Maternal Adverse Childhood Experiences and Child Socio-Emotional and Behavioural Outcomes: A Systematic Review of Prenatal Mechanisms.
TL;DR
Prenatal maternal depression and anxiety emerged as the most frequently studied mechanisms, showing some evidence of independent effects irrespective of postnatal factors, but most of the findings point towards a 'chain-of-risk' model, where prenatal mental health interacts with the postnatal environment.
Abstract
Background
Pregnancy represents a crucial period for understanding key pathways contributing to the intergenerational effects of adverse childhood experiences (ACEs). However, prenatal mechanisms linking maternal ACEs to subsequent child mental health outcomes are still poorly understood compared to postnatal ones.
Objective
To review the biopsychosocial mechanisms during pregnancy that may contribute to the relationship between maternal ACEs and child socio-emotional and behavioural development. DATA SOURCES We systematically searched PubMed, PsycInfo and Web of Science from inception up to February 2026. STUDY SELECTION AND DATA EXTRACTION We included peer-reviewed observational studies (cohort, case-control, cross-sectional) evaluating prenatal biological, psychological, or social mechanisms linking maternal ACEs to child socio-emotional/behavioural outcomes (Ages 0-18); qualitative studies and grey literature were excluded. Two reviewers independently screened studies and extracted data on study design, mediators and effect sizes, with disagreements resolved by a third reviewer. SYNTHESIS Narrative synthesis was used to summarise study characteristics, mediation pathways and analytical strategies in tabular form. Results were synthesised by type of prenatal mechanism.
Results
Of 2641 records identified, 122 full texts were assessed and 13 studies met inclusion criteria. Prenatal maternal depression and anxiety emerged as the most frequently studied mechanisms, showing some evidence of independent effects irrespective of postnatal factors, but most of the findings point towards a 'chain-of-risk' model, where prenatal mental health interacts with the postnatal environment. Biomedical antepartum risks and maternal-fetal attachment also showed mediating effects, but without accounting for postnatal influences. The small number of eligible studies underscores the limited exploration of prenatal transmission pathways.
Conclusions
Prenatal mental health difficulties, particularly in interaction with postnatal factors, may play a role in the intergenerational transmission of ACEs. Further studies using robust methods to disentangle prenatal and postnatal contributions are needed to inform targeted interventions.