(371) Association between preterm birth and adverse childhood experiences in a diverse population

To determine whether a relationship exists between adverse childhood experiences, maternal race, earlier gestational age at delivery and maternal cortisol and choline levels among a diverse population.

Study Design: This a prospective, observational cohort study of pregnant women enrolled before 16 weeks gestation. Demographics, including race and previous pregnancy outcomes were obtained. The Adverse Childhood Experiences (ACE) scale was used to quantify lifetime stressors. Hair cortisol concentration (HCC) and plasma choline levels were obtained from participants at 16 weeks gestation. Continuous and categorical statistical analyses were used.    

Results: Of 151 participants enrolled, 23 identified as Black and 128 as White.  Black women had higher ACE scores compared with white women (3.59 + 2.12 vs 2.31 + 2.39, p = 0.034, b = 0.457).  Gestational age at birth was earlier for Black infants than White infants (266.4 + 21.1 days v s 274.0 + 16.7 days, p =  0.043).  In White women, ACE score > 5 and plasma choline concentrations below the mean were associated with earlier gestational age at birth.  ACE and maternal HCC were correlated for all women (p = 0.048, b = 0.216) although depression/anxiety, obesity, and Black race did not independently affect HCC.  Maternal plasma choline concentration was lower for Black women compared with White women (p = 0.008) and HCC was negatively associated with plasma choline concentration (p = 0.016, b = -0.571) in Black, but not White participants (p = 0.050, b = -0.416).

Conclusion: Higher ACE scores were correlated with higher HCC and lower serum choline concentration for both Black and White women.  These factors were also associated with earlier gestational age at birth.  Black women reported higher ACE scores than White women and have a known higher risk of preterm birth.  Addressing childhood trauma and stress, and supplementing pregnancies with choline, may contribute to a reduction in known racial disparities in preterm birth.