Out-of-home (Foster) Care’s Influence on Subsequent Preterm Delivery: Stress Matters :

The importance of an infant or child experiencing adverse childhood experiences early in life, that can influence their overall health and well-being as adults, cannot be overemphasized based on numerous studies that have appeared in our journal and others focused on toxic stress. This week, we release another important study regarding the stress of a female child being in “out-of-home” or foster care in Sweden and the odds of that child growing up to give birth to a preterm infant when compared to women not spending their childhood or even adolescence in foster care.  Liu et al. (10.1542/peds.2017-2729) have used a national registry of all women born in Sweden 1973-1977 (n= 175, 821) and linked these women to the Swedish birth registry for 343,828 livebirths.  They then looked at whether there was an association between a woman being in foster care and the risk of her having a preterm delivery either spontaneously or for medical reasons.  Sadly but as you might expect, women placed in out-of-home care in childhood regardless of their own perinatal history were more likely to have an increased risk of their infant being born preterm.  The authors provide some reasons for how stress accumulates in these children that can then affect the hypothalamic-pituitary access to initiate labor earlier than one would like.  We asked Dr. Moira Szilagyi, an expert in the area of diagnosing and preventing toxic stress to add her input on the results of this study in an accompanying commentary (10.1542/peds.2018-1616).  Dr. Szilagyi illustrates in her editorial what we can do intergenerationally to prevent these results from continuing across generations as they do in this study.  There is a lot to learn from both the study and commentary that are designed to help us find ways to promote resiliency rather than toxic stress in the patients and families we care for so as to insure a healthier future for all.  Read both and in turn think what else you could be doing to enhance the wellness, not just of your individual patients, but also of the community environments and educational settings in which these children are living.