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

Abstract

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.

Prenatal exposures to phthalates and life events stressors in relation to child behavior at age 4–6: A combined cohort analysis

“…The preschool version (ages 1.5–5) and school-age version (ages 6–18) include 99 and 112 items, respectively ( Achenbach, 2011 ). In our analysis, the types and counts of behaviors reported across the two forms were comparable, indicating the similar developmental stages of participating children across the narrow age span of 4–6 years, and the measure was harmonized across both form types as has been done previously ( Bush et al, 2023 ). Our outcome measure was the raw Total Problems score, calculated as the sum of all maternal-reported behaviors related to aggression, inattention, depression, anxiety, and hyperactivity, among others.…”

“…Given that our prior work in this combined cohort found that prenatal PSLEs were associated with higher Total Problems scores as well as higher odds of clinically relevant problem behaviors at age 4–6 ( Bush et al, 2023 ), echoing results from other cohorts showing the adverse impacts of prenatal stressful life events on child development ( Bergman et al, 2007 ; Bush et al, 2017 ; MacKinnon et al, 2018 ; Tearne et al, 2015 ), we had anticipated that PSLEs would exacerbate the impacts of phthalates alone on neurodevelopment (if any). The apparent “antagonistic” interactions between phthalate exposures and PSLEs on problem behaviors in males observed here were unexpected, and there is a very limited literature to help contextualize those results.…”

“…In the current analysis, we focused on a single summary outcome measure, Total Problems, to evaluate children’s overall levels of emotional and behavior problems, which have been found in our prior work within this harmonized cohort to be associated with exposure to PSLEs ( Bush et al, 2023 ). Our focus on a single outcome measure is in contrast to prior studies which have generally fitted models examining numerous narrowband behavior syndrome “DSM-oriented” sub-scales.…”

“…Perhaps the most noteworthy limitation of the current literature is the lack of consideration of the potentially powerful role of early life exposure to non-chemical stressors in programming children’s development, particularly mental health. Children born to mothers who experienced more stressful life events during pregnancy (PSLEs) have been found to exhibit more behavioral problems and fearfulness, as well as reduced self-regulation, and these changes can persist into adolescence ( Bergman et al, 2007 ; Bush et al, 2017 ; Bush et al, 2023 ; MacKinnon et al, 2018 ; Noroña-Zhou et al, 2023 ; Tearne et al, 2015 ). Notably, chemical and non-chemical stressors often co-occur, operate through the same mechanistic pathways (e.g., oxidative stress, endocrine disruption, inflammation), and influence the same endpoints (e.g., growth, neurodevelopment, airway health) ( Barrett and Padula 2019 ).…”

Prenatal maternal stress: triangulating evidence for intrauterine exposure effects on birth and early childhood outcomes across multiple approaches

“…As such, the eld relies on observational data. Several prospective, longitudinal studies have found an association between maternal stress, depression and anxiety and in pregnancy and various emotional and behavioral outcomes in offspring, see e.g., (11)(12)(13)(14)(15)(16)(17)(18)(19)(20). For example, one US study that analyzed data from three different pregnancy cohorts found a relationship between maternal stress during pregnancy and emotional issues in offspring observed at ages 8 to 9 years (15).…”