Date of Award

11-4-2024

Degree Type

Thesis

Degree Name

MS in Public Health

First Advisor

Dr. Zahra Hoodbhoy

Second Advisor

Dr. Nazmul Alam

Third Advisor

Miss Sabahat Naz

Department

Community Health Sciences

Abstract

Introduction Adverse Childhood Experiences (ACEs) refer to a series of traumatic and stressful events that occur during the first eighteen years of life. The burden of ACEs varies globally. Few studies have reported ACEs and their association with preterm birth in HICs, but limited evidence is available from LMICs. Objectives To examine the relationship between ACEs and preterm birth among women in the peri urban communities of Karachi, Pakistan.  
Study design This case-control study is nested within an ongoing cohort, Pregnancy Risk Infant surveillance and Measurements Alliance (PRISMA) that enrolls pregnant women from the communities and follows them till one year after delivery.
Study setting Rehri Goth (RG) and Ibrahim Hyderi (IH), Karachi, Pakistan. 
Method This case control study is nested within an ongoing PRISMA cohort that aims to longitudinally capture information on maternal and neonatal morbidities. Cases were women with a preterm delivery (< 37 GA) . Controls were women with a full-term delivery (≥ GA) liv. Data on sociodemographic and covariates was obtained from the existing study. Data on ACEs and xi resilience was collected using the ACE-IQ and BRS tool. A total of 560 (280 cases and 280 controls) were included in the study. Univariate and multivariable logistic regression were performed.
Results On chi-2 test, ACEs categories such as physical neglect, bullying and collective violence using both binary and frequency version were associated with preterm birth (p< 0.001). Multivariable analysis showed that every unit increase in total ACEs were associated with 12% odds of preterm birth, regardless of maternal age, any comorbidities during current pregnancy, use of tobacco, history of poor pregnancy outcomes, anemia status, education status, nutrition status using MUAC (aOR, 1.12; 95%CI, 1.01-1.26). Exposure to ACEs domains (parents (aOR, 2.34;95%CI, 1.52-3.60) and violence (aOR,1.80;95%CI,1.29-2.51) were associated with a twofold risk of having preterm birth in our study population.
Conclusion Total ACEs, and ACEs from parental and violence domain showed an association with preterm birth. The data showed that exposure to ACEs can have a significant impact on poor pregnancy outcomes such as preterm birth.

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1

Last Page

55

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