The importance of adverse childhood experiences during the perinatal period

Osofsky, J. D., Osofsky, H. J., Frazer, A. L., Fields-Olivieri, M. A., Many, M., Selby, M., Holman, S., & Conrad, E. (2021). The importance of adverse childhood experiences during the perinatal period. American Psychologist, 76(2), 350–363.


The Adverse Childhood Experiences (ACEs) study (Felitti et al., 1998) has led to an understanding of how exposure to abuse, neglect, and family dysfunction in childhood are related to subsequent physical and mental health problems. These issues are important to consider during the perinatal period, with studies indicating that pregnant women who report adverse experiences in childhood may be at risk of experiencing mental health and substance use problems.

This study examined the association of pregnant women’s ACEs with symptoms of depression, anxiety, posttraumatic stress, and substance use, and examined the potential buffering effect of women’s resilience against the deleterious effects of ACES on mental health and substance use.

Women reported on ACES, mental health symptoms, substance use, and resilience when they were screened for participation in a perinatal psychosocial support intervention, which was integrated into obstetrical clinics in a Southern academic medical center. Almost a quarter of the 303 women in this sample reported four or more ACEs, indicating significant risk. Those reporting more overall ACEs also reported more symptoms of depression, posttraumatic stress, and increased risk of tobacco use. Unique effects of specific ACEs subtypes were also found. Women exposed to child maltreatment reported more anxiety, depression, and posttraumatic stress symptoms, and were at risk for tobacco, cannabis, or opioid use during pregnancy. Women exposed to household dysfunction reported more posttraumatic stress symptoms and were at increased risk of tobacco and alcohol use during pregnancy. Women’s resilience attenuated effects of household dysfunction on posttraumatic stress symptoms.

Impact Statement

Public Significance Statement—This study demonstrates the importance of including adverse childhood experiences in evaluating and treating mental health symptoms and substance use during pregnancy.

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