Action on ACEs Gloucetershire. County conference report. 2018. (accessed 9 January 2019)

Angerud K, Annerback E-M, Tyden T, Boddeti S, Kristiansson P. Adverse childhood experiences and depressive symptomatology among pregnant women. Acta Obstetricia et Gynecologica Scandinavica. 2018; 97:701-708

Balaam MC, Thomson G. Building capacity and wellbeing in vulnerable/marginalised mothers: a qualitative study. Women and Birth.. 2018; 31:E341-E347

Bellis MA, Hughes K, Leckenby N, Perkins C, Lowey H. National household survey of adverse childhood experiences and their relationship with resilience to health-harming behaviors in England. BMC Med.. 2014; 12

Bethell CD, Carle A, Hudziak J, Gombojav N, Powers K, Wade R, Braveman P. Methods to assess adverse childhood experiences of children and families: towards approaches to promote child well-being in policy and practice. Academic Pediatrics.. 2017; 17:S51-S69

Brandon M, Sidebotham P, Belderson P, Cleaver H, Dickens J, Garstang J, Harris J, Sorensen P, Wate R. Complexity and challenge: a triennial analysis of Serious Case Reviews 2014–2017.: Department of Education; 2020

Bressan V, Bagnasco A, Aleo G, Timmins F, Barisone M, Bianchi M, Pellegrini R, Sasso L. Mixed methods research in nursing – a critical review. Journal of Clinical Nursing.. 2016; 26:2878-2890

Bright MA, Knapp C, Hinojosa MS, Alford S, Bonner B. The comorbidity of physical, mental, and developmental conditions associated with childhood adversity: a population based study. Maternal and Child Health Journal.. 2016; 20:843-853

Adverse childhood experiences and their relationship to complex health profiles among child welfare–involved children: a classification and regression tree analysis. 2019.

Brown SM, Shillington AM. Childhood adversity and the risk of substance use and delinquency: the role of protective adult relationships. Child Abuse and Neglect.. 2017; 63:211-221

Christiaens I, Hegadoren K, Olson DM. Adverse childhood experiences are associated with spontaneous preterm birth: a case-control study. BMC Medicine.. 2015; 13

Liam 0319 SCR Overview report Gloucestershire safeguarding children board. 2020. (accessed 30 April 2020)

Fabreques S, Pare MH. Appraising the quality of mixed methods research in nursing: a qualitative case study of nurse researchers' views. Nursing Inquiry.. 2018; 25 10.1111/nin.12247

Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the adverse childhood experiences (ACE) study. American Journal of Preventative Medicine.. 1998; 14:245-258

Finkelhor D. Screening for adverse childhood experiences (ACEs): cautions and suggestions. Child Abuse and Neglect.. 2018; 85:174-179

Flanagan T, Alabaster A, McCaw B, Stoller N, Watson C, Young-Wolff KC. Feasibility and acceptability of screening for adverse childhood experiences in prenatal care. Journal of Womens Health.. 2018; 27:(7)903-911

Asking about adverse childhood experiences (ACEs) in health visiting. Findings from a pilot study. 2019. (accessed 5 February 2019)

Hughes K, Bellis MA, Hardcastle KA, Sethis D, Butchart A, Mikton C, Jones L, Dunne MP. The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. Lancet: Public Health.. 2017; 2:e356-e366

Health and financial burden of adverse childhood experiences in England and Wales: a combined primary data study of five surveys. 2020.

Johnson K, Woodward A, Swenson S, Weis C, Gunderson M, Deling M, Cristiani V, Lynch B. Parents' adverse childhood experiences and mental health screening using home visiting programs: a pilot study. Public Health Nursing.. 2017; 34:522-530

Kan K, Gupta R, Davis MM, Heard-Garris N, Garfield C. Adverse experiences and special health care needs among children. Maternal and Child Health Journal.. 2020; 24:552-560

Adverse childhood experiences and mental health, chronic medical conditions, and development in young children. 2015.

The 1001 Critical Days: the importance of the conception to age two period. 2013. (accessed 26 February 2019)

Risk factors for unfavorable pregnancy outcome in women with adverse childhood experiences. 2014.

Marryat L, Frank J. Factors associated with adverse childhood experiences in Scottish children: a prospective cohort study. British Medical Journal Paediatrics Open.. 2019; 3

Mersky JP, Lee C-TP, Gilbert RM. Client and provider discomfort with an adverse childhood experiences survey. American Journal of Preventive Medicine.. 2019; 57:(2)e51-e58

Better Births Improving outcomes of ma-ternity services in England. A five year forward view for maternity care.: NHSE; 2016

James 0116 SCR and action plan. The Gloucester-shire Safeguarding Children Board. 2019. (accessed 30 July 2019)

Nowell LS, Norris JM, White DE, Moules NJ. Thematic analysis: striving to meet the trustworthiness criteria. In-ternational Journal of Qualitative Methods.. 2017; 16:1-13

Nguyen MW, Heberlein E, Covington-Kolb S, Gerstner AM, Gaspard A, Eichelberger KY. Assessing adverse childhood experiences during pregnancy: evidence toward a best practice. American Journal of Perinatology Reports.. 2019; 9:(1)e54-e59

Oh DL, Jerman P, Marques SS, Koita K, Boparai SKP, Burke Harris N, Bucci M. Systematic review of pediatric health outcomes associated with childhood adversity. BMC Pedi-atrics.. 2018; 18

Olander EK, Darwin ZJ, Atkinson L, Smith DM, Gardner B. Beyond the “teachable moment” – a conceptual analy-sis of women's perinatal behaviour change. Women and Birth.. 2016; 29:e67-e71

Olson JM. Integrative review of pregnancy health risks and outcomes associated with Adverse Childhood Experiences. Journal of Obstetric, Gynecologic and Neonatal nursing.. 2018; 47:(6)783-794

Panisch LS, LaBrenz CA, Lawson J, Gerlach B, Tennant PS, Nulu S, Faulkner M. Relationships between adverse child-hood experiences and protective factors among parents at-risk for child maltreatment. Children and Youth Services Review.. 2020; 110

Pechtel P, Pizzagalli DA. Effects of early life stress on cogni-tive and affective function: an integrated review of human literature. Psychopharmacology.. 2011; 214:55-70

Routine Enquiry about Adverse child-hood experiences. Implementation pack pilot evaluation (final report). 2018. (accessed 8 July 2020)

Racine NM, Madigan SL, Plamondon AR Differential as-sociations of adverse childhood experiences on maternal health. American Journal of Preventative Medicine.. 2018; 54:368-375

Romanowicz M. Adverse childhood experiences and father-hood: a systematic review of published reports. Jour-nal of the American Academy of Child and Adolescent Psychiatry.. 2019; 58

Rariden C, SmithBattle L, Hye Yoo J, Cibulka N, Loman D. Screening for Adverse Childhood Experiences: Litera-ture Review and Practice Implications. The Journal for Nurse Practitioners.. 2020;

Salmon D, Baird KM, White P. Women's views and experi-ences of antenatal enquiry for domestic abuse during pregnancy. Health Expectations.. 2015; 18:867-878

Schofield TJ, Lee RD, Merrick MT. Safe, stable, nurturing relationships as a moderator of intergenerational continuity of child maltreatment, a meta-analysis. Journal of Adoles-cent Health.. 2013; 53:S32-S38

Sidebotham P, Brandon M, Bailey S, Belderson P, Dodsworth J, Garstand J, Harrison E, Retzer A, Sorenson P. Pathways to harm, pathways to pro-tection: a triennial analysis of serious case reviews 2011 to 2014.: Department for Education; 2016

Skjothaug T, Smith L, Wentzel-Larsen T, Moe V. Prospective fathers' adverse childhood experiences, pregnancy related anxiety and depression during pregnancy. Infant Mental Health Journal.. 2015; 36:104-113

Smith MV, Gotman N, Yonkers KA. Early childhood adversity and pregnancy outcomes. Maternal and Child Health Jour-nal.. 2016; 20:(04)790-798

Identifying adverse childhood experiences in maternity services

02 February 2021
Volume 29 · Issue 2



Maternity services have a unique opportunity to support women and families to build resilience and mitigate against the harmful impact of parental exposure to adverse childhood experiences (ACEs) but, most importantly, to prevent exposure to ACEs in future generations.


To identify ACEs in families who use maternity services in order to improve the professional response to risk, build parental resilience and strengthen parenting capacity.


A quality improvement project piloted an ACEs screening tool with 44 women and their partners when booking for maternity services. Implementation was supported by the development of a range of bespoke tools. Evaluation took place through quantitative data analysis and qualitative feedback from professionals and parents.


The use of the ACEs screening tool successfully identified ACEs which would otherwise not have been known using the previous antenatal booking questions. The bespoke tool kit was well-received by women, their partners and professionals. Identification and discussion of ACEs enabled appropriate support to be offered.


Identifying ACEs in maternity services and offering additional support requires further work before wider implementation. These interventions have the potential to reduce risk, build resilience and strengthen parenting capacity which could protect infants from experiencing a cycle of adversity.

The aim of the project was to introduce into maternity services a screening tool for women and their partners at booking, in order to identify adverse childhood exper iences (ACEs) and improve professional response to risk, build parental resilience and strengthen parenting capacity.

Analysis of serious case reviews (SCR) has shown that the largest proportion of non-accidental incidents involving significant harm, maltreatment or death, occur in the youngest children (Sidebotham et al, 2016; Brandon et al, 2020). In the most recent triennial review of a total of 368 SCRs from 2014–2017, 42% (154) involved children aged under one year (Brandon et al, 2020). Serious and sometimes fatal maltreatment may take place within the family, with children living at home, or with relatives at the time of the injury (Brandon et al, 2020).

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