Intergenerational Trauma-Related Risk Transmission: Difficulties in Emotion Regulation Are a Mechanism By Which Women's Childhood Maltreatment Creates Risk for High-Risk Eating during Early Pregnancy in Women with High Levels of Prenatal Stress

Pregnancy is a critical time for intergenerational transmission of high-risk eating from mother to child (e.g. restraint [efforts to reduce intake or certain foods regardless of success], emotional [eating in response to negative emotions], external eating [eating in response to food-related stimuli regardless of state of hunger]). Yet, why women develop high-risk eating during this period is still largely unknown. Childhood maltreatment, a common and severe form of stress associated with later mental health challenges (e.g. emotion regulation difficulties), has been identified as a risk factor for high-risk eating. Difficulties in emotion regulation are also strongly associated with high-risk eating. Yet, little is understood about the mechanisms by which women’s childhood maltreatment creates risk for her high-risk eating during early pregnancy. The aim of this study is to examine if difficulties in emotion regulation are a mechanism by which women’s childhood maltreatment leads to high-risk eating in pregnancy in a sample of women with high levels of prenatal stress. We hypothesized that childhood maltreatment would have a negative impact on emotion regulation capacity which would, in turn, be associated with high-risk eating. We also asked: Which types of childhood maltreatment would be associated with high-risk eating through difficulties in emotion regulation?

Methods
Women (N = 440) with prenatal stress including intimate partner violence (IPV) victimization and poverty were drawn from a larger longitudinal, prospective study of the influence of prenatal stressors on mother and infant outcomes. Data was drawn from the first assessment when women were 15-17 weeks pregnant. Sequential mediation using bias-corrected bootstrap resampling (1,000 resamples) in Mplus was used to examine the role of maternal childhood maltreatment on high-risk eating behaviors through difficulties in emotion regulation, controlling for recent IPV victimization and structural factors (income, race, education, and marital status).

Results
Sequential mediation revealed a significant indirect effect of maternal childhood maltreatment on emotional B= 0.09 (95% CI [0.001, 0.003]), external B= 0.06 (95% CI [0.002, 0.007]), and restraint eating B=0.07 (95% CI [0.001, 0.002]) in pregnancy via difficulties in emotion regulation. Follow-up exploratory analyses revealed that emotional abuse drives this association: sequential mediation showed an indirect effect of emotional abuse on emotional B= 0.10 (95% CI [0.004, 0.013]), external B= 0.07 (95% CI [0.007, 0.024]), and restraint eating B=0.08 (95% CI [0.003, 0.010]) via difficulties in emotion regulation. Finally, having more structural risk factors was associated with less emotional (b = -.18, p < .001) and restraint eating (b = -.28, p < .001).

Conclusions
Findings suggest that difficulties in emotion regulation are a mechanism by which childhood maltreatment leads to high-risk eating during early pregnancy. Interventions should address difficulties in emotion regulation in women with histories of childhood emotional abuse to mitigate high-risk eating in pregnancy and interrupt the intergenerational transmission of trauma-related eating to offspring. Findings further point to the need to identify and support emotionally unavailable mothers as second-generation prevention for high-risk eating. The talk will conclude with a discussion of the association between structural risk factors and high-risk eating in this context.