An overview of racial disparities in preterm birth rates: caused by infection or inflammatory response?

• Type of Material: Article
• Authors: Ramkumar Menon, Emory University; Anne Dunlop, Emory University; Michael Kramer, Emory University; Stephen J. Fortunato, Centennial Women's Hospital; Carol Hogue, Emory University
• Language: English
• Date: 2011-12-01
• Publisher: Wiley
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 1999 - 2017 John Wiley & Sons, Inc. All Rights Reserved
• Final Published Version (URL): http://dx.doi.org/10.1111/j.1600-0412.2011.01135.x
• Title of Journal or Parent Work: Acta Obstetricia et Gynecologica Scandinavica
• ISSN: 0001-6349
• Volume: 90
• Issue: 12
• Start Page: 1325
• End Page: 1331
• Grant/Funding Information: Ramkumar Menon is also supported by Grants from March of Dimes, New York, NY, USA (21-FY08–557) to study genetic and biomarker differences in preterm birth racial disparity.; This article follows a four-part seminar series on causes of racial disparities in preterm birth held in the fall of 2009 at the Rollins School of Public Health, Emory University, Atlanta, GA. The series and this work are supported in part by the National Institute of Health Reproductive, Perinatal, and Pediatric Health Training grant T32 HD052460.
• Keywords: infant health; POSSIBLE EXPLANATION; PERSPECTIVE; AFRICAN-AMERICANS; MORTALITY; health disparities; CORTICOTROPIN-RELEASING HORMONE; Life Sciences & Biomedicine; African American; Science & Technology; OBSTETRICS & GYNECOLOGY; UNITED-STATES; Obstetrics & Gynecology; EPIDEMIOLOGY; prematurity; LABOR; INTERLEUKIN-6; AMNIOTIC-FLUID; infection
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Public Health

Abstract

Infection has been hypothesized to be one of the factors associated with spontaneous preterm birth (PTB) and with the racial disparity in rates of PTB between African American and Caucasian women. However, recent findings refute the generalizability of the role of infection and inflammation. African Americans have an increased incidence of PTB in the setting of intraamniotic infection, periodontal disease, and bacterial vaginosis compared to Caucasians. Herein we report variability in infection- and inflammation-related factors based on race/ethnicity. For African American women, an imbalance in the host proinflammatory response seems to contribute to infection-associated PTB, as evidenced by a greater presence of inflammatory mediators with limited or reduced presence of immune balancing factors. This may be attributed to differences in the genetic variants associated with PTB between African Americans and Caucasians. We argue that infection may not be a cause of racial disparity but in association with other risk factors such as stress, nutritional deficiency, and differences in genetic variations in PTB, pathways and their complex interactions may produce differential inflammatory responses that may contribute to racial disparity. © 2011 Nordic Federation of Societies of Obstetrics and Gynecology.