The ACE Study and Preconception Health – Making the Connection

by Steffie Duginske

If anyone has talked with me in the past 6 months or so, you have probably noticed I can’t make it through a training, discussion, or conversation without bringing up the ACE Study; which stands for Adverse Childhood Experiences.  I learned about the study through the Innovative Approaches Project housed within Buncombe County Health and Human Services, who has a dedicated sub-committee collaborating to address this important research. When I mention the ACE Study, some have heard about it, but many have not.  Through my work with the North Carolina Preconception Health Campaign, we have a long list of goals including improving women’s wellness, reducing health disparities, reducing chronic health conditions, and improving reproductive outcomes - and I can’t help but connect the ACE study findings to the work of the NC Preconception Health Campaign. ACEs are common; nearly two-thirds (64%) of adults have at least one adverse childhood experience.  This information is important for us to be aware of, because when addressing preconception health, the focus is on reaching all women (and often men) of childbearing age with important health messages to improve birth outcomes. Anyone working with this age population is bound to reach many individuals with any number of ACE’s. 

For those not familiar with what ACE’s are, they are adverse childhood experiences that occur prior to your 18th birthday, that can change and can even harm children's developing brains so profoundly that the effects may show up decades later. Research has shown that traumatic, or stressful events in childhood (ACEs), may injure a child’s brain, impairing the brain’s physical development and function.   Research has shown that ACEs can be the cause of chronic disease, mental illness, and are correlated to the root of many types of violence.  Examples of adverse childhood experiences are physical, sexual and emotional abuse, as well as physical and emotional neglect. They also include, having a parent who is mentally ill, an alcoholic or substance abuser, in jail, or a victim of domestic violence, as well as the absence of a parent through divorce, death or abandonment. These are all ACEs. To learn more about what questions are used to determine someone’s ACE score and to find your own ACE score, click here: . 

Through the Campaign, not only are we able to provide educational trainings to the community, we are fortunate to be able to participate in community coalitions such as Innovative Approaches.  As we all know, collaboration is the key, not only to individual program success, but big picture community success – improving community health for everyone.  For those of us who work in the world of prevention, public health, education and so many other social service agencies, the phrase “root cause” always seem to come up in conversation.  I’m so fascinated with the ACE study, because to me, the application of this work has so much potential to break cycles that can improve lives and prevent future health problems for individuals and families for generations.  The key is, knowing about ACE’s and what they mean to one’s self on a personal level, learning if you have any, and understanding how your own adverse childhood experiences  have affected your life.  Understanding your own ACEs will help you to understand your child and your relationship to raising your child.  The link between childhood trauma - which many of us have experienced but may not identify as trauma or understand the very real and potential implications it can have on one’s health as an adult - is knowledge that everyone must know.  Earlier I mentioned the link between those with an ACE score and the work of the NC Preconception Health Campaign.  The research shows, the higher the ACE score, the more likely a person is to experience an increased risk for the following health problems and diseases.  Each time I look at the list, the link between preconception and interconception health and ACEs is glairing.  The list of health trainings we offer through the Campaign and the long list of health problems associated with ACE’s, no doubt, overlap.

  • Alcoholism and Alcohol Abuse
  • Illicit Drug Use
  • Early Initiation of Smoking
  • Smoking
  • Early Initiation of Sexual Activity
  • Adolescent Pregnancy
  • Multiple Sexual Partners
  • Sexually Transmitted Diseases (STDs)
  • HIV
  • Unintended Pregnancies
  • Fetal Death
  • Risk for Intimate Partner Violence
  • Depression
  • Suicide Attempts
  • Health-Related Quality of Life
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Ischemic Heart Disease (IHD)
  • Liver Disease

I know my ACE score.  What do I do Now?  Resources and Building Resilience.
Let’s say you are a woman in childbearing age, and you find that you have an ACE score that has impacted your life – potentially one or several of the health consequences listed above.  To further the scenario, you could also be a woman who already has children or wants to have children someday.  What can you do?  You can find help in breaking the cycle of ACEs in your family.  There are personal strategies and community resources that exist to help you.  Asking for help, developing trusting relationships, forming a positive attitude, and paying attention to your instincts and feelings are ways to improve your life.  Reaching out to a trusted member of your community such as a doctor, a counselor, a teacher, or a church or spiritual leader is another way to get help.  I have attended some wonderful Community Resiliency Model (CRM) Trainings in the Western region which are available for community members or professionals.  You could contact your local department of health and human services to find out what kinds of classes or trainings are offered in your area.  To learn more about Resiliency through the Trauma Resource Institute, visit this link:  Using these suggestions, both early in a child’s life and as an adult, can lessen the impact of ACEs on you and your family.  To learn more about ACEs and resources in the Western Region, visit the website created by the Innovative Approaches work group:  Innovative Approaches is a grant funded project that works on improving systems of care for children and youth with special health care needs, which is funded through the North Carolina Department of Public Health, Children and Youth Branch. 

Whether you are a person with ACEs or not, through the NC Preconception Health Campaign, we recommend some very specific healthy steps you can take to improve birth outcomes.  They include, taking a multivitamin with 400mcg every day to reduce neural tube defects, choose an effective form of birth control and use it regularly until you are ready to start a family, stop smoking and using street drugs or misusing prescription drugs and avoid alcohol, have regular checkups with your doctor, reduce stress in your life and get mentally healthy, and maintain a healthy weight by eating healthy foods and being active at least 30 minutes per day. 

Some final points about ACEs and the impacts on health:  Remember, they don’t occur alone….if you have one, there’s an 87% chance that you have two or more.  The more ACEs you have, the greater the risk for chronic disease, mental illness, violence and being a victim of violence. For example, people with an ACE score of 4 are twice as likely to be smokers and seven times more likely to be considered an alcoholic. People with high ACE scores are more likely to be violent, to have more marriages, more broken bones, more drug prescriptions, more depression, more autoimmune diseases, and more work absences. People with an ACE score of 6 or higher are at risk of their lifespan being shortened by 20 years.

The ACE study was conducted in the late 90’s by a team of doctors in San Diego who were on staff at Kaiser Permanente.  It is one of the largest investigations ever conducted to assess associations between childhood maltreatment and later-life health and well-being.  The study is a collaboration between the Centers for Disease Control and Prevention and Kaiser Permanente.  To learn more about the ACE study, visit CDC-Kaiser Adverse Childhood Experiences Study


Resources used in this article
CDC ACE Website

Additional Resources
ACE Study
ACEs Too High
National Center for Trauma Informed Care
Order the ACE Study DVD
ACEs Connection

North Carolina ACE Specific Data


Revised: January 5, 2015

This web site is designed for informational use only; it is not designed to give advice, diagnose, cure or treat any medical condition you may have. If you have any questions about your health, please contact your health care provider.