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As a labor and delivery nurse at DMC Sinai-Grace Hospital in Detroit, Alexandra Nowak saw her share of pregnancy complications.
But none stuck with her as much as preterm births—births that happen before the 37th week of pregnancy. When born prematurely, babies run a higher risk of suffering immediate complications, such as breathing and heart problems, as well as long-lasting effects, including cerebral palsy and developmental delays.
And while preterm births happen across populations, Nowak noticed a puzzling trend. “I saw a lot of preterm births among Black women,” says Nowak, now an assistant professor at Loyola University Chicago’s Marcella Niehoff School of Nursing. “And I began to wonder why these rates are so high for Black women, and whether their neighborhood environment has anything to do with it.”
In fact, Black women have 1.5 times greater risk of a preterm birth than non-Hispanic white women, an inequity that can’t be fully explained by socioeconomic status or poor physical health alone.
Preterm birth remains one of the leading causes of death for infants, according to the U.S. Centers for Disease Control and Prevention.
Dr. Nowak’s research on stress and preterm birth in Black women will change the lives of mothers, babies, and families.
— Lorna Finnegan, dean of the Marcella Niehoff School of Nursing
To find out more, Nowak became a research nurse in the Pregnancy and Perinatology Branch of the National Institutes of Health (NIH). Intrigued, she pursued her PhD, where she studied potential preterm birth factors, including neighborhood disadvantage and psychological stress.
But finding the biological pathways that underlie preterm birth remained the ultimate goal. Now, armed with a prestigious $473,000 mentored career development award from the NIH National Institute on Minority Health and Health Disparities, Nowak will study how environmental factors interact with genetic processes, with the hope of finding those pathways. She received the award in spring 2024.
“Dr. Nowak’s research on stress and preterm birth in Black women will change the lives of mothers, babies, and families,” says Lorna Finnegan, dean of the Marcella Niehoff School of Nursing.
Finding the right pathway
At the heart of Nowak’s research is the idea that preterm birth, like other medical issues, is a complex interplay between our genes and the environment. DNA methylation, which regulates gene expression, can be influenced by environmental factors like stress, diet, and exposure to chemicals. But other genetic factors, like single nucleotide polymorphisms (SNPs) — variations in our gene sequences — are not affected by the environment.
Previous studies have shown that women who have preterm births have certain SNPs and DNA methylation associations, but Nowak will take this research a step further by integrating that data with measures of environmental impact. That includes socio-demographic data, perceived and objective neighborhood disadvantage, crime data, and measures of psychological stress.
Her hypothesis: Neighborhood disadvantage and psychological stress foster DNA methylation in genes that regulate certain stress hormones. This, combined with SNPs, forms a specific biological pathway that alters the inflammatory balance in pregnant women, leading to preterm birth in Black women.
“We want to narrow down the pathways and get an idea of how all these factors are working together,” she says.
Her study will use data from previous research on preterm births in Black women and combine it with new data on neighborhoods (including crime, vacant housing, and even the amount of litter in the area) and SNP variants.
“We know that certain issues affect preterm birth, but none of them can fully explain this disparity we have,” Nowak says. “We want to find a biological pathway where we can say that if someone has this, their likelihood for preterm birth is much higher.”
Nowak hopes to have results within the next two years. If a pathway for preterm birth is identified, it opens the door for potential interventions that could eliminate it altogether.
“I’m motivated to try to find out why this is happening and make some changes to help,” she says.
For Nowak, who joined the School of Nursing in 2021, the school has been an incredibly supportive in jumpstarting her research. “Everyone at Loyola is very conscious and forward thinking, especially about DEI issues,” she says. “It’s a really good fit.”
Read more stories from the Marcella Niehoff School of Nursing.
