Association Between Adverse Childhood Experiences and Prenatal Pandemic-Related Traumatic Stress

Background: Adverse childhood experiences (ACEs) are prevalent and have long-term effects on regulation, stress, and health. Given the heightened physiological and psychological vulnerability of pregnancy, early life adversity may increase susceptibility to traumatic stress during crisis, such as the COVID-19 pandemic. Objective: To evaluate associations between maternal ACE exposure and prenatal pandemic-related traumatic stress (PTS) measured by symptom count and domains. Methods: This secondary analysis included baseline data collected from a longitudinal cohort of 424 pregnant individuals receiving prenatal care in Kaiser Permanente Northern California between August 2020 and April 2021. ACEs were measured with the Adverse Childhood Experiences Questionnaire and dichotomized ≥3 versus <3 exposures, and by type (abuse, neglect, household dysfunction, violence in home). PTS was evaluated using the 9-item PTS Scale, capturing intrusion, avoidance, arousal, and dissociation. Linear and log-binomial regression models estimated associations between ACEs and PTS, adjusting for covariates. Results: Participants with ≥3 ACEs reported more traumatic stress symptoms (mean difference [MD]: 1.1; 95% confidence interval [CI]: 0.6,1.7) and significantly higher PTS scores (MD: 3.5; 95% CI: 2.0,5.0). After adjustment, higher ACE exposure was associated with elevated intrusion (risk ratio [RR]: 2.03; 95% CI: 1.34-3.07) and dissociation (RR: 1.54; 95% CI: 1.26-1.88) symptoms. Abuse, neglect, and household dysfunction were independently associated with higher total prenatal PTS scores; abuse and neglect were associated with increased dissociative symptoms, and household dysfunction was associated with higher intrusion and arousal symptoms. Conclusions: Higher ACE exposure was associated with increased prenatal PTS, with distinct risk patterns across ACE domains. Findings underscore the importance of trauma-informed, ACE-aware prenatal care models, especially during public health emergencies.