These results suggest that women with a history of time in foster care or in a children’s home carry social disadvantage into adulthood and motherhood. Comparison with other studies As far as we are aware, this study is one of the first studies to look at health

status and maternal outcomes of pregnant women who have previously been in care. The links between social disadvantage and being in care, selleck chemical and the links between social disadvantage and poor maternal outcomes are well documented. It is not surprising that the findings of this study show that being in care is associated with social disadvantage and adverse maternal outcomes. Previous studies have shown that children who have been in care are more likely to become teenage parents. Compared to previous estimates of the number of children in England in care at any given time, our estimate is considerably lower. Simkiss et al3 suggest that 3% of children in the UK have spent some time in care. Our estimate may be

low because we have missed many mothers who have previously been in care, which could be due to them declining to take part, or because their children had been taken into care. If this is the case, then these mothers are likely to be different from those who had agreed to the recruitment of their children. The worse birth outcomes in terms of birth weight and prematurity found in the exposed group could be in part a result of the association between antenatal smoking with low birth weight and prematurity,37 and the high rate of antenatal smoking in this group. Younger mothers are more likely to have an unassisted birth38 and we postulate that the higher proportion

of normal deliveries seen in the exposed group is associated with the lower average age of women in this group. There is likely to be an association between social class and mode of delivery, but previous studies are conflicting in describing this effect. While some studies find an increased rate of caesarean section with area level deprivation,39 40 others find a more complicated relationship between age-at-first delivery, education, social class and mode of delivery, with primigravida women from a lower socioeconomic class having a higher rate of planned caesarean Cilengitide section or instrumental delivery,41 while still others have found that individuals with a higher socioeconomic class have a higher rate of elective caesarean section, those with a lower socioeconomic class have a higher rate of emergency caesarean section.42 Strengths and limitations A strength of this study is the use of Millennium Cohort Study data, a nationally representative sample which ensured adequate representation from socially disadvantaged groups and people from ethnically diverse backgrounds. Using this cohort allowed us to capture women who had previously been in care during their adult lives, which can be otherwise difficult to do.