Conceptual framework for preterm birth review in San Francisco

Area of Science:

• Public Health
• Epidemiology
• Health Equity

Background:

• Preterm birth remains a major cause of infant mortality and morbidity.
• Existing interventions often fail due to not accounting for social determinants of health (SDH) and interacting risk factors.
• Persistent preterm birth disparities are linked to SDH like race, housing, and zip code.

Purpose of the Study:

• To develop a conceptual framework for preterm birth review (PTBR) in San Francisco.
• To guide data collection, analysis, and intervention strategies for preventing preterm birth phenotypes.
• To enable essential public health services by systematically considering SDH and other risk factors.

Main Methods:

• Developed a PTBR conceptual framework integrating 10 SDH domains, 9 whole-person domains, and 8 within-person domains.
• Conducted a scoping review of literature on SDH effects on preterm birth.
• Utilized health authority consensus reports and pilot data for framework validation.

Main Results:

• The framework systematically considers multiple levels of influence on preterm birth.
• Pilot data confirmed data collection feasibility and the prevalence of co-occurring risk factors.
• Identified potential for joint effects on specific preterm birth phenotypes and opportunities for intervention.

Conclusions:

• The PTBR conceptual framework provides practical implications for risk stratification, visualization, analysis, and intervention design.
• It facilitates a multi-level, multi-component approach to preterm birth prevention.
• Lessons learned will inform the development of PTBR infrastructure for ongoing public health efforts.