The odds of experiencing accelerated reproductive events are increased in female patients with adverse childhood experiences (ACEs), according to a recent study published in the American Journal of Obstetrics & Gynecology.
Takeaways
- Female patients who experience adverse childhood experiences (ACEs) face a heightened likelihood of accelerated reproductive events, such as early puberty and menarche, compared to those without ACEs, with a pooled odds ratio of 1.91.
- Various forms of childhood adversity, including abuse, low socioeconomic status (SES), accumulative ACEs, and familial dysfunction contribute to the risk of accelerated reproductive events, with dysfunctional family environments showing the most significant impact.
- Studies utilizing interviews to assess childhood adversity reported the largest pooled estimate effect size, emphasizing the importance of comprehensive data collection methods in understanding the association between ACEs and reproductive milestones.
- ACEs are associated with a range of reproductive outcomes, including early sexual initiation and pregnancy loss, with effect sizes varying across different adverse experiences, highlighting the nuanced impact of childhood adversity on female reproductive health.
- The findings underscore the need for further research to explore the influence of specific types and timing of childhood adversity on female reproductive events, emphasizing the importance of tailored interventions and support for individuals with ACEs.
Reproductive events are biological milestones among female patients and include pubertal onset, first sexual intercourse, pregnancy loss, menarche, first birth, parity, and menopause. Researchers have theorized patients with early life adversity will experience trade-offs between physical development and future reproduction, potentially leading to earlier reproductive events.
ACEs have been linked to adverse reproductive outcomes including pregnancy loss and preterm birth. However, most literature about the association between ACEs and reproductive events evaluate a single stage of reproductive history.
Investigators conducted a review to determine whether patients who experience ACEs are at an increased risk of accelerated reproductive events compared to patients who do not experience ACEs. Literature was found through searches of the Embase, Pubmed, and Web of Science databases.
Types of childhood adversity were used as search terms. Human studies published between 2012 and 2022 in English with an observational study design, exposure variable of adversity before 18 years of age, outcome of any type of accelerated reproductive events, and effect size of the association were included in the analysis.
Two authors independently evaluated titles and abstracts, followed by a full-text screening with a third author consulted during differences. Data extracted included country, publication year, author, study type, sex, age range, sample size, sample source, type of report, and type of exposure and outcome.
Risk of bias was determined using the Newcastle–Ottawa assessment scale. Domains evaluated by the scale include selection, comparability, and outcome or exposure.
There were 33 studies with 326,327 participants included in the final analysis. While most studies were longitudinal, 9 were cross-sectional and 3 were case-control studies. Race and ethnicity were the most common covariates reported in the studies.
Exposures evaluated included abuse by 17 studies, low socioeconomic status (SES) by 5, accumulative ACEs by 8, family member with mental illness by 2, and childhood adoption or foster care placement by 1. Questionnaires were utilized by 15 studies, interviews by 12, and archive materials by 6.
Outcomes evaluated included early puberty by 4 studies, early menarche by 7, early sexual initiation by 4, preterm birth by 8, adolescent childbirth by 3, pregnancy loss by 5, and early menopause by 2. A fair quality of evidence was observed in 5 studies and good quality in 28.
A pooled odds ratio (OR) of 1.91 was reported, indicating the odds of accelerated reproductive events are increased 1.9 times in individuals with ACEs vs those without ACEs. Significant heterogeneity was observed across studies.
Childhood adversity groups included an abuse group, cumulative ACEs group, low SES group, and dysfunctional family group. The dysfunctional family group had the most significant impact on accelerated reproductive events, with an OR of 2.13. The lowest OR of 1.61 was reported in the low SES group.
Reproductive events not associated with abuse include puberty with an OR of 1.59 and early sexual initiation with an OR of 2.31. Additionally, low SES was not associated with early menarche. Effect sizes of reproductive events for female individuals with childhood adversity ranged from 1.07 to 5.69.
The largest pooled estimate effect size with an OR of 2.27 was reported in studies utilizing interviews to assess adversity. Significant differences from 0 were found when groups were stratified based on age, study type, and sample size.
These results indicated an association between ACEs and accelerated reproductive events. Investigators recommended research to determine the influence of types and timing of childhood adversity on female reproductive events.
Reference
Ding W, Xu Y, Kondracki AJ, Su Y. Childhood adversity and accelerated reproductive events: a systematic review and meta-analysis. American Journal of Obstetrics & Gynecology. 2024;230(3):315-329. doi:10.1016/j.ajog.2023.10.005
