From Trauma to Prevention: Why Tackling ACEs Is the Next Frontier in Reducing Maternal and Infant Mortality

At a recent UCLA event, California’s Surgeon General Dr. Diana Ramos made a powerful statement: “We have to remember what happens in childhood does not stay in childhood. It shapes our biology, our behavior, and our health outcomes across the lifespan.”

Dr. Ramos was speaking about Adverse Childhood Experiences (ACEs)—childhood exposure to abuse, neglect, family instability, or violence—and their profound impact on pregnancy and maternal health. Her message carries implications far beyond California: if we want to improve both maternal and infant outcomes, we must confront how trauma travels across generations.

ACEs, Epigenetics, and the Multi-Generational Ripple

Decades of research confirm what Dr. Ramos described. Chronic stress and unaddressed trauma don’t vanish when someone becomes an adult; they can alter hormone regulation, immune response, and even gene expression. These epigenetic changes can influence fetal development, leading to higher rates of hypertension, preterm birth, and low birth weight—conditions that not only endanger mothers but also increase an infant’s risk for Sudden Unexpected Infant Death (SUID).

This is what Dr. Ramos calls the multi-generational nature of maternal health: helping one pregnant person means improving the well-being of the next generation. But to make that vision real, we have to connect systems that have long operated in silos—maternal care, mental health, and infant-safety education.

Connecting Maternal Morbidity and Infant Mortality

The data tells a stark story.

  • Black women are three times more likely to die from pregnancy-related causes than white women.
  • Black infants die at nearly three times the rate from SUID.
  • Preterm babies, often born to mothers with untreated stress or chronic illness, are up to five times more likely to die from SUID than full-term infants.

These aren’t separate crises; they are part of a shared cycle of inequity rooted in trauma, toxic stress, and limited access to preventive care.

Dr. Ramos’s Preconception Medical Assessment (PreMA) initiative offers one model for breaking that cycle—screening women for risk factors early and connecting them with resources before pregnancy complications occur. Prevention, she emphasized, is “health care at its most powerful.”

At First Candle, we see that same principle play out in our Let’s Talk Community Chats—a trauma-informed, community-led model designed to reach families before tragedy strikes.

 

Meeting Families Where They Are

Through Let’s Talk, trusted community members—doulas, lactation consultants, grandparents, and fathers—host informal conversations in places where families already gather: laundromats, WIC clinics, churches, retail stores, and NICUs. These are safe spaces to discuss safe sleep, breastfeeding, and mental-health stressors without fear of judgment.

The outcomes speak volumes:

  • 98 % of participants report feeling comfortable with facilitators.
  • 100 % say they gained confidence in safe-sleep practices.
  • 70 % report adopting safer behaviors such as removing soft objects from sleep areas.

In the NICU setting, where preterm infants are especially vulnerable, parents say these sessions “helped put my mind at ease” and “confirmed what I needed to do to keep my baby safe.”

When families are heard and supported, they act on life-saving information.

A National Call for an ACE-Informed Approach

Dr. Ramos’s message to future clinicians and policymakers—“If we all integrated the recognition of ACEs in our health encounters, imagine the healing we could start”—should become a national imperative.

To close the gaps between maternal morbidity and infant mortality, states and health systems must:

  • Integrate ACE screening and trauma-informed care into prenatal and postnatal services.
  • Train all perinatal providers—from OB-GYNs to home-visiting nurses—in how trauma and stress influence pregnancy and infant outcomes.
  • Embed culturally responsive, community-rooted programs like Let’s Talk within hospitals, WIC centers, and NICUs.
  • Invest in upstream prevention, not just emergency response.

Breaking the Cycle, Together

As Dr. Ramos reminded us, losing one mother—or one baby—is one too many. Addressing ACEs is not a peripheral issue; it’s central to preventing both maternal and infant deaths.

By bringing trauma-informed prevention into every stage of care—from preconception through infancy—we can finally begin to break a cycle that has persisted for generations.

Because when we help mothers heal, we help babies thrive.
And when we confront trauma with compassion, we build the foundation for healthier families and stronger communities.