Maternal Fetal Medicine and High Risk Obstetrics

Preterm Labor and Low Birth Weight

Toward the elimination of race-based medicine: replace race with racism as preeclampsia risk factor: In this commentary, we reviewed the evidence that supports race as a sociopolitical construct and the health impacts of racism. We presented a call to action to remove racial determination in the guidelines for aspirin prophylaxis in preeclampsia and more broadly in our practice of medicine.

The color of health: how racism, segregation, and inequality affect the health and well-being of preterm infants and their families, Beck et al, 2020 This review discusses the causal pathways of increased risk; lower-quality care; and socioeconomic disadvantages that persist after birth.

Using Index of Concentration at the Extremes as Indicators of Structural Racism to Evaluate the Association with Preterm Birth and Infant Mortality—California, 2011–2012, Chambers et al, 2019The Index of Concentration At the Extremes (ICE) measures spatial, social polarization by quantifying extremes of deprived and privileged social groups in one metric. This study demonstrates an association between ICE and preterm birth, indicating that ICE can be used as a proxy measurement for structural racism and have implications in intervening on birth related racial disparities.

The Enigma of Spontaneous Preterm Birth, Muglia & Katz, 2010This review discusses the challenge of identifying causes of premature birth and preventing it: environmental factors influence racial differences in pregnancy outcomes, but these influences may overwhelm the effect of what might seem to be small genetic differences. Several studies support that a mother's racial discrimination experience may increase the risk of preterm and low birth weight. 

Racial Differences in Birth Outcomes: The Role of General, Pregnancy, and Racism Stress, Parker Dominguez et al, 2008 Research suggests exposure to racism partially explains why Black women are 2-3 times more likely to deliver low birth weight and preterm infants. Childhood racism interacted with diastolic blood pressure to predict birth weight. Women with two or more indirect exposures to racism in childhood and increases in diastolic blood pressure between 18 and 32 weeks had lower gestational age-adjusted birth weight than other women. 

Disparities in Infant Mortality: What’s Genetics Got to Do With It? David and Collins, 2007This review article critiques the idea of a genetic basis for preterm birth and instead theorizes that racial preterm birth disparities are caused by social determinants of health and racism. It discusses the misconceptions regarding a genetic basis of race and reviews epidemiological data of birth outcomes, specifically comparing outcomes between US born Black women and African immigrants, to support their argument. 

Epidemiology, Racism, and Health: The Case of Low Birth, Krieger, 2000 This editorial article asserts that racial/ethnic disparities in health cannot be studied without reference to racial discrimination. They use this framework to review findings of pivotal research on racial disparities in infant birth by Collins et al. (2000) and Parker (2000). The article uses this research to emphasize the need to address racial/ethnic and related social inequalities in health and discusses the nature of research methods required to do so. 

Low-Income African-American Mothers’ Perception of Exposure to Racial Discrimination and Infant Birth Weight, Collins et al, 2000. This case control study demonstrates an association between racism experienced during pregnancy and very low birth weight in low-income Black women in Chicago. Racism was self reported on a questionnaire. They postulate the maternal perception of racism is part of the psychophysiologic impact of stress that may lead to adverse birth outcomes. 

Reproductive Injustice: Racism, Pregnancy, and Premature Birth Book by Dána-Ain Davis, The experiences of mothers, fathers, neonatologists, nurses, and midwives whom Davis interviewed paint a vivid picture of the relationship between medical racism and adverse birth outcomes. The book also discusses community-based birthing projects, doulas, and midwives as upstream interventions. 

Frontiers | Explaining the Black-White Disparity in Preterm Birth: A Consensus Statement: It reviews the literature on the many likely downstream contributors to the racial disparity in preterm birth, and concludes that racism is a (and the only identified ) highly plausible upstream cause of virtually all of them.

Courtesy of the Black OBGYN Project:

Structural racism increases the risk of preterm birth and infant mortality in California (Bixby Center)

Research priorities of woman at risk for preterm birth (Franck et al., 2020) 

Birth outcome racial disparities (Burris and Hacker, 2017)

Prevention of preterm delivery: current challenges and future prospects (Zijl et al., 2016) 

Differing Birth Weight among Infants of U.S.-Born Blacks, African-Born Blacks, and U.S.-Born Whites (David and Collins, 1997, NEJM)

Using Index of Concentration at the Extremes as Indicators of Structural Racism to Evaluate the Association with Preterm Birth and Infant Mortality (Chambers et al., 2018)

Racial disparities in prematurity persist among women of high socioeconomic status (SES) (Johnson et al., 2018) 

Fighting at Birth: Eradicating the Black-White Infant Mortality Gap (Smith et al., 2018) 

High Premature Rates May Reflect Stress of Racism and Economic Factors (Jan 2021)

Hypertension Disorders of Pregnancy

As a Woman: Maternal Health Disparities, with Dr. Jasmine Johnson on Apple Podcasts, discussing racial inequalities in OBGYN

Does Race or Ethnicity Play a Role in the Origin, Pathophysiology, and Outcomes of Preeclampsia? An Expert Review of the Literature, Johnson & Louis, 2020This review article synthesizes what is known about race and preeclampsia and is firmly grounded in a framework of health equity. It focuses on the following domains: prevalence, presentation, and outcomes and how they relate to race and ethnicity.

Severe Preterm Preeclampsia: An Examination of Outcomes by Race, Peterson et al, 2020 This retrospective cohort study investigated the outcomes of patients undergoing expectant management for severe preeclampsia at <34 weeks at a single institution. They found there was no difference in their primary outcome, a composite representing maternal morbidity, between Black and non-Black patients. Limitations discussed.

Maternal Race/Ethnicity, Hypertension, and Risk for Stroke During Delivery Admission, Miller et al, 2020 This cross sectional analysis of  65,286,425 women from 1998 to 2014 identified 7,764 strokes during delivery admission. They found that normotensive, pregnancy related hypertensive, and chronically hypertensive Black women had an increased risk of stroke compared to white women. Additionally, all minority women with chronic hypertensive had an increased risk of stroke compared to white hypertensive women. They found similar results when adjusting for income and comorbidities, which leads them to postulate that minority women may be receiving different care.  

Racial Residential Segregation and Hypertensive Disorder of Pregnancy Among Women in Chicago: Analysis of Electronic Health Record Data, Mayne et al, 2018 This retrospective cohort study used electronic records from 4,748 births among Black women in Chicago, IL (2009–2013) and evaluated the level of residential segregation of their neighborhoods based on their address at the time of birth. Overall, they found no association between neighborhood segregation and hypertensive disorder of pregnancy (gestational HTN or preeclampsia). When they looked specifically at women living in neighborhoods where >20% of residents lived below the federal poverty line, they did find a significant association between segregation and hypertensive disorder. 

Continued disparities in postpartum follow-up and screening among women with gestational diabetes and hypertensive disorders of pregnancy: A systematic review, Jones et al, 2019 This systematic review of 9 studies published since 2011 found several instances of racial disparities during the postpartum period. Notably, Black and Hispanic women were less likely to present for their follow up visit when compared to White and Asian women. 

Racial/ethnic disparities in the association between preeclampsia risk factors and preeclampsia among women residing in Hawaii, Nakagawa et al, 2019 This retrospective study of 271,569 deliveries between 1995 and 2013 looked at the prevalence of preeclampsia at hospital discharge by race in Hawaii. They found compared to White women, native Hawaiians and Filipinos were more likely to have preeclampsia even when controlling for age and obesity. 

Racial Disparity in Hypertensive Disorders of Pregnancy in New York State: A 10-Year Longitudinal Population-Based Study, Tanaka et al, 2007This study encompassed data from 2.5 million women in New York State between 1993 and 2010 to evaluate trends in hypertensive disorders of pregnancy. Overall, they found that Black women had a higher rate of preeclampsia regardless of location within New York State or income level. They also found that the degree of disparity in the rates of preeclampsia between Black and White women increased over the study period (even when controlling for age and presence of diabetes).

Multi-Fetal Gestation

Racial Disparities in Delivery Gestational Age among Twin Pregnancies, Grant et al, 2017 This study (a secondary analysis from a RCT comparing 17-OHPC vs placebo‘s effect on preterm birth in twin gestations) looked at the association between race and gestational age at delivery. They found that Black women have a significantly increased risk of early delivery and neonatal morbidity compared with non-Hispanic White women.

Diabetes

Disparities in the risk of gestational diabetes by race-ethnicity and country of birth, Hedderson et al, 2010This cohort study examined whether the risk of gestational diabetes differs between women born inside and outside the US -- stratified by race-ethnicity groups of over 200,000 women who delivered over a decade. Multivariable analysis found an association between being born outside of the US with an increased risk of gestational diabetes among black, Asian Indian, Filipina, Pacific Islanders, Chinese, Mexicans and non-Hispanic white women (but decreased among Japanese and Korean women).

“We Know but We Don’t Really Know”: Diet, Physical Activity and Cardiovascular Disease Prevention Knowledge and Beliefs Among Underserved Pregnant Women (springer.com): Cultural factors impacting chronic illness in pregnancy

Cardiovascular and Thrombotic disease

Comparison of Clinical Characteristics and Outcomes of Peripartum Cardiomyopathy Between African American and Non-African American Women, Irizarry Et al. 2017 This retrospective cohort study found that Black women diagnosed with peripartum cardiomyopathy are diagnosed at a younger age, later in the postpartum period, and present with more severe disease than their non-Black counterparts. They found Black women are also twice as likely to not recover, and if they do, take approximately twice as long despite similar treatment. 

Trends in Incidence and Outcomes of Pregnancy-Related Acute Myocardial Infarction (From a Nationwide Inpatient Sample Database), Tripathi Et al. 2019 This study found that Black race correlates significantly with a higher risk of acute myocardial infarction during pregnancy, even when other risk factors for coronary artery disease are controlled. The study also found those with the highest mean household incomes have a decreased risk of an MI during pregnancy.

Neonatal ICU Care (Courtesy of TheBlackOBGYNProject)

This Doctor Wants to Humanize Death | Op-Docs - YouTube

Interdisciplinary Recommendations for the Psychosocial Support of NICU Parents (nature.com)

Opinion | Dying in Your Mother’s Arms - The New York Times (nytimes.com)

Grahams Foundation

Hand to Hold

Project NICU: dedicated to supporting families with children in the neonatal intensive care unit and the medical professionals who care for them

National Perinatal Association: psychosocial support provided to NICU parents – as well as improving training and support for those who provide care in NICUs

Family Advocacy Network (FAN): champions collaborative relationships between families and the medical professions who care for them

Nonprofits for Black Parents of NICU Babies (Courtesy of TheBlackOBGYNproject)

Mighty Little Giants:  supporting families experiencing preterm deliveries resulting in long-term stays in the hospitals’ NICU via education and hope. Dedicated to lowering the African American Infant mortality rates

My Kota Bear: bringing awareness and support to those in Essex & Warren Counties in New Jersey and surrounding areas 

Our Little Preemie (Back Owned Premature Awareness Baby Clothing Store)

Praying for my Preemie