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  • Addressing or reinforcing injustice? Artificial amnion and placenta technology, loss-sensitive care and racial inequities in preterm birth

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Addressing or reinforcing injustice? Artificial amnion and placenta technology, loss-sensitive care and racial inequities in preterm birth
  1. Sophie L Schott1,
  2. Faith Fletcher1,
  3. Alice Story1,
  4. April Adams2
  1. 1 Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
  2. 2 Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
  1. Correspondence to Dr Faith Fletcher, Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA; faith.fletcher{at}bcm.edu

https://doi.org/10.1136/jme-2023-109821

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    Preterm birth is defined as delivery occurring before 37 weeks gestation.1 Infants born prematurely have increased risks of morbidity and mortality throughout life, especially during the first year. These risks increase as the gestational age at birth decreases.2 Additionally, there are significant racial and ethnic differences in preterm birth rates. In 2022, the rate of preterm birth among non-Hispanic black women was approximately 50% higher than that observed in non-Hispanic white women.1 The outcomes for these infants are also disparate–preterm birth and low birth weight are the second-leading causes of infant mortality (deaths before 1 year of age). Notably, among preterm neonates, infants born to non-Hispanic black women have a mortality rate more than double that of infants born to non-Hispanic white mothers.3

    Importantly, there is a small but significant group of neonates that can be classified as severely premature (those born <28 weeks). Infants born before 28 weeks have varied and uncertain outcomes. While this group accounts for only 0.4% of preterm births, it also accounts for 40% of deaths among preterm neonates.4 As noted by Romanis and Adkins, the advent of artificial amnion and placenta technology (AAPT) holds promise for its potential to address the physiologic complications and mortality risks of extreme prematurity by introducing amniotic substitutes that mimic in vivo placental oxygenation and substrate delivery. In contrast …

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    Footnotes

    • X @MyBestSchott

    • Contributors SLS: conceptualisation, writing–original draft, writing–review and editing. FF: conceptualisation, writing–original draft, writing–review and editing. AS: writing–original draft, review and editing. AA: writing–original draft, review and editing.

    • Funding This work was supported in part by the National Human Genome Research Institute of the National Institutes of Health under award number K01HG011495-01 and the Greenwall Faculty Scholars Program in Bioethics Grant awarded to FF.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.

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