Adverse Childhood Experiences among Reproductive Age Women: Findings from the 2019 Behavioral Risk Factor Surveillance System

Published:April 22, 2022DOI:



      Adverse childhood experiences (ACEs) are associated with many negative health outcomes. Despite this well-documented association, most research on how health conditions affect women's preconception and perinatal health overlooks ACEs.


      This study analyzes self-reported ACE history and health outcomes among young adults (ages 18–39) using data from the 2019 Behavioral Risk Factor Surveillance System. Our aims were to 1) assess differences by gender in overall ACE scores and specific ACEs; 2) identify trends in women's ACE scores by birth cohort; and 3) estimate the association of ACE scores with health conditions that increase risk for adverse perinatal outcomes.


      Findings include that women had higher overall ACE scores than men and that women were more likely to report experiencing seven of the eight ACEs queried. More than 23% of women respondents reported an ACE score of 4+, with a 3-percentage point difference between the youngest and oldest women in our sample. Compared with those reporting zero ACEs, women with four or more ACEs were almost four times as likely to report a history of depression and more than twice as likely to report fair or poor health, even after accounting for sociodemographic characteristics. Women with four or more ACEs were 62% more likely to have obesity, 41% more likely to report a hypertension diagnosis, and 36% more likely to report a diabetes diagnosis than those with zero ACEs.


      ACEs are a root cause in the development of adverse health conditions in young women, and their prevention should be central to policies aimed at improving women and children's well-being.
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      Laura Hurley, MPH, is a fourth-year medical student at Rush Medical College, a member of the Family Medicine Research Program there, and a recent graduate of the Northwestern University Masters in Public Health Degree program.


      Audrey Stillerman, MD, is a Clinical Assistant Professor of Family and Community Medicine, integrative healer, and trauma expert. With 30+ years of experience, she focuses on equity, trauma prevention and healing, non-pharmacological modalities, lifecourse, and transformation of the medical paradigm.


      Joe Feinglass, PhD, is a Research Professor of Medicine with over 30 years of experience and over 250 publications on health services, health disparities, quality improvement, patient outcomes, medical informatics, cost effectiveness, women's health, social epidemiology, and community-based participatory research.


      Christine Percheski, PhD, is an Associate Professor of Sociology at Northwestern University. Her research focuses on the well-being of U.S. women and families with children and investigates questions at the intersection of family demography, social inequality, and health policy.