High Philadelphia Adverse Childhood Experiences Survey Score Is Associated With Spontaneous Preterm Birth Among Black Pregnant Individuals: A Secondary Analysis of a Prospective Cohort.

OBJECTIVE

To assess associations between two surveys of adverse childhood experiences (ACEs)-Kaiser ACE and Philadelphia ACE-and spontaneous preterm birth (sPTB) among Black individuals.

DESIGN

Secondary analysis of a prospective observational cohort.

SETTING

Tertiary academic medical center.

POPULATION OR SAMPLE: Black pregnant persons who completed both Kaiser and Philadelphia ACE surveys with adjudicated birth outcomes.

METHODS

We used Chi-square analyses to measure bivariate associations between high ACE scores for both surveys (threshold ≥ 4) and sPTB. Multivariable logistic regression estimated odds ratios for sPTB comparing high vs. low Kaiser ACE score and Philadelphia ACE score, controlling for maternal education and insurance. We compared proportions of individuals who endorsed single adversities across surveys using McNemar's test (p-value < 0.05 for statistical significance).

MAIN OUTCOME MEASURES: sPTB (< 37 weeks' gestation).

RESULTS

Among 350 participants, 5.4% experienced sPTB. Among the same 350 participants, 40.8% reported a high Philadelphia ACE score and 20.9% reported a high Kaiser ACE score. In bivariate analysis, a high Philadelphia ACE score but not a high Kaiser ACE score was associated with sPTB. After adjustment, those with a high Philadelphia ACE score had 3.7 times (95% CI 1.41, 10.99) higher odds of sPTB compared to those with low scores. Comparing the conventional ACEs measured in both instruments, a higher proportion of individuals endorsed subscales of adversities on the Philadelphia ACE survey compared to the Kaiser ACE survey.

CONCLUSIONS

A high Philadelphia ACE score was associated with increased sPTB. The Philadelphia ACE survey may capture childhood adversity more comprehensively than the conventional Kaiser ACE survey and thus more accurately reflect the impact of early lived experiences on adverse pregnancy outcomes, such as PTB, in Black, urban populations.