African American women have 1.5 times the rates of preterm birth (PTB) (<37 weeks completed gestation)compared with non-Hispanic white women. This disproportionately high PTB rate in African Americans is apersistent health inequity that leads to high child mortality, morbidity, and developmental delays. In the U.S.approximately $26 billion are spent annually on health care costs for infants and children that were bornprematurely. Recent attempts to explain the high PTB rates in African American women have focused onsocial stressors, such as disadvantaged neighborhoods, racial discrimination, and stressful life events. Thesesocial stressors may lead to PTB by increasing women?s emotional stress levels. Not surprisingly, emotionalstress along with levels of the stress hormone cortisol and systemic inflammation - both physiologicalresponses to stress - have all been related to higher risk of PTB. In contrast, one?s psychosocial resources(e.g., social support) can lessen emotional stress and have protective effects on PTB. Little is yet known aboutthe pathways by which social stressors affect inflammation, and ultimately PTB. The objective of the proposedstudy is to determine how social stressors alter inflammation during pregnancy and lead to PTB in AfricanAmerican women.
We aim to: 1) determine the pathways by which social stressors affect PTB; and 2) describesocial stressors, emotional stress and psychosocial resources; the associations among these concepts; andtheir impact on PTB from women?s perspectives. In this longitudinal convergent mixed methods design, we will enroll 1,500 African American women who livein the Detroit metropolitan area. We will collect data on social stressors, emotional stress, and psychosocialresources through questionnaires and administrative (e.g., census) data. This will be done three timesprenatally. At these same time points, levels of cortisol and systemic inflammation will be determined from hairand blood samples, respectively. We will also obtain birth data from the prenatal and hospital records. In asubsample of 60 women, semi-structured interviews will be conducted to more specifically understand theassociations among social stressors, emotional stress and psychosocial resources; and their impact on PTB.We will conduct a variety of statistical, qualitative and mixed methods analyses using both quantitative andqualitative data to determine answers to the aims of our study. We will also consider the timing of pregnancy inour analyses, as the prenatal data are collected at three distinct time points. The proposed research is highlyrelevant to NIH?s mission to elucidate mechanisms underlying health disparities in PTB. Insights gained fromthis mixed methods approach may lead to the development of an individualized PTB risk profile based on awoman's social stressors and biomarkers which will have potential use in clinical practice and be a target forculturally appropriate interventions to reduce PTB incidence in African American women, and will generate newperspectives for future research in other racial groups through our detailed focus on this high risk group.
Preterm birth is a major risk for neonatal mortality and long-term child health problems; including motor andmental developmental delays and chronic illness. Knowledge of the social context of African Americanwomen?s lives will increase our understanding of why some women have poor pregnancy outcomes; generatenew perspectives for future research; inform new lines of inquiry regarding the pathways through which stressaffects preterm birth in other racial groups; contribute to the development of culturally appropriate interventionsto reduce racial disparities in preterm birth; and ultimately improve birth outcomes.