A Multi-Cohort Examination of the Independent Contributions of Maternal Childhood Adversity and Pregnancy Stressors to the Prediction of Children’s Anxiety and Depression

Amanda Noroña-Zhou, Michael Coccia, Alexis Sullivan, Thomas G. O’Connor, Brent R. Collett, Karen Derefinko, Lynette M. Renner, Christine T. Loftus, Danielle Roubinov, Kecia N. Carroll, Ruby H.N. Nguyen, Catherine J. Karr, Sheela Sathyanarayana, Emily S. Barrett, W. Alex Mason, Kaja Z. LeWinn, Nicole R. Bush

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Women’s social experiences can have long-term implications for their offspring’s health, but little is known about the potential independent contributions of multiple periods of stress exposures over time. This study examined associations of maternal exposure to adversity in childhood and pregnancy with children’s anxiety and depression symptoms in a large, sociodemographically diverse sample. Participants were 1389 mother-child dyads (child age M = 8.83 years; SD = 0.66; 42% Black, 42% White; 6% Hispanic) in the ECHO-PATHWAYS Consortium’s three U.S. pregnancy cohorts. Women reported their exposure to childhood traumatic events (CTE) and pregnancy stressful life events (PSLE). Children self-reported on their symptoms of anxiety and depression at age 8–9 years. Regression analyses estimated associations between maternal stressors and children’s internalizing problems, adjusting for confounders, and examined child sex as a modifier. Exploratory interaction analyses examined whether geospatially-linked postnatal neighborhood quality buffered effects. In adjusted models, PSLE counts positively predicted levels of children’s anxiety and depression symptoms ([ßAnxiety=0.08, 95%CI [0.02, 0.13]; ßDepression=0.09, 95%CI [0.03, 0.14]); no significant associations were observed with CTE. Each additional PSLE increased odds of clinically significant anxiety symptoms by 9% (95%CI [0.02, 0.17]). Neither sex nor neighborhood quality moderated relations. Maternal stressors during pregnancy appear to have associations with middle childhood anxiety and depression across diverse sociodemographic contexts, whereas maternal history of childhood adversity may not. Effects appear comparable for boys and girls. Policies and programs addressing prevention of childhood internalizing symptoms may benefit from considering prenatal origins and the potential two-generation impact of pregnancy stress prevention and intervention.

Original languageEnglish (US)
Pages (from-to)497-512
Number of pages16
JournalResearch on Child and Adolescent Psychopathology
Issue number4
StatePublished - Apr 2023

Bibliographical note

Funding Information:
This study was supported by the NIH ECHO program (NIH UG3/UH3OD023271 and UG3/UH3OD023305), NIEHS (1R01ES25169, R01ES016863, P30ES005022, P30ES007033), NHLBI (1R01 HL132338), NCATS (UL1 TR002319), the Urban Child Institute, and the Lisa Stone Pritzker Family Foundation. This three-cohort work could not be conducted without the incredible study staff, data teams, and co-investigators on the three cohorts and PATHWAYS award team, and we are grateful for their efforts as well as the generous contributions of participating women and children over the past decade. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. This manuscript has been reviewed by PATHWAYS for scientific content and consistency of data interpretation with previous PATHWAYS publications.

Publisher Copyright:
© 2022, The Author(s).


  • Child anxiety
  • Child depression
  • Childhood trauma
  • Intergenerational transmission
  • Pregnancy stress


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