Burden of adverse childhood experiences and birth outcomes among pregnant individuals with SUD and a reference population receiving prenatal care

Abstract Background Adverse childhood experiences (ACEs) are linked to increased risk of substance use disorder (SUD) and adverse birth outcomes. Given their intergenerational effects, pregnancy offers a critical window for screening and intervention. The purpose of this study was to describe ACEs and birth outcomes among pregnant individuals with SUD and a reference population from the same OBGYN center. Additionally, this study aimed to assess variations in ACE exposure by SUD type among pregnant patients receiving trauma-informed, collaborative prenatal care at the Magdalene Clinic. Methods This study used retrospective clinical and survey data to characterize ACEs and birth outcomes among patients with a SUD in Magdalene Clinic and a reference population. The Magdalene Clinic cohort included 360 pregnant individuals with SUD and the reference population consisted of 549 individuals who received standard prenatal care in the broader OBGYN center. Data from 2018 to 2023 (Magdalene Clinic) and 2016 (reference population) included ACEs, SUD type, and select birth outcomes. Crude odds ratios and unadjusted logistic regression analyses examined group differences in ACE exposure and birth outcomes, with significance set at p < 0.05. Results Pregnant individuals with SUD at the Magdalene Clinic had higher prevalence of ACE exposure and negative birth outcomes than the reference population. The mean ACE score was 3.72 versus 1.89 in the reference population, with 47% of Magdalene Clinic patients having a high ACE burden compared to 20% of the reference population. Magdalene Clinic patients had significantly higher odds of each ACE item, particularly family mental health history, household drug exposure, and sexual abuse. They also experienced higher odds of preterm birth (OR = 2.9) and low birth weight (OR = 2.16). ACE exposure did not significantly differ by SUD type. Conclusions This study underscores the high burden of ACEs among pregnant individuals with SUD, particularly experiences of abuse, sexual abuse, and emotional neglect, which previous studies have linked to adverse maternal and infant outcomes. Findings highlight the importance of trauma-informed, integrated care models, such as the Magdalene Clinic, to address impacts of ACEs and SUD during pregnancy.