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

Nora K Moog; Peter D Cummings; Kathryn L Jackson; Judy L Aschner; Emily S Barrett; Theresa M Bastain; Courtney K Blackwell; Michelle Bosquet Enlow; Carrie V Breton; Nicole R Bush; Sean C L Deoni; Cristiane S Duarte; Assiamira Ferrara; Torie L Grant; Alison E Hipwell; Kathryn Jones; Leslie D Leve; Stephanie Lovinsky-Desir; Richard K Miller; Catherine Monk; Emily Oken; Jonathan Posner; Rebecca J Schmidt; Rosalind J Wright; Sonja Entringer; Hyagriv N Simhan; Pathik D Wadhwa; Thomas G O'Connor; Rashelle J Musci; Claudia Buss; ECHO collaborators

doi:10.1016/S2468-2667(23)00025-7

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

Lancet Public Health. 2023 Mar;8(3):e226-e237. doi: 10.1016/S2468-2667(23)00025-7.

Authors

Nora K Moog¹, Peter D Cummings², Kathryn L Jackson², Judy L Aschner³, Emily S Barrett⁴, Theresa M Bastain⁵, Courtney K Blackwell², Michelle Bosquet Enlow⁶, Carrie V Breton⁷, Nicole R Bush⁸, Sean C L Deoni⁹, Cristiane S Duarte¹⁰, Assiamira Ferrara¹¹, Torie L Grant¹², Alison E Hipwell¹³, Kathryn Jones¹⁴, Leslie D Leve¹⁵, Stephanie Lovinsky-Desir¹⁶, Richard K Miller¹⁷, Catherine Monk¹⁰, Emily Oken¹⁴, Jonathan Posner¹⁸, Rebecca J Schmidt¹⁹, Rosalind J Wright²⁰, Sonja Entringer²¹, Hyagriv N Simhan²², Pathik D Wadhwa²³, Thomas G O'Connor²⁴, Rashelle J Musci²⁵, Claudia Buss²⁶; ECHO collaborators

Affiliations

¹ Institute of Medical Psychology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
² Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
³ Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ, USA; Albert Einstein College of Medicine, Bronx, NY, USA.
⁴ Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Environmental and Occupational Health Sciences Institute, Piscataway, NJ, USA.
⁵ Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
⁶ Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
⁷ Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA.
⁸ Department of Psychiatry and Behavioral Sciences and Department of Pediatrics, Division of Developmental Medicine, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.
⁹ Advanced Baby Imaging Lab, School of Engineering, Brown University, Providence, RI, USA.
¹⁰ Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA.
¹¹ Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
¹² Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
¹³ Department of Psychiatry and Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA.
¹⁴ Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, MA, USA.
¹⁵ Prevention Science Institute, University of Oregon, Eugene, OR, USA.
¹⁶ Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
¹⁷ Department of Obstetrics and Gynecology, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA; Department of Pediatrics, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA.
¹⁸ Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.
¹⁹ Department of Public Health Sciences and the MIND Institute, School of Medicine, University of California Davis, Sacramento, CA, USA.
²⁰ Department of Pediatrics, Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
²¹ Institute of Medical Psychology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Pediatrics, School of Medicine, University of California, Irvine, Orange, CA, USA.
²² Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee Women's Hospital, University of Pittsburgh, Pittsburgh, PA, USA.
²³ Department of Pediatrics, School of Medicine, University of California, Irvine, Orange, CA, USA; Department of Psychiatry and Human Behavior, University of California, Irvine, Orange, CA, USA; Department of Epidemiology, University of California, Irvine, Orange, CA, USA.
²⁴ Department of Obstetrics and Gynecology, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA; Department of Pediatrics, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA; Department of Psychiatry, Psychology, and Neuroscience, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA.
²⁵ Department of Mental Health, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
²⁶ Institute of Medical Psychology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Pediatrics, School of Medicine, University of California, Irvine, Orange, CA, USA. Electronic address: claudia.buss@charite.de.

Abstract

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

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

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

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

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

MeSH terms

Adolescent
Asthma*
Autism Spectrum Disorder* / epidemiology
Child
Child Abuse*
Female
Humans
Hypersensitivity*
Male
Maternal Exposure
Obesity
Pregnancy
Retrospective Studies
United States

Abstract

MeSH terms

Grants and funding