Background & Specific Aims: Preterm delivery (PTD), the birth of an infant occurring prior to 37 weeks of gestation, is one of the leading causes of infant mortality in the United States and of significant concern for child and maternal well-being. Moreover, significant racial and socioeconomic disparities in PTD have persisted for over 30 years. Life stressors are hypothesized as one pathway through which PTD disparities may be influenced. Specifically, adverse childhood experiences (ACEs), adverse life events occurring in the first 18 years of life, are a type of life stressor with repercussions for pregnancy and reproductive health. While foundational research has demonstrated that ACEs can negatively impact pregnancy health and birth outcomes, few studies have 1) assessed the influence of ACEs on PTD by race and socioeconomic status (SES) subgroups using diverse, nationally representative longitudinal datasets 2) assessed whether specific ACEs, or co-occurring patterns of certain ACEs, exert greater detrimental effects on PTD risk than others or 3) examined the role that potential protective factors play to buffer against the risk of ACEs on PTD. These gaps prevent a complete understanding of how the interplay between adverse life stressors and protective factors may influence disparities in PTD. Acknowledging these gaps, this dissertations aims to 1) Determine the association between specific ACEs and PTD and evaluate whether this relationship differs across race and SES; 2) Identify subgroups of women characterized by early life patterns of ACEs and determine the association between subgroup membership and PTD; 3) Examine the role that potential protective factors (i.e., religiosity (R) and spirituality (S)) play in the association between ACEs and PTD, and whether these factors operate differently by race and SES. Methods: I used data on n=3,884 and n=3,767 women from the National Longitudinal Study of Adolescent to Adult Health (Add Health; 1994-2018), a nationally representative study which examines the influences on adolescent health and their development into adulthood. Data on six ACEs (sexual, physical, and emotional abuse; neglect; family member suicide or death; foster care placement), race, SES, R, S, and a composite variable of R and S (R/S), were collected via self-report. I used 1) logistic regression to assess the association between specific ACEs and PTD and 2) latent class methods to identify underlying classes based on patterns of ACEs, assess the relationship between latent class membership and PTD, and determine whether R, S, and R/S modified the relationship between latent class membership and PTD. Results: There were no statistically significant associations between any of the six ACEs and PTD among women overall. Two latent classes of ACEs were identified (high ACEs and low ACEs) but neither were associated with PTD. While R, S, and R/S modified the association between latent class membership and PTD, these factors were not protective against PTD amongst women in the high ACEs class. Finally, race and SES did not play an overall significant role in the relationships between ACEs, PTD, R, S, and R/S. Conclusion: This body of work suggests that ACEs may not impact PTD in hypothesized ways in this sample of women. This work also contributes to an improved understanding of how religiosity and spirituality may not operate equally for all women in all contexts of adversity, highlighting the need to consider adversity thresholds in clinical interventions. Future research should assess how factors such as maternal age and prevalence of ACEs among women who do not have live birth pregnancies may influence the relationship between ACEs and PTD and disparities by race and socioeconomic status.
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