First name
Ai
Last name
-Ris Y Collier

Title

Resilience as a potential modifier of racial inequities in preterm birth.

Year of Publication

2023

Date Published

04/2023

ISSN Number

1873-2585

Abstract

PURPOSE: In the United States, preterm birth is 55% more common among Black compared to White individuals and psychosocial stressors may contribute. Resilience is associated with improved health outcomes outside of pregnancy. However, whether resilience modifies preterm birth inequity is unknown. We hypothesized that high resilience would reduce inequities in preterm birth risk.

METHODS: This study analyzes data from 535 pregnancies among Black (n=101, 19%) and White (n=434, 81%) participants from the Spontaneous Prematurity and Epigenetics of the Cervix prospective cohort. Participants completed the Connor-Davidson Resilience Scale. We calculated risk ratios (RR) for preterm birth among Black compared to White participants, stratified by resilience tertiles, to test for effect measure modification.

RESULTS: Among those in the lowest resilience tertile, there were 6 (20.7%) preterm births among Black and 7 (4.9%) among White participants (RR: 4.26; 95% confidence interval (CI): 1.53, 11.81). Among those in the highest resilience tertile, there were 8 (18.2%) preterm births among Black and 14 (9.5%) among White participants (RR: 1.92; 95% CI: 0.87, 4.24. Adjusting for education and income, the Black:White RR was 2.00 (95% CI 0.47, 8.64) in the lowest tertile, and 3.49 (95% CI 1.52, 8.01) in the highest tertile.

CONCLUSIONS: Black-White preterm birth inequity did not differ among resilience strata and remained significant in the highest tertile. Our findings suggest that high resilience is inadequate to overcome Black:White racial inequity in preterm birth.

DOI

10.1016/j.annepidem.2023.04.010

Alternate Title

Ann Epidemiol

PMID

37088321
Featured Publication
No

Title

Cervical microRNA expression and spontaneous preterm birth.

Year of Publication

2023

Number of Pages

100783

Date Published

01/2023

ISSN Number

2589-9333

Abstract

BACKGROUND: Preterm birth remains a major public health issue affecting 10% of all pregnancies and increases risks of neonatal morbidity and mortality. Approximately 50% to 60% of preterm births are spontaneous, resulting from preterm premature rupture of membranes or preterm labor. The pathogenesis of spontaneous preterm birth is incompletely understood, and prediction of preterm birth remains elusive. Accurate prediction of preterm birth would reduce infant morbidity and mortality through targeted patient referral to hospitals equipped to care for preterm infants. Two previous studies have analyzed cervical microRNAs in association with spontaneous preterm birth and the length of gestation, but the extent to which microRNAs serve as predictive biomarkers remains unknown.

OBJECTIVE: This study aimed to examine associations between cervical microRNA expression and spontaneous preterm birth, with the specific goal of identifying a subset of microRNAs that predict spontaneous preterm birth.

STUDY DESIGN: We performed a prospective, nested, case-control study of 25 cases with spontaneous preterm birth and 49 term controls. Controls were matched to cases in a 2:1 ratio on the basis of age, parity, and self-identified race. Cervical swabs were collected at a mean gestational age of 17.1 (4.8) weeks of gestation, and microRNAs were analyzed using a quantitative polymerase chain reaction array. Normalized microRNA expression was compared between cases and controls, and a false discovery rate of 0.2 was applied to account for multiple comparisons. Histopathologic analysis of slides of cervical swab samples was performed to quantify leukocyte burden for adjustment in conditional regression models. We explored the use of Relief-based unsupervised identification of top microRNAs and support vector machines to predict spontaneous preterm birth. We performed microRNA enrichment analysis to explore potential biologic targets and pathways in which up-regulated microRNAs might be involved.

RESULTS: Of the 754 microRNAs on the polymerase chain reaction array, 346 were detected in ≥75% of participants' cervical swabs. Average cervical microRNA expression was significantly higher in cases of spontaneous preterm birth than in controls (P=.01). There were 95 significantly up-regulated individual microRNAs (>2-fold change) in cases of subsequent spontaneous preterm birth compared with term controls (P<.05; q<0.2). Notably, miR-143, miR-30e-3p, and miR-199b were all significantly up-regulated, which is consistent with the 1 previous study of cervical microRNA and spontaneous preterm birth. A Relief-based, novel variable (feature) selection machine learning approach had low-to-moderate prediction accuracy, with an area under the receiver operating curve of 0.71. Enrichment analysis revealed that identified microRNAs may modulate inflammatory cell signaling.

CONCLUSION: In this prospective nested case-control study of cervical microRNA expression and spontaneous preterm birth, we identified a global increase in microRNA expression and up-regulation of 95 distinct microRNAs in association with subsequent spontaneous preterm birth. Larger and more diverse studies are required to determine the ability of microRNAs to accurately predict spontaneous preterm birth, and mechanistic work to facilitate development of novel therapeutic interventions to prevent spontaneous preterm birth is warranted.

DOI

10.1016/j.ajogmf.2022.100783

Alternate Title

Am J Obstet Gynecol MFM

PMID

36280145

Title

Racial and ethnic representation in epigenomic studies of preterm birth: a systematic review.

Year of Publication

2020

Date Published

2020 Dec 02

ISSN Number

1750-192X

Abstract

<p>We conducted a systematic review evaluating race/ethnicity representation in DNA methylomic studies of preterm birth. PubMed, EMBASE, CINHAL, Scopus and relevant citations from 1 January&nbsp;2000 to 30 June&nbsp;2019. Two authors independently identified abstracts comparing DNA methylomic differences between term and preterm births that included&nbsp;race/ethnicity data. 16&nbsp;studies were included. Black and non-Hispanic Black deliveries were well represented (28%). However, large studies originating from&nbsp;more than&nbsp;95% White populations were excluded due to unreported race/ethnicity data. Most studies were cross-sectional, allowing for reverse causation. Most studies were also racially/ethnically homogeneous, preventing direct comparison of DNA methylomic differences across race/ethnicities. In DNA methylomic studies, Black women and infants were well represented. However, the literature has limitations and precludes drawing definitive conclusions.</p>

DOI

10.2217/epi-2020-0007

Alternate Title

Epigenomics

PMID

33264049

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