Harvard research: Impact of poverty begins in the womb, but it doesn't have to

Documentary produced by Kristyn Martin

The dangers of fetal exposure to alcohol, drugs and lead are widely known by now. But researchers have found increasing evidence of another potential threat to babies in utero: toxic stress. And, more specifically, the kind that’s churned up in a mother who’s struggling to make ends meet.

“People living in poverty are at much greater risk to experience toxic stress, because the causes of stress in their daily lives don’t go away easily — the stress of having a roof over your head, the stress of food, the stress of having bills to pay, the stress of not being able to get out of that hole,” says Jack Shonkoff, a Harvard University professor of pediatrics and director of Harvard’s Center on the Developing Child. The physiologic results of constant worry include elevated heart rate and blood pressure and the release of stress hormones into the bloodstream — where they can cross the placenta and affect the development of the fetal brain.

“When you are in the kind of stresses that come from not knowing where you’re going to be living or where your next meal is coming from, the severity of the stress can cause us to actually shut down certain aspects of the brain,” explains Elisabeth Babcock, president and CEO of Economic Mobility Pathways (EMPath), a Boston-based nonprofit that aims to end poverty through scientific research and direct support.

A scene from "Baby Brain," a new original documentary from Yahoo News. (Photo: Yahoo News)
Nurse-Family Partnership caregiver Lori Rogers, left, visits new mom Latreta Turner and her baby Aubrey in a scene from "Baby Brain," a new mini-doc from Yahoo News. (Photo: Yahoo News)

The stresses of poverty essentially handicap a baby for life literally before birth, according to a massive and growing body of research from over the past decade, causing the brain to react in ways that lead to riskier behavior — and to a higher likelihood of bad health, poor grades, lower earnings and prison time.

How, then, to level the playing field for babies being born into the disadvantage of poverty? Scientists think the answer is simpler than you might think.

“When we ask anybody’s grandmother about what you need, it’s just somebody to love you,” says Shonkoff, whose research is at the forefront of this new field. “What science says is you need someone who will create an environment that’s well-regulated and protective and predictable.” Whatever way you say it, the upshot is that “kids are developing and thriving.”

That, in a nutshell, is the essence of a burgeoning field of research showing that the imprint of poverty and its toxic stressors can actually be reversed — just by making some radical shifts in prenatal care for poor moms, through programs that provide consistent, empathic one-on-one coaching with the mother while she is pregnant, and continuing through early childhood. “The right kinds of supports during pregnancy are ultimately the earliest intervention for ... increasing the likelihood that that next generation will do better,” Shonkoff says.

And that formula — of having one person caring for another — is one that experts believe could have a potentially huge impact on intergenerational poverty.

“What's been wonderful is that there’s just been this explosion of studies — and a convergence of behavioral sciences, social sciences and pure sciences coming at this [area of] study from different perspectives, but saying the same things,” Babcock says. “So, the information is powerful, and it's cascading in a way that you can barely stay on top of it.”

“It’s nothing less than transformational,” she adds.

The rush of findings is the focus of a new documentary from Yahoo News, “Baby Brain,” which takes viewers into the lives of America’s most vulnerable: single mothers living below the poverty line, from West Virginia to Alabama, where such prenatal support programs have been reversing the stress effects on developing brains — and have the scientific evidence to prove it.

A scene from "Baby Brain," a new mini-doc from Yahoo News
Nurse-Family Partnership caregiver Lori Rogers, left, visits new mom Breanna Watkins and her baby in a scene from "Baby Brain," a new documentary from Yahoo News. (Photo: Yahoo News)

New research published in the journal Pediatrics in November, was the most substantial of its kind — a study of Nurse-Family Partnership (NFP), a pioneering national early-intervention program serving first-time mothers and their children living in poverty. The article, which built on past findings including a previous 15-year NFP study as well as some studies from as far back as the 1980s and ’90s, measured youth cognitive development and academic performance, and the results were groundbreaking, finding that NFP significantly improved the cognitive functioning and academic performance of 18-year-olds born to such high-risk mothers.

An additional Pediatrics study over the same 18-year period found that NFP saved the government $17,310 per family in public benefit costs, resulting in a net savings of $4,732 in government costs (in 2009 dollars) such as Medicaid and the Supplemental Nutrition Assistance Program (SNAP) payments. This finding would likely be welcomed by the Trump administration, which announced earlier this month it was tightening the rules for obtaining food stamp benefits, ending them for about 700,000 Americans.

“It’s rare for studies of early-intervention programs to examine early-intervention effects over an 18-year period,” said David Olds, professor of pediatrics at University of Colorado and one of the lead investigators of the studies, in a press release. “This early intervention, Nurse-Family Partnership, produced long-term improvements in the cognitive functioning of 18-year-old youth born to mothers who had limited personal resources to cope with the adversities of living in deep poverty. This new evidence shows promise that Nurse-Family Partnership’s effects may carry over into adulthood.”

‘She was here like a mom’

That’s welcome news for young women such as Latreta Turner, 24, a single mom living in Montgomery, Ala. As a carhop at a Sonic drive-in restaurant who earns just $3.13 an hour plus tips, she struggles with the stresses of poverty and homelessness, not to mention the lingering grief over two previous miscarriages. And she spends most of her time — “I’d say 90 percent” — worrying about how she will provide for her 18-month-old, Aubrey.

But she’s also been working consistently with Lori Rogers, a visiting nurse of NFP Montgomery, who begins working with moms in their third trimester of pregnancy, coaching them to set goals, reduce stress and get healthy.

“The whole point is to just try to see what we can do to bring this environment to a safer, more calm place for this mom to develop her baby,” says Amy Trammell, director of nursing for NFP at Gift of Life in Montgomery.

Rogers says that, through her work with Turner, “when she was feeling stressed, we talked about stressors, we talked about how she could overcome those or deal with them in a better way.” For Turner, that presence was vital.

“Honestly,” she says, “I wouldn't have thought I would have made it if it wasn't for nurse Lori, because it's so new to me.”

Another client of Rogers’s is Breanna Watkins, 20, who describes how the support of NFP has brought support, love and consistency into the lives of her and her baby.

Jenny, right, a single mom in West Virginia, speaks with Stephanie Sy with Jenny and her son Carter
Jenny, right, a single mom in West Virginia, speaks with Stephanie Sy of Yahoo News in the new mini-doc "Baby Brain." Jenny's son Carter is in the foreground. (Photo: Yahoo News)

“It wasn't even just she was here as a nurse, she was here like a mom, like a second mom. So everything she ever told me, everything she ever gave ... even a little care, made me feel like I was loved by many,” she says. “And just for an outside person to … come and love you like their own, that makes a big impact.”

Love, yes … but what about more money?

As Shonkoff explains, this research is grounded in science. “The way biology works is, if you're threatened or you're dealing with hardship, biology is trying to get you on the course of healthy development. What pulls it off is adversity and all of these obstacles,” he says. “The goal here is not so much to give people special treatment or have children be coddled. It’s to take the weight off their necks. Take the weight of adversity and poverty and racism and violence and give children a chance to flourish.”

What if there could be more than one way to approach the removal of that weight? It’s a question now being explored by a team of researchers — experts in public policy, education, psychology, pediatrics and neuroscience — who are conducting the first U.S. randomized study, called Baby’s First Years, to assess the impact of poverty reduction on brain development.

“What if we tried to help young children in poverty by simply giving their families more money?” asks neuroscientist, pediatrician and lead researcher Kim Noble in a January 2019 TED Talk about the study, which, in 2018, recruited 1,000 new mothers living below the federal poverty line to receive unconditional monthly cash gifts for the first 40 months of their children’s lives. The mothers have been randomized, with some receiving a nominal gift and others receiving several hundred dollars a month, increasing some incomes by 25 percent.

“While income might not be the only or even most important factor in determining children’s brain development, it may be one that, from a policy perspective, can be easily addressed.”

Results won’t be in for several years, but Noble is hopeful that the findings could provide yet one more solution when it comes to stopping the cycle of intergenerational poverty, noting that “our experiences change our brains,” in a phenomenon known as neuroplasticity.

“The brain is not destiny,” she says. “And if a child’s brain can be changed, then anything is possible.”

And if anything is possible, then babies being born into adverse and stressful world of poverty does not have to mean the end of the story — whether it’s because of the love of a NFP representative or other consistent figure, an influx of cash or anything else that can “take the weight off their necks,” as Shonkoff says.

“It's absolutely not the end of the story,” says Babcock, “and I think that's the gift that this science provides us. Because it says very, very clearly that our past is not prologue, that we can change the destiny that might have been mapped out for us.”


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