Racial and ethnic disparities in preterm birth outcomes: a call to action for neonatal providers

Burris, Heather H.; Parker, Margaret G.

doi:10.1038/s41372-021-00917-x

Cited by 9 publications

(4 citation statements)

References 9 publications

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“…Substantial disparities in dual burden by race and ethnicity have been identified elsewhere, with significantly higher risk among racially and ethnically minoritized groups compared to non-Hispanic white women, including a two-fold increased risk for non-Hispanic Black women (Lyndon et al, 2019 ). Our current findings are consistent with the literature linking structural racism to adverse perinatal outcomes (Burris & Parker, 2021 ; Chambers et al, 2018 ; Lyndon et al, 2019 ; Shrimali et al, 2020 ; Taylor, 2020 ), with significantly increased risk of dual burden for Black compared to non-Hispanic white women for women with all insurance types except women with no insurance. The absence of a statistically significant Black-white disparity among uninsured women may reflect the greater level of disadvantage among this population overall.…”

Section: Discussionsupporting

confidence: 91%

Risk Factors for Dual Burden of Severe Maternal Morbidity and Preterm Birth by Insurance Type in California

Ayadi

Baer

Gay

et al. 2022

Matern Child Health J

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Objectives Among childbearing women, insurance coverage determines degree of access to preventive and emergency care for maternal and infant health. Maternal-infant dyads with dual burden of severe maternal morbidity and preterm birth experience high physical and psychological morbidity, and the risk of dual burden varies by insurance type. We examined whether sociodemographic and perinatal risk factors of dual burden differed by insurance type. Methods We estimated relative risks of dual burden by maternal sociodemographic and perinatal characteristics in the 2007–2012 California birth cohort dataset stratified by insurance type and compared effects across insurance types using Wald Z-statistics. Results Dual burden ranged from 0.36% of privately insured births to 0.41% of uninsured births. Obstetric comorbidities, multiple gestation, parity, and birth mode conferred the largest risks across all insurance types, but effect magnitude differed. The adjusted relative risk of dual burden associated with preeclampsia superimposed on preexisting hypertension ranged from 9.1 (95% CI 7.6–10.9) for privately insured to 15.9 (95% CI 9.1–27.6) among uninsured. The adjusted relative risk of dual burden associated with cesarean birth ranged from 3.1 (95% CI 2.7–3.5) for women with Medi-Cal to 5.4 (95% CI 3.5–8.2) for women with other insurance among primiparas, and 7.0 (95% CI 6.0–8.3) to 19.4 (95% CI 10.3–36.3), respectively, among multiparas. Conclusions Risk factors of dual burden differed by insurance type across sociodemographic and perinatal factors, suggesting that care quality may differ by insurance type. Attention to peripartum care access and care quality provided by insurance type is needed to improve maternal and neonatal health.

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Section: Discussionsupporting

confidence: 91%

Risk Factors for Dual Burden of Severe Maternal Morbidity and Preterm Birth by Insurance Type in California

Ayadi

Baer

Gay

et al. 2022

Matern Child Health J

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“…These factors may affect parental preferences which consequently influence neonatal treatment decisions . Clinician counseling and intervention in the periviable period may also differ by the race and ethnicity of the patient …”

Section: Discussionmentioning

confidence: 99%

“…36 Clinician counseling and intervention in the periviable period may also differ by the race and ethnicity of the patient. 37…”

Section: Discussionmentioning

confidence: 99%

Trends in Active Treatment of Live-born Neonates Between 22 Weeks 0 Days and 25 Weeks 6 Days by Gestational Age and Maternal Race and Ethnicity in the US, 2014 to 2020

Venkatesh

Lynch

Costantine

et al. 2022

JAMA

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ImportanceBirth in the periviable period between 22 weeks 0 days and 25 weeks 6 days’ gestation is a major source of neonatal morbidity and mortality, and the decision to initiate active life-saving treatment is challenging.ObjectiveTo assess whether the frequency of active treatment among live-born neonates in the periviable period has changed over time and whether active treatment differed by gestational age at birth and race and ethnicity.Design, Setting, and ParticipantsSerial cross-sectional descriptive study using National Center for Health Statistics natality data from 2014 to 2020 for 61 908 singleton live births without clinical anomalies between 22 weeks 0 days and 25 weeks 6 days in the US.ExposuresYear of delivery, gestational age at birth, and race and ethnicity of the pregnant individual, stratified as non-Hispanic Asian/Pacific Islander, non-Hispanic Black, Hispanic/Latina, and non-Hispanic White.Main Outcomes and MeasuresActive treatment, determined by whether there was an attempt to treat the neonate and defined as a composite of surfactant therapy, immediate assisted ventilation at birth, assisted ventilation more than 6 hours in duration, and/or antibiotic therapy. Frequencies, mean annual percent change (APC), and adjusted risk ratios (aRRs) were estimated.ResultsOf 26 986 716 live births, 61 908 (0.2%) were periviable live births included in this study: 5% were Asian/Pacific Islander, 37% Black, 24% Hispanic, and 34% White; and 14% were born at 22 weeks, 21% at 23 weeks, 30% at 24 weeks, and 34% at 25 weeks. Fifty-two percent of neonates received active treatment. From 2014 to 2020, the overall frequency (mean APC per year) of active treatment increased significantly (3.9% [95% CI, 3.0% to 4.9%]), as well as among all racial and ethnic subgroups (Asian/Pacific Islander: 3.4% [95% CI, 0.8% to 6.0%]); Black: 4.7% [95% CI, 3.4% to 5.9%]; Hispanic: 4.7% [95% CI, 3.4% to 5.9%]; and White: 3.1% [95% CI, 1.1% to 4.4%]) and among each gestational age range (22 weeks: 14.4% [95% CI, 11.1% to 17.7%] and 25 weeks: 2.9% [95% CI, 1.5% to 4.2%]). Compared with neonates born to White individuals (57.0%), neonates born to Asian/Pacific Islander (46.2%; risk difference [RD], −10.81 [95% CI, −12.75 to −8.88]; aRR, 0.82 [95% CI, [0.79-0.86]), Black (51.6%; RD, −5.42 [95% CI, −6.36 to −4.50]; aRR, 0.90 [95% CI, 0.89 to 0.92]), and Hispanic (48.0%; RD, −9.03 [95% CI, −10.07 to −7.99]; aRR, 0.83 [95% CI, 0.81 to 0.85]) individuals were significantly less likely to receive active treatment.Conclusions and RelevanceFrom 2014 to 2020 in the US, the frequency of active treatment among neonates born alive between 22 weeks 0 days and 25 weeks 6 days significantly increased, and there were differences in rates of active treatment by race and ethnicity.

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“…PTB is the leading cause of death in children under 5 (Chawanpaiboon et al., 2019), and those who survive commonly suffer from life‐long deleterious health disparities (Cooke, 2006). PTL, defined as sustained contractions prior to 37 weeks of gestation, occurs in about 10% of all pregnancies (Martin et al., 2021), with women of African descent being as much as 40% more likely to deliver preterm (Korinek & Ahmmad, 2022), and their infants twice as likely to die as a result (Burris & Parker, 2021). While advances in perinatal care have ameliorated many serious complications if addressed during late preterm (>32 weeks), each year 13 million infants are born preterm globally, costing in excess of 38 billion annually (adjusted) in the USA alone (Behrman & Butler, 2007).…”

Section: Introductionmentioning

confidence: 99%

Novel identification and modulation of the mechanosensitive Piezo1 channel in human myometrium

Barnett

Asif

Buxton

2022

The Journal of Physiology

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Approximately 10% of US births deliver preterm before 37 weeks of completed gestation. Premature infants are at risk for life‐long debilitating morbidities and death, and spontaneous preterm labour explains 50% of preterm births. In all cases existing treatments are ineffective, and none are FDA approved. The mechanisms that initiate preterm labour are not well understood but may result from dysfunctional regulation of quiescence mechanisms. Human pregnancy is accompanied by large increases in blood flow, and the uterus must enlarge by orders of magnitude to accommodate the growing fetus. This mechanical strain suggests that stretch‐activated channels may constitute a mechanism to explain gestational quiescence. Here we identify for the first time that Piezo1, a mechanosensitive cation channel, is present in the uterine smooth muscle and microvascular endothelium of pregnant myometrium. Piezo is downregulated during preterm labour, and stimulation of myometrial Piezo1 in an organ bath with the agonist Yoda1 relaxes the tissue in a dose‐dependent fashion. Further, stimulation of Piezo1 while inhibiting protein kinase A, AKT, or endothelial nitric oxide synthase mutes the negative inotropic effects of Piezo1 activation, intimating that actions on the myocyte and endothelial nitric oxide signalling contribute to Piezo1‐mediated contractile dynamics. Taken together, these data highlight the importance of stretch‐activated channels in pregnancy maintenance and parturition, and identify Piezo1 as a tocolytic target of interest. Key points Spontaneous preterm labour is a serious obstetric dilemma without a known cause or effective treatments. Piezo1 is a stretch‐activated channel important to muscle contractile dynamics. Piezo1 is present in the myometrium and is dysregulated in women who experience preterm labour. Activation of Piezo1 by the agonist Yoda1 relaxes the myometrium in a dose‐dependent fashion, indicating that Piezo1 modulation may have therapeutic benefits to treat preterm labour.

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Racial and ethnic disparities in preterm birth outcomes: a call to action for neonatal providers

Cited by 9 publications

References 9 publications

Risk Factors for Dual Burden of Severe Maternal Morbidity and Preterm Birth by Insurance Type in California

Risk Factors for Dual Burden of Severe Maternal Morbidity and Preterm Birth by Insurance Type in California

Trends in Active Treatment of Live-born Neonates Between 22 Weeks 0 Days and 25 Weeks 6 Days by Gestational Age and Maternal Race and Ethnicity in the US, 2014 to 2020

Novel identification and modulation of the mechanosensitive Piezo1 channel in human myometrium

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