P1.175: Is the Association Between Preterm Birth and Parental Outcomes Mediated by the Increased Presence of Children with Special Healthcare Needs?

Background: Parents of children born preterm often face disruptions in health and employment, but mechanisms underlying these associations remain poorly understood. One potential mediator is the increased presence of children with special healthcare needs (SHCN) among those born preterm. We aimed to examine whether SHCN mediates the relationship between preterm birth and adverse parental outcomes using a large, nationally representative dataset.

Methods: We analyzed pooled cross-sectional data from the 2016–2022 National Survey of Children’s Health, restricted to children ages 0–3 with a biological or adoptive parent respondent. Preterm birth was categorized into term (reference), low birthweight (LBW; 1500–2499g), and very low birthweight (VLBW; < 1500g). SHCN were categorized dichotomized by the presence or absence of special health care needs according to established methods. Descriptive statistics were estimated for each group using chi-squared tests.

Outcomes analyzed included parent-reported poor/fair physical health, poor/fair mental health, and three employment disruptions (reduced hours, leaving workforce, job retention for insurance) which we have previously analyzed. We explored the effects of SHCN on our various outcomes via two methods: first by performing analysis with and without inclusion of SHCN as a covariate in our multivariable logistic regression model to determine whether inclusion of a SHCN affected adjusted odds ratio (aOR). Second, we also separately performed a mediation analysis estimating the direct and indirect effects of SHCN on our various outcomes. Analyses were performed in Stata Version 18.

Results: Treating the presence or absence of SHCN as a covariate in the model, the association with caregiver outcomes was partially decreased among parents of VLBW children. For example, the aOR for leaving the workforce due to child’s health decreased from 8.31 (95% CI: 4.37–15.77) to 5.22 (2.85–9.55) after adjusting for SHCN. The aOR for parental physical health among VLBW families decreased from 2.94 (95% CI: 1.58-5.51) to 2.08 (95% CI: 1.08-4.03). Among LBW families, inclusion of SHCN also reduced the association, though to a lesser degree. For example, the aOR for reducing hours due to a child’s health decreased from 2.17 (95% CI: 1.56-3.01) to 1.76 (95% CI: 1.23-2.52). Trends were similar using mediation analysis.

Conclusion: Even after accounting for the presence of special healthcare needs, the association between preterm birth and adverse caregiver outcomes remains largely significant. These findings highlight the ongoing health and economic distress experienced by families affected by preterm birth regardless of the child’s medical complexity. More work is needed to characterize the cascading impact of early medical vulnerability on family wellbeing and determine effective policies and interventions to support parents navigating complex caregiving demands after NICU discharge.