What does measuring resilience tell us about pregnant women who have experienced ACEs? For one thing, it affirms that understanding how a mom-to-be weathers difficult experiences gives greater meaning to her ACE score and what it might mean for her children.

That was one of the takeaways from a recent study in the Journal of Women’s Health entitled  “Adverse Childhood Experiences and Mental and Behavioral Health Conditions During Pregnancy: The Role of Resilience,” says Dr. Carey Watson, one of the authors.

“Women who have ACEs are more likely to have depressive symptoms than women who have no reported ACEs,” says Watson, a physician in Obstetrics & Gynecology at Kaiser Medical Center in Antioch, Calif. “When you add resilience, women who have low resilience and ACEs are the ones who are most likely to experience depressive symptoms.”

But another finding in the study puts the question of resilience even more central. The study found that women with no ACEs but with low resilience have more depressive symptoms than those with high ACEs and high resilience, according to Watson.

“Maybe, in some instances, resilience is more significant than ACEs,” says Watson. “I don’t know the answer to that, but it’s a question that opens the door for a lot more discussion about how to screen for health and wellbeing, and fostering resilience might be one of the most helpful things we can do to support healthy pregnancies and families.”

Watson says all this with the caveat that the study that she and her colleagues conducted was a small sample. It’s the companion study to an earlier one that was testing the feasibility of screening for ACEs for pregnant women and their health care providers. In thatthey learned that a full 85 percent of the 355 patients queried agreed or strongly agreed that it was a good thing for doctors to ask their patients about their history of childhood adversity and resilience. The health care providers who participated had similarly positive reactions to discussing ACEs and resilience with their patients. (Here’s a link to a story about the first study.)

In these related studies, 355 prenatal patients who visited Kaiser medical centers in Richmond and Antioch, Calif over a four-month period in 2016 were asked to fill out ACEs and resilience surveys. Some 54% had 0 ACEs, 18% had 1 ACE, 10% of the moms-to-be had  experienced 2 ACEs and 18% had experienced 3 or more ACEs. The prenatal patients also filled out the Connor-Davidson 10-item resilience screener It asks participants to rate their ability to feel better after experiencing a difficult situation, how flexible to change they are, and whether they tend to find a humorous way to view their problems, according to the report.

Another big takeaway for Watson is how adding resilience changed the nature of the interaction for the doctors, nurses and midwives who participated in the study.

“We all felt that including resilience was really valuable; we got a lot of feedback that it created a more positive and helpful conversation,” says Watson. “It does shape the conversation in a more positive way to make it future focused and empowering.”

While participants reported that they appreciated being asked about ACEs and resilience and talking about it with their doctor, less clear to Watson and her colleagues is why almost none of their patients used any of the many supportive resources made available to them. Those resources, explains Watson, include  mental health referrals, health education about anxiety and depression, podcasts, and books. And Watson and her colleagues would like to know why.

“What resources did you actually use? Did you throw it all away? What resources do you wish you would have been offered?” says Watson, listing examples of questions they want to ask patients.

 Watson thinks an aversion to mental health services might be part of it. “I think that one of the reasons is of course, stigma,” she suggests. But practical reasons might also play a role. “Many of my patients are working or taking care of children, so making time for another appointment is hard. It may not happen unless they think whatever is going on is life threatening.”

In fact, looking deeper into what patients want in the way of support will be part of a larger study that she and her colleagues will be pursuing in 2019.

”Often people do research in a silo and don’t really get a patient perspective. Most of us doing this work feel that the patient perspective is very valuable, because we’re trying to translate the original ACE Study from the 1990s into something that’s useful and practical and helpful,” says Watson.  “Not just for outcomes, but really to help interrupt the intergenerational cycle of ACEs.”