The rate of preterm births in the U.S. has been on the rise during the past six years, with a stark difference in the rate of preterm births among non-Hispanic Black women compared to non-Hispanic white women.
Preterm, or premature, birth is when a baby is born before 37 weeks of pregnancy have been completed, with the earlier the birth, the higher the risk of disability or death. According to the U.S. Centers for Disease Control and Prevention, rates for preterm births among Black women were about 50 percent higher than those for white women in 2019.
This discrepancy is why a University of Central Florida College of Nursing researcher is leading projects to identify if factors, such as social stress and paternal roles, are behind it.
The work got an additional boost of nearly $460,000 recently from the U.S. National Institutes of Health to increase its scope, including examining the experiences of Black women during the COVID-19 pandemic and identifying factors related to maternal morbidity and mortality among Black women.
We need to know how social determinants of health influence birth outcomes among Black families. The hope is that we have the foundation to develop interventions that have the potential to decrease adverse birth outcomes among Black families."
Carmen Giurgescu, professor and associate dean for research, University of Central Florida College of Nursing
The researchers will examine if perceived social stressors increase psychological stress and depressive symptoms resulting in greater systemic inflammation, such as higher levels of C-reactive protein, and increase the risk for preterm birth among Black women. Examples of these perceived social stressors are living in a disadvantaged neighborhood or experiencing racial discrimination.
The work is funded by two overall NIH awards. One, which was received in 2017, is for $3.5 million to study the effects of social stressors and systemic inflammation on preterm birth in Black women. The other, received in 2018, is $1.8 million to study the paternal role in adverse birth outcomes in Black families.
The recently received COVID-19 supplement of $197,000 and morbidity supplement of $260,000 from NIH will allow the researchers to explore Black women's experiences during the COVID-19 pandemic and the factors related to maternal morbidity and mortality, respectively.
"The CDC reports that Blacks are more likely to be infected with the virus and also have a higher risk of dying from the virus," Giurgescu says. "So, these factors may increase stress that Black women experience during this pandemic."
Maternal morbidity and mortality were added as a focus because Black women are more likely to die during pregnancy or in the first year after birth compared to white women, Giurgescu says.
"We want to explore if any of our psychosocial measures are related to increased risk for maternal morbidity," she says.
Giurgescu is principal investigator of the social-stressors project and is co-principal investigator of the paternal-roles project.
Chronic stress can increase cortisol levels and results in greater systemic inflammation, which has been shown to ultimately increase the risk of preterm birth.
Prior research has shown that women who live in what are considered to be bad neighborhoods with high poverty rates have a higher risk of having a preterm birth compared to those who live in better neighborhoods, based on U.S. census and other data.
Giurgescu says what has not been studied are women's perceptions of their neighborhood environment, which may be more directly connected to the amount of stress they experience than the status of the area.
"There may be two women living in the same neighborhood, but they may experience their neighborhood differently, and they may have different stress levels based on those perceptions of their neighborhood," Giurgescu says.
The research is currently underway, and the researchers are recruiting Black women from two medical clinics, one in Detroit, Michigan, and another in Columbus, Ohio. These sites are where the project started before Giurgescu came to UCF in 2019.
The study participants are surveyed about stressors in their life and have blood and saliva samples collected at three points - early, mid and late in their pregnancy. The researchers are examining the relationship of the survey responses with biomarkers for stress in the body and gestational age at birth.
This data will allow the researchers to examine which sources of stress are most associated with stress in the body and the risk of preterm birth.
"My hope is to raise awareness about the disparity in preterm birth and factors that may relate to preterm birth among Black families and also to improve and develop interventions that have the potential to improve birth outcomes," Giurgescu says. "And as clinicians to consider not just the medical history, but also the social determinants of health when we assess a woman's life and a woman's pregnancy."
Co-investigators for the social-stressors project are: Christopher G. Engeland with Penn State University; Cindy M. Anderson with The Ohio State University; Dawn P. Misra with Michigan State University; Karen L. Kavanaugh with the Children's Hospital of Wisconsin; and Shannon N. Zenk with the National Institute of Nursing Research.
Principal investigators for the paternal-factors project include Dawn P. Misra with Michigan State University and Cleopatra Howard Caldwell with University of Michigan. Collaborators are Cindy Anderson with The Ohio State University and Stacy Drury with Tulane University.
Giurgescu worked for nearly 15 years as a labor and delivery nurse and as a women's healthcare nurse practitioner. She earned her doctorate in nursing from Loyola University of Chicago in 2004 and completed a postdoctoral fellowship in the Department of Maternal-Child Nursing at the University of Illinois in Chicago in 2006.