Intergenerational transmission of stress: Multi-domain stressors from maternal childhood and pregnancy predict children’s mental health in a racially and socioeconomically diverse, multi-site cohort

Nicole R. Bush, Amanda Noroña-Zhou, Michael Coccia, Kristen L. Rudd, Shaikh I. Ahmad, Christine T. Loftus, Shanna H. Swan, Ruby H.N. Nguyen, Emily S. Barrett, Frances A. Tylavsky, W. Alex Mason, Catherine J. Karr, Sheela Sathyanarayana, Kaja Z. LeWinn

Research output: Contribution to journalArticlepeer-review


Purpose: Despite growing recognition that unfortunately common maternal stress exposures in childhood and pregnancy may have intergenerational impacts on children’s psychiatric health, studies rarely take a life course approach. With child psychopathology on the rise, the identification of modifiable risk factors is needed to promote maternal and child well-being. In this study, we examined associations of maternal exposure to childhood traumatic events (CTE) and pregnancy stressful life events (PSLE) with child mental health problems in a large, sociodemographically diverse sample. Methods: Participants were mother–child dyads in the ECHO-PATHWAYS consortium’s harmonized data across three U.S. pregnancy cohorts. Women completed questionnaires regarding their own exposure to CTE and PSLE, and their 4–6-year-old child’s mental health problems using the Child Behavior Checklist (CBCL). Regression analyses estimated associations between stressors and child total behavior problems, adjusting for confounders. Results: Among 1948 dyads (child age M = 5.13 (SD = 1.02) years; 38% Black, 44% White; 8.5% Hispanic), maternal history of CTE and PSLE were independently associated with children’s psychopathology: higher CTE and PSLE counts were related to higher total problems ([ßCTE = 0.11, 95% CI [.06,.16]; ßSLE = 0.21, 95% CI [.14, 0.27]) and greater odds of clinical levels of problems (ORCTE = 1.41; 95% CI [1.12, 1.78]; ORPSLE = 1.36; 95% CI [1.23, 1.51]). Tests of interaction showed PSLEs were more strongly associated with child problems for each additional CTE experienced. Conclusion: Findings confirm that maternal exposure to CTE and PSLE are independently associated with child mental health, and history of CTE exacerbates the risk associated with PSLE, highlighting intergenerational risk pathways for early psychopathology. Given the prevalence of these exposures, prevention and intervention programs that reduce childhood trauma and stress during pregnancy will likely positively impact women’s and their children’s health.

Original languageEnglish (US)
JournalSocial Psychiatry and Psychiatric Epidemiology
StateAccepted/In press - 2023

Bibliographical note

Funding Information:
This study was supported by the NIH ECHO program (UG3/UH3OD023271, UG3/UH3OD023305), NIEHS (1R01ES25169, R01ES016863, P30ES007033, P30ES005022), NCATS (UL1 TR002319), and the Urban Child Institute. Dr. Bush is the Lisa and John Pritzker Distinguished Professor of Developmental and Behavioral Health and receives support from 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:
© 2023, The Author(s).


  • Child mental health
  • Child psychopathology
  • Childhood trauma
  • Intergenerational transmission
  • Pregnancy stress

PubMed: MeSH publication types

  • Journal Article


Dive into the research topics of 'Intergenerational transmission of stress: Multi-domain stressors from maternal childhood and pregnancy predict children’s mental health in a racially and socioeconomically diverse, multi-site cohort'. Together they form a unique fingerprint.

Cite this