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Patricia M. Dietz, DrPH; Alison M. Spitz, MPH; Robert F. Anda, MD; David F. Williamson, PhD; Pamela M. McMahon, PhD; John S. Santelli, MD; Dale F. Nordenberg, MD; Vincent J. Felitti, MD; Juliette S. Kendrick, MD

JAMA. 1999;282:1359-1364.

Context  Studies have identified childhood sexual and physical abuse as a risk factor for adolescent pregnancy but the relationship between exposure to childhood abuse and unintended pregnancy in adulthood has, to our knowledge, not been studied.

Objective  To assess whether unintended pregnancy during adulthood is associated with exposure to psychological, physical, or sexual abuse or household dysfunction during childhood.

Design and Setting  Analysis of data from the Adverse Childhood Experiences Study, a survey mailed to members of a large health maintenance organization who visited a clinic in San Diego, Calif, between August and November 1995 and January and March 1996. The survey had a 63.4% response rate among the target population for this study.

Participants  A total of 1193 women aged 20 to 50 years whose first pregnancy occurred at or after age 20 years.

Main Outcome Measure  Risk of unintended first pregnancy by type of abuse (psychological, physical, or sexual abuse; peer sexual assault) and type of household dysfunction (physical abuse of mother by her partner, substance abuse by a household member, mental illness of a household member).

Results  More than 45% of the women reported that their first pregnancy was unintended, and 65.8% reported exposure to 2 or more types of childhood abuse or household dysfunction. After adjustment for confounders (marital status at first pregnancy and age at first pregnancy), the strongest associations between childhood experiences and unintended first pregnancy included frequent psychological abuse (risk ratio [RR], 1.4; 95% confidence interval [CI], 1.2-1.6), frequent physical abuse of the mother by her partner (RR, 1.4; 95% CI, 1.1-1.7), and frequent physical abuse (RR, 1.5; 95% CI, 1.2-1.8). Women who experienced 4 or more types of abuse during their childhood were 1.5 times (95% CI, 1.2-1.8) more likely to have an unintended first pregnancy during adulthood than women who did not experience any abuse.

Conclusions  This study indicates that there may be a dose-response association between exposure to childhood abuse or household dysfunction and unintended first pregnancy in adulthood. Additional research is needed to fully understand the causal pathway of this association.

Author Affiliations: National Center for Chronic Disease Prevention and Health Promotion (Drs Dietz, Anda, Williamson, Santelli, and Kendrick and Ms Spitz), the National Center for Injury Prevention and Control (Dr McMahon), Centers for Disease Control and Prevention and the Department of Pediatrics, Emory University School of Medicine (Dr Nordenberg) Atlanta, Ga; and the Department of Preventive Medicine, Southern California Permanente Medical Group, San Diego (Dr Felitti).

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