Breaking research on the use of race in prenatal screens, health outcomes of HIV-exposed children could advance healthcare for underserved populations
In a new study, researchers have demonstrated that there is an insufficient basis for incorporating race in prenatal screening for birth defects.
In a second, separate study, researchers have found that HIV-exposed uninfected children are at higher risk for health problems compared to uninfected, unexposed children.
Both of these studies will be presented at ADLM 2024 (formerly the AACC Annual Scientific Meeting & Clinical Lab Expo) and could help to improve medical care for Black pregnant patients and HIV-exposed uninfected children, respectively.
As the use of race in a variety of clinical testing algorithms continues to be reevaluated, the medical community has debated incorporating race in tests for alpha-fetoprotein (AFP), which is used to diagnose a class of birth defects known as open neural tube defects (ONTD) during pregnancy. Current testing algorithms for AFP account for race because self-reported Black individuals on average have higher AFP levels than White individuals. However, many question whether the clinical benefit of incorporating race into AFP screening models is great enough to justify doing so.
Dr. William Butler and a team of researchers from the Hospital of the University of Pennsylvania compared the risk classification for ONTD given by two different models, one of which accounted for self-reported maternal race and one that did not. Their study involved 7,702 patients who were pregnant with one child, 2,360 of whom self-identified as Black. The researchers found that self-reported Black race or ethnicity had a small, yet statistically significant association with AFP concentration. However, only 0.2% of patients were classified differently when race was not accounted for. Furthermore, none of these discordantly classified patients had children born with ONTD.
The global rates of HIV transmission from mother to child have dropped drastically thanks to a treatment regimen known as combination antiretroviral therapy (cART). This has led to an increase in the number of HIV-exposed uninfected children, who currently total 16 million worldwide. Although HIV-free and generally healthy, these children may face heightened risks of adverse health outcomes due to prenatal exposure to cART, including growth restriction, increased susceptibility to infections, and neurobehavioral disorders. Furthermore, infants with growth restriction are at a greater risk of developing chronic diseases such as cardiometabolic and neurological disorders later in life — a risk that is worsened by low socioeconomic status.
Drs. Eros Qama and Kayode Balogun of Montefiore Medical Center and Albert Einstein College of Medicine sought to assess the prevalence of neurodevelopmental disorders and hyperlipidemia in HIV-negative children born to HIV-infected mothers in the Bronx, New York, an area of low socioeconomic status. They compared the medical records of 127 HIV-exposed uninfected children from the Bronx to 157 HIV-unexposed and uninfected children from the Bronx, aged 0-15. HIV-exposed uninfected children were found to have significantly higher rates of attention-deficit/hyperactivity disorder, autism spectrum disorder, unspecified developmental delay, and abnormal cholesterol levels.
