(336) Adverse Childhood Experiences and Adverse Community Environments Among Maternal Mortality Cases in Arizona

Objective: Adverse Childhood Experiences (ACEs) - exposure to emotional, physical, or sexual abuse, and household dysfunction- as well as adverse community environments (ACoE) are associated with increased risk of perinatal morbidity. ACEs and ACoE as it relates to maternal mortality (MM) have yet to be investigated. The objective of this study is to examine the association of ACEs and ACoE on MM in Arizona (AZ).

Study Design:

This retrospective cohort study includes maternal deaths in AZ in 2018-2019. De-identified patient narratives were abstracted from medical records, law enforcement reports, death certificates, and other relevant case records. Narratives were reviewed by the AZ Maternal Mortality Review Committee (MMRC) and our research team.  Standard MMRC data collection, sociodemographic characteristics (SDC), ACE exposures, ACoE, and perinatal outcomes were identified. ACoE were defined by the health equity dashboards based on the decedent's last known residence at time of death. Univariate and bivariate analysis were conducted to assess trends in distribution of characteristics. Unadjusted and adjusted logistic regression models were used to assess the association between ACE exposure and adverse outcomes.

Results:

In total, 146 cases were reviewed. SDC and prevalence of ACE and ACoE are noted in Table 1. An ACE score of > 1 had a 20-fold increased odds of mental health diagnosis (MHD) (95%CI: 4-102.52), 6-fold increased odds of substance use disorder (SUD) (95% CI 1.8-20.4) and pregnancy-related accidental death (95%CI: 1.1-36.3), and a 23-fold increase of pregnancy-related death due to SUD (95%CI: 2.8-185.2) compared to cases with an ACE score of 0. A 2-fold increase in accidental death (95%CI: 0.47 -4.02) was seen with 1 or more ACoE.

Conclusion:

ACEs increase the odds of a MHD and MM due to SUD. ACE screening during prenatal care may be a beneficial adjunct to substance abuse screening in pregnancy. Further research should investigate risk reducing interventions once ACEs are identified in the pregnant population.  Additional studies are needed to further evaluate the role of ACoE on MM.