The impact of household-level ACEs on future pregnancy loss: evidence from the 2022–2023 National Survey of Family Growth (NSFG)

Abstract Background Adverse childhood experiences (ACEs) have far-reaching health implications throughout an individual’s lifespan. However, their impact on pregnancy loss (PL) remains elusive. Very few studies have examined this association for a specific class of ACEs. This paper examines the effects of exposure to household-level (HL-ACEs) on PL. Methods Data from the 2022–2023 National Survey of Family Growth (NSFG) were used to estimate the impact of exposure to HL-ACEs on PL, using logistic regression models. Exposure to at least one of the following six experiences before age 18 represented a HL-ACEs: living in a non-intact family; living on your own; witnessing adults beat each other up; living with a parent/guardian who had alcohol or drug problems; living with a parent/guardian who was mentally ill, depressed or suicidal; and living separated from parent/guardian due to jail time. Inverse probability of treatment weighting (IPTW) was used to balance exposure status across pre-exposure covariates. Results The final sample included 2,797 WRA who reported 6,274 non-aborted pregnancies (NAPs), of which 26.86% ( n = 807; k = 2,375 PLs) ended in at least one PL. HL-ACEs exposure was reported by 26.09% ( n = 745) of WRA. Adjusting for 14 covariates, exposure to HL-ACEs was associated with 33% (OR 1.33; 95% CI 1.03 – 1.70) increased odds of experiencing at least one PL. When assessed individually, living with a parent/guardian who had alcohol or drug problems or having been separated from parent/guardian due to jailed time were associated with a significant increase in the odds of experiencing at least one PL (OR 1.90; 95% CI 1.08– 3.34 and 6.99; 95% CI 1.64–29.76, respectively) compared to living with a parent/guardian with no alcohol or drug problems or a not having been separated from parent/guardian due to jail. However, estimates for jail are imprecise due to small sample size. Conclusions Exposure to HL-ACEs was associated with increased odds of experiencing PL. Specifically, growing up with a parent/guardian who struggled with alcohol or drug problems, or a parent/guardian who served jail time are ostensibly the two forms of HL-ACEs that need further attention from researchers and policymakers. Future research should also investigate pathways causing these adverse outcomes.