Attachment Security in Pregnancy Mediates the Association Between Maternal Childhood Maltreatment and Emotional and Behavioral Problems in Offspring


Attachment security may be a mechanism by which exposure to early life adversity affects subsequent generations. We used a prospective cohort design to examine this possibility in a convenience sample of 124 women (age = 23–45 years, M = 32.32 [SD = 4.83] years; 57.3% White, 22.6% Asian) who provided self-reports of attachment style during pregnancy using the Attachment Style Questionnaire, of whom 96 (age = 28–50 years, M = 36.67 [SD = 4.90] years; 60.4% White, 19.8% Asian) were reassessed when their child was preschool-age (M = 4.38 [SD = 1.29] years). Women self-reported on their own childhood maltreatment severity and their child’s current emotional and behavioral problems using the Childhood Trauma Questionnaire and the Child Behavior Checklist for ages 1.5–5, respectively. Maternal childhood maltreatment severity was associated with less secure, and more avoidant and anxious attachment. Mediation analyses revealed further that less secure maternal attachment, but not avoidant or anxious attachment, mediated the associations between maternal childhood maltreatment and offspring emotional and behavioral problems. These findings suggest that improving maternal attachment security, which can be identified even prior to the child’s birth, is an important target to consider for intervention efforts aimed at minimizing adverse intergenerational effects of early life adversity.

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We thank Nicole Wilcox, MD, Susan Crowe, MD, Lin Lee, CNM, and Maria Greulich, CNM for their assistance with the initial recruitment of the cohort. We would also like to acknowledge all the women who provided their time and information to this research.


Salary support during recruitment was provided by an NIMH T32 Training Grant at the Stanford University Department of Psychiatry (5T32MH019938-19; PI: Schatzberg; trainee: Robakis). Collection of the follow-up data was funded by a Stanford University Maternal and Child Health Research Institute Clinician-Educator grant and a Stanford Psychiatry Departmental Innovator Grant to TR. Salary support was also provided by a Jacobs Foundation Early Career Research Award to KH (2017-1261-05). The Stanford REDCap platform ( is developed and operated by Stanford Medicine Research IT team. The REDCap platform services at Stanford are subsidized by (a) Stanford School of Medicine Research Office, and (b) the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1 TR001085.

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Correspondence to Marissa C. Roth.

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Roth, M.C., Humphreys, K.L., King, L.S. et al. Attachment Security in Pregnancy Mediates the Association Between Maternal Childhood Maltreatment and Emotional and Behavioral Problems in Offspring. Child Psychiatry Hum Dev (2020).

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  • Childhood maltreatment
  • Adult attachment
  • Pregnancy
  • Intergenerational effects