Maternal adverse childhood experiences linked to higher risk of preterm birth

Maternal adverse childhood experiences linked to higher risk of preterm birth | Image Credit: © ondrooo - stock.adobe.com.

Mothers who experienced adverse childhood experiences (ACEs) are at increased risk of giving birth prematurely, according to new research presented at the American Academy of Pediatrics (AAP) 2025 National Conference & Exhibition in Denver, Colorado.^1,2

The study, The Association of Maternal Adverse Childhood Experiences with Preterm Birth of Their Infants, found that mothers with two or more ACEs were nearly twice as likely to deliver preterm as those with fewer or no ACEs.

“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 research author Molly Easterlin, MD, MS, FAAP, neonatologist at Children’s Hospital Los Angeles and assistant professor of clinical pediatrics at the Keck School of Medicine of USC.

Study design

Researchers conducted a secondary retrospective analysis using data from the Panel Study of Income Dynamics, a nationally representative household survey that links maternal and child health outcomes.

The study population included 823 women who gave birth to 1,285 children between 2011 and 2021. Maternal ACEs included experiences of abuse, neglect, or household dysfunction such as parental separation, mental illness, incarceration, domestic violence, or substance use.

Mothers were categorized into 2 groups: those with 0–1 ACEs and those with two or more ACEs. Multivariable logistic regression analyses examined associations between maternal ACEs and preterm birth (<37 weeks’ gestation), adjusting for socioeconomic, behavioral, and clinical factors. Researchers also analyzed the impact of individual ACEs.

Key findings

Results showed significant associations between maternal ACEs and birth outcomes:

• Preterm birth rates: 12.6% of mothers with 2 or more ACEs delivered preterm, compared with 6.7% of mothers with 0–1 ACEs.
• Adjusted analysis: Maternal exposure to ≥2 ACEs was associated with more than twice the odds of preterm birth (OR 2.10; 95% CI, 1.24–3.57).
• Individual ACEs: Physical abuse, emotional abuse, and parental interpersonal violence were each significantly associated with preterm birth.
• Other ACEs: Experiences such as parental separation, parental mental illness, and substance abuse did not demonstrate significant associations when analyzed individually.

Implications

Adverse childhood experiences, as defined by the Centers for Disease Control and Prevention, include potentially traumatic events such as abuse, neglect, or household instability. Importantly, children do not have to be direct victims to be affected; witnessing these events can be equally damaging.

The study underscores the potential intergenerational impact of ACEs. “As intensive care doctors who care for critically ill infants in the neonatal intensive care unit, it is important to understand the changing landscape of where, when, and how pregnant people are delivering their babies and the associated impact on infant health outcomes,” Easterlin said.

Researchers recommend that obstetric practices consider incorporating ACE screening into prenatal care. Identifying women with histories of childhood trauma may help clinicians provide additional social support, anticipate risks, and improve monitoring for preterm birth.

Conclusion

The findings highlight how maternal experiences beginning in childhood may shape health outcomes in the next generation. Addressing ACEs through screening, support services, and trauma-informed care may reduce preterm birth risk and improve maternal and infant health.

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

References:

1. American Academy of Pediatrics. Maternal exposure to adverse childhood experiences are associated with an increased risk of preterm birth. Eurekalert. September 26, 2025. Accessed September 26, 2025. https://www.eurekalert.org/news-releases/1098757
2. Easterlin M. The Association of Maternal Adverse Childhood Experiences with Preterm Birth of their Infants. Abstract. Presented at: American Academy of Pediatrics 2025 National Conference & Exhibition. September 26-30, 2025. Denver, Colorado.