Maternal Childhood Trauma Research Articles

The perinatal origins of childhood anxiety disorders and the role of early-life maternal predictors.

The development of childhood anxiety disorders (CADs) is likely to depend on pathways that can be programmed by early-life risk factors. We test the hypothesis that early-life maternal factors can predict this programming effect on CAD. Data were obtained from 198 women and children from the Mercy Pregnancy and Emotional Wellbeing Study (MPEWS), a cohort study with data collected across pregnancy, postpartum and until 4 years of age. Maternal antenatal depression was measured using the Structured Clinical Interview for DSM-IV (SCID-IV), together with antenatal hair cortisol concentrations, maternal childhood trauma and parenting stress at 6 months postpartum. CAD was assessed with the Preschool Age Psychiatric Assessment and the Child Behaviour Checklist. Antenatal depression, a history of maternal childhood trauma and lower gestational age at birth were each associated with anxiety disorders at 4 years of age in their children. A multivariate binary logistic model with these early predictors explained approximately 9% of variance in CAD outcome at 4 years of age; however, only maternal trauma and gestational age were significant predictors in the model. The effect of early parenting stress on CAD was found to vary by the concentration of maternal antenatal hair cortisol, whereby postpartum parenting stress was associated with CAD only when there were higher maternal antenatal cortisol levels. This study suggests the importance of maternal factors pre-conception, pregnancy and in the postnatal period, which predict CADs and this is consistent with a developmental programming hypothesis for CAD.

Mothers with a History of Child Welfare Involvement: A Brief Literature Review of Cross Generational Impact of Maternal Trauma.

A number of studies to this day have examined the role of maternal childhood trauma in parenting styles, mental health, and child attachment patterns; however, there are limited data on parenting of mothers who were raised in institutional care (IC) and involved in the child welfare system. The current review focuses on maternal history of institutionalization and foster care placement and its impact on parenting and child development. Studies show that the history of maternal trauma such as maltreatment, which is often linked to an orphan status, can be transferred to children through maladaptive parenting strategies, evoking a cycle of cross-generational maltreatment. Mothers raised in institutions show an early sexual debut that is often resulting in unplanned pregnancies, and are lacking competence in taking care of their own children. Directions for future research involving mothers with a history of IC are discussed.

Associations of antenatal maternal psychological distress with infant birth and development outcomes: Results from a South African birth cohort

BackgroundAntenatal maternal psychological distress is common in low and middle-income countries (LMIC), but there is a dearth of research on its effect on birth and developmental outcomes in these settings, particularly in Sub-Saharan Africa. This study set out to identify risk factors for antenatal maternal psychological distress and determine whether antenatal maternal psychological distress was associated with infant birth and developmental outcomes, using data from the Drakenstein Child Health Study (DCHS), a birth cohort study in South Africa. MethodsPregnant women were enrolled in the DCHS from primary care antenatal clinics. Antenatal maternal psychological distress was measured using the Self-Reporting Questionnaire 20-item (SRQ-20). A range of psychosocial measures, including maternal childhood trauma, depression, and posttraumatic stress disorder (PTSD) were administered. Birth outcomes, including premature birth, weight-for-age z-score and head circumference-for-age z-score, were measured using revised Fenton growth charts. The Bayley III Scales of Infant and Toddler Development was administered at 6 months of age to assess infant development outcomes, including cognitive, language, and motor domains in a subset of n=231. Associations of maternal antenatal psychological distress with psychosocial measures, and with infant birth and developmental outcomes were examined using linear regression models. Results961 women were included in this analysis, with 197 (21%) reporting scores indicating the presence of psychological distress. Antenatal psychological distress was associated with maternal childhood trauma, antenatal depression, and PTSD, and inversely associated with partner support. No association was observed between antenatal maternal psychological distress and preterm birth or early developmental outcomes, but antenatal maternal psychological distress was associated with a smaller head circumference at birth (coefficient=−0.30, 95% CI: −0.49; −0.10). ConclusionAntenatal maternal psychological distress is common in LMIC settings and was found to be associated with key psychosocial measures during pregnancy, as well as with adverse birth outcomes, in our study population. These associations highlight the potential value of screening for antenatal maternal psychological distress as well as of developing targeted interventions.

Using graph learning to understand adverse pregnancy outcomes and stress pathways.

To identify pathways between stress indicators and adverse pregnancy outcomes, we applied a nonparametric graph-learning algorithm, PC-KCI, to data from an observational prospective cohort study. The Measurement of Maternal Stress study (MOMS) followed 744 women with a singleton intrauterine pregnancy recruited between June 2013 and May 2015. Infant adverse pregnancy outcomes were prematurity (<37 weeks' gestation), infant days spent in hospital after birth, and being small for gestational age (percentile gestational weight at birth). Maternal adverse pregnancy outcomes were pre-eclampsia, gestational diabetes, and gestational hypertension. PC-KCI replicated well-established pathways, such as the relationship between gestational weeks and preterm premature rupture of membranes. PC-KCI also identified previously unobserved pathways to adverse pregnancy outcomes, including 1) a link between hair cortisol levels (at 12–21 weeks of pregnancy) and pre-eclampsia; 2) two pathways to preterm birth depending on race, with one linking Hispanic race, pre-gestational diabetes and gestational weeks, and a second pathway linking black race, hair cortisol, preeclampsia, and gestational weeks; and 3) a relationship between maternal childhood trauma, perceived social stress in adulthood, and low weight for gestational age. Our approach confirmed previous findings and identified previously unobserved pathways to adverse pregnancy outcomes. It presents a method for a global assessment of a clinical problem for further study of possible causal pathways.

Risk and protective factors for child development: An observational South African birth cohort.

BackgroundApproximately 250 million (43%) children under the age of 5 years in low- and middle-income countries (LMICs) are failing to meet their developmental potential. Risk factors are recognised to contribute to this loss of human potential. Expanding understanding of the risks that lead to poor outcomes and which protective factors contribute to resilience in children may be critical to improving disparities.Methods and findingsThe Drakenstein Child Health Study is a population-based birth cohort in the Western Cape, South Africa. Pregnant women were enrolled between 20 and 28 weeks’ gestation from two community clinics from 2012 to 2015; sociodemographic and psychosocial data were collected antenatally. Mothers and children were followed through birth until 2 years of age. Developmental assessments were conducted by trained assessors blinded to background, using the Bayley-III Scales of Infant and Toddler Development (BSID-III), validated for use in South Africa, at 24 months of age. The study assessed all available children at 24 months; however, some children were not able to attend, because of loss to follow-up or unavailability of a caregiver or child at the correct age. Of 1,143 live births, 1,002 were in follow-up at 24 months, and a total of 734 children (73%) had developmental assessments, of which 354 (48.2%) were girls. This sample was characterised by low household employment (n = 183; 24.9%) and household income (n = 287; 39.1% earning <R1,000 per month), and high prevalence of maternal psychosocial risk factors including alcohol use in pregnancy (n = 95; 14.5%), smoking (n = 241; 34.7%), depression (n = 156; 23.7%), lifetime intimate partner violence (n = 310; 47.3%), and history of maternal childhood trauma (n = 228; 34.7%). A high proportion of children were categorised as delayed (defined by scoring < −1 standard deviation below the mean scaled score calculated using the BSID-III norms from a United States population) in different domains (369 [50.5%] cognition, 402 [55.6%] receptive language, 389 [55.4%] expressive language, 169 [23.2%] fine motor, and 267 [38.4%] gross motor). Four hundred five (55.3%) children had >1 domain affected, and 75 (10.2%) had delay in all domains. Bivariate and multivariable analyses revealed several factors that were associated with developmental outcomes. These included protective factors (maternal education, higher birth weight, and socioeconomic status) and risk factors (maternal anaemia in pregnancy, depression or lifetime intimate partner violence, and maternal HIV infection). Boys consistently performed worse than girls (in cognition [β = −0.74; 95% CI −1.46 to −0.03, p = 0.042], receptive language [β = −1.10; 95% CI −1.70 to −0.49, p < 0.001], expressive language [β = −1.65; 95% CI −2.46 to −0.84, p < 0.001], and fine motor [β = −0.70; 95% CI −1.20 to −0.20, p = 0.006] scales). There was evidence that child sex interacted with risk and protective factors including birth weight, maternal anaemia in pregnancy, and socioeconomic factors. Important limitations of the study include attrition of sample from birth to assessment age and missing data in some exposure areas from those assessed.ConclusionsThis study provides reliable developmental data from a sub-Saharan African setting in a well-characterised sample of mother–child dyads. Our findings highlight not only the important protective effects of maternal education, birth weight, and socioeconomic status for developmental outcomes but also sex differences in developmental outcomes and key risk and protective factors for each group.

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.

An Investigation of the Impact of Childhood Trauma on Quality of Caregiving in High Risk Mothers: Does Maternal Substance Misuse Confer Additional Risk?

The quality of caregiving is often compromised when mothers have co-occurring difficulties such as substance misuseand problems associated with extreme emotional dysregulation. These, in turn, areassociated with poor child outcomes. The aim of the current study was twofold. First, to investigate the potential differences in risk factors associated with poor child outcome by comparing three groups: substance misusing mothers (Substance Misusing Mothers; SMM); mothers matched on demographic characteristics (Matched Comparison Mothers; MCM) and mothers recruited from the community (Matched Control Comparison; MCC). Second, to investigate the underlying mechanisms which are associated with poor child outcome by testing a mediated moderation model to ascertain (i) whether environmental risk and borderline psychopathology was a mediator between maternal childhood trauma and quality of caregiving and (ii) maternal substance misuse status moderated outcome. There were no significant differences found between the SMM and MCM groups on the key variables, but significant differences on all variables for both SMM and MCM compared to CCM. The moderated mediation analysis found that while there was significant mediation of environmental risk and borderline pathology between maternal childhood trauma and child outcome, this was not moderated by maternal substance abuse status. The importance of environmental-risk as a mechanism leading to reduced caregiving quality suggest treatment programs need to consider targeting these factors in high risk families.

Food-insecure pregnant women in South Africa: a cross-sectional exploration of maternal depression as a mediator of violence and trauma risk factors

ObjectivesBetter understanding of psychosocial risk factors for food insecurity (FI) during pregnancy and how they interact is crucial, given long-term health implications for maternal and child health. We investigated the...

5.62 Intersectionality, Maternal Childhood Trauma, and Birth Narratives

5.62 Intersectionality, Maternal Childhood Trauma, and Birth Narratives

When one childhood meets another - maternal childhood trauma and offspring child psychopathology: A systematic review.

Child maltreatment can have a long-term impact on mental health. Less is known about the consequences of child maltreatment on the next generation's psychological wellbeing. This systematic review aimed to synthesise the existing empirical literature on the association between a mother's history of maltreatment in her own childhood and her children's experiences of psychopathology, and to characterise potential mediating pathways. Electronic database and hand searches yielded 12 studies, with a combined sample size of 45,723 mother-child dyads, which met criteria for inclusion in the review. There was evidence of an overall positive association between a mother's history of child maltreatment and her child's experience of emotional and behavioural difficulties across childhood and adolescence. Maternal psychological distress and poorer parenting practices were found to be key mediating pathways of this association. Children of mothers who were exposed to maltreatment in childhood appear to be at an increased risk for psychopathology. Mothers with traumatic childhood experiences should be offered improved access to psychological therapies and parenting programmes to help mitigate the potential impact of child maltreatment on future generations.

Association between maternal childhood trauma and offspring childhood psychopathology: mediation analysis from the ALSPAC cohort.

BackgroundStudies have shown that a mother's history of childhood maltreatment is associated with her child's experience of internalising and externalising difficulties.AimsTo characterise the mediating pathways that underpin this association.MethodData on a mother's history of childhood maltreatment, depression during pregnancy, postnatal depression, maladaptive parenting practices and her child's experience of maltreatment and internalising and externalising difficulties were analysed in an Avon Longitudinal Study of Parents and Children (ALSPAC) sample of 9397 mother-child dyads followed prospectively from pregnancy to age 13.ResultsMaternal history of childhood maltreatment was significantly associated with offspring internalising and externalising difficulties. Maternal antenatal depression, postnatal depression and offspring child maltreatment were observed to significantly mediate this association independently.ConclusionsPsychological and psychosocial interventions focused around treating maternal depression, particularly during pregnancy, and safeguarding against adverse childhood experiences could be offered to mothers with traumatic childhood histories to help protect against psychopathology in the next generation.

Intergenerational transmission of well being–genetic and epigenetic mechanisms

IntroductionMaternal mental well being influences offspring development. Research suggests that an interplay between genetic and environmental factors underlies this familial transmission of mental disorders.ObjectivesTo explore an interaction between genetic and environmental factors to predict trajectories of maternal mental well being, and to examine whether these trajectories are associated with epigenetic modifications in mothers and their offspring.MethodWe assessed maternal childhood trauma and rearing experiences, prenatal and postnatal symptoms of depression and stress experience from 6 to 72 months postpartum, and genetic and epigenetic variation in a longitudinal birth-cohort study (n = 262) (Maternal adversity, vulnerability and neurodevelopment project). We used latent class modeling to describe trajectories in maternal depressive symptoms, parenting stress, marital stress and general stress, taking polygenetic risk for major depressive disorder (MDD), a composite score for maternal early life adversities, and prenatal depressive symptoms into account.ResultsGenetic risk for MDD associated with trajectories of maternal well being in the postpartum, conditional on the experience of early life adversities and prenatal symptoms of depression. We will explore whether these trajectories are also linked to DNA methylation patterns in mothers and their offspring. Preliminary analyses suggest that maternal early life adversities associate with offspring DNA methylation age estimates, which is mediated through maternal mental well being and maternal DNA methylation age estimates.ConclusionWe found relevant gene-environment interactions associated with trajectories of maternal well being. Our findings inform research on mechanisms underlying familial transmission of vulnerability for psychopathology and might thus be relevant to prevention and early intervention programs.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Maternal childhood trauma, postpartum depression, and infant outcomes: Avoidant affective processing as a potential mechanism

BackgroundWomen who have experienced childhood trauma may be at risk for postpartum depression, increasing the likelihood of negative outcomes among their children. Predictive pathways from maternal childhood trauma to child outcomes, as mediated by postpartum depression, require investigation. MethodsA longitudinal sample of South African women (N=150) was followed through pregnancy and postpartum. Measures included maternal trauma history reported during pregnancy; postpartum depression through six months; and maternal-infant bonding, infant development, and infant physical growth at one year. Structural equation models tested postpartum depression as a mediator between maternal experiences of childhood trauma and children’s outcomes. A subset of women (N=33) also participated in a lab-based emotional Stroop paradigm, and their responses to fearful stimuli at six weeks were explored as a potential mechanism linking maternal childhood trauma, postpartum depression, and child outcomes. ResultsWomen with childhood trauma experienced greater depressive symptoms through six months postpartum, which then predicted negative child outcomes at one year. Mediating effects of postpartum depression were significant, and persisted for maternal-infant bonding and infant growth after controlling for covariates and antenatal distress. Maternal avoidance of fearful stimuli emerged as a potential affective mechanism. LimitationsLimitations included modest sample size, self-report measures, and unmeasured potential confounders. ConclusionsFindings suggest a mediating role of postpartum depression in the intergenerational transmission of negative outcomes. Perinatal interventions that address maternal trauma histories and depression, as well as underlying affective mechanisms, may help interrupt cycles of disadvantage, particularly in high-trauma settings such as South Africa.

596: Maternal childhood trauma is associated with both maternal and newborn perinatal stress

596: Maternal childhood trauma is associated with both maternal and newborn perinatal stress

493: Maternal childhood trauma is associated with a pro-inflammatory state during pregnancy

493: Maternal childhood trauma is associated with a pro-inflammatory state during pregnancy

Intergenerational Effects of Childhood Trauma: Evaluating Pathways Among Maternal ACEs, Perinatal Depressive Symptoms, and Infant Outcomes.

Maternal adverse childhood experiences (ACEs) have been associated with negative physical and mental health outcomes in adulthood. Less is known regarding how maternal ACEs relate to perinatal depressive symptoms or the intergenerational effect of maternal childhood trauma history on birth outcomes and infant functioning. To address this gap, an at-risk sample of 398 pregnant women was recruited from Women, Infants, and Children health clinics. Participants completed a prenatal ( M = 4.84 months before due date) and postnatal ( M = 6.76 months after birth) assessment and provided birth outcome data. At the prenatal assessment, mothers completed an ACEs measure which assessed experiences of childhood maltreatment and household dysfunction. Self-report measures of maternal depressive symptoms were obtained at both time points. Mothers reported on infant socioemotional functioning at 6 months. Maternal ACEs predicted higher levels of prenatal depressive symptoms. Childhood maltreatment experiences, in particular, predicted higher postnatal depressive symptoms and a smaller reduction in depressive symptoms across the perinatal period. Regarding intergenerational associations, maternal childhood maltreatment directly predicted higher levels of maladaptive infant socioemotional symptoms, whereas maternal household dysfunction indirectly related to infant socioemotional symptoms through maternal age at first pregnancy and infant birth weight. Limitations and future directions are discussed.

308: Maternal childhood trauma depressive symptoms and small-for-gesational age birth

308: Maternal childhood trauma depressive symptoms and small-for-gesational age birth

Multiple Mediation of Trauma and Parenting Stress in Mothers in Home Visiting

ABSTRACTParenting stress is associated with poor maternal and child outcomes. Multiple contributors to parenting stress have been proposed, but disaggregation of distinct pathways has been relatively unexplored. In addition, the contribution of maternal experience of childhood trauma has been inadequately considered. Childhood trauma and parenting stress are common in mothers in home visiting programs. Understanding the relation between childhood trauma and parenting stress holds promise for improvement of home visiting approaches. This study examined the relation between childhood trauma and parenting stress, with a focus on the mediating roles of depression and social support. Participants consisted of 208 first‐time mothers enrolled in a home visiting program who were assessed at about 5 months’ postpartum. Measures of maternal childhood trauma, depression, social support, and parenting stress were administered. A multiple mediator model revealed that childhood trauma was related to parenting stress, and the relation between childhood trauma and parenting stress was separately mediated by both depression and social support. Depression and social support uniquely and distinctly accounted for the association between childhood trauma and parenting stress. Home visiting programs may improve their impact on parenting stress by augmenting or modifying strategies to more effectively address maternal depression and social support.

Assessing expressed emotion during pregnancy

We assessed Expressed Emotion (EE) with an adapted version of the Five-Minute Speech Sample in 847 pregnant women. The prevalence of high EE was 6%. High EE was significantly associated with having a first child, low income, maternal childhood trauma and lack of parental emotional warmth during childhood.

Mediating links between maternal childhood trauma and preadolescent behavioral adjustment.

Structural equation modeling was used to simultaneously examine maternal psychological distress and social support as mediators linking maternal childhood trauma (MCT) to both maternal and child-reported behavior at 9 years of age in 231 birth mother-child dyads, who were primarily poor, urban, and African American. One half of the mothers (n = 116) reported a history of childhood abuse and neglect. Although MCT was associated with both increased maternal psychological distress and limited social support at 6 years, the pathway to child behavior ratings at 9 years was informant dependent. MCT influenced maternal ratings of her child's behavior, with some effects mediated through psychological distress. MCT indirectly influenced children's self-perception of behavior through maternal experience of social support. Maternal ratings and child self-ratings of child behavior problems were moderately correlated. No significant gender interaction was found. Findings suggest a need for understanding trauma histories in the lives of mothers who seek assistance for parenting and child behavior problems, especially in urban low income communities. Interventions targeting both increasing maternal social support and reducing psychological distress may promote competency and resiliency among children for whom MCT poses a risk to optimal development.