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. To investigate the association of the clusters of ACEs with MP and UWP, while also examining the mediating effect of education years. A retrospective cohort study among 7652 postpartum women in Chiba, Japan. 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. 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. 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.

中文翻译：

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受教育年限介导不良童年经历与意外怀孕之间的关联：日本的一项基于人群的研究

不良童年经历 (ACE) 与意外怀孕有关，包括不合时宜的怀孕 (MP) 和意外怀孕 (UWP)。然而，目前尚不清楚哪一组 ACE（即儿童虐待/家庭功能障碍和剥夺/威胁）与 MP/UWP 相关，以及受教育年限是否介导这些关联。调查 ACE 簇与 MP 和 UWP 的关联，同时还检验教育年限的中介作用。一项针对日本千叶县 7652 名产后妇女的回顾性队列研究。 MP/UWP 是通过确认怀孕时的情绪反应来定义的。使用多个估算数据集的多项逻辑回归分析通过累积分数和每组 ACE 估计 MP/UWP 的相对风险比 (RRR)。因果中介分析评估了受教育年限的间接影响。具有 4 个或更多 ACE 的女性患 MP 的风险高出 2.4 倍（95% 置信区间 (CI)：1.6–3.8），患 UWP 的风险高出 5.0 倍（95% CI：3.1–8.2）。在 ACE 集群中，有 3 次或更多家庭功能障碍与 MP 的关联最强（RRR：1.91，95 % CI：1.23-2.95），有 3 次或更多的剥夺与 UWP 的关联最强（RRR：3.69，95 % CI：1.23-2.95） ：2.00–6.83）。教育年限分别介导总 ACE 与 MP/UWP 之间关联的 16% 和 11%，在每个聚类中观察到类似的趋势。不仅 ACE 得分，每个 ACE 簇都与 MP 和 UWP 相关。受教育年限的中介效应不大。