Black-White Differences in the Association between Maternal Early Life Adversity and Child Asthma Outcomes from the Add Health Study

Background: Maternal adverse childhood experiences (ACEs) are associated with greater risk of poor health in children of exposed mothers. Structural inequalities such as race and socioeconomic status (SES) confer differential exposure to ACEs; effects in the association with child asthma are underexplored. This study tests the hypothesis that the association between maternal ACEs and child asthma is stronger in Black compared to White mothers. Methods: This study examined 2,557 mother-child dyads from the National Longitudinal Study of Adolescent to Adult Health. Using log-binomial regression stratified by maternal race and child sex, asthma diagnosis in a firstborn child was modeled as a function of high maternal ACEs (binary variable using cutpoint of 3 ACEs). Analyses including interaction with child sex and maternal race were adjusted for mothers’ childhood income, education, and smoking, and accounted for complex survey design. Results: The association between maternal ACEs and child asthma was strongest for Black mothers of female children (3-way interaction between ACEs, child sex, and race: p = 0.018); mothers in this category with high ACEs were 5.3 times as likely to report an asthma diagnosis in their children relative to similar mothers with low ACEs (95% CI: 2.22-12.69). Associations for male children born to Black mothers, and children of White mothers, were weak or absent. Conclusions: Study findings suggest that maternal ACEs exposure elevates the risk of asthma in female children of Black mothers. Greater understanding of structural, environmental and psychosocial contributions to these differences is needed to mitigate intergenerational propagation of inequities