@article{ref1,
title="Years of education mediate the association between adverse childhood experiences and unintended pregnancy: A population-based study in Japan",
journal="Child abuse and neglect",
year="2024",
author="Terada, Shuhei and Isumi, Aya and Yamaoka, Yui and Fujiwara, Takeo",
volume="153",
number="",
pages="e106817-e106817",
abstract="BACKGROUND: Adverse childhood experiences (ACEs) have been associated with unintended pregnancies, including mistimed pregnancies (MP) and unwanted pregnancies (UWP). However, it remains unknown which cluster of ACEs (i.e., child maltreatment/household dysfunction and deprivation/threat) are associated with MP/UWP and whether years of education mediate these associations. <br><br>OBJECTIVE: To investigate the association of the clusters of ACEs with MP and UWP, while also examining the mediating effect of education years. PARTICIPANTS AND SETTING: A retrospective cohort study among 7652 postpartum women in Chiba, Japan. <br><br>METHODS: MP/UWP was defined by emotional responses to confirming pregnancy. Multinomial logistic regression analyses with multiple imputed datasets estimated the relative risk ratio (RRR) of MP/UWP by cumulative scores and each cluster of ACEs. Causal mediation analysis assessed the indirect effects of years of education. <br><br>RESULTS: Women with 4 or more ACEs were at a 2.4 times higher risk of MP (95 % confidence interval (CI): 1.6-3.8) and a 5.0 times higher risk of UWP (95 % CI: 3.1-8.2). Among ACE clusters, having 3 or more household dysfunction showed the strongest association with MP (RRR: 1.91, 95 % CI: 1.23-2.95), and having 3 or more deprivation showed the strongest association with UWP (RRR: 3.69, 95 % CI: 2.00-6.83). Education years mediated 16 % and 11 % of the association between total ACEs and MP/UWP, respectively, with a similar trend observed in each cluster. <br><br>CONCLUSIONS: Not only ACEs score but also each cluster of ACEs was associated with MP and UWP. The mediating effects of years of education were modest.<p /> <p>Language: en</p>",
language="en",
issn="0145-2134",
doi="10.1016/j.chiabu.2024.106817",
url="http://dx.doi.org/10.1016/j.chiabu.2024.106817"
}