Neighborhoods Most Affected by Racism, Inequities and COVID-19 Pandemic Stressors at a Greater Risk for Preterm Births, Study Finds
Journal: American Journal of Obstetrics & Gynecology Maternal-Fetal Medicine, April 2022
Authors: Teresa Janevic, PhD, MPH, Co-Director of the Blavatnik Family Women’s Health Research Institute and Associate Professor of Population Health Science and Policy; Obstetrics, Gynecology and Reproductive Science; and Global Health at the Icahn School of Medicine at Mount Sinai, and other coauthors.
Bottom Line: The cohort study follows women through pregnancy and birth to study if a SARS-CoV-2 infection, the virus that causes COVID-19, is associated with poor pregnancy outcomes. In this part of the study, Mount Sinai researchers specifically examined how existing structures of racism and socioeconomic inequity, as well as pandemic-related social and economic stressors, influence COVID-19 infection during pregnancy and adverse birth outcomes.
Results: The study concluded that structural racism is associated with both increased risk of COVID-19 infection and preterm births. The researchers say their study is the first to show this using antibody test results—a very reliable measure of infection—instead of COVID-19 testing data.
Women in mostly Black, low-income neighborhoods had nearly three times the risk of COVID-19 infection as those in White, wealthy neighborhoods. Among birthing people in the most disadvantaged neighborhoods: 94% were non-White, 50% had public insurance, 41% were obese, 32% had COVID-19 antibodies, 11% delivered preterm, and 12% delivered an infant small-for-gestational-age. In contrast, birthing people in neighborhoods with the lowest structural disadvantages were: 38% were White, 17% had public insurance, 15% were obese, 9% had COVID-19 antibodies, and 6% delivered preterm. Their analysis found that structural racism and community unemployment were associated with both COVID-19 infection and preterm births.
The researchers also found that communities with the highest increases in unemployment in the first wave of the pandemic experienced 60% higher increased risk of preterm birth, compared to those with the lowest increase. This study is among the first to demonstrate a link between the COVID-19-related unemployment crisis and preterm birth. However, the team found no links between COVID-19 infection, coupled with structural racism or socioeconomic stress, on birth outcomes.
How: The researchers analyzed data for nearly 1,000 patients from a cohort of pregnant persons treated at the Mount Sinai Health System in New York City, comprised of White (38%), Black (17%), Latina (30%), Asian (9%), and unknown (5%) race and ethnicity backgrounds. The researchers evaluated structural racism (social structural disadvantage and racial-economic segregation) and pandemic-related stress (community COVID-19 mortality and community unemployment rate increase) in quartiles by zip code. They also examined medical records to determine if patients experienced preterm birth or delivered a newborn small-for-gestational-age, and reviewed blood test results that measured COVID- 19 antibodies.
Why the Research Is Interesting: Given that social and economic impacts of the COVID-19 pandemic are associated with an increased risk of preterm birth—especially among communities of color—policy makers are encouraged to consider this latest data when considering measures to mitigate structural racism and inequities. Physicians should also consider these findings when developing a plan of care for patients from communities that face high pandemic-related unemployment and stressors, and thus, an increased risk of preterm births.
Said Mount Sinai's Dr. Teresa Janevic of the research:
In our study of pregnant persons in New York City, the same neighborhoods most affected by structural racism and pandemic stress experienced the highest risk of preterm birth. Nonetheless, our study, demonstrates that pregnant persons of color are disproportionately impacted by COVID-19 infection and pandemic-related community stressors. Future interventions on mitigating structural racism and socioeconomic inequity could reduce the impact of the pandemic on pregnant persons.
About the Mount Sinai Health System
The Mount Sinai Health System is New York City's largest academic medical system, encompassing eight hospitals, a leading medical school, and a vast network of ambulatory practices throughout the greater New York region. Mount Sinai advances medicine and health through unrivaled education and translational research and discovery to deliver care that is the safest, highest-quality, most accessible and equitable, and the best value of any health system in the nation. The Health System includes approximately 7,300 primary and specialty care physicians; 13 joint-venture ambulatory surgery centers; more than 415 ambulatory practices throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and more than 30 affiliated community health centers. The Mount Sinai Hospital is ranked on U.S. News & World Report's "Honor Roll" of the top 20 U.S. hospitals and is top in the nation by specialty: No. 1 in Geriatrics and top 20 in Cardiology/Heart Surgery, Diabetes/Endocrinology, Gastroenterology/GI Surgery, Neurology/Neurosurgery, Orthopedics, Pulmonology/Lung Surgery, Rehabilitation, and Urology. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 12 in Ophthalmology. Mount Sinai Kravis Children's Hospital is ranked in U.S. News & World Report’s “Best Children’s Hospitals” among the country’s best in four out of 10 pediatric specialties. The Icahn School of Medicine is one of three medical schools that have earned distinction by multiple indicators: ranked in the top 20 by U.S. News & World Report's "Best Medical Schools," aligned with a U.S. News & World Report "Honor Roll" Hospital, and No. 14 in the nation for National Institutes of Health funding. Newsweek’s “The World’s Best Smart Hospitals” ranks The Mount Sinai Hospital as No. 1 in New York and in the top five globally, and Mount Sinai Morningside in the top 20 globally.