McConnell Krystle, Gleason Jessica, Shenassa Edmond
Towson University, Towson, and the University of Maryland, College Park, Maryland.
Obstet Gynecol. 2025 May 15;146(2):267-273. doi: 10.1097/AOG.0000000000005946.
To estimate the association between historical maternal adverse childhood experiences (ACEs) and offspring internalizing (ie, depression, anxiety, social withdrawal) and externalizing (ie, aggression, conduct disorders, attention-deficit/hyperactivity disorder) behavior symptoms not explained by offspring ACEs.
This was a retrospective cohort study using childhood adversity data collected from a nationally representative sample of mothers enrolled in the National Longitudinal Survey of Youth 1979 cohort study and their offspring born between 1970 and 2014 who were enrolled in a separate Child and Young Adult cohort. The exposure of maternal ACEs was categorized to assess dose-dependent associations (zero, one, two, or three or more). The outcomes of offspring internalizing and externalizing behavior were assessed from maternal report between age 4 and 14 years using symptom scores from the Behavior Problem Index derived from the Child Behavior Checklist. We fit marginal structural models with robust SEs to estimate the independent association between maternal ACEs and offspring internalizing and externalizing behavior while adjusting for offspring ACEs and other selected covariates.
Among 5,445 offspring born to 2,792 mothers, 60.0% of the offspring were born to mothers who reported no ACEs, 23.2% to mothers who reported one ACE, 10.4% to mothers who reported two ACEs, and 6.5% to mothers who reported three or more ACEs. Mothers with more ACEs more frequently gave birth at younger ages, were less frequently married, and had lower educational attainment. In models adjusted for offspring ACEs, one, two, and three or more maternal ACEs were independently associated with a 1.81- (95% CI, 0.87-2.75), 2.07- (95% CI, 0.71-3.43), and 2.68- (95% CI, 1.00-4.36) point increase in offspring internalizing score and a 1.78- (95% CI, 0.83-2.73), 3.08- (95% CI, 1.74-4.41), and 3.30- (95% CI, 1.47-5.13) point increase in offspring externalizing score, respectively, suggesting a dose-response association.
Maternal ACEs were associated with elevated offspring internalizing and externalizing symptoms independently of offspring ACEs. These findings support the utility of maternal ACE screening in the prenatal period to inform early interventions, services, and referrals to promote maternal health and to potentially disrupt intergenerational transmission of adversity.
评估母亲童年不良经历（ACEs）与后代内化行为（即抑郁、焦虑、社交退缩）和外化行为（即攻击性行为、品行障碍、注意力缺陷多动障碍）症状之间的关联，这些症状不能用后代的ACEs来解释。
这是一项回顾性队列研究，使用从参加1979年全国青年纵向调查队列研究的具有全国代表性的母亲样本中收集的童年逆境数据，以及她们在1970年至2014年之间出生且参加了单独的儿童和青年成人队列的后代的数据。将母亲ACEs的暴露情况进行分类，以评估剂量依赖性关联（零、一、二或三个及以上）。使用从儿童行为清单得出的行为问题指数的症状评分，从母亲报告中评估4至14岁后代的内化和外化行为结果。我们拟合了具有稳健标准误的边际结构模型，以估计母亲ACEs与后代内化和外化行为之间的独立关联，同时调整后代ACEs和其他选定的协变量。
在2792名母亲所生的5445名后代中，60.0%的后代母亲报告没有ACEs, 23.2%的后代母亲报告有一次ACEs, 10.4%的后代母亲报告有两次ACEs, 6.5%的后代母亲报告有三次及以上ACEs。有更多ACEs的母亲更频繁地在年轻时生育，结婚频率更低，教育程度也更低。在调整了后代ACEs的模型中，母亲有一次、两次和三次及以上ACEs分别与后代内化得分增加1.81（95%CI，0.87 - 2.75）、2.07（95%CI，0.71 - 3.43）和2.68（95%CI，1.00 - 4.36）分，以及后代外化得分增加1.78（95%CI，0.83 - 2.73）、3.08（95%CI，1.74 - 4.41）和3.30（95%CI，1.47 - 5.13）分独立相关，表明存在剂量反应关联。
母亲的ACEs与后代内化和外化症状的增加独立相关，与后代的ACEs无关。这些发现支持在孕期进行母亲ACEs筛查，以便为早期干预、服务和转诊提供信息，以促进母亲健康，并可能中断逆境的代际传递。
