As the guest editor of this series, I share my excitement about the National Children's Study (NCS) and the incredible learning opportunity offered through the NCS website (http://www.nationalchildrensstudy.gov/Pages/default.aspx). I learned about the NCS when an epidemiology postdoctoral research fellow casually mentioned it, and I have watched its development since 2002. Paying close attention to the dissemination of a plethora of ever-changing scientific information on the NCS website has critically shaped my perinatal nursing teaching, research, and practice. My love of nursing stems from caring for pregnant women and ensuring each family's optimal health outcomes. If you share this passion and have a love of learning, look at the NCS website. Here, you will learn the latest science disseminated by the leading interdisciplinary scientists. You will see that the NCS is a dynamic study that is always undergoing changes.
Mandated by Congress in 2000, the NCS is the largest study ever undertaken to investigate environmental influences on the health and development of children. Ensuring optimal health of tomorrow's children through scientific discoveries of the NCS is one of the most important investments for the future. Contributors to the NCS seek information that will help us prevent and treat health problems such as autism, birth defects, diabetes, heart disease, and obesity by studying a cohort of 100,000 infants from before birth until age 21. This extensive and well-designed prospective study ensures the best opportunity to answer some of the most perplexing and complex research questions related to children's health.
By now, many nurses throughout the country are aware of the NCS, especially since the pilot study, also known as the Vanguard Study, rolled out in 2011. In addition to the many nurse researchers involved in planning, developing, and implementing the NCS, clinical perinatal nurses are actively involved as they care for enrolled study participants during pregnancy and childbirth. The purpose of this series is to share some of the key scientific underpinnings of the NCS and the key roles nurses play in this enormous research endeavor.
As nurses, we are all aware of the multiple factors that can affect health outcomes. Despite an understanding of the general association between maternal and child health, the importance of specific exposures during pregnancy on different aspects of child health is not clearly understood. This lack of understanding can be linked to the sheer number of exposures and influences that need to be considered and assessed. Environmental and chemical exposures, genetic differences, biological factors, and the cultural and social milieu of a family within its community all contribute to children's health. The NCS defines environment broadly beginning with the multidimensional perinatal environment, and the four articles in this series focus on the perinatal environment. Three of the articles provide insight into the science and the theoretical underpinnings of perinatal influences on subsequent infant, child, and adult health. The other article describes the successful research nurse–clinical nurse collaboration model designed by the research nurses of Children's Hospital of Philadelphia's NCS Center (CHOP-SC) for the Vanguard Study.
In the first article, my colleagues and I explain maternal psychosocial determinants of fetal and infant health within the theoretical framework of stress biology and the life course perspective. It becomes clear that the NCS provides a unique scientific opportunity to understand maternal psychosocial determinants within the context of many other early life factors. Elucidating complex relationships among risk and protective maternal psychosocial factors is critical for advancing nursing knowledge and practice.
In the second article, the authors describe the placenta as a critical link to understanding key physiological processes occurring before birth. Ryan and colleagues summarize the large and complex literature on the emerging science on the molecular biomarkers that have been identified in the placenta and their associations with birth outcomes. This important and emerging area in biobehavioral research relates to immune modulation, inflammation, and infection.
In the third article, Pak and Souders provide a broad overview of environmental reproductive epidemiology. Although we know that toxic environmental exposures in-utero can lead to adverse infant, child, and adult health outcomes, there are large gaps in existing knowledge that the NCS is designed to fill. Emerging areas of science pertaining to environmental chemical exposure during pregnancy and gene–environmental interaction are highlighted, and the authors provide clear examples of toxic agents nurses can educate pregnant women to avoid.
The final article is authored by the CHOP-SC nurses, key members of the large NCS multisite interdisciplinary team. Kent and colleagues share their insights in tailoring their approach by designing a RN birth team model to successfully implement NCS research protocols during the Vanguard Study. The success of conducting a large multisite clinical study involves cooperation of many. Surprisingly, scant literature is available to direct those with the responsibility of developing and sustaining such collaboration. Buy-in and support from health system personnel, including clinical nurses, can make or break a study. After reading this article, it is clear how the success of the study site in Philadelphia was determined by the nurses on the front lines of the CHOP-SC Vanguard Study.
Nurses play an important role in informing women of childbearing age of how to reduce environmental exposure to achieve optimal health for themselves and their families. It is my hope that the authors of these articles provide readers with foundational knowledge about the NCS, the science involved, and the relevance of the study to perinatal nursing. It is important for perinatal nurses to stay informed. Go to the NCS website and encourage your colleagues and students to do so as well. Think of creative ways to participate and integrate the NCS into your nursing practice, teaching, and research.