A Mobile Intervention to Reduce the Impact of Chronic Stress on Preterm Birth Risk in African American Women

Preterm birth rates are high among African American women (<37 weeks gestation). Among Black newborns, it is the leading cause of infant mortality. Even late preterm births (34–36 weeks) carry a roughly threefold higher risk of death in the first year than births at term. Health challenges for infants born preterm can persist across the lifespan, including higher rates of neonatal complications (e.g., respiratory distress syndrome, sepsis), cognitive and behavioral disorders (e.g., ADHD, anxiety), and chronic conditions in adulthood (e.g., hypertension, ischemic heart disease, diabetes).
Rates of preterm birth among Black infants have remained elevated since standardized gestational age data collection began in 1981. These rates have not consistently declined. Evidence points to multiple contributing factors. A focus on stress regulation provides a practical framework for understanding these patterns and for shaping strategies to improve outcomes. High levels of stress over time may influence preterm birth rates via activation of the hypothalamic-pituitary-adrenal axis and indirectly through multiple downstream pathways.
While evidence links chronic stress with preterm birth, current interventions fail to target this fundamental driver. This gap represents a significant opportunity for scientific, clinical, and commercial innovation. We intend to fill this void by developing a tailored, mobile-based intervention for African American women to support stress regulation and prenatal health behaviors. The intervention will feature interactive video content with guided prompts to enhance engagement and improve knowledge retention. Personalized text messages will deliver encouragement, reminders, and tailored educational content that aligns with each user’s specific stress-related needs. To address the physiological arousal linked to chronic stress, the program will train users in prenatal yoga and mindfulness practices, offering practical techniques to foster relaxation and emotional regulation. And finally, the intervention will integrate health education, behavioral health promotion, and chronic disease monitoring to provide comprehensive support.
Eight obstetric care providers and 24 African American women across the perinatal continuum will be recruited for focus group discussions to help shape the proposed intervention. Informed by the insights gathered from these groups and our expert team of consultants, we will develop a prototype mobile intervention. When completed, the 24 target end-users will return for usability testing. The usability test will include the completion of a series of tasks intended to highlight the different features of the proposed intervention. Three usability metrics will be assessed: efficiency, accuracy, and subjective satisfaction.
Clin. 2015;66:7-30.
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J
Clin. 2015;66:7-30.
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J
Clin. 2015;66:7-30.
PHS 398/2590 (Rev. 09/04, Reissued 4/2006) Page Biographical Sketch Format Page

Grant Number: 1R43MD021147-01
NIH Institute/Center: NIH
Principal Investigator: DOUGLAS BILLINGS