(156) The Philadelphia Urban ACE is associated with spontaneous preterm birth among Black pregnant individuals.

Objective: Adverse childhood experiences (ACE), including physical, sexual, and verbal abuse and household dysfunction associate with poor health across an individual’s life course. Evidence of associations with these exposure and adverse pregnancy outcomes has been based on the traditional Kaiser ACE survey (KACE), which quantifies childhood adversity within the home. The Philadelphia Urban ACE survey (PHLACE) expands on KACE by incorporating community-level stressors derived from a more socioeconomically and racially diverse urban population. We sought to assess associations between these surveys and spontaneous preterm birth (sPTB) among Black individuals.

Study Design: From a prospective cohort of Black pregnant persons (N=638), those who completed both KACE and PHLACE and had an adjudicated birth outcome were included for this analysis (N=336). A high score was defined as ≥4 for both surveys. We used multivariable logistic regression to estimate odds ratios for sPTB among participants with high vs. low KACE and high vs. low PHLACE, controlling for maternal education and insurance.

Results: Overall, 5.2% of participants experienced sPTB, 68.4% reported high PHLACE while only 15.8% reported high KACE (Table 1). In bivariate analysis, high PHLACE (p=0.015), but not high KACE (p=0.774) was associated with sPTB. In adjusted models, those with high PHLACE had 3.9 times (95% CI 1.46, 11.49) higher odds of sPTB compared to those with low PHLACE. Removing those with prior sPTB, the association persisted (aOR 4.55 95% CI 1.21, 21.74). Among the same single childhood adversities, the PHLACE appears to capture higher rates of positive responses compared to the KACE (Table 2).

Conclusion: PHLACE may capture childhood adversity more comprehensively than KACE and may more accurately reflect the impact of early lived experiences on adverse pregnancy outcomes in Black, urban populations. Understanding how these experiences perturb biological pathways leading to sPTB is imperative for the optimization of therapeutic strategies. Importantly, policies that help to mitigate these experiences can also improve pregnancy health.