Intergenerational transmission of adverse childhood experiences via maternal depression and anxiety and moderation by child sex

The relationship between parental adverse childhood experiences and parenting behaviors

BACKGROUND

Adverse childhood experiences (ACEs) are strongly related to the development of various health problems. Several previous studies have revealed the link between ACEs, parental mental health, and child psychopathology. However, the direct association between ACEs and parenting behaviors is still understudied.

OBJECTIVES

To examine the relationship between parental ACEs and parenting, the effect of mental health which possibly mediated parenting behaviors, and the prevalence of ACEs.

PARTICIPANTS AND SETTING

Data was obtained from 403 parents of 6-18-year-old students in Chiang Mai, Thailand, from January to February 2023.

METHODS

Relationships among ACEs, depression, anxiety, stress, and parenting behaviors were examined using correlation analysis and path analysis. The direct and indirect effects of potential associated factors on parenting behaviors were also examined.

RESULTS

Overall, 62.5 % of parents reported at least one ACE. Path analysis revealed significant direct effects of ACEs on poorer mental health in all subscales: depression, anxiety, and stress (β = 0.19, 0.21, 0.18 respectively). ACEs were directly associated with the use of corporal punishment (β = 0.15). Stress also had a positive direct effect on inconsistent discipline (β = 0.18).

CONCLUSION

ACEs are common in parents and associated with mental health problems. ACEs also affect parenting behaviors via direct and indirect pathways. It is important to detect and provide interventions to parents having a history of ACEs and poor mental health to improve the quality of parenting practices.

A developmental framework for understanding the influence of sex and gender on health: Pediatric pain as an exemplar

Sex differences are a robust finding in many areas of adult health, including cardiovascular disease, psychiatric disorders, and chronic pain. However, many sex differences are not consistently observed until after the onset of puberty. This has led to the hypothesis that hormones are primary contributors to sex differences in health outcomes, largely ignoring the relative contributions of early developmental influences, emerging psychosocial factors, gender, and the interaction between these variables. In this paper, we argue that a comprehensive understanding of sex and gender contributions to health outcomes should start as early as conception and take an iterative biopsychosocial-developmental perspective that considers intersecting social positions. We present a conceptual framework, informed by a review of the literature in basic, clinical, and social science that captures how critical developmental stages for both sex and gender can affect children's health and longer-term outcomes. The literature on pediatric chronic pain is used as a worked example of how the framework can be applied to understanding different chronic conditions.

Early Childcare Precarity and Subsequent Maternal Health

PURPOSE

We examined prospective associations between early childcare precarity, or the security and reliability of childcare arrangements, and subsequent maternal health.

STUDY DESIGN

We conducted a secondary analysis of survey responses from mothers of 2,836 children in the Future of Families and Child Wellbeing study. We assessed the following childcare measures: insecure childcare, insecure childcare with missed work, inadequate childcare, and emergency childcare support. We used linear and logistic regression models with robust standard errors to examine associations between these measures when the index child was age 3 and maternal health outcomes (overall health, depression, and parenting stress) later when the child was age 9. We then examined additive experiences of childcare measures across child ages 1 and 3 on maternal health outcomes.

RESULTS

Early inadequate childcare was associated with higher odds of later poor maternal overall health (adjusted odds ratio [aOR], 1.64; 95% confidence interval [CI], 1.11-2.41). All early childcare precarity measures were associated with higher odds of maternal depression (insecure childcare [aOR, 1.64; 95% CI, 1.23-2.18]; insecure childcare with missed work [aOR, 1.58; 95% CI, 1.13-2.22]; and inadequate childcare [aOR, 1.75; 95% CI, 1.22-2.51]). Emergency childcare support was associated with lower odds of adverse maternal health outcomes (poor overall health [aOR, 0.65; 95% CI, 0.48 to 0.88]; depression [aOR, 0.73; 95% CI, 0.54 to 0.99]; and parenting stress [B -0.45; 95% CI, -0.80 to -0.10]). Prolonged experiences had stronger associations with maternal health than shorter experiences.

CONCLUSION

Early childcare precarity has long-term adverse associations with maternal health, and emergency childcare support seems to be favorable for maternal health. These findings highlight childcare precarity as a social determinant of women's health for researchers, clinicians, and decision-makers.

Inter- and transgenerational heritability of preconception chronic stress or alcohol exposure: Translational outcomes in brain and behavior

Chronic stress and alcohol (ethanol) use are highly interrelated and can change an individual's behavior through molecular adaptations that do not change the DNA sequence, but instead change gene expression. A recent wealth of research has found that these nongenomic changes can be transmitted across generations, which could partially account for the "missing heritability" observed in genome-wide association studies of alcohol use disorder and other stress-related neuropsychiatric disorders. In this review, we summarize the molecular and behavioral outcomes of nongenomic inheritance of chronic stress and ethanol exposure and the germline mechanisms that could give rise to this heritability. In doing so, we outline the need for further research to: (1) Investigate individual germline mechanisms of paternal, maternal, and biparental nongenomic chronic stress- and ethanol-related inheritance; (2) Synthesize and dissect cross-generational chronic stress and ethanol exposure; (3) Determine cross-generational molecular outcomes of preconception ethanol exposure that contribute to alcohol-related disease risk, using cancer as an example. A detailed understanding of the cross-generational nongenomic effects of stress and/or ethanol will yield novel insight into the impact of ancestral perturbations on disease risk across generations and uncover actionable targets to improve human health.

Maternal preconception stress produces sex-specific effects at the maternal:fetal interface to impact offspring development and phenotypic outcomes†

Entering pregnancy with a history of adversity, including adverse childhood experiences and racial discrimination stress, is a predictor of negative maternal and fetal health outcomes. Little is known about the biological mechanisms by which preconception adverse experiences are stored and impact future offspring health outcomes. In our maternal preconception stress (MPS) model, female mice underwent chronic stress from postnatal days 28-70 and were mated 2 weeks post-stress. Maternal preconception stress dams blunted the pregnancy-induced shift in the circulating extracellular vesicle proteome and reduced glucose tolerance at mid-gestation, suggesting a shift in pregnancy adaptation. To investigate MPS effects at the maternal:fetal interface, we probed the mid-gestation placental, uterine, and fetal brain tissue transcriptome. Male and female placentas differentially regulated expression of genes involved in growth and metabolic signaling in response to gestation in an MPS dam. We also report novel offspring sex- and MPS-specific responses in the uterine tissue apposing these placentas. In the fetal compartment, MPS female offspring reduced expression of neurodevelopmental genes. Using a ribosome-tagging transgenic approach we detected a dramatic increase in genes involved in chromatin regulation in a PVN-enriched neuronal population in females at PN21. While MPS had an additive effect on high-fat-diet (HFD)-induced weight gain in male offspring, both MPS and HFD were necessary to induce significant weight gain in female offspring. These data highlight the preconception period as a determinant of maternal health in pregnancy and provides novel insights into mechanisms by which maternal stress history impacts offspring developmental programming.

Maternal and Paternal Adverse Childhood Experiences (ACEs) and Offspring Health and Wellbeing: A Scoping Review

BACKGROUND

Adverse childhood experiences (ACEs) are common, often co-occur, and are associated with poor health outcomes across the life course. Emerging research has emphasized the lasting consequences of ACEs across generations, suggesting parental ACEs are associated with poor physical and mental health outcomes in children. However, the individual effects of fathers' ACEs and pathways of transmission remain unclear. A scoping review was conducted to summarize the current knowledgebase of the intergenerational consequences of parental ACEs on offspring health, clarify pathways of transmission, understand how ACEs are operationalized in the intergenerational literature, and identify gaps in knowledge.

METHODS

Six electronic databases were searched for articles published in English from 1995 to 2022 relating to the long-term consequences of parental ACEs on offspring physical and mental health. Articles underwent title, abstract, and full-text review by two investigators. Content analysis was performed to integrate findings across the included studies.

RESULTS

The search yielded 14,542 unique articles; 49 met the inclusion criteria. Thirty-six articles focused exclusively on mothers, one solely on fathers, and 12 included both mothers and fathers in their analyses. Six studies used an expanded definition of ACEs. Both direct and indirect associations between parental ACEs and poor offspring outcomes were identified, primarily through biological and psychosocial pathways.

CONCLUSIONS

Findings underscore the importance and oversight of fathers and the need to solidify a unified definition and measure of ACEs. This review identified modifiable protective factors (social support, father involvement) and pathways of transmission (parental mental health, parenting); both having important implications for intervention development.

Maternal Childhood Maltreatment and Adolescent Internalizing Problems: The Mediating Role of Maternal Depressive Symptoms and Offspring Childhood Maltreatment

Research has demonstrated the predictive effect of maternal childhood maltreatment on adolescent internalizing problems. However, few studies have explored the mediating mechanisms of how mothers' experiences of childhood maltreatment are transmitted to their offspring's internalizing problems over time. The present multi-informant study investigated the potential mediating effects of maternal depressive symptoms and offspring's childhood maltreatment experiences on the relation between maternal childhood maltreatment and adolescent internalizing problems. A total of 823 Chinese youth (43.4% girls; Mage = 10.26 years, SD = 0.94) and their mothers participated in a two-wave longitudinal study with one-year intervals. Mothers reported their experiences of childhood maltreatment and depressive symptoms, while youth reported their childhood maltreatment experiences and internalizing problems. Findings of path analysis indicated that maternal emotional abuse at T1 could significantly predict adolescent internalizing problems at T2, after controlling for a baseline of adolescent internalizing problems. Maternal emotional abuse, emotional neglect, and physical neglect at T1 can influence adolescent internalizing problems at T2 through maternal depressive symptoms at T1 to adolescent internalizing problems at T1. Maternal emotional abuse at T1 displayed statistically significant indirect effects on adolescent internalizing problems at T2 successively through the pathway from adolescent emotional abuse at T1 to adolescent internalizing problems at T1. The findings supported the cycle of maltreatment hypothesis. The present study highlights the intergenerational link between maternal childhood maltreatment and adolescent internalizing problems, as well as reveals the mediating mechanisms in this relation.

A virtual mother-infant postpartum psychotherapy group for mothers with a history of adverse childhood experiences: open-label feasibility study

OBJECTIVES

Mothers with a history of adverse childhood experiences (ACE) are at elevated risk for postpartum mental illness and impairment in the mother-infant relationship. Interventions attending to maternal-infant interactions may improve outcomes for these parents and their children, but barriers to accessing in-person postpartum care limit uptake. We adapted a postpartum psychotherapy group for mothers with mental illness (e.g., mood, anxiety, trauma-related disorders) and ACE for live video-based delivery, and evaluated feasibility, acceptability, and preliminary efficacy in an open-label pilot study.

METHODS

We recruited adults with children (6-18 months) from a perinatal psychiatry program in Toronto, Canada. The intervention was a live video-based 12-week interactive psychotherapy group focused on maternal symptoms and maternal-infant relationships. The primary outcome was feasibility, including feasibility of recruitment and retention, fidelity of the intervention, and acceptability to patients and group providers. Maternal clinical outcomes were compared pre- to post-intervention, as secondary outcomes.

RESULTS

We recruited 31 participants (mean age 36.5 years (SD 3.9)) into 6 groups; 93.6% (n = 29) completed post-group questionnaires, and n = 20 completed an optional post-group acceptability interview. Mean weekly group attendance was 83% (IQR 80-87); one participant (3.2%) dropped out. All group components were implemented as planned, except for dyadic exercises where facilitator observation of dyads was replaced with unobserved mother-infant exercises followed by in-group reflection. Participant acceptability was high (100% indicated the virtual group was easy to access, beneficial, and reduced barriers to care). Mean maternal depressive [Edinburgh Postnatal Depression Scale: 14.6 (SD 4.2) vs. 11.8 (SD 4.2), paired t, p = 0.005] and post-traumatic stress [Posttraumatic Stress Disorder Checklist for DSM-5: 35.5 (SD 19.0) vs. 27.1 (SD 16.7)], paired t, p = 0.01] symptoms were significantly lower post vs. pre-group. No differences were observed on mean measures of anxiety, emotion regulation or parenting stress.

CONCLUSIONS

Recruitment and retention met a priori feasibility criteria. There were significant pre- to post-group reductions in maternal depressive and post-traumatic symptoms, supporting proceeding to larger-scale implementation and evaluation of the intervention, with adaptation of dyadic exercises.

Intergenerational Transmission of Parental Adverse Childhood Experiences and Children's Outcomes: A Scoping Review

Adverse childhood experiences (ACEs) are among the leading environmental causes of morbidity and mortality. Extending research on within-generation effects, more recent scholarship has explored between-generation consequences of ACEs. Despite growing interest in the intergenerational effects of parents' ACEs on children's outcomes, this line of scholarship has yet to be coalesced into a comprehensive review. The current study is a scoping review on the intergenerational transmission of parental ACEs and children's outcomes. Ten databases such as PubMed, APA PsycArticles, and Social Work Abstracts were searched. To be included, empirical studies must have been published in English and analyzed associations between a cumulative measure of at least four parental ACEs and children's outcomes. Sixty-eight studies qualified for the review and, among these, 60 were published in the most recent 5 years (2018-2022). Fifty-one studies had sample sizes smaller than 500, and 55 focused on the effect of maternal ACEs. Nearly all studies demonstrated that parental ACEs could affect children's outcomes directly or indirectly via mechanisms like maternal mental health problems or parenting-related factors. By scoping the extant literature, this review advances the knowledge base regarding the intergenerational impacts of parental childhood trauma and children's outcomes. It also reveals methodological limitations that should be addressed in future research to strengthen causal inferences along with practical implications for interventions that aim to interrupt the intergenerational transmission of trauma.

Prospective Associations between Maternal Depressive Symptoms during Early Infancy and Growth Deficiency from Childhood to Adolescence

Maternal health represents an important predictor of child development; yet it often goes unnoticed during pediatric visits. Previous work suggests that mental state affects parenting. The relationship between infant exposure to maternal depressive symptoms suggests conflicting findings on physical growth. Body mass index (BMI) has not been rigorously examined across development. Using a prospective-longitudinal birth cohort of 2120 infants (50.7% boys), we estimated the prospective relationship between symptoms of maternal depressive symptoms at 5 months postpartum and later BMI in typically developing children. We hypothesized that maternal depressive symptom severity would predict later BMI through to adolescence. Mothers self-reported depressive symptoms at 5 months. Child BMI was measured by a trained research assistant at ages 6, 8, 10, 13, and 15 years. We estimated a series of sex-stratified regressions in which BMI was linearly regressed on maternal symptoms, while controlling for potential pre-existing/concurrent individual and family confounding factors. Boys born to mothers with more severe depressive symptoms at age 5 months had a significantly lower BMI than other boys at subsequent ages. There were no such associations observed for girls. Maternal depressive symptoms were prospectively associated with later BMI for sons and not daughters, predicting risk of faltering in growth through to adolescence. Health practitioners should routinely assess maternal psychological functioning during pediatric visits to optimize parent and child flourishment.

Intergenerational transmission of stress: Multi-domain stressors from maternal childhood and pregnancy predict children's mental health in a racially and socioeconomically diverse, multi-site cohort

PURPOSE

Despite growing recognition that unfortunately common maternal stress exposures in childhood and pregnancy may have intergenerational impacts on children's psychiatric health, studies rarely take a life course approach. With child psychopathology on the rise, the identification of modifiable risk factors is needed to promote maternal and child well-being. In this study, we examined associations of maternal exposure to childhood traumatic events (CTE) and pregnancy stressful life events (PSLE) with child mental health problems in a large, sociodemographically diverse sample.

METHODS

Participants were mother-child dyads in the ECHO-PATHWAYS consortium's harmonized data across three U.S. pregnancy cohorts. Women completed questionnaires regarding their own exposure to CTE and PSLE, and their 4-6-year-old child's mental health problems using the Child Behavior Checklist (CBCL). Regression analyses estimated associations between stressors and child total behavior problems, adjusting for confounders.

RESULTS

Among 1948 dyads (child age M = 5.13 (SD = 1.02) years; 38% Black, 44% White; 8.5% Hispanic), maternal history of CTE and PSLE were independently associated with children's psychopathology: higher CTE and PSLE counts were related to higher total problems ([ßCTE = 0.11, 95% CI [.06, .16]; ßSLE = 0.21, 95% CI [.14, 0.27]) and greater odds of clinical levels of problems (ORCTE = 1.41; 95% CI [1.12, 1.78]; ORPSLE = 1.36; 95% CI [1.23, 1.51]). Tests of interaction showed PSLEs were more strongly associated with child problems for each additional CTE experienced.

CONCLUSION

Findings confirm that maternal exposure to CTE and PSLE are independently associated with child mental health, and history of CTE exacerbates the risk associated with PSLE, highlighting intergenerational risk pathways for early psychopathology. Given the prevalence of these exposures, prevention and intervention programs that reduce childhood trauma and stress during pregnancy will likely positively impact women's and their children's health.

Maternal adverse childhood experiences on child growth and development in rural Pakistan: An observational cohort study

Maternal adverse childhood experiences (ACEs) have significant impacts on the next generation with links to negative birth outcomes, impaired cognitive development, and increased socioemotional problems in children. However, not all types or levels of adversity are similarly deleterious and research from diverse contexts is needed to better understand why and how intergenerational transmission of adversity occurs. We examined the role of maternal ACEs on children's growth, cognitive, and socioemotional development at 36 months postpartum in rural Pakistan. We used data from 877 mother-child dyads in the Bachpan Cohort, a birth cohort study. Maternal ACEs were captured using an adapted version of the ACE-International Questionnaire. Outcomes at 36 months of age included child growth using the WHO growth z-scores, fine motor and receptive language development assessed with the Bayley Scales of Infant and Toddler Development, and socioemotional and behavioral development measured with the Ages and Stages Questionnaire: Socioemotional and Strengths and Difficulties Questionnaire. To estimate the associations between maternal ACEs and child outcomes, we used multivariable generalized linear models with inverse probability weights to account for sampling and loss to follow-up. Over half of mothers in our sample (58%) experienced at least one ACE. Emotional abuse, physical abuse, and emotional neglect were the most commonly reported ACEs. We found null relationships between the number of maternal ACEs and child growth. Maternal ACEs were associated with higher fine motor and receptive language development and worse socioemotional and behavioral outcomes. Maternal ACE domains had similarly varying relationships with child outcomes. Our findings highlight the complexity of intergenerational associations between maternal ACEs and children's growth and development. Further work is necessary to examine these relationships across cultural contexts and identify moderating factors to mitigate potential negative intergenerational effects.

Intergenerational transmission of parent adverse childhood experiences to child outcomes: A systematic review and meta-analysis

OBJECTIVE

The current meta-analytic review provides a comprehensive synthesis of studies examining parent exposure to ACEs and the developmental and mental health outcomes of their children.

PARTICIPANTS AND SETTING

Eligible studies up to August 2021 were identified through comprehensive database searches in PsycINFO, MEDLINE, and Embase. Studies that were included examined the intergenerational effects of parent ACEs on child development (i.e., cognitive, language, motor, social difficulties, and early social-emotional development) or mental health (i.e., internalizing problems, externalizing problems) outcomes.

METHODS

Data were extracted by two coders using a standardized extraction protocol. A multi-level meta-analytic approach was used to derive pooled effect sizes and test for moderators.

RESULTS

A total of 52 studies were included in the meta-analysis. Parent ACEs were positively associated with child mental health problems (r=0.17, 95% CI [0.12, 0.21], p<.001), child externalizing difficulties (r=0.20, 95% CI [0.15, 0.26], p<.001), and child internalizing difficulties (r=0.17, 95% CI [0.11, 0.22], p<.001). There were no significant sociodemographic (i.e., child age, parent age, income level, child sex, or racial/ethnic minority status) or methodological (i.e., study type or quality) moderators of these associations. Preliminary evidence suggests that parent ACEs were not associated with offspring developmental outcomes, such as cognitive or language skills.

CONCLUSIONS

Results suggest that parent ACEs are associated with some, but not all child outcomes. Additional research focused on the mechanisms of transmission are needed to inform policies and practices related to the intergenerational transmission of ACEs.

Maternal childhood maltreatment: associations to offspring brain volume and white matter connectivity

The deleterious effects of adversity are likely intergenerational, such that one generation's adverse experiences can affect the next. Epidemiological studies link maternal adversity to offspring depression and anxiety, possibly via transmission mechanisms that influence offspring fronto-limbic connectivity. However, studies have not thoroughly disassociated postnatal exposure effects nor considered the role of offspring sex. We utilized infant neuroimaging to test the hypothesis that maternal childhood maltreatment (CM) would be associated with increased fronto-limbic connectivity in infancy and tested brain-behavior associations in childhood. Ninety-two dyads participated (32 mothers with CM, 60 without; 52 infant females, 40 infant males). Women reported on their experiences of CM and non-sedated sleeping infants underwent MRIs at 2.44 ± 2.74 weeks. Brain volumes were estimated via structural MRI and white matter structural connectivity (fiber counts) via diffusion MRI with probabilistic tractography. A subset of parents (n = 36) reported on children's behaviors at age 5.17 ± 1.73 years. Males in the maltreatment group demonstrated greater intra-hemispheric fronto-limbic connectivity (b = 0.96, p= 0.008, [95%CI 0.25, 1.66]), no differences emerged for females. Fronto-limbic connectivity was related to somatic complaints in childhood only for males (r = 0.673, p = 0.006). Our findings suggest that CM could have intergenerational associations to offspring brain development, yet mechanistic studies are needed.

Indigenous Cultural Identity Protects Against Intergenerational Transmission of ACEs Among Indigenous Caregivers and Their Children

A large body of empirical research has demonstrated that caregiver adverse childhood experiences (ACEs) predict ACEs in one's child, a phenomenon known as the intergenerational transmission of ACEs. Little of this empirical research, however, has focused specifically on Indigenous peoples despite a growing body of theoretical literature and the wisdom of Elders and Traditional Knowledge Keepers that speaks to the presence of this phenomenon within Indigenous communities as well as the protective role of Indigenous cultural identity in preventing the intergenerational transmission of ACEs. The purpose of the current study was to conduct an empirical evaluation of this hypothesis, specifically that Indigenous cultural identity and social support protects against the intergenerational transmission of ACEs among Indigenous peoples and their children in the USA. Participants were 106 Indigenous women caregivers of children ages 10 to 14 in South Dakota who completed surveys. Results showed that Indigenous cultural identity moderated the association between caregiver ACEs and child ACEs. At high levels of cultural identity, there was no association between caregiver ACEs and child ACEs. At low levels of Indigenous cultural identity, however, there was a strong and positive relationship between caregiver ACEs and child ACEs. Social support did not moderate the association between caregiver ACEs and child ACEs. These findings underscore the need for initiatives that enhance Indigenous cultural identity and social support among Indigenous caregivers to prevent the intergenerational transmission of ACEs.

Adverse childhood experiences, the risk of pregnancy complications and adverse pregnancy outcomes: a systematic review and meta-analysis

BACKGROUND

Adverse childhood experiences (ACEs) have a profound negative impact on health. However, the strength of the association between ACEs and pregnancy complications and adverse pregnancy outcomes is not well quantified or understood.

OBJECTIVE

To conduct a systematic review and meta-analysis of the association between ACEs and risk of pregnancy complications and adverse pregnancy outcomes.

SEARCH STRATEGY

A comprehensive search was conducted using PubMed, Embase, CINAHL, PsycINFO, ClinicalTrials.gov and Google scholar up to July 2022.

DATA COLLECTION AND ANALYSIS

Two reviewers independently conducted the screening and quality appraisal using a validated tool. Meta-analysis using the quality-effects model on the reported odds ratio (OR) was conducted. Heterogeneity and inconsistency were examined using the I2 statistics.

RESULTS

32 studies from 1508 met a priori inclusion criteria for systematic review, with 21 included in the meta-analysis. Pooled analyses showed that exposure to ACEs increased the risk of pregnancy complications (OR 1.37, 95% CI 1.20 to 1.57) and adverse pregnancy outcomes (OR 1.31, 95% CI 1.17 to 1.47). In sub-group analysis, maternal ACEs were associated with gestational diabetes mellitus (OR 1.39, 95% CI 1.11 to 1.74), antenatal depression (OR 1.59, 95% CI 1.15 to 2.20), low offspring birth weight (OR 1.27, 95% CI 1.02 to 1.47), and preterm delivery (OR 1.41, 95% CI 1.16 to 1.71).

CONCLUSION

The results suggest that exposure to ACEs increases the risk of pregnancy complications and adverse pregnancy outcomes. Preventive strategies, screening and trauma-informed care need to be examined to improve maternal and child health.

A Review of Factors that Serve to Protect Pregnant and Post-partum Women from Negative Outcomes Associated with Adverse Childhood Experiences

PURPOSE

The objective of this review is to examine factors, during the perinatal period, that serve to protect women and infants from poor mental or physical outcomes most commonly associated with maternal adverse childhood experiences (ACEs).

METHODS

The electronic databases of PubMed, Ovid MEDLINE, CINAHL and Web of Science were searched. The searches were conducted using the following mesh terms and keywords: ('adverse childhood experiences' or 'ACEs') and ('protective factor' or 'social support' or 'buffer' or 'resilience') and ('pregnan*' or 'prenatal' or 'postpartum' or 'maternal' or 'antenatal'). Studies that examined the association of maternal ACEs and protective factors during the perinatal period were included. A total of 317d articles were screened and 19 are included in this review. The quality of the articles was evaluated with the Newcastle-Ottawa-Scale (NOS).

RESULTS AND CONCLUSION

This review indicates a positive association between maternal ACEs and protective perinatal factors including social support, resiliency and positive childhood experiences.

Maternal history of maltreatment and offspring's emotional and behavioral problems in adolescence: Do family factors contribute to the intergenerational risk transmission?

BACKGROUND

A history of childhood maltreatment often has a negative and long-lasting impact across different domains in life. A childhood maltreatment experience in parents may even affect the next generation. So far, the effects of family factors have been considered in the intergenerational transmission of adversity across the childhood years, but whether the effects remain until adolescence is less clear.

OBJECTIVE

Using data from a large population-based study in the Netherlands, including both mother and child reports, we examined whether maternal childhood maltreatment history is associated with increased mental health problems in offspring and the role of family functioning and harsh parenting as a potential pathway.

PARTICIPANTS

4912 adolescents (aged 13 years) and their mothers were recruited in the Generation R study.

METHODS

Mothers reported childhood maltreatment experiences using the Childhood Trauma Questionnaire (CTQ), and adolescents reported on their mental health using the Youth Self Report (YSR). Structural equation modeling (SEM) was used to test the association of maternal childhood maltreatment on mental health problems in offspring and family functioning and harsh parenting as mechanisms to explain this association.

RESULTS

Adolescents of mothers with a history of maltreatment had greater internalizing (β = 0.07, p < .01) and externalizing problems (β = 0.08, p < .01). Moreover, we found an indirect effect via family functioning over time and harsh parenting at ages 3 and 8 years which mediated this association.

CONCLUSION

We concluded an intergenerational effect of maternal childhood maltreatment on adolescents internalizing and externalizing problems. The findings might enable earlier intervention within the family context to mitigate the consequences of maternal childhood maltreatment.

Preconception maternal posttraumatic stress and child negative affectivity: Prospectively evaluating the intergenerational impact of trauma

The developmental origins of psychopathology begin before birth and perhaps even prior to conception. Understanding the intergenerational transmission of psychopathological risk is critical to identify sensitive windows for prevention and early intervention. Prior research demonstrates that maternal trauma history, typically assessed retrospectively, has adverse consequences for child socioemotional development. However, very few prospective studies of preconception trauma exist, and the role of preconception symptoms of posttraumatic stress disorder (PTSD) remains unknown. The current study prospectively evaluates whether maternal preconception PTSD symptoms predict early childhood negative affectivity, a key dimension of temperament and predictor of later psychopathology. One hundred and eighteen women were recruited following a birth and prior to conception of the study child and were followed until the study child was 3-5 years old. Higher maternal PTSD symptoms prior to conception predicted greater child negative affectivity, adjusting for concurrent maternal depressive symptoms and sociodemographic covariates. In exploratory analyses, we found that neither maternal prenatal nor postpartum depressive symptoms or perceived stress mediated this association. These findings add to a limited prospective literature, highlighting the importance of assessing the mental health of women prior to conception and providing interventions that can disrupt the intergenerational sequelae of trauma.

A Multi-Cohort Examination of the Independent Contributions of Maternal Childhood Adversity and Pregnancy Stressors to the Prediction of Children's Anxiety and Depression

Women's social experiences can have long-term implications for their offspring's health, but little is known about the potential independent contributions of multiple periods of stress exposures over time. This study examined associations of maternal exposure to adversity in childhood and pregnancy with children's anxiety and depression symptoms in a large, sociodemographically diverse sample. Participants were 1389 mother-child dyads (child age M = 8.83 years; SD = 0.66; 42% Black, 42% White; 6% Hispanic) in the ECHO-PATHWAYS Consortium's three U.S. pregnancy cohorts. Women reported their exposure to childhood traumatic events (CTE) and pregnancy stressful life events (PSLE). Children self-reported on their symptoms of anxiety and depression at age 8-9 years. Regression analyses estimated associations between maternal stressors and children's internalizing problems, adjusting for confounders, and examined child sex as a modifier. Exploratory interaction analyses examined whether geospatially-linked postnatal neighborhood quality buffered effects. In adjusted models, PSLE counts positively predicted levels of children's anxiety and depression symptoms ([ßAnxiety=0.08, 95%CI [0.02, 0.13]; ßDepression=0.09, 95%CI [0.03, 0.14]); no significant associations were observed with CTE. Each additional PSLE increased odds of clinically significant anxiety symptoms by 9% (95%CI [0.02, 0.17]). Neither sex nor neighborhood quality moderated relations. Maternal stressors during pregnancy appear to have associations with middle childhood anxiety and depression across diverse sociodemographic contexts, whereas maternal history of childhood adversity may not. Effects appear comparable for boys and girls. Policies and programs addressing prevention of childhood internalizing symptoms may benefit from considering prenatal origins and the potential two-generation impact of pregnancy stress prevention and intervention.

Maternal adverse childhood experiences and health-related quality of life in preschool children: a cross-sectional study

BACKGROUND

The intergenerational association between maternal adverse childhood experiences (ACEs) and their children's health-related quality of life (HRQOL) is underexplored. This study aimed to examine such association in Chinese preschool children and to test the moderation role of children's sex.

METHODS

A cross-sectional study was conducted among 4243 mother-child dyads who attended randomly selected preschools. Mothers self-reported their experience of 12 forms of ACEs, including emotional abuse, physical abuse, emotional neglect, physical neglect, intimate partner violence, substance abuse in the household, incarcerated household member, mental illness in household, parental death, parental separation or divorce, bullying, and community violence. Children's HRQOL was evaluated through mother report of the Pediatric Quality of Life Inventory version 4.0. Linear regression models were established to estimate the associations between maternal ACEs and their children's HRQOL sub-scores and total scores. Stratified analysis and test for interaction were further conducted to evaluate whether the associations were moderated by children's sex.

RESULTS

Of the included mothers, 85.8% (n = 3641) had reported exposure to at least one ACE, and 22.3% (n = 948) were exposed to three or more ACEs. Compared to children of mothers without any ACE exposure, those of mothers with 1, 2, or ≥ 3 ACEs all had significantly lower scores of physical, social, and school functioning, as well as lower psychosocial health summary score and total scale score in both crude and adjusted models. However, only children of mothers with two or more ACEs had significantly poorer emotional functioning when compared to their counterparts whose mothers had no ACE exposure. A significant dose-response pattern was also observed between the number of maternal ACEs and children's HRQOL sub-scores and total scores. Stratified analysis revealed sex-specific pattern between maternal ACEs and their children's HRQOL. Nonetheless, children's sex was not a significant moderator.

CONCLUSIONS

Our study showed that preschool children of mothers who had any experience of ACEs were at risk of poorer HRQOL. Our findings indicated that screening maternal ACEs in young children and promoting targeted interventions might be a feasible way to mitigate or stop the potential negative intergenerational health and wellbeing implications of ACEs.

Association Between Maternal Health Status and Family Resilience: Results from a National Survey

OBJECTIVE

The relationship between maternal health and health outcome of offspring has been studied extensively. However, measures such as family resilience in the context of maternal health are not well understood. The objective of this study was to determine if overall maternal health status is associated with family resilience.

METHODS

Using the 2016 National Survey of Children's Health, a nationally representative survey of parents/guardians of children ages 0-17, we evaluated the association of overall maternal health status with measures of family resilience. The analysis was performed using descriptive and multivariable analyses. The study adjusted for current health insurance status, family structure of child's household, income level, highest education of adult in household, child race, primary household language, children with special health care needs, emotional support, neighborhood support, parental aggravation, and adverse childhood experiences.

RESULTS

Compared to mothers who reported their physical health to be good, mothers who had a very good/excellent physical health status reported significantly higher adjusted rates for family resilience measures [Adjusted Odds Ratio (AOR) 0.741, 95% Confidence Interval (CI) (0.640, 0.859); p < 0.001]. Results suggested also that mothers whose mental health was very good/excellent were more likely to exhibit greater family resilience as compared to those that were good [(AOR) 0.452, 95% (CI) (0.390, 0.525); p < 0.001] or poor/fair [(AOR) 0.283, 95% (CI) (0.223, 0.360); p < 0.001].

CONCLUSION

Our findings suggest that maternal mental and physical health may contribute to how families respond to adversity. Our findings highlight the importance of evaluating interventions that target both physical and mental aspects of maternal health status to better the resilience of the family unit. In the healthcare setting, maternal health services should ensure early detection and prevention of chronic conditions beyond obstetric care and detection and treatment of mental health.

Developmental inflection point for the effect of maternal childhood adversity on children's mental health from childhood to adolescence: Time-varying effect of gender differences

Childhood adversities have a well-established dose-response relationship with later mental health. However, less attention has been given to intergenerational influences. Further, it is unknown how intergenerational influences intersect with children's developmental stages and gender. The current study examined whether a developmental inflection point exists when the intergenerational influences of childhood adversities gain salience and explored differences by children's gender. Data were from the Young Women and Child Development Study (n = 361). Time-varying effect models (TVEMs) and moderation TVEMs by child's gender were evaluated. Our findings reveal that ages 5-8, the period of transition into primary schools, may represent a developmental inflection point when the intergenerational influences of maternal childhood adversity start emerging substantially. The results from gender interaction TVEMs reveal that maternal childhood adversity was a statistically significant predictor of internalizing problems until age 11, regardless of child's gender, and remained statistically significant for girls' internalizing problems until age 16.7. For externalizing problems, maternal childhood adversity was a statistically significant predictor until age 13, regardless of gender.

Intergenerational Pathways Linking Mothers' Adverse Childhood Experiences and Children's Social-Emotional Problems

Despite the persistent hypothesis that adverse childhood experiences (ACE) have intergenerational implications, empirical research documenting the effects and the mechanisms of transmission remains underdeveloped. This study examined the intergenerational effects of mothers' adverse childhood experiences on their offspring's social-emotional development and whether the association was mediated by mothers' mental health, adult adversity, and perceptions of paternal involvement. The study sample included 831 mothers (19-49 years old, 47.5% White) with children aged 12-48 months who participated in a longitudinal investigation of low-income families in Wisconsin. ACEs were assessed by home visitors, and two waves of survey data were collected by researchers to assess demographics, mediators, and social-emotional outcomes. A path analysis showed that the association between maternal ACEs and children's social-emotional problems was fully mediated, with postpartum mental health acting as a primary mechanism. Implications for intervention and future research directions are discussed.

Prevalence and predictors of benevolent childhood experiences among a representative sample of young people

Emerging research evidence suggests that benevolent childhood experiences (BCEs) may partly explain more favourable mental health outcomes among individuals affected by adverse childhood experiences (ACEs). However, much of this research has focused on adult populations. Consequently, this study sought to provide the first rigorous assessment of the prevalence and predictors of BCEs using a nationally representative sample of young people from Northern Ireland (NI). Participants were 11-19-years-olds (N = 1293) who participated in the NI Youth Wellbeing Prevalence Survey (NI-YWS, 2020). Prevalence rates, gender differences and predictors of BCEs were investigated. Results revealed how most of the sample experienced multiple BCEs (95%, n = 1084), with females reporting higher levels of BCEs. Significant positive predictors of BCEs were female gender, parental education, living with both biological parents, and living in areas with lower deprivation, while significant negative predictors of BCEs included family being in receipt of social welfare and older age. Overall, this study highlights how BCEs are common, while the identification of factors associated with likelihood of having positive experiences during early development provides novel insights into those young people who may be at greater risk for maladaptive psychological outcomes.

Postnatal maternal distress, infant subcortical brain macrostructure and emotional regulation

BACKGROUND

Maternal distress is associated with an increased risk for adverse emotional development in infants, including difficulties with emotion regulation. Prenatal maternal distress has been associated with alterations in infant brain development. However, less is known about these associations with postnatal maternal distress, despite this being an important modifiable risk factor that can promote healthy brain development and emotional outcomes in infants.

METHODS & RESULTS

Infants underwent magnetic resonance imaging (MRI) and mothers completed standardized questionnaires concerning their levels of perceived distress 2-5 months postpartum. Infant emotion regulation was assessed at 8-11 months via maternal report. When examining the associations between maternal distress and infant macrostructure, maternal anxiety was associated with infant right pallidum volumes. Increased display of negative emotions at 8-11 months of age was associated with smaller hippocampal volumes and this association was stronger in girls than boys.

CONCLUSION

Findings suggest that postnatal maternal distress may be associated with early infant brain development and emphasize the importance of maternal mental health, supporting previous work. Furthermore, macrostructural properties of infant subcortical structures may be further investigated as potential biomarkers to identify infants at risk of adverse emotional outcomes.

Intergenerational associations of adverse and positive maternal childhood experiences with young children's psychosocial well-being

Background: Maternal adverse childhood experiences (ACEs) are believed to have negative consequences on offspring health. However, positive childhood experiences (PCEs) may be concurrent with ACEs, and little is known about how ACEs and PCEs transmit intergenerationally in the context of each other.Objective: To explore the independent effect of maternal ACEs and PCEs on offspring psychosocial well-being and how ACEs and PCEs are intergenerationally transmitted in their context.Method: Data were 2587 mother-child dyads in Anhui provinces of China. Mothers retrospectively reported their ACEs and PCEs, as well as provided demographic characteristics and their children's psychosocial well-being. Logistic regression models were performed to explore the associations of maternal ACEs and PCEs with offspring psychosocial well-being.Results: Separate unadjusted logistic regression models showed that children with mothers reported high ACEs scores were more likely to have psychosocial challenges (total difficulties and prosocial problems), while children whose mothers reported high PCEs scores were less likely to have psychosocial challenges. When we added maternal ACEs and PCEs to a same model, we found that PCEs slightly neutralised the negative effects of ACEs on offspring's total difficulties and prosocial problems. When stratified by sample, mothers with high PCE scores and higher maternal ACEs were related with a higher risk of offspring total difficulties; mothers with low levels of ACEs and high PCEs tend to report a lower risk of offspring total difficulties.Conclusions: Results suggest that PCEs are positively and intergenerationally transmitted. Results suggest that PCEs are positively and intergenerationally transmitted. More programme should be provided to increase maternal PCEs. When preventing the intergenerational transmission of ACEs, specific interventions should be provided to mothers with different levels of PCEs.

Potential Points of Intervention to Minimize the Impact of Parents' Adverse Childhood Experiences on Child Mental Health

OBJECTIVE

Children of parents who experienced adverse childhood experiences (ACEs) are at elevated risk for mental health (MH) issues. The goal of this study was to explore the relationships between parent ACEs and child MH and to identify potential mediators and points of psychosocial intervention.

METHODS

Participants were 1307 children aged 5 to 9 years from diverse backgrounds and their primary caregivers. Using cross-sectional questionnaire data, we used structural equation modeling to examine the research questions.

RESULTS

Parent ACEs were directly related to child MH issues (β = 0.189, p < 0.001). This relationship was fully mediated by parent MH (β = 0.374, p < 0.001; β = 0.246, p < 0.001) and positive parenting behaviors (β = -0.237, p < 0.001; β = -0.556, p < 0.001). High parent ACEs were negatively associated with parent MH (β = 0.374, p < 0.001), which was then negatively associated with parenting behaviors (β = -0.500, p < 0.001), which was then negatively associated with child MH (β = -0.600, p < 0.001). Parent MH maintained a significant, though attenuated, direct relationship with child MH (β = 0.102, p < 0.05).

CONCLUSION

Parents with high ACEs but who have good mental health and positive parenting behaviors demonstrated no impact of their ACEs on their children's mental health. Providing MH care to parents and parenting programs may be strategies for improving children's MH. Parenting behavior assessment is recommended for clinicians when pediatric patients present with MH concerns.

A path model examination: maternal anxiety and parenting mediate the association between maternal adverse childhood experiences and children's internalizing behaviors

BACKGROUND

Children of mothers with adverse childhood experiences (ACEs) are at increased risk for developmental problems. However, the mechanisms through which a mother's experience of ACEs are transmitted to her offspring are understudied. The current study investigates potential modifiable mediators (maternal psychopathology and parenting) of the association between maternal ACEs and children's behavioral problems.

METHODS

We utilized data from a pregnancy cohort study (N = 1030; CANDLE study) to investigate longitudinal associations between maternal ACEs, postpartum anxiety, observed parenting behavior, and child internalizing behaviors (meanage = 4.31 years, s.d. age = 0.38) in a racially diverse (67% Black; 33% White/Other) sample. We used structural equation modeling to test for direct associations between maternal ACEs and children's internalizing behaviors, as well as indirect associations via two simple mediations (maternal anxiety and parenting), and one serial mediation (sequence of maternal anxiety to parenting).

RESULTS

Simple mediation results indicated that maternal anxiety and cognitive growth fostering behaviors independently mediated the association between maternal ACEs and child internalizing. We observed no evidence of a serial mediation from ACEs to internalizing via the effects of maternal anxiety on parenting.

CONCLUSIONS

This study supports and refines extant literature by confirming the intergenerational association between maternal ACEs and child internalizing behaviors in a large, diverse sample, and identifies potential modifiable mediators: maternal anxiety and parenting behaviors related to fostering cognitive development. Findings may inform interventions targeting mothers who have experienced ACEs and suggest that providing support around specific parenting behaviors and addressing maternal anxiety may reduce internalizing behaviors in children.

Links between mothers' ACEs, their psychopathology and parenting, and their children's behavior problems-A mediation model

Introduction

Children of mothers with a history of adverse childhoods are at greater risk of behavior problems. However, the mechanisms through which a mother's early adverse experiences (ACEs) are transmitted to her children need further study. Our goal was to examine a conceptual mediational model linking mothers' ACEs, maternal psychopathology symptoms, and parenting behaviors with children's internalizing and externalizing behaviors sequentially.

Methods

A sample of 153 Israeli mothers of children ages 3-12 (52% girls) participated in the study, and most of the mothers (94.7%) were cohabiting with a spouse. Mothers completed online questionnaires about their early adverse experiences, psychopathology symptoms, parenting behavior, and their children's internalizing and externalizing behavior.

Results

Results showed that mothers with higher ACE scores reported more maternal psychopathology symptoms and more internalizing behavior in their children. The mother's psychopathology in and of itself mediated the link between her ACEs and her child's internalizing and externalizing behavior. Moreover, an indirect sequential path emerged linking ACEs with the mother's psychopathology symptoms, which, in return, were linked with hostile parenting. Hostile parenting, in turn, was linked with children's internalizing and externalizing behavior.

Discussion

These findings highlight the complicated and intertwined ways in which adverse experiences early in the mother's life might put her child's wellbeing at risk. The findings suggest that ACEs are linked to maternal affect dysregulation, which interferes with parenting, increasing the risk of behavior problems in children. The findings underscore the need to assess mothers' adverse history, psychological distress, and parenting behavior, and provide treatments that can reduce the intergenerational transmission of early adverse experiences.

The impact of maternal childhood maltreatment on child externalizing behaviour and the mediating factors underlying this association: a three-level meta-analysis and systematic review

Child maltreatment can negatively impact not only survivors but also survivors' children. However, research on the intergenerational effect of maternal childhood maltreatment on child externalizing behaviour has yielded contradictory results and has not yet been systematically synthesised. The current three-level meta-analysis and systematic review aimed to provide a quantitative estimate of the strength of the association between maternal childhood maltreatment and child externalizing behaviour and to summarise research on potential mediating factors of this association. PsycINFO, PubMed, and Embase were searched and 39 studies with 82 effects sizes were included in the meta-analysis. Results revealed a small significant association between maternal childhood maltreatment and child externalizing behaviour (r = 0.16; 95% CI 0.12-0.19; publication bias-adjusted effect size: r = 0.12, 95% CI 0.08-0.16). Maternal mental health, particularly depressive symptoms, maternal parenting and children's maltreatment exposure were the most frequently examined mediators of this association, with relatively robust mediating effects for children's maltreatment exposure and maternal depressive symptoms, but mixed evidence for the mediating role of maternal parenting. This meta-analysis provides evidence for a small but significant association between maternal childhood maltreatment and children's externalizing behaviour, emphasizing the need to develop effective preventive and intervention strategies to minimise the effects of childhood maltreatment on the next generation.

Association between maternal reflective function and preschool children’s cognitive abilities

Children’s cognitive abilities (e.g., working memory) are associated with mental health, adaptive behaviors, and academic achievement, and may be enhanced by parental reflective function (i.e., capacity to reflect on mental states, feelings, thoughts, and intentions in one’s child and oneself). We evaluated associations between maternal reflective function and children’s cognitive abilities alone and while controlling for parent-child attachment and interaction quality, and psychosocial (i.e., maternal depressive symptoms, adverse childhood experiences) and sociodemographic (e.g., socioeconomic status) factors. Our sample, recruited in Canada, was primarily white and included 73 mothers and their 4–5 year old preschool children. Maternal reflective function was measured with the Reflective Functioning Scale applied to the Parent Development Interview and the Parental Reflective Functioning Questionnaire. Multiple regression analyses revealed that maternal reflective function was associated with children’s cognitive abilities. The Parent Development Interview rated child-reflective function was associated with children’s higher verbal comprehension alone and while adjusting for covariates (e.g., parent-child interaction quality, socioeconomic status), and the Parental Reflective Functioning Questionnaire Interest and Curiosity with higher verbal comprehension while adjusting for parent-child interactions and attachment pattern. The Parental Reflective Functioning Questionnaire Certainty in Mental States was associated with higher working memory scores for children while adjusting for covariates. Full Scale IQ and Visual Spatial Index were not significantly associated with maternal reflective function. Associations were found between secure and disorganized attachment with higher verbal comprehension and lower working memory, respectively. These findings highlight the importance of high maternal reflective function to cognitive abilities in early childhood.

Maternal adverse childhood experiences and infant subcortical brain volume

Background

A large body of research supports the deleterious effects of adverse childhood experiences (ACEs) on disease susceptibility and health for both the exposed individual and the next generation. It is likely that there is an intergenerational transmission of risk from mother to child; however, the mechanisms through which such risk is conferred remain unknown. The current study evaluated the association between maternal ACEs, neonatal brain development of the amygdala and hippocampus, and later infant negative emotionality at six months of age.

Methods

The sample included 85 mother-infant dyads (44 female infants) from a longitudinal study. Maternal ACEs were assessed with the Adverse Childhood Experiences Questionnaire (ACE-Q) and neonatal hippocampal and amygdala volume was assessed using structural magnetic resonance imaging (MRI). Infant negative emotionality was assessed at 6 months using the Infant Behavior Questionnaire (IBQ).

Results

Multivariate analyses demonstrated that maternal ACEs were associated with bilateral amygdala volume (F(2,78) = 3.697,p = .029). Specifically, higher maternal ACEs were associated with smaller left (β = -0.220, t(79) = -2.661, p = .009, R² = 0.494, and right (β = -0.167, t(79) = -2.043, p = .044, R² = 0.501) amygdala volume. No significant association between maternal ACEs and bilateral hippocampal volume (F(2,78) = 0.215,p = .0807) was found. Follow-up regression analyses demonstrated that both high maternal ACEs and smaller left amygdala volume were associated with higher infant negative emotionality at six months of age (β = .232, p = .040, R² = 0.094, and β = -0.337, p = .022, R² = 0.16, respectively) although statistically significant mediation of this effect was not observed (Indirect effect = 0.0187, 95% CI [-0.0016-0.0557]).

Conclusions

Maternal ACEs are associated with both newborn amygdala volume and subsequent infant negative emotionality. These findings linking maternal adverse childhood experiences and infant brain development and temperament provide evidence to support the intergenerational transmission of adversity from mother to child.

Associations of Maternal Adverse Childhood Experiences with Behavioral Problems in Preschool Children

Investigations have found maternal adverse childhood experiences (ACEs) cause an intergenerational danger to their children's health. However, no study has investigated the effects of maternal ACEs on behavioral problems of preschool children in China and gender differences on these effects. This paper aims to investigate the role of maternal ACEs on behavioral problems of preschool children in China and explore gender differences as related to these behavioral problems. Stratified cluster sampling method was used to select 7318 preschool children from 12 districts in Hefei city, China. A questionnaire survey was conducted to collect information on maternal exposure to ACEs and Conners' Parent Rating Scales. Logistic regression was used to analyze the relationship between maternal ACEs and children's behavioral problems. The prevalence of behavioral problems in preschool children was 16.0%, while it was higher among girls (18.4%) than boys (13.92%) (χ² = 27.979, p < 0.001). The rate of behavioral problems in children in the group of mothers with ACEs was higher than those without ACEs (all p < 0.05). Maternal ACEs were associated with increased risk of the behavior problems in preschool children (adjusted OR 2.91, 95% CI 2.45-3.45), and no gender difference (in girls 3.01, 2.38-3.81, in boys 2.79, 2.17-3.58, respectively) was found. Maternal ACEs were associated with increased risk of each type of the behavioral problems of preschool children, except that maternal emotional neglect was not associated with psycho-physical problems, impulse-activities, and anxiety. The only gender differences found were higher conduct problems related to maternal emotional abuse and ACEs and higher anxiety related to maternal physical abuse and community violence in girls compared with boys. Mothers exposured to ACEs are more likely to have children with behavioral health problems in preschool period. Further research is needed to explore the mechanisms by which maternal ACEs influence children's behavioral problems.

Pathway to Expectations of Child Functioning Following Sexual Abuse: Caregiver Maltreatment History and Depressive Symptoms

Caregiver responses and behaviors often play a significant role in a child's recovery following child sexual abuse (CSA). Caregiver expectations of their child's postabuse functioning has been associated with child symptoms, such that negative expectations lead to worse outcomes for the child. Additionally, caregivers who experienced maltreatment in their own childhood may face difficulties providing support to their child after CSA. Caregivers' own psychological symptoms may influence their expectations for their child's future functioning following CSA. This study utilized structural equation modeling (SEM) to examine the association between caregivers' childhood maltreatment histories, their expectations for their child's future functioning following CSA, and the indirect effect of caregiver depressive symptoms on this relationship. Participants were 354 nonoffending caregivers presenting to treatment with their child following CSA disclosure. Caregivers were 23-72 years old (M = 38.38, SD = 8.02), predominately white, and predominately biological mothers to the youth who were abused. Results indicated that caregivers who experienced maltreatment in childhood were more likely to experience depressive symptoms, which then lead to more negative expectations of their child's future functioning. As negative expectations are associated with poorer outcomes for children following CSA, increased attention to caregivers' depressive symptoms in treatment may promote more positive expectations for their child's postabuse functioning.

Maternal childhood trauma and prenatal stressors are associated with child behavioral health

Maternal adversity and prenatal stress confer risk for child behavioral health problems. Few studies have examined this intergenerational process across multiple dimensions of stress; fewer have explored potential protective factors. Using a large, diverse sample of mother-child dyads, we examined associations between maternal childhood trauma, prenatal stressors, and offspring socioemotional-behavioral development, while also examining potential resilience-promoting factors. The Conditions Affecting Neurocognitive Development and Learning and Early Childhood (CANDLE) study prospectively followed 1503 mother-child dyads (65% Black, 32% White) from pregnancy. Exposures included maternal childhood trauma, socioeconomic risk, intimate partner violence, and geocode-linked neighborhood violent crime during pregnancy. Child socioemotional-behavioral functioning was measured via the Brief Infant Toddler Social Emotional Assessment (mean age = 1.1 years). Maternal social support and parenting knowledge during pregnancy were tested as potential moderators. Multiple linear regressions (N = 1127) revealed that maternal childhood trauma, socioeconomic risk, and intimate partner violence were independently, positively associated with child socioemotional-behavioral problems at age one in fully adjusted models. Maternal parenting knowledge moderated associations between both maternal childhood trauma and prenatal socioeconomic risk on child problems: greater knowledge was protective against the effects of socioeconomic risk and was promotive in the context of low maternal history of childhood trauma. Findings indicate that multiple dimensions of maternal stress and adversity are independently associated with child socioemotional-behavioral problems. Further, modifiable environmental factors, including knowledge regarding child development, can mitigate these risks. Both findings support the importance of parental screening and early intervention to promote child socioemotional-behavioral health.

Sex-dependence and comorbidities of the early-life adversity induced mental and metabolic disease risks: Where are we at?

Early-life adversity (ELA) is a major risk factor for developing later-life mental and metabolic disorders. However, if and to what extent ELA contributes to the comorbidity and sex-dependent prevalence/presentation of these disorders remains unclear. We here comprehensively review and integrate human and rodent ELA (pre- and postnatal) studies examining mental or metabolic health in both sexes and discuss the role of the placenta and maternal milk, key in transferring maternal effects to the offspring. We conclude that ELA impacts mental and metabolic health with sex-specific presentations that depend on timing of exposure, and that human and rodent studies largely converge in their findings. ELA is more often reported to impact cognitive and externalizing domains in males, internalizing behaviors in both sexes and concerning the metabolic dimension, adiposity in females and insulin sensitivity in males. Thus, ELA seems to be involved in the origin of the comorbidity and sex-specific prevalence/presentation of some of the most common disorders in our society. Therefore, ELA-induced disease states deserve specific preventive and intervention strategies.

Intergenerational transmission of maternal childhood adversity and depression on children's internalizing problems

OBJECTIVE

Childhood trauma exacts a lasting toll on one's own mental health and the health of one's offspring; however, limited research has examined the pathways through which this intergenerational transmission occurs. This study aimed to identify the transactions and mechanisms that link maternal early life trauma, maternal depressive symptoms, and children's internalizing symptoms.

METHOD

A pregnancy cohort of N = 1462 mothers (66% Black, 32% White, 2% Other race) reported their childhood trauma exposure and depressive symptoms during pregnancy. Maternal depressive and children's internalizing symptoms were measured repeatedly when offspring were 12, 24, 36, and 48-60 months of age. A path model tested the transactional associations between maternal and child symptomatology and mediation of maternal childhood trauma on offspring symptoms via maternal depressive symptoms.

RESULTS

Mothers' childhood trauma history was related to greater prenatal and postnatal (12 and 24 months) maternal depressive symptoms, which were prospectively associated with offspring internalizing problems at 36 and 48-60 months. Child-directed effects on maternal depressive symptoms were not observed. The association of maternal trauma on children's internalizing at 36 months was mediated by maternal depressive symptoms at 24 months.

LIMITATIONS

Assessments of the key study variables were provided by mothers. Childhood trauma was evaluated retrospectively.

CONCLUSION

Women's experiences of adversity in childhood have persistent and cumulative effects on their depression during the transition to parenthood, which is associated with risk for children's internalizing. Given the two-generation influence of maternal childhood trauma exposure, attending to its impact may protect both caregivers and their children.

Intergenerational Transmission of Maternal Adverse Childhood Experiences on Next Generation's Development: A Mini-Review

(Adverse childhood experiences (ACEs) have extremely harmful impacts on an individual’s physical, social and mental health throughout their life-span. Recently, it has been reported that maternal ACEs increase the risk of developmental delay in the offspring across generations. This mini review focuses on the direct relationship between maternal ACEs and child developmental delay, and potential mediators/moderators that associate their relationship. Six studies were identified using three search engines. The results indicated that four out of six studies reported at least one significant direct association between maternal ACEs and child development. Additionally, maternal biological, psychological, and social factors were identified as mediators or moderators. In summary, we identified that maternal ACEs increased the risk of developmental delay in children via biological and psychosocial pathways. Future research should examine potential buffering factors and identify when it is crucial to break the intergenerational transmission.

Maternal childhood abuse and neglect predicts offspring development in early childhood: The roles of reflective functioning and child sex

BACKGROUND

Recent evidence suggests that offspring of mothers having been exposed to childhood abuse and neglect (CA&N) are at increased risk of developmental problems and that boys are more affected by maternal CA&N than girls. Since impairments in reflective functioning (RF) have been associated with maternal CA&N and offspring development, RF could represent a key mechanism in these intergenerational risk trajectories.

OBJECTIVE

This study evaluated mediating (RF) and moderating (child sex) mechanisms in the association between maternal CA&N and child development.

PARTICIPANTS AND SETTING

In a longitudinal setting, 111 mothers completed measures during pregnancy and between 11 and 36 months postpartum.

METHODS

CA&N and impairments in RF were assessed during pregnancy and offspring development was measured during the longitudinal follow-up using the Ages and Stages Questionnaires (ASQ-3). Child development was operationalized in two ways: using the global score at the ASQ-3 and using a dichotomous score of accumulation of delays across domains of development.

RESULTS

Structural equation modeling indicated that RF mediated the association between maternal CA&N and offspring development. Child sex moderated the association between CA&N and the clustering of developmental problems (Wald = 5.88, p = 0.02), with boys being particularly likely to accumulate developmental delays when their mother experienced CA&N (RR = 2.62). Accumulation of developmental problems was associated with impairments in maternal RF in girls and with maternal exposure to CA&N in boys.

CONCLUSIONS

Results provide novel insights on the role of mentalization and child sex in the association between maternal CA&N and child development.

Prenatal internalizing symptoms as a mediator linking maternal adverse childhood experiences with infant temperament

BACKGROUND

Maternal adverse childhood experiences are known to significantly influence offspring development. However, mediators linking maternal early-life adversity with infant temperament remain largely unknown.

AIMS

The current study investigated whether prenatal internalizing symptoms mediate the association between maternal adverse childhood experiences and infant temperament at two months. Maternal sensitivity/responsiveness during the postpartum period was also examined as a moderator of these associations.

STUDY DESIGN

We used a repeated-measures design, with self-report measures administered during pregnancy. Self-report and observational data were also collected at 2 months postpartum.

SUBJECTS

The study included a community sample of 64 pregnant women and their infants.

OUTCOME MEASURES

Participants completed measures assessing their early-life adversity and current depression/anxiety symptoms. At two months postpartum, mothers reported on their infant's temperament and participated in a parent-child interaction task designed to assess maternal sensitivity/responsiveness.

RESULTS AND CONCLUSIONS

Maternal adverse childhood experiences indirectly predicted poor self-regulation during early infancy via prenatal internalizing symptoms. Maternal sensitivity/responsiveness was also found to moderate the association between maternal adverse childhood experiences and certain aspects of infant regulatory capacity and positive affectivity at two months. This research has implications for mental health screening procedures during pregnancy and the development of early intervention programs.

Association between maternal adverse childhood experiences and child resilience and self-esteem: Results from the K-CHILD study

BACKGROUND

Previous studies have found that children of mothers with adverse childhood experiences (ACEs) are more likely to have adverse mental health outcomes. However, little is known about the role of other cognitive abilities, such as resilience and self-esteem, in how children deal with stressful situations.

OBJECTIVE

To examine the association between maternal ACEs and resilience and self-esteem in children.

PARTICIPANTS AND SETTING

The data was collected as part of the population-based Kochi Child Health Impact of Living Difficulty (K-CHILD) study in 2016. Participants included 2759 in first grade, 2878 in fifth grade, 3143 in eighth grade, and 3611 children in 11th grade living in Kochi Prefecture, Japan (N = 12,391).

METHODS

Maternal ACEs and covariates were reported by mothers. Mothers provided information regarding their children's resilience for children in the first, fifth, and eighth grades. Children in the fifth, eighth, and 11th grades reported their own self-esteem.

RESULTS

Children of mothers with a larger number of ACEs had lower levels of resilience (p for trend (i.e., linear associations) < 0.001) as well as lower levels of self-esteem (p for trend <0.001), adjusting for potential confounding variables. These associations became non-significant after adjusting for potential mediators, and the relationship was mediated by variables such as maternal psychological distress, current socioeconomic status, and parenting behaviors.

CONCLUSIONS

There was a significant dose-response relationship between the number of maternal ACEs and children's resilience and self-esteem, and this relationship may be mediated by maternal psychological distress, current socioeconomic status, and positive parenting behaviors. Further interventional studies that break the link between maternal ACEs and resilience and self-esteem should be conducted.

Experiences of childhood adversity across generations - Continuity or change? A study from the Northern Ireland youth wellbeing survey

BACKGROUND

Although a wealth of international literature consistently links cumulative experiences of adverse childhood experiences (ACEs) with physical, mental and emotional problems in later life, only a few studies have focused on intergenerational ACE exposure and research using nationally representative populations is lacking.

OBJECTIVE

This paper examines intergenerational associations between parent and child ACE scores in a large nationally representative sample of parent-child dyads.

PARTICIPANTS AND SETTING

Participant comprise 1042 pairs of parents and young people (11-19 year olds) who both completed questions relating to their exposure to ACEs (N = 1042) as part the Northern Ireland Youth Wellbeing Survey (NIYWS) - a stratified random probability household survey of the prevalence of mental health disorders among 2 to 19 year olds in Northern Ireland (N = 3074).

METHODS

Hierarchical regression was used to identify the relationship between parent and young people ACE scores and investigate the extent to which this is influenced by child, parent, family and socio-economic variables.

RESULTS

In the final model, young person ACE scores were associated with older child age (β = 0.082, p = .016), younger parental age (β = -0.083, p = .022), fewer children in the household (β = -0.120, p < .001), poor child health (β = 0.160, p < .001), low family support (β = 0.118, p = .001) and the household being in receipt of benefits (β = 0.223, p < .001).

CONCLUSIONS

This study found a small association between parent and young person ACE exposure which was attenuated through other variables.

Mediation-Moderation Links Between Mothers' ACEs, Mothers' and Children's Psychopathology Symptoms, and Maternal Mentalization During COVID-19

Research has suggested adverse childhood experiences (ACEs) as a transdiagnostic risk factor for a variety of affective disorders. They are also linked with a parent's tendency toward affect dysregulation and hyperarousal, which may interfere with parenting and children's wellbeing. On the other hand, maternal mentalization can serve as a moderating factor that can help parents regulate their arousal, shielding children during adverse circumstances. We studied the mediated links between ACEs and mothers' and children's psychopathology symptoms during COVID-19 to determine whether maternal mentalization and the child's age moderate these links. Using results from 152 Israeli mothers of children aged 3-12 years recruited during the month-long lockdown in Israel, we documented that the mothers' ACEs were linked with increased risk of depressive and anxiety symptoms and with children's internalizing and externalizing behaviors. Moreover, as hypothesized, the mothers' symptoms of depression and anxiety mediated the links between their ACEs and their children's internalizing behaviors. In addition, the mothers' mentalization skills and, in the case of their depressive symptoms, their child's age, moderated these indirect links. For mothers of young children (3-6 years old) with higher mentalization levels, the link between the mothers' ACEs and the children's behavior problems was weaker compared to mothers with low mentalization levels. For mothers of older children (6-12 years old), and only in the case of maternal depressive symptoms, higher levels of maternal mentalization were linked with more internalizing behaviors. We discuss the potential clinical implications of the findings.

A Systematic Review of the Effect of Parental Adverse Childhood Experiences on Parenting and Child Psychopathology

Adverse childhood experiences (ACEs) are defined as early exposure to maltreatment and household dysfunction. Researchers have demonstrated the link between ACEs and negative psychological, behavioral, interpersonal, and health outcomes. A growing area of interest in the ACE literature concerns the relationship between ACEs, parenting, and child psychopathology due to the intergenerational effect of ACEs. Emotional availability and discipline strategies are two domains of parenting that can increase understanding of the associations between ACEs, parenting, and child psychopathology from an attachment framework because they are both salient during early childhood and directly influence a child's later behavior. This paper utilized the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to elucidate the relationships between parental ACEs, parents' emotional availability and discipline strategies, and children's psychopathology. PubMed, PSYCINFO, and Psychology and Behavioral Sciences Collection were used to access the literature on June 16, 2020, and 26 studies met the inclusion criteria. Results from this review suggested that there is a direct association between ACEs and parental emotional availability and discipline techniques. Depression and dissociation were identified as potential mediators. There was support for the direct association between parental ACEs and children's internalizing and externalizing difficulties. Maternal anxiety and depressive symptoms, emotional availability, attachment, and children's maltreatment experiences were found to be possible mediators. Recommendations are proposed to address limitations within the literature to further expand upon the research of ACEs, parenting, and child psychopathology.

The Alberta Pregnancy Outcomes and Nutrition (APrON) longitudinal study: cohort profile and key findings from the first three years

PURPOSE

The objectives of the ongoing Canadian longitudinal cohort called the Alberta Pregnancy Outcomes and Nutrition (APrON) study are to: (1) determine the relationship between maternal nutrient intake and status before, during, after pregnancy, and (a) maternal mental health, (b) pregnancy and birth outcomes, and (c) infant/child neurodevelopment and behavior; (2) identify maternal mental health and nutrient predictors of child behaviour; and (3) establish a DNA biobank to explore genomic predictors of children's neurodevelopment and behavior. The purpose of this paper is to describe the participants, measures, and key findings on maternal and paternal mental health, maternal nutrition, and child outcomes to when children are 3 years of age.

PARTICIPANTS

Participants included mothers and their children (n=2189) and mothers' partners (usually fathers; n=1325) from whom data were collected during the period from pregnancy to when children were 3 years of age, in Alberta, Canada. More than 88% of families have been retained to take part in completed data collection at 8 years of age.

FINDINGS TO DATE

Data comprise: questionnaires completed by pregnant women/mothers and their partners on mothers', fathers' and children's health; dietary interviews; clinical assessments; linkage to hospital obstetrical records; and biological samples such as DNA. Key findings on mental health, nutrition and child outcomes are presented. APrON women who consumed more selenium and omega-3 were less likely to develop symptoms of perinatal depression. Higher prenatal consumption of choline rich foods such as eggs and milk were recommended as was vitamin D supplementation for both mothers and children to meet guidelines. Couples in which both mothers and fathers were affected by perinatal depression reported lower incomes and higher maternal prenatal depressive symptoms and lower support from fathers postnatally and their children presented with the most behavioural problems. Maternal experiences of early adversity predicted increased likelihood of perinatal depression and anxiety and children's behavioural problems.

FUTURE PLANS

The APrON cohort offers a unique opportunity to advance understanding of the developmental origins of health and disease. There is a planned follow-up to collect data at 12 years of age.

Using Microbiome-Based Approaches to Deprogram Chronic Disorders and Extend the Healthspan following Adverse Childhood Experiences

Adverse childhood experiences (ACEs), which can include child trafficking, are known to program children for disrupted biological cycles, premature aging, microbiome dysbiosis, immune-inflammatory misregulation, and chronic disease multimorbidity. To date, the microbiome has not been a major focus of deprogramming efforts despite its emerging role in every aspect of ACE-related dysbiosis and dysfunction. This article examines: (1) the utility of incorporating microorganism-based, anti-aging approaches to combat ACE-programmed chronic diseases (also known as noncommunicable diseases and conditions, NCDs) and (2) microbiome regulation of core systems biology cycles that affect NCD comorbid risk. In this review, microbiota influence over three key cyclic rhythms (circadian cycles, the sleep cycle, and the lifespan/longevity cycle) as well as tissue inflammation and oxidative stress are discussed as an opportunity to deprogram ACE-driven chronic disorders. Microbiota, particularly those in the gut, have been shown to affect host–microbe interactions regulating the circadian clock, sleep quality, as well as immune function/senescence, and regulation of tissue inflammation. The microimmunosome is one of several systems biology targets of gut microbiota regulation. Furthermore, correcting misregulated inflammation and increased oxidative stress is key to protecting telomere length and lifespan/longevity and extending what has become known as the healthspan. This review article concludes that to reverse the tragedy of ACE-programmed NCDs and premature aging, managing the human holobiont microbiome should become a routine part of healthcare and preventative medicine across the life course.