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. Author manuscript; available in PMC: 2024 May 1.
Published in final edited form as: Child Abuse Negl. 2023 Mar 2;139:106107. doi: 10.1016/j.chiabu.2023.106107

Threat versus Deprivation in Mother’s Childhood: Differential Relations to Hair Cortisol and Psychopathology in Pregnancy

Francesca Penner a, Jennifer E Khoury b, Michelle Bosquet Enlow c, Karlen Lyons-Ruth d
PMCID: PMC10101698  NIHMSID: NIHMS1879290  PMID: 36870268

Abstract

Background:

The negative effects of childhood maltreatment can be intergenerational, and the prenatal period may play an important role in this intergenerational transmission. Maternal hypothalamic-pituitary-adrenal (HPA) axis dysfunction and maternal psychopathology represent two mechanisms through which the effects of childhood maltreatment are hypothesized to be transmitted across generations.

Objective:

This study first sought to extend prior research on pathways of intergenerational transmission by examining whether mother’s childhood experiences of abuse versus neglect differentially relate to maternal HPA activity and to maternal psychopathology during the prenatal period. Second, exploratory analyses examined the links between maternal variables and their State Protective Service involvement as a parent, as an indicator of maladaptive caregiving.

Methods:

During the third trimester of pregnancy, 51 women reported on experiences of childhood maltreatment, on State Protective Service involvement as an adult parent, and on current depressive and post-traumatic stress symptoms, and provided a hair sample for cortisol assay.

Results:

Regression analyses indicated that greater severity of abuse, but not neglect, in childhood was associated with higher maternal depressive symptoms (β=.488, p=.020). In contrast, greater severity of neglect, but not abuse, in mothers’ childhood was associated with lower maternal HCC (β=−.437, p=.031). Lower maternal HCC, but not maternal psychopathology or severity of childhood abuse or neglect, in turn, was associated with State Protective Service involvement (β=−.785, p < .001).

Conclusions:

Findings extend prior work by suggesting that childhood abuse and neglect may have different sequelae for mothers during pregnancy and that these sequelae may have different relations to parenting.

Keywords: neglect, abuse, intergenerational transmission, hair cortisol, maternal depression, pregnancy

There is increasing evidence that the negative effects of childhood maltreatment may be transmitted across generations, such that physiological and mental health vulnerabilities can be observed in children whose parents experienced maltreatment (Brand et al., 2010; Glackin et al., 2021; Greene et al., 2020; Jovanovic et al., 2011; Su et al., 2022). While multiple pathways are thought to underlie transmission of the negative effects of childhood maltreatment, recent work has highlighted the critical importance of the prenatal period. Buss and colleagues (2017) outlined how childhood maltreatment can alter mothers’ biology, including the brain, endocrine, and immune systems (Heim & Binder, 2012), in ways that may go on to create adversity within the intrauterine environment and affect fetal development. Additionally, childhood maltreatment is known to increase risk for psychopathology, including during pregnancy (Plant et al., 2013), and maternal psychopathology during fetal development has been linked to adverse outcomes for offspring (Pawlby et al., 2011; Talge et al., 2007). Taken together, evidence suggests that maternal experiences of childhood maltreatment may result in adverse psychophysiological effects and that the prenatal period is a critical window when these maternal effects may begin to transmit to the child. What is less understood, and therefore the primary investigation of the current study, is whether maternal experiences of childhood abuse versus neglect have differential effects on maternal psychophysiological functioning during pregnancy. This question is particularly important given that neglect is typically understudied compared to abuse (Stoltenborgh et al., 2015), despite reports of child neglect constituting 75% of child protective service reports (U.S. Department of Health & Human Services, 2021).

Effects of Childhood Maltreatment on Maternal Stress Biology

The hypothalamic-pituitary-adrenal (HPA) axis is a primary stress system and hypothesized to be a critical mechanism linking childhood maltreatment to negative physical and mental health outcomes (Loman et al., 2010). The HPA axis activates in response to stress or threat, with cortisol released as the end product in this process. Activity of the HPA axis is then down-regulated when the threat is no longer present (Gunnar et al., 2015; Sapolsky et al., 2000). Experiences of chronic stress, including childhood maltreatment, can contribute to long-term HPA dysregulation, resulting in either hypo- or hyperreactivity of the system (Khoury et al., 2019; Miller et al., 2007). In the context of HPA dysregulation, cortisol levels may be blunted (in a hyporeactive system) or increased (in a hyperreactive system).

Cortisol measurement via hair samples has become more common over the last decade. Cortisol concentration assayed from hair represents cortisol accumulated over multiple months, depending on the length of hair sampled, thereby indexing more chronic stress and HPA activity, relative to acute assessments such as salivary cortisol (Russell et al., 2012; Stalder & Kirschbaum, 2012). A meta-analysis of relations between adversity and hair cortisol concentration (HCC) found evidence for both increased and blunted HCC following adversity, with the association moderated by factors, including type and timing of adversity and sample characteristics (Khoury et al., 2019).

Studies that have examined childhood maltreatment and HCC during pregnancy have also shown mixed effects. Schreier et al. (2015) found that childhood sexual or physical abuse was associated with increased HCC in pregnant women. Swales et al. (2018) also found that exposure to more traumatic events in childhood was associated with elevated HCC in pregnancy. On the other hand, Bowers et al. (2018) demonstrated that the number of ACEs reported by pregnant women was inversely associated with their HCC. Schury et al. (2017) showed that severity of childhood maltreatment was not significantly associated with HCC measured in the third trimester of pregnancy, and Nyström-Hansen et al. (2019) also found no association between childhood abuse and HCC in pregnancy. Given mixed prior findings, and the broader evidence for both blunted and elevated cortisol linked to childhood maltreatment, more research is needed to elucidate the nature of the association between childhood maltreatment and HCC in pregnancy. In particular, testing whether childhood experiences of abuse and neglect differentially relate to HCC in pregnancy may shed additional light on this question.

Notably, the fetal environment may be negatively affected by mothers’ HPA axis dysfunction (Buss et al., 2017), and this is one way in which pregnancy may be an important period in the intergenerational transmission of childhood maltreatment risk. Specifically, Buss and colleagues (2017) discuss how negative effects on maternal endocrine functioning, including the HPA axis, can “spillover” into gestational biology and subsequently to fetal programming. Therefore, maternal HCC—and HCC during pregnancy in particular—may be an important mechanism linking maternal childhood maltreatment to negative outcomes in their offspring.

Effects of Childhood Maltreatment on Maternal Psychopathology

There is also robust evidence that experiences of childhood maltreatment increase risk for later psychopathology (Jaffee, 2017). For example, childhood maltreatment, and abuse in particular, has been associated with significantly increased liability for both internalizing (e.g., depression, anxiety) and externalizing (e.g., aggression, rule breaking) disorders (Keyes et al., 2012). Research that has assessed psychiatric symptoms during pregnancy has also found that childhood maltreatment specifically increases risk for prenatal psychopathology. A systematic review of the associations between childhood maltreatment and perinatal anxiety and depressive disorders found that there was strongest evidence for associations with perinatal depression and post-traumatic stress disorder, and that maltreatment predicted these forms of psychopathology over and above sociodemographic, psychiatric (history of psychiatric disorders prior to pregnancy), perinatal, and psychosocial factors (Choi & Sikkema, 2016). Understanding the associations between childhood maltreatment and mental health risks in pregnancy is particularly important because the psychological effects of childhood maltreatment may also impact mothers’ gestational biology and subsequent fetal development (Buss et al., 2017). Moreover, there is evidence that maternal perinatal psychopathology is associated with physical and mental health risks for offspring (Pawlby et al., 2011; Plant et al., 2016, 2017; Talge et al., 2007).

Childhood Threat versus Deprivation Experiences: Possible Differential Relations

One important question in understanding the transmission of the adverse effects of childhood maltreatment to the next generation, and the role of the prenatal period in this transmission, is whether mothers’ childhood experiences of neglect versus abuse have differential associations with potential transmission mechanisms during pregnancy. A systematic review by McLaughlin and colleagues (2019) revealed that the neurodevelopmental effects of childhood threat experiences, defined as involving harm or the potential for harm to the child, were different from the effects of childhood deprivation experiences (indexed by neglect, institutional rearing, parental absence), with threat associated with alterations in amygdala activity to threatening stimuli and deprivation associated with reduced cortical grey matter thickness and deficits in executive functioning. In a longitudinal study from infancy, higher levels of parental harshness (threat) toward their adolescents were associated with higher adolescent salivary cortisol, whereas higher levels of parental disengagement in infancy (deprivation) were associated with lower adolescent salivary cortisol (Doom et al., 2022). Other studies also suggest that abuse-related experiences are more strongly related to hyperreactivity and neglect-related experiences to hypo-reactivity of the HPA axis (Bruce et al., 2009; LoPilato et al., 2020; Reijman et al., 2015; Schalinski et al., 2019; van der Vegt et al., 2009; White et al., 2017). Given the potential for bifurcated effects of childhood abuse-related versus neglect-related experiences, the links between childhood maltreatment and maternal HCC and between childhood maltreatment and maternal psychopathology may differ for maternal childhood abuse compared to neglect. If this is the case, intergenerational transmission pathways and mechanisms may operate differently for maternal childhood abuse versus neglect. Because abuse and neglect co-occur in a subset of children, with estimates ranging from 2.1% in a large general population sample (Armour et al., 2014) to 37.6% among young children in foster care (Pears et al., 2008), it is important to control for abuse experiences when assessing the unique effects of neglect and vice versa.

Childhood Maltreatment, Maternal Psychophysiology, and Adverse Caregiving in the Next Generation

Not only may adverse effects of childhood maltreatment be transmitted to the next generation, but childhood maltreatment itself is often intergenerational (Greene et al., 2020), with meta-analytic evidence suggesting that parents who were maltreated are more than two times as likely to have children who are maltreated (Madigan et al., 2019). Moreover, studies have linked maternal cortisol, both high and low levels, with poor caregiving (Crockett et al., 2013; Gordon et al., 2010; Khoury et al., 2020). In addition, maternal psychopathology, including during the perinatal period, has been linked to disrupted caregiving and risk of later child maltreatment (Ayers et al., 2019; Pawlby et al., 2011). Thus, maternal experiences of maltreatment in childhood, and mothers’ physiology and psychopathology in adulthood, may be predictors of adverse caregiving for offspring.

Goals of the Current Study

The main aim of the current study was to assess whether maternal childhood abuse versus neglect have different relations to both maternal HPA functioning (HCC) and psychopathology (depressive and post-traumatic stress symptoms) in pregnancy. A second, exploratory aim was to assess the relations between each of these maternal risk variables (childhood abuse and neglect, HCC, psychopathology) and maternal family involvement in adulthood with the State Protective Services agency (SPS) due to concerns about the welfare of one or more of their children, as one index of adverse caregiving.

We hypothesized that maternal childhood abuse and neglect each would be associated with maternal HCC, with a tentative hypothesis that neglect would be associated with lower HCC and abuse with elevated HCC (e.g., Doom et al., 2022). We further hypothesized that childhood abuse, but not neglect, would be positively associated with mothers’ depressive and post-traumatic stress symptoms in pregnancy, based on evidence from Keyes and colleagues (2012) that neglect was not associated with later psychiatric disorders when exposure to abuse was accounted for. For the exploratory aim, family involvement with SPS was assessed in relation to maternal childhood maltreatment and to maternal HCC, depressive symptoms, and post-traumatic stress symptoms in pregnancy. These were considered exploratory analyses given the small number of families involved with SPS (9.8% of sample, n = 5).

Methods

Participants and Procedure

The Mother-Infant Neurobiological Development (MIND) Study included, as the first wave of the study, the recruitment and assessment of 51 women during the third trimester of pregnancy. Study recruitment was accomplished through advertising in prenatal classes and recruiting packets in local obstetric offices. Participants were recruited such that approximately half of the mothers (47.1%) reported one or more types of abuse or neglect on the Adverse Childhood Experiences (ACEs) Screening Interview. Exclusion criteria included (a) English not a primary language spoken at home and (b) maternal age over 44 years at time of the infant’s expected birth. The second wave of the study included the recruitment and assessment of an additional 128 mother-infant dyads when the infants were approximately 4 months of age. Given the focus of the current study on data collected in the first wave in pregnancy (N=51), participants recruited into the MIND Study postnatally were not included in the current analyses and are thus not described further. The 51 mothers were on average 32.56 years old (SD = 4.28, range 20–39 years). In regard to ethnicity, 15.7% (n=8) of mothers identified as Hispanic/Latina. With regard to race, 3.9% (n=2) of mothers identified as Black or African American, 11.8% (n=6) as Asian American, 2.0% (n=1) as Native Hawaiian or Pacific Islander, 9.8% (n=5) as Biracial or Multiracial, and 70.6% (n=36) as White. One participant did not report race or ethnicity. The median annual household income reported by mothers was $76,000-$100,000, and median level of education was a Master’s degree. The majority of mothers (88.2%) reported living with a partner.

Participants attended a laboratory visit during the third trimester of pregnancy, during which they completed self-report questionnaires assessing sociodemographic factors, depressive and post-traumatic stress symptoms, childhood maltreatment experiences, and a background questionnaire that included questions related to their history of family referral to SPS due to concerns about the welfare of any of their children. Participant hair samples for extracting cortisol were also collected during the third trimester laboratory visit. Questions pertaining to SPS involvement were asked again at a subsequent 4-month study visit to obtain a record of SPS involvement through 4 months postpartum.

Measures

Hair Cortisol Concentration (HCC)

At the pregnancy visit, a small bundle of hair (2–3 mm in diameter) was cut from participants’ scalps, specifically from the posterior vertex region because it has most uniform hair growth (Pragst & Balikova, 2006). Hair samples were stored in aluminum foil in manila envelopes at room temperature and out of direct sunlight (D’Anna-Hernandez et al., 2011). Cortisol analysis of hair was conducted at the Technical University of Dresden, Department of Psychology, Kirschbaum Laboratory. To wash hair and extract cortisol, liquid chromatography-tandem mass spectrometry (Gao et al., 2013) was used, following an established protocol (Stalder et al., 2013). The first 4-cm piece of hair, starting from the scalp, was used for cortisol extraction. Given that hair grows approximately 1-cm per month, this segment reflects hair growth over the prior 4 months (Stalder & Kirschbaum, 2012; Wennig, 2000). Therefore, segments used in analyses correspond to hair from the second and third trimesters of pregnancy. HCCs were standardized based on sample weight and reported in pg/mg. Average inter- and intraassay variabilities were 7.98% and 6.36%, respectively.

Maternal Depressive Symptoms

Participants completed the Edinburgh Postnatal Depression Scale (EPDS; Cox et al., 1987), which has been shown to be valid for measuring depression postnatally as well as during pregnancy (Murray & Cox, 1990). The EPDS includes 10 items, which are rated from 0—as much as I always could to 3—not at all and summed for a total score of 0–30, with higher scores indicating greater depressive symptoms. A cutoff score of ≥13 has been demonstrated to indicate a clinically significant risk for depression (Matthey et al., 2006).

Maternal Post-Traumatic Stress Symptoms

Participants also completed the PTSD Checklist for DSM-5 (PCL-5; Weathers et al., 2013), a 20-item self-report measure that assesses symptoms of DSM-5 PTSD. Items are rated from 0—Not at all to 4—Extremely. In the current study we used the PCL-5 total symptom severity score, a sum of all 20 items. Total severity scores range from 0–80, with higher scores reflecting greater levels of PTSD symptoms. A PCL-5 clinical cutoff score between 31–33 has been identified, with scores above cutoff indicative of probable PTSD (Weathers et al., 2013).

Maternal Childhood Maltreatment

Mothers completed the 75-item Maltreatment and Abuse Chronology of Exposure scale (MACE; Teicher & Parigger, 2015) The MACE assesses the severity of 10 types of maltreatment (verbal abuse, non-verbal emotional abuse, physical abuse, sexual abuse, emotional neglect, physical neglect, peer emotional abuse, peer physical bullying, witnessing interparental violence, witnessing violence to siblings) on 10-point scales, as well as overall severity of childhood maltreatment, through age 18 years (Teicher & Parigger, 2015). The MACE has demonstrated high test-retest reliability, and the total score has been shown to correlate strongly with the Childhood Trauma Questionnaire (CTQ) and the ACE questionnaire (Teicher & Parigger, 2015), providing evidence for its validity. Following the threat/deprivation framework, two composite variables were created: the severity of neglect score (created by adding the emotional neglect scale and the physical neglect scale; possible score range 0–20) and the severity of parental abuse score (created by adding the verbal abuse scale, the non-verbal emotional abuse scale, the physical abuse scale, and the sexual abuse scale; possible score range 0–40).

Involvement with State Protective Services (SPS) as an Adult Parent

The background questionnaire administered in pregnancy and at 4 months postpartum inquired about the participant’s family’s involvement with SPS, the state agency that investigates reports of potential maltreatment of children. The questions included the following: “Have you ever received services from SPS?” If so: “What was the nature of the services? Which children were the focus of the services? Are you currently receiving services? Was a child ever placed in out-of-home care? If so, for how long? If so, in what kind of care?” Responses at both time points were coded for any involvement with SPS for any of the participant’s children. The variable was initially coded as 0 = no involvement, 1 = SPS involved, and 2 = child removed from the home. Because only two children had been removed from the home in this sample, the SPS variable was collapsed into two categories (0 = No involvement/ 1 = Involvement).

Demographics and covariates potentially related to HCC

Participants self-reported their age, race, ethnicity, educational attainment, annual household income, and relationship status. In addition, participants reported their pre-pregnancy height and weight (used to calculate BMI), their smoking status, and several hair-related variables (hair color, whether hair was dyed or colored or chemically straightened or curled in the last year, shampooing frequency, use of gels/creams/oils the day hair was sampled) as potential correlates of HCC.

Data Analytic Strategy

For the main statistical analyses, SPSS Version 28 was used. Descriptive statistics were calculated, and score distributions were examined for skewness and kurtosis. Due to skewness and kurtosis in the HCC variable, HCC scores were log 10 transformed, and these transformed scores were used in analyses. The EPDS and PCL-5 both had a high kurtosis value; one outlier was identified in the distribution of EPDS scores and two outliers in the distribution of PCL-5 scores. Results were analyzed both with and without outliers, and the main findings were the same; therefore, we did not exclude outliers from analysis.

For the primary study aim, three regression models were evaluated. In each model, maternal abuse and neglect severity in childhood were entered as independent variables, and the dependent variable was a) maternal HCC, b) maternal depressive symptoms, or c) maternal post-traumatic stress symptoms. Covariates were included in each regression model if they were associated with the dependent variable at the bivariate level.

For the exploratory aim, we evaluated two binary logistic regression models, each with SPS involvement as the dependent variable. In the first model, maternal childhood abuse and neglect were entered as independent variables. In the second model, maternal HCC, depressive symptoms, and post-traumatic stress symptoms were entered as independent variables. Missing data was 0% for EPDS, PCL-5, and HCC, 1.96% (1) for MACE abuse and neglect severity, and 9.8% (5) for SPS involvement. To account for missing data in the SPS variable, MPlus (WLSMV estimator with 150 random starting values) with full information maximum likelihood (FIML) was used to test the binary logistic regression models for the exploratory aim.

Results

Descriptive Statistics

Descriptive statistics are shown in Table 1. 37.3% (n=19) of the sample reported emotional abuse, 27.5% (n=14) physical abuse, 9.8% (n=5) sexual abuse, 25.5% (n=13) emotional neglect, and 13.7% (n=7) physical neglect, based on the ACEs Screening Interview. Twelve mothers (23.5%) endorsed both abuse and neglect experiences. On the EPDS, 23.5% (n=12) had scores at or above the clinical cutoff of 13. On the PCL-5, 3.9% (n=2) had scores above the clinical cut-off of 31. By 4 months postpartum, 9.8% of the sample (n=5) reported family SPS involvement. Given that 4.29% of families were investigated by child protective services in 2020 nationally (U.S. Department of Health & Human Services, 2021), the rate in this sample is somewhat elevated, likely due to the oversampling for maternal childhood maltreatment history. Mothers reported the following reasons for SPS involvement with one or more of their children: father’s substance abuse (n = 1), domestic violence by father (n = 1), sexual abuse by father (n = 1), and drinking history (parent not specified) (n = 1). In one final case, the child was removed from the home and then reunited with the family, but no reason for the initial removal was given.

Table 1.

Descriptive statistics

Minimum Maximum Mean or Frequency Std. Dev. Skewness Kurtosis
Maternal HCCa 0.07 2.19 0.80 0.41 1.13 2.56
EPDS Total 0.00 29.00 6.41 4.96 1.92 7.32
PCL-5 Total 0.00 72.00 7.63 12.31 3.20 14.37
SPS Involvement through Four Months Postpartum -- -- 9.8% (n=5) -- -- --
MACE Childhood Abuse Severity 0.00 31.00 10.40 8.44 0.63 −0.61
MACE Childhood Neglect Severity 0.00 16.00 2.88 3.50 1.71 3.26
Maternal Age 20.00 39.00 32.56 4.28 −0.81 1.11
Minority Race or Ethnicity -- -- 33.3% (n=17) -- -- --
Maternal Education Level High school graduate Doctoral degree Median: Master’s degree -- -- --
Annual Household Income $0–15,000 $201,000 or more Median: $76–100,000 -- -- --
Living with Partner -- -- 88.2% (n=45) -- -- --
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Note.

a

Log-transformed HCC used in all analyses. SPS Involvement, Minority Race/Ethnicity, and Living with Partner are binary variables, 0 = No, 1 = Yes; Maternal Educational Level was coded from 1 = High school graduate to 5 = Doctoral degree; Annual Household Income was coded from 1 = 0-$15,000 to 8 = $201,000 or more. Std. Dev. = standard deviation; HCC = hair cortisol concentration; EPDS = Edinburgh Prenatal/Postnatal Depression Scale; PCL-5 = PTSD Checklist for DSM-5; SPS = State Protective Services; MACE = Maltreatment and Abuse Chronology of Exposure scale.

Bivariate Associations Between Main Study Variables

Bivariate associations among the main study variables are shown in Table 2. There was a positive association between maternal childhood neglect severity and abuse severity. Greater childhood neglect severity was associated with lower maternal HCC in pregnancy, and greater childhood abuse severity was associated with higher levels of depressive and post-traumatic stress symptoms in pregnancy. Depressive and post-traumatic stress symptoms were positively correlated. SPS involvement was associated with lower maternal HCC.

Table 2.

Bivariate correlations among main study variables and potential covariates

1 2 3 4 5 6 7 8 9 10
1 Maternal HCCa --
2 EPDS Total .18 --
3 PCL-5 Total .04 .79** --
4 SPS Involvement −.35* .06 0.15 --
5 MACE Childhood Abuse Severity −.11 .32* .37** .13 --
6 MACE Childhood Neglect Severity −.31* .13 .26 .25 .74** --
7 Maternal Age −.13 .06 .00 .13 .01 .30* --
8 Minority Race or Ethnicity .29* −.02 .01 .18 .29* .13 −.14 --
9 Maternal Educational Level −.10 −.11 −.19 −.25 −−.34* −.21 .41** −.49** --
10 Annual Household Income −.07 −.20 −.31* −.19 −.33* −.23 .26 −.28* .61** --
11 Living with Partner −.06 −.00 −.04 −.07 −.06 .09 .57** −.13 .49** .35**
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Note.

a

Log-transformed HCC used in all analyses. HCC = hair cortisol concentration; EPDS = Edinburgh Prenatal/Postnatal Depression Scale; PCL-5 = PTSD Checklist for DSM-5; SPS = State Protective Services; MACE = Maltreatment and Abuse Chronology of Exposure scale.

*

Correlation significant at the 0.05 level (2-tailed).

**

Correlation significant at the 0.01 level (2-tailed).

Covariate Assessment

Of the sociodemographic variables, minority race/ethnicity was associated with higher HCC, and higher income was associated with lower post-traumatic stress symptoms. None of the other sociodemographic variables was associated with any of the dependent variables. Therefore, minority race/ethnicity was entered as a covariate in the regression model with HCC as the dependent variable, and income was entered as a covariate in the regression model with post-traumatic stress symptoms as the dependent variable. There were no covariates for the regression models involving maternal depressive symptoms or family SPS involvement. Of the variables potentially associated with HCC, there was one significant association, between HCC and whether mothers had chemically straightened or dyed their hair in the last year (p = .04). However, when this variable was entered as a covariate in the model with HCC, its association with HCC did not remain significant, and regression results did not change. We therefore did not include this or other potential covariates related to HCC in our main presentation of results for the sake of parsimony.

Maternal Childhood Abuse/Neglect and Maternal Prenatal HCC

Consistent with the bivariate correlations, childhood abuse severity was not associated with HCC (β = .118, p = .564), whereas childhood neglect severity was negatively associated with HCC (β = −.437, p = .031), such that higher neglect scores were associated with lower prenatal HCC (see Table 3). Moreover, when examining R2 change due to the contribution of each variable with the other controlled, neglect severity explained 8.5% of variance in maternal HCC with childhood abuse severity controlled, whereas childhood abuse severity accounted for only 0.6% of variance with childhood neglect severity controlled. Figure 1 displays the partial regression plots for both associations after controlling for the other maltreatment variable and relevant covariates. This pattern of results suggests that the observed effect of maternal childhood neglect severity on prenatal HCC was not due to cooccurrence of abuse and neglect experiences, but due to the specific contribution of neglect.

Table 3.

Linear regression models testing unique contributions of maternal childhood abuse and neglect severity to maternal hair cortisol concentration and psychopathology in pregnancy

Model 1: Maternal Hair Cortisol Concentration
B (SE) β p
F(3, 46)=4.12, p=.012, R2=.21
MACE Neglect Severity −.05 (.02) −.44 .03
MACE Abuse Severity .01 (.01) .12 .56
Maternal Minority Status .27 (.12) .31 .03
Model 2: Maternal Depressive Symptoms
B (SE) β p
F(2, 47)=3.32, p=.045, R2=.12
MACE Neglect Severity −.33 (.29) −.23 .26
MACE Abuse Severity .28 (.12) .49 .02
Model 3: Maternal PTSD Symptoms
B (SE) β p
F(3, 45)=3.41, p=.025, R2=.19
MACE Neglect Severity −.21 (.71) −.06 .77
MACE Abuse Severity .53 (.31) .36 .09
Annual Household Income −1.29 (.92) −.20 .17
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Note. Bolded values are significant at the level of p < .05. Maternal minority status is a binary variable representing minority race/ethnicity, 0 = No, 1 = Yes. MACE = Maltreatment and Abuse Chronology of Exposure scale.

Figure 1.

Figure 1.

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Relations of abuse and neglect severity to maternal HCC and depressive symptoms.

Note. Residualized scatterplots: (1a) Childhood abuse severity with HCC (childhood neglect and minority status partialled out); (1b) Childhood neglect severity with HCC (childhood abuse and minority status partialled out); (1c) Childhood abuse severity with depressive symptoms (childhood neglect partialled out); (1d) Childhood neglect severity with depressive symptoms (childhood abuse partialled out). HCC = hair cortisol concentration

Maternal Childhood Abuse/Neglect and Maternal Prenatal Psychopathology

Results of the linear regression models are shown in Table 3. In the model with maternal depressive symptoms in pregnancy as the dependent variable, childhood abuse severity was positively associated with maternal depressive symptoms (β = .488, p = .020), while childhood neglect severity was not associated with maternal depressive symptoms (β = −.233, p = .256). When examining R2 change due the contribution of each variable with the other controlled, neglect severity explained 2.5% of variance in depressive symptoms after childhood abuse severity was controlled, whereas childhood abuse severity accounted for 10.8% of the variance after childhood neglect severity was controlled. Figure 1 displays partial regression plots showing each association, after controlling for the other child maltreatment variable. This pattern of results suggests that the effect of maternal childhood abuse severity on depressive symptoms was not due to cooccurrence of abuse and neglect experiences, but was specific to abuse.

In the third regression model with maternal post-traumatic stress symptoms as the dependent variable, neither maternal childhood abuse severity (β = .363, p = .092) nor childhood neglect severity (β = −.059, p = .772) was associated with symptoms. However, the effect size for maternal childhood abuse severity suggests that further work may be warranted.

Maternal Variables and Family Involvement with State Protective Services

For the exploratory aim, in the first binary logistic regression model, where maternal childhood abuse and neglect severity were entered as predictors of SPS involvement, neither childhood abuse severity (β = −.112, p = .672) nor childhood neglect severity (β = .411, p = .107) reached significance. However, the effect size for maternal childhood neglect severity suggests that further work may be warranted. In the second model, where maternal HCC, depressive symptoms, and post-traumatic stress symptoms were entered as predictors, maternal HCC was negatively associated with SPS involvement (β = −.785, p < .001) with a large effect size, such that lower HCC levels were associated with higher likelihood of family SPS involvement. Maternal depressive symptoms (β = .149, p =.772) and PTSD symptoms (β = .107, p = .803) were not associated with SPS involvement. Across both models, results did not change when sociodemographic variables (minority race/ethnicity, income, education, age) were controlled.

Discussion

Pregnancy is a sensitive period when both psychological and endocrine (e.g., HPA axis functioning) factors can affect gestational biology (Buss et al., 2017). The primary aim of the current study was to examine maternal history of childhood abuse and neglect separately in association with mothers’ hair cortisol concentration (HCC) and with mothers’ psychopathology symptoms in pregnancy. In addition, exploratory analyses examined whether maternal childhood abuse and neglect, as well as HCC and psychopathology symptoms in pregnancy, were associated with mothers’ family involvement with SPS as an adult parent. Results indicated that greater maternal childhood neglect severity, but not abuse severity, was associated with lower maternal HCC in the third trimester of pregnancy. In contrast, maternal childhood abuse was not related to HCC in pregnancy but was associated with greater depressive symptoms in pregnancy. In addition, in exploratory analyses, mothers’ reported family SPS involvement as a parent was associated with lower HCC during pregnancy. Therefore, the pattern of findings obtained here supported a specific contribution of maternal childhood neglect experiences to lower HCC, and a specific contribution of maternal childhood abuse to elevated depressive symptoms. Findings underscore the importance of examining both abuse and neglect experiences in the same models and suggest that experiences of threat versus deprivation may have different effects on maternal physiology and psychopathology.

Results provide further evidence for hypoactivity of the HPA axis as a specific correlate of childhood neglect and as a possible mechanism in the intergenerational transmission of childhood maltreatment, given its relation to SPS involvement. Results of the study also add to growing evidence that abuse-related experiences may be more strongly related to hyperreactivity of the HPA axis and neglect-related experiences to hypo-reactivity of the HPA axis (Bruce et al., 2009; Doom et al., 2022; LoPilato et al., 2020; Reijman et al., 2015; Schalinski et al., 2019; van der Vegt et al., 2009; White et al., 2017).

Moreover, the obtained relation of lower maternal HCC with family SPS involvement adds to prior evidence linking lower maternal psychophysiological arousal markers to higher levels of disrupted caregiving. Specifically, Crockett and colleagues (2013) found that low maternal salivary cortisol was associated with very high levels of disruption in maternal-infant interactions at four months. They hypothesized that blunted cortisol may lead to disruptions in mothers’ attuned responses to infants because mothers with blunted HPA activity may experience impaired access to their own emotional states, making it more difficult to be appropriately attuned to their infant’s emotional signals and experiences. Reijman and colleagues (2015) also documented lower autonomic arousal in mothers with maltreatment claims, as indexed by lower salivary α-amylase levels, particularly in response to infant crying. They proposed that lower autonomic arousal in response to infant crying may signal difficulty with empathy or understanding of the child’s needs and how to meet them. Taken together, one interpretation of our results related to HCC is that mothers with greater experiences of neglect in childhood may be more vulnerable to experiencing hypoactivation of their HPA system, and this hypoactivation may be associated with a damping of their awareness of their own and their children’s emotional states and needs, which may increase risk for adverse caregiving experiences for their child. Given that the majority of reported concerns warranting SPS involvement in this sample involved fathers, such dampened maternal physiological responsiveness may contribute to a family environment in which the child is not protected, rather than to maternal abuse directly. However, these results linking maternal lower HCC to SPS involvement should be regarded as preliminary and in need of replication due to the small number of SPS-involved families.

Our results also indicated that childhood abuse severity, but not childhood neglect severity, was associated with higher levels of depressive symptoms in the third trimester of pregnancy. That childhood abuse, but not neglect, was associated with depressive symptoms in pregnancy aligns with prior findings, such as those by Keyes and colleagues (2012), who found that neither physical nor emotional neglect predicted later psychopathology when abuse was included in the model. Notably, they also found that associations between childhood abuse and later psychiatric disorders were accounted for by an increased liability to experience internalizing and externalizing pathology, as assessed in adulthood. Therefore, the positive association between severity of childhood abuse and depressive symptoms in pregnancy may represent a broader liability to psychiatric problems following childhood abuse. The relation between maternal childhood abuse and post-traumatic stress symptoms trended in a positive direction but did not reach significance (p = .09). Notably, there was a low rate of clinically significant levels of post-traumatic stress symptoms endorsed in this sample, with 3.9% of mothers reporting symptoms above the clinical cutoff. Thus, there may not have been sufficient power to detect associations between PCL-5 scores and other relevant variables in this study.

Childhood abuse is generally thought to represent a threat experience (McLaughlin et al., 2019) that may lead to hyperactivation of the stress response system (e.g. Doom et al., 2022), and hyperactivity of the HPA axis has been further linked to depression (Pariante & Lightman, 2008). However, childhood abuse was not associated with greater levels of HCC in our study, even after controlling for the effects of neglect severity on HCC. Pregnancy is a time period of natural elevations in cortisol (including HCC), with cortisol levels peaking in the third trimester (Romero-Gonzalez et al., 2020). Therefore, possible links among childhood abuse, depression, and higher levels of HCC may be more difficult to observe during pregnancy. Notably, Nyström-Hansen et al. (2019) also found that maternal HCC in the third trimester of pregnancy was not elevated in relation to maternal childhood abuse, although it was meaningfully related to a number of other variables, including severe mental illness and postnatal maternal behavior. Given increasing evidence for intergenerational transmission of maternal maltreatment-related effects during the gestational period (Buss et al., 2017), further work is needed differentiating the effects of maternal childhood abuse versus neglect on the HPA axis during pregnancy.

One additional noteworthy finding is that minority race/ethnicity was related to higher maternal HCC. The minority race/ethnicity variable represented the study mothers who identified as Hispanic/Latina, Black/African American, Asian, Native Hawaiian/Pacific Islander, and/or multiracial. Therefore, this included a diverse group of mothers. It is possible that minority race/ethnicity was associated with elevated HCC due to experiences of racial or ethnic discrimination, as cumulative and chronic experiences of discrimination have been shown to predict higher hair cortisol values (O’Brien et al., 2017). There is also evidence for higher HCC among Black and Hispanic/Latinx individuals and individuals with greater socioeconomic adversity, which have also been attributed to greater experiences of chronic stress leading to higher HCC values (Anand et al., 2020). Future studies with large, diverse samples should further evaluate the role of minoritized status as a stressor in studies of cortisol levels during pregnancy and their potential effects on offspring.

Study Limitations and Future Directions

An important limitation of the current study was its sample size. The relatively small sample size may have yielded limited power to detect significant associations. A related limitation is that the sample was somewhat advantaged in terms of income and education, despite oversampling for maternal childhood maltreatment. Given the low rate of clinically significant PCL-5 scores in the sample, these results cannot be generalized to women experiencing clinical levels of PTSD. Future work is needed to address the study hypotheses in a sample of women experiencing clinical levels of PTSD symptoms. In addition, the relation of low HCC to SPS involvement should be considered preliminary because of the limited number of families with SPS involvement in the study. Although SPS involvement is not a frequent occurrence for families, it is crucial to examine this ecologically important measure of adverse caregiving when evaluating intergenerational transmission of maltreatment. One direction for future research would be to assess whether lower maternal HCC is a mediator between maternal childhood neglect and maltreatment of her offspring in a larger sample stratified for substantiated maltreatment claims. In addition, lower maternal HCC may reflect current stressors in the mother’s life, including in her relationship with the father/partner. Future work is needed that examines the potentially separable effects of childhood and current/adult adversity.

The time periods assessed by the variables in this study also represent potential limitations. Experiences of maternal childhood maltreatment were assessed in adulthood and are based on retrospective recall, which may be subject to bias. However, the MACE measure includes a detailed assessment of childhood maltreatment experiences (Teicher & Parigger, 2015), and the MACE has shown validity in relation to other measures of childhood maltreatment (Teicher & Parriger, 2015). The time period covered by the SPS involvement variable was also a limitation. SPS involvement was coded if it occurred at any time in the family during the mother’s history as a parent, with any child, up to four months after the birth of the study child. Thus, SPS involvement primarily occurred regarding an older child in the family. However, children in families who have been involved with protective services are at increased risk for maltreatment (Hindley et al., 2006), so that SPS involvement is an important indicator of risk to subsequent children. A final limitation is that different forms of abuse and of neglect were grouped together into the abuse and neglect severity variables, respectively. It may be the case that rather than broader threat versus deprivation experiences, specific forms of abuse and neglect have differential effects on maternal HPA functioning and psychopathology in pregnancy. This should be evaluated in future work.

Conclusion

Maternal risk factors in pregnancy may function as mechanisms that foster the transmission of the negative effects of childhood maltreatment to the next generation. A threat versus deprivation framework further suggests that abuse and neglect may have different psychophysiological effects on the mother. The current findings represent an important step in differentiating the contributions of mother’s childhood abuse versus childhood neglect to her psychophysiology during pregnancy. Childhood neglect, but not abuse, predicted HPA hypoactivity, and childhood abuse, but not neglect, predicted elevated depressive symptoms in pregnancy. These findings point to potentially different pathways of intergenerational transmission associated with childhood neglect versus childhood abuse. Finally, exploratory findings suggest that maternal HPA axis hypoactivity may serve as a further marker of increased risk to her offspring. Thus, additional work is needed to explore the role of HPA hypoactivity during pregnancy as a possible mechanism in the intergenerational transmission of maltreatment.

Acknowledgements:

This work was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development [R01HD079484], the National Institute of Mental Health [T32MH018268], and the National Institute on Drug Abuse [F32DA055389].

Footnotes

Declaration of Interest: No conflicts of interest to disclose.

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