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RCOG World Congress 2025
June 23 - 25, 2025 | ExCeL London, UK
EP.1190
The Impact of Ethnicity on Preterm Birth Rates and Research Recruitment
Part of Topic
Hot topics (emerging research/issues) in obstetrics
Audio
The Impact of Ethnicity on Preterm Birth Rates and Recruitment to Preterm Birth Studies: Utilising Patient and Public Involvement to Improve Outcomes.
Neeraja Suresh1, Sihao Zhao1,2 , Katie Mountain1,3, Sanna Rhiani-el Achhab1,2, Milissa Coker1,2, David A MacIntyre1,2,4, Vasso Terzidou1,2, Phillip R Bennett1,2, Annemarie Lodder1, Lynne Sykes1,2,3
1Institute of Reproductive and Developmental Biology, Imperial College London, London, UK, 2March of Dimes Prematurity Research Centre at Imperial College London, UK, 3The Parasol Foundation for Women’s Health and Cancer Research, London, UK, 4Robinson Research Institute, University of Adelaide, Australia
Introduction
•Globally an estimated 13.4 million babies were born preterm in 20201.
•There are significant ethnic disparities in preterm birth (PTB) rates, with Black and South Asian women having a 65% and 26% increased rate of PTB respectively compared to White women2.
•Spontaneous preterm birth (sPTB) is multifactorial. Research has shown that adverse vaginal microbial composition can be a risk factor for sPTB. Women of African descent have greater tendency for high species diversity and reduced presence of Lactobacillus crispatus compared to women of European descent3-5.
•Women from ethnic minorities are often underrepresented in maternity research studies, with a paucity of studies investigating barriers to participation6-7.
•There is an urgent need to drive equity in preterm birth prevention research.
Objective
•To report on rates of PTB by ethnicity at the Imperial College Healthcare NHS Trust (ICHT).
•To determine if there was equity in PTB prevention study recruitment by ethnicity.
•To use patient and public involvement (PPI) to explore challenges in recruitment.
Methods
•PTB rates from the general ICHT population were determined using routinely recorded data from ICHT Secure data environment Imperial Clinical Analytics Research and Evaluation (ICARE) between 2018 to 2023 (n=48,098).
•PTB rates of women defined as ‘high risk’ were reported from the ICHT PTB prevention clinics at St Mary’s and Queen Charlotte’s and Chelsea hospitals during 2022 (n=552).
•Ethnicity distributions between the general maternity, the PTB prevention clinic and the Vaginal Microbiome and Metabonome in pregnancy (VMET2) study populations were compared.
•Using PPI activities, including focus groups and a service evaluation questionnaire, we investigated barriers to PTB prevention study participation for women of ethnic minorities.
Results
•Black and Asian women had increased PTB rates in the local Trust population compared to White women from 2018 to 2023 (Figure 1).
•Within the ‘high risk’ PTB prevention clinic population, sPTB rates were higher in Black and Asian women compared with White women (19.19% vs 5.77%, p=0.0001 and 18.56% vs 5.77%, p<0.0001 respectively).
•Asian women had greater proportions of iatrogenic PTB (iPTB) compared to White women (10.31% vs 5.77%, p=0.0302) (Figure 2).
•PPI activities identified distrust in research, language barriers, stress during pregnancy and experiences of discrimination and racism as participation barriers. Female genital mutilation concerns also presented a barrier for women participating in research involving vaginal samples (Figure 3).
•The ethnicity of women recruited to the VMET2 study were representative of the PTB clinic population.
•No difference was seen in the proportions of women of each ethnicity recruited into VMET2 who consented to sample collection versus women who consented to data collection from medical records only (Figure 4).
Key Findings
•There is pronounced disparity in the rates of PTB, with Black and Asian women having greater PTB rates within the general ICHT and the ‘high risk’ PTB prevention clinic populations.
•PPI activities conducted highlighted language barrier, stress during pregnancy, racism and female genital mutilation concerns as the main barriers to participation in PTB prevention studies. The VMET2 study participants are representative of the diverse ethnic population of women at risk of spontaneous PTB.
•The use of PPI should be embedded into all studies to ensure equity and representation of all ethnicities in active research studies.
References
1.Ohuma E, Moller A-B, Bradley E, et al. National, regional, and worldwide estimates of preterm birth in 2020, with trends from 2010: a systematic analysis. Lancet. 2023;402(10409):1261-1271. doi:10.1016/S0140-6736(23)00878-4.
2.Sheikh J, Allotey J, Kew T, Fernández-Félix BM, Zamora J, Khalil A, Thangaratinam S; IPPIC Collaborative Network. Effects of race and ethnicity on perinatal outcomes in high-income and upper-middle-income countries: an individual participant data meta-analysis of 2 198 655 pregnancies. Lancet. 2022 Dec 10;400(10368):2049-2062. doi: 10.1016/S0140-6736(22)01191-6. Erratum in: Lancet. 2023 Jan 14;401(10371):104. PMID: 36502843.
3.Fettweis, J.M., Serrano, M.G., Brooks, J.P. et al. The vaginal microbiome and preterm birth. Nat Med 25, 1012–1021 (2019). https://doi.org/10.1038/s41591-019-0450-2
4.Brown RG, Al-Memar M, Marchesi JR, Lee YS, Smith A, Chan D, et al. Establishment of vaginal microbiota composition in early pregnancy and its association with subsequent preterm prelabor rupture of the fetal membranes. Transl Res. 2019; 207 30-43. 10.1016/j.trsl.2018.12.005.
5.Chan D, Bennett PR, Lee YS, Kundu S, Teoh TG, Adan M, et al. Microbial-driven preterm labour involves crosstalk between the innate and adaptive immune response. Nat Commun. 2022; 13 (975): 10.1038/s41467-022-28620-1.
6.Lovell H, Silverio SA, Story L, Skelton E, Matthew J. Factors which influence ethnic minority women's participation in maternity research: A systematic review of quantitative and qualitative studies. PLoS One. 2023 Feb 24;18(2):e0282088. doi: 10.1371/journal.pone.0282088. PMID: 36827386; PMCID: PMC9956875.
7.Garg N, Round TP, Daker-White G, Bower P, Griffiths CJ. Attitudes to participating in a birth cohort study, views from a multiethnic population: a qualitative study using focus groups. Health Expect. 2017; 20 (1): 146-158. 10.1111/hex.12445.