(455) Adverse Childhood Experiences and Perceived Control Over Birth

Thursday, January 30, 2025

4:00 PM – 6:00 PM

Submitting Author and Presenting Author(s)

Dana R. Canfield, MD

Maternal Fetal Medicine Fellow
UC San Diego Health
San Diego, CA, United States

Coauthor(s)

Cynthia Gyamfi-Bannerman, MD, MS (she/her/hers)

Professor and Chair
University of California, San Diego
San Diego, California, United States
Emmanuel Elijah, BS (he/him/his)

Medical Student
University of California, San Diego
San Diego, California, United States
KG

Karoline Gutierrez, MD

Resident Physician
University of Miami
Miami, Florida, United States
Minhazur R. Sarker, MD (he/him/his)

Fellow
University of California, San Diego
San Diego, California, United States
Rachel L. Wiley, MD, MPH (she/her/hers)

MFM Fellow
University of California, San Diego
San Diego, California, United States
Elizabeth Nicole Teal, MD, MPH (she/her/hers)

Assistant Professor, Division of Maternal-Fetal Medicine
University of California, San Diego
San Diego, California, United States
MJ

Marni B. Jacobs, PhD

University of California, San Diego Health
San Diego, California, United States

Objective: Adverse childhood experiences (ACEs) have been shown to impact adult health but have not been studied in connection with perceived control over labor, termed labor agentry. We aimed to study the impact of ACEs on labor agentry as recorded on the Labor Agentry Scale (LAS), a 29-item Likert-scale response survey in which higher score corresponds with greater agentry.

Study Design: In this prospective cohort study, patients were enrolled from high-risk obstetric clinics at a single institution from 27-34 weeks gestation. Participants were asked to complete mental health surveys on enrollment including ACE-Q, a 10-item measure to assess adverse experiences prior to age 18. At the time of birth participants completed the LAS. Patients were divided into three conventional ACE categories: low-risk (ACE=0), moderate-risk (ACE=1-3), and high-risk (ACE=4+). LAS was analyzed as a continuous variable. Demographic factors independently associated with ACE scores were included in a multivariable linear regression model of labor agentry score, except history of a mental health condition given concern for effect mediation (Tables 1 and 2).

Results: Of 59 patients that completed the ACE-Q and LAS, 17 (28.8%) were low risk, 29 (49.2%) moderate risk, and 13 (22.0%) high risk. Participants in the high-risk ACE category tended to be younger (Table 1, p = 0.005). Mean labor agentry was 159.9, 166.6, and 162.7 for low, moderate, and high-risk ACE, respectively, and did not differ significantly by ACE group (p=0.74). Compared to the low-risk ACE group, moderate and high-risk ACE scores were associated with the higher LAS in our adjusted model, but this was not statistically significant.

Conclusion: We did not find significant differences in agentry by ACE score. While additional studies are needed to confirm these findings, is plausible that patients with trauma history are more accustomed to a lack of agentry and this alters their expectations and perceptions during childbirth, attenuating differences that would otherwise be found between groups.