Influence of Maternal Adverse Childhood Experiences on Birth Outcomes in American Indian and non-Hispanic White Women

Abstract

Abstract Purpose: Maternal adverse childhood experiences (ACEs) are an antecedent risk during prenatal and postpartum periods. We examined race-based differences of the mediating influences of antepartum health risks (prenatal depression, high blood pressure, gestational diabetes) on associations between ACEs and maternal and birth outcomes (postpartum depression, preterm birth, low birthweight) among American Indian and non-Hispanic White women. Methods: Public use data from the South Dakota Pregnancy Risk Assessment Monitoring System PRAMS (2017-2019) were used for this secondary analysis of postpartum women. ACEs and depression were measured based on self-report survey results. Antepartum risks and birth outcomes were extracted from birth certificate data. A moderated mediation logit model estimated direct, indirect, and moderating effects by race, controlling for maternal characteristics and perinatal risks to understand ACEs' impact on pregnancy and birth outcomes between groups. Results: The sample included 2,343 postpartum women. American Indian versus non-Hispanic White women had a higher mean ACE score (3.37 vs. 1.64) and substantial disparities. Race-based differences were attributed to social, economic, and health-related factors. Adjusting for proportional differences, members of both groups with ACEs demonstrated significantly increased odds of prenatal and postpartum depression. ACEs influenced postpartum depression and preterm birth through the indirect effect of prenatal depression in both races. Prenatal depression indirectly influenced the relationship between ACEs and low birthweight in non-Hispanic White women. Clinical Implications: ACEs were associated with higher levels of prenatal depression, which may negatively influence maternal and birth outcomes in American Indian and non-Hispanic White women. Improving perinatal outcomes must emphasize psychosocial care along with medical care to address the high burden of maternal ACEs in the United States.