Effect of Maternal Adverse Childhood Experiences (ACEs) and Maternal Resiliency on Early Childhood Outcomes on Vaccination Adherence and Emergency Department Visits

Introduction: Adverse Childhood Experiences (ACEs) are traumatic events that occurred to an individual during ages 0-17 years. The 1998 Adverse Childhood Experiences (ACE) suggested higher ACE scores contributed to negative future health outcomes. The tool is now used to screen at-risk populations for the development of chronic health conditions. Protective factors, such as resilience, were later studied and found to offset the negative health impacts of traumatic childhood events. The 7Cs questionnaire was a tool developed to measure resilience in adolescents and demonstrated better health outcomes despite the presence of higher ACE scores. This pilot study evaluated whether higher maternal ACEs would result in more frequent pediatric ED visits and less vaccination adherence and whether higher 7Cs would be protective. Methods: This IRB approved study recruited pregnant women and new mothers in a tertiary NJ urban hospital, between their second trimester and their child’s one month well visit at the pediatric clinic. All subjects completed the Adverse Childhood Events (ACEs) survey, 7Cs resilience tool, and a Maternal Health questionnaire at the time of recruitment. A review of children’s electronic medical records was conducted at 2-, 4-, 6-, and 12-months to evaluate pediatric outcomes, adherence to AAP recommended vaccine schedule and emergency department visits. Results: Total of 34 women were enrolled, their and their children’s medical and demographic data collected. There was no difference in higher ACE scores and number of ED visits for the babies (OR 0.9645 [CI 0.7643 - 1.2172]), with no effect seen with higher resilience scores and number of ED visits (OR 0.8477 [0.6192 – 1.1604]). Increase in ACE scores resulted in reduction in vaccination adherence (OR 0.3555 [CI 0.1417 – 0.8923]). Increase in resilience scores decreased vaccination adherence by 44% (OR 0.5578 [CI 0.4164 - 0.7471]). Conclusion: There was no significant relationship between ACE or resilience scores and pediatric ED visits. A higher ACE score and lower levels of resilience were associated with decreased child vaccine adherence rate. ACE scores relate to higher traumatic childhoods, suggest poorer outcomes in offspring. Women with higher ACE scores could benefit from closer interventions and resources from obstetricians, and closer follow up of their children by the pediatricians.