African American Women Experience Over One and a Half Times the Rate of PTB.

Abstract

African American women in the United States (US) experience over one and a half times the rate of PTB (14.1% vs. 9.1%) and nearly double the risk of early PTB (< 32 weeks) compared to US white women. Their infants are twice as likely to die. More than a decade ago, the National Academy of Medicine identified chronic stress experienced by African American women as one of the key factors contributing to this elevated risk. Unfortunately, in the decade since, there has been little if any improvement in birth outcomes among the population, and this health disparity has continued unabated. Therefore, in order to better address this intractable problem, our team of experts with complementary skills in prenatal health, stress research, health disparity, and metabolomics came together with a fresh approach. As a group, and as described in our recent article, “Metabolites and Metabolic Pathways Associated with Glucocorticoid Resistance in Pregnant African-American Women”,we identified for the first time, the metabolites and metabolic pathways that associated with increased chronic stress within a socioeconomically diverse cohort of pregnant African American women, an essential first step in the successful development of a targeted intervention. For our study, the level of chronic stress exposure was determined by the concentration of the cortisol-like steroid dexamethasone (Dex) required to produce a 50% inhibition (i.e., Dex IC50) of the in vitro release of the cytokine tumor-necrosis-factor alpha (TNF-alpha) from white blood cells in response to a standard dose of lipopolysaccharide (LPS); this variable, Dex IC50, is commonly defined as glucocorticoid resistance.