Abstract
Maternal adverse childhood experiences (ACEs) can lead to intergenerational effects beginning in the earliest stages of offspring development. This systematic review and meta-analysis examined the biopsychosocial pathways linking maternal ACEs to offspring outcomes from birth to age 3. The systematic review evaluated both mediators and moderators of these associations, whereas the meta-analysis focused exclusively on mediation effects. A total of 41 studies were included in the systematic review and 26 in the meta-analysis, covering publications up to September 2025. Findings indicate that maternal mental health—including distress (c’ = 0.045, 95% CI: 0.011–0.086), depression (c’ = 0.020, 95% CI: 0.010–0.033), and anxiety (c’ = 0.018, 95% CI: 0.009–0.030)—emerged as the most robust and consistent mediator. Other mediators, such as physical health problems, parenting style (c’ = 0.011, 95% CI: 0.003–0.020), and broader psychosocial factors (c’ = 0.014, 95% CI: -0.001–0.034), showed more variable or context-dependent associations when integrating evidence from both the review and the meta-analysis. The systematic review also identified several biological moderators of intergenerational risk, including child sex, age, markers of cellular aging, and genetic factors. Taken together, these findings underscore the complex pathways through which maternal ACEs influence offspring development and highlight maternal mental health as a key target for early identification and intervention.