Table 1.

Studies Organized by Protective and Promotive Factor Category

Study	N	Population characteristics	Type of childhood adversity	Measures of childhood adversity	Promotive/Protective factor (s)	Prenatal or postpartum assessment	Outcome(s) of interest	Findings
Internal Cognitive/Psychological Capacities
Berthelot et al. (2015)	57	Predominately low-income, white adults	Lack of parental care (neglect and antipathy), parental physical abuse, and sexual abuse from any adult before age 17	Childhood Experience of Care and Abuse (CECA) interview	Reflective functioning (mentalization) regarding general and trauma specific relationships	Postpartum (17 months)	Infant attachment	Mothers with high trauma-related reflective functioning had infants with predominantly organized attachment strategies, whereas 2/3 of mothers with low trauma-related reflective functioning had infants with attachment disorganization.
Leigh & Milgrom (2008)	367	Australian pregnant women	Emotional, sexual, & physical abuse during childhood	Extracted from Demographics & Psychosocial Risk Factors Questionnaire	Self-esteem	Prenatal (26–34 weeks) & Postpartum (10–12 weeks)	Depressive symptoms	Higher self-esteem was associated with fewer antenatal depressive symptoms.
Meltzer-Brody et al. (2013)	187	Predominately low-income, racial and ethnic-minority pregnant adolescents	Adolescents’ reported history of neglect and physical, sexual, and emotional abuse	Trauma history interview	Maternal selfefficacy, positive view of the pregnancy	Prenatal (2nd or 3rd trimester) & Postpartum (6 weeks)	Depressive symptoms	Maternal self-efficacy and positive views of the pregnancy were associated with fewer prenatal depressive symptoms. Positive views of the pregnancy were also associated with fewer postnatal depressive symptoms.
Sexton et al. (2015)	214	Adults	Emotional abuse, physical abuse, sexual abuse, physical neglect, and emotional neglect before age 17	Childhood Trauma Questionnaire (CTQ)	Ability to cope with stress (Connor-Davidson Resilience Scale)	Postpartum (6 months)	Major Depressive Disorder (MDD), PTSD	Ability to cope with stress moderated the relation between childhood abuse/neglect and PTSD, as well as the relation between childhood abuse/neglect and MDD. Among mothers with high levels of childhood abuse/neglect, those with high ability to cope with stress had fewer MDD and PTSD diagnoses, compared to mothers with low ability to cope with stress.
External Early Childhood Resources
Bartlett & Easterbrooks (2015)	447	Predominately low income, ethnic-minority adolescents	Physical abuse, sexual abuse, or neglect before age 18	CPS substantiated	Positive maternal care and involvement	Postpartum (average 11.95 months)	Infant neglect (by any perpetrator, CPS substantiated), maternal parenting empathy	Positive care in childhood did not significantly moderate the relation between history of childhood neglect, and maternal parenting empathy or neglect of her infant.
Chung et al. (2008)	1476	Predominately low-income, African American adults	Verbal hostility, physical and sexual abuse, domestic violence, witnessing a shooting, having a guardian in trouble with the law or in jail, and homelessness before age 16	7-item Adverse Childhood Experiences (ACEs)	Positive influences in childhood (PICs), including positive parental ‘relationships and physical and verbal affection	Prenatal (first prenatal care visit)	Depressive symptoms	Greater positive influences in childhood were associated with fewer prenatal depressive symptoms. Among women with a history of childhood sexual abuse or a parent who had gotten in trouble with the law, those who had a positive maternal relationship in childhood or who reported often receiving hugs were less likely to have depressive symptoms.
Narayan et al. (2018)	101	Predominately low-income, ethnic- minority adults	Maltreatment (verbal/emotional, physical and sexual abuse, emotional and physical neglect) and family dysfunction (domestic violence, parental divorce/separation, substance use, ^ mental illness, and incarceration) before age 18	10-item Adverse Childhood Experiences (ACEs) scale	Benevolent childhood experiences (BCEs) scale	Prenatal (2nd or 3rd trimester)	PTSD, stressful life events during pregnancy	Among mothers with high levels of ACEs, those who also had high levels of benevolent childhood experiences (BCEs) reported fewer PTSD symptoms and stressful life events compared to women with high levels of ACEs but lower BCEs.
External Contemporaneous Resources
Bartlett & Easterbrooks (2015)	447	Predominately low-income, ethnic-minority adolescents	Physical abuse, sexual abuse, or neglect before age 18	CPS substantiated	Social support frequency and dependability	Postpartum (average 11.95 months)	Infant neglect (by any perpetrator, CPS substantiated), maternal parenting empathy	Greater frequency of social support was associated with lower rates of infant neglect. Social support also moderated the association between history of childhood neglect and maternal empathy. Mothers with a history of childhood neglect demonstrated higher parenting empathy when they had frequent access to social support; whereas there was no effect of social support among mothers without a history of childhood neglect.
Bell & Seng (2013)	467	Predominately low-income adults	Physical, sexual, emotional abuse or physical neglect before age 16	Life Stressor Checklist (LSC)	Mental health services use prior to pregnancy, alliance with health care provider during pregnancy	Prenatal (across pregnancy)	Adequate prenatal care (at least nine visits, with the first visit occurring before 14 weeks)	Mothers who had utilized mental health services prior to pregnancy and had stronger alliance with the health care provider during pregnancy were more likely to receive adequate prenatal care.
Bublitz et al. (2014)	185	Predominately ethnic-minority adults	Sexual abuse, physical abuse, neglect or witnessed domestic violence before age 18	15-item Adverse Childhood Experiences (ACEs) scale	Supportive current family environment	Prenatal (25, 29, & 35 weeks)	Cortisol awakening response (CAR) Trajectories across pregnancy	Family functioning moderated the association between childhood sexual abuse and change in CAR over pregnancy. Mothers who reported higher support from family displayed more typical CAR across pregnancy.
Easterbro oks et al. (2011)	361	Predominately low-income, ethnic-minority adolescents and adults	Childhood experiences (psychological and physical abuse, parental nurturance) and current circumstances (neighborhood poverty, financial stress, poor indoor and outdoor living conditions)	Conflict Tactics Scale (CTS), Parental Bonding Instrument (PBI), current poverty level by census data, financial stress measure, Family Assessment Form for indoor & outdoor living conditions	Social network	Postpartum (average 20 months; range: 11.5months – 3 years)	Lack of perpetration of child maltreatment	Among mothers experiencing high levels of childhood adversity or high childhood and current adversity, those who did not perpetrate child maltreatment against their offspring were less likely to live with their family of origin and less likely to rely on their own mother for emotional or caregiving support.
Guyon- Harris et al. (2017)	95	Predominately low-income ethnic minority adults	Emotional abuse, physical abuse, or sexual abuse before age 17 and/or intimate partner psychological, physical, or sexual violence and victimization in the past year	Childhood Trauma Questionnaire (CTQ), Conflict Tactics Scales-2 (CTS-2)	Social support from family and friends	Prenatal (3rd trimester) & Postpartum (1 and 2 years)	Trajectory of PTSD symptoms (stable low PTSD symptoms vs. moderate dysfunction)	Among women with a history of childhood abuse and/or intimate partner violence, women with low PTSD symptoms across time reported consistently higher levels of family social support across time than the women with moderate PTSD symptoms over time. Levels of social support from friends did not differ between the two groups.
Leeners et al. (2016)	255	Predominately white adults	Sexual abuse before age 18	Modified form of Wyatt Sexual History Questionnaire	Presence of trusted person at birth, participation in medical decision making	Delivery	Satisfaction with birth experience and fear during birth experience	Having a trusted person in the delivery room and participation in medical decision-making were associated with greater satisfaction with the delivery experience.
Leigh & Milgrom (2008)	367	Australian pregnant women	Emotional, sexual, & physical abuse during childhood	Extracted from Demographics & Psychosocial Risk Factors Questionnaire	Six domains of social support	Prenatal (26–34 weeks) & Postpartum (10–12 weeks)	Depressive symptoms	Higher social support was associated with fewer prenatal depressive symptoms.
Meltzer-Brody et al. (2013)	187	Predominately low-income, racial and ethnic-minority Pregnant adolescents	Adolescents’ reported history of neglect and physical, sexual, and emotional abuse	Trauma history interview	Four domains of social support, paternal involvement	Prenatal (2nd or 3rd trimester) & Postpartum (6 weeks)	Depressive symptoms	Higher social support was associated with fewer prenatal depressive symptoms. Increased social support and greater involvement from the baby’s father were also associated with fewer postnatal depressive symptoms.
Milan et al. (2004)	203	Predominately low-income, ethnic-minority adolescents	Adolescents’ reported history of physical abuse	Physical Assault domain of the Conflict Tactics Scale (CTS)	Supportive romantic relationship during pregnancy	Postpartum (4 months)	Mother-infant relationship difficulty	Adolescents’ greater physical abuse history predicted more mother-infant relationship difficulties in the low partner support group, but not in the high partner support group.
Mitchell et al. (2018)	84	Approximately 50% low- income, African American perinatal women	Childhood SES; Childhood trauma (emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect)	Perceived childhood social class, maternal and Paternal educational attainment; 28-item Childhood Trauma Questionnaire (CTQ)	Social support from family, friends, and significant others	Prenatal (12, 20, & 29 weeks) and Postpartum (8 weeks)	Telomere length	Three indicators of childhood SES, low perceived childhood social class, low maternal educational attainment, and low paternal educational attainment, each predicted shorter telomere length; whereas high social support from family predicted longer telomere length. (Family social support did not moderate the relation between childhood SES and telomere length, and no significant differences in telomere length were found for childhood trauma and social support from friends and significant others.)
Olhaberry et al.	96	Chilean, low- income pregnant women	Sexual and/or physical abuse before age 17	Specific items in the Childhood Experience of Care and Abuse (CECA-Q)	Number of people providing support & satisfaction	Prenatal (3–7 months)	Depressive symptoms	Satisfaction with social networks was associated with fewer prenatal depressive symptoms.
Osborne & Rhodes (2001)	265	Predominately low-income, African American adolescents	Adolescents’ reported history of sexual victimization	Sexual Experiences Survey	Social support satisfaction	Prenatal & Postpartum (≤3 months)	Depressive and anxiety symptoms	Greater social support was associated with fewer anxiety and depressive symptoms during conditions of low stress for sexually-victimized adolescents. By contrast, non-victimized adolescents benefited from social support at moderate and high levels of stress.
Racine et al. (2018b)	1994	Predominately White pregnant women	Exposure to childhood abuse (physical, sexual, emotional) and family dysfunction (e.g., parent mental illness, substance abuse, incarceration, domestic violence)	11-item modification of Adverse Childhood Experiences (ACEs)	Four domains of social support	Prenatal (<25 weeks)	Prenatal health risk (based on maternal medical conditions, pregnancy history, substance use)	Social support moderated the association between ACEs and prenatal health risk. Higher levels of ACEs were associated with elevated prenatal health risks for women with low social support, but not for women with high social support.
Seng et al. (2013)	566	Adult & adolescent mothers	Physical abuse, sexual abuse emotional abuse, and physical neglect before age 16	Life Stressor Checklist, 5 childhood items	Several domains of quality of life	Postpartum (6 weeks)	Symptoms of depression alone or comorbid with PTSD, impaired bonding with infant	Higher quality of life in late pregnancy was associated with fewer postpartum depressive symptoms and less impairment in mother-infant bonding.