Polypharmacy and Pregnancy among Foster Children

By Gardner, Harold H.; Corsi, Steve et al. | Child Welfare, January 1, 2017 | Go to article overview

Polypharmacy and Pregnancy among Foster Children


Gardner, Harold H., Corsi, Steve, Nelson, Marty, Schaneman, Justin, Pendleton, Pamela, Simison, Bob, Child Welfare


Acknowledgements: The authors wish to acknowledge the support of the State of Wyoming for this research. The study was based on healthcare data compiled for the state government. The Wyoming Department of Family Services funded analytical and other research work performed by HCMS Group. In addition, we acknowledge the contributions of HCMS research librarian Elaine Hammond, MSLS, CHIS.

By the time foster children reach adolescence, many of them have been subjected to years of abuse, neglect, and unstable living conditions. Studies such as the landmark 2005 survey of more than 600 girls in Iowa, Wisconsin, and Illinois by the Chapin Hall Center for Children at the University of Chicago (Courtney et al., 2005) have shown that foster teenagers have substantially higher rates of pregnancy than girls who aren't in foster care. Additionally, children in foster care are prescribed multiple medications-including narcotics and psychiatric drugs such as antidepressants, antipsychotics, and drugs for attention deficit/hyperactivity disorder-at much higher rates than other children (Zito et al., 2008).

However, there is no accurate national data on the number of foster-teen pregnancies (Center for the Study of Social Policy, 2013). The Census Bureau reports on pregnancy rates don't single out foster children. (The federal government's National Survey of Child and Adolescent Well-Being did find that teenage girls in the general child welfare system report high rates of risky behavior, sexual abuse, and pregnancy [Casanueva, Wilson, Smith, & Dolan, 2014]). There is little authoritative information on the use of narcotics or psychotropic medication, or prescribing rates of all categories of drugs for foster children (Center for the Study of Social Policy, 2013).

Previous research has not drawn a link between foster teen pregnancy and the taking of multiple prescription drugs, known as polypharmacy. This is an important field of inquiry because of the lifealtering effects of teen pregnancies and the constantly increasing rate of prescription drug use. Of the 402,738 American children in foster care in 2013, 143,846 were ages 12-20, according to the U.S. Department of Health and Human Services' Adoption and Foster Care Analysis and Reporting System. Females accounted for 48% of the total number of children in foster care (U.S. Department of Health and Human Services, 2014).

There may be a logical connection between the judgment-altering effects of psychotropic, narcotic, and other medications and adolescent decision-making regarding sexual behavior, use of birth control, and pregnancy. Some researchers have suggested that young people may see pregnancy as an opportunity to discontinue psychiatric medications as they seek to avoid the side effects and stigma associated with such drugs (Center for the Study of Social Policy, 2013). Foster teens may also see pregnancy as an opportunity to seize control over their bodies in a child-protective system that they experience as disempowering (Center for the Study of Social Policy, 2013).

The goal of this study was to examine the relationship between polypharmacy and pregnancy rates using statewide data on Medicaid healthcare coverage for foster children in Wyoming. For comparison, the Wyoming data also included teenage girls on Medicaid who weren't in foster care and teenage girls who had private health insurance. The study findings suggest that the foster teen pregnancy rate is more than twice as high as previous surveys have indicated (Courtney et al., 2005). Our data also showed that a teenager's likelihood of pregnancy rises significantly with multiple prescription medications of all drug classes.

Methods

Database

The study used a research reference database maintained for the State of Wyoming by a private health information technology firm. The data consists of de-identified healthcare and pharmaceutical records for about 400,000 people covering 11 years, beginning in 2003. …

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