Association of maternal exposure to childhood abuse with elevated risk for autism in offspring

"I Just Wouldn't Like Him to go Through What I Went Through as a Kid": A Qualitative Study on the Mitigating Effects of Positive Childhood Experiences in Mothers with a History of Adverse Childhood Experiences in an Irish Population

Adverse Childhood Experiences (ACEs) are increasingly being acknowledged as a major risk factor for instigating and sustaining cycles of trauma between mother and child. Recently, the concept of Benevolent Childhood Experiences (BCEs) has been introduced to ACEs research as a buffer against the transmission of ACEs between generations. Positive childhood experiences such as attachment to caregivers, positive peer relations and positive sense of self have been found to counteract the effects of adverse childhood experiences. The emergence of positive childhood experiences as an adaptive capacity against ACEs should be explored as a tool for psychological change, to help break the cycle of inherited trauma between generations. The present study aims to examine the lived experiences of mothers with a history of ACEs, if they consider their positive childhood experiences when parenting, and how they use these positive experiences to break the cycle of intergenerational trauma. Three women residing in a low-support service for parenting were recruited for this study. Participants were all low-income, first-time single mothers in their early thirties. A qualitative approach was designed for the study. ACEs and BCEs questionnaires were administered to participants and scores were taken into account to contextualise participant interviews. A semi-structured interview was designed in accordance with IPA guidelines. Questions were directed towards phenomenological material, focusing on participants' understanding of their experiences as mothers. Analysis of the interview data revealed three superordinate themes (replicating positive experiences, creating new positive experiences and protecting children from intergenerational trauma) related to participants' BCEs, their children's BCEs and their desire to break the cycle of intergenerational trauma. The findings of this study, namely that participants intentionally tried to create positive experiences with their own children through drawing on their own positive experiences in childhood, supports the idea that BCEs are a legitimate source of adaptive capacity for mothers with ACEs. Parenting interventions for parents with ACEs should be developed taking into account ACE and BCE scores.

Microbial reconstitution reverses prenatal stress-induced cognitive impairment and synaptic deficits in rat offspring

Stress during pregnancy is often linked with increased incidents of neurodevelopmental disorders, including cognitive impairment. Here, we report that stress during pregnancy leads to alterations in the intestinal flora, which negatively affects the cognitive function of offspring. Cognitive impairment in stressed offspring can be reproduced by transplantation of cecal contents of stressed pregnant rats (ST) to normal pregnant rats. In addition, gut microbial dysbiosis results in an increase of β-guanidinopropionic acid in the blood, which leads to an activation of the adenosine monophosphate-activated protein kinase (AMPK) and signal transducer and activator of transcription 3 (STAT3) in the fetal brain. Moreover, β-guanidinopropionic acid supplementation in pregnant rats can reproduce pregnancy stress-induced enhanced glial differentiation of the fetal brain, resulting in impaired neural development. Using probiotics to reconstruct maternal microbiota can correct the cognitive impairment in the offspring of pregnant stressed rats. These findings suggest that microbial reconstitution reverses gestational stress-induced cognitive impairment and synaptic deficits in male rat offspring.

Childhood abuse and perinatal outcomes for mother and child: A systematic review of the literature

Childhood abuse can have long-term adverse outcomes in adulthood. These outcomes may pose a particular threat to the health and well-being of perinatal women; however, to date, this body of knowledge has not been systematically collated and synthesized. This systematic review examined the child abuse literature and a broad range of perinatal outcomes using a comprehensive search strategy. The aim of this review was to provide a clearer understanding of the distinct effect of different abuse types and areas where there may be gaps in our knowledge. Following PRISMA guidelines, EBSCO, PsychInfo, Scopus, Medline, CINAHL, PubMed, and Google Scholar databases and gray literature including preprints, dissertations and theses were searched for literature where childhood abuse was associated with any adverse perinatal outcome between 1969 and 2022. Exclusion criteria included adolescent samples, abuse examined as a composite variable, editorials, letters to the editor, qualitative studies, reviews, meta-analyses, or book chapters. Using an assessment tool, two reviewers extracted and assessed the methodological quality and risk of bias of each study. From an initial 12,384 articles, 95 studies were selected, and the outcomes were categorized as pregnancy, childbirth, postnatal for the mother, and perinatal for mother and child. The prevalence of childhood abuse ranged from 5-25% with wide variability (physical 2-78%, sexual 2-47%, and emotional/psychological 2-69%). Despite some consistent findings relating to psychological outcomes (i.e., depression and PTSD), most evidence was inconclusive, effect sizes were small, or the findings based on a limited number of studies. Inconsistencies in findings stem from small sample sizes and differing methodologies, and their diversity meant studies were not suitable for a meta-analysis. Research implication include the need for more rigorous methodology and research in countries where the prevalence of abuse may be high. Policy implications include the need for trauma-informed care with the Multi-level Determinants of Perinatal Wellbeing for Child Abuse Survivors model a useful framework. This review highlights the possible impacts of childhood abuse on perinatal women and their offspring and areas of further investigation. This review was registered with PROSPERO in 2021 and funded by an internal grant from Charles Sturt University.

Anti-angiogenic mechanisms and serotonergic dysfunction in the Rgs2 knockout model for the study of psycho-obstetric risk

Psychiatric and obstetric diseases are growing threats to public health and share high rates of co-morbidity. G protein-coupled receptor signaling (e.g., vasopressin, serotonin) may be a convergent psycho-obstetric risk mechanism. Regulator of G Protein Signaling 2 (RGS2) mutations increase risk for both the gestational disease preeclampsia and for depression. We previously found preeclampsia-like, anti-angiogenic obstetric phenotypes with reduced placental Rgs2 expression in mice. Here, we extend this to test whether conserved cerebrovascular and serotonergic mechanisms are also associated with risk for neurobiological phenotypes in the Rgs2 KO mouse. Rgs2 KO exhibited anxiety-, depression-, and hedonic-like behaviors. Cortical vascular density and vessel length decreased in Rgs2 KO; cortical and white matter thickness and cell densities were unchanged. In Rgs2 KO, serotonergic gene expression was sex-specifically changed (e.g., cortical Htr2a, Maoa increased in females but all serotonin targets unchanged or decreased in males); redox-related expression increased in paraventricular nucleus and aorta; and angiogenic gene expression was changed in male but not female cortex. Whole-cell recordings from dorsal raphe serotonin neurons revealed altered 5-HT1A receptor-dependent inhibitory postsynaptic currents (5-HT1A-IPSCs) in female but not male KO neurons. Additionally, serotonin transporter blockade by the SSRI sertraline increased the amplitude and time-to-peak of 5-HT1A-IPSCs in KO neurons to a greater extent than in WT neurons in females only. These results demonstrate behavioral, cerebrovascular, and sertraline hypersensitivity phenotypes in Rgs2 KOs, some of which are sex-specific. Disruptions may be driven by vascular and cell stress mechanisms linking the shared pathogenesis of psychiatric and obstetric disease to reveal future targets.

Association of Preconception or Antepartum Maternal Intimate Partner Violence with Autism Spectrum Disorder in 3-Year-Old Offspring: The Japan Environment and Children's Study

Objective: We investigated the association between maternal antepartum intimate partner violence (IPV) and autism spectrum disorder (ASD) in 3-year-old offspring. Materials and Methods: Secondary analysis of the Japan Environment and Children's Study, a nationwide prospective birth-cohort study, for preconceptional and antepartum psychological/physical IPV against mothers was undertaken based on data obtained from a maternal self-report questionnaire. Subgroup analysis by four-level IPV frequency versus no IPV was conducted, and the incidence of ASD diagnosed during ages 2-3 years was estimated using self-reported questionnaire data of participants from when the child was 3 years old. Multivariate logistic regression was used to determine the association of preconceptional/antepartum IPV with ASD in 3-year-old offspring. Results: Among 79,324 offspring, 355 (0.45%) had ASD; preconceptionally and prenatally, 1,504 (1.9%) and 839 (1.1%) mothers were exposed to physical IPV whereas 9,162 (11.6%) and 10,240 (12.9%) mothers were exposed to psychological IPV, respectively. Multivariate logistic regression revealed a significant association of preconceptional physical IPV with ASD in offspring (adjusted odds ratio, 3.21; 95% confidence interval, 1.24-8.31), but not for antepartum physical IPV and preconceptional and antepartum psychological IPV. Conclusion: Preconceptional, but not antepartum, physical IPV was associated with ASD in 3-year-old offspring. Preconceptional and antepartum psychological IPV was unassociated with ASD in 3-year-old offspring. Preconceptional care through prevention of preconceptional physical IPV is important for neurodevelopment in offspring, and the mechanisms underlying the effects of IPV among nonpregnant individuals on ASD development in offspring should be elucidated.

Developmental Neuroendocrinology of Early-Life Stress: Impact on Child Development and Behavior

Our internal balance, or homeostasis, is threatened or perceived as threatened by stressful stimuli, the stressors. The stress system is a highly conserved system that adjusts homeostasis to the resting state. Through the concurrent activation of the hypothalamic-pituitary-adrenal axis and the locus coeruleus/norepinephrine-autonomic nervous systems, the stress system provides the appropriate physical and behavioral responses, collectively termed as "stress response", to restore homeostasis. If the stress response is prolonged, excessive or even inadequate, several acute or chronic stress-related pathologic conditions may develop in childhood, adolescence and adult life. On the other hand, earlylife exposure to stressors has been recognized as a major contributing factor underlying the pathogenesis of non-communicable disorders, including neurodevelopmental disorders. Accumulating evidence suggests that early-life stress has been associated with an increased risk for attention deficit hyperactivity disorder and autism spectrum disorder in the offspring, although findings are still controversial. Nevertheless, at the molecular level, early-life stressors alter the chemical structure of cytosines located in the regulatory regions of genes, mostly through the addition of methyl groups. These epigenetic modifications result in the suppression of gene expression without changing the DNA sequence. In addition to DNA methylation, several lines of evidence support the role of non-coding RNAs in the evolving field of epigenetics. In this review article, we present the anatomical and functional components of the stress system, discuss the proper, in terms of quality and quantity, stress response, and provide an update on the impact of early-life stress on child development and behavior.

Environmental Influences on Individuals with Autistic Spectrum Disorders with Special Emphasis on Seasonality: An Overview

This paper offers an in-depth exploration of the intricate relationship between environmental factors and autism spectrum disorder (ASD), with a special emphasis on seasonality. It reviews existing research, providing a comprehensive summary of findings and highlighting the multifaceted dimensions of several environmental factors influencing the etiology of ASD. The discussion encompasses various elements, including birth months, maternal health, dietary choices, and vitamin D deficiency, delving into the intricate interplay of seasonality with environmental influences such as viral infections and solar radiation. The present study raises essential questions regarding the timing of environmental influences and the factors contributing to the rising prevalence of ASD. Ultimately, it underscores the need for future epidemiological research to incorporate more extensive investigations of environmental risk factors and employ advanced statistical analyses. This comprehensive overview contributes to a deeper understanding of how environmental factors, particularly seasonality, may be linked to the occurrence of ASD and its increasing prevalence, recognizing the multifaceted and diverse nature of these interactions.

Autism Spectrum Disorder in Children with an Early History of Paediatric Acquired Brain Injury

Autism spectrum disorder (ASD) is a neurodevelopmental condition that arises from a combination of both genetic and environmental risk factors. There is a lack of research investigating whether early acquired brain injury (ABI) may be a risk factor for ASD. The current study comprehensively reviewed all hospital records at The Brain Injury Service, Kids Rehab at the Children's Hospital at Westmead (Australia) from January 2000 to January 2020. Of the approximately 528 cases, 14 children with paediatric ABI were subsequently given an ASD diagnosis (2.7%). For this ASD sample, the mean age at the time of the ABI was 1.55 years, indicating a high prevalence of early ABI in this diagnostic group. The mean age of ASD diagnosis was, on average, 5 years later than the average ASD diagnosis in the general population. Furthermore, 100% of children had at least one medical comorbidity and 73% had three or more co-occurring DSM-5 diagnoses. Although based on a small data set, results highlight early paediatric ABI as a potential risk factor for ASD and the potential for a delayed ASD diagnosis following early ABI, with comorbidities possibly masking symptoms. This study was limited by its exploratory case series design and small sample size. Nonetheless, this study highlights the need for longitudinal investigation into the efficacy of early screening for ASD symptomatology in children who have sustained an early ABI to maximise potential intervention.

The Relationship between Maternal Antibodies to Fetal Brain and Prenatal Stress Exposure in Autism Spectrum Disorder

Environmental and genetic factors contribute to the etiology of autism spectrum disorder (ASD), but their interaction is less well understood. Mothers that are genetically more stress-susceptible have been found to be at increased risk of having a child with ASD after exposure to stress during pregnancy. Additionally, the presence of maternal antibodies for the fetal brain is associated with a diagnosis of ASD in children. However, the relationship between prenatal stress exposure and maternal antibodies in the mothers of children diagnosed with ASD has not yet been addressed. This exploratory study examined the association of maternal antibody response with prenatal stress and a diagnosis of ASD in children. Blood samples from 53 mothers with at least one child diagnosed with ASD were examined by ELISA. Maternal antibody presence, perceived stress levels during pregnancy (high or low), and maternal 5-HTTLPR polymorphisms were examined for their interrelationship in ASD. While high incidences of prenatal stress and maternal antibodies were found in the sample, they were not associated with each other (p = 0.709, Cramér's V = 0.051). Furthermore, the results revealed no significant association between maternal antibody presence and the interaction between 5-HTTLPR genotype and stress (p = 0.729, Cramér's V = 0.157). Prenatal stress was not found to be associated with the presence of maternal antibodies in the context of ASD, at least in this initial exploratory sample. Despite the known relationship between stress and changes in immune function, these results suggest that prenatal stress and immune dysregulation are independently associated with a diagnosis of ASD in this study population, rather than acting through a convergent mechanism. However, this would need to be confirmed in a larger sample.

The relationship between parental adverse childhood experiences and the health, well-being and development outcomes of their children: a systematic review

OBJECTIVES

A growing body of research is emerging regarding the relationship between parental adverse childhood experiences (ACEs) and negative health, well-being and developmental outcomes in their children. This systematic review seeks to understand the relationship between parental ACEs and the health, well-being and developmental outcomes of their children and whether the relationships differ according to the number and type of parental ACEs.

STUDY DESIGN

Systematic review.

METHOD

The review includes articles published between 2000 and 2021 from studies using quantitative longitudinal methods and multivariate analysis to investigate the relationship between parental ACEs and their offspring's outcomes. Relevant studies were identified through a systematic search of five databases and findings synthesised using a narrative synthesis. This review was registered on PROSPERO (CRD42021274068).

RESULTS

Nineteen studies met the inclusion criteria and were included in the review. This resulted in a combined population sample of 124,043 parents and 128,400 children. Diversity in measurement of parental ACE exposure and in the type of ACEs measured within the studies precluded a meta-analysis. Offspring of parents exposed to ACEs had a higher risk of a range of negative health, well-being and developmental outcomes. This relationship differs according to the number and type of parental ACEs, with a positive relationship observed between the number of parental ACEs and the risk of negative health, well-being and development outcomes in their children.

CONCLUSIONS

These findings indicate that screening for parental ACEs by health visitors, midwives and other health or social care staff may identify an at-risk population of infants, children and adolescents and improve child outcomes.

Early Life Stress, Hormones, and Neurodevelopmental Disorders

BACKGROUND

Early life stress (ELS) describes a broad spectrum of adverse and stressful prenatal events, namely, prenatal maternal stress (PMS), or early postnatal events, which can have detrimental long-term influences on the physiology, cognition, and behavior of an individual. There is abundant evidence indicating that ELS exerts its lasting effects on the physical and mental health of the individual, likely acting through a number of mediating mechanisms, including the disruption of developmental programming of the fetus. Neurodevelopmental disorders (NDDs), for example, attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), are a group of conditions that typically manifest during infancy, childhood, or adolescence and are characterized by developmental deficits in various domains.

SUMMARY

The scope of the current mini-review is to provide an up-to-date summary of the findings regarding the association of ELS and NDDs and the possible hormonal mechanisms through which PMS exerts its impact on neurodevelopment. We focus on the available evidence regarding children and adolescents diagnosed with ADHD or ASD. ELS exposure during developmental vulnerability windows may increase the risk for either subclinical neuropsychological alterations or clinical conditions, such as NDDs. In fact, a large body of evidence underlies the association of ELS exposure and increased risk for NDDs in the offspring.

KEY MESSAGES

The majority of data suggest that ELS, including PMS, may be associated with ADHD and ASD in the offspring, although there is no consensus regarding the critical developmental periods. Carefully controlled prospective studies are needed to determine the possible causal processes and mechanisms underlying the association of ELS and NDDs.

Maternal early life stress is associated with pro-inflammatory processes during pregnancy

Early life stress (ELS) is common in the United States and worldwide, and contributes to the development of psychopathology in individuals with these experiences and their offspring. A growing body of research suggests that early life stress may contribute to adverse health partly through modulation of immune (and particularly inflammatory) responses. Therefore, increased maternal prenatal inflammation has been proposed as a mechanistic pathway by which the observed cross-generational effects of parental early life stress on child neuropsychiatric outcomes may be exerted. We examined associations between early life stress and molecular markers of inflammation (specifically pro-inflammatory gene expression and receptor-mediated transcription factor activity) and a commonly studied circulating marker of inflammation (C-Reactive Protein) in a diverse group of women in or near their third trimester of pregnancy, covarying for age, race/ethnicity, BMI, concurrent infection, concurrent perceived stress, and per capita household income. Mothers who experienced higher levels of early life stress had significantly increased pro-inflammatory (NF-κB) and decreased anti-viral (IRF) transcription factor activity. Transcripts that were up or down regulated in mothers with high ELS were preferentially derived from both CD16+ and CD16- monocytes. Early life stress was not associated with elevated CRP. Taken together, these findings provide preliminary evidence for an association between ELS and a pro-inflammatory transcriptional phenotype during pregnancy that may serve as a mechanistic pathway for cross-generational transmission of the effects of early life stress on mental and physical health.

Intergenerational transmission of the effects of maternal exposure to childhood maltreatment in the USA: a retrospective cohort study

BACKGROUND

Childhood maltreatment is associated with adverse health outcomes and this risk can be transmitted to the next generation. We aimed to investigate the association between exposure to maternal childhood maltreatment and common childhood physical and mental health problems, neurodevelopmental disorders, and related comorbidity patterns in offspring.

METHODS

We conducted a retrospective cohort study using data from the Environmental influences on Child Health Outcomes (ECHO) Program, which was launched to investigate the influence of early life exposures on child health and development in 69 cohorts across the USA. Eligible mother-child dyads were those with available data on maternal childhood maltreatment exposure and at least one child health outcome measure (autism spectrum disorder, attention-deficit hyperactivity disorder [ADHD], internalising problems, obesity, allergy, and asthma diagnoses). Maternal history of childhood maltreatment was obtained retrospectively from the Adverse Childhood Experiences or Life Stressor Checklist questionnaires. We derived the prevalence of the specified child health outcome measures in offspring across childhood and adolescence by harmonising caregiver reports and other relevant sources (such as medical records) across cohorts. Child internalising symptoms were assessed using the Child Behavior Checklist. Associations between maternal childhood maltreatment and childhood health outcomes were measured using a series of mixed-effects logistic regression models. Covariates included child sex (male or female), race, and ethnicity; maternal and paternal age; maternal education; combined annual household income; maternal diagnosis of depression, asthma, ADHD, allergy, or autism spectrum disorder; and maternal obesity. Two latent class analyses were conducted: to characterise patterns of comorbidity of child health outcomes; and to characterise patterns of co-occurrence of childhood maltreatment subtypes. We then investigated the association between latent class membership and maternal childhood maltreatment and child health outcomes, respectively.

FINDINGS

Our sample included 4337 mother-child dyads from 21 longitudinal cohorts (with data collection initiated between 1999 and 2016). Of 3954 mothers in the study, 1742 (44%) had experienced exposure to abuse or neglect during their childhood. After adjustment for confounding, mothers who experienced childhood maltreatment were more likely to have children with internalising problems in the clinical range (odds ratio [OR] 2·70 [95% CI 1·95-3·72], p<0·0001), autism spectrum disorder (1·70 [1·13-2·55], p=0·01), ADHD (2·09 [1·63-2·67], p<0·0001), and asthma (1·54 [1·34-1·77], p<0·0001). In female offspring, maternal childhood maltreatment was associated with a higher prevalence of obesity (1·69 [1·17-2·44], p=0·005). Children of mothers exposed to childhood maltreatment were more likely to exhibit a diagnostic pattern characterised by higher risk for multimorbidity. Exposure to multiple forms of maltreatment across all subtypes of maternal childhood maltreatment was associated with the highest risk increases for most offspring health outcomes, suggesting a dose-response relationship.

INTERPRETATION

Our findings suggest that maternal childhood maltreatment experiences can be a risk factor for disease susceptibility in offspring across a variety of outcomes and emphasise the need for policies focusing on breaking the intergenerational transmission of adversity.

FUNDING

Environmental influences on Child Health Outcomes Program, Office of the Director, National Institutes of Health.

Association between previous abortion history and risk of autism spectrum disorders among offspring: a meta-analysis

BACKGROUND

Previous studies have been showed an association between previous abortion history and risk of Autism spectrum disorders (ASD). However, there is still controversy about true effect estimate of the association.

PURPOSE

This meta-analysis aimed to evaluate the association between previous abortion history and the risk of ASD.

METHODS

A systematic search was performed using PubMed, Scopus, and Web of Sciences databases to identify potential studies published until December 2021. The presence of statistical heterogeneity was determined using the I2 value. In the case of substantial heterogeneity, the random-effects model meta-analysis was used to estimate the pooled relative risks. The publication bias was assessed using the Egger and Begg tests.

RESULTS

Thirteen studies with a total of 331,779 children remained in the present meta-analysis. The estimated odds ratio of the risk of ASD associated with previous abortion history was 1.64 (95% confidence interval [CI], 1.28-2.0; I2=61.7%) in adjusted studies and 1.10 (95% CI, 1.01-1.20; I2=0.0%) in crude studies, based on the random effect model. There was moderate heterogeneity in adjusted studies. The p values for Egger and Begg regression among children with ASD were 0.393 and 0.056, respectively.

CONCLUSION

This meta-analysis suggests that children born from mothers with a history of previous abortion have an increased risk of development of ASD compared to children of mothers without a history of previous abortion.

Prenatal, perinatal, postnatal risk factors, and excess screen time in autism spectrum disorder

BACKGROUND

The aim of this study was to investigate pre-, peri-, and postnatal factors, screen time in a group of patients with autism spectrum disorder (ASD) and age and sex-matched clinical controls to evaluate risk factors specific to ASD.

METHODS

The study included 211 ASD patients (177 boys, 34 girls; mean age 44.3 ± 13.0 months) and 241 (190 boys, 51 girls; mean age 44.6 ± 14.1 months) age and sex group matched clinical controls. Non-ASD diagnoses were expressive language disorder (n = 135, 56.0%), intellectual disability (n = 15, 6.2%), attention deficit-hyperactivity disorder (n = 6, 2.4%), oppositional disorder (n = 6, 2.4%), and other behavioral or emotional problems (no diagnosis; n = 79, 32.8%). A sociodemographic data form was used to collect data regarding pre-, peri-, and postnatal factors and total daily screen exposure.

RESULTS

According to our findings, maternal severe psychological stress and depression during pregnancy, and maternal postpartum depression were more frequent in the ASD group (p = 0.005, p = 0.035, and p = 0.001 respectively). There was a statistically significant difference between groups with regards to maternal any medication use during pregnancy (p = 0.004). The mean duration of daily screen exposure was higher in the ASD group (9.90 ± 5.10 h) compared to non-ASD children (4.46 ± 3.40 h; p < 0.001). A ROC curve showed that 8.5 h and above total daily screen exposure (AUC = 0.808 [95% CI: 0.769-0.848], p < 0.001; 55% sensitivity, 90.5% specificity) is likely to be associated with increased risk for ASD.

CONCLUSION

Our study suggests that prenatal maternal psychological stress, prenatal and postpartum depression, and excess exposure to screen might be related to an increased risk for ASD.

A Prospective Cohort Study on the Intergenerational Transmission of Childhood Adversity and Subsequent Risk of Psychotic Experiences in Adolescence

BACKGROUND AND HYPOTHESIS

Previous studies have shown a robust relationship between childhood adversity and subsequent psychotic symptoms. However, the role of familial risk factors underlying this relationship remains largely unclear. Here, we tested whether offspring childhood adversity and postnatal maternal psychopathology mediated the relationship between maternal childhood adversity and offspring psychotic experiences.

STUDY DESIGN

N = 3068 mother-offspring dyads were included. Maternal history of childhood adversity was retrospectively assessed using the Childhood Trauma Questionnaire during pregnancy. Maternal psychopathology was assessed during and after pregnancy. Twenty-four offspring childhood adversities were assessed by maternal interview when the child was 10 years old. Offspring psychotic experiences were examined using self-report at 14 years. Structural equation mediation models were conducted to explore whether maternal postnatal psychopathology and offspring childhood adversities sequentially mediated the relationship between maternal childhood adversity and offspring psychotic experiences. Analyses were adjusted for sociodemographic confounders.

STUDY RESULTS

Maternal history of childhood adversity was associated with offspring childhood adversities (β = 0.12, 95% CI: 0.09 to 0.16). Offspring childhood adversity mediated the association of maternal childhood adversity with offspring hallucinations (βindirect effect = 0.008, 95% CI: 0.002 to 0.014, proportion mediated = 16.3%) and delusions (βindirect effect = 0.006, 95% CI: 0.000 to 0.012, proportion mediated = 13.1%).

CONCLUSIONS

Intergenerational transmission of childhood adversity can be considered of relevance in the etiology of psychosis vulnerability and can potentially serve as a modifiable risk factor.

Intergenerational continuity of parent-child separation among mother-offspring dyads: Implication for child cognitive development in rural China

The labor migration in China often leads to parent-child separation. Research to date has primarily focused on understanding mental and cognitive outcomes for children exposed to parent-child separation, with little consideration for the cumulative effects of intergenerational continuity of parent-child separation. A total of 2729 children between the ages of 4 and 6, along with one parent (primarily mothers, 86.2%) and/or one primary caregiver (if the child is separated from both parents), were recruited in the rural area of Anhui Province, China. A unique subsample of children (n = 249) with persistent experience of parent-child separation or whose mother reported being left behind by her parents during early childhood were enrolled for cognitive assessment. A total of 239 age-, gender- and residence-matched children without any parent-child separation experience were selected as the control group. Child cognitive performance was examined with the Chinese version of the Wechsler Preschool and Primary Scale of Intelligence, Fourth edition (WPPSI-IV). The association between intergenerational continuity of parent-child separation and child cognition was described using multivariate OLS regression models. Compared to mother-offspring dyads without any history of parent-child separation, girls (n = 236/450, 52.4%) who experienced the intergenerational continuity of parent-child separation showed a significant decrease of 5.73 points (95% CI: -9.83, -1.62; p = 0.006) on full-scale intelligence quotient (FSIQ) and a decrease of 5.71 points (95% CI: -9.80, 1.63; p = 0.006) on verbal comprehension index. No similar result was observed in boys. The cumulative effects of parent-child separation among mother-offspring dyads on child cognitive development highlight the need for effective early intervention to break the intergenerational cycle of disadvantage. Sex differences and possible epigenetic mechanisms underlying the intergenerational effects of parent-child separation warrant further investigation.

Mediators and moderators in the relationship between maternal childhood adversity and children's emotional and behavioural development: a systematic review and meta-analysis

Maternal experiences of childhood adversity can increase the risk of emotional and behavioural problems in their children. This systematic review and meta-analysis provide the first narrative and quantitative synthesis of the mediators and moderators involved in the link between maternal childhood adversity and children's emotional and behavioural development. We searched EMBASE, PsycINFO, Medline, Cochrane Library, grey literature and reference lists. Studies published up to February 2021 were included if they explored mediators or moderators between maternal childhood adversity and their children's emotional and behavioural development. Data were synthesised narratively and quantitatively by meta-analytic approaches. The search yielded 781 articles, with 74 full-text articles reviewed, and 41 studies meeting inclusion criteria. Maternal mental health was a significant individual-level mediator, while child traumatic experiences and insecure maternal-child attachment were consistent family-level mediators. However, the evidence for community-level mediators was limited. A meta-analysis of nine single-mediating analyses from five studies indicated three mediating pathways: maternal depression, negative parenting practices and maternal insecure attachment, with pooled indirect standardised effects of 0.10 [95% CI (0.03-0.17)), 0.01 (95% CI (-0.02 to 0.04)] and 0.07 [95% CI (0.01-0.12)], respectively. Research studies on moderators were few and identified some individual-level factors, such as child sex (e.g. the mediating role of parenting practices being only significant in girls), biological factors (e.g. maternal cortisol level) and genetic factors (e.g. child's serotonin-transporter genotype). In conclusion, maternal depression and maternal insecure attachment are two established mediating pathways that can explain the link between maternal childhood adversity and their children's emotional and behavioural development and offer opportunities for intervention.

Adverse Childhood Experiences among Reproductive Age Women: Findings from the 2019 Behavioral Risk Factor Surveillance System

INTRODUCTION

Adverse childhood experiences (ACEs) are associated with many negative health outcomes. Despite this well-documented association, most research on how health conditions affect women's preconception and perinatal health overlooks ACEs.

METHODS

This study analyzes self-reported ACE history and health outcomes among young adults (ages 18-39) using data from the 2019 Behavioral Risk Factor Surveillance System. Our aims were to 1) assess differences by gender in overall ACE scores and specific ACEs; 2) identify trends in women's ACE scores by birth cohort; and 3) estimate the association of ACE scores with health conditions that increase risk for adverse perinatal outcomes.

RESULTS

Findings include that women had higher overall ACE scores than men and that women were more likely to report experiencing seven of the eight ACEs queried. More than 23% of women respondents reported an ACE score of 4+, with a 3-percentage point difference between the youngest and oldest women in our sample. Compared with those reporting zero ACEs, women with four or more ACEs were almost four times as likely to report a history of depression and more than twice as likely to report fair or poor health, even after accounting for sociodemographic characteristics. Women with four or more ACEs were 62% more likely to have obesity, 41% more likely to report a hypertension diagnosis, and 36% more likely to report a diabetes diagnosis than those with zero ACEs.

CONCLUSIONS

ACEs are a root cause in the development of adverse health conditions in young women, and their prevention should be central to policies aimed at improving women and children's well-being.

Adverse Childhood Experiences in Autistic Children and Their Caregivers: Examining Intergenerational Continuity

Although there is an urgent need to develop trauma-informed services for autistic youth, little research has evaluated adverse childhood experiences (ACEs) in autistic youth from an intergenerational perspective. 242 caregivers of autistic (n = 117) and non-autistic (n = 125) youth reported on ACEs that they experienced in their own childhoods and ACEs experienced by their children, as well as measures of depression, stress, and child autistic traits and behavioral concerns. Autistic youth and their caregivers both experienced significantly higher rates of ACEs than the non-autistic dyads. Intergenerational continuity, the association between caregiver and child ACEs, was significantly stronger for autistic youth. ACEs showed differential patterns of associations with parent depressive symptoms and child autistic traits across groups.

Religious or spiritual coping, religious service attendance, and type 2 diabetes: A prospective study of women in the United States

PURPOSE

To investigate religion and spirituality (R/S) as psychosocial factors in type 2 diabetes risk.

METHODS

Using the Nurses' Health Study II, we conducted a 14-year prospective analysis of 46,713 women with self-reported use of religion or spiritual beliefs to cope with stressful situations, and 42,825 women with self-reported religious service attendance, with respect to type 2 diabetes. Cox regression was used to assess the associations.

RESULTS

Compared with not using religious or spiritual coping at all, the fully-adjusted hazard ratios (HR) were minimally different across all categories: a little bit (HR=1.01; 95% CI:0.85, 1.19), a medium amount (HR=0.96; 95% CI:0.80, 1.14), a lot (HR=0.93; 95% CI: 0.77, 1.11) (Ptrend=0.24). Similarly, compared with participants who never or almost never attend religious meetings or services, there were minimal differences with participants attending less than once/month (HR=1.06; 95% CI:0.92, 1.22), 1-3 times/month (HR=1.00; 95% CI:0.85, 1.17), once/week (HR=0.98; 95% CI:0.85, 1.14), more than once/week (HR=1.20; 95% CI:1.01, 1.43) (Ptrend=0.29). Perceived stress did not modify these associations. Our hypothesis of mediated effects through lifestyle factors and social integration was not supported.

CONCLUSIONS

R/S was not significantly associated with type 2 diabetes, but its role in other chronic conditions may be important.

Childhood Abuse and Cognitive Function in a Large Cohort of Middle-Aged Women

Cognitive function at middle age is of particular public health interest, as it strongly predicts later dementia. Children who have experienced abuse subsequently have worse cognitive function than those who have not. However, it remains unclear whether the association of abuse with cognitive function persists into middle age. In 2014-2016, 14,151 women ages 49-69 years who had previously responded to a childhood abuse questionnaire completed a cognitive battery. In models adjusted for childhood socioeconomic status and head trauma, combined physical, emotional, and sexual abuse was associated with lower scores on both Learning/Working Memory (severe abuse, lower scores similar to that observed in women 4.8 years older in our data) and Psychomotor Speed/Attention (severe abuse, lower scores similar to that observed in women to 2.9 years older in our data). Adjustment for adulthood socioeconomic status and health factors (e.g., smoking, hypertension) slightly attenuated associations. In exploratory analyses further adjusted for psychological distress, associations were attenuated. Women exposed versus unexposed to childhood abuse had poorer cognitive function at mid-life. Associations were particularly strong for learning and working memory and were not accounted for by adulthood health factors. Childhood abuse should be investigated as a potential risk factor for cognitive decline and dementia in old age.

Intergenerational Effect of Maternal Childhood Maltreatment on Next Generation's Vulnerability to Psychopathology: A Systematic Review With Meta-Analysis

Many studies have identified the multiple negative consequences of childhood maltreatment on subsequent mental health. However, research on the intergenerational effect of maternal childhood maltreatment has not been systematically synthesized. This meta-analysis aimed to provide a quantitative estimate of the intergenerational effect of maternal childhood maltreatment on their offspring's psychopathology. Electronic databases and gray literature were searched for English-language prospective cohort studies. Two reviewers independently extracted data and assessed study quality with the Newcastle-Ottawa Scale. This review only included those studies with (1) maternal childhood maltreatment occurring prior to 18 years of age, (2) using a clear and reliable assessment for maltreatment exposure and offspring's mental health problems prior to age 18. Random-effect models were used to calculate the pooled effect size of maternal childhood maltreatment on offspring's psychopathology, and meta-regression was used to explore potential confounders. Twelve studies met eligibility criteria. Significant heterogeneity was found across selected studies. Maternal childhood maltreatment was found to have a small but significant effect on the offspring's depression and internalizing behaviors (r = .14, 95% confidence interval [.09, .19]). Two moderators were found, maternal depression and ethnicity. Maternal depression reduced the effect size of maternal maltreatment on offspring's depression and internalizing disorders. The offspring of non-Caucasian mothers who had a history of childhood maltreatment faced a higher risk of mental health problems. There was no evidence of publication bias. This review provides robust evidence to reinforce the need for policies to reduce its occurrence, as it can influence not just one but two or possibly more generations.

Maternal childhood trauma and perinatal distress are related to infants' focused attention from 6 to 18 months

Maternal distress is repeatedly reported to have negative impacts on the cognitive development in children and is linked to neurodevelopmental disorders (e.g. attention-deficit/hyperactivity disorder and autism spectrum disorder). However, studies examining the associations between maternal distress and the development of attention in infancy are few. This study investigated the longitudinal relationships between maternal distress (depressive symptoms, anxiety symptoms, and exposure to childhood trauma) and the development of focused attention in infancy in 118 mother-infant dyads. We found that maternal exposure to non-interpersonal traumatic events in childhood was associated with the less focused attention of the infants to audio-visual stimuli at 6, 10, and 18 months. In addition, exposure to interpersonal traumatic events in childhood was identified as a moderator of the negative effect of maternal anxiety during the 2nd trimester on the development of focused attention in infants. We discuss the possible mechanisms accounting for these cross-generational effects. Our findings underscore the importance of maternal mental health to the development of focused attention in infancy and address the need for early screening of maternal mental health during pregnancy.

Co-occurrence of preconception maternal childhood adversity and opioid use during pregnancy: Implications for offspring brain development

Understanding of the effects of in utero opioid exposure on neurodevelopment is a priority given the recent dramatic increase in opioid use among pregnant individuals. However, opioid abuse does not occur in isolation-pregnant individuals abusing opioids often have a significant history of adverse experiences in childhood, among other co-occurring factors. Understanding the specific pathways in which these frequently co-occurring factors may interact and cumulatively influence offspring brain development in utero represents a priority for future research in this area. We highlight maternal history of childhood adversity (CA) as one such co-occurring factor that is more prevalent among individuals using opioids during pregnancy and which is increasingly shown to affect offspring neurodevelopment through mechanisms beginning in utero. Despite the high incidence of CA history in pregnant individuals using opioids, we understand very little about the effects of comorbid prenatal opioid exposure and maternal CA history on fetal brain development. Here, we first provide an overview of current knowledge regarding effects of opioid exposure and maternal CA on offspring neurodevelopment that may occur during gestation. We then outline potential mechanistic pathways through which these factors might have interactive and cumulative influences on offspring neurodevelopment as a foundation for future research in this area.

Prenatal maternal stress and autistic-like behaviours in Chinese preschoolers

Exposure to prenatal maternal stress (PNMS) has been implicated as a risk factor for a range of psychiatric disorders in children. However, there have been a few studies showing inconsistent associations between PNMS and offspring autistic-like behaviours. We therefore aimed to examine whether trimester-specific PNMS exposure might be related to an increased risk of autistic-like behaviours among preschoolers. Using data from Longhua Children Cohort Study, mothers of 65,931 preschool children were asked to recall their level of PNMS in each of the three trimesters of pregnancy, while children's current autistic-like behaviours were assessed using the Autism Behaviour Checklist. A series of Cox regression models were fitted to assess the association between PNMS exposure and autistic-like behaviours. After adjusting for potential confounders, the Cox regression models showed that PNMS exposure, especially during the second pregnant trimester, was significantly and positively associated with the presence of children's autistic-like behaviours. The strength of these associations was enhanced with the increase of PNMS exposure level. Furthermore, based on different permutations of exposure versus no exposure in each trimester, the participants were divided into eight groups. A cross-over analysis confirmed the aforementioned finding that the second pregnant trimester might be the sensitive period for PNMS exposure increasing the risk of autistic-like behaviours. Our findings supported the hypothesis of an association between PNMS exposure and autistic-like behaviours among preschoolers. Preventive interventions should be trialled to examine whether minimizing maternal psychological stress during pregnancy, especially the second trimester, may reduce the risk of offspring autistic-like behaviours.

Maternal Childhood Adversity as a Risk for Perinatal Complications and NICU Hospitalization

OBJECTIVE

To examine maternal childhood adversity in relation to increased risk for maternal and infant perinatal complications and newborn Neonatal Intensive Care Unit (NICU) admittance.

METHODS

A sample of 164 women recruited at their first prenatal appointment participated in a longitudinal study through 6 weeks postdelivery. Participants self-reported on their adverse childhood experiences (ACEs), negative health risks (overweight/obesity, smoking, and alcohol use), adverse infant outcomes, NICU admittance, and maternal perinatal complications across three pregnancy assessments and one post-birth assessment. Logistic binomial regression analyses were used to examine associations between maternal ACEs and adverse infant outcomes, NICU admittance, and maternal perinatal complications, controlling for pregnancy-related health risks.

RESULTS

Findings showed that women with severe ACEs exposure (6+ ACEs) had 4 times the odds of reporting at least one adverse infant outcome (odds ratio [OR] = 4.33, 95% CI: 1.02-18.39), almost 9 times the odds of reporting a NICU admission (OR = 8.70, 95% CI: 1.34-56.65), and 4 times the odds of reporting at least one maternal perinatal outcome (OR = 4.37, 95% CI: 1.43-13.39).

CONCLUSIONS

The findings demonstrate the extraordinary risk that mothers' ACEs pose for infant and maternal health outcomes over and above the associations with known maternal health risks during pregnancy, including overweight/obesity, smoking, and alcohol use. These results support a biological intergenerational transmission framework, which suggests that risk from maternal adversity is perpetuated in the next generation through biophysical and behavioral mechanisms during pregnancy that negatively affect infant health outcomes.

Schizophrenia: a classic battle ground of nature versus nurture debate

Much has been learned about the etiology and pathogenesis of schizophrenia since the term was first used by Eugene Bleuler over a century ago to describe one of the most important forms of major mental illness to affect mankind. Both nature and nurture feature prominently in our understanding of the genesis of the overall risk of developing schizophrenia. We now have a firm grasp of the broad structure of the genetic architecture and several key environmental risk factors have been identified and delineated. However, much of the heritability of schizophrenia remains unexplained and the reported environmental risk factors do not explain all the variances not attributable to genetic risk factors. The biggest problem at present is that our understanding of the causal mechanisms involved is still in its infancy. In this review, we describe the extent and limits of our knowledge of the specific genetic/constitutional and non-genetic/environmental factors that contribute to the overall risk of schizophrenia. We suggest novel methods may be required to understand the almost certainly immensely complex multi-level causal mechanisms that contribute to the generation of the schizophrenia phenotype.

Polygenic risk for autism, attention-deficit hyperactivity disorder, schizophrenia, major depressive disorder, and neuroticism is associated with the experience of childhood abuse

People who experience childhood abuse are at increased risk of mental illness. Twin studies suggest that inherited genetic risk for mental illness may account for some of these associations. Yet, the hypothesis that individuals who have experienced childhood abuse may carry genetic loading for mental illness has never been tested with genetic data. Using polygenic risk scores for six psychiatric disorders-attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), bipolar disorder (BPD), major depressive disorder (MDD), neuroticism, and schizophrenia-we tested whether genetic risk for mental illness was associated with increased risk of experiencing three types of childhood abuse: physical/emotional abuse, physical assault, and sexual abuse, in a cohort of white non-Hispanic women (n = 11,315). ADHD and MDD genetic risk scores were associated with a higher risk of experiencing each type of childhood abuse, while neuroticism, schizophrenia, BPD, and ASD genetic scores were associated with a higher risk of experiencing physical/emotional abuse and physical assault, but not sexual abuse. Sensitivity analyses examining potential bias from the differential recall of childhood trauma, parental socioeconomic status, and population stratification were consistent with the main findings. A one-standard-deviation increase in genetic risk for mental illness was associated with a modestly elevated risk of experiencing childhood abuse (OR range: 1.05-1.19). Therefore, inherited genetic risk may partly account for the association of childhood abuse with mental illness. In addition, future treatments for mental illness will benefit from taking into consideration the co-occurrence of childhood trauma and genetic loading.

Pregnancy and obstetric complications in women with a history of childhood maltreatment: Results from a nationally representative sample

INTRODUCTION

A history of childhood maltreatment is associated with increased risk of perinatal complications, with research primarily focused on childhood sexual abuse. Limited research has examined the relationship between different types of childhood maltreatment on perinatal complications, particularly in population-based samples.

METHODS

This study examined the association between childhood maltreatment and self-reported perinatal complications in a sample of pregnant and postpartum women (n = 1279) drawn from the 2012-2013 NESARC-III, a nationally representative survey of United States adults.

RESULTS

Nearly half (45%) of pregnant or postpartum women reported at least one form of childhood maltreatment and a quarter (24.6%) of these women experienced a perinatal complication compared to 13.5% of women without a history of childhood maltreatment. Exposure to any childhood maltreatment, childhood sexual abuse and intimate partner violence (IPV) during childhood were significantly associated with increased odds of perinatal complications after adjusting for sociodemographic characteristics and lifetime psychiatric disorders (AOR ranged from 1.87 to 2.09). Experiencing two or more types of childhood maltreatment (compared to none) was also associated with increased odds of perinatal complications (AOR 2.18 [99% CI = 1.22, 3.90]).

CONCLUSIONS

This association may be explained by vulnerability to physical diseases/complications due to persistent changes in biological stress systems, physical injuries from abuse, or as a result of traumatic memories triggered by pregnancy and childbirth. Findings highlight one of many negative sequelae of childhood maltreatment and the importance of promoting healthcare provider awareness of this association so they can provide appropriate interventions when needed.

Bias due to Selection on Live Births in Studies of Environmental Exposures during Pregnancy: A Simulation Study

BACKGROUND

Studies of the effects of prenatal environmental exposures on postnatal outcomes are particularly vulnerable to live birth bias; i.e., the bias that arises from the necessary restriction of the analysis to live births when that is influenced by both the exposure under study A and unmeasured factors U that also affect the outcome.

OBJECTIVES

In the context of a recent publication of nitrogen dioxide (NO2) and autism spectrum disorder (ASD) that found an odds ratio (OR) of 0.77 per 5.85 ppb NO2 during pregnancy, we aimed to examine what parameters would be needed to account for this protective association through live birth bias.

METHODS

We simulated the magnitude of bias under two selection mechanisms and when both mechanisms co-occur, assuming a true null effect. Simulation input parameters were based on characteristics of the original study and a range of plausible values for the prevalence of unmeasured factor U and the ORs for the selection effects (i.e., the effects of NO2 and U on loss and of U on ASD). Each scenario was simulated 1,000 times.

RESULTS

We found that the magnitude of bias was small when NO2 and U independently influenced pregnancy loss (collider-stratification without interaction), was stronger when NO2-induced loss preferentially occurred in U=1 (depletion of susceptibles), and was strongest when both mechanisms worked together. For example, ORs of 3.0 for NO2-loss, U-loss, U-ASD, and U prevalence=0.75 yielded NO2-ASD ORs per 5.85 ppb NO2 of 0.95, 0.89, and 0.75 for the three scenarios, respectively. The bias is amplified with multiple Us, yielding ORs as low as 0.51.

DISCUSSION

Our simulations illustrate that live birth bias may lead to exposure-outcome associations that are biased downward, where the extent of the bias depends on the fetal selection mechanism, the strength of that selection, and the prevalence of U. https://doi.org/10.1289/EHP7961.

microRNAs and Gene-Environment Interactions in Autism: Effects of Prenatal Maternal Stress and the SERT Gene on Maternal microRNA Expression

Background: Genetics and environment both are critical in autism spectrum disorder (ASD), but their interaction (G × E) is less understood. Numerous studies have shown higher incidence of stress exposures during pregnancies with children later diagnosed with ASD. However, many stress-exposed mothers have unaffected children. The serotonin transporter (SERT) gene affects stress reactivity. Two independent samples have shown that the association between maternal stress exposure and ASD is greatest with maternal presence of the SERT short (S)-allele (deletion in the promoter region). MicroRNAs play a regulatory role in the serotonergic pathway and in prenatal stress and are therefore potential mechanistic targets in this setting. Design/methods: We profiled microRNA expression in blood from mothers of children with ASD, with known stress exposure during pregnancy. Samples were divided into groups based on SERT genotypes (LL/LS/SS) and prenatal stress level (high/low). Results: Two thousand five hundred mature microRNAs were examined. The ANOVA analysis showed differential expression (DE) of 119 microRNAs; 90 were DE in high- vs. low-stress groups (stress-dependent). Two (miR-1224-5p, miR-331-3p) were recently reported by our group to exhibit stress-dependent expression in rodent brain samples from embryos exposed to prenatal stress. Another, miR-145-5p, is associated with maternal stress. Across SERT genotypes, with high stress exposure, 20 significantly DE microRNAs were detected, five were stress-dependent. These microRNAs may be candidates for stress × SERT genotype interactions. This is remarkable as these changes were from mothers several years after stress-exposed pregnancies. Conclusions: Our study provides evidence for epigenetic alterations in relation to a G × E model (prenatal maternal stress × SERT gene) in ASD.

Association between Maternal Adverse Childhood Experiences and Attention-Deficit/Hyperactivity Disorder in the Offspring: The Mediating Role of Antepartum Health Risks

Objectives

This study aimed to examine the effect of maternal adverse childhood experiences (ACEs) on the attention-deficit/hyper-activity disorder (ADHD) symptoms in the offspring and to examine the mediating role of antepartum health risk on the intergenera-tional transmission of maternal ACEs.

Methods

The participants consisted of 461 mother-child dyads. Mothers completed the ACEs questionnaire and Diagnostic Predictive Scales. Multivariate logistic regression analysis was used to estimate the risk of ADHD symptoms in the offspring of mothers with ACEs and the mediating effect of antepartum health risks by path analysis.

Results

In all, 35.4% (n=163) had at least one maternal ACE, and 11.1% (n=51) had three or more. Compared to the non-ADHD symp-tom group, the group of offspring with ADHD symptoms showed a significant association with maternal ACE score (p<0.001) and an-tepartum health risks (p<0.001). Multivariate analysis further showed a significant association between the sum of maternal ACEs [odds ratio (OR)=1.264, 95% confidence interval (CI)= 1.060–1.516, p=0.009], antepartum health risks (OR=1.236, 95% CI=1.036–1.475, p= 0.019), and ADHD symptoms in the offspring. In the mediation model in which the mother’s ACE score affected the offspring’s ADHD symptoms, partial mediation through antepartum health risks was found to be significant (B=0.041, 95% CI=0.011–0.124).

Conclusion

Maternal ACEs are significantly related to the incidence of ADHD symptoms in the offspring and antepartum health risks exert an indirect effect. These findings suggest that maternal ACEs have a negative impact on the offspring’s brain development through intergenerational transmission, resulting in neurodevelopmental disorders such as ADHD.

Methodological Issues in Population-Based Studies of Multigenerational Associations

Laboratory-based animal research has revealed a number of exposures with multigenerational effects-ones that affect the children and grandchildren of those directly exposed. An important task for epidemiology is to investigate these relationships in human populations. Without the relative control achieved in laboratory settings, however, population-based studies of multigenerational associations have had to use a broader range of study designs. Current strategies to obtain multigenerational data include exploiting birth registries and existing cohort studies, ascertaining exposures within them, and measuring outcomes across multiple generations. In this paper, we describe the methodological challenges inherent to multigenerational studies in human populations. After outlining standard taxonomy to facilitate discussion of study designs and target exposure associations, we highlight the methodological issues, focusing on the interplay between study design, analysis strategy, and the fact that outcomes may be related to family size. In a simulation study, we show that different multigenerational designs lead to estimates of different exposure associations with distinct scientific interpretations. Nevertheless, target associations can be recovered by incorporating (possibly) auxiliary information, and we provide insights into choosing an appropriate target association. Finally, we identify areas requiring further methodological development.

Maternal exposure to childhood traumatic events, but not multi-domain psychosocial stressors, predict placental corticotrophin releasing hormone across pregnancy

Maternal psychosocial stress increases the risk of adverse birth and postnatal outcomes for the mother and child, but the role of maternal exposure to childhood traumatic events (CTE) and multi-domain psychosocial stressors for the level and rise of placental Corticotrophin-Releasing Hormone (pCRH) across pregnancy has been understudied. In a sociodemographically and racially diverse sample of 1303 women (64% Black, 36% White/others) with low-medical risk pregnancies at enrollment from Shelby County, Tennessee, USA, blood samples were drawn twice, corresponding roughly to second and third trimester, and extracted prior to conducting radioimmune assays for pCRH. Mothers reported CTE (physical abuse, sexual abuse, or family violence, in childhood), adulthood traumatic events, and interpersonal violence during pregnancy. Neighborhood crime/deprivation was derived using geospatially-linked objective databases. General linear and mixed models tested associations between stress exposure variables and pCRH levels and rate of rise, adjusting for obstetric/clinical/health related factors. Maternal CTE did not predict pCRH levels at time 1, but positively predicted levels at time 2, and the rate of rise in pCRH across pregnancy. Race did not moderate this association. No additional maternal stress exposures across adulthood or during pregnancy predicted pCRH outcomes. Findings indicate that childhood violence or abuse exposure can become biologically embedded in a manner predicting later prenatal physiology relevant for maternal and offspring health, and that such embedding may be specific to childhood, but not adulthood, stress. Findings also highlight the placental-fetal unit as a mechanistic pathway through which intergenerational transmission of the adverse effects of childhood adversities may occur.

Intimate Partner Violence: A Risk Factor for Gestational Diabetes

The early detection and management of gestational diabetes mellitus (GDM) is an important public health goal. GDM, which is defined as a glucose intolerance that develops during pregnancy, affects about 14% of pregnancies globally, and without effective treatment, it is associated with adverse short- and long-term maternal and neonatal outcomes. Risk-factor screening is an acceptable and affordable strategy to enable risk stratification and intervention. However, common biological risk factors such as overweight or obesity, excessive gestational weight gain, and family history of diabetes often have poor predictive ability, failing to identify a large proportion of women at risk of developing GDM. Accumulating evidence implicate psychosocial factors in contributing to GDM risk. As such, intimate partner violence (IPV), through its contributing effects on maternal stress and depression, presents a plausible risk factor for GDM. Experiencing IPV during pregnancy may dysregulate the hypothalamus-pituitary-adrenal (HPA) axis, leading to increased cortisol secretion and insulin resistance. These effects may exacerbate the insulin-resistant environment characteristic of pregnancy, thus increasing GDM risk. This review explores the relationship between IPV and GDM. We highlight studies that have linked IPV with GDM and propose a biological mechanism that connects IPV and GDM. Recommendations for IPV screening strategies to prevent GDM are discussed.

Doing things differently: Exploring attachment patterns and parental intentions in families where a child has a diagnosis of autism

The article examines the experience of parenting a child with a diagnosis of autism with a focus on scripts and intentions in relation to the parents' own childhood experiences of being parented. Five parents participated in a multiple case study design involving in-depth interviews, Adult Attachment Interviews and a parenting intentions scaling task. The findings revealed that all of the parents had experienced significant adverse events in their own childhoods, including trauma and losses. They also expressed intentions to offer parenting that was 'corrective' in terms of providing a better emotional environment for their children. Their corrective attempts and also intentions to repeat positive aspects of being parented were moderated by unconscious aspects of their early childhood experiences and also by the autistic features of their children. The interplay between early embodied experiences, theories of autism, parenting experiences and intentions is discussed along with clinical implications.

Childhood maltreatment is associated with changes in mitochondrial bioenergetics in maternal, but not in neonatal immune cells

Childhood maltreatment (CM) comprises experiences of abuse and neglect during childhood. CM causes psychological as well as biological alterations in affected individuals. In humans, it is hardly explored whether these CM consequences can be transmitted directly on a biological level to the next generation. Here, we investigated the associations between maternal CM and mitochondrial bioenergetics (mitochondrial respiration and intracellular mitochondrial density) in immune cells of mothers and compared them with those of their newborns. In n = 102 healthy mother-newborn dyads, maternal peripheral blood mononuclear cells and neonatal umbilical cord blood mononuclear cells were collected and cryopreserved shortly after parturition to measure mitochondrial respiration and intracellular mitochondrial density with high-resolution respirometry and spectrophotometric analyses, respectively. Maternal CM was assessed with the Childhood Trauma Questionnaire Maternal and neonatal mitochondrial bioenergetics were quantitatively comparable and positively correlated. Female newborns showed higher mitochondrial respiration compared to male newborns. Maternal CM load was significantly and positively associated with mitochondrial respiration and density in mothers, but not with mitochondrial respiration in newborns. Although maternal and neonatal mitochondrial bioenergetics were positively correlated, maternal CM only had a small effect on mitochondrial density in newborns, which was not significant in this study after adjustment for multiple comparisons. The biological relevance of our finding and its consequences for child development need further investigation in future larger studies. This study reports data on mitochondrial bioenergetics of healthy mother-newborn dyads with varying degrees of CM.

Perinatal fluoxetine treatment and dams' early life stress history alter affective behavior in rat offspring depending on serotonin transporter genotype and sex

Many women diagnosed with a major depression continue or initiate antidepressant treatment during pregnancy. Both maternal stress and selective serotonin inhibitor (SSRI) antidepressant treatment during pregnancy have been associated with changes in offspring behavior, including increased anxiety and depressive-like behavior. Our aim was to investigate the effects of the SSRI fluoxetine (FLX), with and without the presence of a maternal depression, on affective behavior in male and female rat offspring. As reduced serotonin transporter (SERT) availability has been associated with altered behavioral outcome, both offspring with normal (SERT+/+) and reduced (SERT+/-) SERT expression were included. For our animal model of maternal depression, SERT+/- dams exposed to early life stress were used. Perinatal FLX treatment and early life stress in dams (ELSD) had sex- and genotype-specific effects on affective behavior in the offspring. In female offspring, perinatal FLX exposure interacted with SERT genotype to increase anxiety and depressive-like behavior in SERT+/+, but not SERT+/-, females. In male offspring, ELSD reduced anxiety and interacted with SERT genotype to decrease depressive-like behavior in SERT+/-, but not SERT+/+, males. Altogether, SERT+/+ female offspring appear to be more sensitive than SERT+/- females to the effects of perinatal FLX exposure, while SERT+/- male offspring appear more sensitive than SERT+/+ males to the effects of ELSD on affective behavior. Our data suggest a role for offspring SERT genotype and sex in FLX and ELSD-induced effects on affective behavior, thereby contributing to our understanding of the effects of perinatal SSRI treatment on offspring behavior later in life.

A traumatic life experience in childhood increases the risk of a psychiatric disorder in the offspring

A traumatic life experience in childhood is a fundamental risk factor of numerous psychiatric disorders. Recently, studies try to evaluate the mental health consequences on victims' offspring, but few psychiatric disorders were examined, and whether these results apply to the general population remains unknown. In this study, we use the National Epidemiologic Survey on Alcohol and Related Conditions, a large representative sample of American population, in order to estimate the impact on the offspring of a traumatic experience in parents. Besides, we use a well-known risk factor for offspring's psychiatric disorder: a familial history of a psychiatric disorder, in order to compare and assess the importance of parental traumatism as a risk factor for the offspring. Our results show that the five psychiatric disorders studied, alcohol use disorder, substance use disorder, mood disorder, antisocial personality disorder and anxiety disorder, are more prevalent in the offspring, when at least one parent report a traumatic life event in his own childhood. Moreover, the magnitude of this risk factor is close to the magnitude of having a parental history of psychiatric disorder.

Intergenerational transmission of the effects of maternal exposure to childhood maltreatment on offspring obesity risk: A fetal programming perspective

Childhood obesity constitutes a major global public health challenge. A substantial body of evidence suggests that conditions and states experienced by the embryo/fetus in utero can result in structural and functional changes in cells, tissues, organ systems and homeostatic set points related to obesity. Furthermore, growing evidence suggests that maternal conditions and states experienced prior to conception, such as stress, obesity and metabolic dysfunction, may spill over into pregnancy and influence those key aspects of gestational biology that program offspring obesity risk. In this narrative review, we advance a novel hypothesis and life-span framework to propose that maternal exposure to childhood maltreatment may constitute an important and as-yet-underappreciated risk factor implicated in developmental programming of offspring obesity risk via the long-term psychological, biological and behavioral sequelae of childhood maltreatment exposure. In this context, our framework considers the key role of maternal-placental-fetal endocrine, immune and metabolic pathways and also other processes including epigenetics, oocyte mitochondrial biology, and the maternal and infant microbiomes. Finally, our paper discusses future research directions required to elucidate the nature and mechanisms of the intergenerational transmission of the effects of maternal childhood maltreatment on offspring obesity risk.

Religious Service Attendance, Religious Coping, and Risk of Hypertension in Women Participating in the Nurses' Health Study II

The association between religious service attendance, religious coping, and hypertension is unclear. Prospective research and assessment of potential mediators is needed to understand this relationship. From 2001-2013, we prospectively followed 44,281 nonhypertensive women who provided information on religious service attendance and religious coping in the Nurses' Health Study II. Cox regression and mediation analyses were conducted to assess associations between religion and hypertension. There were 453,706 person-years of follow-up and 11,773 incident hypertension cases. Women who attended religious services were less likely to develop hypertension. In the fully adjusting model, compared with women who never or almost never attend religious meetings or services, women attending less than once per month (hazard ratio (HR) = 0.97, 95% confidence interval (CI): 0.91, 1.03), 1-3 times per month (HR = 0.94, 95% CI: 0.88, 1.00), once per week (HR = 0.93, 95% CI: 0.88, 0.98), or more than once per week (HR = 0.91, 95% CI: 0.86, 0.97) showed a decreased risk of hypertension (P for trend = 0.001). Body mass index was an important mediator (11.5%; P < 0.001). Religious coping had a marginal association with hypertension. In conclusion, religious service attendance was modestly associated with hypertension in an inverse dose-response manner and partially mediated through body mass index. Future research is needed on biological or social reasons for the lower risk of hypertension.

Impact of maternal childhood trauma on child behavioral problems: The role of child frontal alpha asymmetry

Childhood trauma is associated with many long-term negative outcomes, and is not limited to the individual experiencing the trauma, but extends to subsequent generations. However, mechanisms underlying the association between maternal childhood trauma and child psychopathology are not well understood. Here, we targeted frontal alpha asymmetry (FAA) as a potential underlying factor of the relationship between maternal childhood trauma and child behavioral problems. Electroencephalography (EEG) was recorded from (N = 45) children (Mean age = 57.9 months, SD = 3.13) during an eyes-closed paradigm in order to evaluate FAA. Mothers reported on their childhood trauma experiences using the Childhood Trauma Questionnaire (CTQ), and on their child's behavior using the child behavior checklist (CBCL). We found that maternal childhood trauma significantly predicted child total, internalizing, and externalizing behavior at age 5 years. We also observed a role for FAA such that it acted as a moderator, but not mediator, for behavioral problems. We found that children with relative more right/less left frontal activity were more at risk to develop behavioral problems when their mother had been exposed to trauma in her childhood. These results indicate that child frontal asymmetry may serve as a susceptibility marker for child behavioral problems.

Maternal exposure to violence and offspring neurodevelopment: A systematic review

BACKGROUND

Stress during pregnancy is known to affect fetal neurodevelopment. It seems likely therefore that intimate partner violence (IPV) and domestic violence (DV) as extreme stressors will have a similarly adverse effect.

OBJECTIVES

A systematic review was conducted to assess the association between prenatal exposure to violence for mothers and developmental difficulties in their children.

DATA SOURCES

PubMed, PsycInfo, CINAHL, ERIC, Science Direct, SCOPUS, PsyARTICLES, Networked Digital Library of Theses and Dissertations, Women's Studies International and Gender Studies Database were all searched using the agreed search terms.

STUDY SELECTION AND DATA EXTRACTION

We include studies of women who have experienced any violence, fear of violence or aggression while pregnant, including emotional, psychological, physical or sexual violence in the context of IPV or DV. Studies were excluded if the neurodevelopmental outcomes of the offspring were not assessed. Studies from all countries were included, in English or translated to English, and search dates were not restricted. We included all years from inception of the database until the search date.

SYNTHESIS

Study design and biases, assessment tools, management of confounding, results and overall quality were assessed.

RESULTS

We identified 11 papers reporting on observational studies. Almost three quarters of the studies found a relationship between prenatal exposure to violence and developmental difficulties in the offspring. Differing assessment tools were used with a range of data collected and not all adjusted their findings for the same confounders.

CONCLUSIONS

Current evidence on the relationship between prenatal violence exposure, as IPV or DV, and consequent child developmental disorders remains limited. Future research using comprehensive study designs, larger samples and longitudinal follow-up of the offspring could clarify this association. While maternal trauma resulting from exposure to violence may play an important role in childhood development disorders, additional intervening factors on the pathway need further explored.

Sexual violence and eclampsia: analysis of data from Demographic and Health Surveys from seven low- and middle-income countries

Background

Scientific literature has provided clear evidence of the profound impact of sexual violence on women’s health, such as somatic disorders and mental adverse outcomes. However, consequences related to obstetric complications are not yet completely clarified. This study aimed to assess the association of lifetime exposure to intimate partner sexual violence with eclampsia.

Methods

We considered all the seven Demographic and Health Surveys (DHS) that included data on sexual violence and on signs and symptoms suggestive of eclampsia for women of reproductive age (15-49 years). We computed unadjusted and adjusted odds ratios (OR) to evaluate the risk of suggestive eclampsia by ever subjected to sexual violence. A sensitivity analysis was conducted restricting the study population to women who had their last live birth over the 12 months before the interview.

Results

Self-reported experience of sexual violence ranged from 3.7% in Mali to 9.2% in India while prevalence of women reporting signs and symptoms compatible with eclampsia ranged from 14.3% in Afghanistan to 0.7% in the Philippines. Reported sexual violence was associated with a 2-fold increased odd of signs and symptoms suggestive of eclampsia in the pooled analysis. The sensitivity analysis confirmed the strength of the association between sexual violence and eclampsia in Afghanistan and in India.

Conclusions

Women and girls in low-and-middle-income countries are at high risk of sexual violence, which may represent a risk factor for hypertensive obstetric complication. Accurate counseling by health care providers during antenatal care consultations may represent an important opportunity to prevent adverse outcomes during pregnancy.

Transgenerational associations between maternal childhood stress exposure and profiles of infant emotional reactivity

Childhood exposure to stress can induce prolonged negative effects on health, which in turn confer risks for the next generation, but greater specificity is needed to inform intervention. A first step is to measure individual differences in emotional reactivity to stress early in life in ways that can account for heterogeneity in child exposure. The present study tested the hypothesis that mothers' childhood exposure to stress would be differentially associated with patterns of positive and negative emotional reactivity in their offspring, suggesting transmission of stress response across generations. Participants were 268 young mothers (age 14-23 years) followed longitudinally since childhood, and their infants aged 3-9 months. Latent class analysis of infant emotions expressed before and during the still-face paradigm yielded five subgroups that varied in valence, intensity, and reactivity. After accounting for sociodemographic factors, infant temperament, and postpartum depression, multinomial regression models showed that, relative to an emotionally regulated still-face response, infants showing low negative reactivity were more likely to have mothers exposed to childhood emotional abuse, and infants showing high and increasing negative reactivity were more likely to have mothers exposed to childhood emotional neglect. Mechanisms by which early maternal stress exposure influences emotional reactivity in offspring are discussed.