Maternal history of adoption or foster care placement in childhood: a risk factor for preterm birth

doi:10.1016/j.ajog.2014.04.001

American Journal of Obstetrics and Gynecology

Volume 211, Issue 4, October 2014, Pages 397.e1-397.e6

Presented, in part, at the annual meeting of the North American Society of Obstetric Medicine, Providence, RI, Sept. 20-21, 2013.

https://doi.org/10.1016/j.ajog.2014.04.001 Get rights and content

Objective

The objective of the study was to assess the impact of maternal history of adoption or foster care placement in childhood on the risk for preterm birth (PTB), controlling for other known risk factors for PTB.

Study Design

Participants were 302 pregnant women from a low-income, diverse sample drawn from 2 intensive prospective studies of maternal mood and behavior and fetal and infant development. Gestational age was determined by best obstetric estimate. Maternal history of adoption or foster care placement prior to age 18 years was determined by maternal report. Other maternal characteristics, including maternal medical conditions, psychosocial characteristics, and health behaviors, were measured during the second and third trimesters of pregnancy.

Results

The odds of delivering preterm (gestational age <37 weeks) were approximately 4 times greater among women with a history of childhood adoption or foster care placement compared with women who were never placed out of the home during childhood. This association remained significant after adjusting for other known risk factors for PTB including maternal medical conditions, psychosocial characteristics, and negative health behaviors in pregnancy.

Conclusion

Findings suggest that a history of adoption/foster care placement is an important risk factor for PTB and may be comparable with other established risk factors for PTB including prior history of PTB, body mass index, African-American race, and advanced maternal age. More studies are needed to understand why women with placement histories may be at increased risk to deliver preterm.

Section snippets

Participants

Participants were 302 women pooled from 2 prospective perinatal studies of maternal mood and behavior and fetal and infant development. Participants were excluded from participating in the larger studies if their pregnancies were complicated by multiple gestations or maternal age younger than 18 or older than 40 years.

The primary aim of one study was to examine the effects of maternal smoking on fetal and infant development (grant R01 DA019558) and thus oversampled for maternal smoking during

Sample characteristics

Maternal and infant characteristics are presented in Table 1. Thirty-nine women in the sample (13%) reported a history of out-of-home placement in childhood. Twenty-six women in the sample (9%) delivered preterm, slightly lower than PTB rates in the United States (12%),¹ which was consistent with aims of the larger studies to select samples of pregnant women at low risk for adverse neonatal outcomes. Twenty-four percent of the women experienced any infection and/or were prescribed antibiotics

Comment

This study was the first, to our knowledge, to examine maternal history of adoption or foster care placement in childhood as a risk factor for PTB. Results revealed that the odds of delivering preterm were approximately 4 times greater among women with a history of childhood placement compared with women who were never placed out of the home during childhood. Adjusting for known risk factors for PTB, including maternal characteristics, health behaviors in pregnancy, and other childhood

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Childhood adversity and accelerated reproductive events: a systematic review and meta-analysis
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Accelerated female reproductive events represent the early onset of reproductive events involving puberty, menarche, pregnancy loss, first sexual intercourse, first birth, parity, and menopause. This study aimed to explore the association between childhood adversity and accelerated female reproductive events.
PubMed, Web of Science, and Embase were systematically searched from September 22, 2022 to September 23, 2022.
Observational cohort, cross-sectional, and case–control studies in human populations were included if they reported the time of reproductive events for female individuals with experience of childhood adversity and were published in English.
Two reviewers independently screened studies, obtained data, and assessed study quality, and conflicts were resolved by a third reviewer. Dichotomous outcomes were evaluated using meta-analysis, and pooled odds ratios and 95% confidence intervals were generated using random-effects models. Moderation analysis and meta-regression were used to investigate heterogeneity.
In total, 21 cohort studies, 9 cross-sectional studies, and 3 case–control studies were identified. Overall, female individuals with childhood adversity were nearly 2 times more likely to report accelerated reproductive events than those with no adversity exposure (odds ratio, 1.91; 95% confidence interval, 1.33–2.76; I²=99.6%; P<.001). Moderation analysis indicated that effect sizes for the types of childhood adversity ranged from an odds ratio of 1.61 (95% confidence interval, 1.23–2.09) for low socioeconomic status to 2.13 (95% confidence interval, 1.14–3.99) for dysfunctional family dynamics. Among the 7 groups based on different reproductive events, including early onset of puberty, early menarche, early sexual initiation, teenage childbirth, preterm birth, pregnancy loss, and early menopause, early sexual initiation had a nonsignificant correlation with childhood adversity (odds ratio, 2.70; 95% confidence interval, 0.88–8.30; I²=99.9%; P<.001). Considerable heterogeneity (I²>75%) between estimates was observed for over half of the outcomes. Age, study type, and method of data collection could explain 35.9% of the variance.
The literature tentatively corroborates that female individuals who reported adverse events in childhood are more likely to experience accelerated reproductive events. This association is especially strong for exposure to abuse and dysfunctional family dynamics. However, the heterogeneity among studies was high, requiring caution in interpreting the findings and highlighting the need for further evaluation of the types and timing of childhood events that influence accelerated female reproductive events.
Care-leavers and their children placed for adoption
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Citation Excerpt :
This includes the outcomes for young people who enter parenthood whilst in or officially leaving state care, as well as for those who become parents at a later age. Bublitz et al. (2014) investigated the relationship between maternal childhood experience of adoption or foster care and pre-term birth. Mothers with prior experience of state care were found to be four times as likely to give birth prematurely (prior to 37 weeks gestation).
Young people in and leaving state care are more likely than the general population to become parents at a young age. Relatively little is known about the experiences and progress of care leaver parents and their children, but emerging evidence suggests an increased risk of intergenerational state intervention. Drawing on data from the Wales Adoption Study, this paper examines the prevalence and profiles of care leavers amongst birth parents whose children were placed for adoption. Findings showed that more than a quarter (27%) of birth mothers and a fifth (19%) of birth fathers with children placed for adoption were themselves care leavers. There were no significant differences between care leaver and non-care leaver birth parents in terms of involvement in crime or substance misuse, but carer leaver birth parents were distinguishable from other birth parents by their own experiences of abuse and neglect. Care leaver birth mothers were also more likely than their non-care leaver counterparts to have diagnosed mental health problems and were less likely to appeal the adoption plan. The profiles of children placed for adoption between care leaver and non-care leaver birth parents were similar. The findings presented in this paper strengthen the moral imperative to address the over-representation of care leavers amongst birth parents whose children are placed for adoption. There is an urgent need to revise how children and young people in state care are prepared for parenthood and supported as parents.
Adoption and foster care placement as a risk factor for preterm birth
2014, American Journal of Obstetrics and Gynecology
Associations Between Maternal Exposure to Child Abuse, Preterm Birth, and Very Preterm Birth in Young, Nulliparous Women
2019, Maternal and Child Health Journal
The long stay in group homes and mental health status of children: A two-year follow-up
2015, Minerva Psichiatrica
Risk prediction for adverse pregnancy outcomes in a medicaid population
2015, Journal of Women's Health

: The current affiliation for Dr Rodriguez is now the Department of Urban Public Health and Nutrition, La Salle University, Philadelphia, PA.

: This work was supported by National Institutes of Health grants R01 MH079153 and R01 DA019558 (L.R.S.).

: The authors report no conflict of interest.

: Cite this article as: Bublitz MH, Rodriguez D, Gobin AP, et al. Maternal history of adoption or foster care placement in childhood: a risk factor for preterm birth. Am J Obstet Gynecol 2014;211:397.e1-6.

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ResearchObstetricsMaternal history of adoption or foster care placement in childhood: a risk factor for preterm birth

Objective

Study Design

Results

Conclusion

Section snippets

Participants

Sample characteristics

Comment

Lancet

Am J Obstet Gynecol

Am J Obstet Gynecol

J Psychosom Res

J Psychiatr Res

Am J Obstet Gynecol

Biol Psychiatry

Psychiatry Res

Am J Obstet Gynecol

Am J Obstet Gynecol

Psychoneuroendocrinology

Am J Obstet Gynecol

Peptides

Am J Obstet Gynecol

Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000

Lancet

The contribution of low birth weight to infant mortality and childhood morbidity

N Engl J Med

The enigma of spontaneous preterm birth

N Engl J Med

Births: preliminary data for 2005

Health E-Stats

Research
Obstetrics
Maternal history of adoption or foster care placement in childhood: a risk factor for preterm birth