Maternal adverse childhood experiences and prenatal stress: Intergenerational transmission and offspring mental health in the ECHO Cohort

Background The rising global prevalence of pediatric mental health problems requires the identification of preventable factors underlying their development. This study assessed whether maternal adverse childhood experiences (ACEs) and pregnancy stress were intergenerationally associated with offspring mental health. Methods This study used data from 34 sites in the nationwide Environmental Influences on Child Health Outcomes Cohort. Eligible parent-child dyads (child age: 1.5-18 years) provided data on at least one measure of maternal stress and at least one measure of child mental health. Study aims were evaluated using regression analyses, including interaction tests to determine potential effect modifiers. Results Participants were organized into three subsamples with data on (1) maternal ACEs (N= 2,906), (2) perceived prenatal stress (N = 4,441), and (3) both stress exposures (N = 834). After adjusting for confounders, maternal ACEs and prenatal stress were significantly associated with child mental health problems (B = 2.53 [95% confidence interval [CI]: 2.09, 2.96], p < 0.0001 and B = 2.36 [95% CI: 2.03, 2.68], p < 0.0001, respectively). Among participants with data on both stress exposures, maternal ACEs (B = 1.72, 95% CI: [0.96, 2.48], p < 0.0001) and prenatal stress (B = 2.05, 95% CI: [1.29, 2.80], p < 0.0001) were independently associated with child mental health problems. Neither maternal ACEs nor child sex modified the association between prenatal stress and child mental health problems. Conclusions Maternal exposure to ACEs and pregnancy stress were associated with the development of child mental health problems. These findings highlight the need for policies and interventions that mitigate exposure to adversity and protect pregnant individuals and their children from the intergenerational transmission of mental health problems.