Online Program

Childhood hardships are associated with many indicators of maternal/infant health and well-being

Sunday, November 1, 2015

Paula Braveman, MD, MPH, Center on Social Disparities in Health, UC San Francisco, San Francisco, CA
Katherine Heck, MPH, Center on Social Disparities in Health, UC San Francisco, San Francisco, CA
Christine Rinki, MPH, Maternal, Child and Adolescent Health program, California Department of Public Health, Sacramento
Kristen Marchi, MPH, CSDH, Dept Family and Community Medicine, University of California, San Francisco, San Francisco, CA
Michael Curtis, PhD, Maternal, Child and Adolescent Health Division, California Department of Public Health, Sacramento, CA
Background:  Adversity in childhood has been linked with poor health in adulthood, but little research has examined impacts during pregnancy or postpartum.

Methods:  Using data from 13,354 US-born women in California’s 2011-2013 Maternal Infant Health Assessment, a statewide-representative survey of postpartum women, we examined relationships between several childhood hardships (parental separation/divorce, incarceration, or alcohol/drug problem;  foster care; trouble meeting basic needs; hunger; housing insecurity) and 31 indicators of health or well-being (including  maternal/infant health-related behaviors, receipt of medical care, maternal health status, birth outcomes, socioeconomic resources and stressors during pregnancy).  We examined the prevalence of each indicator in relation to the number of childhood hardships, unadjusted and adjusted for potential confounders.

Results: Half of US-born women experienced at least 1 childhood hardship and 28% experienced 2 or more. After adjustment, experiencing 2 or more childhood hardships was significantly associated with poorer outcomes in 20 of 31 indicators.  For 17 of the indicators, there was an apparent gradient effect, with magnitude of risk increasing as the number of childhood hardships increased.  Adjusted prevalence ratios varied, but in 14 indicators there was a doubling (or more) of risk for women with 4 or more childhood hardships compared to none.

Conclusions: The pervasive and strong relationship of California women’s childhood hardships to so many adverse health-related indicators around the time of pregnancy is striking.  These associations, particularly given the dose-response patterns observed for many outcomes, add to a growing literature suggesting that policies to improve health in adulthood may require improving conditions during childhood.

Learning Areas:

Program planning
Public health or related public policy
Public health or related research
Social and behavioral sciences

Learning Objectives:
Describe relationships between hardship experiences in childhood and health outcomes and behaviors around the time of pregnancy.

Keyword(s): MCH Epidemiology, Maternal and Child Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: For over 25 years, Dr. Braveman has studied and published on socioeconomic and racial/ethnic disparities in health. She is the PI for the Maternal and Infant Health Assessment, a collaboration with the California DPH; she led the development of questions on childhood hardships used in this study. She is nationally and internationally recognized for her research to document, understand and address social inequalities in health. She was elected to the Institute of Medicine in 2002.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.