What I wish I knew: The truth about preterm birth for black women
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In the world of maternal healthcare, few voices resonate with as much urgency and clarity as that of Dr. Kim Bruno. A healthcare provider with 17 years of experience, Dr. Bruno has transitioned from private practice to Sera Prognostics’ Associate Director of Medical Science Liaison, where she bridges science, medicine, and patient education. Her mission: to make preterm birth prevention proactive, not reactive.
Rethinking prenatal care
Traditionally, obstetrics has operated from a reactive standpoint—intervening only after symptoms arise. But Dr. Bruno is helping to flip that approach on its head.
“Too often in women’s health, we wait until labor starts early or something goes wrong. That’s reactive medicine,” Dr. Bruno told blackDoctor.org. “We want to catch risks earlier, ideally in the second trimester, so we can intervene before it becomes a crisis.”
Sera Prognostics is doing just that. With cutting-edge proteomics testing, they aim to identify women at risk for spontaneous preterm birth, particularly those considered “low risk” by traditional metrics.
There’s a strong need to raise public awareness about preterm labor and birth. One in ten women are at risk, and black women face even higher risks.
“We need to educate both clinicians and the public on what those risks are, how to mitigate them, and how to apply evidence-based strategies and treatment bundles to improve outcomes,” Dr. Bruno adds.
The reasons why black women face higher risks are multifactorial.
“Unfortunately, there’s rarely just one reason we can point to and fix. Instead, it’s usually a combination of many factors,” Dr. Bruno explained. “We see a lot of influence from the social determinants of health—things like access to healthcare in a woman’s community. For example, black women are more likely to live in healthcare deserts, where access to quality care is limited. That lack of access plays a significant role.”
Additionally, underlying chronic conditions—like diabetes and hypertension— can contribute to increased risk.
“When we look at data, including from sources like the CDC, and we see that black women are significantly more likely to experience preterm birth, we have to consider both access to care and the prevalence of chronic health issues as major contributing factors,” Dr. Bruno added.
Recognizing the signs
Education is a key part of prevention. Dr. Bruno explained that early signs of preterm labor may be subtle. If women don’t know they’re at risk, they’re more likely to ignore these signs.
“There’s a great book called Upstream that talks about how we keep pulling people out of the river, but what we really need to do is go upstream and figure out why they’re falling in in the first place,” Dr. Bruno noted. “Let’s start with the ‘pulling people out of the river’ part—those first signs of preterm labor. For some women, that might be intense back pain. Others may experience early rupture of membranes—basically, their water breaking too early—or early spotting and bleeding. But sometimes it’s more subtle, like what feels like back pain or what they assume are Braxton Hicks contractions.”
That’s where it gets tricky, Dr. Bruno added. A lot of times, women, especially first-time moms, may not recognize the seriousness.
“They might think, ‘Oh, it’s just Braxton Hicks,’ and instead of calling their provider, they call their mom—and mom said, ‘Oh yeah, that’s totally normal.’ And if they haven’t had any early testing to indicate they’re at risk for preterm birth, they might just brush it off. They might take a warm bath, drink some water, and lie down, when in reality, they may need to be seen by a healthcare provider right away,” she said.
Understanding your individual risk is key. Knowing whether those back pains or cramps could be early contractions or something more concerning is critical. Even if symptoms seem mild, knowing your risk status helps determine the urgency.
“Of course, there are more obvious signs—if your water breaks early, if there’s any kind of bleeding, or if you notice a decrease in fetal movement. In any of those cases, regardless of whether you’ve been told you’re at risk or not, you need to contact your doctor immediately,” Dr. Bruno added
How to be more proactive
On the preventative side, there are ways to assess risk before symptoms begin.
“For women considered low-risk, we can still perform a simple blood test during the second trimester, typically between 18 and 20 weeks and six days, to stratify their risk for preterm birth,” Dr. Bruno explained.
How the test works
The proteomic blood test measures two key proteins: IBP4 (Insulin-like Growth Factor Binding Protein 4) and SHBG (Sex Hormone- Binding Globulin). These proteins, when imbalanced, signal changes in the placenta that can indicate an increased risk for preterm labor.
If a patient is identified as high-risk, the care model shifts.
“If they’re identified as higher risk, we can start proactive care management. That might include weekly nurse check-ins. The nurse goes through a structured questionnaire covering exactly the symptoms we just discussed: increased pelvic pressure or back pain, ruptured membranes, bleeding, fever, or signs of infection—anything that could indicate the body is preparing for early labor,” Dr. Bruno said.
These weekly touchpoints do a couple of important things:
First, they educate the mom on what’s normal and what’s not.
Second, they create a trusted connection between the mom and the nurse. If anything concerning comes up, the nurse can escalate it right away.
“You know what, you need to head to triage and call your doctor immediately,” Dr. Bruno noted. “This system keeps the mom on the radar—not just of the nurse, but also of the doctor’s office—and helps her stay informed and empowered. Care management like this is a big part of identifying and mitigating risk early. The best time to deploy this kind of support is right after we’ve identified someone as being at higher risk.”
Pregnancy spacing and maternal health
Another overlooked factor in preterm birth? Back-to-back pregnancies.
“…Pregnancy takes a lot from a mom,” Dr. Bruno noted. “Building a baby requires a tremendous amount of nutrients, energy, and effort— from her mitochondria, from every system in her body. It’s a demanding process to grow another human being. And it doesn’t end there—after the baby is born, she’s likely sleep-deprived, possibly breastfeeding, and still giving so much of herself, emotionally and physically. So, if she becomes pregnant again too soon, she’s starting from a depleted baseline, which can increase her risk for complications, including preterm birth.”
There are also multiple contributing factors, and stress is a big one. But stress isn’t just external, like jobs, finances, or family obligations. It also includes internal stress. That’s where the HPA axis (hypothalamic-pituitary-adrenal) comes in—the body’s stress response system.
So, for example:
Do we have enough calcium to build a baby’s skeleton?
Do we have enough omega-3 fatty acids to support a developing nervous system?
Or have those resources already been used up during the first pregnancy?
“If the body is still nutritionally depleted, it might not have what it needs to support a second pregnancy well. Also, we’re learning that the maternal microbiome may play a role in preterm birth, so allowing time for that to rebalance may be important too,” Dr. Bruno explained. “Giving the body enough time to recover— physically, nutritionally, and hormonally—after pregnancy is essential. It helps restore a more stable baseline, which can lead to better outcomes in future pregnancies.”
Advocating for yourself
As Dr. Bruno noted, both aspects are important—what can moms be doing, and also, what should they be asking their doctors?
As far as moms go, stress management is key. Stress is a huge factor, not only in the risk for preterm birth, but also in the risk for hypertension, which can lead to preeclampsia and other complications. So, it’s really important to create an environment with lower stress, both externally and internally.
That means:
What’s going on in your world?
What’s happening inside your body?
Are you eating well?
Are you getting enough sleep?
Are you moving your body?
Are you taking care of yourself overall?
“All of those foundational things—eating well, sleeping well, creating a supportive atmosphere—can make a real difference, not just when you’re trying to get pregnant, but throughout your pregnancy,” Dr. Bruno said. She also urged women to be their own best health advocates.
“Don’t wait for your provider to bring up the topic. Go in prepared,” she advised. “Do your research, talk to your provider, and ask the right questions. Unfortunately, appointment times are often short, but if you come prepared, you can make the most of them. For example, Sera has a great discussion guide that moms can use to help start conversations with their doctor about preterm birth risks.”
You can ask:
“Am I at risk?”
“What if my mom had a preterm birth?”
“What if I was born prematurely?”
“What if I have a high stress job?”
Bringing these topics up can help you and your doctor understand your individual risk and make a plan.
“We may not be able to prevent every preterm birth, but we can work to make sure it’s not a surprise. We can extend gestation when possible, and we can improve neonatal outcomes by being prepared,” Dr. Bruno concluded.
