UK policy recognizes that the first 1,000 days of a child’s life (from conception to the age of two) is a critical period. The Marmot Review (2010) states that “What happens in these formative years begins in the womb, has lifelong effects” On a person’s health, well-being and life prospects.
There is a vast body of research into adverse childhood experiences (ACEs) and biopsychosocial consequences throughout development. Less research has been done into the possible mechanisms involved in the transmission of the effects of transgenerational trauma. Transgenerational trauma is the psychological and physical effects of trauma on subsequent generations (eg the effects on a child of their mother who experienced childhood abuse).
The impact of transgenerational trauma is needed to better understand how to support vulnerable families. Although the government recently pledged £492 million to early support services, this follows a decade of underinvestment. Therefore building up the evidence base around child abuse in the UK is essential to present to future policy-makers. Focusing on mothers who were abused as children (maternal childhood maltreatment), Soch and colleagues (2022) conducted a systematic review on perinatal outcomes.
Soch and colleagues (2022) searched for journal articles that looked at the association between maternal childhood abuse and adverse perinatal outcomes. Specifically, the following four adverse perinatal outcomes were discovered:
- Pregnancy and childbirth (eg, miscarriage, birth weight, parental anxiety)
- Maternal mental health (eg, depression, thoughts of suicide, emotion regulation)
- infant outcomes (eg, infant emotional processing, infant cognitive, infant physical development)
- Quality of the caregiving environment (eg, mother-infant bonding quality, child abuse potential, maternal emotional availability).
The authors followed PRISMA guidelines and searched eight databases. Two reviewers independently screened full texts and assessed data quality. The reviewers also examined the reference lists of included studies and contacted first authors of included studies to identify unpublished and in-press studies. Data were extracted and tabulated, and quality was assessed with the Newcastle-Ottawa Quality Assessment Scale (Wells et al., 2017), which examines the selection of study groups; comparison of groups; and assessment of results.
In total, 49 studies were included in the review. More than 50% of the included studies were conducted in the United States. The total number of women included in this review was almost 20,000, of whom almost a quarter had experienced abuse as a child growing up. About 40% of studies assessed maternal childhood abuse and consequences during pregnancy, and the remainder assessed after birth. Maternal childhood maltreatment was measured in various self-report questionnaires. Quality ratings for the included studies are presented individually in a table and are not discussed further.
The review found that maternal childhood abuse was associated with the following adverse perinatal outcomes:
- Changes in infants’ emotional processing
- likelihood of parental child abuse
- maternal emotional availability
- maternal impulse and risk taking
- suicidal thoughts during the perinatal period
- Maternal emotion regulation difficulties.
Through analysis of included studies, the authors found that maternal childhood abuse was associated with pre-pregnancy psychosis, socioeconomic status, and substance use (all of which have been previously identified as being related to adverse perinatal outcomes). ). The review assimilates the evidence for each subtype of adverse outcome through narrative synthesis.
Only a few studies examined perinatal outcomes by maternal childhood malnutrition subtype. Within studies that measured this, emotional and sexual childhood abuse were the most consistent predictors of adverse perinatal outcomes.
Looking at the included studies together, several psychosocial factors were identified as covariates. These included: maternal alcohol use, substance use, age, education, smoking and ethnicity.
The authors concluded that maternal childhood abuse was associated with a number of negative outcomes for mothers and their offspring. The authors also found that maternal childhood abuse was associated with several factors previously identified as being related to adverse perinatal outcomes. The review assimilates the processes outlined in the included studies that may account for the association between maternal childhood maltreatment and negative perinatal outcomes.
strengths and limitations
In terms of methodological strength, the authors followed the PRISMA guidelines which means that the review followed a set of evidence-based minimum items in reporting. The authors searched eight databases and checked the reference lists of all eligible papers, so it is likely that the search was thorough and retrieved all eligible journal articles. The review included approximately 50 papers which is a large number for such a review, and the authors thoroughly synthesized the existing evidence on maternal childhood maltreatment and adverse perinatal outcomes using narrative synthesis, which is a meta-analysis. The analysis was instead justified by the generally small number of studies within each subtype of outcome. Although the authors used a quality rating scale, its results were not discussed in relation to the papers included in the review.
The main methodological difficulty of the review, noted by the authors, is that reporting of maternal childhood abuse was all done via self-report and different studies use different measures (within 49 studies 12 different measures). Therefore, little is known about the type, duration and timing of abuse experienced by mothers. It is likely that different experiences will lead to different complications in the perinatal period.
In terms of ideology, in my opinion, this review takes a reductionist view on a child’s complex interactions with their environment and their consequences. Maternal childhood abuse is just one factor within the diathesis-stress model that may influence perinatal outcomes. For example, it is important to note that children are more likely to have adverse experiences if their parents were also subject to childhood abuse and trauma (Wave Trust). I understand the need for a review on a specific factor for this to be viable, however, I feel that the background and findings in this review could take a more biopsychosocial stance rather than focusing on biological mechanisms. For example, the authors write that they identified pre- and postnatal processes associated with maternal childhood undernutrition and write that these processes may influence “maternal programming processes” (St-Cyr et al., 2017). The paper by St-Cyr and colleagues (2017) is a study on mice that refers to this process in fish, rats, and mice. So, it seems a bit jumpy to draw that conclusion.
Implications for Practice
Despite the small number of included studies reporting on these mechanisms, reviews are ongoing to attempt to synthesize the potential biological mechanisms leading to adverse outcomes of childhood maternal abuse (e.g. genetic factors, hormone alterations). The authors also summarized the psychosocial mediating mechanisms (such as pre-pregnancy functioning) discussed in the included studies. The Early Intervention Foundation argues that it is important not to create a narrative where all opportunities to support child development are lost at the end of infancy because development continues throughout childhood and adolescence. To give every child the best start in life, interventions should begin before conception and continue throughout childhood.
Population-level screening for parental childhood abuse may be a tool to identify families that may need support to reduce the risk of adverse outcomes in children. It may also be useful in terms of safety as research has found that parents with a history of childhood abuse (especially emotional or physical abuse) are more likely to report abuse as well as their children (Burt et al., 2009). There was also high risk. anger levels, and more violent physical discipline toward infants (Altemeier et al., 1986).
This paper focused on mothers and did not consider the arrangements surrounding infants and did not specifically mention the role of fathers. Future research on the effects of fathers experiencing childhood abuse may be interesting to develop a broader understanding of the effects of abuse on parenting.
description of interests
Soch, AJ, Jones, IR, Shelton, KH, & Waters, CS (2022). Maternal childhood maltreatment and perinatal outcomes: a systematic review (PDF). Journal of Affective Disorders.
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Burt SC, Gunner BM, Lanzi RG, and Center for the Prevention of Child Neglect. (2009). The effect of maternal history of abuse on parenting knowledge and behavior. Family Relations, 58(2), 176-187.
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Saint-Cyr, S., Abuesh, S., Sivanathan, S., & McGowan, PO (2017). Maternal programming of sex-specific responses to predator odor stress in adult rats. Hormones and Behavior, 94, 1–12.
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The Best Start for Life: A Vision for the 1001 Critical Days. Department of Health and Social Care. March 2021.
Wave Trust (2014) A preventive and integrative approach to early child development: what is missing? and next steps, page 4,
Wells, G., Shea, B., O’Connell, D., Peterson, J., Welch, V., Lossos, M., & Tugwell, P. (2006). (2017). The Newcastle-Ottawa Quality Assessment Scale (NOS) for assessing the quality of non-randomised studies in meta-analyses. Clin Epidemiol [Internet]2017, 1–2.