth outcomes, and infant health. The original cohort consisted of women who received prenatal care at health centers in Philadelphia, Pennsylvania, and who were recruited consecutively from February 2000 to November 2002. These health centers consisted of Federally Qualified Health Center Look Alikes and Federally Qualified Health Centers and have been described previously.35 The ability to speak English or Spanish and

Results

The sociodemographic characteristics and the overall prevalence of risky health behaviors are shown in Table 1. The sample largely consisted of young, African American, low-income, single women of low education. Twenty-three percent of women reported smoking even after finding out they were pregnant, 7% reported alcohol use, and 7% reported illicit drug use during pregnancy. Of those reporting any illicit drug use, 5% reported any marijuana use, 2% other illicit drugs, and 1% reported marijuana

Discussion

This study investigated the relationship between childhood experiences and subsequent risky health behaviors among low-income, urban, mothers-to-be. Individual and total ACEs were associated with smoking, alcohol use, and any illicit drug use during pregnancy.

In this sample of urban, low-income women, the prevalence of ACEs was high. Reports of physical abuse (52%) were high despite a strict definition that excluded spanking. This rate is higher than previous estimates of physical abuse.37, 38

Acknowledgments

This research was funded in part by grants from the Centers for Disease Control and Prevention (TS-286-14/14, Jennifer F. Culhane, co–principal investigator) and the National Institute of Child Health and Human Development (1-R01-HD36462-01A1, Jennifer F. Culhane and Irma T. Elo, co–principal investigators). We would especially like to thank all of the women who participated in this study and all of the interviewers who collected data.

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