Triple Threat: Preterm Birth, Poverty and Toxic Stress

Abstract

Category/Date Emerging Knowledge for Clinical Practice Podium Presentations focusing on the Research Agenda Priority of Pediatric Research: Professional Role & Health Promotion and Disease Prevention, Presented at NAPNAP's 40th National Conference on Pediatric Health Care, March 8, 2019, New Orleans, LA. Purpose The specific aim of this study was to apply the Eco-Bio Developmental Model of Poverty and Preterm Birth (EBDPPB) to cross-sectional data from 2016 National Survey of Children's Health (NSCH) to elucidate the interaction between extrinsic factors of poverty and toxic stress and educational outcomes of children born preterm. Background Preterm birth, defined as birth before the completion of 37 weeks of gestation, is a multifactorial global epidemic with psychosocial, economic and physical ramifications affecting the child, family and larger community. Toxic stress, the result of exposure to adverse childhood experiences, results in changes to brain structure and function that negatively affects future health. Poverty is a multifaceted risk factor affecting child health and development, family resilience and access to resources. Problem Statement Children born preterm at all gestational ages are at risk for impaired educational outcomes. Toxic stress and poverty are additive risk factors for child health and educational success. It is hypothesized that in the presence of toxic stress and poverty, children born preterm will have increased risk, compared to children born at term, for chronic conditions may impair educational success as well as an increased risk of reporting special education services and grade repetition. Methods A subset of data representing children 6 to 11 years old (N = 15,010) from the 2016 NSCH was utilized for multivariate analysis of demographic variables, and neurodevelopmental and educational outcome variables. Toxic stress was defined as exposure to 1 or more adverse childhood experiences. Living in poverty was defined as household income less than 100% of the Federal Poverty Level. Pearson's Chi-square, logistic regression and interaction effects explored the relationships between prematurity, toxic stress and poverty. Villanova University of Institutional Review Board evaluated the research plan and determined that the study was not subject to federal regulations under HHS 45 CRF 46. Results Children in this sample born preterm had a higher incidence of toxic stress, poverty, developmental delay, learning disability, intellectual disability, speech/language disorders, ADD/ADHD, autism and special education/early intervention plans when compared to children born term. The combination of preterm birth and toxic stress significantly increased the risk of these conditions. After accounting for gender, insurance coverage, race and parental education, children in the sample born preterm remained more likely to experience developmental delay, intellectual disability, speech/language disorder, learning disability, and ADD/ADHD. Toxic stress increased the incidence of ADD/ADHD and autism in both the preterm and full-term samples. Discussion The negative effect of poverty and toxic stress on children born preterm as depicted by the EBDPPB is supported by this analysis. Health care providers are encouraged to address the tripartite vulnerability resulting from prematurity, poverty and toxic stress. Addressing this issue begins with recognizing that preterm birth is an ongoing risk factor to child health and neurodevelopment.