Pregnant women’s perspectives on screening for adverse childhood experiences and resilience during prenatal care

I have talked about adverse childhood experiences (ACEs) before. I like this study because there is a lot of conversation about how much to specifically ask about ACEs. The early work by Dr. Nadine Burke Harris advocated only asking people how many ACEs they had experienced. In this study, published in Psychological Trauma: Theory, Research, Practice, and Policy by Watson et al. (2022). Although they only studied 119 women, their sample is quite diverse, including participants who are 36.1% non-Hispanic White, 26.1% Hispanic, 8.4% Black, 23.5% Asian/Pacific Islander, and 5.9% Other, with a median age of 31 and a range from 28 to 34. They had an average neighborhood median household income of $100,734 (SD = $37,079). Their sample included 62.2% who reported no ACEs, 21% who reported 1 or 2 ACEs, and 16.8% who report 3 or more. Asked about resilience, 64.7% reported high resilience, the rest low. Their methodology was a post-screening telephone survey. Their abstract adds:

Most women thought prenatal care should include conversations about ACEs (82.2%) and resilience (94.0%) and very strongly believed that good coping skills can help reduce the harmful effects of childhood stress (79.0%). Nearly half (41.2%) used ≥1 mental health resource from the resource handout provided at screening. Some women thought conversations could be improved if they took place with a mental health professional (37.3%), with more provider empathy (40.7%), more education about ACEs and health (55.1%), and if the screening included additional stressors (53.4%). Notably, most women (73.5%) would like their partner to also receive the screening. Women with more ACEs were more likely to want a longer conversation, and those with low versus high resilience were more likely to prefer that a mental health professional conduct the screening. Conclusions: Results indicate that women value ACEs screening during prenatal care and provide actionable recommendations to improve future screenings and discussions. 

As usual, there is a need for more research but these results suggest that talking with pregnant individuals or couples may be very helpful. The data also highlight the value of multidisciplinary teams so that mental health professionals are directly involved in the conversations.