Adverse childhood experiences, resilience, and substance use during early pregnancy.

Abstract

Adverse childhood experiences (ACEs) are common risk factors for unhealthy behaviors and poor health outcomes throughout the life course, but their relationship with prenatal substance use is understudied. This retrospective cohort study included 44,284 patients with pregnancies between January 1, 2022, and June 28, 2024, in a large healthcare system in Northern California, United States of America with universal screening for ACEs, resilience, and substance use during early pregnancy. Multivariable regression models examined the relationship between ACEs and prenatal substance use and tested whether resilience moderated these associations. Pregnant individuals with a greater number of ACEs had lower resilience, were younger, more likely to be Black, Non-Hispanic White, or Hispanic, and live in an area with greater neighborhood deprivation. In adjusted models, compared to those without ACEs, those with ACEs had a higher adjusted prevalence of prenatal alcohol use, cannabis use, nicotine use, pharmaceutical opioid use, stimulant use, and multiple substance use. Low resilience was independently associated with an increased prevalence of prenatal substance use. Results indicate that routine screening for ACEs may help identify pregnant individuals at risk for prenatal substance use, allowing for earlier linkage to resources and potentially improved maternal and child outcomes.