San Francisco Preterm Birth Review (SF PTBR)

Summary: 
The goal of this project was to make it possible to find out what specific aspect(s) of housing, neighborhood, access to care and/or other community factors increase risk.

Principal Investigators:
Rebecca Jackson, MD | Department of Obstetrics, Gynecology & Reproductive Sciences | Department of Epidemiology & Biostatistics

Background

In San Francisco, Black/African American (AA) moms are about two times more likely to have a preterm birth than White moms. Information from birth certificates suggests that the higher rates for Black/AA moms are related to community factors, such as housing, neighborhood, and access to prenatal care.

Objective

The goal of this project was to make it possible to find out what specific aspect(s) of housing, neighborhood, access to care and/or other community factors increase risk.

Method

This project developed a way to ask moms who have a preterm birth about their experience, by survey, interview, and medical record review. In 2017-2019, 11 Black/AA moms who had a preterm birth at one hospital in San Francisco shared what happened to them.

Results

Moms, who ended up induced early for high blood pressure, did not receive medication for high blood pressure. Their blood pressure was not limited by taking leave from work, because they were homeless, with less than $16k, not enough accumulated work-leave time, and needed to keep working to pay for shelter. Their blood pressure was not limited by a low salt diet; They ate ready-to-eat foods like cup-o-noodles. Their blood pressure was not limited by supports to relieve stress from the murder of family members during pregnancy. The mom’s experience suggests need to improve systems of care, housing, work, income, food, and crime, all at the same time. The next steps are to invite moms who deliver at other hospitals to tell their experience and develop multi-factor community interventions.