Adverse Childhood Experiences Increase Vulnerability for Maternal-Infant Bonding Impairment: Examining Psychological and Neuroendocrine Mediational Processes

Maternal-infant early bonding, a robust precursor for later healthy infant development, may be jeopardized by maternal early exposures to adverse experiences (ACEs). Both psychological and biological aspects of maternal functioning have been identified as potential putative mechanisms for the deleterious effects of ACEs on maternal-infant bonding, but research has rarely included both in mediation testing, limiting our understanding of the relative contributions of each. We prospectively evaluated the direct and indirect effects of maternal report of ACEs on mother-infant bonding using pregnancy maternal mental health (depression, anxiety, and posttraumatic stress symptoms) and cortisol levels, a marker of HPA-axis functioning. Participants were 446 women recruited from the community; poverty and intimate partner violence (IPV) were overrepresented in our sample. Women completed self-report surveys during their pregnancy and at 1 month postpartum. Baseline cortisol levels were assessed in the laboratory during late pregnancy. A structural equation model to test sequential mediation was estimated and included relevant covariates (race, IPV, traumatic birth). There was a significant indirect effect of ACEs on maternal-infant postpartum bonding via late-pregnancy mental health, but not through maternal late-pregnancy baseline cortisol levels. Our findings underscore the potential for screening and therapeutic intervention addressing depression, anxiety, and PTSD symptoms during pregnancy among women with ACEs history, with benefits that may span two generations and set the stage for a healthy mother-child relationship.