TOPLINE

Biological mothers with four or more adverse childhood experiences (ACEs) had significantly higher odds of pregnancy complications than those with no ACEs; however, no significant association was observed between maternal ACEs and birth outcomes.

METHODOLOGY

• Researchers conducted a retrospective cross-sectional study to assess the association between ACEs and adverse perinatal outcomes.
• They analysed data from 793 biological mothers with a singleton child younger than 2 years who were included in the study between 2023 and 2024. Data were collected using online surveys distributed via child health clinics and a paediatric hospital and through nationwide social media advertisements in Netherlands.
• ACEs were assessed using the Dutch questionnaire covering 10 different types of adverse experiences (score range, 0-10); mothers were classified based on exposure to ACEs as having no exposure (zero ACEs; n = 280), moderate exposure (one to three ACEs; n = 369), or high exposure (at least four ACEs; n = 144). The mean maternal age across the ACE groups ranged from 31.16 to 31.75 years.
• Perinatal outcomes were pregnancy complications (gestational hypertension, gestational diabetes, preeclampsia, and premature rupture of membranes) and birth outcomes (prematurity, gestational age, birthweight, small for gestational age, and NICU admission).

TAKEAWAY

• Mothers with high exposure to ACEs had 70% higher odds of pregnancy complications than mothers with no ACE exposure (adjusted odds ratio [aOR], 1.70; P = .031); no significant association was observed for moderate exposure to ACEs.
• Similarly, high exposure to ACEs was associated with 61% higher odds of the composite perinatal outcome (aOR, 1.61; P = .043).
• No significant associations were observed between maternal ACE exposure and birth outcomes.

IN PRACTICE

"Our findings underline the importance of studying the impact of maternal ACEs within specific healthcare contexts and contribute to the literature by providing insight into these associations in a setting characterized by universal, preventive, and psychosocially oriented care," the authors wrote.

"Although clinical screening and recognition remain a challenge, using trauma-informed care and further strengthening antenatal care pathways, mental health support, and social safety nets may reduce the long-term impact of ACEs, even in the absence of formal screening," they added.

SOURCE

This study was led by Mark F.M. Ketelaars, Leiden University Medical Center, The Hague, Netherlands. It was published online on September 6, 2026, in Birth.

LIMITATIONS 

The study sample consisted predominantly of highly educated mothers (84.2%), which may have introduced response bias. The study had limited power to detect less frequent outcomes, including preterm birth, small-for-gestational-age birth, and NICU admission, increasing the possibility of a type 2 error. The ACE-10 index omitted some important adversities such as poverty and community violence and may have oversimplified childhood adversity.

DISCLOSURES

This study was supported by Haga Teaching Hospital. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.