Review
Intergenerational Transmission of Maternal Childhood Maltreatment Exposure: Implications for Fetal Brain Development

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Objective

Growing evidence suggests the deleterious consequences of exposure to childhood maltreatment (CM) not only might endure over the exposed individual’s lifespan but also might be transmitted across generations. The time windows, mechanisms, and targets of such intergenerational transmission are poorly understood. The prevailing paradigm posits that mother-to-child transmission of the effects of maternal CM likely occurs after her child’s birth. The authors seek to extend this paradigm and advance a transdisciplinary framework that integrates the concepts of biological embedding of life experiences and fetal origins of health and disease risk.

Method

The authors posit that the period of embryonic and fetal life represents a particularly sensitive time for intergenerational transmission; that the developing brain represents a target of particular interest; and that stress-sensitive maternal-placental-fetal biological (endocrine, immune) pathways represent leading candidate mechanisms of interest.

Results

The plausibility of this model is supported by theoretical considerations and empirical findings in humans and animals. The authors synthesize several research areas and identify important knowledge gaps that might warrant further study.

Conclusion

The scientific and public health relevance of this effort relates to achieving a better understanding of the “when,” “what,” and “how” of intergenerational transmission of CM, with implications for early identification of risk, prevention, and intervention.

Section snippets

Prevalence and long-term consequences of exposure to childhood maltreatment and biological pathways

The term childhood maltreatment is commonly used to refer to specific traumatic events that occur in childhood such as different forms of childhood abuse (physical, sexual, emotional) or neglect (physical, emotional). Large population-based surveys have suggested many children in the United States are exposed to CM,19, 20 and that 30% to 40% of adult women have experienced at least 1 and 15% to 25% have experienced more than 1 type of abuse or neglect in their childhood.21, 22, 23 Similar

Intergenerational transmission of effects of maternal exposure to childhood maltreatment

Increasing evidence suggests that the detrimental consequences of CM exposure might not be restricted to the exposed individual alone but might be transmitted to the next generation, thus significantly extending the long-term reach of CM. Several studies have reported that children of mothers with a history of CM exposure exhibit a higher prevalence of adverse birth outcomes,46 neurodevelopmental and behavioral problems (e.g., conduct disorders, antisocial behavior, externalizing and

Mechanisms of intergenerational transmission of childhood maltreatment

Broadly, the intergenerational transmission of characteristics and states (phenotypes) can be mediated through genetic and/or environmental mechanisms. The independent contribution of genetic (DNA base pair sequence) variation for most complex common traits including psychopathology appears to be relatively modest.49, 50, 51, 52, 53, 54 Specifically in the context of CM-related phenotypes, intergenerational transmission of these sequelae through inheritance of genetic variants would imply the

Questions, issues, considerations, and future research directions

Our framework and the empirical findings discussed earlier support the plausibility that maternal CM exposure might alter the gestational environment in ways that program offspring phenotypes to increase susceptibility for psychopathology. In this context, it is apparent that the efficacy of potential interventions would be enhanced by the extent to which they can target earlier rather than later stages of brain development. Currently, there are many open questions on the extent of

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    An interview with the author is available by podcast at www.jaacap.org or by scanning the QR code to the right.

    The preparation of this article was supported by US Public Health Service (National Institutes of Health) grants R01 MH-091351 to C.B. and P.D.W.; R01 MH-105538 to C.B., D.A.F., and P.D.W.; and R01 HD-060628 to P.D.W.

    Drs. Buss and Wadhwa, the first and senior authors, respectively, contributed equally to the preparation of this article.

    Disclosure: Drs. Buss, Entringer, Fair, Simhan, Heim, Wadhwa, Ms. Moog, and Mr. Toepfer report no biomedical financial interests or potential conflicts of interest.

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