Adverse childhood experiences and select risk factors for cardiovascular disease: findings from the North and South Dakota PRAMS, 2017–2022

Abstract Purpose Adverse childhood experiences (ACEs) are associated with deleterious health outcomes, including poorer cardiovascular health over the life course. This study assesses the association between cumulative ACE exposure and a composite set of select risk factors for cardiovascular disease measures among a sample of women with a recent live birth. Methods Data were from the 2017–2022 Pregnancy Risk Assessment Monitoring System (PRAMS Phase 8) in North Dakota and South Dakota ( N = 8,355). A composite score was created from select risk factors for cardiovascular disease: smoking, body mass index, diabetes, and hypertension. Weighted multivariable logistic regression models, adjusted for sociodemographic and pregnancy-related covariates, estimated the association between ACEs and cardiovascular disease risk. Results Overall, 48.1% ( n = 4,365) of respondents were classified as having a poor select risk factors for cardiovascular disease, and 22.4% ( n = 2,190) reported ≥ 4 ACEs. In adjusted multiple logistic regression models, women reporting 2–3 ACEs and ≥ 4 ACEs had higher odds of poor select risk factors for cardiovascular disease compared with women reporting zero ACEs (aOR = 1.54; 95% CI = 1.31, 1.80 and aOR = 1.90; 95% CI = 1.62, 2.22, respectively). Supplemental analyses indicated the association was most pronounced for the BMI and smoking components. Conclusions Greater cumulative ACE exposure is associated with select risk factors for cardiovascular disease during pregnancy. Screening for ACEs and integrating trauma-informed BMI and smoking-cessation interventions into preconception and prenatal care may help reduce cardiovascular-related maternal morbidity and mortality in the wake of ACE exposure.