African-American women are nearly twice as likely to give birth prematurely as white women. Such births often coincide with low birth weight, and together are linked to other developmental delays and health effects believed responsible for almost one-fifth of infant deaths nationwide.

The trend holds up . That means, for example, that a black woman with a college degree and a comfortable income has a greater chance of giving birth prematurely than a white woman who didn鈥檛 graduate high school.

Past research has pointed to other contributing factors to the difference, such as post-traumatic stress disorder. In a in winter issue of the Journal of Health Disparities Research and Practice, , an associate professor in the 91探花 School of Social Work, connects racial discrimination to PTSD, and thus to preterm birth.

鈥淧regnancy is a stress test for the body. If you鈥檝e been stressed during your life through discrimination, poverty and residential segregation, then the likelihood of having a healthy birth outcome has been compromised,鈥� Gavin said.

A typical pregnancy lasts about 40 weeks; a birth before the end of the 37^th week is considered 鈥減reterm.鈥� According to the Centers for Disease Control and Prevention, 鈥� a slight uptick that year, following a steady decline for several years prior. While the CDC attributed that decline to the decrease in the number of teen mothers, the agency noted a consistent difference in the rates of preterm birth among African-American versus white women. In 2016, the preterm birth rate among African American women was 14 percent, compared to 9 percent for white women. There are medical causes of preterm birth, 鈥渂ut the majority of cases have an unknown cause,鈥� Gavin said.

Research over the years has examined behavioral and biological risk factors for preterm birth, including access to prenatal care, substance use and stress. PTSD, associated not only with combat experiences, but also other traumatic events such as natural disasters, assault and abuse, affects more women than men. Several studies have linked PTSD with a .

When broken down by race and ethnicity, PTSD affects African-Americans .

Meanwhile, studies have tied racial discrimination to poor health, and to African-American women鈥檚 health, in particular. The daily experiences of discrimination, as well as the legacy of racism 鈥� neighborhoods with higher crime and fewer resources, generational poverty and limited access to health care 鈥� can lead to , and .

Gavin drew a hypothesis from those connections: If discrimination is associated with PTSD, and PTSD is associated with preterm birth, then racial discrimination, via PTSD, also can be tied to preterm birth.

The racial disparity among preterm birth sparked her research interest in graduate school, Gavin said. By studying childhood poverty and abuse, as well as maternal depression, Gavin honed in on PTSD.

鈥淚鈥檓 trying to unpack, from a life course perspective, how risk factors in black women鈥檚 lives can have an impact on the next generation,鈥� she said. 鈥淓xploring the mechanisms by which racial discrimination affects the next generation is really important, and that means taking into consideration maternal mental health status. When we talk about racial disparities in health outcomes, we have to think about how we construct mental health, the role of PTSD and how different racial and ethnic groups experience it.鈥�

One challenge has been how PTSD is defined, generally by members of the mental health community, Gavin said. PTSD isn鈥檛 always related to one physically or emotionally devastating event; events can recur and continue to affect a person over the long term. There has been little research into how racial discrimination could manifest as PTSD and influence an early childbirth, she said.

Further research could more definitively demonstrate the role of PTSD as the conduit between racial discrimination and preterm birth, Gavin said.

In the paper, Gavin and her co-authors recommend that health-care providers start screening all pregnant women for prenatal PTSD, in order to spot those at risk for preterm birth. Pursuing the role of racial discrimination, of course, requires more wide-ranging, social-justice-oriented strategies. The authors suggest greater government investment in the quantity of and access to affordable housing, and in funding for K-12 education and health care. By addressing such social factors, the authors write, the health of African-American women and their offspring can improve.

Other authors were and Taurmini Fentress of the 91探花 School of Social Work, and Kyaien Conner of the University of South Florida.

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For more information, contact Gavin at gavina@uw.edu or 206-616-8847.

“It was Gyllenhaal. I thought, well, could it be?” recalled , a 91探花associate professor of social work.

Indeed it was.

“” was written, produced and directed by Kathleen Man Gyllenhaal and Stephen Gyllenhaal, stepmother and father of famous siblings and actors Jake and Maggie. The 91探花is hosting a free, public of the film at 6 p.m. May 31 that includes a Q&A with Gavin, 91探花senior lecturer in health services and global health Dr. and Dr. , a best-selling author and expert on addiction and child development from Vancouver, British Columbia.

The , which premiered at the 2015 Seattle International Film Festival, is described as “a cinematic rumination on what will emerge as the most provocative subject of the 21st century 鈥� life in the womb and its lasting impact on human development, human behavior and the state of the world.” It explores how the prenatal environment, combined with maternal experiences across generations, impact human development.

That鈥檚 a topic Gavin, who appears in the film as a featured expert, has spent years studying. She was awarded a National Institute of Mental Health Dissertation Grant for her graduate work on depression and birth outcomes among African-American women, and is the principal investigator on a looking at the link between risk factors in women鈥檚 lives and adverse birth outcomes.

Prenatal care is important, Gavin said, but it can鈥檛 mitigate the impact of stress throughout women鈥檚 lives on their physiology and, by extension, their babies.

“Nine months is too short a period of time to really deal with the health concerns and social conditions of women who are most at risk of delivering a preterm or low birth weight baby,” she said. “Both acute and chronic risk exposures across the life course, have important implications for mothers, which then have consequences for the next generation.鈥�

The issue is both a professional and personal one for Gavin. Her great-grandmother had two sets of twins who died as infants, tragedies Gavin believes were linked to the stress associated with racism and marginalization. A mother to twin boys herself, Gavin said being interviewed by Stephen Gyllenhaal about her life was intense. The experience, she said, dredged up the worries she鈥檇 had, knowing what her great-grandmother went through, about how stresses in her life might impact her unborn children.

鈥淎s a scientist, you鈥檙e objective and try to present the facts, produce the research and move on,鈥� she said. 鈥淏ut he got me to talk about my grandmother and my great-grandmother. It was really quite personal.鈥�

The producers also wanted to film Gavin and her husband with their twin boys, then 8, and 1-year-old son. The older boys were in fine form, she said, hanging from branches on trees outside the family鈥檚 home on Queen Anne and jumping off a retaining wall at nearby Kerry Park.

鈥淭he minute the film crew showed up at our house, they started their usual twin antics,鈥� she said, laughing.

Gavin admits she was nervous about seeing the finished documentary, but was ultimately pleased.

鈥淭o me, it highlights this really important piece of women鈥檚 health that doesn鈥檛 really get highlighted a lot,鈥� she said. 鈥淎 more comprehensive, life-course approach to women鈥檚 health is needed if we really want to address and reduce health disparities, especially around birth outcomes.鈥�

The documentary screening will be held in Room 305 of the 91探花School of Social Work, 4101 15^th Ave. NE. For planning purposes, attendees are asked to .