Association Between Maternal Adverse Childhood Experiences and Offspring Internalizing and Externalizing Behavior

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.