Women with Multiple Adverse Childhood Experiences Have an Elevated Risk of Unwanted Pregnancies, Study Finds

April 18, 2021

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WASHINGTON, DC (March 25, 2021)— Although some research has found that women with a history of adverse childhood experiences (ACEs) are at elevated risk of having unintended pregnancies, past studies have not differentiated between the two forms of unintended pregnancies—those that are wanted but mistimed vs those that are unwanted. In a study selected as the Editor’s Choice for the March/April issue of Women’s Health Issues, the authors found that having two or more ACEs was associated with a higher odds of having an unwanted pregnancy, but not a mistimed pregnancy.

Women’s Health Issues is the official journal of the Jacobs Institute of Women’s Health, which is based in the Department of Health Policy and Management at Milken Institute School of Public Health (Milken Institute SPH) at the George Washington University.

Kelly Young-Wolff of Kaiser Permanente Northern California (KPNC) and her colleagues used electronic health records from 745 women who received prenatal care at two KPNC medical centers. During their second or third prenatal visit, women completed questionnaires that asked about pregnancy intention and history of several kinds of ACEs: loss of parent, sexual abuse, physical abuse, emotional abuse, neglect, and family dysfunction. Nineteen percent of women reported one ACE, and 23 percent reported two or more; family dysfunction was the most commonly reported ACE, followed by loss of a parent and emotional abuse. 

The authors found that compared with women without ACEs, those with two or more ACEs had more than two times greater odds of having an unwanted versus wanted pregnancy, even after adjusting for sociodemographic and clinical characteristics. Unwanted pregnancies were more common among women who reported losing a parent or experiencing emotional neglect during childhood, they report.

“A particularly important contribution of the current paper is the finding that ACEs were only associated with risk of having an unwanted pregnancy, but not a mistimed pregnancy,” Young-Wolff and her co-authors write. They note that women who continue unwanted pregnancies may need different forms of support than women continuing mistimed pregnancies—for instance, “women with unwanted pregnancies may benefit from education about the impact of ACEs on health and parenting, and extra resources and support to help break the intergenerational cycle of ACEs.”

“Although recent years have seen more research into both ACEs and unintended pregnancy, information on specific forms of ACEs and unwanted vs mistimed pregnancies has been lacking,” said Amita Vyas, Editor-in-Chief of Women's Health Issues and associate professor of prevention and community health at Milken Institute SPH. “This study fills important research gaps and can help providers offer the kinds of services women need in order to improve their health and care for their families.”

Adverse Childhood Experiences and Pregnancy Intentions among Pregnant Women Seeking Prenatal Care” has been published in the March/April 2021 issue of Women’s Health Issues.