Association of Adverse Childhood Experiences with Fear of Childbirth and Prenatal Attachment Among Pregnant Women: A Cross-Sectional Study

Background/Objectives: Adverse childhood experiences (ACEs) may be associated with psychological responses during pregnancy. This study examined the associations of ACEs with fear of childbirth and prenatal attachment, accounting for measured sociodemographic and obstetric characteristics. Methods: This cross-sectional study included 537 pregnant women attending an obstetrics and gynecology outpatient clinic in Istanbul, Türkiye, between June and December 2022. Data were collected using a Personal Information Form, the Adverse Childhood Experiences Scale, the Wijma Delivery Expectancy/Experience Questionnaire-A (W-DEQ-A), and the Prenatal Attachment Inventory (PAI). Analyses included group comparisons, Spearman correlations, and multivariable regression with sensitivity analyses. Results: The mean maternal age was 28.1 ± 4.47 years; 43.8% had a university education, 36.9% were employed, and 74.3% reported a planned pregnancy. Higher ACE scores were associated with greater fear of childbirth in the fully adjusted model (B = 2.430, β = 0.154, 95% CI: 1.102–3.758, p < 0.001), with a consistent association in the minimally adjusted model. ACE scores were not significantly associated with prenatal attachment in the fully adjusted model (B = 0.375, β = 0.054, p = 0.206). In secondary exploratory analyses, unplanned pregnancy was associated with lower PAI scores compared with planned pregnancy (B = −3.905, 95% CI: −5.855–−1.955, p < 0.001). Conclusions: Higher ACE scores were associated with greater fear of childbirth, whereas no statistically significant association with prenatal attachment was observed after adjustment. These findings support consideration of trauma-informed antenatal care but do not establish causality or demonstrate the benefit of routine ACE screening.