Adverse Childhood Experiences (ACEs), Traumatic Stress, Maternal-Fetal Attachment, and Health Behaviors: Preliminary Findings from a Mixed Methods Study of Low-Income Pregnant Teens

Background: Social work has been involved with “unwed mothers,” including teens, since its founding. By the 1970s, teen pregnancy and childbearing had been defined as a significant social and public health problem, although long-term outcomes for teens and their babies vary considerably. When help and support is provided in pregnancy and through early childhood, outcomes improve for mothers and children..

Question: This mixed-methods study documents trauma and mental health needs in low-income urban pregnant teens so that early intervention and supportive services may be enhanced. While these issues have been examined in at-risk pregnant adults, they have not yet been studied together in pregnant teens.

Methods: The Nurse-Family Partnership (NFP) program is an evidence-based early intervention program with proven benefits to at-risk mothers and their infants. Using a purposive sample drawn from pregnant teens served by NFP in New York City, this cross-sectional study examines the relationships of trauma history (Adverse Childhood Experiences--ACEs) and current traumatic stress (Trauma Symptom Checklist for Children) with Maternal-Fetal Attachment (Maternal Antenatal Emotional Attachment Scale) and prenatal health behaviors (Health Practices in Pregnancy II). All are well-validated measures. Qualitative questions elicit more information about the teen’s subjective experience of their pregnancies, prior life experiences, and mental health. Details on sampling criteria, recruitment methods and participant compensation will be covered in the presentation. Data collection is ongoing; the recruitment goal is 100 teens.

Findings: Our study sample is dominantly Hispanic with varying racial identifications, with half being only 15 or 16, and 75% enrolled in school. Data on living arrangements, foster care, and family and partner relationships will be provided. Analysis of quantitative data obtained to date show that (1) only one teen reported no past trauma; 31% of teens had ACE scores of 4 and over compared to about 4%in the general population; (2) the mean for the Traumatic Stress Scale score was 46.6, and on the Perceived Stress Scale, the mean of 19.0 was higher than in the average US female; (3) teens scored high on Maternal Fetal Attachment (mean 84.8), with a score of 76 representing high maternal-fetal attachment; and (4)  the mean prenatal health behavior scores (123.4) was close to the middle class mean of 138. Bivariate correlations and multivariate findings, including mediator and moderator analysis, will be presented based on the larger sample size then available.

Themes found in the analysis of qualitative data collected to date included reports of abusive or unstable family environments prior to the pregnancy. The pregnancy itself was described as stigmatizing and isolating but also as motivating positive changes and generating hopefulness with respect to the future.

Implications: Many in this disadvantaged sample experienced significant trauma and stress, but, perhaps reflecting self-selection into the NFP program, prenatal attachment scores were high. Despite narratives of losses and family instability, the teens viewed pregnancy as a chance to start a healthier life and as a postponement rather than a roadblock to their futures, supporting intervention models like NFP and suggesting enhanced attention to mental health needs.