title: Maternal childhood trauma, postpartum depression, and infant outcomes: Avoidant affective processing as a potential mechanism.
abstract: Women who have experienced childhood trauma may be at risk for postpartum depression, increasing the likelihood of negative outcomes among their children. Predictive pathways from maternal childhood trauma to child outcomes, as mediated by postpartum depression, require investigation.
  
  
  
  A longitudinal sample of South African women (N=150) was followed through pregnancy and postpartum. Measures included maternal trauma history reported during pregnancy; postpartum depression through six months; and maternal-infant bonding, infant development, and infant physical growth at one year. Structural equation models tested postpartum depression as a mediator between maternal experiences of childhood trauma and children's outcomes. A subset of women (N=33) also participated in a lab-based emotional Stroop paradigm, and their responses to fearful stimuli at six weeks were explored as a potential mechanism linking maternal childhood trauma, postpartum depression, and child outcomes.
  
  
  
  Women with childhood trauma experienced greater depressive symptoms through six months postpartum, which then predicted negative child outcomes at one year. Mediating effects of postpartum depression were significant, and persisted for maternal-infant bonding and infant growth after controlling for covariates and antenatal distress. Maternal avoidance of fearful stimuli emerged as a potential affective mechanism.
  
  
  
  Limitations included modest sample size, self-report measures, and unmeasured potential confounders.
  
  
  
  Findings suggest a mediating role of postpartum depression in the intergenerational transmission of negative outcomes. Perinatal interventions that address maternal trauma histories and depression, as well as underlying affective mechanisms, may help interrupt cycles of disadvantage, particularly in high-trauma settings such as South Africa.
authors.affiliation: Department of Psychology & Neuroscience, Duke University, Durham, NC, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Duke Global Health Institute, Duke University, Durham, NC, USA. Electronic address: kwchoi@mgh.harvard.edu.
authors.forename: Karmel W
authors.initials: KW
authors.lastname: Choi
authors.affiliation: Department of Psychology & Neuroscience, Duke University, Durham, NC, USA; Duke Global Health Institute, Duke University, Durham, NC, USA; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
authors.forename: Kathleen J
authors.initials: KJ
authors.lastname: Sikkema
authors.affiliation: Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
authors.forename: Bavi
authors.initials: B
authors.lastname: Vythilingum
authors.affiliation: Department of Obstetrics and Gynecology, Stellenbosch University, South Africa.
authors.forename: Lut
authors.initials: L
authors.lastname: Geerts
authors.affiliation: MRC Research Unit on Anxiety and Stress Disorders, Stellenbosch University, Cape Town, South Africa.
authors.forename: Sheila C
authors.initials: SC
authors.lastname: Faure
authors.affiliation: Duke Global Health Institute, Duke University, Durham, NC, USA.
authors.forename: Melissa H
authors.initials: MH
authors.lastname: Watt
authors.affiliation: MRC Research Unit on Anxiety and Stress Disorders, Stellenbosch University, Cape Town, South Africa.
authors.forename: Annerine
authors.initials: A
authors.lastname: Roos
authors.affiliation: Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; MRC Research Unit on Anxiety and Stress Disorders, Stellenbosch University, Cape Town, South Africa.
authors.forename: Dan J
authors.initials: DJ
authors.lastname: Stein
mesh_terms: D000328:Adult; D000069586:Adult Survivors of Child Adverse Events / Q000523:psychology / Q000706:statistics & numerical data*; D002648:Child; D002657:Child Development; D003863:Depression / Q000209:etiology / Q000523:psychology; D019052:Depression, Postpartum / Q000209:etiology / Q000523:psychology*; D005260:Female; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D009769:Object Attachment; D036801:Parturition; D049590:Postpartum Period / Q000523:psychology*; D011247:Pregnancy; D013019:South Africa; D055815:Young Adult
keywords: Child outcomes; Early adversity; Emotion processing; Emotional Stroop; Intergenerational transmission; Perinatal depression; South Africa