Racial Disparities in Perinatal Outcomes Are a Blight on Our Progress.

The year 2020 will remain etched in our memories like none other in recent times. Multiple disruptions have created unprecedented challenges, which have engulfed the entire globe. First, it was the SARS-CoV-2 virus, and the pandemic it caused, that paralyzed every nation, big and small, and brought life as we know it to a standstill. Then came the economic downturn, lost jobs, and businesses turned upside down and their many downstream consequences. And then, particularly for those of us in the United States, unrest related to racial injustice spread like a wildfire. It highlighted the disproportionately high toll COVID-19 has taken on minorities as well as the health disparities that are so pervasive in our environment.

Lucky Jain, MD, Consulting Editor

Indeed, births to non-Hispanic black women are associated with a significantly higher risk of prematurity and other adverse outcomes when compared with non-Hispanic white women. A systematic review and metaanalysis by and colleagues showed that black women had a twofold higher risk of preterm birth compared with whites. Similar data can be seen in annual vital statistics year after year and across all preterm gestations (Fig. 1 ). A better understanding of these differences could help shape interventions, but little progress has been made in this regard. Decades ago, David and colleagues showed that black women born in the United States were at greater risk for delivering low-birth-weight babies than women with similar ancestry who had immigrated to the United States from Africa. Studies such as these questioned previously held beliefs about racial differences in birth outcomes resulting from genetic differences and laid bare the consequences of life in the United States as a person of color.

Fig. 1

Proportion of preterm births stratified by gestational age at delivery and maternal race, 2015. Data from Martin et al. Final birth data 2015.

The interplay of social and environmental factors contributing to poorer perinatal outcomes in black women has been the subject of much investigation. Glimmers of hope come from “pockets of progress” in certain counties where racial differences in outcomes have all but disappeared (Fig. 2 ). Positive experiences from these areas could and should set the stage for larger public health interventions to remove health disparities once and for all. That will require political will and a societal call for action.

Fig. 2

Aggregated low-birth-weight rates for US counties with convergent racial disparity trend pattern (reductions in black LBW and no increase in white LBW) from 2003-20013.

Needless to say, there is more to improving perinatal outcomes than just eliminating racial and health disparities. In this issue of the Clinics in Perinatology, Drs Gyamfi-Bannerman and Miller have brought together experts in perinatology to cover topics of great importance in neonatal-perinatal medicine. The authors cover a wide array of topics, including prematurity, infections, maternal conditions, and racial disparities, to name just a few. As always, I am grateful to the publishing staff at Elsevier, including Kerry Holland, Casey Potter, and Nicholas Henderson, for their support in bringing this important publication to you.