Health disparities in preterm births

Abstract

Introduction: Black African American (B/AA) women have a 2-fold to 3-fold elevated risk compared with non-Hispanic White (W) women for preterm birth. Further, preterm birth is the leading cause of mortality among B/AA infants, and among survivors, preterm infant adverse health outcomes occur disproportionately in B/AA infants. Racial inequities in maternal and infant health continue to pose a public health crisis despite the discovery >100 years ago. The purpose of this study was to expand on reported preterm infant outcome disparities. A life-course approach, accumulation of lifelong stress, including discrimination, may explain social factors causing preterm birth rate and outcome inequities in B/AA mothers.

Methods: Anthropometric measures and clinical treatment information for 197 consented participants were milled from electronic health records across 4 years. The Neonatal Infant Stressor Scale was used to tally acute and chronic painful/stressful procedures. Neurobehavioral differences were investigated using the Neonatal Intensive Care Unit (NICU) Network Neurobehavioral Scale.

Results: B/AA mothers gave birth to preterm infants earlier than W mothers. NICU hospitalization stays were extended more than 2 weeks for the significantly smaller B/AA preterm infants in comparison to the age-matched W preterm infants. A higher number of chronic lifesaving procedures with demonstrated altered stress response patterns were recorded for B/AA preterm infants.

Discussion: This cross-sectional analysis of preterm birth rates and preterm infant developmental and neurodevelopmental outcomes are presented in the context of NICU stress and pain, with attendant implications for infant mortality and future health disparities. Preterm birth rate and outcome inequities further support the need to develop interventions and policies that will reduce the impact of discrimination and improve social determinants of health for Black, Indigenous, and other People of Color.

Keywords: health inequities; neurodevelopment; pain; preterm birth; social determinants of health.

Figure 1

Summary statistics for gestational age by race with data points on box whisker plots from lowest value (minimum), first quartile, median, third quartile, and maximum value for B/AA infants on the left and W infants on the right.

Figure 2

(A) Looking at mean over time, the number of Neonatal Infant Stressors for B/AA preterm infants (pink/top line) and W preterm infants (blue/bottom line) over postnatal age by day during the NICU stay. B/AA preterm infants experienced more acute pain procedures (n.s.) and chronic painful/stressful procedures (p = 0.01) than the W preterm infants (B).

Figure 3

Racial disparities in preterm births. (A) Black/African American (B/AA) women experience disproportionately heavier stress than their White (W) counterparts, primarily because of Social Determinants of Health (SDOH), leading to increased measures of cardiometabolic syndromes, e.g. blood pressure and cortisol levels. (B) B/AA preterm babies are born 52 percent more often, are significantly smaller and have longer hospital stays than W preterm babies. Created with BioRender.com.