Maternal Childhood Trauma May Increase Risk of Preterm Birth

Preterm birth is a leading cause of neonatal health problems and a major reason why babies need intensive care. Now, new research from Children’s Hospital Los Angeles and the USC Schaeffer Institute for Public Policy & Government Service has found that a mother’s early-life experiences may influence this risk.

The study was led by Molly Easterlin, MD, MS, a neonatologist in CHLA’s Fetal and Neonatal Institute, which diagnoses and treats the most critically ill infants and newborns, including those born prematurely. The team found that mothers who reported two or more adverse childhood experiences (ACEs) had more than twice the odds of delivering preterm. Dr. Easterlin presented the findings Sept. 27 at the American Academy of Pediatrics conference in Denver.

“This research provides more evidence that the effects of adverse childhood experiences may be passed from generation to generation,” she says. “It also highlights the importance of better identifying and supporting at-risk mothers to improve birth outcomes.”

Severe ACEs may have the most impact

Adverse childhood experiences—including abuse, neglect, and household dysfunction such as domestic violence and parental substance abuse—are common in the U.S. population and are linked to long-term impacts on physical and mental health, socioeconomic status, and social well-being.

But much less is known about how maternal ACEs affect birth outcomes. To explore this, the team—which included Fetal and Neonatal Institute Co-Director Philippe Friedlich, MD, MSEpi, MBA, and was supported by the Keck School of Medicine of USC Dean’s Pilot Funding Program—analyzed data from the nationally representative Panel Study of Income Dynamics.

The study included 823 mothers who gave birth to 1,285 children between 2011 and 2021. Researchers controlled for other factors that can influence preterm delivery, including socioeconomic status, maternal health, prior preterm birth, and health behaviors.

Among the individual ACEs, physical abuse, emotional abuse, and witnessing parental intimate partner violence were most strongly linked to preterm birth.

“This suggests that more severe forms of childhood trauma may have the biggest intergenerational impact,” Dr. Easterlin says. “Public policies should focus most on addressing and preventing these ACEs, and on providing support to those who experience them.”

Toward screening and support

CHLA has long offered prenatal psychological support by specially trained psychologists for mothers and families as part of its Fetal-Maternal Center, along with comprehensive infant-family mental health services in its Level IV Newborn and Infant Critical Care Unit (NICCU).

But these findings may help inform a future prenatal ACEs screening tool that could be used in antenatal care. Such a tool could be used to direct at-risk expectant moms into supportive programs or trigger closer follow-up during pregnancy.

“Any screening would have to be done in a trauma-informed way,” she notes. “And we need to understand how best to intervene. Do these moms need more medical care? More social support? More economic support? That’s what we have to figure out.”

The team also hopes to investigate how positive childhood experiences may buffer these risks.

“We want to study the factors that provide resilience, too,” Dr. Easterlin says. “Our hope is that understanding these links can lead to fewer preterm births and better health outcomes for moms and babies.”

(Newswise/VK)