Carmen Giurgescu, PhD, RN, WHNP, FAAN, associate dean of research at UCF College of Nursing, talks about factors related to preterm birth including racism.
Just to start off, could you briefly explain what your studies about how it works?
GIURGESCU: My, it’s going to be a lot! I started to be focused on preterm birth years back, actually, I was a labor and delivery nurse and a women’s nurse practitioner years back, about 20 some years ago. And during those times, I used to have women in antepartum unit for a long period of time if they had complications, like if they have a rupture of membranes or they have preterm labor, they were more likely to stay in hospital for a long period of time. So during those days, I had the opportunity to talk to women and learn about their experiences. Now we’re talking about the mid nineties, late 90s. We didn’t have cell phones. We didn’t have Internet. So, a lot of women were isolated in the hospitals. They didn’t get to see their family that much. We didn’t have face time to communicate with, though, for them to communicate. So, I had the opportunity to learn more about their experiences. So, during the time I learned that pregnant women experienced stress not just because of this pregnancy, that they are at risk of having a premature infant, but also they lack support. They didn’t get to see their family and friends as much as they wanted. And of course, many of them couldn’t work because, again, we didn’t have Internet during those times available, readily available. So that’s actually put me to think more of the stress and uncertainty with the high-risk pregnancy. So, my research has been focused during my dissertation. Research has been focused on stress during high-risk pregnancy and looked at social support, uncertainty and psychological well-being for high-risk pregnant women. Once I graduated from my Ph.D., I started to focus on the experience of African-American women. African-American women are more likely to have preterm birth compared with white women. For example, last year, African-American women had preterm birth rate of 14 percent, compared to nine percent for whites. So African-American women are one and a half times more likely to have preterm birth compared to white women. Therefore, years back, after my PhD, I decided to examine factors related to Britain birth among African-American women. And that was my first study as a postdoctoral fellow at University of Illinois at Chicago. Coming from there, I learned that experiences of racial discrimination and living in disadvantaged neighborhoods may be risk factors for preterm birth but for African Americans, I conducted a few pilot studies focused on the social determinants of health, but also psychological stress for these women, which led to the funding from NIH for an auto one study focused on social stressor and systemic inflammation related to preterm birth for African-Americans.
So how are you performing the study to examine those stressors for them?
GIURGESCU: Right now, we have a study from 2017, we have funding from NIH to conduct the study with African-American women prior to COVID. We started to recruit in Columbus, Ohio, and Detroit, Michigan. We are all six hundred and twenty women. Prior to March, this year, women completed questionnaires related to neighborhood environment, racial discrimination, depressive symptoms, social support. And also, they had blood collected and saliva collected. And the purpose for the blood is to examine systemic inflammation. A panel of inflammatory cytokines, which have been related to preterm birth. Saliva is processed by one of my colleagues, Dr. Stacey Drewry at Tulane University. And we are looking at telomere length, which is the marker of chronic stress. Research suggests that people who experience chronic stress are more likely to have shorter telomeres.
And then what kind of stressors… You mentioned a lot of signs every step of the way first. And how does the social stressors impact preterm birth? How does one lead to the other?
GIURGESCU: Women who experienced racism or live in disadvantaged neighborhoods are more likely to experience stress, are more likely to worry about the stressors in their lives. So physiological stress may influence our body and leads to risk factors such as cardiovascular disease, even higher morbidity and mortality, and, of course, increased risk for both adverse outcomes, including preterm birth.
What kind of social stressors are specific to the African-American community that you think is causing this disparity?
GIURGESCU: African-American women are more likely to experience racism and racism has been related to adverse health outcomes. I’m just trying to think. Good that it’s going to be editing.
So, what is your hunch as to why black women are having preterm birth and also maternal morbidity. What’s your hypothesis there?
GIURGESCU: Other researchers and I found that racism across the lifespan increases a woman’s health, increases a woman’s risk for adverse health outcomes. Let me repeat. Other researchers and I found that racism across lifespan increases a woman’s risk for adverse outcomes such as preterm birth and also increases her risk for morbidity and mortality. We know also that in the past few years there’s been an increase in the rates of mortality among African-American women complete compared with white women.
And what’s the rate of disparity between black and white women for preterm birth and maternal morbidity?
GIURGESCU: African-American women are one and a half times more likely to have preterm birth. For example, in twenty nineteen, African American women had a rate of return to 40 percent and white women had a rate of nine percent preterm birth. As far as mortality, Black women are three times more likely to die in during the pregnancy and the first year after having a baby compared with white women.
And we’re talking about preterm birth is there a specific amount of prematurity? Like is there any specific time that this often happens or is there a general pattern?
GIURGESCU: Preterm birth is any birth of less than 37 completed weeks gestation. A normal gestation is 40 weeks. Of course, the earlier the infant is born, the more risk for that infant. Preterm birth is the leading cause of mortality for African-American infants. Even infants who survive are high risk of childhood illness and developmental delays.
What do you hope to do when the results of this research? How do you hope to impact these birth outcomes?
GIURGESCU: First is acknowledgement that African-American women experience chronic stress. African-American women experience racism, I think as a health care provider. This should be the first step that we should acknowledge. Listening to the women, listening about their concerns. As clinicians, we have to listen to the nurses and hear about their concerns. I think that’s one of the first things that we have to consider. We should not ask the woman to take responsibility for her health and the health of her pregnancy. There is the saying that it takes a village to raise a child. I think that could actually be applied in regard to a healthy pregnancy. It takes a village to have a healthy baby. It’s the health care providers, it’s the family, friends, father of the baby who should also take responsibility for pregnancy, not just to be everything on a pregnant woman.
And speaking of that village, if there’s a pregnant woman, a pregnant African-American woman who scared, he’s nervous about all these things they’re hearing about outcomes and premature, what steps can I take, what questions to ask their health care providers to ensure they’re safe and they’re being healthy?
GIURGESCU: African-American women need to talk to their health care providers, need to tell their concerns. Do not expect that the health providers knows everything. And sometimes the clinics are busy, sometimes there’s not enough time. So, it’s both for the health care providers to listen to the woman we have as the health care providers who have a lot of responsibilities. And sometimes the clinics are busy. Sometimes there’s not enough time to talk to a woman. However, we have to listen to her concerns. And as far as the women to talk to their providers, they need to say their concerns. Women need to tell the providers about their concerns. Do not expect that a health care provider knows everything. Each woman experiences stress differently, and they need to talk to their providers about that. Also, the family and friends should be advocating for these women. Go to the the father of the baby, the grandmother, the aunt, and the cousin, the friend, go to the prenatal clinic. I know now with covid, we cannot do that. But still, advocate for the woman. Ask the woman to talk to her health care provider about her concerns, about the stress, the racism that she might experience. We don’t want the woman to take a whole responsibility for her pregnancy.
I know we talked a little bit about the symptoms and the things that are happening that are leading to preterm birth. But when you’re looking at your medical history, when you’re seeing these signs of their stress and they’re not saying anything, what are those signs look like that they might be under stress?
GIURGESCU: Stress has been related with depressive symptoms, some women may be sad, may show signs of depression and it’s recommended. And majority of clinics actually conduct tool to assess that for depressive symptoms of pregnant women. So that’s the first step to see if there are any depressive symptoms experienced by these women. Women who have serious depressive symptoms, they should be referred to a health care provider who has the ability to care for these women. Also, stress has been related to preterm labor. We may experience contractures. Some may experience complaints that may be sometimes very vague, not one labor is the same like the other one. So, some women may experience different symptoms of Britain labor compared to other women. So as a health care provider, we should listen to those concerns and further investigate those symptoms.
And then we’re seeing racism as a term. But like what are some of those specific things that could lead to stress other than just the blanket term. Are there specific things that happen in the African-American community?
GIURGESCU: African-American women may experience racism in different situations. Some may be at a store. And some may be very subtle. We had a dissident who recently published a manuscript focusing on this shielding. Sometimes women try to shield themselves to protect themselves. So, they say like, oh, if you ask her directly, oh, no. I don’t experience the racism myself. Maybe other women do, but not myself. However, in her study also conducted qualitative interviews in what she learned is that even though women responded no on a questionnaire when the (unintelligible) was able to talk to the woman, she found some experiences of discrimination that initially the woman didn’t think to say, like, yes, I had that experience on a piece of paper, on a questionnaire, but in the discussion. So that’s why we have to really talk to the women to learn more about the experiences. She experienced discrimination at the back, like somebody, a white male kept looking and staring at her. There was another woman who experienced discrimination in store and said, she was at the mall and there was the other woman who presented some experience of discrimination at the retail store and the salesperson kept looking for her like following her throughout the store. So, the woman herself thought that this salesperson thinks that she’s stealing probably so different experiences of discrimination that women have that may not be straight. If you ask her, have you experienced discrimination, they may say no. But when you get to talk to them about their stories, listen to their stories, then they may actually tell about experiences of discrimination.
Anything else I didn’t ask you also ask you that you would like to say about factors related to preterm birth?
GIURGESCU: Definitely factors related to freedom bird, for example, multiple pregnancies, hypertensive disorder, which puts puts a woman at high risk for Britain. However, in addition to those medical factors, we have to take into consideration the chronic stress experienced by minority women. As noted before, they are more likely to experience African-American women are more likely to experience stress the racism due to living in disadvantaged neighborhoods compared with white women.
Are you able to speak at all to the impact of having preterm child would have on a black mom and a family?
GIURGESCU: Preterm birth is the leading cause of infant mortality among African-American infants, even infants who survive are more likely to have high risk of developmental delays and childhood illness. It is also a higher cost for the society. I don’t know the recent numbers, but having a premature infant in the neonatal unit, it’s a lot more expensive than a newborn at term who goes home in a couple of days. What else? I’m just thinking like development.
More about the emotional impact. If you’re already stressed out, now you have a premature baby. What’s that like?
GIURGESCU: Research suggests that African-American women are more likely to have depressive symptoms during the pregnancy compared with white women. Perinatal depressive symptoms are related to postpartum depression. So, think about a mother who might bring a home, an infant who was born prematurely, who has more risk factors and may need more care. If she’s already depressed, if she already has signs or symptoms of depression. She’s more likely to have postpartum depression. Does the health care providers need to assess for postpartum depression, but also for family members to look for those signs? And I think it’s a matter of informing the public about risk for postpartum depression, because we know postpartum depression can lead to suicide and every woman’s life is important.
Interview conducted by Ivanhoe Broadcast News.
END OF INTERVIEW
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