Racial disparities in prematurity persist among women of high socioeconomic status

Johnson, Jeff; Green, Celeste A.; Vladutiu, Catherine J.; Manuck, Tracy A.

doi:10.1016/j.ajogmf.2020.100104

Cited by 50 publications

(29 citation statements)

References 24 publications

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“…Many studies have observed that differentials by race (332) and nativity (immigrant vs. US-born Black women) (378-381) persist after controlling for income and/or education. Income and education consistently predict White, but not Black, PTB rates, with the racial gap widest at the highest socioeconomic levels (382)(383)(384)(385), and little (316,386) to no (383, 387) racial differences in PTB rates among socioeconomically disadvantaged women. Income predicts exposure to environmental hazards and lack of exposure to health-promoting conditions in the home and neighborhood.…”

Section: Income and Educationmentioning

confidence: 87%

Explaining the Black-White Disparity in Preterm Birth: A Consensus Statement From a Multi-Disciplinary Scientific Work Group Convened by the March of Dimes

Braveman

Dominguez

Burke

et al. 2021

Front. Reprod. Health

122

130

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In 2017–2019, the March of Dimes convened a workgroup with biomedical, clinical, and epidemiologic expertise to review knowledge of the causes of the persistent Black-White disparity in preterm birth (PTB). Multiple databases were searched to identify hypothesized causes examined in peer-reviewed literature, 33 hypothesized causes were reviewed for whether they plausibly affect PTB and either occur more/less frequently and/or have a larger/smaller effect size among Black women vs. White women. While definitive proof is lacking for most potential causes, most are biologically plausible. No single downstream or midstream factor explains the disparity or its social patterning, however, many likely play limited roles, e.g., while genetic factors likely contribute to PTB, they explain at most a small fraction of the disparity. Research links most hypothesized midstream causes, including socioeconomic factors and stress, with the disparity through their influence on the hypothesized downstream factors. Socioeconomic factors alone cannot explain the disparity's social patterning. Chronic stress could affect PTB through neuroendocrine and immune mechanisms leading to inflammation and immune dysfunction, stress could alter a woman's microbiota, immune response to infection, chronic disease risks, and behaviors, and trigger epigenetic changes influencing PTB risk. As an upstream factor, racism in multiple forms has repeatedly been linked with the plausible midstream/downstream factors, including socioeconomic disadvantage, stress, and toxic exposures. Racism is the only factor identified that directly or indirectly could explain the racial disparities in the plausible midstream/downstream causes and the observed social patterning. Historical and contemporary systemic racism can explain the racial disparities in socioeconomic opportunities that differentially expose African Americans to lifelong financial stress and associated health-harming conditions. Segregation places Black women in stressful surroundings and exposes them to environmental hazards. Race-based discriminatory treatment is a pervasive stressor for Black women of all socioeconomic levels, considering both incidents and the constant vigilance needed to prepare oneself for potential incidents. Racism is a highly plausible, major upstream contributor to the Black-White disparity in PTB through multiple pathways and biological mechanisms. While much is unknown, existing knowledge and core values (equity, justice) support addressing racism in efforts to eliminate the racial disparity in PTB.

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Section: Income and Educationmentioning

confidence: 87%

Explaining the Black-White Disparity in Preterm Birth: A Consensus Statement From a Multi-Disciplinary Scientific Work Group Convened by the March of Dimes

Braveman

Dominguez

Burke

et al. 2021

Front. Reprod. Health

122

130

View full text Add to dashboard Cite

show abstract

“…However, the vast majority of mothers in our study began prenatal care before the third trimester and HLHS can be diagnosed on routine second trimester ultrasound, suggesting that many of the infants in our study could have been diagnosed prenatally. Many studies have associated race/ethnicity with disparities in prenatal care for all infants, not just those with congenital heart disease; infants born to black mothers have higher rates of preterm birth [ 30 ], even when accounting for socioeconomic status [ 31 ]. It is unknown if these inequities in prenatal care led to differences in prenatal planning for the mothers in our study.…”

Section: Discussionmentioning

confidence: 99%

Timing of Transfer and Mortality in Neonates with Hypoplastic Left Heart Syndrome in California

Purkey

Lee

et al. 2021

Pediatr Cardiol

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Maternal race/ethnicity is associated with mortality in neonates with hypoplastic left heart syndrome (HLHS). We investigated whether maternal race/ethnicity and other sociodemographic factors affect timing of transfer after birth and whether timing of transfer impacts mortality in infants with HLHS. We linked two statewide databases, the California Perinatal Quality Care Collaborative and records from the Office of Statewide Health Planning and Development, to identify cases of HLHS born between 1/1/06 and 12/31/11. Cases were divided into three groups: birth at destination hospital, transfer on day of life 0–1 (“early transfer”), or transfer on day of life ≥ 2 (“late transfer”). We used log-binomial regression models to estimate relative risks (RR) for timing of transfer and Cox proportional hazard models to estimate hazard ratios (HR) for mortality. We excluded infants who died within 60 days of life without intervention from the main analyses of timing of transfer, since intervention may not have been planned in these infants. Of 556 cases, 107 died without intervention (19%) and another 52 (9%) died within 28 days. Of the 449 included in analyses of timing of transfer, 28% were born at the destination hospital, 49% were transferred early, and 23% were transferred late. Late transfer was more likely for infants of low birthweight (RR 1.74) and infants born to US-born Hispanic (RR 1.69) and black (RR 2.45) mothers. Low birthweight (HR 1.50), low 5-min Apgar score (HR 4.69), and the presence of other major congenital anomalies (HR 3.41), but not timing of transfer, predicted neonatal mortality. Late transfer was more likely in neonates born to US-born Hispanic and black mothers but was not associated with higher mortality. Supplementary Information The online version of this article (10.1007/s00246-021-02561-w) contains supplementary material, which is available to authorized users.

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“…This hypothesis is supported by studies suggesting that age-related increases in PTB are higher among non-Hispanic black women than non-Hispanic white women 17 and that racial and ethnic disparities in PTB and other adverse pregnancy outcomes persist among women of high socioeconomic status. 18 Effects of stress on pregnancy outcomes Acute stress, chronic stress, and allostatic overload have all been associated with a variety of adverse pregnancy outcomes, including spontaneous PTB, preeclampsia, neonatal morbidity, and low birthweight (Table ). 14,15,19 In turn, PTB (regardless of indication) is associated with a higher risk of short-term neonatal morbidities (including neurologic, pulmonary, cardiovascular, gastrointestinal, immune, and metabolic complications) and long-term complications among survivors (eg, cerebral palsy, neurodevelopmental delay, visions problems,…”

Section: Stress and Pregnancymentioning

confidence: 99%

Effects of psychological stress on adverse pregnancy outcomes and nonpharmacologic approaches for reduction: an expert review

Traylor

Johnson

Kimmel

et al. 2020

American Journal of Obstetrics & Gynecology MFM

Self Cite

136

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Both acute and chronic stress can cause allostatic overload, or long-term imbalance in mediators of homeostasis, that results in disruptions in the maternal-placental-fetal endocrine and immune system responses. During pregnancy, disruptions in homeostasis may increase the likelihood of preterm birth and preeclampsia. Expectant mothers traditionally have high rates of anxiety and depressive disorders, and many are susceptible to a variety of stressors during pregnancy. These common life stressors include financial concerns and relationship challenges and may be exacerbated by the biological, social, and psychological changes occurring during pregnancy. In addition, external stressors such as major weather events (eg, hurricanes, tornados, floods) and other global phenomena (eg, the coronavirus disease 2019 pandemic) may contribute to stress during pregnancy.This review investigates recent literature published about the use of nonpharmacologic modalities for stress relief in pregnancy and examines the interplay between psychiatric diagnoses and stressors, with the purpose of evaluating the feasibility of implementing nonpharmacologic interventions as sole therapies or in conjunction with psychotherapy or psychiatric medication therapy. Further, the effectiveness of each nonpharmacologic therapy in reducing symptoms of maternal stress is reviewed. Mindfulness meditation and biofeedback have shown effectiveness in improving one's mental health, such as depressive symptoms and anxiety. Exercise, including yoga, may improve both depressive symptoms and birth outcomes. Expressive writing has successfully been applied postpartum and in response to pregnancy challenges. Although some of these nonpharmacologic interventions can be convenient and low cost, there is a trend toward inconsistent implementation of these modalities. Future investigations should focus on methods to increase ease of uptake, ensure each option is available at home, and provide a standardized way to evaluate whether combinations of different interventions may provide added benefit.

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Racial disparities in prematurity persist among women of high socioeconomic status

Cited by 50 publications

References 24 publications

Explaining the Black-White Disparity in Preterm Birth: A Consensus Statement From a Multi-Disciplinary Scientific Work Group Convened by the March of Dimes

Explaining the Black-White Disparity in Preterm Birth: A Consensus Statement From a Multi-Disciplinary Scientific Work Group Convened by the March of Dimes

Timing of Transfer and Mortality in Neonates with Hypoplastic Left Heart Syndrome in California

Effects of psychological stress on adverse pregnancy outcomes and nonpharmacologic approaches for reduction: an expert review

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